Body mass index in relation to cardiovascular recovery from psychological stress among trauma-exposed women.

Delayed cardiovascular recovery has been associated with greater heart disease risks. However, relative to stress reactivity, cardiovascular recovery has been understudied. Further, few studies have examined associations of recovery with modifiable factors that might inform efforts to enhance recovery. The focus of the present study was whether body mass index (BMI) was associated with recovery following two stress tasks (speech and mental arithmetic). Based on the conceptualization that obesity may lead to impaired post-stress recovery, we also examined whether higher BMI accounted for previously reported associations between elevated PTSD symptoms and delayed recovery. The sample consisted of 50 trauma-exposed civilian women ages 19-49 (M±SD = 30 ± 8). The stress tasks were followed by 15-min post-task rest periods. Cardiovascular recovery was assessed as percentage return to baseline; the recovery measures consisted of heart rate (HR), cardiac output (CO), systolic blood pressure (SBP) and diastolic blood pressure (DBP). PTSD severity was based on structured interview. Higher BMI was associated with significantly less CO recovery from the speech task and less HR recovery from mental arithmetic. Higher BMI was associated with more SBP recovery from the math task, but was not associated with DBP recovery. The indirect effects of BMI in the PTSD/CO recovery relationship based on the Sobel test of mediation were significant. These results partially support the hypotheses that BMI is associated with cardiovascular recovery and that associations of PTSD with recovery may be mediated by BMI.

HIV Testing Characteristics Among Hispanic Adolescents.

Hispanic adolescents are disproportionally impacted by HIV/AIDS. Among Hispanic people living with HIV, delayed testing and late entry into HIV care have been documented. The current study examined Hispanic adolescents' HIV testing characteristics and factors related to testing. Adolescents aged 13-16 (N = 223) completed a survey on HIV testing motivation, perceptions, and experience, sexual behavior, and substance use. Results indicate few adolescents (9%) had taken an HIV test. Among those who have not been tested, 32.5% expressed interest in testing. HIV testing was favorably perceived with 82.4% reported testing should be done with all youth or those are sexually active. Adolescents who had engaged in high risk behaviors (history of sexual intercourse, substance use) were more likely to have been tested or to express interest in testing. Given that HIV testing is positively perceived by Hispanic adolescents, prevention efforts should focus on minimizing barriers and enhancing accessibility to HIV screening.

Cultural influences on HIV testing among Latino youth.

Young Latinos aged 13-24 years in the USA are disproportionately impacted upon by HIV. Despite the elevated risk, lower rates of HIV testing have been documented among Latino youth relative to other racial/ethnic groups. The objective of the current study was to examine the influence of acculturation and cultural values on HIV testing among Latino youth. The study consisted of 51 sexually experienced young Latinos aged 13-16 years from a major city in the Southeastern USA. Participants completed a survey on HIV testing history, cultural orientation and Latino cultural values. Results indicate that 21.6% of the young people had been tested for HIV. The number of times tested ranged from one to four (M = 1.9 ± 1.0). HIV testing was associated with US American cultural orientation and familism (and emphasis on strong family commitment, family support and emotional closeness). Participants with greater orientation to US American culture were more likely, whereas those who endorsed higher familism value were less likely, to have had an HIV test. For participants scoring high on familism, the desire to maintain family honour may serve as a deterrent to testing. Incorporating culturally relevant strategies, such as promoting sexual communication and conversations on HIV prevention within the family, may enhance testing and narrow the gap in HIV infection between Latino youth and other ethnic groups.

Racial/Ethnic Differences in Knowledge of Personal and Target Levels of Cardiovascular Health Indicators.

This study aimed to examine ethnic differences in knowledge of personal and target levels of cardiovascular health indicators between non-Hispanic whites and African Americans. A secondary objective was to evaluate the associations between knowledge of cardiovascular health indicators and health promotion behaviors. Participants (66.7% female) consisted of 265 whites and 428 African Americans, ages 18 and older recruited from primary care clinics and churches. Respondents completed a brief survey on blood pressure (BP), total cholesterol, blood glucose, body mass index (BMI), diet, and physical activity. Whites were more likely than African Americans to report knowing their personal and target levels of cardiovascular health indicators. Knowledge of personal BP and/or BMI was positively associated with actual physical activity, and awareness of personal blood glucose was positively associated with healthy dietary practices for participants in both groups. Among whites, awareness of personal BP and knowledge of target levels for BP, total cholesterol, and BMI were also associated with healthy diet. Results suggest there are racial/ethnic disparities in knowledge of personal and ideal levels of cardiovascular health indicators, and that this knowledge is related to health promotion behaviors. Targeted educational efforts are warranted to enhance knowledge of personal risk indicators among African Americans.

Latino cultural values as protective factors against sexual risks among adolescents.

The study objective was to examine the associations between cultural values and sexual risk factors among Latino youth. A sample of 226 Latino adolescents ages 13-16 completed a survey on cultural and sexual variables. Results indicate higher levels of Latino cultural orientation were related to greater sexual self-efficacy and fewer sexual partners for female adolescents and greater condom use self-efficacy for both males and females. Greater endorsement of simpatia (belief in interpersonal relationship harmony) was associated with sexual abstinence and greater sexual self-efficacy for all adolescents, and with being older at sexual debut for females. Stronger endorsement of respeto (respect towards parents and other authority figures) was correlated with a lower intention to have sex during secondary school and greater condom use self-efficacy. American cultural orientation was associated with less condom use. Our findings indicate Latino cultural values may serve as protective factors against sexual risk behaviors among Latino youth.

Gratitude is associated with greater levels of protective factors and lower levels of risks in African American adolescents.

The literature suggests gratitude is associated with positive youth development. The current study examined the relationship between gratitude and protective/risk factors among African American youth. Adolescents (N = 389; 50.4% males) ages 12-14 completed measures of gratitude (moral affect and life-orientation), protective factors (e.g., academic and activity engagement, family relationship), and high-risk behaviors (e.g., sexual attitudes and behaviors, drug/alcohol use). Results indicated greater moral affect gratitude was the only variable significantly associated with greater academic interest, better academic performance, and more extra-curricular activity engagement. Greater moral affect and life-orientation gratitude both significantly correlated with positive family relationship. Greater life-orientation gratitude was the only variable significantly associated with abstinence from sexual intimacy, sexual intercourse, likelihood of engaging in sex during primary school, and abstinence from drug/alcohol use. The findings suggest that moral affect gratitude may enhance protective factors while life-orientation gratitude may buffer against high-risk behaviors among African American youth.

Pilot Findings Indicate a Cognitive Behavioral Healthy Lifestyle Intervention for PTSD Improves Sleep and Physical Activity.

Research has indicated strong associations between post-traumatic stress and cardiovascular disease (CVD) risk. Individuals with post-traumatic stress disorder (PTSD) tend to show patterns of elevated CVD risk earlier in life than the general population. The need for developing effective interventions for CVD risk reduction in PTSD is increasingly evident. The purpose of the present pilot study was to examine the effects of a healthy lifestyle intervention that addresses CVD-related heath behaviors (physical activity, sleep, stress) among civilian adults with PTSD. Participants were randomized to the healthy lifestyle intervention condition or a wait-list control. A total of 22 women completed the protocol (11 per group). The mean age was 32 (SD ± 14). Evaluations were conducted before and after the 12-week intervention program in the experimental group, and 12 weeks apart for the control group, and included standardized self-report measures of sleep, physical activity, and general stress. The healthy lifestyle group showed an increase in the amount of sleep pre to post (mean of 1.2 h per night), which was significantly different to the control group, who had no change (p < 0.05; effect size = 1.41). Notable pre to post increases in physical activity were observed between the intervention group (mean increase = 115.8 min over 7 days) and control condition (mean = 4.5 min over 7 days); however, this effect was not significant in the small sample (effect size = 0.70). These preliminary findings suggest that a healthy lifestyle intervention is feasible and can produce desired changes in target behaviors/outcomes.

Racial Concordance on Healthcare Use within Hispanic Population Subgroups.

OBJECTIVE: To examine the association of patient-provider racial and ethnic concordance on healthcare use within Hispanic ethnic subgroups. METHODS: We estimate multivariate probit models using data from the Medical Expenditure Panel Survey, the only national data source measuring how patients use and pay for medical care, health insurance, and out-of-pocket spending. We collect and utilize data on preventive care visits, visits for new health problems, and visits for ongoing health problems from survey years 2007-2017 to measure health outcomes. Additionally, we include data on race and ethnicity concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis. The sample includes 59,158 observations: 74.3% identified as Mexican, 10.6% identified as Puerto Rican, 5.1% identified as Cuban, 4.8% identified as Dominican, and 5.2% classified in the survey as Other Hispanics. Foreign-born respondents comprised 56% of the sample. A total of 8% (4678) of cases in the sample involved Hispanic provider-patient concordance. RESULTS: Hispanic patient-provider concordance is statistically significant and positively associated with higher probabilities of seeking preventive care (coef=.211, P<.001), seeking care for a new problem (coef=.208, P<.001), and seeking care for an ongoing problem (coef=.208, P<.001). We also find that the association is not equal across the Hispanic subgroups. The association is lowest for Mexicans in preventive care (coef=.165, P<.001) and new problems (coef=.165, P<.001) and highest for Cubans in preventive care (coef=.256, P<.001) and ongoing problems (coef=.284, P<.001). Results are robust to the interaction of the Hispanic patient-provider concordance for the Hispanic patient categories and being foreign-born. CONCLUSIONS: In summary, racial disparities were observed in health utilization within Hispanic subgroups. While Hispanic patient-provider concordance is statistically significant in associating with healthcare utilization, the findings indicate that this association varies across Hispanic subpopulations. The observations suggest the importance of disaggregating Hispanic racial and ethnic categories into more similar cultural or origin groups. Linked with the existence of significant differences in mortality and other health outcomes across Hispanic subgroups, our results have implications for the design of community health promotion activities which should take these differences into account. Studies or community health programs which utilize generalized findings about Hispanic populations overlook differences across subgroups which may be crucial in promoting healthcare utilization.

Racial disparities in health care utilization, the affordable care act and racial concordance preference.

The Affordable Care Act was implemented with the aim of increasing coverage and affordable access with hopes of improving health outcomes and reducing costs. Yet, disparities persist. Coverage and affordable access alone cannot explain the health care gap between racial/ethnic minorities and white patients. Instead, the focus has turned to other factors affecting utilization rates such as the patient-provider relationship. Data from nationally represented U.S. households in 2009-2017 were used to study the association between patient-provider social distance as measured by "racial/ethnic concordance" and health care utilization rates for periods covering pre- and post-ACA. Despite the reduction in financial barriers to health access with the implementation of the ACA, the correlation between racial/ethnic concordance and utilization remains positive and significant. The results suggest that while the ACA may have improved coverage and affordability, other dimensions of access, particularly acceptability, as measured by patient-provider clinical interaction experience, remains a factor in the decision to utilize care.

Barriers and facilitators to HIV testing in primary care among health care providers.

PURPOSE: Human immunodeficiency virus (HIV) is a preventable disease that can have improved outcomes with early diagnosis and treatment. The CDC recommends that HIV testing be incorporated into clinical settings as part of routine medical care. METHODS: Individual, open-ended interviews were conducted with primary care providers and administrators to obtain their views regarding the meaning of routine HIV testing and the barriers and facilitators to implementing routine HIV testing in their respective practices. RESULTS: Most respondents supported routine HIV testing, although their definitions of routine varied. Barriers for providers included time and financial constraints to appropriately conduct HIV counseling and testing and inadequate HIV education and training. Facilitators for implementing routine HIV testing included patients' feelings of empowerment and reduced HIV stigma. CONCLUSIONS: The implementation of routine HIV testing in primary care practices appears to be an acceptable public health intervention. Next steps should include efforts to standardize the definition of routine HIV testing and working with primary care settings to better understand and reduce barriers to routine testing.

The effects of priming on a public health campaign targeting cardiovascular risks.

Public health interventions are cost-effective methods to reduce heart disease. The present study investigated the impact of a low-cost priming technique on a public health campaign targeting cardiovascular risk. Participants were 415 individuals (66% female) ages 18 and older recruited through clinics and churches. The study consisted of three phases. In Phase I, participants completed a brief survey to assess knowledge of the cardiovascular health indicators. The survey served as the prime (intervention) for the study. At Phase II, participants were provided with access to a public health campaign consisting of an education brochure on cardiovascular health. Following the educational campaign, all participants completed a post-campaign survey in Phase III of the study. Participants who completed the surveys in both Phase I and III were placed in the intervention condition (26%) and those who only completed the Phase III survey were placed in the control condition (74%). Participants who were primed reported greater awareness of the public health campaign. Additionally, more intervention participants reported they had knowledge of their own and the normal ranges for cholesterol, glucose, and body mass index. For participants who were aware of the health promotion campaign, more participants in the primed group indicated they had knowledge of their own cholesterol and glucose levels and had made positive lifestyle changes as a result of the campaign. Results suggest the presence of a priming effect. Public health campaigns may benefit from the inclusion of a low-cost prime prior to intervention.

The Relationship Between Racial/Ethnic Concordance and Hypertension Control.

INTRODUCTION: Given the increasing impact of the healthcare cost of hypertension on the economy, understanding the control of high blood pressure is warranted, particularly as it pertains to racial/ethnic disparities in hypertension control. OBJECTIVE: To understand the relationship between hypertension control and racial/ethnic concordance, we investigated whether the racial/ethnic concordance between a patient's race/ethnicity and that of the individual's provider is a predictor of high blood pressure control. METHODS: Data was collected for 612,524 patients from Kaiser Permanente Southern California who were at least 18 year old and received a diagnosis of hypertension between January 1, 2016 and December 31, 2019. A multiple regression analysis was carried out to assess the correlation between hypertension control and patient-provider concordance. RESULTS: The independent variables proxying for patient-provider relationship are positive and statistically significant at the 5% level. Out of the 3 types of concordance, language has the highest standardized estimate, followed by gender and race. DISCUSSION: We found correlations between racial/ethnic patient-provider concordance and hypertension control. Consistent with previous studies, we found that Asian patients experience more time in hypertension control. By contrast, Black and Hispanic patients have less time in hypertension control. Having the same primary care provider for a longer span of time is also positively correlated with length of hypertension control. CONCLUSION: Correlation between racial/ethnic concordance, length of time under the primary provider's care, and length of time spent in hypertension control suggests that the patient-provider relationship remains a critical component of health outcomes.

Hypertension in relation to posttraumatic stress disorder and depression in the US National Comorbidity Survey.

The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.

The Impact of Patient-Provider Race/Ethnicity Concordance on Provider Visits: Updated Evidence from the Medical Expenditure Panel Survey.

OBJECTIVE: To examine the association between race/ethnicity concordance and in-person provider visits following the implementation of the Affordable Care Act. DESIGN: Using 2014-2015 data from the Medical Expenditure Panel Survey, we examine whether having a provider of the same race or ethnicity ("race/ethnicity concordance") affects the probability that an individual will visit a provider. Multivariate probit models are estimated to adjust for demographic, socioeconomic, and health factors. RESULTS: Race/ethnicity concordance significantly increases the likelihood of seeking preventative care for Hispanic, African-American, and Asian patients relative to White patients (coef = 1.46, P < 0.001; coef = 0.71, P = 0.09; coef = 1.70, P < 0.001, respectively). Race/ethnicity concordance also increases the likelihood that Hispanic and Asian patients visit their provider for new health problems (coef = 2.14, P < 0.001 and coef = 1.49, P < 0.05, respectively). We find that race/ethnicity concordance is also associated with an increase in the likelihood that Hispanic and Asian patients continue to visit their provider for ongoing medical problems (Hispanic coef = 1.06, P < 0.001; Asian coef = 1.24, P < 0.05). CONCLUSIONS: There is an association between race/ethnicity concordance and the likelihood of patients visiting their provider. Our results demonstrate that racial disparities in health care utilization may be partially explained by race/ethnicity concordance.

The relationship of character strengths to sexual behaviors and related risks among African American adolescents.

BACKGROUND: Relatively few studies have examined positive character traits that are associated with lower HIV/STD risks. PURPOSE: In the present study, the relationships of character strengths with sexual behaviors and attitudes were assessed among 383 African-American adolescents. METHOD: Character strengths were measured using the Values in Action Inventory of Strengths. Because the strengths were highly inter-correlated, stepwise discriminant function analyses were utilized to assess their independent associations with sexual behaviors and attitudes. RESULTS: Greater Love of Learning was related to self-reported abstinence from sexual intercourse for boys and self-reported abstinence from drug use for boys and girls. Greater Love of Learning and Curiosity were related to the belief in no premarital sex for boys, whereas only Curiosity was significant for girls. Prudence was related to reported abstinence from sexual intimacy (e.g., touching or kissing). Judgment was related to sexual initiation efficacy for girls and boys, whereas Leadership was only significant for girls. CONCLUSIONS: The findings suggest that character strengths may be associated with lower levels of sexual behaviors and sex-related beliefs among a sample of African-American adolescents.

Cardiovascular risks in relation to posttraumatic stress severity among young trauma-exposed women.

BACKGROUND: Posttraumatic stress is associated with elevated risk for cardiovascular disease (CVD). Relatively little research, particularly among women, has documented mechanisms by which PTSD might confer CVD risk during early adulthood. The purpose of the present study was to examine whether the number and relative levels of CVD risk factors are associated with posttraumatic stress symptom severity among young, trauma-exposed women. METHODS: Participants were premenopausal women ages 19-49 with varying levels of posttraumatic stress and no history of chronic medical illness (n = 54), and were recruited from mental health clinics and the general community. Posttraumatic stress severity was assessed with a structured clinical interview (Clinician-Administered PTSD Scale). The CVD risk factors assessed were lipids (total cholesterol, triglycerides, high- and low-density lipoproteins), resting blood pressure (BP), body mass index (BMI), no exercise in typical week, and cigarette smoking. RESULTS: Posttraumatic stress severity was associated with lower high-density lipoprotein levels and higher triglycerides, greater systolic and diastolic BP, greater BMI, and a greater number of total CVD risk factors. LIMITATIONS: The main limitation is the limited number of participants who displayed clinical levels on some of the CVD risk factors (e.g., BP). Nonetheless, most participants exhibited more than one CVD risk factor, indicating the potential for many of the women in this relatively young sample to progress toward greater risk later in life. CONCLUSIONS: The present results support the contention that, in the absence of medical illness, posttraumatic stress symptom severity among young women is associated with several CVD risk factors early in life.

Cultural Assets and Substance Use Among Hispanic Adolescents.

Research on cultural factors and substance use among Hispanic adolescents has focused primarily on acculturation, while specific core Hispanic values and attributes have received minimal attention. The objective of the current study was to examine the relationship between traditional Hispanic cultural assets and substance use among adolescents. A purposive sample of 225 Hispanic adolescents (47% male) aged 13 to 16 years were recruited from community venues (e.g., park, school, mall) in a predominately Hispanic neighborhood. Participants completed a survey to assess cultural factors (familism, simpatía, respeto, and ethnic pride) and substance use in the past 3 months (alcohol and drug). Point-biserial correlations revealed significant associations of alcohol and drug use with greater familism (family connectedness), simpatía (interpersonal relationship harmony), and respeto (respect). Two stepwise binary logistic regressions were performed to evaluate the independent association between the cultural factors and substance use. The interaction of gender with each cultural factor was examined in both analyses. Simpatía emerged as the only cultural factor independently associated with alcohol use. Greater simpatía was related to abstention from alcohol. Both simpatía and familism independently correlated with drug use. Stronger endorsements of simpatía and familism were associated with absence from drug use. Interactions between cultural factors and gender were not observed. Simpatía emerged as the strongest cultural asset that may confer protection against substance use. If replicated, our results suggest substance prevention programs targeting Hispanic adolescents may benefit from the inclusion of cultural assets in the intervention paradigm.

Routine testing for HIV in the United States: the intersection between recommendations and practice.

The purpose of this study was to examine the current practices of family practice (FP) providers and their allied staff with regard to routine HIV testing in Rhode Island (RI) and Mississippi (MS). Anonymous experimenter-derived surveys were mailed to both groups of providers in 2002. The questionnaire contained five questions about their current practices and attitudes toward HIV testing as well as patient demographics. Five hundred twenty-one questionnaires were sent to American Academy of Family Practitioners (AAFP) members in RI and MS and to FPs with listings in the phone book in RI. The response rate was 52% in RI and 41% in MS. The vast majority of providers (93%) tested their high-risk patients for HIV, but less tested pregnant (57%) and other sexually active (37%) patients. The FPs in this survey wanted HIV testing to be done in the primary care setting, yet only 7% recommended HIV testing to their sexually active patients aged 18-50 in the previous year. In order not to stigmatize any specific risk group, nor to miss any patients who are unable to be identified as being "at high risk," routine testing in the primary care setting should be encouraged.

Psychophysiological Reactivity and PTSD Symptom Severity among Young Women.

Mixed findings with regard to cardiovascular reactivity (CVR) and posttraumatic stress disorder (PTSD) have suggested a need to further explore the nature of this relationship and factors that might explain differences in reactivity across and within samples. In the present study, the severity of PTSD symptoms was investigated in relation to CVR among young women. In addition, we examined whether severity within PTSD symptom clusters and level of dissociative symptoms were related to CVR. Heart rate, systolic and diastolic blood pressure, cardiac output (CO) and total peripheral resistance (TPR) reactivity in response to an oral speaking task were assessed for 58 young trauma-exposed civilian women with varying levels of PTSD symptomatology (from no symptoms to high severity of PTSD). The PTSD severity sub-scores for the DSM-V symptom clusters and total PTSD severity were based on structured interview (Clinician Administered PTSD Scale), and dissociative symptoms were assessed using the Dissociative Experiences Scale. Severity of total PTSD symptoms was associated with greater CO reactivity (r = .48, p < .01) and lower TPR reactivity (r = -.50, p < .01). Significant associations were not observed for heart rate or blood pressure. Results did not vary according to severity of symptoms within PTSD symptom cluster, with correlations for CO reactivity ranging from .40 to .49 and correlations for TPR reactivity ranging from -.40 to -.50 within symptom clusters. Dissociative symptoms were not significantly correlated with the CVR measures. Results partially supported the expectation that PTSD severity is one factor that would be associated with CVR, and suggest that reactivity for the underlying components of blood pressure (CO and TPR) provide additional information in probing stress reactivity in PTSD.

Clinical effectiveness of sustained-release bupropion and behavior therapy for tobacco dependence in a clinical setting.

Despite decades of public education, cigarette smoking remains a serious health problem. The treatment approach at Tripler Army Medical Center is a unique collaboration of family practice physicians and health psychologists providing combination therapy to patients attempting to quit smoking. This article discusses a program evaluation of the Tripler Army Medical Center smoking cessation program. Patients attempting to quit smoking were assisted with a combination of cognitive-behavioral group therapy and sustained-release bupropion hydrochloride. At 6 months postintervention, patients who attended the smoking cessation programs were contacted via telephone and asked to complete a survey regarding their smoking status. One hundred forty-four participants completed the survey. Thirty-five percent of all contacted attendees remained abstinent from smoking at 6 months after intervention. A significantly greater percentage of men quit than women. There were no significant differences of abstinence rates by any other demographic characteristic or smoking history variable. Family practice physicians and health psychologists providing a combination of pharmacological and group cognitive-behavior therapy for nicotine dependence are effective in promoting abstinence from smoking.