Denver Metro Area Research Articles

Discrimination among American Indian and Alaska Native people: implications for public health communication

IntroductionAmerican Indian and Alaska Native People (AI/AN) have experienced discrimination stemming from sustained attempts to erase AI/AN People and their culture or livelihood. Research identifying the types of discrimination experienced by AI/AN People is needed to help individuals recognize discrimination in daily life. We examine experiences of discrimination among an urban AI/AN population using a mixed methods approach.MethodsSelf-identified AI/AN participants (N = 303, n = 294 with complete data; 63% women, mean age = 43 years) were recruited from the Denver-metro area in Colorado. Stress and coping models of discrimination guided our analysis. Exposure to discrimination was quantitatively assessed via the Brief Perceived Ethnic Questionnaire – Community Version (BPEDQ-CV), a self-report measure including four subscales assessing workplace discrimination, social exclusion, physical threat and harassment, and stigmatization. Participants responded to a laboratory recall task in which they described an episode of discrimination and their affective and coping responses. Content analysis was conducted on transcribed responses to illustrate discrimination exposure as reported in the BPEDQ-CV and in prior theoretical work on coping with discrimination.ResultsRepeated measures analyses revealed participants reported experiencing social exclusion more than other forms of discrimination, followed by reports of workplace discrimination, stigmatization, and physical threat. Consistent with these quantitative findings, participants were more likely to recall experiences of social threat (94%), including episodes of workplace discrimination, social exclusion, and stigmatization than physical threat and harassment. Almost half the participants (47%) reported confronting or directly addressing the discrimination, and 38% reported avoiding a direct approach. For 44% of participants, their predominant emotional response included internalizing emotions such as fear/sadness/embarrassment, and another 44% reported experiencing externalizing emotions, including anger.ConclusionOur descriptive findings present the experiences of urban AI/AN People who have experienced many forms of unjust and prejudicial treatment. These data can provide useful information to help the general public and AI/AN individuals more readily recognize and prevent discriminatory behavior, and consequently mitigate deleterious effects of discrimination on health.

Whole Genome Sequencing to Identify Multiple Clusters of Carbapenemase-Producing Enterobacterales Cases – Colorado, 2022-2023

Background: The Colorado Department of Public Health and Environment (CDPHE) detected an increase in Klebsiella pneumoniae carbapenemase-producing carbapenem-resistant Enterobacterales (KPC-CRE) infections in October 2022. We investigated patient epidemiological links and isolate relatedness to characterize interfacility transmission of KPC-CRE in the Denver metro area and inform regional prevention strategies. Methods: We defined a case as polymerase chain reaction detection of KPC from clinical or screening specimens collected during January 2022 – January 2023. Cases were identified through statewide CRE surveillance and carbapenemase testing at the CDPHE laboratory and counted once within a 30-day period. Medical records were reviewed to identify healthcare facility admissions and patient facility overlap in the 12 months prior to sample collection. Whole genome sequencing (WGS) was performed for 34 patients with available KPC-CRE isolates using short- and long-read sequencing techniques. We performed multi-locus sequence typing, generated genome phylogenetic trees, and compared plasmid contig sequences to identify relatedness between KPC-CRE isolates. Clusters were defined as ≥2 genetically related isolates of the same organism or carbapenemase plasmid, from different patients. Results: We identified 48 cases (34 clinical and 14 screening) among 39 patients (figure). Patients had a mean age of 52 years (range 16-86) and median of three healthcare facility admissions (range 1-14). Twenty-eight patients (72%) were male. We identified 16 (41%) patients with epidemiological links to one acute care hospital (ACH), 11 (28.2%) patients to one long-term acute care hospital (LTACH), and four (10.2%) patients to each of two ventilator-capable skilled nursing facilities (vSNF). Five distinct clusters of KPC-CRE were identified by WGS among 23 patients (E. hormaechei, two distinct E. cloacae clusters, K. pneumoniae, and K. oxytoca) with linkages to ten healthcare facilities, including two vSNFs, two LTACHs, and six ACHs. Three distinct KPC genes were identified among the clusters: KPC-2, KPC-3, and KPC-4. Genomes assembled from long reads identified identical or similar KPC-gene-containing plasmids across different species or sequence types, suggesting horizontal gene transfer of KPC. Conclusions: Multiple KPC-CRE strains co-circulated and were associated with patient movement between acute and post-acute care settings. WGS allowed us to identify multi-facility clusters. Time and location of carbapenemase acquisition were challenging to determine for genetically related isolates when epidemiologic links could not be determined from medical records. This could be due to undetected cases. We notified healthcare facilities of their shared transmission risk and advocated for improved attention to infection control, carbapenemase screening, and communication upon patient transfer.

An innovative referral system: Bridging healthcare providers and community supports for pregnant and parenting people.

The connection between community healthcare providers and available community-based programs is often weak. For community members to be connected with services, a strong referral link between providers and programs is paramount. The Referral Express and Central Hub (REACH) project was born out of this need for Nurse-Family Partnership (NFP) program sites in the Denver Metro area of Colorado to be better connected and coordinated with local referral sources. The objective of the REACH pilot was to create a centralized referral system and determine its feasibility in practice. After a 12-month pilot, this innovative referral system supported the increase in a number of referral partners to Denver Metro area sites, an increase in clients served across the Denver Metro area, as well as an increase in the "refer to enroll" rate which increased by 37%. The success of the pilot of REACH led the developers to test the process on a second program, Child First, which was also successful. REACH has proved to be sustainable and continues to operate for both programs. Additionally, REACH acts as a consultant to NFP sites outside the Denver Metro area, in the state of Colorado, as each site works to increase its relationships with referral partners.

No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system

BackgroundRelease from prison is characterized by discontinuity of healthcare services and results in poor health outcomes, including an increase in mortality. Institutions capable of addressing this gap in care seldom collaborate in comprehensive, data-driven transition of care planning. This study harnesses information from a data exchange between correctional facilities and community-based healthcare agencies in Colorado to model a care continuum after release from prison.MethodsWe merged records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either (a) released to the Denver metro area (Denver and its five neighboring counties), or (b) assigned to the DH Regional Accountable Entity, or (c) assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. Outcomes explored were outpatient, acute care, and inpatient utilization in the first 180 days after release. We used Pearson’s chi-squared tests or Fisher exact for univariate comparisons and logistic regression for multivariable analysis.ResultsThe care continuum describes the healthcare utilization at DH by people released from CDOC. From January 1, 2021, to June 30, 2021, 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the 2848 were released to the Denver metro area or attributed to DH. In the study population of 905, 78.1% had a chronic medical or psychological condition. Within 180 days of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. 10.1% utilized outpatient services within the first 30 days of release.ConclusionsThis care continuum highlights drop offs in accessing healthcare. It can be used by governmental, correctional, community-based, and healthcare agencies to design and evaluate interventions aimed at improving the health of a population at considerable risk for poor health outcomes and death.

Early-life exposure to residential black carbon and childhood cardiometabolic health

BackgroundEarly life exposure to air pollution, such as particulate matter ≤2.5 μm (PM2.5), may be associated with obesity and adverse cardiometabolic health outcomes in childhood. However, the toxicity of PM2.5 varies according to its chemical composition. Black carbon (BC) is a constituent of PM2.5, but few studies have examined its impact on childhood cardiometabolic health. Therefore, we examined relationships between prenatal and early childhood exposure to BC and markers of adiposity and cardiometabolic health in early childhood. MethodsThis study included 578 mother-child pairs enrolled in the Healthy Start study (2009–2014) living in the Denver-metro area. Using a spatiotemporal prediction model, we assessed average residential black carbon levels during pregnancy and in the year prior to the early childhood follow-up visit at approximately 5 years old. We estimated associations between prenatal and early childhood BC and indicators of adiposity and cardiometabolic biomarkers in early childhood (mean 4.8 years; range, 4.0, 8.3), using linear regression. ResultsWe found higher early childhood BC was associated with higher percent fat mass, fat mass index, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR), and lower leptin and waist circumference at approximately 5 years old, after adjusting for covariates. For example, per interquartile range (IQR) increase in early childhood BC (IQR, 0.49 μg/m3) there was 3.32% higher fat mass (95% CI; 2.05, 4.49). Generally, we did not find consistent evidence of associations between prenatal BC and cardiometabolic health outcomes in early childhood, except for an inverse association between prenatal BC and adiponectin, an adipocyte-secreted hormone typically inversely associated with adiposity. ConclusionsHigher early childhood, but not in utero, ambient concentrations of black carbon, a component of air pollution, were associated with greater adiposity and altered insulin homeostasis at approximately 5 years old. Future studies should examine whether these changes persist later in life.

Case Study: A Novel Approach to Tankless Zero-Emission Crude Oil Production Facilities

_ The Environmental Protection Agency (EPA) and numerous states are introducing new emissions regulations which impact oil and gas producers. Additionally, under the pressure of stakeholders, the producers are committing themselves to decarbonize their operations. A large portion of these emissions occur at oilfield production sites. To eliminate these emissions, Pioneer Energy created a new type of skid‑mounted production facility. The technology was deployed on a pad in Weld County, Colorado, and demonstrated elimination of emissions, improved operational efficiency, and an increased crude yield of 11.3%. If adopted by the industry, this solution can dramatically reduce the emissions and carbon footprint of oil production. The Challenge There are five populated areas in the US that the EPA currently designates as Severe Ozone Nonattainment Zones. The Denver Metro and Front Range area, which also encompasses most of the Denver‑Julesburg (DJ) Basin, is one of these areas, and the EPA is currently working to include the Permian Basin as a sixth nonattainment zone. Oil and gas producers are actively seeking solutions to drill and produce wells while significantly reducing pad‑level emissions to achieve attainment. Strategies currently being employed include eliminating crude storage tanks, eliminating natural gas actuators, and consolidating processing from offset pads, each of which offer incremental improvements but do not address the whole problem. Current production facilities use passive means to separate the oil, gas, and water. This incomplete separation results in gas remaining in the crude, and when this gas leaves the crude, it results in fugitive emissions. The Solution To address this challenge, Pioneer Energy developed an active separation process called the Emission Control Treater (ECT) as seen in Fig. 1. The ECT receives wellhead fluid and uses a combination of heat and gravity in a closed‑ loop process to separate water, oil, and gas. The system sorts the hydrocarbons much more efficiently than traditional processes, resulting in crude which is completely stabilized, containing no flash gas. An additional benefit is that crude molecules that would be left in the gas instead remain in the crude, increasing its volume. By eliminating the flash gas, and through process electrification, pad emissions are eliminated. Pipeline-quality crude oil is output from the ECT and can be directed straight to the Lease Automatic Custody Transfer (LACT) unit or surge vessel if buffer capacity is needed for the crude midstream provider. The ECT is emissions‑free when run on grid power, contains no gas-venting actuators, and replaces nearly all existing production facility equipment, including high-low pressure separators (HLPs), vapor recovery units (VRUs), gas busters, vapor recovery towers (VRTs), and storage tanks. It is capable of bulk processing and when assembled in parallel with multiple skids, the ECT system can accommodate a wide range of production profiles.

Association of Clostridioides difficile infection rates with social determinants of health in Denver area census tracts, 2016–2019

We evaluated the association between census tract measures of socioeconomic status and Clostridioides difficile infection (CDI) rates in the Denver metro area from 2016 to 2019. Social vulnerability index, poverty, and race were associated with CDI. Findings may relate to differences in chronic disease prevalence, antibiotic exposure, and access to quality care.

Characterizing Spatial Accessibility of COVID-19 Testing and Vaccination Sites using Dasymetric Mapping and GIS

Abstract. The COVID-19 pandemic accentuated existing health disparities in the U.S., inflicting staggeringly disproportionate rates of exposure, infection and death among racial and ethnic minority populations. Early evidence in 2020 had suggested that testing locations were not equitably accessible to racial/ethnic minority populations, and thus, increased the likelihood of unnoticed virus spread in minority communities. Additionally, racial/ethnic minority populations have been less likely to be vaccinated for COVID-19 as of February 2021, when vaccination had just started rolling out. In this study, we use Intelligent Dasymetric Mapping (IDM) and GIS Service Area analysis to examine spatial access to testing and vaccination sites in the Denver metropolitan area in January 2021, when testing and vaccination access was limited and competitive. Our results indicate that the racial/ethnic composition in total service areas with short walking- or driving-travel times was similar to the expected racial/ethnic composition of the Denver metro area, with minority populations slightly overrepresented in the total service areas. To ensure equitable vaccination and testing in minority communities in the future, in addition to ensuring spatial access, policymakers and health officials should increase community outreach, establish trust, and lower potential costs. Our study demonstrates the value of IDM in studying public health access.

Racial/Ethnic Discrimination and Food Consumption: Examination in Diverse Samples.

Racial/ethnic discrimination has been linked to poor health outcomes. Effects of discrimination on health behaviors, including patterns of food consumption, may contribute to health outcomes. We examined relations of discrimination to consumption of healthy and unhealthy foods in two diverse samples. Structural equation modeling was used to examine variations in associations of discrimination to consumption by the timing and type of discrimination, for healthy vs. unhealthy food, and by sample. Study 1 included a racially and ethnically diverse sample of adults from New York City (NYC: N = 157); Study 2 included a sample of American Indian and Alaska Native (AI/AN) adults from the Denver metro area (N = 303), many of whom also identified with other racial/ethnic groups. Participants completed self-report measures of racial/ethnic discrimination, food consumption, life stressors, and sociodemographic variables. Structural equation models indicated discrimination was associated with food consumption. Tests of model invariance indicated that the model of discrimination to food consumption can be applied to both samples. Discrimination within the past-week was associated with more frequent consumption of both unhealthy and healthy foods, whereas lifetime discrimination was associated with more frequent consumption only of unhealthy foods. The data were limited to self-report measures and only the frequency of consumption was assessed. The findings suggest discrimination may contribute to health disparities through effects on food consumption. Differential effects for past-week and lifetime discrimination suggest that multiple mechanisms may be involved.

Modeling county-level benzene emissions using transportation analysis zones in the Denver metro area

The link between exposure to benzene (an important toxic air pollutant) and physical health is well-documented as benzene is a known carcinogen. Understanding benzene concentration distributions in urban areas is very important and can be done using air dispersion models. An essential input requirement for dispersion models is the spatial and temporal allocation of emissions. Since most county-level benzene emissions come from gasoline powered motor vehicles, the goal of this work was to develop a new method of county-level benzene emission allocation using transportation analysis zones (TAZs) commonly used in travel demand models. The high spatial resolution provided by the TAZ allocation method helped visualize different flux patterns generated from five emission sectors and identified where more effort is needed to reduce benzene concentrations. The new allocation method was also tested using the AERMOD dispersion model to estimate benzene concentrations in the Denver metropolitan area. The model performance was assessed using 2014 morning benzene measurements from a monitoring station located in downtown Denver; results showed an acceptable model-to-monitor ratio. The model was also used to investigate the effect of temperature inversions on morning benzene concentrations. As expected, predicted benzene concentrations were higher during temperature inversions and model-to-monitor ratios during investigated days were within a factor of two. The TAZ allocation modeling methodology demonstrated in this work can improve the estimation of air pollution exposure in future health-related studies. • County-level benzene emissions were allocated based on transportation analysis zones. • This new allocation method identified on-road, non-road, and oil and gas as major emission sources. • Urban benzene concentrations were reasonably predicted using the updated emission allocations and a dispersion model. • Model-predicted and measured benzene concentrations were elevated during morning temperature inversions.

Improving Tobacco Cessation Rates Using Inline Clinical Decision Support.

Tobacco use is a significant cause of morbidity and mortality in the United States. Even brief advice from a clinician can significantly influence cessation rates among tobacco users, but clinicians often miss opportunities to provide this simple intervention. The intent of this quality improvement project was to increase tobacco cessation among tobacco users by nudging clinicians using a clinical decision support (CDS) tool. We developed a CDS tool using principles of user-centered design and the CDS Five Rights to dynamically insert actionable information about current tobacco users into the Assessment and Plan section of clinicians' notes. We conducted a retrospective analysis of patients at four primary care practices in the Denver Metro area evaluating the impact of the CDS tool on time to tobacco cessation. A multivariable Cox proportional-hazards model was used in this determination. Kaplan-Meier curves were used to estimate tobacco cessation probabilities at 90, 180, and 365 days. We analyzed 5,644 patients with a median age of 45 years, most of whom lived in an urban location (99.5%) and the majority of whom were males (60%). The median follow-up time for patients was 16 months. After adjustment for age, gender, practice site, and patient location (rural, urban), the intervention group had significantly greater risk of tobacco cessation compared to those in the control group (hazard ratio: 1.22, 95% confidence interval: 1.08-1.36; p = 0.001). This study suggests a CDS intervention which respects the CDS Five Rights and incorporates user-centered design can affect tobacco use rates. Future work should expand the target population of this CDS tool and continue a user-centered, iterative design process.

Reducing disparities in kidney transplantation for Spanish-speaking patients through creation of a dedicated center

IntroductionHispanic Americans receive disproportionately fewer organ transplants than non-Hispanic whites. In 2018, the Hispanic Kidney Transplant Program (HKTP) was established as at the University of Colorado Hospital (UCH). The purpose of this quality improvement study was to examine the effect of this culturally sensitive program in reducing disparities in kidney transplantation.MethodsWe performed a mixed-methods analysis of data from 436 Spanish-speaking patients referred for transplant to UCH between 2015 and 2020. We compared outcomes for patients referred between 2015–2017 (n = 156) to those referred between 2018–2020 (n = 280). Semi-structured phone interviews were conducted with 6 patients per time period and with 6 nephrology providers in the Denver Metro Area. Patients and providers were asked to evaluate communication, transplant education, and overall experience.ResultsWhen comparing the two time periods, there was a significant increase in the percentage of patients being referred (79.5% increase, p-0.008) and evaluated for transplant (82.4% increase, p = 0.02) during 2018–2020. While the number of committee reviews and number waitlisted increased during 2018–2020, it did not reach statistical significance (82.9% increase, p = 0.37 and 79.5% increase, p = 0.75, respectively. During patient and provider interviews, we identified 4 themes reflecting participation in the HKTP: improved communication, enhanced patient education, improved experience and areas for advancement. Overall, patients and providers reported a positive experience with the HKTP and noted improved patient understanding of the transplantation process.ConclusionsThe establishment of the HKTP is associated with a significant increase in Spanish-speaking Hispanic patients being referred and evaluated for kidney transplantation.

A 6-Month clinical practice pilot study of sucroferric oxyhydroxide on nutritional status in patients on peritoneal dialysis

BackgroundHyperphosphatemia is common in patients on peritoneal dialysis (PD). Restricting dietary phosphorus often leads to a decrease in protein intake, which may result in hypoalbuminemia. The high pill burden of phosphate binders may also contribute to compromised appetite and dietary intake. Hypoalbuminemia is associated with an increased risk of morbidity and mortality in PD patients. The goal of this study was to determine if sucroferric oxyhydroxide improves albumin and self-reported measures of appetite in PD patients.MethodsWe performed a prospective, open-label, 6-month, pilot study of 17 adult PD patients from the Denver Metro Area. Patients had to use automated peritoneal dialysis for ≥ 3 months, have a serum albumin ≤ 3.8 g/dL, and have serum phosphate ≥ 5.5 mg/dL or ≤ 5.5 mg/dL on a binder other than SO. SO was titrated to a goal serum phosphate of < 5.5 mg/dL. The primary outcome was change in serum phosphate, albumin, and phosphorus-attuned albumin (defined as albumin divided by phosphorus) over 6 months.ResultsThe mean (SD) age and dialysis vintage was 55 ± 13 years and 3.8 ± 2.7 years, respectively. Participants’ serum phosphate significantly decreased with fewer phosphate binder pills/day after switching to SO. There was no change in serum albumin, appetite, or dietary intake. However, participants had significant improvements in phosphorus-attuned albumin.ConclusionThe transition to SO improved phosphorus control, phosphorus-attuned albumin, and pill burden. There were no significant changes in self-reported appetite or dietary intake during the study. These findings suggest that PD patients maintained nutritional status with SO therapy.Trial registrationFirst registered at ClinicalTrials.gov (NCT04046263) on 06/08/2019.

Capabilities and Limitations of Telematics for Vehicle Emissions Inventories

Eastern Research Group, Inc. evaluated the current state of personal vehicle telematics data with respect to emission inventory development, identifying relative strengths and weaknesses, and how these data could align better with the needs of emission modelers. A market survey of telematics firms provided an overview of available data, and identified several candidate sources for location-based and engine-based telematics data on personal vehicles. Data were then purchased from three different vendors: StreetLight Data, Moonshadow Mobile, and Otonomo. These data were applied in case studies conducted in the Denver metro area, U.S., to assess strengths and weaknesses of telematics for developing emission inventories. Case studies included using telematics to estimate regional vehicle miles traveled (VMT) for annual emission inventories; tracking the VMT impacts of COVID shutdown; generating location- and time-specific vehicle activity inputs for project scale “hot spot” air quality analysis; and estimating the distribution of fuel fill level from real-world data, which is important for evaporative emissions. These case studies confirmed that telematics can serve a growing range of emission inventory use cases, and use of these data may help improve emission inventory accuracy. However, there are also several limitations of the data to consider in preparing emission inventories; for example, it can be difficult to assess the representativeness of telematics data because of a lack of vehicle information. The authors encourage telematics firms to cater data products more directly to the needs of emission inventory modelers, to better harness the enormous potential of these data for refining vehicle emission inventory estimates.

The Childhood Obesity Data Initiative: A Case Study in Implementing Clinical-Community Infrastructure Enhancements to Support Health Services Research and Public Health.

We describe a participatory framework that enhanced and implemented innovative changes to an existing distributed health data network (DHDN) infrastructure to support linkage across sectors and systems. Our processes and lessons learned provide a potential framework for other multidisciplinary infrastructure development projects that engage in a participatory decision-making process. The Childhood Obesity Data Initiative (CODI) provides a potential framework for local and national stakeholders with public health, clinical, health services research, community intervention, and information technology expertise to collaboratively develop a DHDN infrastructure that enhances data capacity for patient-centered outcomes research and public health surveillance. CODI utilizes a participatory approach to guide decision making among clinical and community partners. CODI's multidisciplinary group of public health and clinical scientists and information technology experts collectively defined key components of CODI's infrastructure and selected and enhanced existing tools and data models. We conducted a pilot implementation with 3 health care systems and 2 community partners in the greater Denver Metro Area during 2018-2020. We developed an evaluation plan based primarily on the Good Evaluation Practice in Health Informatics guideline. An independent third party implemented the evaluation plan for the CODI development phase by conducting interviews to identify lessons learned from the participatory decision-making processes. We demonstrate the feasibility of rapid innovation based upon an iterative and collaborative process and existing infrastructure. Collaborative engagement of stakeholders early and iteratively was critical to ensure a common understanding of the research and project objectives, current state of technological capacity, intended use, and the desired future state of CODI architecture. Integration of community partners' data with clinical data may require the use of a trusted third party's infrastructure. Lessons learned from our process may help others develop or improve similar DHDNs.

The Effects of Exercise Duration and Intensity on Breast Cancer-Related DNA Methylation: A Randomized Controlled Trial.

Simple SummaryWhile physical activity has been associated with reduced cancer risk, it is not well understood why this is the case. One possible reason is that physical activity affects DNA methylation—a process that functions to turn certain genes “on” or “off”—which can affect cancer-related processes in the body. We tested this in an experimental study, where women aged 30–45 were randomly assigned to complete 16 weeks of exercise of varying intensity and duration. We hypothesized that higher levels of exercise would lead to changes in DNA methylation that would be associated with reduced cancer risk. Contrary to our hypotheses, we found that the total amount of exercise completed was not associated with changes in DNA methylation, though we did find that increases in VO2max, a marker of physical fitness, were associated with decreases in methylation of the BRCA1 gene, and higher levels of exercise during a follow-up period were associated with lower levels of methylation of the GALNT9 gene. This study provides preliminary evidence that increased exercise behavior or fitness may affect the methylation of some genes that are related to breast cancer.Emerging research suggests that one mechanism through which physical activity may decrease cancer risk is through its influence on the methylation of genes associated with cancer. The purpose of the current study was to prospectively test, using a rigorous experimental design, whether aerobic exercise affects DNA methylation in genes associated with breast cancer, as well as whether quantity of exercise completed affects change in DNA methylation in a dose–response manner. 276 women (M age = 37.25, SD = 4.64) were recruited from the Denver metro area for a randomized controlled trial in which participants were assigned to a supervised aerobic exercise program varying in a fully crossed design by intensity (55–65% versus 75–85% of VO2max) and duration (40 versus 20 min per session). DNA methylation was assessed via blood samples provided at baseline, after completing a 16-week supervised exercise intervention, and six months after the intervention. 137 participants completed the intervention, and 81 had viable pre-post methylation data. Contrary to our hypotheses, total exercise volume completed in kcal/kg/week was not associated with methylation from baseline to post-intervention for any of the genes of interest. An increase in VO2max over the course of the intervention, however, was associated with decreased post-intervention methylation of BRCA1, p = 0.01. Higher levels of self-reported exercise during the follow-up period were associated with lower levels of GALNT9 methylation at the six-month follow-up. This study provides hypothesis-generating evidence that increased exercise behavior and or increased fitness might affect methylation of some genes associated with breast cancer to reduce risk.

Physician Perceived Barriers and Solutions to DASH Diet Recommendations for Hypertension Prevention and Management

We designed a survey to assess four domains: (1) Provider beliefs/knowledge of DASH benefits, (2) Patient characteristics influencing likelihood of recommendation, (3) Practice barriers to provision of DASH diet advice, and (4) Resources of perceived value. The survey was sent to University of Colorado School of medicine primary care providers practicing in the Denver metro area.

Prescribing and Deprescribing for Heart Failure

Prescribing and Deprescribing for Heart Failure

Impact of a nutrition education programme on preschool children's willingness to consume fruits and vegetables.

To evaluate the impact of a preschool-based nutrition education programme consisting of twelve 'hands on' nutrition education lessons delivered during the school year on young children's willingness to consume fruits and vegetables. Quasi-experimental, pre-post design including the collection of plate waste evaluation data at the start and end of the 2015-2016 school year within two groups: (1) randomly selected classrooms receiving the intervention and (2) within conveniently sampled preschool classrooms not receiving the intervention serving as a comparison group. Centre-based preschool programmes serving low-income families in the Denver metro area. Three- to five-year-old children in preschool classrooms participating in the intervention during the 2015-2016 school year (n 308) and children enrolled in comparison classrooms (n 215). Repeated-measures logit models assessed whether increases in the odds of consuming small samples of fruits and vegetables between Time 1 (pre-intervention) and Time 2 (post-intervention) were different for children within the intervention group compared with the comparison group. Analyses showed that the change over time in consumption of the three vegetable samples varied by intervention status with greater change occurring among children within the intervention group (edamame: P = 0·001; cauliflower: P ≤ 0·0001 and red pepper: P ≤ 0·0001). Unlike vegetables, the change over time in consumption of the two fruit samples was not different between children within the intervention and comparison groups. An experiential-learning nutrition education programme can positively influence eating behaviours of low-income preschoolers in a centre-based setting by increasing willingness to consume vegetables.

What Can We Learn from Parents of Caries-Free and Caries-Active Hispanic Children?

This study evaluated strength-based motivators within Hispanic families that support the creation of health in their children. A mixed-methods approach was used to understand differences in Hispanic parental factors between caries-free (CF) and caries-active (CA) children. A cross-sectional survey was conducted with 200 parent-child triads (primary child: between 0 and 6 y; reference child: between 0 and 10 y) recruited from health centers in the Denver Metro area. All the participating children received an oral examination, and the triads were grouped as CF or CA based on the caries status of the primary child. Qualitative data were collected through in-depth individual interviews with the parents. The analysis only involved the primary child. Bivariable analysis were conducted between parent factors (independent variables) and presence or absence of caries (outcome variable). The variables with P < 0.20 in the bivariable analysis were subjected to 2 multivariable logistic regression models. The children in the CF group had mean (SD) age of 2.8 (1.28) y compared to the CA group at 4.0 (1.55) y (P < 0.001). Bivariable analysis demonstrated that parents in the CF group reported higher oral hygiene behavior scores (P = 0.047), perceived fewer barriers (P = 0.009) to accessing preventive dental care, and considered their children more susceptible to cavities (P = 0.001) compared to parents in the CA group. Multivariable model (adjusting for socioeconomic characteristics) demonstrated that parents of CF children perceived high susceptibility to caries for their children (P = 0.040). Multivariable model (adjusting for acculturation) demonstrated an association of parental oral hygiene behavior (P = 0.040) and parent-perceived susceptibility to caries (P = 0.010) with CF child status. Qualitative interviews revealed that parents in the CF group were concerned about their children's higher susceptibility to caries and tried to establish good oral hygiene routines for their children. The results of this study demonstrated that parental behaviors and health beliefs could be significant determinants of caries status in Hispanic children. Results of this study indicate that parental oral health beliefs and behaviors are significant determinants of caries status in children of Hispanic population. Parental beliefs could motivate them to take action or establish behavior that prevents dental caries in their children. Health care providers and caries prevention efforts can incorporate this information to tailor oral health promotional messaging and approaches to improve the oral health of Hispanic children.