Poor Health Behaviors Research Articles

Efficacy of team-based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease (TEACH): study protocol of a multicenter randomized controlled trial

BackgroundCoronary heart disease (CHD) is the leading cause of death and years of life lost worldwide. While effective treatments are available for both acute and chronic disease stages there are unmet needs for effective interventions to support patients in health behaviors required for secondary prevention. Psychosocial distress is a common comorbidity in patients with CHD and associated with substantially reduced health-related quality of life (HRQoL), poor health behavior, and low treatment adherence.MethodsIn a confirmatory, randomized, controlled, two-arm parallel group, multicenter behavioral intervention trial we will randomize 440 distressed CHD patients with at least one insufficiently controlled cardiac risk factor to either their physicians' usual care (UC) or UC plus 12-months of blended collaborative care (TeamCare = TC). Trained nurse care managers (NCM) will proactively support patients to identify individual sources of distress and risk behaviors, establish a stepwise treatment plan to improve self-help and healthy behavior, and actively monitor adherence and progress. Additional e-health resources are available to patients and their families. Intervention fidelity is ensured by a treatment manual, an electronic patient registry, and a specialist team regularly supervising NCM via videoconferences and recommending protocol and guideline-compliant treatment adjustments as indicated. Recommendations will be shared with patients and their physicians who remain in charge of patients’ care. Since HRQoL is a recommended outcome by both, several guidelines and patient preference we chose a ≥ 50% improvement over baseline on the HeartQoL questionnaire at 12 months as primary outcome. Our primary hypothesis is that significantly more patients receiving TC will meet the primary outcome criterion compared to the UC group. Secondary hypotheses will evaluate improvements in risk factors, psychosocial variables, health care utilization, and durability of intervention effects over 18–30 months of follow-up.DiscussionTEACH is the first study of a blended collaborative care intervention simultaneously addressing distress and medical CHD risk factors conducted in cardiac patients in a European health care setting. If proven effective, its results can improve long-term chronic care of this vulnerable patient group and may be adapted for patients with other chronic conditions.Trial registration: German Clinical Trials Register, DRKS00020824, registered on 4 June, 2020; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020824

Abstract PO-195: Factors affecting disparities in delivery of preventive services to cancer survivors

Abstract Background: Current guidelines promulgate annual influenza immunization and pneumococcal vaccination in cancer patients. Cancer disparities in preventive services affected by multiple socioeconomic and behavioral factors have not been studied systematically. The goal of this study was to identify potential disparities in influenza and pneumonia vaccinations and to analyze association of socioeconomic factors and health behaviors in delivery of immunization preventive services in adult cancer survivors. Methods: Data from the National Health Interview Survey (NHIS) from 2010 to 2018 were used to analyze vaccination status among adult cancer survivors. After pooling the data with proportionally adjusted weights, SAS procedures PROC SURVEYFREQ and PROC SURVEYLOGISTIC were performed to adjust for hierarchical sampling. Chi-square tests were applied to determine whether differences in vaccination prevalence stratified by patient characteristics were statistically significant. Multiple logistic regression was used to estimate the association between predictors (racial/ethnic groups, gender, education, income, body mass index (BMI), marital, smoking and drinking status) and immunization services. Results: Overall, 16,450 (63.4%) and 14,489 (54.1%) cancer survivors reported having a flu shot and pneumonia immunization, respectively, with over 90% of them being non-Hispanic. Also, 90.2% of cancer patients with flu shots and 91.1% with pneumococcal vaccination were White. The lowest influenza vaccination rate was found in cancer patients with low socioeconomic status (less than 12 years of education: 9.4%, total income below the poverty threshold of the year: 6.7%, single people: 5.8%). Lower immunization rates were associated with poor health behaviors. Results further indicated that racial/ethnic, as well as socioeconomic status disparities in flu and pneumonia immunization, were maximal at the aggregate level: Non-Hispanic cancer patients had higher immunization rates than Hispanic patients. Immunization rates in Asians and Whites were much higher than in Blacks and other races. Additionally, gender disparity in immunization was found with women having significantly lower immunization rates. After adjusting for covariates, logistic regression demonstrated that Hispanic cancer patients had 0.66 and 0.54 times the probability of having flu and pneumonia immunization as compared to non-Hispanic patients, respectively. Comparing to Whites, Odds Ratio of having flu shot for Blacks was 0.73 (0.64-0.83, p<0.0001) Conclusions: Our analysis demonstrated significantly higher odds of receiving flu and pneumonia vaccination by non-Hispanic cancer patients as compared with Hispanic cancer patients. People with higher socioeconomic status were more likely to receive preventive services than those with low socioeconomic status. Significant disparity existed in immunization of Blacks as compared to White and Asians. Citation Format: Xingyue Huo, Joseph Finkelstein. Factors affecting disparities in delivery of preventive services to cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-195.

Comparison of shear bond strength of etch and rinse, self-etch adhesive system followed by flowable composite resin, and self-adherent composite resin

Introduction: Early childhood period has a high caries risk that needs special attention from parents, especially the mothers, as their role models. Mothers’ knowledge and positive behaviour towards oral health care are essential in preventive dentistry since it is the crucial thing that can support the children’s oral hygiene. Purpose of study was aimed to analyse the relationship between the mother’s knowledge and behaviour regarding oral health with the early childhood oral health status. Methods: Type of study was a cross-sectional study with correlational research method. The material from this research were questionnaires and standard instruments for an oral examination. The study was conducted on 44 children of the early childhood period and their mothers, which was chosen as sample using a purposive sampling technique for respondents who met the inclusion criteria. The inclusion criteria were mothers who took up their children to the mother and children’s health centre, children in the early childhood period with complete deciduous teeth eruption, and willing to participate in the research. A Kendall’s-tau test was used for statistical analysis. Results: The results showed that the def-t index was 7.6 (very high) and there was a significant relationship between mother’s knowledge (p-value=0.0001) and behaviour (p-value=0.004) towards oral health status of the children (def-t index). The results also showed strong correlation coefficient to knowledge (τ = -0.643) and sufficient correlation coefficient to behaviour (τ = -0.415). Ironically, mothers with sufficient knowledge regarding the children’s oral health are not fully reflected in daily oral hygiene practice. The mean value of caries teeth in each child was seven teeth, mostly found in children with mothers with poor oral health knowledge and behaviour. Conclusion: There is a strong relationship between mother’s knowledge and oral health status of early childhood, while the mother’s behaviour and oral health status has a moderate relationship.

Relationship between mother’s knowledge and behaviour with oral health status of early childhood

Introduction: Early childhood period has a high caries risk that needs special attention from parents, especially the mothers, as their role models. Mothers’ knowledge and positive behaviour towards oral health care are essential in preventive dentistry since it is the crucial thing that can support the children’s oral hygiene. Purpose of study was aimed to analyse the relationship between the mother’s knowledge and behaviour regarding oral health with the early childhood oral health status. Methods: Type of study was a cross-sectional study with correlational research method. The material from this research were questionnaires and standard instruments for an oral examination. The study was conducted on 44 children of the early childhood period and their mothers, which was chosen as sample using a purposive sampling technique for respondents who met the inclusion criteria. The inclusion criteria were mothers who took up their children to the mother and children’s health centre, children in the early childhood period with complete deciduous teeth eruption, and willing to participate in the research. A Kendall’s-tau test was used for statistical analysis. Results: The results showed that the def-t index was 7.6 (very high) and there was a significant relationship between mother’s knowledge (p-value=0.0001) and behaviour (p-value=0.004) towards oral health status of the children (def-t index). The results also showed strong correlation coefficient to knowledge (τ = -0.643) and sufficient correlation coefficient to behaviour (τ = -0.415). Ironically, mothers with sufficient knowledge regarding the children’s oral health are not fully reflected in daily oral hygiene practice. The mean value of caries teeth in each child was seven teeth, mostly found in children with mothers with poor oral health knowledge and behaviour. Conclusion: There is a strong relationship between mother’s knowledge and oral health status of early childhood, while the mother’s behaviour and oral health status has a moderate relationship.

Social networks and health-promoting behaviors among North Korean refugees in South Korea

ABSTRACT Poor health behaviors among North Korean refugees (NKRs) in South Korea are serious risk factors hindering their overall well-being. Despite their significance, little is known about the roles of social networks in promoting health behaviors of NKRs. Thus, we examined how social network characteristics were associated with health-promoting behaviors among 202 NKRs. We found that social networks featuring members of religious organizations were positively associated with overall health-promoting behaviors, health responsibility, exercise, and nutrition, whereas networks with South Korean friends were negatively associated with nutrition. Findings suggest that health interventions facilitating religion-based network ties may promote health behaviors among NKRs.

Mother-child separation among women living with HIV and their children in the first four years postpartum in South Africa.

Mother-child pairs may separate during early life, yet the health impacts thereof are unclear. We explored the patterns and impact of separation among women living with HIV (WLHIV) and their children in South Africa. WLHIV who had initiated antiretroviral therapy (ART) during pregnancy received HIV viral load (VL) testing and completed a timeline questionnaire of mother-child separation since delivery at 3-5years post-partum. Health care usage was abstracted from routine medical records. We examined associations between separation and (a) maternal health outcomes (engagement in HIV care and HIV viral suppression, [VS]) and (b) child health outcomes (post-breastfeeding HIV testing and immunisation completion), using logistic regression. Of 346 mother-child pairs (median maternal age at antenatal ART initiation, 28years), 24% were ever separated (median time to first separation 20months, interquartile range [IQR] 9, 31). Most separated children were living with their grandmothers (65/83, 78%). Mothers who ever separated were younger, and more likely to be employed, and to reside in informal housing than those who never separated. Any separation reduced the odds of VS≤50 copies/mL at four years post-partum (odds ratio 0.57; 95% CI 0.34-0.93); associations were similar for VL≤1000 copies/mL and maternal engagement in care. No association was found between separation and child confirmatory HIV testing or immunisation completion. In this setting, mother-child separation is common in the first four years of life and appears associated with suboptimal maternal outcomes. Further research is required to understand the drivers and implications of mother-child separation.

Abstract 219: Characterizing Covid-19 Pandemic Related Anxiety and Its Impact on Cardioprotective Health Behaviors Among Racially and Ethnically Diverse Cardiac Arrest Survivors

Introduction: Cardiac arrest (CA) patients’ fear of contracting Coronavirus disease 2019 (COVID-19) may limit their ability or willingness to perform cardio-protective health behaviors. We assessed the association of COVID-19 anxiety with physical activity (PA), sleep, and the likelihood of seeking medical care. Methods: Between May 15-28, 2020, a month after the NYC COVID-19 pandemic peak, CA survivors from a prospective cohort were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and behavioral dimensions. COVID-19 anxiety was assessed using the 7-item Perceived Coronavirus Threat Questionnaire (PCTQ; range 1-42). PA in 7 days both pre- and during COVID-19 was categorized into International Physical Activity Questionnaire-based low, moderate, or high activity levels. Self-reported poor sleep quality and hours of sleep per night in the previous month were assessed via the Pittsburgh Sleep Quality Index. Self-reported likelihood of delay in seeking care for non-COVID related conditions was assessed. Results: Of 100 approached, 75 CA survivors participated (53% male; age 61±15 years; 44% White, 20% Black, and 31% Latinx). The majority (84%) were COVID-19 tests and/or symptoms negative. The median COVID-19 anxiety score was 28 (interquartile range [IQR]: 21-37)- indicating substantial fear. Black and Latinx participants reported greater COVID-19 anxiety than White (33±6 vs 32±8 vs 23±10 respectively, p=0.03). Compared to pre-COVID, CA survivors had reduced their days per week engagement in any PA by an average of 2±3.6 days. COVID-19 anxiety was highest in those who were previously high PA and now were low PA (high-high:25±9, low-low:28±9, and high-low:32±4, ANOVA p=0.06). For every 1 SD increase in COVID-19 anxiety, participants reported 45 min less sleep per night (B= -0.05, p =.06) and poorer sleep quality (OR = 1.07, 95% CI [1.0, 1.1], p=0.017). Participants (48%) who said they were “moderately” to “extremely” likely to delay seeking care for non-COVID related conditions had greater levels of COVID-19 anxiety (32±9 vs 26±10, p=0.02) compared to other responses. Conclusions: COVID-19 anxiety is more frequent in Black and Latinx participants and is associated with poorer health behaviors.

Pulmonary function and factors associated with current smoking among the hill tribe populations in northern Thailand: a cross-sectional study

BackgroundSmoking is considered one of the major poor health behaviors leading to several health problems. Individuals with a poor education and economic status are vulnerable to smoking, particularly the hill tribe people in Thailand. This study aimed to estimate the prevalence of current smoking, assess pulmonary function, and identify factors associated with current smoking among individuals aged 20 years and older of the hill tribes in northern Thailand.MethodA cross-sectional study was conducted to gather information from the hill tribe people living in 42 hill tribe villages. A validated questionnaire, spirometry, and pulse oximetry were used as the research tools. Face-to-face interviews were conducted to collect data from the participants in a private room after obtaining informed consent voluntarily. Chi-squared test and logistic regression were used to detect the associations between the variables at the significance level of α = 0.05.ResultsIn total, 2216 participants were recruited into the study: 54.6% were women, 80.3% were aged 31–59 years, and 86.1% were married. The prevalence of smoking was 36.3%; 20.6% were current smokers (36.7% among men and 7.0% among women), and 15.7% were ever smokers. Half of the participants (50.1%) had smoked for ≤9 years, 80.1% smoked ≤10 pieces per day, 64.2% smoked traditional tobacco, 42.8% had low-to-moderate levels of knowledge of the harms of smoking, and 68.4% had low-to-moderate levels of attitudes toward the harms of smoking. Only sex was statistically significant among the different smoking behaviors (p-value< 0.001), and the participants’ pulmonary function was not significantly different. After controlling for age, sex, religion, and education, three variables were found to be associated with current smoking among the hill tribe people in Thailand: men were more likely to smoke than women (AOR = 7.52, 95% CI = 5.53–10.24); those who used amphetamines were more likely to smoke than those who did not (AOR = 2.92, 95% CI = 1.69–5.03); those who had poor attitudes toward the harms of smoking were more likely to smoke than those who had a positive attitude toward the harms of smoking (AOR = 2.47, 95% CI = 1.53–3.97).ConclusionTranslating essential health messages into the hill tribe language and improving the channel to deliver this information to the target populations, particularly men, are crucial strategies for improving their knowledge and attitudes toward the harms of smoking and making them quit smoking.

Education differences in sickness absence and the role of health behaviors: a prospective twin study

BackgroundLong-term sickness absences burden the economy in many industrialized countries. Both educational attainment and health behaviors are well-known predictors of sickness absence. It remains, however, unclear whether these associations are causal or due to confounding factors. The co-twin control method allows examining causal hypotheses by controlling for familial confounding (shared genes and environment). In this study, we applied this design to study the role of education and health behaviors in sickness absence, taking sex and cohort differences into account.MethodsParticipants were two cohorts of in total 8806 Norwegian twins born 1948 to 1960 (older cohort, mean age at questionnaire = 40.3, 55.8% women), and 1967 to 1979 (younger cohort, mean age at questionnaire = 25.6, 58.9% women). Both cohorts had reported their health behaviors (smoking, physical activity and body mass index (BMI)) through a questionnaire during the 1990s. Data on the twins’ educational attainment and long-term sickness absences between 2000 and 2014 were retrieved from Norwegian national registries. Random (individual-level) and fixed (within-twin pair) effects regression models were used to measure the associations between educational attainment, health behaviours and sickness absence and to test the effects of possible familial confounding.ResultsLow education and poor health behaviors were associated with a higher proportion of sickness absence at the individual level. There were stronger effects of health behaviors on sickness absence in women, and in the older cohort, whereas the effect of educational attainment was similar across sex and cohorts. After adjustment for unobserved familial factors (genetic and environmental factors shared by twin pairs), the associations were strongly attenuated and non-significant, with the exception of health behaviors and sickness absence among men in the older cohort.ConclusionsThe associations between educational attainment, health behaviors, and sickness absence seem to be confounded by unobserved familial factors shared by co-twins. However, the association between health behaviors and sickness absence was consistent with a causal effect among men in the older cohort. Future studies should consider familial confounding, as well as sex and age/cohort differences, when assessing associations between education, health behaviors and sickness absence.

The impact of adverse childhood experiences on the health and health behaviors of young Australian women

BackgroundAdverse childhood experiences have been linked to poor health and adverse health behavior in adulthood. ObjectiveThis study aimed to estimate the prevalence of adverse childhood experiences among young Australian women (aged 20–25) and examine associations between adverse childhood experiences and adult health behaviors and physical and mental health. Participants and SettingsData were from the 1989−95 cohort of the Australian Longitudinal Study on Women’s Health, who completed the Adverse Childhood Experiences Scale at Survey 3 in 2015 (N = 8609). MethodsOutcomes included: self-rated health, sexual health, psychological distress, depression, anxiety, suicide ideation, self-harm, substance abuse (drinking, smoking, illicit drugs), severe obesity, and exercise. Prevalence of childhood adversities were presented, with the association between childhood adversity and outcomes evaluated using log-binomial multivariable regressions (99% CI). ResultsWhile 59% of women reported experiencing at least one childhood adversity, 10% of participants reported adverse childhood experiences across four or more categories, indicating a significant burden of risk for young Australian women. Women reporting four or more categories had higher rates of poor physical health (adjPR = 1.79, 99% CI = 1.51–2.12), sexually transmitted infections (adjPR = 1.36, 99% CI = 1.11–1.67), and poor mental health (adjPR = 2.78, 99% CI = 2.34–3.32), and increased rates of severe obesity (adjPR = 2.14, 99% CI = 1.61–2.86) and smoking (adjPR = 2.23, 99% CI = 1.89–2.64). ConclusionUsing nationally representative data, this study shows adverse childhood experiences directly impact physical and mental health, and health behaviors in adulthood among young Australian women. The management of health and wellbeing in adulthood should look beyond the contemporaneous factors, incorporating a focus on how childhood adversity may negatively influence health behavior, health and wellbeing in later life.

Weight Stigma across the Preconception, Pregnancy, and Postpartum Periods: A Narrative Review and Conceptual Model.

Weight stigma is a pervasive issue promoting significant adverse health and psychosocial consequences. Preconception, pregnant, and postpartum women are particularly vulnerable to weight stigma, which can directly impact their health and that of the next generation. Of note, weight stigma affects women living with obesity who are already at risk for developing gestational diabetes and experiencing associated stigmas. This narrative review aimed to examine the literature on weight stigma across the preconception, pregnancy, and postpartum periods, specifically to (1) synthesize the evidence using a socioecological lens; (2) develop a conceptual model of weight stigma tailored to women across this life phase; and (3) provide recommendations for future research. To date, weight stigma research across the preconception, pregnancy, and postpartum periods has focused predominately on pregnancy and antenatal care. The drivers and facilitators of this stigma are pervasive, occurring across various contexts and settings. Manifestations of weight stigma include decreased reproductive healthcare quality, mental health symptoms, poorer health behaviors, and adverse pregnancy outcomes. Future research should further investigate the experiences of women preconception and postpartum, and health/social impacts beyond healthcare. The model herein will guide such research to ultimately identify opportunities for stigma reduction and improve multigenerational health and well-being outcomes.

Effect of plasma polyunsaturated fatty acid levels on leukocyte telomere lengths in the Singaporean Chinese population

BackgroundShorter telomere length (TL) has been associated with poor health behaviors, increased risks of chronic diseases and early mortality. Excessive shortening of telomere is a marker of accelerated aging and can be influenced by oxidative stress and nutritional deficiency. Plasma n6:n3 polyunsaturated fatty acid (PUFA) ratio may impact cell aging. Increased dietary intake of marine n-3 PUFA is associated with reduced telomere attrition. However, the effect of plasma PUFA on leukocyte telomere length (LTL) and its interaction with genetic variants are not well established.MethodsA nested coronary artery disease (CAD) case-control study comprising 711 cases and 638 controls was conducted within the Singapore Chinese Health Study (SCHS). Samples genotyped with the Illumina ZhongHua-8 array. Plasma n-3 and n-6 PUFA were quantified using mass spectrometry (MS). LTL was measured with quantitative PCR method. Linear regression was used to test the association between PUFA and LTL. The interaction between plasma PUFAs and genetic variants was assessed by introducing an additional term (PUFA×genetic variant) in the regression model. Analysis was carried out in cases and controls separately and subsequently meta-analyzed using the inverse-variance weighted method. We further assessed the association of PUFA and LTL with CAD risk by Cox Proportional-Hazards model and whether the effect of PUFA on CAD was mediated through LTL by using structural equation modeling.ResultsHigher n6:n3 ratio was significantly associated with shorter LTL (p = 0.018) and increased CAD risk (p = 0.005). These associations were mainly driven by elevated plasma total n-3 PUFAs, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (p < 0.05). There was a statistically significant interaction for an intergenic single nucleotide polymorphism (SNP) rs529143 with plasma total n-3 PUFA and DHA on LTL beyond the genome-wide threshold (p < 5 × 10− 8). Mediation analysis showed that PUFA and LTL affected CAD risk independently.ConclusionsHigher plasma n6:n3 PUFA ratio, and lower EPA and DHA n-3 PUFAs were associated with shorter LTL and increased CAD risk in this Chinese population. Furthermore, genetic variants may modify the effect of PUFAs on LTL. PUFA and LTL had independent effect on CAD risk in our study population.

Predictors of cardiac self-efficacy among patients diagnosed with coronary artery disease in tertiary hospitals in Nepal.

Background: Cardiac self-efficacy determines how people feel, think, motivate themselves and behave with regards to improving their cardiac health subsequently preventing complications of coronary artery disease (CAD). Given almost one-third of global death is contributed by CAD with 10% of disability adjusted life years lost in low- and middle-income countries (including Nepal), it is important to identify factors that can promote cardiac self-efficacy. There are no studies in Nepal focusing on predictors of self-efficacy. Therefore, we aim to determine the predictors of cardiac self-efficacy of CAD patients in Nepal.Design and Methods: This is a cross-sectional study where we recruited 170 patients (≥30 years) diagnosed with CAD from two tertiary level hospitals. Multiple linear regression model was used to identify the predictors of cardiac self-efficacy.Results: The mean age of the participants was 60.45±10.39 years (range, 31-83). Most of the participants were diagnosed as myocardial infarction (91.2%), rest with unstable angina (6.5%) and stable angina (2.4%). The multivariate analysis shows age (p<0.001), health behaviors (p<0.001) and knowledge of the disease (p<0.001) were statistically significant predictors to cardiac self-efficacy. Every 1-year increase in age was associated with 0.23 units increase in cardiac self-efficacy score. Similarly, every unit increase in health behavior score and knowledge of disease score was associated with 0.432 units and 0.475 units increase in cardiac self-efficacy score respectively.Conclusion: Age and health behaviors were the strongest predictors of cardiac self-efficacy followed by knowledge of the disease. We conclude that those with poor health behavior are at a greater risk of poorer cardiac self-efficacy compared to those with relatively good level of self-efficacy. Public health interventions such as awareness raising about cardiac disease and health behavior modification along with early screening, diagnosis and appropriate care are essential to improving self-efficacy and cardiac care outcomes.Significance for public healthThe global number of deaths from cardiovascular disease (CVD) has increased during the past decade by 12.5%. Since the CVD rates are increasing in developing countries including Nepal, a multifaceted approach to prevention and control of CVD is needed. Studies have demonstrated the importance of including selfefficacy as a key component in CVD self-management programs. These programs should be multidisciplinary in approach, should be tailored to the needs of the patients, and should have a theoretical foundation of behavior change. The findings of the study suggest the need for developing public health interventions focused on improving knowledge and behavior for increasing cardiac self-efficacy in patients with coronary artery disease in Nepal.

Geographic Variation in Racial Disparities in Health and Coronavirus Disease-2019 (COVID-19) Mortality.

ObjectiveTo evaluate the race-stratified state-level prevalence of health determinants and the racial disparities in coronavirus disease 2019 (COVID-19) cumulative incidence and mortality in the United States.Patients and MethodsThe age-adjusted race-stratified prevalence of comorbidities (hypertension, diabetes, dyslipidemia, and obesity), preexisting medical conditions (pulmonary disease, heart disease, stroke, kidney disease, and malignant neoplasm), poor health behaviors (smoking, alcohol abuse, and physical inactivity), and adverse socioeconomic factors (education, household income, and health insurance) was computed in 435,139 American adult participants from the 2017 Behavioral Risk Factor Surveillance System survey. Correlation was assessed between health determinants and the race-stratified COVID-19 crude mortality rate and infection-fatality ratio computed from respective state public health departments in 47 states.ResultsBlacks had a higher prevalence of comorbidities (63.3%; 95% CI, 62.4% to 64.2% vs 55.1%; 95% CI, 54.7% to 55.5%) and adverse socioeconomic factors (47.0%; 95% CI, 46.0% to 47.9% vs 30.9%; 95% CI, 30.6% to 31.3%) than did whites. The prevalence of preexisting medical conditions was similar in blacks (30.4%; 95% CI, 28.8% to 32.1%) and whites (30.8%; 95% CI, 30.2% to 31.4%). The prevalence of poor health behaviors was higher in whites (57.2%; 95% CI, 56.3% to 58.0%) than in blacks (50.2%; 95% CI,46.2% to 54.2%). Comorbidities and adverse socioeconomic factors were highest in the southern region, and poor health behaviors were highest in the western region. The cumulative incidence rate (per 100,000 persons) was 3-fold higher in blacks (1546.4) than in whites (540.4). The crude mortality rate (per 100,000 persons) was 2-fold higher in blacks (83.2) than in whites (33.2). However, the infection-fatality ratio (per 100 cases) was similar in whites (6.2) and blacks (5.4). Within racial groups, the geographic distribution of health determinants did not correlate with the state-level COVID-19 mortality and infection-fatality ratio (P>.05 for all).ConclusionRacial disparities in COVID-19 are largely driven by the higher cumulative incidence of infection in blacks. There is a discordance between the geographic dispersion of COVID-19 mortality and the regional distribution of health determinants.

Changes in Diet, Sleep, and Physical Activity Are Associated With Differences in Negative Mood During COVID-19 Lockdown.

The United Kingdom and Scottish governments instigated a societal lockdown in response to the COVID-19 pandemic. Subsequently, many experienced substantial lifestyle changes alongside the stresses of potentially catching the virus or experiencing bereavement. Stressful situations and poorer health behaviors (e.g., higher alcohol consumption, unhealthy diet, poorer sleep quality, physical inactivity) are frequently linked to poor mental health. Our objective was to examine changes in health behaviors and their relationship with negative mood during COVID-19 lockdown. We also considered associations between health behaviors and socio-demographic differences and COVID-19-induced changes. 399 participants completed a questionnaire asking about their personal situation and health behaviors during lockdown as well as a negative mood scale. The significance threshold for all analyses was α = 0.05. Poorer diet was linked to more-negative mood, and to changes to working status. Poorer sleep quality was linked with more-negative mood, and with ‘shielding’ from the virus. Being less physically active was related to more-negative mood and student status, whereas being more physically active was linked to having or suspecting COVID-19 infection within the household. Increased alcohol consumption was linked to living with children, but not to negative mood. Changes to diet, sleep quality, and physical activity related to differences in negative mood during COVID-19 lockdown. This study adds to reports on poor mental health during lockdown and identifies lifestyle restrictions and changes to health behaviors which may, to some extent, be responsible for higher negative mood. Our data suggests that it is advisable to maintain or improve health behaviors during pandemic-associated restrictions.

Association between non-adequate health literacy and cancer screening adherence: a meta-analysis

Abstract Objective Individuals with non-adequate health literacy (NAHL) are more likely to have poor health outcomes and behaviors, including a limited use of preventive services. This study aimed at summarizing the evidence on the association between NAHL and adherence to cancer screening programs. Methods PubMed, Scopus, and Web of Science were searched. Cross-sectional studies conducted in any country, published through January 2020 and quantifying the association between NAHL and cancer screening adherence, were included. An adapted Newcastle-Ottawa Scale was used to assess quality. Inverse-variance random-effects methods were used to produce pooled estimates: overall, by cancer and by HL tool. Results Seventeen articles of heterogeneous quality were included in the systematic review and 45 analyses were combined. NAHL was found to negatively influence screening adherence in both the crude (n = 26) and adjusted (n = 19) pooled analyses, and the association was slightly stronger in the latter (OR = 0.70, 95%CI: 0.62-0.79 and aOR=0.66, 95%CI: 0.57-0.76, respectively). Moreover, NAHL was significantly associated with lower adherence in all the types of cancer screening investigated: breast cancer (n = 7), aOR=0.55, 95%CI: 0.38-0.78; cervical cancer (n = 4), aOR=0.63, 95%CI: 0.53-0.75; prostate cancer (n = 1), aOR=0.60, 95%CI: 0.36-0.99, and colorectal cancer (n = 7), aOR=0.85, 95%CI: 0.74-0.97. Lastly, tools measuring NAHL with reading comprehension/numeracy items yielded the strongest association with the outcome (n = 5, aOR= 0.53, 95%CI: 0.35-0.80), that was attenuated in tools with either self-reported comprehension items (n = 7, aOR=0.72, 95%CI: 0.65-0.80) or medical term recognition items (n = 7, aOR=0.74, 95%CI: 0.57-0.95). Conclusions This study shows that NAHL may have a significant impact on adherence in all types of screening programs analysed, independently of the tools applied to measure it. Hence, it should be a useful focus for interventions to improve screening participation rates. Key messages Non-adequate health literacy negatively influences cancer screening adherence. Efforts to promote the uptake of cancer screening programs should consider and address NAHL.

Intervening on fear after acute cardiac events: Rationale and design of the INFORM randomized clinical trial.

Many acute coronary syndrome (ACS) patients are nonadherent to cardiovascular medications despite their known benefits for lowering risk of recurrent cardiovascular events. Research suggests that greater cardiac-related fear of recurrence (FoR) may be associated with higher nonadherence to cardiovascular medications and avoidance of physical activity. We aim to test the effect of an intervention that targets FoR as a potentially modifiable mechanism underlying nonadherence to recommended health behaviors among patients with suspected ACS. The INFORM trial ("INvestigating Fear Of Recurrence as a modifiable Mechanism of behavior change to improve medication adherence in acute coronary syndrome patients") is a double-blind, parallel-group randomized clinical trial. It compares an 8-session, at-home, electronic tablet-delivered, cognitive bias modification training (CBMT) intervention with a sham control. Patients who experience high perceived threat at the time of presentation to the emergency department (ED) with a suspected ACS are enrolled and randomized within 6 weeks of their ED visit. The primary outcome, FoR, is measured by the adapted Concerns about Recurrent ACS Scale. The trial also tests the intervention's effect on a potential mechanism of health behavior change that is inversely correlated with fear: an expansive future time perspective. Additional outcomes include electronically measured adherence to a cardiovascular medication and self-reported physical activity. This study takes a mechanistic approach to addressing the dangerous problem of poor health behaviors after ACS. The trial will test whether targeting FoR or future time perspective by CBMT is a promising approach to improving nonadherence after ACS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assessing health professionals\u2019 perception of health literacy in Rhode Island community health centers: a qualitative study

BackgroundLimited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy.MethodsUsing the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes.ResultsEight unique themes centered on health literacy, sources of health information, organizational culture’s impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients’ health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy.ConclusionsStudy findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids.

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

What’s eating you? Risk factors for poor health behaviors among family caregivers

Objectives Overeating and obesity are major public health issues in the United States. Caregivers are at greater risk of engaging in poor health behaviors, such as emotional eating, to cope with the demands of caregiving. Using Heatherton and Baumeister (1991) Escape Theory, this study examines the associations between caregiver characteristics (i.e. age, gender, and BMI) and emotional eating, including the extent to which family strain mediates these associations. Method Data are from the MIDUS 3 dataset (N = 326) and include family caregivers of older adults and children with special health care needs (Mage = 62.88 years, SD = 10.28; 69.6% female). Results Female caregivers were more likely than male caregivers to engage in emotional eating. Age was significantly associated with emotional eating, where increased age was associated with less emotional eating. ANCOVA results indicated that obese caregivers were the most likely to engage in emotional eating. Results also indicated that family strain significantly mediated the association between caregiver age and emotional eating. Linear regression analyses indicated that female gender predicted emotional eating, although family strain did not mediate the association between gender and emotional eating. Similarly, after controlling for family strain as a mediator, higher BMI was still significantly associated with emotional eating, suggesting that BMI is a strong predictor of emotional eating among family caregivers regardless of present family strain. Conclusion Interventions targeted at managing family strain, particularly for younger, female caregivers, could improve coping and decrease poor health behaviors.