Addressing the Harms of Structural Racism on Health in Incarcerated Youth Through Improved Nutrition and Exercise Programs.

Every year, hundreds of thousands of youth across the country enter the juvenile legal system. A significantly disproportionate number of them are youth of color. While youth arrests have declined over the past several decades, racial disparities have increased and persist at every stage of the system. Many youth of color enter the juvenile legal system with a history of trauma and stress that compromises their health and well-being. Arrest, prosecution, and incarceration exacerbate these poor health outcomes. This paper examines several of the health impacts of structural racism in the policing and incarceration of youth of color. The paper begins by highlighting some of the most pressing social determinants of adolescent health and then considers how youth detention and incarceration contribute to unhealthy weight, hypertension, diabetes, and cardiovascular disease through unhealthy food environments, limited physical activity, and the added stress of the incarceration setting. This paper adds to the existing literature on the harms of youth detention and advocates for harms elimination strategies grounded in a public health approach to public safety and community-based alternatives to detention. For those youth who will remain in detention, the authors offer suggestions to reduce harms and improve the health of systems-involved youth, including opportunities for research.

Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age.

Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.

Trends in the Prevalence of Coronary Heart Disease in the U.S.: National Health and Nutrition Examination Survey, 2001-2012.

INTRODUCTION: This study evaluated recent trends in the prevalence of coronary heart disease in the U.S. population aged ≥40 years. METHODS: A total of 21,472 adults aged ≥40 years from the 2001-2012 National Health and Nutrition Examination Survey were included in the analysis. The analysis was conducted in 2015. Coronary heart disease included myocardial infarction, angina, and any other type of coronary heart disease, which were defined as a history of medical diagnosis of these specific conditions. Angina was also defined as currently taking anti-angina medication or having Rose Angina Questionnaire responses that scored with a Grade ≥1. Trends from 2001 to 2012 were analyzed overall, within demographic subgroups, and by major coronary heart disease risk factors. RESULTS: Between 2001 and 2012, the overall prevalence of coronary heart disease significantly decreased from 10.3% to 8.0% (p-trend<0.05). The prevalence of angina significantly decreased from 7.8% to 5.5% and myocardial infarction prevalence decreased from 5.5% to 4.7% (p-trend <0.05 for both groups). Overall coronary heart disease prevalence significantly decreased among women, adults aged >60 years, non-Hispanic whites, non-Hispanic blacks, adults who did not complete high school, adults with more than a high school education, and adults who had health insurance (p-trend <0.05 for all groups). CONCLUSIONS: The overall prevalence of coronary heart disease including angina and myocardial infarction decreased significantly over the 12-year survey period. However, this reduction was seen mainly among persons without established coronary heart disease risk factors. There was no change in coronary heart disease prevalence among those with specific coronary heart disease risk factors.

Hypertension Prevalence and Control Among Adults: United States, 2011-2014.

KEY FINDINGS: Hypertension is a public health challenge in the United States because it directly increases the risk for cardiovascular disease (1). National and regional health initiatives, including Healthy People 2020, the Million Hearts Initiative, and the Community Preventive Services Task Force, have sought to increase public awareness of the health benefits of improving blood pressure control (2-4). This report presents updated estimates for the prevalence and control of hypertension in the United States for 2011-2014.

National surveillance definitions for hypertension prevalence and control among adults.

BACKGROUND: Clear and consistent definitions of hypertension and hypertension control are crucial to guide diagnosis, treatment, and surveillance. A variety of surveillance definitions are in frequent use, resulting in variation of reported hypertension prevalence and control, even when based on the same data set. METHODS AND RESULTS: To assess the variety of published surveillance definitions and rates, we performed a literature search for studies and reports that used National Health and Nutrition Examination Surveys (NHANES) data from at least as recent as the 2003 to 2004 survey cycle. We identified 19 studies that used various criteria for defining hypertension and hypertension control, as well as different parameters for age adjustment and inclusion of subpopulations. This resulted in variation of reported age-standardized hypertension prevalence from 28.9% to 32.1% and hypertension control from 35.1% to 64%. We then assessed the effects of varying the definitions of hypertension and hypertension control, parameters for age adjustment, and inclusion of subpopulations on NHANES data from both 2007 to 2008 (n=5645) and 2005 to 2008 (n=10 365). We propose standard surveillance definitions and age-adjustment parameters for hypertension and hypertension control. By using our recommended approach with NHANES 2007 to 2008 data, the age-standardized prevalence of hypertension in the United States was 29.8% (SE, 0.62%) and the rate of hypertension control was 45.8% (SE, 4.03%). CONCLUSIONS: Surveillance definitions of hypertension and hypertension control vary in the literature. We present standard definitions of hypertension prevalence and control among adults and standard parameters for age-adjustment and population composition that will enable meaningful population comparisons and monitoring of trends.

Cholesterol management in the United States: the national health and nutrition examination survey, 1999 to 2006.

OBJECTIVES: This study assesses (1) the prevalence of ever having a blood test for cholesterol, (2) current practices of following advice from a health care professional to manage high cholesterol, and (3) the association between total serum cholesterol level and following the advice. METHODS: A total of 17,260 adults aged 20 and older participated in the interview and medical examination in National Health and Nutrition Examination Survey (1999-2006). Cholesterol management was examined among adults previously diagnosed with high cholesterol who were advised to change their lifestyles through low-fat diets, weight loss, or exercise and/or to take medications. Five analytic groups were defined: (1) Those taking medications only, (2) those making one or more lifestyle changes, (3) those making one or two lifestyle changes and taking medications, (4) those making three lifestyle changes and taking medications, and (5) those not following any advice. RESULTS: Between 69% and 80% of adults advised to lower cholesterol reported following advice to control their cholesterol. Adults on medication only and adults with lifestyle changes and medication were more likely to have cholesterol level below 240 mg/dL compared with adults with lifestyle changes only (medication only: odds ratio [OR], 2.7; 95% confidence interval [CI], 1.3-5.8); one or two lifestyle changes and medication: OR, 4.1; 95% CI, 3.1-5.4; three lifestyle changes and medication: OR, 4.3; 95% CI, 3.0-6.2; referent: one or two or three lifestyle changes). CONCLUSION: The combination of medication and lifestyle changes was more strongly associated with decreasing cholesterol compared with making one or more lifestyle changes without medication use.

Recent trends in the prevalence of high blood pressure and its treatment and control, 1999-2008.

High blood pressure is one of the most common risk factors for cardiovascular disease and stroke (1). This report evaluates the overall trends in age-adjusted high blood pressure prevalence, awareness, treatment, and control using the most recent 10 year NHANES data. It also examines these age-adjusted rates for hypertension by sex, age, and race and ethnicity.