Racial and Ethnic Differences in Directâ toâ Consumer Genetic Tests Awareness in HINTS 2007: Sociodemographic and Numeracy Correlates

To examine the association of 1) race/ethnicity and 2) numeracy with awareness of DTC genetic tests. Secondary analysis of 6,754 Hispanic, black, and white adult respondents to the National Cancer Institute’s 2007 Health Information National Trends Survey (HINTS). Logistic regression was used to examine sociodemographic predictors of DTC genetic tests awareness including race/ethnicity, income, education, and gender. Next, two numeracy variables were added to the model. After controlling for sociodemographic variables, black respondents were significantly less likely to have heard of DTC genetic tests compared to white respondents (ORâ =â 0.79; CI: 0.65â 0.97). When numeracy variables were added to the model, the effect of black race was no longer significant (ORâ =â 0.84; CI: 0.69â 1.04). Hispanic respondents did not significantly differ from white respondents in awareness of DTC genetic tests. Other significant correlates of DTC genetic tests awareness in the full model included education, income, age, and numeracy variables including degree to which people use medical statistics and numbers to make health decisions, and preference for words or numbers when discussing â the chance of something happening.â Although black respondents were generally less aware of DTC genetic tests than white respondents, this relationship appears to be partially mediated by numeracy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146912/1/jgc40440.pd

Response to Letter Written by Shelly Cummings, MS, CGC of Myriad Genetics Laboratories, Inc. Regarding the Paper, â Racial and Ethnic Differences in Directâ toâ Consumer Genetic Tests Awareness in HINTS 2007: Sociodemographic and Numeracy Correlates.â J Genet Counsel (2012) 21:440â 447

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147095/1/jgc40154.pd

Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson Heart Study.

Background Chronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community-based cohort of blacks. Methods and Results Analyses included 1829 participants without hypertension at baseline (Exam 1, 2000-2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005-2008) or Exam 3 (2009-2012). Each follow-up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported "a lot" or "extreme" stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow-up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age-, sex-, and time-adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04-1.37) and 1.37 (1.20-1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001). Conclusions In a community-based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk

Addressing Health Literacy in Patient Decision Aids:An Update from the International Patient Decision Aid Standards

BACKGROUND: There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development. PURPOSE: An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of low health literacy/disadvantaged populations. DATA SOURCES: Reference list of Cochrane review of randomised controlled trials (RCTs) of PtDAs (2014, 2017 and upcoming 2021 versions). STUDY SELECTION: RCTs that assessed the impact of PtDAs on low health literacy or other disadvantaged groups (i.e. ≥50% participants from disadvantaged groups and/or subgroup analysis in disadvantaged group/s). DATA EXTRACTION: Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify reading level, understandability and actionability. DATA SYNTHESIS: Twenty-five out of 213 RCTs met inclusion criteria illustrating that only 12% of studies addressed the needs of low health literacy or other disadvantaged groups. Reading age was calculated in 8/25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at 6(th) grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post-hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared to studies that did not (Chi(2)=14.11, p=0.0002, I(2)=92.9%). LIMITATIONS: We were unable to access 13 out of 24 PtDAs. CONCLUSIONS: Greater attention to health literacy and disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support

Addressing Health Literacy in Patient Decision Aids:An Update from the International Patient Decision Aid Standards

Background: There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development. Purpose: An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations. Data Sources: Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions). Study Selection: RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s). Data Extraction: Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability. Data Synthesis: Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ2 = 14.11, P = 0.0002, I2 = 92.9%). Limitations: We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.</p

Differential and Combined Effects of Physical Activity Profiles and Prohealth Behaviors on Diabetes Prevalence among Blacks and Whites in the US Population: A Novel Bayesian Belief Network Machine Learning Analysis

The current study assessed the prevalence of diabetes across four different physical activity lifestyles and infer through machine learning which combinations of physical activity, sleep, stress, and body mass index yield the lowest prevalence of diabetes in Blacks and Whites. Data were extracted from the National Health Interview Survey (NHIS) dataset from 2004–2013 containing demographics, chronic diseases, and sleep duration (N = 288,888). Of the total sample, 9.34% reported diabetes (where the prevalence of diabetes was 12.92% in Blacks/African Americans and 8.68% in Whites). Over half of the sample reported sedentary lifestyles (Blacks were more sedentary than Whites), approximately 20% reported moderately active lifestyles (Whites more than Blacks), approximately 15% reported active lifestyles (Whites more than Blacks), and approximately 6% reported very active lifestyles (Whites more than Blacks). Across four different physical activity lifestyles, Blacks consistently had a higher diabetes prevalence compared to their White counterparts. Physical activity combined with healthy sleep, low stress, and average body weight reduced the prevalence of diabetes, especially in Blacks. Our study highlights the need to provide alternative and personalized behavioral/lifestyle recommendations to generic national physical activity recommendations, specifically among Blacks, to reduce diabetes and narrow diabetes disparities between Blacks and Whites

Social Determinants of Health and Diabetes-Related Distress in Patients With Insulin-Dependent Type 2 Diabetes: Cross-sectional, Mixed Methods Approach

BackgroundSocial determinants of health (SDOH) refer to the social, economic, and psychosocial conditions that influence health. Lower levels of SDOH factors including income, education, and employment are associated with a higher prevalence of diabetes, poorer glycemic control, and increased diabetes-related mortality. Few studies have conducted a comprehensive evaluation of multiple SDOH factors in a population with type 2 diabetes mellitus (T2DM). ObjectiveThis study aimed to identify the range of SDOH challenges—including diabetes-related distress—that impact patients with insulin-dependent diabetes at an urban safety-net clinic using the 5-domain SDOH framework developed by the Healthy People 2020 initiative. MethodsThe pilot study used a cross-sectional, mixed methods approach. Participants were recruited from 3 programs within a general internal medicine clinic that provides ambulatory care for patients with uncontrolled T2DM. We administered an investigator-developed SDOH survey based on the Healthy People 2020 framework and the validated Diabetes Distress Scale (DDS), which assesses 4 domains of diabetes-related distress. One-on-one interviews were conducted to gain in-depth information about challenges. ResultsIn total, 57 participants had an average hemoglobin A1c level of 11.0% (SD 2.6%). Overall, 92% (52/57) of participants had a barrier in at least one SDOH domain. SDOH challenges were most commonly reported in the domain of Health and Health Care (84%, 48/57), followed by Economic Stability (54%, n=31), Neighborhood and Built Environment (53%, n=30), Education and Health Literacy (47%, n=27), and Social and Community context (37%, n=21). The mean overall DDS score was 2.09 (SD 0.84), where scores of ≥2 indicate distress. Further, 79% (45/57) of participants had at least moderate diabetes-related distress in one of the 4 DDS domains. General themes that emerged from participant interviews included job interference with healthy behaviors, concerns about burdening others, challenges communicating with providers, and difficulty getting appointments in a timely manner. ConclusionsWe found high levels of SDOH barriers across all 5 domains of the Center for Disease Control and Prevention’s Healthy People 2020 framework, including significant levels of diabetes-related distress. Future programs to address SDOH barriers in patients with uncontrolled insulin-dependent diabetes should consider screening for and focusing on a wide range of challenges

Mediating effects of body mass index, physical activity, and emotional distress on the relationship between short sleep and cardiovascular disease

The current study investigated the mediating effects of body mass index (BMI), physical activity, and emotional distress on the association between short sleep duration (<7 hours per 24-hour period) and cardiovascular disease (CVD) and risk factors. We used data from the National Health Interview Survey, an ongoing nationally representative cross-sectional study of noninstitutionalized US adults (>= 18 years) from 2004 to 2013 (N=206,049). Participants provided information about anthropometric features (height and weight), sociodemographic factors, health behaviors (smoking and physical activity), emotional distress, and physician-diagnosed health conditions, including hypertension, coronary heart disease, diabetes, heart attack, stroke, kidney disease, and cancer. Structural equation modeling was used to assess the mediating effects of physical activity, BMI, and emotional distress on the relationship between short sleep and CVDs and risk factors (coronary heart disease, hypertension, diabetes, chronic kidney disease, heart attack, and stroke). Of the sample, 54.7% were female, 60.1% identified as white, 17.7% as Hispanic, and 15.4% as black. The mean age of the respondents was 46.75 years (SE=0.12), with a mean BMI of 27.11kg/m(2) (SE=0.02) and approximately 32.5% reported short sleep duration. The main relationship between short sleep and CVD and risk factors was significant (beta=0.08, P<.001), as was the mediated effect via BMI (indirect effect=0.047, P<.001), emotional distress (indirect effect=0.022, P<.001), and physical activity (indirect effect=-0.022, P=.035), as well as after adjustment for covariates, including age, race, sex, marital status, and income: short sleep and CVD (B=0.15; SE=0.01; P<.001), BMI (B=0.05; SE=0.00; P<.001), emotional distress (B=0.02; SE=0.00; P<.001), and physical activity (B=0.01; SE=0.00; P<.001). Our findings indicate that short sleep is a risk factor for CVD and that the relationship between short sleep and CVD and risk factors may be mediated by emotional distress and obesity, and negatively mediated by physical activity