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Both physical activity and social network size decline as people age. However, limited research has examined if social network size and contact frequency differentially influence physical activity across the adult lifespan. This study aimed to assess if these social network characteristics moderated the relationship between age and physical activity level across adulthood. Multiple regression analyses were conducted to examine the main-effect association between age, past-week physical activity, and past-year physical activity, as well as the moderating effect of social network characteristics (i.e., friend network size, friend contact frequency, relative network size, and relative contact frequency) on age-physical activity associations. The results revealed that friend network size had moderated associations between age and past-week physical activity (β = -7.03; p = .025, f 2 = 0.13) and past-year physical activity (β = -585.52; p = .017, f 2 = 0.15). Specifically, adults who were older and had smaller friend networks performed more minutes of moderate-vigorous physical activity (MVPA) over the past week and past year; on the other hand, adults who were younger and had larger friend networks performed more minutes of MVPA over the past week and past year. Relative network size, friend contact frequency, and relative contact frequency did not moderate the relationship between age and past-week physical activity and past-year physical activity. These findings suggested that building friend networks throughout adulthood may help promote active living across the adult lifespan.

Objectives: The Life's Simple 7 score (LS7) promotes cardiovascular health (CVH). Despite this, some with optimal LS7 develop cardiovascular disease (CVD), while others with poor CVH do not, termed the "CVH paradox." This paper explores pathways explaining this paradox., Methods: We examined methodological aspects: 1) misclassification bias in self-reported lifestyle factors (smoking, physical activity, diet); 2) cumulative exposure to risk factors over a lifetime, impacting the CVH paradox. Punctual risk factor assessments are suboptimal for predicting outcomes. We proposed personalized prevention using "novel" elements to refine CVH assessment: 1) subclinical vascular disease markers, 2) metabolic biomarkers in blood and urine, 3) emerging risk factors, 4) polygenic risk scores (PRS), 5) epigenetics, and 6) the exposome., Results: Addressing the CVH paradox requires a multifaceted approach, reducing misclassification bias, considering cumulative risk exposure, and incorporating novel personalized prevention elements., Conclusion: A holistic, individualized approach to CVH assessment and CVD prevention can better reduce cardiovascular outcomes and improve population health. Collaboration among researchers, healthcare providers, policymakers, and communities is essential for effective implementation and realization of these strategies., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Gaye, Naji, Sims, Cuffee, Ogungbe, Michos, Lassale, Sabouret and Jouven.)

Background: The prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women., Objective: This substudy aimed to examine health social networks and describe the peers' characteristics, as reported by a convenience sample of Black women with hypertension., Methods: In this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network., Results: Collectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants' health social network size (number of peers named) and their systolic blood pressure levels., Discussion: The health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Racial and ethnic minorities are disproportionately affected by limited health literacy. Therefore, this study assessed census block health literacy level and medication adherence in Delaware among Black individuals with hypertension (HTN) receiving health care through Medicaid. This was a cross-sectional study of Black Delaware Medicaid beneficiaries (18-64 years old) from the 3 counties in Delaware (Kent, New Castle, and Sussex) from 2016 to 2019. The primary outcome was medication adherence (full adherence = 80%-100%, partial adherence = 50%-79%, and nonadherence = 0-49%) as a function of health literacy. Health literacy scores were categorized as below basic (0-184), basic (184-225), intermediate (226-309), and proficient (310-500). The results of the study showed that 18,958 participants (29%) had ≥1 HTN diagnosis during the study period. Mean area health literacy score for participants without HTN was significantly higher than participants with HTN (234.9 vs. 233.7, P  < 0.0001). Men had lower odds of adherence compared with women (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.75-0.92, P  < 0.001). Increased time enrolled in Medicaid decreased full adherence. Participants 21-30 and 31-50 years of age are significantly less likely to have full adherence in comparison with participants 51-64 years of age ( P  < 0.0001). Participants living in an area with basic level of health literacy reported lower medication adherence than those living in an area with an intermediate level of health literacy (OR: 0.72, 95% CI: 0.64-0.81, P  < 0.001). In conclusion, men, younger adults, increased time enrolled in Medicaid for the study period, and basic health literacy were significantly associated with low adherence to medication among 3 census blocks in Delaware.

Background: Neuroimaging tools, such as functional magnetic resonance imaging, are useful in understanding differences in brain activity that predict behavior change. Designing interventions based on brain activity and response may enhance current self-management regimens. Yet, diverse groups, such as Black women with chronic illness, have historically been left out of neuroimaging research., Objectives: The aims of this study were to assess (a) the feasibility of conducting neuroimaging research among Black women with hypertension and (b) the predictors of willingness to participate in future studies., Methods: A survey designed to assess interest in participating in neuroimaging research was distributed through a Facebook campaign targeting Metro-Detroit Blacks with hypertension. A 10-minute, 44-item survey queried the women regarding their perspectives related to participation in neuroimaging studies. Logistic regression analyses were conducted to predict willingness to participate in a future study; they included a range of predictors: demographic indicators, history of blood pressure diagnosis, systolic and diastolic blood pressure, and availability of a support person who could accompany the participant to a future study session., Results: Two hundred fifty-seven Black women completed the survey. On average, the women were 59 years old, had been diagnosed with hypertension for 14 years, and had a systolic blood pressure of 141 mmHg. Participants were willing to travel 40 miles to participate, and many preferred to drive a personal vehicle. Some women were claustrophobic (20%) or had metal in their bodies (13%) and, therefore, would likely be ineligible to participate in neuroimaging studies. Some were nervous about the "small space" of a scanner, but others stated they would "enjoy participating" and wanted to "help future people…get well." Women who had a support person to attend their appointment with them were almost 4 times more likely to state they would participate in future studies. Those who had been diagnosed with hypertension for more than 11 years (the median) were almost 3 times more likely to report interest in participating in a future study than those participants who had been diagnosed with hypertension for 11 years or less., Discussion: Black women with hypertension were interested and eligible to participate in neuroimaging research. Despite some of the facilitators and barriers we identified, the women in our sample were interested in participating in future studies. The presence of a support person and length of time with a hypertension diagnosis are important predictors of willingness to participate in a future study., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women's status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women's diabetes self-management employing a conceptual framework based on Walby's structures of patriarchy., Methods: An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework., Results: Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women's patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women's access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy., Conclusion: Patriarchal practices that start early on within women's lives, such as child marriage, religious restrictions as well as women's access to education and autonomy impacted NSB women's access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health., Competing Interests: The authors have declared that no competing interests exist.

Menstrual health and hygiene are a major public health and social issues in Nepal. Due to inadequate infrastructure to provide education, healthcare, and communication as well as religious teachings, women and girls are excluded from participation in many activities of daily living and community activities during menstruation. Evidence based research addressing menstrual health and hygiene in Nepal is scares. The objective of this paper is to review the current state of knowledge on menstrual health and hygiene in Nepal through a socio-ecological perspective. This systematic review identifies knowledge gaps and targets for future research and interventions. Studies from Nepal that examined factors contributing to menstrual health and hygiene were identified through searches across six databases (Medline, CINAHL, Web of Science, PsychInfo, Nepal Journals Online and Kathmandu University Medical Journal) in January 2019. The SEM is a public health framework that describes how health is impacted at multiple levels including the individual, interpersonal, community, organizational and policy levels. Key themes were identified, and factors contributing to menstrual health and hygiene were categorized as per the level of socio-ecological model (SEM). After a comprehensive literature review, twenty peer-reviewed publications, published between 2003 and January 2019 were included in this review. Eighteen studies were descriptive and two were interventional. The main outcomes reported were reproductive health concerns and menstrual hygiene practices. Nine studies focused on knowledge, attitude, and practices regarding menstruation, seven studies highlighted reproductive health issues, three studies focused on prevalence of culturally restrictive practices, and one on school absenteeism and intimate partner violence. Lack of awareness regarding menstrual health and hygiene, inadequate WASH facilities, no sex education and culturally restrictive practices makes menstruation a challenge for Nepali women. These challenges have negative implications on women and girls' reproductive as well as mental health and school attendance among adolescent girls. There are gaps in the evidence for high quality interventions to improve menstrual health and hygiene in Nepal. Future research and interventions should address needs identified at all levels of the SEM., (© 2022. The Author(s).)

Background: Little is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension., Objective: The aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness., Design: Analysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population., Participants/setting: A total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included., Main Outcome Measures: Diet quality was assessed by Healthy Eating Index 2015 (HEI-2015)., Statistical Analysis Performed: Weighted χ 2 tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates., Results: Among the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status., Conclusions: There were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness., (Copyright © 2022 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate sex differences in demographic and clinical characteristics, treatments and outcomes for patients with diagnosed obstructive hypertrophic cardiomyopathy (oHCM) in the USA., Setting: Retrospective observational study of administrative claims data from MarketScan Commercial Claims and Encounters Database from IBM Watson Health., Participants: Of the 28 million covered employees and family members in MarketScan, 9306 patients with oHCM were included in this analysis., Main Outcome Measures: oHCM-related outcomes included heart failure, atrial fibrillation, ventricular tachycardia/ fibrillation, sudden cardiac death, septal myectomy, alcohol septal ablation (ASA) and heart transplant., Results: Among 9306 patients with oHCM, the majority were male (60.5%, p<0.001) and women were of comparable age to men (50±15 vs 49±15 years, p<0.001). Women were less likely to be prescribed beta blockers (42.7% vs 45.2%, p=0.017) and undergo an implantable cardioverter-defibrillator (1.7% vs 2.6%, p=0.005). Septal reduction therapy was performed slightly more frequently in women (ASA: 0.08% vs 0.05%, p=0.600; SM: 0.35% vs 0.18%, p=0.096), although not statistically significant. Women were less likely to have atrial fibrillation (6.7% vs 9.9%, p<0.001)., Conclusion: Women were less likely to be prescribed beta blockers, ACE inhibitors, anticoagulants, undergo implantable cardioverter-defibrillator and have ventricular tachycardia/fibrillation. Men were more likely to have atrial fibrillation. Future research using large, clinical real-world data are warranted to understand the root cause of these potential treatment disparities in women with oHCM., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The COVID-19 pandemic has disrupted physical activity, particularly among women. Limited research has explored how social network support may explain gender-based variations in physical activity during COVID-19. The purpose of this study was to examine the mediating role of social networks in the association between gender and physical activity during a pandemic. This cross-sectional survey assessed whether social network characteristics (i.e., in-person social network size, frequency of in-person social network interactions, and online friend network size) mediate the relationship between gender and either past-week or past-year physical activity. Multiple mediation analyses were conducted to determine the indirect effect of gender on physical activity through social networks. Among 205 participants, women (n = 129) were significantly less physically active (β = −73.82; p = 0.02) than men (n = 76) and reported significantly more Facebook friends (β = 0.30; p < 0.001) than men, which was inversely associated with past-week physical activity (β = −64.49; p = 0.03). Additionally, the indirect effect of gender on past-week physical activity through Facebook friends was significant (β = −19.13; 95% CI [−40.45, −2.09]). Findings suggest that social media sites such as Facebook could be used to encourage physical activity among women during a pandemic.

Hypertrophic cardiomyopathy is the most common genetic heart disease in the US, with an estimated prevalence of 1 in 500. However, the extent to which obstructive hypertrophic cardiomyopathy is clinically recognized is not well-established. Therefore, the objective of this study was to estimate the annual prevalence of clinically diagnosed oHCM in the US from 2016 to 2018. Data from the MarketScan® database were queried from years 2016 to 2018 to identify patients with ≥1 claim of oHCM (International Statistical Classification of Disease and Related Health Problems diagnosis code: I42.1). Prevalence rates for oHCM were calculated and stratified by sex and age. In 2016, 4,612 unique patients had clinical diagnosis of oHCM, resulting in an estimated oHCM prevalence of 1.65 per 10,000. The prevalence of oHCM in males and females was 2.07 and 1.26, respectively. Prevalence of oHCM was highest in patients 55-64 years of age (4.82). Prevalence of oHCM generally increased with age, from 0.36 per 10,000 in those under 18 to 4.82 per 10,000 in those 55-65. Trends in prevalence of oHCM over time, including by sex and age group, remained similar and consistent in 2017 and 2018. The prevalence of oHCM was stable over the 3-year time period, including higher rates of oHCM in males and patients aged 55-64 years. These results suggest that the majority of privately insured patients with oHCM are undiagnosed in the US and reinforce the need for policies and research to improve the clinical identification of oHCM patients in the US., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Butzner, Leslie, Cuffee, Hollenbeak, Sciamanna and Abraham.)

The Nepali-speaking Bhutanese (NSB) community living in Central Pennsylvania has been significantly affected by COVID-19 due to various biopsychosocial determinants of health. In this paper, we discuss interventions developed by a tertiary care health system in Central Pennsylvania to provide immediate support to the NSB community.

Background: In rural communities, there are gaps in describing the design and effectiveness of technology interventions for treating diseases and addressing determinants of health., Objective: The aim of this study is to evaluate literature on current applications, therapeutic areas, and outcomes of telehealth interventions in rural communities in the United States., Methods: A narrative review of studies published on PubMed from January 2017 to December 2020 was conducted. Key search terms included telehealth, telemedicine, rural, and outcomes., Results: Among 15 included studies, 9 studies analyzed telehealth interventions in patients, 3 in health care professionals, and 3 in both patients and health care professionals. The included studies reported positive outcomes and experiences of telehealth use in rural populations including acceptability and increased satisfaction; they also noted that technology is convenient and efficient. Other notable benefits included decreased direct and indirect costs to the patient (travel cost and time) and health care service provider (staffing), lower onsite health care resource utilization, improved physician recruitment and retention, improved access to care, and increased education and training of patients and health care professionals., Conclusions: Telehealth models were associated with positive outcomes for patients and health care professionals, suggesting these models are feasible and can be effective. Future telehealth interventions and studies examining these programs are warranted, especially in rural communities, and future research should evaluate the impact of increased telehealth use as a result of the COVID-19 pandemic., (©Michael Butzner, Yendelela Cuffee. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.08.2021.)

Importance: Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre-COVID-19 experiences of food insecurity and COVID-19 infection rates through a race/ethnicity lens., Objective: To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates and the interactions of race/ethnicity and food insecurity, while controlling for demographic, socioeconomic, risk exposure, and geographic confounders., Design, Setting, and Participants: This cross-sectional study examined the associations of race/ethnicity and food insecurity with cumulative COVID-19 infection rates in 3133 US counties, as of July 21 and December 14, 2020. Data were analyzed from November 2020 through March 2021., Exposures: Racial/ethnic minority groups who experienced food insecurity., Main Outcomes and Measures: The dependent variable was COVID-19 infections per 1000 residents. The independent variables of interest were race/ethnicity, food insecurity, and their interactions., Results: Among 3133 US counties, the mean (SD) racial/ethnic composition was 9.0% (14.3%) Black residents, 9.6% (13.8%) Hispanic residents, 2.3% (7.3%) American Indian or Alaska Native residents, 1.7% (3.2%) Asian American or Pacific Islander residents, and 76.1% (20.1%) White residents. The mean (SD) proportion of women was 49.9% (2.3%), and the mean (SD) proportion of individuals aged 65 years or older was 19.3% (4.7%). In these counties, large Black and Hispanic populations were associated with increased COVID-19 infection rates in July 2020. An increase of 1 SD in the percentage of Black and Hispanic residents in a county was associated with an increase in infection rates per 1000 residents of 2.99 (95% CI, 2.04 to 3.94; P < .001) and 2.91 (95% CI, 0.39 to 5.43; P = .02), respectively. By December, a large Black population was no longer associated with increased COVID-19 infection rates. However, a 1-SD increase in the percentage of Black residents in counties with high prevalence of food insecurity was associated with an increase in infections per 1000 residents of 0.90 (95% CI, 0.33 to 1.47; P = .003). Similarly, a 1-SD increase in the percentage of American Indian or Alaska Native residents in counties with high levels of food insecurity was associated with an increase in COVID-19 infections per 1000 residents of 0.57 (95% CI, 0.06 to 1.08; P = .03). By contrast, a 1-SD increase in Hispanic populations in a county remained independently associated with a 5.64 (95% CI, 3.54 to 7.75; P < .001) increase in infection rates per 1000 residents in December 2020 vs 2.91 in July 2020. Furthermore, while a 1-SD increase in the proportion of Asian American or Pacific Islander residents was associated with a decrease in infection rates per 1000 residents of -1.39 (95% CI, -2.29 to 0.49; P = .003), the interaction with food insecurity revealed a similar association (interaction coefficient, -1.48; 95% CI, -2.26 to -0.70; P < .001)., Conclusions and Relevance: This study sheds light on the association of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19 infection rates were markedly different during the pandemic.

Objective: The aim of this study was to determine whether long-standing racial disparities in lead exposure still exists for children age 1-5 years old. We examined if blood lead levels were higher among non-Hispanic Black children and others compared to non-Hispanic White children., Methods: Data from the National Health and Nutrition Examination Survey (NHANES) from 1999-2016 were used. Geometric mean blood lead levels (BLLs) were compared by race/ethnicity using log-transformed simple linear regression. Associations between race and elevated BLL were assessed using weighted Chi-square tests. Log-transformed multiple weighted linear regression was used to assess what factors affected BLLs., Results: A total of 6772 children were included in this study. In 1999-2000, the geometric mean BLL for non-Hispanic Black children was 3.08 μg/dL, compared to 2.03 μg/dL for non-Hispanic White children (p = 0.01). The difference in geometric mean BLL between non-Hispanic Black children and non-Hispanic White children continued to be statistically significant in later years (all p < 0.05) until 2015-2016 (0.89 μg/dL vs 0.74 μg/dL, p = 0.17). Log-transformed linear regression showed that being non-Hispanic Black and having low family income were independently associated with higher BLL., Conclusion: Although lead exposure in the general population continued to decline for all racial/ethnic groups, non-Hispanic Black children still had higher BLL than non-Hispanic White children. In more recent years, the racial/ethnic gap was lesser but persisted. Racial/ethnic disparity in childhood BLL could be partially explained by socio-economic factors.

A depressed African American emerging adult's intention to seek help can be affected by the severity of their mental health or perception of self-flourishing, or positive mental health. Using the Healthy Minds Study, a nationally representative dataset, utilization of mental health services among African American emerging adult students who have been diagnosed with depression by a health professional (n = 201), and the mediating effect of positive mental health on help-seeking intentions were examined. The findings revealed that 89.45% of students reported help-seeking intentions, and they may have one or more than one way of seeking help from a professional clinician, roommate or friend, or significant. The findings show that there are specific groups of people that African Americans prefer to engage with when addressing their mental health. It is critical that we consider these groups when developing interventions or programs for their service access on college campuses and beyond.

The aim of this study was to investigate the association between blood lead level (BLL) and hypertension in adults when lead exposure for the general population is low. The study used data from the US National Health and Nutrition Examination Survey (NHANES) 1999-2016. Participants aged 20 to 79 years were included in our study. Weighted multiple linear regression and logistic regression were conducted to test the association between BLL and systolic/diastolic blood pressure and hypertension status, respectively, while controlling for age, gender, race/ethnicity, body mass index, income level, and education. A total of 30,467 participants were included in this study. There was no association between BLL and hypertension status for the overall sample. Among those who were not taking antihypertensive medication, after adjusting for covariates, systolic blood pressure was positively correlated with BLL in non-Hispanic Whites (P = 0.004) and non-Hispanic Blacks (P = 0.0005), but not Hispanics (P = 0.07) nor Others (P = 0.37). The relationship between diastolic blood pressure and lead levels was also significant in non-Hispanic Whites and non-Hispanic Blacks. This study showed that higher BLL was associated with higher systolic and diastolic blood pressure in some population groups, but not associated with hypertension status.

Introduction: Home remedies are used for the treatment of hypertension despite unsubstantiated claims of their effectiveness. Home remedy use is often attributed to mistrust towards healthcare providers. Few studies examine the relationship between home remedy use and physician trust. The objective of this study was to examine and compare the association between home remedy use and trust in physicians in a cohort of low-income Blacks and Whites with hypertension living in an inner city in Alabama., Methods: A cross-sectional examination was conducted among 925 Black and White patients receiving care at an urban hospital. Data was collected from in-person surveys. Trust in physicians was self-reported using the Hall General Trust Scale which included questions about honesty, confidentiality, and trust. Home remedy use was self-reported using the Brown and Segal scale which included questions about home remedy use and types of home remedies used. Covariates included demographic factors such as age, race, gender, and health outcomes. Data were analyzed using linear regression., Results: Twenty-eight percent of Black and 15% of White participants reported home remedy use (p = 0.001). Black home remedy users (38.9) and non-users (39.3) had similar trust scores (p = 0.582). Whites home remedy users (32.9) reported lower trust in physicians than White non-users (37.7) (p = 0.026)., Conclusions: Black home remedy users, non-users, and White non-users reported similar trust scores; the lowest trust scores were found among White home remedy users. Home remedy use was higher among Black participants. Future studies should examine the context of mistrust and home remedy use among Whites.

Previous evidence suggests modest improvements in antihypertensive medication adherence occurred from 2007 to 2012 among US adults ≥65 years of age. Whether adherence improved over time among adults <65 years of age is unknown. We assessed trends in antihypertensive medication nonpersistence and low adherence among 379 658 commercially insured adults <65 years of age initiating treatment in 2007-2014 using MarketScan claims. Nonpersistence was defined as having no days of medication available to take during the final 90 days of the 365 days following initiation. Among beneficiaries who were persistent to treatment, low adherence was defined by having antihypertensive medication available to take for <80% of the days in the 365 days following initiation (ie, proportion of days covered <80%). In 2007 and 2014, 23.3% and 23.5% of patients were nonpersistent to treatment, respectively, and 42.3% and 40.2% had low adherence, respectively. The relative risks for nonpersistence and low adherence were lower among beneficiaries initiating treatment with an angiotensin-converting enzyme inhibitor (0.95; 95% CI, 0.94-0.97 and 0.97; 95% CI, 0.96-0.98, respectively), angiotensin receptor blocker (0.86; 95% CI, 0.85-0.88 and 0.99; 95% CI, 0.97-1.00, respectively), or multiclass regimen (0.82; 95% CI, 0.80-0.84 and 0.88; 95% CI, 0.86-0.89, respectively), prescribed 90-day versus 30-day prescriptions (0.67; 95% CI, 0.66-0.68 and 0.70; 95% CI, 0.69-0.71, respectively), or who received medications by mail versus at the pharmacy (0.93; 95% CI, 0.90-0.95 and 0.90; 95% CI, 0.88-0.92, respectively). In conclusion, several modifiable factors were associated with lower rates of both antihypertensive medication nonpersistence and low adherence among adults <65 years of age initiating treatment in 2007-2014.

Background: Few studies have examined the social and behavioral predictors of insufficient sleep., Objective: To assess the social and behavioral predictors of insufficient sleep in the U.S., Methods: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Telephone interviews were conducted in six representative states that completed the optional sleep module. A total of 31,059 respondents were included in the present analysis. BRFSS-provided weights were applied to analyses to adjust for the use of complex design., Results: The mean age for the sample was 56 ± 16 years, with 63% of the sample being female; 88% identified as non-Hispanic white and 12% identified as non-Hispanic black; 42% were not married and 8% did not have a high school degree. The prevalence of insufficient sleep (<7 hours) was 37%. Multivariate-adjusted logistic regression revealed associations of four important factors with insufficient sleep, which were: working more than 40 hours per week [OR = 1.65, p < 0.001, 95% CI = 1.65-1.66], black race/ethnicity [OR = 1.37, p < 0.001, 95% CI = 1.37-1.38], history of heart disease [OR = 1.26, p < 0.001, 95% CI = 1.25-1.28], care-giving to family/friends [OR = 1.50, p < 0.001, 95% CI = 1.49-1.51], and lack of social and emotional support [OR = 1.24, p < 0.001, 95% CI = 1. 23-1.25]., Conclusion: Social and behavioral predictors of health uniquely contribute to the report of insufficient sleep and should be considered when developing programs to increase awareness of the adverse effects of insufficient sleep., Competing Interests: The authors report no conflict of interest and have signed the ICMJE Uniform Disclosure Form. The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.02.533., (Copyright © 2015 Elsevier B.V. All rights reserved.)

A growing body of research demonstrates that psychosocial factors play an important role in the development of hypertension. Previous reviews have identified several key factors (i.e., occupational stress) that contribute to the onset of hypertension; however, they are now outdated. In this review, we provide an updated synthesis of the literature from 2010 to April 2014. We identified 21 articles for inclusion in the review, of which there were six categories of psychosocial stressors: occupational stress, personality, mental health, housing instability, social support/isolation, and sleep quality. Sixteen of the studies reported an association between the psychosocial stressor and blood pressure. While several findings were consistent with previous literature, new findings regarding mediating and moderating factors underlying the psychosocial-hypertension association help to untangle inconsistencies reported in the literature. Moreover, sleep quality is a novel additional factor that should undergo further exploration. Areas for future research based on these findings are discussed.

Objectives: Much of the excessive morbidity and mortality from cardiovascular disease among African Americans results from low adherence to anti-hypertensive medications. Therefore, we examined the association between weight-based discrimination and medication adherence., Methods: We used cross-sectional data from low-income African Americans with hypertension. Ordinal logistic regression estimated the odds of medication non-adherence in relation to weight-based discrimination adjusted for age, sex, education, income, and weight., Results: Of all participants (n = 780), the mean (SD) age was 53.7 (9.9) years and the mean (SD) weight was 210.1 (52.8) lbs. Reports of weight-based discrimination were frequent (28.2%). Weight-based discrimination (but not weight itself) was associated with medication non-adherence (OR: 1.94; 95% CI: 1.41-2.67). A substantial portion 38.9% (95% CI: 19.0%-79.0%) of the association between weight-based discrimination and medication non-adherence was mediated by medication self-efficacy., Conclusion: Self-efficacy is a potential explanatory factor for the association between reported weight-based discrimination and medication non-adherence. Future research should develop and test interventions to prevent weight-based discrimination at the societal, provider, and institutional levels.

Introduction: Innovative approaches are needed to promote physical activity among young adult overweight and obese African American women. We sought to describe key elements that African American women desire in a culturally relevant Internet-based tool to promote physical activity among overweight and obese young adult African American women., Methods: A mixed-method approach combining nominal group technique and traditional focus groups was used to elicit recommendations for the development of an Internet-based physical activity promotion tool. Participants, ages 19 to 30 years, were enrolled in a major university. Nominal group technique sessions were conducted to identify themes viewed as key features for inclusion in a culturally relevant Internet-based tool. Confirmatory focus groups were conducted to verify and elicit more in-depth information on the themes., Results: Twenty-nine women participated in nominal group (n = 13) and traditional focus group sessions (n = 16). Features that emerged to be included in a culturally relevant Internet-based physical activity promotion tool were personalized website pages, diverse body images on websites and in videos, motivational stories about physical activity and women similar to themselves in size and body shape, tips on hair care maintenance during physical activity, and online social support through social media (eg, Facebook, Twitter)., Conclusion: Incorporating existing social media tools and motivational stories from young adult African American women in Internet-based tools may increase the feasibility, acceptability, and success of Internet-based physical activity programs in this high-risk, understudied population.

Objective: Racial/ethnic discrimination has adverse effects on health outcomes, as does low income and education, but the relationship between discrimination, income, and education is not well characterized. In this study, we describe the associations of discrimination with income and education in elderly African Americans (AA) and European Americans (EA)., Design: Cross-sectional observational study involving computer-assisted telephone survey., Setting: Southeastern United States., Participants: AA and EA Medicare managed care enrollees., Main Outcome Measures: Discrimination was measured with the Experience of Discrimination (EOD) scale (range 0-35). We used zero-inflated negative binomial models to determine the association between self-reported income and education and 1) presence of any discrimination and 2) intensity of discrimination., Results: Among 1,800 participants (45% AA, 56% female, and mean age 73 years), EA reported less discrimination than AA (4% vs. 47%; P < .001). AA men reported more discrimination and more intense discrimination than AA women (EOD scores 4.35 vs. 2.50; P < .001). Both income and education were directly and linearly associated with both presence of discrimination and intensity of discrimination in AA, so that people with higher incomes and education experienced more discrimination. In adjusted models, predicted EOD scores among AA decreased with increasing age categories (3.42, 3.21, 2.99, 2.53; P < .01) and increased with increasing income (2.36, 3.44, 4.17; P < .001) and education categories (2.31, 3.09, 5.12; P < .001)., Conclusions: This study suggests future research should focus less on differences between racial/ethnic groups and more on factors within minority populations that may contribute to healthcare disparities.