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Behavioral risk factors are among the preventable causes of health disparities, yet long-term change remains elusive. Many interventions are designed to increase self-efficacy, but little is known about the effect on long-term behavior change in older, low-income African Americans, especially when facing more problematic barriers. A cohort of 185 low-income African-Americans with hypertension reported barriers they encountered while undergoing a multiple behavior change trial from 2002 to 2006. The purpose of the present study was to explore the relationships between self-efficacy, barriers, and multiple behavior change over time. Higher self-efficacy seemed to be partially helpful for smoking reduction and increasing physical activity, but not for following a low-sodium diet. Addiction was indirectly associated with less reduction in smoking through lower self-efficacy. Otherwise, different barriers were associated with behavior change than were associated with self-efficacy: being 'too busy' directly interfered with physical activity and 'traditions' with low-sodium diet; however, they were neither the most frequently reported barriers, nor associated with lower self-efficacy. This suggests that an emphasis on self-efficacy alone may be insufficient for overcoming the most salient barriers encountered by older African Americans. Additionally, the most common perceived barriers may not necessarily be relevant to long-term behavioral outcomes. Keywords African Americans * Self-efficacy * Behavior change barriers * Smoking * Physical activity * Low sodium diet * Hypertension, Introduction The three leading causes of death in the United States are heart disease, cancer, and stroke. African Americans generally bear a disproportionate burden of risk factors, incidence, morbidity, and [...]

Choosing an optimal design for local population health surveys involves balancing cost, data quality, potential nonresponse bias, and time considerations. Measuring physical parameters such as height, weight, blood pressure, and […]

Nonadherence to medications is an important cause of poor blood pressure control. Long-acting antihypertensive agents could theoretically be beneficial in partially adherent patients, who are commonly seen in contemporary practice. Little has been reported about the duration of drug holidays (DHs) in treated hypertensives outside of generally compliant patients in phase 4 clinical trials. The authors described patterns of nonadherence to single and multiple antihypertensives in a random sample of 120 primary care patients with uncontrolled hypertension. Adherence to up to 3 antihypertensives was measured by electronic monitoring. Frequencies of single-day omissions and DHs of 2 consecutive days (DH2), 3 days (DH3), or ≥4 days (DH ≥4) for each drug were calculated. Overall, 89 (74%) of patients had at least a 1-day omission. A single day omission was found in 61.4% of the patients taking 1 drug, followed by DH ≥4 (28.1%), DH2 (26.3%), and DH3 (8.8%). In patients using multiple drugs, single-day omissions were also most common, followed by DH ≥4, DH2, and DH3. Omissions of ≤3 days comprise on average 74% of all omissions. Although encouraging full adherence remains important, it may be prudent to prescribe long-acting antihypertensive agents, which can compensate for the majority of dose omissions. J Clin Hypertens (Greenwich). 2012; 00:00-00. ©2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The article explores the process and outcomes of care of type 2 diabetes achieved by clinicians and their patients in member practices from four practice-based research networks. The authors evaluated practice design strategies for diabetes care, the composition of the health care team, the complexity of the health problems experienced by type 2 diabetic patients, control of diabetes and the treatment regimen provided by their clinicians. The authors concluded that by reengineering primary care practice, there would be substantial improvement in the care of patients.

Type 2 diabetes (DM) has been linked to an increased risk of cognitive impairment and dementia. It is not clear whether poor glycemic control is associated with worse cognitive performance in persons with type 2 DM. We examined the cross-sectional association between specific cognitive domains and metabolic parameters in patients with type 2 DM who participated in a cross-cultural validation study of a brief psychometric test battery suitable for use in low-literacy, multi-ethnic populations. We recruited participants from public and private primary care clinics to undergo cognitive function testing with the following measures: Buschke Selective Reminding Test (verbal memory), the Rey-Osterrieth Complex Figure Test (visuo-spatial construction and memory), the Raven Colored Matrices (non-verbal intellectual ability), Digit Symbol Modalities (attention/concentration), finger-tapping (motor coordination), Controlled Word Association Test (language ability), and the Mini-Mental State Exam (global function). BMI, waist circumference, blood pressure, presence of microalbuminuria or ketonuria, capillary blood glucose, and a detailed medical history were obtained before testing. Total and HDL cholesterol, plasma triglycerides, glucose and insulin, Hba1c and C-reactive protein were measured from a fasting blood sample. We used multiple linear regression to test the association between each cognitive function measure and metabolic parameters, adjusting for age, sex, ethnic/racial group membership, education, duration of diabetes. The sample (n=209) had a mean age of 56.8 (± 10.3) years, 11.9 (±4.8) years of education, mean HbA1c 7.7±1.8 % and mean MMSE score 27.9 (±2.6); 78 (37%) were male, 54 (26%) non-Hispanic white, 75 (36%) black, and 80 (38%) Hispanic. Higher BMI (or waist circumference), higher fasting plasma insulin, and insulin treatment were associated with lower visuo-spatial memory and Raven Colored Matrices scores in non-Hispanic whites and Hispanics, but not in African-Americans. There was no evidence of differential cognitive performance attributable to HbA1c, lipid measures, blood pressure or CRP. In treated patients with type 2 DM, variation in cognitive performance attributable to metabolic parameters was observed only in domains involving visuo-spatial processing and visuo-spatial memory, and was associated associated with plasma insulin levels but not HbA1c. The results suggest ethnic/racial group differences in the cognitive impact of type 2 DM. [ABSTRACT FROM AUTHOR]

Introduction: The U.S. study to protect brain health through lifestyle intervention to reduce risk (U.S. POINTER) is conducted to confirm and expand the results of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) in Americans., Methods: U.S. POINTER was planned as a 2-year randomized controlled trial of two lifestyle interventions in 2000 older adults at risk for dementia due to well-established factors. The primary outcome is a global cognition composite that permits harmonization with FINGER., Results: U.S. POINTER is centrally coordinated and conducted at five clinical sites (ClinicalTrials.gov: NCT03688126). Outcomes assessments are completed at baseline and every 6 months. Both interventions focus on exercise, diet, cognitive/social stimulation, and cardiovascular health, but differ in intensity and accountability. The study partners with a worldwide network of similar trials for harmonization of methods and data sharing., Discussion: U.S. POINTER is testing a potentially sustainable intervention to support brain health and Alzheimer's prevention for Americans. Impact is strengthened by the targeted participant diversity and expanded scientific scope through ancillary studies., (© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Physician behavior--not patient noncompliance--is the major cause of poor hypertension control in the United States, many studies show. Hypertension control is unlikely to improve unless physicians become more aggressive in treating mildly elevated systolic blood pressure.