Racial/ethnic heterogeneity in associations of blood pressure and incident cardiovascular disease by functional status in a prospective cohort: the Multi-Ethnic Study of Atherosclerosis.

OBJECTIVES:Research has demonstrated that the association between high blood pressure and outcomes is attenuated among older adults with functional limitations, compared with healthier elders. However, it is not known whether these patterns vary by racial/ethnic group. We evaluated race/ethnicity-specific patterns of effect modification in the association between blood pressure and incident cardiovascular disease (CVD) by functional status. SETTING:We used data from the Multi-Ethnic Study of Atherosclerosis (2002-2004, with an average of 8.8 years of follow-up for incident CVD). We assessed effect modification of systolic blood pressure and cardiovascular outcomes by self-reported physical limitations and by age. PARTICIPANTS:The study included 6117 participants (aged 46 to 87; 40% white, 27% black, 22% Hispanic and 12% Chinese) who did not have CVD at the second study examination (when self-reported physical limitations were assessed). OUTCOME MEASURES:Incident CVD was defined as an incident myocardial infarction, coronary revascularisation, resuscitated cardiac arrest, angina, stroke (fatal or non-fatal) or death from CVD. RESULTS:We observed weaker associations between systolic blood pressure (SBP) and CVD among white adults with physical limitations (incident rate ratio (IRR) per 10 mm Hg higher SBP: 1.09 (95% CI 0.99 to 1.20)) than those without physical limitations (IRR 1.29 (1.19, 1.40); P value for interaction <0.01). We found a similar pattern among black adults. Poor precision among the estimates for Hispanic or Chinese participants limited the findings in these groups. The attenuated associations were consistent across both multiplicative and additive scales, though physical limitations showed clearer patterns than age on an additive scale. CONCLUSION:Attenuated associations between high blood pressure and incident CVD were observed for blacks and whites with poor function, though small sample sizes remain a limitation for identifying differences among Hispanic or Chinese participants. Identifying the characteristics that distinguish those in whom higher SBP is associated with less risk of morbidity or mortality may inform our understanding of the consequences of hypertension among older adults

Understanding Neighborhood Physical and Social Environments in Relation to Blood Pressure Changes in the Multi-Ethnic Study of Atherosclerosis.

Neighborhood environments have been associated with a variety of health outcomes, but much of the existing research has relied on cross-sectional data or used non-specific measures of the neighborhood. This dissertation uses longitudinal data on specific measures of neighborhood physical and social environments from the Multi-Ethnic Study of Atherosclerosis (MESA) to explore how neighborhood environments change over time and how specific neighborhood environments affect blood pressure. The first analysis investigated how changes in four survey-based measures of neighborhood environments (availability of healthy food, walking environment, social cohesion, and safety) were patterned by area socio-demographic characteristics (area socioeconomic status [SES], percentage of Black residents, and percentage of Hispanic residents). After adjusting for individual-level characteristics, we found that lower SES neighborhoods and neighborhoods with more minority residents generally had poorer physical and social environments, and that these disparities were stable or increasing over time. The second analysis used proportional hazards models to explore neighborhood physical and social environments in relation to incident hypertension using survey-based measures of neighborhood environments and GIS-based measures of the density of favorable food stores and recreational activity resources. After adjustment for individual and neighborhood-level covariates, one standard deviation higher healthy food availability was associated with a 12% lower rate of hypertension (HR = 0.88, 95% CI 0.82-0.95); other neighborhood environment measures were not related to incidence of hypertension. The third analysis used linear mixed models to describe how neighborhood survey- and GIS-based measures of physical and social environments were associated with baseline levels and changes over time in systolic blood pressure (SBP). Using imputed values for SBPs influenced by antihypertensive medication use, we found that better neighborhood food and physical activity environments were associated with lower SBPs at baseline, while better neighborhood social environments were associated with higher SBPs at baseline. There was little evidence that neighborhood environments affected SBP trajectories over time. The results of this dissertation add new evidence on the way that neighborhood socio-demographic characteristics relate to neighborhood physical and social environments, and how those environments affect cardiovascular health; these results may shape interventions to reduce social disparities in health.PhDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/108928/1/pbkaiser_1.pd

The dynamics of condom use with regular and casual partners: analysis of the 2006 National Sexual Behavior Survey of Thailand.

OBJECTIVE: This study aims to determine factors associated with levels of condom use among heterosexual Thai males in sex with regular partners and in sex with casual partners. METHODS: The data used in this study are from the national probability sample of the 2006 National Sexual Behavior Study, the third nationally representative cross-sectional survey in Thailand. A subtotal of 2,281 men were analyzed in the study, including young (18-24) and older (25-59) adults who were residents of rural areas of Thailand, non-Bangkok urban areas, and Bangkok. Two outcomes of interest for this analysis are reported condom use in the past 12 months by males in relationships with the most recent regular and casual partners who were not sex workers. Chi-square statistics, bivariate regressions and the proportional odds regression models are used in the analysis. RESULTS: Condom use for men with their regular partner is revealed to be positively related to education, knowledge of condom effectiveness, and pro-condom strategy, and negatively related to non-professional employment, status of registered marriage, and short relationship duration. Condom use with casual partner is positively determined by education, condom knowledge, non-professional occupation, short relationship duration, and lack of history of paid sex. CONCLUSION: The national survey emphasized the importance of risk perceptions and condom motivations variables in explaining condom use among men in Thailand. These factors include not only education and knowledge of condom effectiveness and pro-condom strategy but also types of partners and their relationship context and characteristics. Program intervention to promote condom use in Thailand in this new era of predominant casual sex rather than sex with sex workers has to take into account more dynamic partner-based strategies than in the past history of the epidemics in Thailand

Unadjusted and adjusted odds ratios of reporting greater condom use (never, sometimes/half, mostly/always) among men with casual partners (N = 520).

*<p>p<0.05</p>**<p>p<0.01</p>***<p>p<0.001.</p

Characteristics of study population: men with at least one regular or casual sex partner in the past 12 months in 2006 the National Sexual Behavior Survey of Thailand (N = 2,281).

<p>Characteristics of study population: men with at least one regular or casual sex partner in the past 12 months in 2006 the National Sexual Behavior Survey of Thailand (N = 2,281).</p