Psychosocial and Behavioral Determinants of Medication Nonadherence Among African Americans with Hypertension: A Dissertation

The overarching goal of this dissertation was to elucidate the psychosocial and behavioral determinants of medication nonadherence among African Americans with hypertension. One in three Americans in the United States has hypertension, and the prevalence of hypertension among African Americans is among the highest in the world. In addition to healthy behaviors such as following a low-salt and low-fat diet, getting regular exercise, and reducing stress, patients with hypertension must also adhere to antihypertensive medications. Poor medication adherence may be driven by psychosocial and behavioral factors; however, the impact of these factors on medication adherence is unclear especially within the African American community. To date, a paucity of research has examined the relationship between psychosocial and behavioral factors such as reported racial discrimination, John Henryism (a measure of active coping and an unhealthy response to stress) and home remedies with medication nonadherence. However, each of these factors has individually been linked with poorer health outcomes among African Americans. Using data from the TRUST study (2006-2008) the association between these constructs and medication adherence was assessed within our sample of 788 African Americans and a comparison group of 137 White participants with hypertension. Ordinal logistic regression was used to assess the association between racial discrimination, John Henryism, home remedies, and medication adherence. The findings from this research indicated more reported racial discrimination, higher John Henryism scores, and greater use of home remedies were associated with lower medication adherence. These findings yield new knowledge about medication adherence and provide practical insights about the psychosocial and behavioral determinants of medication adherence

Sex differences in clinical outcomes for obstructive hypertrophic cardiomyopathy in the USA: a retrospective observational study of administrative claims data

ObjectivesTo evaluate sex differences in demographic and clinical characteristics, treatments and outcomes for patients with diagnosed obstructive hypertrophic cardiomyopathy (oHCM) in the USA.SettingRetrospective observational study of administrative claims data from MarketScan Commercial Claims and Encounters Database from IBM Watson Health.ParticipantsOf the 28 million covered employees and family members in MarketScan, 9306 patients with oHCM were included in this analysis.Main outcome measuresoHCM-related outcomes included heart failure, atrial fibrillation, ventricular tachycardia/ fibrillation, sudden cardiac death, septal myectomy, alcohol septal ablation (ASA) and heart transplant.ResultsAmong 9306 patients with oHCM, the majority were male (60.5%, p<0.001) and women were of comparable age to men (50±15 vs 49±15 years, p<0.001). Women were less likely to be prescribed beta blockers (42.7% vs 45.2%, p=0.017) and undergo an implantable cardioverter-defibrillator (1.7% vs 2.6%, p=0.005). Septal reduction therapy was performed slightly more frequently in women (ASA: 0.08% vs 0.05%, p=0.600; SM: 0.35% vs 0.18%, p=0.096), although not statistically significant. Women were less likely to have atrial fibrillation (6.7% vs 9.9%, p<0.001).ConclusionWomen were less likely to be prescribed beta blockers, ACE inhibitors, anticoagulants, undergo implantable cardioverter-defibrillator and have ventricular tachycardia/fibrillation. Men were more likely to have atrial fibrillation. Future research using large, clinical real-world data are warranted to understand the root cause of these potential treatment disparities in women with oHCM

Examining medication adherence and preferences for a lifestyle intervention among Black and Latinx adults with hypertension: a feasibility study

BACKGROUND: Approximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension. METHODS: In this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data. RESULTS: Black and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure. CONCLUSION: This study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources

Recommendations for a culturally relevant Internet-based tool to promote physical activity among overweight young African American women, Alabama, 2010-2011

INTRODUCTION: Innovative approaches are needed to promote physical activity among young adult overweight and obese African American women. We sought to describe key elements that African American women desire in a culturally relevant Internet-based tool to promote physical activity among overweight and obese young adult African American women. METHODS: A mixed-method approach combining nominal group technique and traditional focus groups was used to elicit recommendations for the development of an Internet-based physical activity promotion tool. Participants, ages 19 to 30 years, were enrolled in a major university. Nominal group technique sessions were conducted to identify themes viewed as key features for inclusion in a culturally relevant Internet-based tool. Confirmatory focus groups were conducted to verify and elicit more in-depth information on the themes. RESULTS: Twenty-nine women participated in nominal group (n = 13) and traditional focus group sessions (n = 16). Features that emerged to be included in a culturally relevant Internet-based physical activity promotion tool were personalized website pages, diverse body images on websites and in videos, motivational stories about physical activity and women similar to themselves in size and body shape, tips on hair care maintenance during physical activity, and online social support through social media (eg, Facebook, Twitter). CONCLUSION: Incorporating existing social media tools and motivational stories from young adult African American women in Internet-based tools may increase the feasibility, acceptability, and success of Internet-based physical activity programs in this high-risk, understudied population

Deep Diving Into the Cardiovascular Health Paradox: A Journey Towards Personalized Prevention

ObjectivesThe Life’s Simple 7 score (LS7) promotes cardiovascular health (CVH). Despite this, some with optimal LS7 develop cardiovascular disease (CVD), while others with poor CVH do not, termed the “CVH paradox.” This paper explores pathways explaining this paradox.MethodsWe examined methodological aspects: 1) misclassification bias in self-reported lifestyle factors (smoking, physical activity, diet); 2) cumulative exposure to risk factors over a lifetime, impacting the CVH paradox. Punctual risk factor assessments are suboptimal for predicting outcomes. We proposed personalized prevention using “novel” elements to refine CVH assessment: 1) subclinical vascular disease markers, 2) metabolic biomarkers in blood and urine, 3) emerging risk factors, 4) polygenic risk scores (PRS), 5) epigenetics, and 6) the exposome.ResultsAddressing the CVH paradox requires a multifaceted approach, reducing misclassification bias, considering cumulative risk exposure, and incorporating novel personalized prevention elements.ConclusionA holistic, individualized approach to CVH assessment and CVD prevention can better reduce cardiovascular outcomes and improve population health. Collaboration among researchers, healthcare providers, policymakers, and communities is essential for effective implementation and realization of these strategies

Abstract P281: Examining Allostatic Load Among Marijuana Users In The United States: An Analysis Of The National Health And Nutrition Examination Surveys, 2007-2010

Introduction: Allostatic Load (AL) has been associated with cardiovascular risk and subsequent cardiovascular disease disparities. Recent studies have investigated pharmacological approaches to reduce and/or reverse AL. One particular area of interest lies in the utility of the cannabinoid system in regulating the physiological irregularities associated with AL. The purpose of this study was to describe AL among marijuana users vs. non-marijuana users in a United States sample. Hypothesis: We hypothesized that AL scores and AL prevalence would be lower among marijuana users compared to non-marijuana users. Methods: Data from adults (20-to-65 years) who completed the National Health and Nutrition Examination Surveys between 2007 and 2010 ( N =6,994) were examined. Marijuana use was defined via computer-assisted self-report of lifetime use (had ever smoked marijuana, yes/no) and current use (had used marijuana at least once in the past 30-days). AL scores were calculated using clinical cut-points for BMI, systolic blood pressure, diastolic blood pressure, pulse, C-reactive protein, high-density lipoprotein, total cholesterol, Glycohemoglobin, albumin, and creatinine clearance. An independent samples t-test was conducted to compare AL scores among lifetime and current marijuana users. Pearson Chi-square analysis was employed to determine whether the prevalence of AL (i.e., AL scores 4 or above) significantly differed between low and high frequency marijuana users. Results: Over half of the sample (58%) reported lifetime use of marijuana. Among current users of marijuana (17.0%), participants reported having used marijuana an average of 12 times in the last month. There was a significant difference in mean AL scores, such that means for those who had ever smoked marijuana (M= 1.67, SD= 1.49) were lower than those who had never smoked marijuana (M=1.84, SD= 1.54; p < .001). Current marijuana users with low frequency of marijuana use in the last 30 days (i.e., less than 12 times) had a significantly higher AL score (M= 1.59, SD= 1.51) than those with high frequency of marijuana use (M=1.37, SD= 1.34; p = .01). The prevalence of AL was significantly higher among participants with low frequency of marijuana use (12.4%) versus those with high frequency (7.0%) ( p = .01). Conclusion: The findings of this analysis describe the relationship between marijuana use and allostatic load. Specifically, allostatic load was lower among individuals reporting lifetime marijuana use and those reporting a higher frequency of current marijuana use. Additional research is needed, in particular - longitudinal studies that examine diverse patterns of marijuana use and variations in allostatic load

Stable Rates of Obstructive Hypertrophic Cardiomyopathy in a Contemporary Era.

Hypertrophic cardiomyopathy is the most common genetic heart disease in the US, with an estimated prevalence of 1 in 500. However, the extent to which obstructive hypertrophic cardiomyopathy is clinically recognized is not well-established. Therefore, the objective of this study was to estimate the annual prevalence of clinically diagnosed oHCM in the US from 2016 to 2018. Data from the MarketScan® database were queried from years 2016 to 2018 to identify patients with ≥1 claim of oHCM (International Statistical Classification of Disease and Related Health Problems diagnosis code: I42.1). Prevalence rates for oHCM were calculated and stratified by sex and age. In 2016, 4,612 unique patients had clinical diagnosis of oHCM, resulting in an estimated oHCM prevalence of 1.65 per 10,000. The prevalence of oHCM in males and females was 2.07 and 1.26, respectively. Prevalence of oHCM was highest in patients 55-64 years of age (4.82). Prevalence of oHCM generally increased with age, from 0.36 per 10,000 in those under 18 to 4.82 per 10,000 in those 55-65. Trends in prevalence of oHCM over time, including by sex and age group, remained similar and consistent in 2017 and 2018. The prevalence of oHCM was stable over the 3-year time period, including higher rates of oHCM in males and patients aged 55-64 years. These results suggest that the majority of privately insured patients with oHCM are undiagnosed in the US and reinforce the need for policies and research to improve the clinical identification of oHCM patients in the US

Abstract P253: Blood Pressure Status Among Current Cigarette, E-cigarette, And Marijuana Users In The United States: An Analysis Of The National Health And Nutrition Examination Surveys, 2013-2016

Introduction: Tobacco and marijuana have been associated with abnormal blood pressure (BP). Yet, little is known about differences in BP status among individuals who smoke cigarettes, e-cigarettes, and marijuana, independently or in combination. The purpose of this study was to provide prevalence estimates of elevated BP, stage 1 hypertension, and stage 2 hypertension among smokers of varied substances and route of administration. Hypothesis: We hypothesized that cigarette users would have higher BP levels compared to e-cigarette or marijuana users. Methods: Data from adults (20-to-59 years) who completed the National Health and Nutrition Examination Surveys between 2013 and 2016 (N=6,282) were examined. Smoking status was ascertained by self-report of use in the last 30-days via computer assisted questionnaires as: cigarette only, cigarette + marijuana, cigarette + e-cigarette, e-cigarette only, e-cigarette + marijuana, marijuana only, and non-smokers of any product. BP was ascertained by the average of three systolic and diastolic readings. Following the latest BP guidelines, BP was categorized as elevated, hypertension stage 1 (HTN1), or hypertension stage 2 (HTN2). Survey method-appropriate chi-squared analyses were conducted to provide weighted prevalence estimates. Results: Over half (60.6%) of the adults in the sample were current smokers [cigarette only (31.9%); e-cigarette only (1.4%); marijuana only (7.3%); cigarette + marijuana (16.1%), cigarette + e-cigarette (3.1%), e-cigarette + marijuana (0.7%)]. A quarter (25.5%) of the sample had elevated BP; 43.9% had HTN1; and 12.7% had HTN2. Among smokers, cigarette only users had the highest prevalence of elevated BP (7.7%), HTN1 (14.7%), and HTN2 (4.3%); followed by the combined use of cigarettes and marijuana (4.8%, 6.0%, 1.2%, respectively). Marijuana and e-cigarette combination users had the lowest prevalence of HTN1 (0.16%) and HTN2 (0.0%) followed by marijuana only users (2.8%, 0.9%, respectively; p=0.04). Conclusions: This analysis is among the first to leverage population-based data to assess BP status among independent and combination users of cigarettes, e-cigarettes, and marijuana. The majority of the sample had at least elevated BP, which is documented to increase cardiovascular disease risk. Additional studies are needed to evaluate the impact of frequency and duration of use on cardiovascular disease risk after considering other lifestyle behaviors (i.e., diet and physical activity)

The Association between Gender and Physical Activity Was Partially Mediated by Social Network Size during COVID-19

The COVID-19 pandemic has disrupted physical activity, particularly among women. Limited research has explored how social network support may explain gender-based variations in physical activity during COVID-19. The purpose of this study was to examine the mediating role of social networks in the association between gender and physical activity during a pandemic. This cross-sectional survey assessed whether social network characteristics (i.e., in-person social network size, frequency of in-person social network interactions, and online friend network size) mediate the relationship between gender and either past-week or past-year physical activity. Multiple mediation analyses were conducted to determine the indirect effect of gender on physical activity through social networks. Among 205 participants, women (n = 129) were significantly less physically active (&beta; = &minus;73.82; p = 0.02) than men (n = 76) and reported significantly more Facebook friends (&beta; = 0.30; p &lt; 0.001) than men, which was inversely associated with past-week physical activity (&beta; = &minus;64.49; p = 0.03). Additionally, the indirect effect of gender on past-week physical activity through Facebook friends was significant (&beta; = &minus;19.13; 95% CI [&minus;40.45, &minus;2.09]). Findings suggest that social media sites such as Facebook could be used to encourage physical activity among women during a pandemic

Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension : Findings from the 2011-2018 National Health and Nutrition Examination Survey

Background: Little is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension. Objective: The aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness. Design: Analysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population. Participants/setting: A total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included. Main outcome measures: Diet quality was assessed by Healthy Eating Index 2015 (HEI-2015). Statistical analysis performed: Weighted χ2 tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates. Results: Among the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status. Conclusions: There were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness