Middle-aged African Americans Research Articles

All Stressors Are Not Equal: The Salience of Racial Discrimination and Appraisal for Blood Pressure in African American Women.

Psychosocial stress is a major predictor of chronic disease among African American (AA) women. Stress is a process involving exposure, appraisal of threat, coping, and psychobiologic adaptation. However, many studies focus on the frequency of stress events and/or coping; few explicitly study stress events and their appraisals; and AA women experience high levels of racial discrimination, a well-known form of social identity threat (i.e., negative experiences due to judgment based on identity). Stressors related to social identity threat may be differentially appraised and associated with divergent physiologic outcomes. This study examined the differences in the frequency and stressfulness associated with general stressors and racial discrimination in relation to blood pressure (BP) among AA women. Multivariable regression was used on cross-sectional data from 208 middle-aged AA women residing in the San Francisco Bay Area. AA women reported less frequency of racial discrimination compared with general stressors, but were more likely to appraise racial discrimination events as stressful. Racial discrimination stressfulness was more strongly associated with systolic BP (SBP) than the number of racial discrimination events. There was a U-shaped association between racial discrimination stress and SBP, with those reporting "none" and "high/very high" distress having the highest SBP ( b = 12.2 [2.7 to 21.8] and b = 15.7 [1.5-29.8], respectively, versus moderate stress). Conversely, those reporting "very low" general stressfulness had the lowest SBP ( b = -7.9 [-15.8 to -0.1], versus moderate stress). Diastolic BP followed a similar pattern, although results were nonsignificant. This study highlights the importance of stress appraisal measures and adds to the body of evidence documenting racial discrimination as a salient psychosocial stressor for AA women.

Cross-sectional and longitudinal analyses of variations of anthropometric measures of obesity with age in the Jackson Heart Study

ObjectiveTo explore how anthropometric measures of obesity vary with age among African American (AA) adults.Participants and setting3634 AA adults participated in the Jackson Heart Study (Jackson, Mississippi, USA) from 2004...

Subjective religiosity as resilience to stressful life events in middle-aged and older African Americans

ABSTRACT This study examined stressful life events, discrimination, and well-being among older African Americans. Through a risk and resilience framework we evaluate the role of subjective religiosity as a moderator. Stressful life events and discrimination represent a double jeopardy risk profile in which discrimination exacerbates the negative relationship between stressful life events and well-being. Subjective religiosity is a resilience resource that should buffer the effect of discrimination on the stress – well-being link. Stressful life events and discrimination predicted poorer well-being, discrimination exacerbated the negative effects of stressful life events on depression and life-satisfaction, but subjective religiosity reduced these effects.

Psychometric evaluation of a culturally adapted illness perception questionnaire for African Americans with type 2 diabetes

BackgroundDiabetes is burdensome to African Americans, who are twice as likely to be diagnosed, more likely to develop complications and are at a greater risk for death and disability than non-Hispanic whites. Medication adherence interventions are sometimes ineffective for African Americans because their unique illness perceptions are not adequately addressed. The Illness Perception Questionnaire-Revised (IPQ-R) that assesses illness perceptions has shown reliability and validity problems when used with African Americans. Thus, the study objective was to adapt the IPQ-R for African Americans and assess the validity and reliability of the culturally adapted questionnaire.MethodsThe parent study used an exploratory sequential mixed methods design, to explore African Americans’ illness perceptions qualitatively, used the results to adapt the IPQ-R, and tested the culturally adapted IPQ-R items quantitatively. In this paper, a preliminary culturally adapted IPQ-R refined based on the qualitative study, was administered to 170 middle-aged United States-based African Americans with type 2 diabetes in a face-to-face survey. Content, construct, convergent, and predictive validity, including reliability was examined. Pearson and item-total correlations, item analysis, exploratory factor analysis, multiple linear regression analysis, and test-retest were conducted.ResultsA revised culturally adapted IPQ-R was identified with a 9-factor structure and was distinct from the old factor structure of the original IPQ-R. The ‘consequences’ domain from the IPQ-R occurred as two factors (external and internal consequences) while the ‘emotional representations’ domain in the IPQ-R emerged as separate ‘present’ and ‘future’ emotional representation factors. Illness coherence’ was differently conceptualized as ‘illness interpretations’ to capture additional culturally adapted items within this domain. Most items had factor loadings greater than 0.4, with moderate factor score correlations. Necessity and concern beliefs in medicines significantly correlated with domains of the culturally adapted IPQ-R. Pearson’s correlation values were not greater than 0.7, indicating good convergent validity. The culturally adapted IPQ-R significantly predicted medication adherence. None of the correlation values were higher than 0.7 for the test-retest, indicating moderate reliability. Most domains of the culturally adapted IPQ-R had Cronbach’s alpha values higher than 0.7, indicating good internal consistency.ConclusionsThe results provide preliminary support for the validity of the culturally adapted IPQ-R in African Americans with diabetes, showing good construct, convergent and predictive validity, as well as reliability.

African American Couples' Experiences during an Exercise Intervention Interrupted by the COVID-19 Pandemic: A Qualitative Case Study.

Exercise intervention researchers often struggle to transition participants from supervised/laboratory-based exercise to independent exercise. Research to inform this critical juncture remains underdeveloped. This qualitative case study investigated the transition from laboratory-based to home-based training in a subset of middle-aged and older African American couples whose exercise intervention experience was interrupted by the COVID-19 pandemic. All four couples (N = 8) whose study participation was interrupted participated in dyadic interviews by videoconference. Two investigators independently reviewed verbatim transcripts, and then used an iterative open coding approach to identify themes from the qualitative data. Three main themes were identified: (1) resistance training program modifications, (2) partner interactions, and (3) external pandemic-related factors. Each theme included both positive and negative feedback related to participants’ experiences. Overall, virtual, home-based training appeared acceptable and feasible in this group. Further research is needed to investigate the utility of virtual training to effectively transition participants from laboratory-based to independent exercise.

Rationale and protocol for a pilot randomized controlled trial of a cognitive prescription intervention for reducing dementia risk factors among African Americans.

African Americans (AAs) are twice as likely to develop dementia than Whites, which may be driven by poorer dementia knowledge and lifestyle factors. This article provides the rationale and protocol for a pilot clinical trial examining a tailored multi-domain lifestyle modification intervention in middle-aged and older AAs. This study will explore the feasibility and efficacy of individualized Cognitive Prescriptions (CogRx) which target five domains: physical activity, cognitive activity, diet, sleep, and social activity. Theoretical underpinnings include Social Cognitive Theory and the Health Belief Model, which suggest that tailored risk factor information, goal-setting, and outcome expectations along with addressing self-efficacy and barriers will promote behavior change. This study plans to enroll 150 community-dwelling AA participants aged 45-65 without significant cognitive impairment. After baseline assessment including data-driven assessment of deficiencies in each of the five CogRx domains, participants are randomized with equal allocation to either: psychoeducation + CogRx, psychoeducation only, or no-contact control. The psychoeducation and CogRx groups receive general psychoeducation on dementia prevalence, prognosis, and risk factors, while the CogRx group also receives information on their risk factor profile and develops a tailored 3-month intervention plan, consisting of simple evidence-based strategies to implement. The CogRx condition receives text-messaging reminders and adherence queries and provides feedback on this program. This study tests a novel multi-domain dementia prevention intervention and has several strengths, including enrolling middle-aged AAs with a focus on prevention, assessing adherence and self-efficacy, tailoring the intervention, and examining dementia knowledge. The goal is to yield new perspectives on person-centered dementia prevention approaches in diverse populations, and ultimately impact clinical and public health recommendations for maintaining cognitive health, thereby reducing disparities in dementia. Modifications to study design due to COVID-19 and future directions are discussed.

Dynamic Associations Between Lifestyle Factors and Positive and Negative Affect in Middle-Aged African Americans

Purpose: The purpose of this study was to examine the dynamic association between lifestyle factors and both positive and negative effect in middle-aged African Americans. Methods: Study participants (N = 69, Mean age=51 years, 80% female) were recruited from two African American churches in the Deep South. Participants completed daily surveys on positive and negative effect, physical activity, sedentary behavior, diet quality, and sleep quality daily for up to 10-days. Mixed-effect models were used to examine associations between the variables of interest. Results: On days that participants were more active, they experienced higher mean positive effect (P = .015) and lower mean negative effect (P = .028) scores. Conversely, more time spent sitting in lagged models (i.e., T-1) was associated with higher mean negative effect (P = .001) and lower mean positive effect (P = .040) scores. In lagged models, better sleep quality was associated with higher positive effects (P = .007) scores but reported lower negative effects (P < .0001) scores on the same day. Lastly, on days where diet quality was higher, positive effect scores were higher (P < 0.05). Association between diet quality and positive effect was moderated by age (P = .025). Conclusion: The data suggest that same and previous day health behaviors may have a significant impact on the health and well-being of middle-aged African Americans. More research is needed to determine whether these behaviors can be targeted in real-time as a means of improving mental health outcomes in this population.

Social Support, Coping Behaviors, and Resilience Among African Americans During COVID-19

Enduring structural inequalities in the United States by race have only become more apparent during COVID-19, as African Americans experienced significant health and economic challenges that far exceeded those observed among other racial and ethnic groups. Relying on multiple nationally representative surveys, this study examines the diversity of ways in which middle-aged and older African Americans’ managed the stress and pressures associated with the pandemic. I summarize the inequities faced by African Americans before and during COVID-19, as well as trends in the utilization of social support, coping behaviors, and degree of resilience. Furthermore, this study investigates the relationship between social support and coping strategies to multiple health outcomes over time. When appropriate, comparisons to other racial and ethnic groups are made. This research underscores the importance of considering social relationships and modifiable coping behaviors when studying African American aging and well-being during times of crisis.

Abstract MP54: Increase in the Urban-Rural Divide in Cerebrovascular Mortality Among Middle-Aged Adults From 2013 to 2018

Introduction: Despite observed overall decline cerebrovascular mortality in the United States over the past 2 decades, geographic pockets of increasing cerebrovascular mortality among middle aged adults have been reported on county-level data; and factors driving this regional increase are poorly understood. Methods: We extracted cerebrovascular mortality rates (ICD tenth revision codes I60-I69) in middle aged adults (age 35-64) from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database from 1999 to 2018. Variations in annual age-adjusted mortality rates, assessed with Joinpoint regression modeling, are expressed as estimated Annual Percentage Change [APC (95% confidence interval)], stratified by urbanization. In regions with increasing stroke mortality, race-ethnicity and gender subgroups were compared. Results: Mid-age cerebrovascular mortality decreased across urbanization strata between 1999 and 2012. Since 2013, stroke mortality has been increasing in Rural counties [APC +1.8% (+1.0% to +2.6%)] and stagnating in Small-to-Medium Metro counties [APC +0.7% (-0.1% to +1.5%)] and Large Metro counties [APC +0.1% (-0.8% to +0.9%)]. Focusing on rural counties, the profound rate difference between non-Hispanic African Americans and non-Hispanic whites decreased between 1999-2012 at Average APC -1.7% (-2.3% to -1.2%) and since then persisted [Average APC -0.2% (-2.1% to 1.8%)]. Both genders were affected. Conclusion: Since 2013, increase in cerebrovascular mortality in middle-aged adults in rural counties contributes to growing urban-rural divide; while the high stroke mortality rate in non-Hispanic African Americans have ceased to converge with non-Hispanic whites. Upstream drivers of stroke mortality in young and middle-aged rural residents and non-Hispanic African Americans should be further elucidated and vigorously targeted by public health initiatives.

A Pilot randomized clinical trial of adapted tango to improve cognition and psychosocial function in African American women with family history of Alzheimer's disease (ACT trial)

Alzheimer's disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in the ability to perform activities of daily living. Ethnicity-related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among women for developing AD indicates that AA women with a parental history of AD are at great risk for developing AD. This phase I study assessed the impact of a 12 week, 20-lesson adapted Argentine Tango intervention (n = 24) to a no-contact control group (n = 10) on measures of plasma inflammatory markers, cognition, and motor and psychosocial performance in middle-aged AA woman at increased risk for AD by virtue of parental history. Some woman (n = 16) were also caregivers; thus, the impact of the intervention on caregiving burden was examined in this subset. Preliminary analysis of efficacy was conducted with significance tests on biomarkers and key measures of cognition, including visuospatial and executive function, balance, and strength. After 12 weeks, Tango participants had significantly decreased inflammatory cytokine, including reductions in IL-7 (p = 0.003), IFN-γ (p = 0.011), TNFα (p = 0.011), and MCP-1 (p = 0.042) compared to controls. Large effects were noted for the Tango group on tests of executive functioning (d = 0.89), and inhibition (p = 0.031). Participants in Tango improved in dynamic and static balance (p = 0.018) and functional lower body strength (p = 0.023). Secondary assessment revealed trends favoring the intervention group were noted in spatial cognition and executive function. Moderate effects were noted in caregiving burden measures among the subset of caregivers. These data demonstrate substantial reductions in inflammatory biomarkers along with cognitive and motor improvements through a non-pharmacologic, affordable intervention among a small, well-characterized cohort of AA women with a parental history of AD.

Qigong Exercise in Frailty, Psychological Health, and Spiritual Well-Being of Middle-Aged and Older Blacks

Interventions are needed to address the frailty and psychological health in middle-aged and older African Americans. Qigong, a traditional medicine exercise, consists of gentle body movements, breathing exercise, and meditation. The benefits of Qigong exercise have been widely reported in Asian adults but there have been no known studies testing Qigong exercise in the African American population. The purpose of this pilot study was to evaluate the potential benefits of an 8-week Qigong exercise in physical and functional ability, balance, frailty, depression and anxiety, and spiritual well-being in community-dwelling middle-aged African Americans using a single group design. Fifteen African Americans aged 45 to 85 years were recruited to receive Qigong exercise over 16 bi-weekly, one-hour sessions. The Layers Module that unfolds the complex multidimensional benefits of Qigong exercise on physical, mental, and spiritual dimensions was used to guide the outcome measures. Data were collected at baseline and 14 days post intervention. Results showed positive trends in repeat chair stands, physical function, and spiritual well-being (p<0.05) with effect sizes ranging from 0.45 to 0.87. Despite no significance, over 52% of the participants showed improved depression scores, fast gait speed, and standing balance than baseline. Nearly 42% demonstrated some levels of frailty improvement than the baseline. No adverse events related to Qigong exercise intervention was reported. Qigong exercise is a potentially promising intervention which needs further testing in a randomized clinical trial.

Abstract 15991: African American Women Attending a Community Blood Pressure Screening Program

Background: The socioeconomic determinants of health (SEDoH) are contributors to the widening health disparities between White and AA women. Low income is a key contributor to poor cardiovascular (CV) health. Limited data exists on socioeconomic characteristics of African American (AA) women attending community blood pressure (BP) screenings. Objective: To examine whether income is related to BP in AA women attending community health screenings. Methods: AA women (n=972) attending community health screenings in metro Atlanta were evaluated from 2015 to 2019. Sociodemographics, health histories, point of care lipids, and BP were collected. Hypertension (HTN) was defined as systolic BP (SBP) &gt;130 or diastolic BP (DBP) &gt; 80 mmHg. Descriptive statistics, chi-square, and OLS linear regression were used to examine SEDoH and BP after adjusting for age, body mass index (BMI), smoking, and lipids. Results: Mean age was 51±14.1 years, mean SBP 132±19.6 mmHg and DBP 82±12 mmHg. In the unadjusted regression model, income of $48K-$96K (ß=4.1, se=2.0, p=&lt;.04) was associated with a higher SBP compared to those earning $96K and above. After adjusting for covariates, income groups &lt;$24K (ß=7.0, se=2.7, p=.01), $24K-$48K (ß=4.6, se=2.3, p=.05), &amp; $48K-$96K (ß=5.5, se=2.1, p=.01) were associated with a higher SBP. Age (ß=.52, se=.05, p=&lt;.001), BMI (ß=.53, se=.10, p=&lt;.001), current smoking (ß=7.7, se=3.5, p=.03) and total cholesterol (ß=1.0, se=.04, p=.02) were the only covariates significantly associated with increased SBP. Income of $48K-$96K (ß=2.7, se=1.4, p=.05) and current smoking (ß=5.1, se=2.3, p=.03) were associated with a higher DBP in the fully adjusted models. Conclusions: Middle-aged AA women have higher prevalence of HTN, even those with higher incomes. Understanding CV risks and SEDoH, between high and low levels of income, is essential to improving culturally appropriate care. Community based BP screenings targeting both low and middle income AA women are needed to identify AA women with HTN and reduce CV events.

Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study.

Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome. Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation. Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.

Feasibility and acceptability of intensive, real‐time biobehavioral data collection using ecological momentary assessment, salivary biomarkers, and accelerometers among middle‐aged African Americans

Perceived racial discrimination is linked to unhealthy behaviors and stress-related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle-aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in-person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message-based EMA five times a day, wear an accelerometer daily for 7 days, and to self-collect saliva samples four times a day for 4 consecutive days. The EMA surveys included perceived racial discrimination, affective states, lifestyle behaviors, and social and physical contexts. The mean EMA response rate was 82.8%. All participants collected saliva samples four times a day for 4 consecutive days. About 83% of participants wore the accelerometer on the hip 6 out of 7 days. Despite the perception that the intensive nature of assessments would result in high participant burden, the acceptability of the study procedures was uniformly favorable.

The church bridge project: Lessons learned from comparing the outcomes of an adapted church-based weight management intervention targeting african american adults

Introduction: Church-based interventions improve weight-related outcomes among underserved populations. African Americans, particularly young to middle age adults, are seldom represented in the literature and are key health intervention targets to prevent obesity-related chronic disease. Thus, the objective of this study was to describe the lessons learned from comparing the intervention outcomes of a two-phase, weight management intervention targeting younger to middle aged adult African Americans in Mississippi.Methods: A weight management intervention was tested and data were collected over two phases using the Bridge2U platform. Descriptive methods examined retention and attendance rates, and anthropometric and demographic data; Wilcoxon signed-rank and Fisher’s exact tests examined group differences in pre and post outcomes.Results: Attendance rates were 39.9 and 55.4% for phases 1 and 2, respectively. Differences were noted between those who dropped out of the phase 1 intervention and those who remained. Weight loss was significant at 5.6 and 4.8% of baseline body weight for phases 1 and 2, respectively. Significant changes were also noted among other variables.Conclusions: Disease diagnosis, more intensive intervention format and technology-assisted delivery may be key factors for improved participation and engagement of young to middle aged African Americans in weight management interventions. This study provides future implications for weight management intervention and chronic disease prevention among young to middle aged adult African Americans in the Deep South.

Abstract 24: Amyloidogenic V122I Transthyretin Variant is Associated With Progression of Adverse Cardiac Mechanics in Middle-aged African American Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Direct-to-consumer testing (e.g. 23andme) reports now include common pathogenic variants in the transthyretin (TTR) gene, such as V122I. TTR cardiac amyloidosis due to V122I is an autosomal dominant disease known to be of variable penetrance in elderly African Americans. However, the association of carrier status for V122I with echocardiographic measures of cardiac mechanics in middle-age African Americans is not known. Hypothesis: Presence of V122I TTR mutation is associated with adverse cardiac mechanics in middle-aged African Americans. Methods: All African Americans from the CARDIA study with imputed genetic data (R 2 = 0.98) and echocardiography at year 25 (Y25) were included. Echo parameters at Y25 and change from Y25 to Y30 were compared between V122I heterozygote carriers and controls using linear regression models. The analysis was adjusted for age, sex, and top 3 principal components of ancestry. Analysis for change from Y25 to Y30 was adjusted for baseline Y25 echo parameters. Results: Of 874 included participants, mean age was 50.2 (3.6) years at Y25. There were 843 controls and 31 carriers for the V122I genotype (3.5% prevalence). There was no difference in age, sex, or clinical characteristics. Carriers of the V122I variant had worse diastolic function as measured by early diastolic tissue Doppler velocity (e’) at Y25 (9.2 [2.1] vs. 10.2 [2.4], p=0.048). From Y25 to Y30, V122I carriers had greater progression of left ventricular (LV) volume and mass as well as greater decline in subclinical LV systolic function as measured by circumferential strain (Table). Conclusions: Prevalence of the carrier status of the V122I genotype in CARDIA is relatively high and consistent with prior studies. Our findings suggest that the V122I mutation may be a unique risk enhancer for heart failure in middle-aged African Americans. Further data are needed for clarity on risk associated with carrier status of V122I and implications for cascade screening given emerging therapies for TTR cardiac amyloidosis.

Abstract P408: Cardiovascular Health And Recovery From Mobility Limitation in Middle Aged African Americans: The Jackson Heart Study

Despite a well-established literature demonstrating that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. Although poor cardiovascular health is a risk factor for mobility limitation, its role in recovery is less clear. The present study investigated demographic and cardiovascular factors associated with recovery from incident mobility limitation within one year in the Jackson Heart Study, a cohort study of African Americans in Jackson, MS. Participants underwent three in-person interviews and exams from 2000-2013, and mobility limitations were assessed by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the following year. Candidate predictor variables were assessed in logistic regression models and included sociodemographic factors, behaviors, cardiovascular health measures, and chronic conditions. Multiple imputation using chained equations was used to address missing data. Among 5,276 participants [mean (SD) age = 55.4 (12.9) years], 1,759 (33%) had an incident mobility limitation over 12 years of follow-up, and 953 (54%) reported recovery from mobility limitation by one year later. Young women were more likely to recover from mobility limitation than young men. However, with increasing age, women were less likely to recovery from mobility limitation compared with men (p-value for age and gender interaction = 0.03). In adjusted models, being married was associated with a greater likelihood of recovering (OR: 1.26; 95% CI: 1.02, 1.55), whereas a history of heart failure and current statin use were associated with a lower likelihood of recovering (OR = 0.57; 95% CI: 0.34, 0.98 and 0.77; 95% CI: 0.61, 0.98, respectively). In conclusion, the majority of incident mobility limitations in this population of middle-aged African Americans was transient. Being married may support recovery from limitations by providing a form of structural social support. Cardiovascular health status appears to be an important factor in recovery.

Race-specific alterations in DNA methylation among middle-aged African Americans and Whites with metabolic syndrome

ABSTRACTMetabolic syndrome (MetS) is a cluster of cardiometabolic risk factors for all-cause mortality, cardiovascular disease, and cancer. Identifying epigenetic alterations associated with MetS in African Americans (AAs) and Whites may provide insight into genes that influence its differential health outcomes. We examined DNA methylation (DNAm) and performed an epigenome-wide association study (EWAS) of MetS among AAs and Whites with and without MetS. We assessed age, race and poverty status associated DNAm among AAs (n = 225) and White (n = 233) adults using NCEP-ATP III guidelines. Genome-wide DNAm measurement was assessed using Illumina Infinium Methylation EPIC BeadChip. Differentially methylated positions (DMPs) and differentially methylated regions (DMRs) were identified using dmpFinder and bumphunter. EWAS was performed using CpGassoc. We found significant DMPs associated with age, poverty status and MetS in each race. GSTT1(Glutathione S-Transferase Theta 1) was one of the top-hypermethylated genes and MIPEP (Mitochondrial Intermediate Peptidase) was one of the most hypomethylated genes when comparing AAs with and without MetS. PPP1R13L (Protein Phosphatase 1 Regulatory Subunit 13 Like) was the top hypermethylated and SCD (stearoyl-CoA desaturase-1) was one of the most hypomethylated genes for Whites with and without MetS. EWAS results showed that DNAm differences might contribute to MetS risk among Whites and AAs since different genes were identified in AAs and Whites. We replicated previously identified MetS associated genes and found that Thioredoxin-interacting protein (TXN1P) was statistically significantly differentially expressed only in Whites. Our results may be useful in further studies of genes underlying differences in MetS among AAs and Whites.

Novel age-associated DNA methylation changes and epigenetic age acceleration in middle-aged African Americans and whites

BackgroundAfrican Americans (AAs) experience premature chronic health outcomes and longevity disparities consistent with an accelerated aging phenotype. DNA methylation (DNAm) levels at specific CpG positions are hallmarks of aging evidenced by the presence of age-associated differentially methylated CpG positions (aDMPs) that are the basis for the epigenetic clock for measuring biological age acceleration. Since DNAm has not been widely studied among non-European populations, we examined the association between DNAm and chronological age in AAs and whites, and the association between race, poverty, sex, and epigenetic age acceleration.ResultsWe measured genome-wide DNA methylation (866,836 CpGs) using the Illumina MethylationEPIC BeadChip in blood DNA extracted from 487 middle-aged AA (N = 244) and white (N = 243), men (N = 248), and women (N = 239). The mean (sd) age was 48.4 (8.8) in AA and 49.0 (8.7) in whites (p = 0.48). We identified 4930 significantly associated aDMPs in AAs and 469 in whites. Of these, 75.6% and 53.1% were novel, largely driven by the increased number of measured CpGs in the EPIC array, in AA and whites, respectively. AAs had more age-associated DNAm changes than whites in genes implicated in age-related diseases and cellular pathways involved in growth and development. We assessed three epigenetic age acceleration measures (universal, intrinsic, and extrinsic). AAs had a significantly slower extrinsic aging compared to whites. Furthermore, compared to AA women, both AA and white men had faster aging in the universal age acceleration measure (+ 2.04 and + 1.24 years, respectively, p < 0.05).ConclusionsAAs have more wide-spread methylation changes than whites. Race and sex interact to underlie biological age acceleration suggesting altered DNA methylation patterns may be important in age-associated health disparities.

Feasibility of a behavioral automaticity intervention among African Americans at risk for metabolic syndrome

BackgroundTargeting habit-development (behavioral automaticity) as part of healthy lifestyle behavior change interventions may improve the adoption and maintenance of healthful behaviors. Few studies, however, have evaluated the feasibility of using a habit-development approach to foster the adoption of recommended physical activity and dietary behaviors. We report quantitative and qualitative data from a feasibility study evaluating a habit-formation intervention to foster healthy dietary and physical activity habits among middle aged African Americans with metabolic syndrome.MethodsUsing a non-comparative design we evaluated the feasibility an 8-week, hybrid format (telecoaching and face-to-face sessions), habit-focused intervention targeting the development of healthful dietary and physical activity habit development among 24 African Americans aged 40 and older with metabolic syndrome recruited from the emergency department – a setting where individuals in under-resourced communities often go for primary care. We administered behavioral automaticity measures tailored to participants’ self-selected habits biweekly during the intervention and collected clinical outcomes of systolic blood pressure, weight, waist circumference, and BMI at baseline week 20.ResultsParticipant attrition from the program was high (~ 50%). Despite high levels of attrition, 92% of intervention completers were extremely satisfied with the program. Intervention completers also experienced gains in behavioral automaticity for both dietary and physical activity habits. Overall, higher levels of adherence were associated with higher positive gains in automaticity with the statistical significance of the associations being more pronounced for physical activity habit plans relative to dietary habit plans.ConclusionsOur preliminary data support a habit-development approach for fostering the adoption of healthful dietary and physical activity habits. However, in this pilot study high rates of attrition were seen, suggesting that strategies to improve retention and participant engagement should be included in future studies, particularly when targeting African American emergency department patients.Trial registrationClinicalTrials.gov ID: NCT03370419 Registered 12/11/2017, retrospectively registered.