Miami Adult Research Articles

Protocol for a Pilot Study on the Gut Microbiome and Cardiometabolic Risk Factors in Latinx Emerging Adults in Miami, Florida

Abstract Objectives Cardiovascular disease (CVD) is one of the leading causes of mortality among the Latinx population in the U.S. In recent years, an increased risk of CVD among young adults has been observed. During emerging adulthood, health behaviors are adapted that can affect cardiometabolic risk factors (CMRF) providing an opportunity for targeted prevention strategies. Research has highlighted an association between gut dysbiosis and elevated risk for CMRF such as obesity and type 2 diabetes. Miami-Dade county's population is predominantly Latinx, with the largest heritage groups being of Cuban and Colombian descent. We hypothesize that gut dysbiosis and reduced microbial diversity will be associated with elevated CMRF. Methods The participants will be community-living young adults recruited from the Florida International University student body and the larger community of Miami-Dade County. This study follows a cross-sectional design to examine the relationship between cardiometabolic risk factors (obesity, body composition, blood pressure, fasting glucose, diet, physical activity, smoking, sleep, and alcohol) and gut microbiome profiles. Individuals are eligible if they are 18–22 years old, self-identify as being of Cuban or Colombian background, are willing to provide a stool sample, have not been on antibiotic treatment in the past 6 months, and do not have autoimmune conditions. Participants will complete two visits; an assessment visit to gather demographic and anthropometric data, and a collection visit where fecal samples are returned and blood pressure, fasting blood glucose and other exposures are assessed. Fecal samples will be collected using the OMNIgene-GUT kit and participants will complete two 24-hour recalls using the Automated Self-Administered Recall System (ASA24). To characterize intestinal bacteria, 16S ribosomal RNA (16S rRNA) sequencing will be performed. Results N/A Conclusions The findings of this study will expand the current knowledge on the relationship between CMRF and the gut microbiome in emerging adulthood. This knowledge is necessary for the development of targeted prevention strategies for Latinx young adults who are at high risk for metabolic syndrome and other CMRF. Funding Sources NHLBI/SUNY Downstate Health Sciences University.

Youth, climate change and visions of the future in Miami

ABSTRACTMiami, FL, is one of the most climate-vulnerable cities in the United States. At an average elevation of only 6 feet above sea level, parts of the city could be made uninhabitable by rising oceans within the next 40 years. The effects of climate change are already beginning to be seen, but the subject of climate change is nevertheless modelled, imagined and contested in the future tense. Today's young people are similarly future oriented, but unlike older generations they will live to feel climate change's full future effects. This study investigates knowledge of and experiences with climate change among young adults in Miami, and their visions of the future in light of predicted changes. Semi-structured interviews were conducted with 19 long-term residents of the city between the ages of 18 and 30 who were students at Miami-Dade College or Florida International University. I discuss participants’ sense of personal responsibility to inform themselves and the individualised understandings of climate science that emerge, their disillusionment with politics and resulting perception of individual responsibility for climate mitigation, and their negotiation of personal future plans in light of fatalistic visions of the future. These young adults’ perspectives on rising seas in their home city are revealed to be socially structured by ideals of individual agency and self-reliance, which become paradoxically disempowering because of the impossibility of addressing the transformational impacts of climate change through individualised means.

Sexual risk behaviours associated with unlicensed driving among young adults in Miami's electronic dance music nightclub scene.

Literature indicates that unlicensed driving (UD) offenders report substance use risk behaviours, yet data related to sexual risk behaviours is unknown. This study examined sexual and other risk behaviours among young adults in Miami, Florida, comparing UD and non-UD offenders (n=498). Compared with others, UD offenders were more likely to report group sex history, being high for sex half the time or more, purchasing sex and sexually transmissible infection history. Results suggest that locating sexual risk reduction interventions inside of the justice system would benefit UD offenders.

Alcohol Use and Zinc Status in HIV+ Adults in Miami, Florida

Objective:Zinc (Zn) deficiency is the most common nutrient deficiency in HIV, and is not reversed with ART. Zn deficiency affects the immune system and may be aggravated by excessive alcohol use. We examined the effect of alcohol consumption on plasma and dietary Zn, and its association with disease progression in HIV+ adults.Methods:After consenting, the Alcohol Use Disorders Identification Test (AUDIT) score 蠅8 was used to identify excessive alcohol intake among 274 HIV+ adults. Nutrient intake was estimated with two 24‐hour dietary recalls; blood was drawn for plasma Zn levels, and parameters of HIV disease progression were obtained from medical charts.Results:Mean age was 45.9±7.8, 64% were male, 69% were Black, 43% had excessive alcohol drinking, 65% were Zn deficient, 40% used multivitamins with 15 mg Zn/day. CD4 cell count was lower in excessive alcohol drinkers compared to non‐drinkers or moderate drinkers (374.8±54.1 vs. 459.2±62.6 cells/mm3, P=0.029). CD4 cell count and viral load were better in non‐drinkers and moderate drinkers (β=0.2, SE=1.7, P=0.03 and β=‐0.18, SE=0.22, P=0.049, respectively) than in excessive drinkers. There was no relationship between excessive drinking and Zn deficiency. Excessive drinking was correlated with tobacco (r=0.24, P<0.001) and illicit drug use (r=0.25, P<0.001). Zn intake was correlated with energy (r=0.491, P<0.001) and protein (r=0.718, P<0.001) intake, but not with plasma levels of Zn.ConclusionModerate or no alcohol consumption is associated with better measures of HIV disease progression than excessive drinking, but is not associated with Zn deficiency.Funded by NIDA & NIAAA

Time-clustered Deaths and Substance Use Disorder among Young Adults

This study assesses whether experiencing multiple deaths of loved ones clustered in time increases risk for substance use problems. Using survey data from a community sample of young adults in Miami, Florida (N = 1747), time-clustered deaths were categorized based on the age of the respondent at the time of each death, with less time between deaths representing greater time-clustering. Results indicate that young adults experiencing multiple deaths that are highly time clustered are at increased risk for substance use disorder and alcohol use. This study provides an alternative way of thinking about how young people may be affected by major life events. It suggests that the increased risk for substance use disorder associated with multiple deaths may be more likely to materialize when the deaths are highly clustered in time.

Higher Health Services Utilization and lower antiretroviral treatment (ART)‐Adherence in Food Insecure HIV‐Infected Adults in Miami, FL

ObjectiveTo examine the relation of food insecurity to health care utilization and ART adherence in HIV+ adults.MethodsAfter consenting 281 HIV+ adults, questionnaires on demographics, food security, and ART adherence were completed. Linear regression models were performed.ResultsParticipants were 66% male, and 83% were on ART. In this cohort, 19% were hospitalized ≥once and 16% had ≤1Emergency Room (ER) visit in the last 6 months. Of the participants, 12% did not have enough food to eat frequently, 32% lack money to buy food and 34 % did not eat balanced meals in the past year. Food insecure participants had significantly higher frequency of ER visits (β=0.102, SE=0.029, p=0.0007) and hospitalization (β=0.081, SE=0.035, p= 0.02) controlling for age and gender, and significantly lower ART‐adherence (β= 0.138, SE=0.069, p=0.0468) controlling for age and baseline HIV viral load.ConclusionFood insecurity is associated with increased health care utilization, and lack of adherence with ART non‐adherence. Factors causing food insecurity should be addressed in HIV treatment programs to improve adherence and reduced the utilization of emergency and hospitalization health‐care system.Funded by NIAAA

Homocysteine Levels are Associated with HIV Disease Progression in HIV+ Adults in Miami

ObjectiveTo examine the relationship of homocysteine levels to alcohol AUDIT score and HIV disease progression in HIV+ adults.MethodsAfter consenting 235 participants, blood was drawn for homocysteine. Hyperhomocysteinemia was defined as >;12μM/L. CD4 count and viral load were obtained from medical records. Questionnaires on demographics, antiretroviral therapy (ART) and the Alcohol Use Disorders Identification Test (AUDIT) were completed.ResultsMean age was 44.9±8.1 years, mean CD4 count was 499.1±341.3 cells/μL and 66.0% were male. The prevalence of hyperhomocysteninemia was 23.4% (N=56). Homocysteine levels were correlated with viral load (r=0.146, p=0.03) and AUDIT score (r=0.167, p=0.011). In multivariate linear regression, viral load remained significant after controlling for AUDIT score, age and gender (β=.188, p=0.006). Higher homocysteine were seen in those with CD4 cell count <200 cells/μL (11.2 vs. 9.8 μM/L, p=0.024) and those not currently on ART (10.4 vs. 9.4 μM/L, p=0.049).ConclusionsIn this HIV+ cohort, homocysteine was associated with HIV disease progression. Further studies on mechanisms through which homocysteine contributes to HIV disease progression are needed.Funded by NIAAA

Association between Selenium (Se) intake, plasma Se levels and disease progression in HIV‐infected adults in Miami

ObjectiveSe deficiency is associated with increased mortality and disease progression in HIV/AIDS. We explored the relationship between inadequate Se intake (<55 mcg/daily) and plasma levels (>0.085 mg/L) with disease progression in HIV+ adults.MethodsWith IRB approval, a cross‐sectional secondary analysis of the de‐identified database from “Zinc Therapy in Zinc deficient HIV+ Adults in Miami” study was performed.ResultsOf 231 HIV+ adults, 144 were on ART; 73.2 % were male. Mean CD4 cell count was 373 SD±279 cells/μL, viral load was 4.0 SD ±1.0 log10 copies/mL and plasma Se levels were 0.121 SD±0.29 mg/L. Higher plasma selenium levels were associated with controlled viral load (β=0.002, p=0.022), and remained significant after controlling for diarrheal disease and C‐reactive protein (p=0.039), and were correlated with Se intake (r=0.3, p>0.001). No association was found between Se intake or plasma Se levels with CD4 cell count. There were no differences in Se status (intake or plasma) between those in early HIV stages (CD4>200 cells/μL) and those with advanced disease (CD4<200 or CD4<100 cells/μL).ConclusionAdequate Se status appears to depend on adequate Se intake and viral load control in HIV+ adults. Further studies on the effect of normalizing Se status and the mechanism through which adequate Se contributes to slower disease progression are needed.Funded by NIDA

Participation in the food stamp program, food insecurity and HIV‐disease among low income HIV+ adults in Miami

ObjectiveThe objective of this pilot study is to define the relationship between participation in the food stamp program, food security and stage of disease in HIV+ adults.MethodsTwenty one HIV+ patients were consented. Demographics, dietary intake and food security status were obtained using questionnaires. Disease stage and other health parameters were obtained from laboratory reports. Anthropometrics were taken. SPSS was used for analysis.ResultsThe participants were mostly male (71%), African American (66.7%), had a high school education or lower (67%) and monthly income ≤$1,000 (66%). Although all were eligible, only about half (52%) received food stamps, and 57.1% (n=12) were food insecure. Of those receiving food stamps, 45.5% were food insecure compared to 70% of those not receiving food stamps. There was a significant positive correlation between participation in the food stamp program and feeling food secure (r=0.54, p<0.039) after controlling for age, gender, quality of life and lean body mass. Moreover, those who were food insecure had significantly lower CD4 count compared to food secure individuals (578 vs. 249 p<0.005).ConclusionFood insecurity is prevalent among HIV+ adults. Participation in the food stamp program significantly improves food security and is associated with slower HIV disease progression. A study with a larger sample size is needed to support these findings.

Relationship of Oxidative Stress with HIV Disease Progression in HIV/HCV Co-infected and HIV Mono-infected Adults in Miami.

HIV and HCV infections are both characterized by increased oxidative stress. Information on the magnitude of this increase and its consequences in HIV/HCV co-infection and viral replication is limited. We investigated the relationship between oxidative stress and HIV-progression in HIV/HCV co-infected and HIV mono-infected adults. 106 HIV/HCV co-infected and 115 HIV mono-infected participants provided demographic information and blood to determine 8-oxo-dG and percent oxidized glutathione. HIV/HCV co-infected subjects had higher percent oxidized glutathione, higher HIV viral load, lower mtDNA copies and higher liver fibrosis than mono-infected subjects. In a small sample of HIV/HCV co-infected participants with liver biopsy, 8-oxo-dG was significantly lower in participants with low fibrosis scores than those with high fibrosis scores, and the grade of inflammation was strongly associated with oxidized glutathione. HIV/HCV co-infection seems to diminish the capacity of the antioxidant system to control oxidative stress, and increases HIV replication.

Nonmarital Romantic Relationships and Mental Health in Early Adulthood

Although social scientists have long assumed that intimate social relationships are more closely associated with women's than men's mental health, recent research indicates that there are no gender differences in the advantages of marriage and disadvantages of unmarried statuses when males' and females' distinct expressions of emotional distress are considered. These findings have led to the conclusion that there has been a convergence in the importance of intimate relationships for men's and women's mental health. However, these patterns may not be evident for nonmarital romantic relationships among current cohorts of young adults. In this article, we examine the associations among several dimensions of these relationships and symptoms of both depression and substance abuse/dependence in a diverse sample of young adults in Miami, Florida. We find gender differences that vary across dimensions of relationships: While current involvements and recent breakups are more closely associated with women's than men's mental health, support and strain in an ongoing relationship are more closely associated with men's than women's emotional well-being. Our findings highlight the need to consider the period in the life course as well as experiences of specific cohorts of men and women when theorizing about gender differences in the importance of intimate relationships for mental health.

Zinc supplementation prevents increases in prevalence of hypertension among HIV infected adults in Miami

ObjectiveHIV is a risk factor for hypertension (HTN). This study examines the prevalence of HTN in a clinical trial of HIV+ adults receiving zinc (12 mg for women and 15 mg for men) or placebo over 18 months.MethodsAfter consenting 231 HIV+ adults, physical examinations were done. HTN was defined as having diagnosed HTN, blood pressure >140/90 or receiving treatment for HTN at baseline, 6, 12, and 18 months. Descriptive statistics, ANOVA (controlled for age and ART), and Post‐Hoc tests were performed.ResultsMean age was 42.7±7.0 years. The prevalence of HTN was 48.9% (n=113; 82 women, 31 men), significantly increasing over 18 months by 12±3.2%. There were significant interactions between time, treatment and gender in modifying HTN (p=0.015). When compared to women supplemented with zinc, women on placebo had a significant and sustained increase in the prevalence of HTN (5.1% vs. 3.28%, p=0.016) by 18 months. Men on placebo, as compared to those on zinc, had significant increase in prevalence of HTN at 6 months (14.8 vs. 1.9%, p=0.037) with no differences afterwards.ConclusionsThe prevalence of HTN among HIV+ adults in Miami is almost twice that of the general population (48.9% vs. 25.5%) of similar age. Zinc supplementation compared to placebo, prevented increases in HTN in women and to a lesser extent in men. Further studies are needed to elucidate the mechanisms for zinc action on HTN.Supported by NIDA

The relationship between depressive symptoms and walking among Hispanic older adults: A longitudinal, cross-lagged panel analysis

Objectives: This study examines the relationship between depressive symptoms and walking behavior across 30 months in a prospective study of 217 community-dwelling, Hispanic older adults in Miami, Florida (ages 70–100 years). Method: Analyses examine the direction of the relationship between depressive symptoms and physical activity (i.e., walking) over time, as well as test for a potential bi-directional or reciprocal relationship between these two variables. Results: Structural equation modeling (SEM) with a cross-lagged panel design revealed that walking was unrelated to subsequent depressive symptoms. However, depressive symptoms were related to subsequent walking behavior at every time-point, such that higher levels of depressive symptoms were predictive of less walking in the future. Older adults who had clinically-relevant depressive symptoms at the initial assessment had 1.34 times the risk of not walking 30 months later, compared to older adults without clinically-relevant depressive symptoms. Conclusion: Results support the need for primary care providers to evaluate and address depressive symptoms among older adults, as a means of reducing sedentary behavior and potentially improving health. Further research on the prevention and management of depressive symptoms and sedentary behavior is needed, given the morbidity related to both of these health risks, particularly for minority and low-socio-economic status (SES) older adults.

Longitudinal relationships between neighboring behavior and depressive symptoms in Hispanic older adults in Miami, Florida

This study examines the relationship between neighboring behavior and depressive symptoms across 3 years in a prospective study of 273 community-dwelling, Hispanic older adults in Miami, Florida. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between neighboring behavior and depressive symptoms over time and examining the relationship between these variables in Hispanic older adults, a group at risk of developing depressive symptoms. Structural Equation Modeling with a cross-lagged panel design showed that depressive symptoms were unrelated to subsequent neighboring behavior. However, neighboring behavior was related to subsequent depressive symptoms at every time point, such that higher levels of neighboring behavior were related to lower levels of depressive symptoms. Findings suggest that neighboring behavior may be a protective factor against depressive symptoms in community-dwelling Hispanic older adults.

Depressive Symptoms Among Urban Hispanic Older Adults in Miami: Prevalence and Sociodemographic Correlates

This study documents a 35% prevalence of clinically relevant depressive symptoms in a population-based sample of mostly Cuban older adults residing in a low-income, urban Miami neighborhood. This rate is comparable to, or higher than, prevalence rates reported by most other population-based samples of U.S. older adults. Logistic regression analyses indicate that perceived financial strain was the only sociodemographic factor associated with greater odds of clinically relevant symptoms when other sociodemographic factors were statistically controlled. Gender, age, and marital status were not related to elevated depressive symptoms. A case study illustrates the impact of financial strain on older adults' mental health. Findings highlight the need for mental health screening and case management services among these older adults, particularly those who experience financial strain.

Longitudinal Relationships Between Cognitive Functioning and Depressive Symptoms Among Hispanic Older Adults

This study examines the relationship between cognitive functioning and depressive symptoms across 3 years in a prospective study of 273 community-dwelling, Hispanic older adults in Miami. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between depressive symptoms and cognitive functioning over time and by examining the relationship between these variables among Hispanics, an understudied population at risk of developing depressive symptoms and cognitive impairments. Structural equation modeling with a cross-lagged panel design showed that depressive symptoms were unrelated to subsequent cognitive functioning. However, cognitive functioning was related to subsequent depressive symptoms at every time point, such that poorer cognitive functioning was related to higher depressive symptoms. Findings suggest that cognitive declines may predict depressive symptoms in community-dwelling Hispanic older adults.

Self-Reported Violent Victimization Among Young Adults in Miami, Florida: Immigration, Race/Ethnic and Gender Contrasts

Does being an immigrant place an individual at greater risk than non-immigrants for violent victimization? Could residence in homogeneous communities, such as ethnic enclaves, serve to protect or mediate victimization among immigrant groups from being targets of victimization? These and related questions are explored using self-report data from a large epidemiological survey project (n = 1,473) in Miami, Florida. Self-reports of three types of victimization data are identified and contrasted among and between Cuban and Nicaraguan immigrants, and members of the host country — U.S. born Cubans, African Americans and non-Hispanic Whites. Controlling for gender, findings from this predominantly-Latino community suggest that immigrant groups in Miami are no more likely to experience vicarious, violent or sexual victimization than non-immigrants. African Americans were found to be more exposed to vicarious forms of violence. These self-report results support findings from recent macro-level criminological studies that have called into question the common stereotype of the immigrant as victim and as criminal. The authors contend that the supportive social, political and cultural environments awaiting Latino immigrants arriving in Miami may be part of a unique historic phenomenon in this Southern Port city, one that suggets a re-evaluation and fine-tuning of traditional structural models of crime and victimization.

Lifetime cumulative adversity, mental health and the risk of becoming a smoker

We analyze the effect of stress exposure on the transition to heavy smoking, in a community sample of 1747 young adults in Miami, Florida. The effects of distal life stress are assessed in the context of recent stress exposure. Distal stress exposure predicts smoking independently of recent stress. Intervening stressful events do not appreciably mediate the influence of distal stress. We investigate the extent to which stress effects may be mediated by psychiatric and substance dependence disorders. We conclude that the effect of social stress on the risk for smoking is additive over time. The significant independent effect of early stress exposure implies that youths who are at greater risk for eventual heavy smoking may be identified at ages considerably younger than peak initiation age.