Preventing Chronic Disease最新文献

Introduction: Understanding health outcomes among people with cardiovascular disease (CVD) is crucial for improving treatment strategies and patient quality of life. This study investigated racial and ethnic disparities in perceived health status among non-Hispanic Black, Hispanic, and non-Hispanic White adults with CVD.

Methods: The study had a retrospective cross-sectional design and used data from the Medical Expenditure Panel Survey spanning 8 calendar years (2014-2021). The study population consisted of adults diagnosed with various CVDs. We used ordinal logistic regression models adjusted for demographic and socioeconomic characteristics, CVD severity, comorbidities, and health care expenditures to assess racial and ethnic differences in perceived health status.

Results: Among the 11,715 (weighted frequency, 15,431,283) adults with CVD, we observed significant differences in perceived health status across racial and ethnic cohorts. The unadjusted analysis showed that non-Hispanic Black adults had significantly higher odds than non-Hispanic White adults of perceiving their health as poorer (odds ratio [OR]= 1.89; 95% CI, 1.74-2.07; P < .001), with a similar observation among Hispanic adults (OR = 2.05; 95% CI, 1.85-2.26; P < .001). Although female sex, higher education, and better income had protective effects on perceived health status independent of race, we found significant racial and ethnic differences in the effect of older age, physical and cognitive limitations, and health insurance status on perceived health status.

Conclusion: This study revealed substantial racial disparities in perceived health status among adults with CVD, with notable differences in the effects of predictive factors. Addressing these disparities requires targeted interventions to improve health care access and enhance socioeconomic conditions tailored to the needs and experiences of racial and ethnic populations.

Purpose and objectives: Significant barriers to the implementation of evidence-based policy exist. Establishing an infrastructure and resources to support this process at the state level can accelerate the translation of research into practice. This study describes the adaptation and initial evaluation of the Texas Research-to-Policy Collaboration (TX RPC) Project, focusing on the adaptation process, legislative public health policy priorities, and baseline researcher policy knowledge and self-efficacy.

Intervention approach: The federal Research-to-Policy Collaboration (RPC) method was adapted to the Texas legislative process in 2020. Policymakers and public health researchers were recruited using direct outreach and referrals. Legislators or their aides were interviewed to determine health policy needs, which directed the development of legislator resources, webinars, and recruitment of additional public health researchers with specific expertise. Researchers were trained to facilitate communication with policymakers, and TX RPC Project staff facilitated legislator and researcher meetings to provide data and policy input.

Evaluation methods: Baseline surveys were completed with legislators to assess the use of health researchers in policy. Surveys were also administered before training to researchers assessing self-efficacy, knowledge, and training needs. Qualitative data from the legislator interviews were analyzed using inductive and deductive approaches. Quantitative survey data were analyzed using descriptive statistics for scales and individual survey items.

Results: Legislative offices (n = 21) identified health care access, mental health, and health disparities as key health issues. Legislators reported that health data were important but did not actively involve researchers in legislation. Researchers (n = 73) reported that policy informed their work but had low engagement with legislators. Researcher training surveys indicated lower policy self-efficacy and knowledge and the need for additional training.

Implications for public health: Adaptation of the RPC model for state-level health policy is feasible but necessitates logistical changes based on the unique legislative body. Researchers need training and resources to engage with policymakers.

Introduction: Despite declining cancer death rates in the US, cancer remains the second deadliest disease and disparities persist. Although research has focused on identifying risk factors for cancer deaths and associated disparities, few studies have examined how these relationships vary over time and space. The primary objective of this study was to identify cancer mortality hot spots and cold spots - areas where cancer death rates decreased less than or more than neighboring areas over time. A secondary objective was to identify risk factors of cancer mortality hot spots and cold spots.

Methods: We analyzed county-level cancer death rates from 2004 through 2008 and 2014 through 2018, exploring disparities in changes over time for socioeconomic and demographic variables. We used hot spot analysis to identify areas with larger decreases (cold spots) and smaller decreases (hot spots) in cancer death rates and random forest machine learning analysis to assess the relative importance of risk factors associated with hot spots and cold spots. We mapped spatial clustering areas.

Results: Geospatial analysis showed hot spots predominantly in the Plains states and Midwest and cold spots in the Southeast, Northeast, 2 Mountain West states (Utah and Idaho), and a portion of Texas. Factors with the strongest influence on hot spots and cold spots were unemployment, preventable hospital stays, mammography screening, and high school education.

Conclusion: Geospatial disparities in changes in cancer death rates point out the critical role of access to care, socioeconomic position, and health behaviors in persistent cancer mortality disparities. Study results provide insights for interventions and policies that focus on addressing health care access and social determinants of health.

Prediabetes disproportionately affects racial and ethnic minority groups in Hawai'i. The National Diabetes Prevention Program lifestyle change program (National DPP LCP) decreases the risk of developing diabetes. However, enrolling and retaining participants is a challenge for program providers. This evaluation aimed to understand factors that influence racial and ethnic minority groups in Hawai'i to enroll in and complete the program. From 2018 through 2023, two federally qualified health centers (FQHCs) in rural Hawai'i administered 6 year-long cohorts. Trained lifestyle coaches, who were FQHC staff members, recruited participants and facilitated the evidence-based curriculum. In 2023, the evaluation team conducted semistructured interviews with 14 of the 40 enrolled participants (35%), all of whom were women aged 25 to 74 years. Six participants identified as Native Hawaiian or Other Pacific Islander and 3 as Filipino. Eight participants reported completing the program. We used qualitative methodology to analyze transcripts. We identified themes around motivators, barriers, facilitators, and suggestions for improvement. Recruitment by trusted individuals in their communities motivated participants to enroll. Caregiving and work obligations were attendance barriers for early withdrawers and graduates. Social support from lifestyle coaches and enrolled friends and family were facilitators for program completion. Suggestions included improving class availability and incorporating culturally relevant recipes. Barriers experienced by Native Hawaiian or Other Pacific Islander and Filipino participants were similar to those reported by racial and ethnic groups in other studies. Program providers in rural communities should use trusted individuals as lifestyle coaches and recruit family and friends, regardless of National DPP LCP eligibility, to reduce caregiving barriers and engage critical support systems to facilitate completion.

Purpose and objectives: The Diabetes Prevention Program (DPP), an effective evidence-based strategy to reduce the incidence of type 2 diabetes, has been widely implemented in various locations, including workplaces. However, most people do not remain engaged in the program for the recommended full year. Limited qualitative research exists around participant engagement in the workplace DPP. Our study aimed to explore participant engagement in the DPP delivered through the employer-based clinic (EBC) at a large technology company.

Intervention approach: The DPP was implemented through the EBC at a large technology company in Southern California, beginning in September 2019 by using in-person and virtual synchronous group classes before and during the COVID-19 pandemic.

Evaluation methods: Virtual focus groups with DPP participants from 2 inaugural cohorts were conducted via Zoom from October 2020 to February 2021. Data were analyzed by using inductive thematic analysis.

Results: Five focus groups with 2 to 3 participants in each (total n = 12) were conducted, 2 focus groups per cohort and 1 focus group with the group instructors. Barriers and facilitators to engagement in the DPP were grouped into thematic domains: Individual Drivers, Small Group Community, Workplace Setting, Integrated EBC, and the COVID-19 Pandemic. Results showed that prepandemic workplace demands (ie, meetings, travel) affected DPP participation, yet the group setting provided social support in the workplace to engage in and maintain healthy habits. With the move to a virtual synchronous offering during the pandemic, participants valued the group setting but expressed a preference for in-person meetings. Collectively, participant engagement was bolstered by shared buy-in and collaboration between the employer and the EBC.

Implications for public health: Our findings suggest that engagement in a workplace DPP can be supported by addressing workplace-specific barriers and gaining buy-in from employers. Delivering the DPP, in person and virtually, through an EBC has the potential to engage employees who have prediabetes.

Introduction: The high prevalence of mental disorders among adolescents calls for community-based and population-level prevention strategies. Diet is an important intervention target for primary prevention of mental disorders among adolescents. We used data from a large longitudinal study of Canadian adolescents (aged 14-18 y) to examine prospective associations between diet and mental health outcomes.

Methods: We estimated the effect of diet (ie, consumption of vegetables and fruit and sugar-sweetened beverages [SSBs]) at baseline on depressive symptoms, anxiety symptoms, and psychological well-being (measured by the Center for Epidemiologic Studies Depression Scale-Revised, Generalized Anxiety Disorder 7 scale, and Flourishing Scale, respectively) and at 1-year follow-up in a sample of 13,887 Canadian secondary school students who participated in the 2017-2018 and 2018-2019 cycles of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary (COMPASS) behavior study. We applied linear mixed-effects methods informed by a directed acyclic graph. Sensitivity analyses assessed the robustness of the effect estimates to unmeasured confounding variables.

Results: Baseline SSB consumption was associated with greater severity of depressive (β = 0.04; 95% CI, 0.01-0.06) and anxiety (β = 0.02; 95% CI, 0-0.05) symptoms, particularly among male students, and poorer psychological well-being (β = -0.03; 95% CI, -0.05 to -0.01) at follow-up. Baseline vegetables and fruit consumption was positively associated with psychological well-being (β = 0.06; 95% CI, 0.03-0.10) but not other mental health outcomes at follow-up.

Conclusion: Our results support the notion that diet should be part of comprehensive mental health prevention and promotion interventions to reduce the prevalence of mental health disorders among adolescents.

Introduction: Previous research suggests that rural-urban disparities in diabetes mortality, hospitalization, and incidence rates may manifest differently across US regions. However, no studies have examined disparities in diabetes prevalence by metropolitan residence and region.

Methods: We used data from the 2019-2022 National Health Interview Survey to compare diabetes status, socioeconomic characteristics, and weight status among adults in each census region (Northeast, Midwest, South, West) according to county metropolitan status of residence (large central metro, large fringe metro, small/medium metro, and nonmetro). We used χ² tests and logistic regression models to assess the association of metropolitan residence with diabetes prevalence in each region.

Results: Diabetes prevalence ranged from 7.0% in large fringe metro counties in the Northeast to 14.8% in nonmetro counties in the South. Compared with adults from large central metro counties, those from small/medium metro counties had significantly higher odds of diabetes in the Midwest (age-, sex-, and race and ethnicity-adjusted odds ratio [OR] = 1.24; 95% CI, 1.06-1.45) and South (OR = 1.15; 95% CI, 1.02-1.30). Nonmetro residence was also associated with diabetes in the South (OR = 1.62 vs large central metro; 95% CI, 1.43-1.84). After further adjustment for socioeconomic and body weight status, small/medium metro associations with diabetes became nonsignificant, but nonmetro residence in the South remained significantly associated with diabetes (OR = 1.22; 95% CI, 1.07-1.39).

Conclusion: The association of metropolitan residence with diabetes prevalence differs across US regions. These findings can help to guide efforts in areas where diabetes prevention and care resources may be better directed.