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The American Heart Association (AHA) created the cardiovascular health (CVH) index to measure and monitor population-level reduction of cardiovascular disease (CVD) risk, with a goal of 20% reduction in CVD morbidity and mortality by 2020. Few U.S. adults meet all seven ideal CVH metrics (non-smoking behavior, healthy diet and body weight, active lifestyle, good cholesterol, glucose, and blood pressure scores), with 17% of men and women only achieving five or more ideal CVH metrics. This review describes the importance of considering sociodemographic, psychosocial, and behavioral factors as key strategies to achieve the AHA 2020 goals. Men, racial/ethnic minorities, and individuals of lower socioeconomic status are less likely to achieve ideal CVH—which may start in early childhood. An emerging body of literature indicates that individuals with high-quality social relationships, positive childhood experiences and psychological functioning, along with lifestyle factors, may impact attainment of optimal CVH. For example, exploring the role of food insecurity in CVH attainment demonstrates the complex interplay between contextual factors and lifestyle behaviors that may promote or deter ideal CVH. Evidence also suggests that the CVH index has convergent validity with intermediate and hard endpoints of CVD. Interventions that seek to promote multi-system resiliency may help close the gap in attainment of the AHA 2020 goals. Research on psychosocial and behavioral factors suggests that social connections, psychological resources, and health-maintaining behaviors are important areas to target to improve CVH in minorities and other vulnerable groups.

Background and Objectives Globally, obesity influences the risk of many major chronic diseases. Our study examines the association between individual nativity and neighborhood level concentration of immigrants with 10-year changes in weight, body mass index (BMI), and waist circumference (WC) among older Latinos. Research Design and Methods The Sacramento Area Latino Study on Aging (SALSA) is a population-based prospective study of community-dwelling older adults of Mexican origin (baseline ages 58–101 years). The primary outcome was repeated measures of weight over a 10-year period for 1,628 respondents. Nativity was defined by participants’ reported place of birth (US-born or Latin American foreign born). Neighborhood immigrant concentration was measured as the percentage of foreign born at census tract level (2000 US Census). We used linear mixed models with repeated measures of weight, height, BMI, and WC as dependent variables (level 1), clustered within individuals (level 2) and neighborhood migrant concentration (level 3). Results Foreign born (FB) respondents had lower baseline weight than the US-born (mean, 160 vs. 171 lbs, p < .0001). Over time, weight differences between the FB and the US-born decreased by 1.7 lbs/5 years as US-born weight decreased more rapidly. We observed a significant interaction between individual nativity and neighborhood immigrant concentration (p = .012). We found similar patterns for BMI, but did not find statistically significant differences in WC trajectories. Discussion and Implications Our study observed significant differences by foreign born vs. US nativity in baseline weight/BMI and in their trajectories over time. Additionally, we found weight/BMI differences in neighborhood immigrant concentration for the FB, but not for the US-born.

Previous research indicates women Veterans have a potentially large, unmet need for alcohol-related care but are under-represented in treatment settings. The purpose of this study was to identify factors associated with women Veterans' receptivity to a recommendation for alcohol-related care when they present to Veterans Affairs (VA) primary care with alcohol misuse. Semi-structured interviews were conducted from 2012-2013 with 30 women Veterans at two VA facilities who screened positive for alcohol misuse during a primary care visit and discussed their alcohol use with their primary-care provider. Qualitative analyses identified 9 themes women used to describe what affected their receptivity to a recommendation for alcohol-related care (i.e., VA specialty substance use disorder services). The most common themes positively associated with women's receptivity included self-appraisal of their drinking behavior as more severe, the provider's presentation of treatment options, availability of gender-specific services, and worse physical and mental health. The themes identified here may have important implications for the clinical strategies providers can use to present alcohol-related care options to women Veterans to facilitate their use of care. These strategies include educating women about the health effects of alcohol misuse and increasing providers' knowledge about available care options (within the care organization or the community), including the availability of gender-specific services.

Background One in five women veterans screens positive for alcohol misuse. Women may be less likely than men to disclose alcohol use to a primary care provider (PCP), resulting in women being less likely to receive effective interventions. We sought to qualitatively examine factors that may affect women veterans' willingness to disclose alcohol use to a PCP. Methods Between October 2012 and May 2013, in-depth interviews were conducted with 30 women veterans at two Department of Veterans Affairs (VA) medical facilities. Qualitative data analyses identified common themes representing factors that influence women's decision to disclose alcohol use to a PCP. Findings Nine themes were endorsed by women veterans as influencing their willingness to disclose alcohol use to their PCP. Themes included provider behaviors perceived as encouraging or discouraging disclosure of alcohol misuse, perceived positive relationship with provider, negative emotions such as concerns about being judged or labeled an “alcoholic,” health concerns about drinking, non–health-related concerns about drinking, self-appraisal of drinking behavior, social support, and clinic factors. Conclusions Our findings demonstrate the importance of social relationships, comfort with one's provider, and education on the potential harms (especially health related) associated with alcohol in encouraging disclosure of alcohol use in women veterans. Our results also support VA national health care efforts, including the provision of brief alcohol counseling and the use of primary care clinics specializing in the care of women veterans.

Pregnancy and employment are critical life events that can affect chronic disease risk in women. Hence, we examined the relationship between parity and cardiovascular risk, and whether job stress affected this association. Cox proportional hazard models examined the association of parity with cardiovascular disease (CVD) risk [myocardial infarction (MI), coronary artery revascularization, ischemic stroke, and CVD death] in 23,905 participants in the Women’s Health Study. Parity was defined at baseline as pregnancy lasting > 6 months gestation, categorized as none (referent), 1–2, 3–4, and 5+. Job strain assessed at year 5 was operationalized using the Karasek job strain model, and job insecurity was defined based on the item “My job security is good” (yes or no). The mean age of the women at baseline was 57.3 ± 5.2 years with an average follow-up for CVD of 16 years. In models adjusted for age, race/ethnicity, income, education, CVD risk factors, and age of menarche, increasing parity was associated with increased CVD risk compared to no pregnancies [hazard ratio (HR), 95% confidence interval (CI) 1.15, 0.94–1.41 (1–2 pregnancies); 1.29, 1.06–1.58 (3–4 pregnancies); 1.52, 1.20–1.93 (5+ pregnancies)]. Further adjustment for job strain did not attenuate the noted relationship (HR, 95% CI 1.15, 0.94–1.41 (1–2 pregnancies); 1.30, 1.06–1.58 (3–4 pregnancies); 1.52, 1.20–1.93 (5+ pregnancies). There was no significant interaction between job strain (p = 0.68) or job insecurity (p = 0.97) and parity. Among working women, increased parity was related to heightened CVD risk, a relationship that was not attenuated by job strain or job insecurity.

Although a growing body of evidence indicates strong links between psychological stress (stress) and untoward cardiovascular disease (CVD) outcomes, comprehensive examination of these effects remains lacking. The "Cumulative Psychological Stress and Cardiovascular Disease Risk in Middle Aged and Older Women" study is embedded within the landmark Women's Health Study (WHS) follow-up cohort and seeks to evaluate the individual and joint effects of stressors (cumulative stress) on incident CVD risk, including myocardial infarction, stroke, coronary revascularization and CVD death. GWAS data will be used for exploratory analyses to identify any genes associated with stress and CVD. This study prospectively follows 25,335 women (mean age 72.2 ± 6.04 years) without CVD who returned a short mailed stress questionnaire at baseline and 3 years of follow-up inquiring about their experiences with stress including perceived stress, work stress, work-family spillover, financial stress, traumatic and major life events, discrimination and neighborhood environment/stressors. Other domains ascertained were sleep, anger, cynical hostility, depression, anxiety, social support, intimate partner relations, and volunteer and social activities. Higher levels of cumulative stress were associated with younger age and black race/ethnicity, divorced or separated marital status, increased prevalence of obesity, smoking, diabetes, depression and anxiety (p

Purpose The drinking practices of a nationally representative sample of white, black, Mexican American, and other Hispanic adult diabetics are described and compared. Methods Combined years (2005/2006–2011/2012) of the National Health and Nutrition Examination Survey provided home interview data from 2220 adults with self-reported diabetes of white ( n = 875), black ( n = 720), Mexican American ( n = 402), and other Hispanic ( n = 223) ethnicity. Current drinking status, the number of drinks consumed per week, and binge drinking were compared across ethnicity. Results The multivariate findings for both diabetic men and women showed no statistically significant ethnic differences in current drinking status, and among women, there were no statistically significant ethnic differences in binge drinking. Among male diabetics, Mexican Americans consumed more drinks per week than whites ( b = 0.35; 95% confidence interval, 0.13–0.58; P = .002) and were at increased risk for binge drinking (odds ratio, 2.04; 95% confidence interval, 1.30–3.21; P = .002). Conclusions Binge drinking is prevalent among Mexican American male diabetics. This pattern of drinking may put them at risk for poor diabetes management and control. It is important that health care providers routinely assess their patients' drinking practices and address the health risks associated with alcohol consumption.

Diabetes disproportionately impacts the Latino population and while individual traditional risk factors are key, additional external factors, such as neighborhoods, may also affect diabetes rates. This review examines the role of living in an ethnic enclave, a neighborhood with a high Latino concentration, on diabetes and its risk factors for the Latino population in the United States (U.S.). Studies fail to find an association between living in an ethnic enclave and diabetes, despite research demonstrating that enclaves have a protective effect on other health outcomes for Latinos. When considering diabetes risk factors, the associations with ethnic enclaves are mixed. For Latinos, living in an ethnic enclave is associated with healthier diets and increased physical inactivity, while data are mixed for obesity prevalence. More research is needed to determine what aspects of an ethnic enclave have a protective effect against diabetes among Latinos.

Low-income older adults with disabilities in California depend on a variety of public programs to help them remain in their own homes. The availability of those services has been in flux since 2009 because of cuts caused by the recession. This article reports on a qualitative study of 33 California seniors who depend on fragile arrangements of paid and unpaid assistance. Thematic analyses of in-depth interviews conducted with these older adults and their caregivers indicate that the disability needs of these individuals are often unstable, with both physical and mental health status sometimes changing day to day. Most have nowhere else to turn for help if their public services are cut. All share the common goal of staying at home and maintaining their independence. Public services serve as a crucial link in the support networks of these individuals.

This policy brief presents findings from a yearlong study that closely followed a small but typical set of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home. Many of these older adults have physical and mental health needs that can rise or fall with little warning; most are struggling with increasing disability as they age. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost. Declines in health status and other personal circumstances among aging Californians have been exacerbated by recent reductions in public support, and will be made even worse by significant additional cuts that are pending. Policy recommendations include consolidating long-term care programs and enhancing support for caregivers.

Despite living in the countryside where open space is plentiful and there is often significant agricultural production, rural older adults have higher rates of overweight/obesity, physical inactivity and food insecurity than older adults living in suburban areas. All three conditions are risk factors for heart disease, diabetes and repeated falls. This policy brief examines the health of rural elders and, by contrast, their urban counterparts, and finds that both groups are more likely to be unhealthy than suburban older adults. Yet rural elders, because of their geographical isolation and lack of proximity to health care providers, experience unique environmental and other risk factors that require context-specific solutions to these health issues. In both policies and programs that impact health, policymakers need to take into account the distinctive environmental and social context of older adults living in California's countryside.