Faculty Bibliography

INTRODUCTION/BACKGROUND:Disparities in vaccination rates exist among racial/ethnic minority adults. This study examined factors associated with influenza (flu) and pneumococcal vaccination rates among non-Hispanic black, Hispanic, and Asian American adults aged 50 or older living in New York City or Los Angeles and Orange counties in California. METHODS:We used data collected by the REACH US Risk Factor Survey 2009-2012 in New York City and California. We analyzed data on 14,139 adults aged 50 or older who were categorized as non-Hispanic black (New York City [n = 1,715], California [n = 530]), Hispanic (New York City [n = 2,667], California [n = 1,099]), Chinese American (New York City [n = 1,656]), Korean American (New York City [n = 310]), Filipino American (California [n = 1,515]), or Vietnamese American (California [n = 3,435]). Bivariate analyses examined difference across race/ethnicity and location, and multivariable logistic regression models, adjusting for sociodemographic and health variables, examined flu and pneumococcal vaccination rates. RESULTS:Among adults aged 50 or older, the flu vaccination rate was lower among non-Hispanic black respondents (New York City, 53.3%; California, 40.5%) than among Hispanic (New York City, 61.0%; California, 49.4%), Chinese (New York City, 67.6%), Korean (New York City, 60.5%), Filipino (California, 66.2%), and Vietnamese (California, 68.0%) respondents. Among adults aged 65 or older, pneumococcal vaccination rates were lowest among Chinese and Korean respondents in New York City (51.7% and 49.1%, respectively), compared with non-Hispanic black (New York City, 62.0%, California, 65.6%), Hispanic (New York City, 60.0%; California 62.7%), Filipino (California, 63.4%), and Vietnamese (California, 63.8%) respondents. Older age, having had a checkup in the past year, and diabetes diagnosis were significantly associated with flu and pneumococcal vaccination in both locations. Additional variables were significant for some vaccinations and locations. CONCLUSION/CONCLUSIONS:When compared with Asian American respondents, non-Hispanic black respondents were least likely to receive the flu vaccine in New York City and California. We found no racial/ethnic differences in pneumococcal vaccination rates. Our findings highlight the need for targeted efforts to increase vaccination rates among racial/ethnic minority older adults.

The objective of this study was to measure change in obesity prevalence among New York City (NYC) adults from 2004 to 2013-2014 and assess variation across sociodemographic subgroups. We used objectively measured height and weight data from the NYC Health and Nutrition Examination Survey to calculate relative percent change in obesity (≥ 30 kg/m²) between 2004 (n = 1987) and 2013-2014 (n = 1489) among all NYC adults and sociodemographic subgroups. We also examined changes in self-reported proxies for energy imbalance. Estimates were age-standardized and statistical significance was evaluated using two-tailed T tests and multivariable regression (p < 0.05). Between 2004 and 2013-2014, obesity increased from 27.5 to 32.4% (p = 0.01). Prevalence remained stable and high among women (31.2 to 32.8%, p = 0.53), but increased among men (23.4 to 32.0%, p = 0.002), especially among non-Latino White men and men age ≥ 65 years. Black adults had the highest prevalence in 2013-2014 (37.1%) and Asian adults experienced the largest increase (20.1 to 29.2%, p = 0.06), especially Asian women. Foreign-born participants and participants lacking health insurance also had large increases in obesity. We observed increases in eating out and screen time over time and no improvements in physical activity. Our findings show increases in obesity in NYC in the past decade, with important sociodemographic differences.

While gender and racial/ethnic disparities in cardiovascular disease (CVD) risk factors have each been well characterized, few studies have comprehensively examined how patterns of major CVD risk factors vary and intersect across gender and major racial/ethnic groups, considered together. Using data from New York City Health and Nutrition Examination Survey 2013-2014-a population-based, cross-sectional survey of NYC residents ages 20 years and older-we measured prevalence of obesity, hypertension, hypercholesterolemia, smoking, and diabetes across gender and race/ethnicity groups for 1527 individuals. We used logistic regression with predicted marginal to estimate age-adjusted prevalence ratio by gender and race/ethnicity groups and assess for potential additive and multiplicative interaction. Overall, women had lower prevalence of CVD risk factors than men, with less hypertension (p = 0.040), lower triglycerides (p < 0.001), higher HDL (p < 0.001), and a greater likelihood of a heart healthy lifestyle, more likely not to smoke and to follow a healthy diet (p < 0.05). When further stratified by race/ethnicity, however, the female advantage was largely restricted to non-Latino white women. Non-Latino black women had significantly higher risk of being overweight or obese, having hypertension, and having diabetes than non-Latino white men or women, or than non-Latino black men (p < 0.05). Non-Latino black women also had higher total cholesterol compared to non-Latino black men (184.4 vs 170.5 mg/dL, p = 0.010). Despite efforts to improve cardiovascular health and narrow disparities, non-Latino black women continue to have a higher burden of CVD risk factors than other gender and racial/ethnic groups. This study highlights the importance of assessing for intersectionality between gender and race/ethnicity groups when examining CVD risk factors.

Readers should note the following two typographical errors in this article.

BACKGROUND:In the United States, 16 million immigrants are 50 years and older, but little is known about their cardiometabolic health and how to best assess their cardiovascular disease (CVD) risk. Aging immigrants may therefore not be benefitting from advances in CVD prevention. OBJECTIVE:In this study, we estimate and compare CVD risk in a nationally representative sample of aging immigrants using 3 different measures. METHODS:This was a cross-sectional analysis using National Health and Nutrition Examination Survey data. Immigrants 50 years and older with no history of CVD were eligible. The Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association Pooled Cohort Risk Equation, and presence of metabolic syndrome (MetS) were used to estimate risk. Bivariate statistics were analyzed using SPSS version 23.0 Complex Survey module to account for National Health and Nutrition Examination Survey unique weighting scheme. RESULTS:The mean age of the sample was 61.3 years; 40% had hypertension, 17% had diabetes, 10% were smokers, and 95% did not meet the recommended physical activity guidelines. Proportions at an elevated CVD risk were as follows: American College of Cardiology/American Heart Association, 42% female and 76% male; FRS, 17.4% female and 76% male; and MetS, 22% female and 24% male. CONCLUSIONS:Immigrants had a lower overall risk using MetS and the American College of Cardiology/American Heart Association equation than has been found using these tools in similarly aged samples. The opposite was true for the FRS. The discrepancy between the proportion at risk and those being treated may reflect healthcare access gaps that warrant further investigation. A more holistic approach to risk measurement is needed that accounts for determinants of health that disproportionately affect immigrants, including language and socioeconomic status.

INTRODUCTION/BACKGROUND:Differences in the social determinants of health and cardiovascular health outcomes by nativity have implications for understanding the immigrant health paradox among black immigrants. We aimed to understand whether blood pressure awareness, a precursor to achieving blood pressure control among hypertensive patients, varied by nativity among a sample of black men. METHODS:Data were collected from 2010 through 2014. In 2016, we conducted logistic regression models using data from a large sample of urban-dwelling middle-aged and older black men. All men in the study had measured high blood pressure at the time of enrollment and were also asked whether they were aware of having high blood pressure. Independent variables included demographics, socioeconomic status, access to care, and health-related behaviors. RESULTS:Foreign-born participants were significantly less likely than US-born participants to report awareness of having high blood pressure (P < .001). We observed a significant positive relationship between proportion of life spent in the US and being aware of having hypertension (β = 0.863; 95% CI, 0.412-1.314; P < .001). This relationship remained after adjusting the model for salient independent variables (β = 0.337; 95% CI, 0.041-0.634; P = .03). CONCLUSIONS:Difference in hypertension awareness by nativity may skew surveillance estimates used to track health disparities by large heterogeneous racial categories. Our results also indicate that prior health care experience and circumstances should be considered when studying the immigrant health paradox.

BACKGROUND:Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN/METHODS:In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION/CONCLUSIONS:The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION/BACKGROUND:NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.

There has been increasing recognition of the need to engage patients, families, and other patient stakeholders in research. This article seeks to provide understanding and examples of how to apply core principles of community-based participatory research (CBPR) in developing patient-centered outcomes research (PCOR) that can impact clinical and public health practice. Authors review CBPR principles and demonstrate how to translate them into effective PCOR strategies. Common themes of CBPR principles and PCOR strategies are related to: (a) fostering joint ownership in the identification of health priorities, the development and evaluation of research strategies and their design, and the dissemination of findings; (b) a keen recognition and appreciation for the importance of stakeholder-driven priorities, research, and solutions; (c) building capacity of both stakeholders and researchers to engage in research collaboratively; and (d) recognizing that conducting the research is not the endpoint but continues on with a commitment to dissemination, spread, adoption and sustainability. The authors highlight the specific strategies in which these CBPR principles can be translated for use in engaging patients and families, and including other stakeholders such as care providers, community partner organizations, health systems, and insurers, in the research process to ensure the development of PCOR.

Behavioral interventions utilizing community health workers (CHWs) have demonstrated effectiveness in improving hypertension disparities in ethnic minority populations in the United States, but few have focused on Asian Americans. We assessed the efficacy of a CHW intervention to improve hypertension management among Filipino Americans with uncontrolled blood pressure (BP) in New York City (NYC) from 2011 to 2013. A total of 240 Filipino American individuals (112 in the treatment group and 128 in the control group) with uncontrolled hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) were recruited from community-based settings in NYC. Using a community-based participatory research approach, treatment participants received 4 educational workshops and 4 one-on-one visits with CHWs over a 4-month period, while control group participants received 1 educational workshop. Main outcome measures included BP control, changes in SBP and DBP, and changes in appointment keeping at 8-months. At 8-months, BP was controlled among a significantly greater percentage of treatment group participants (83.3%) compared to the control group (42.7%). The adjusted odds of controlled BP for the treatment group was 3.2 times the odds of the control group (P < 0.001). Both groups showed decreases in SBP and DBP, with greater decreases among treatment participants. Significant between-group differences were also demonstrated in adjusted analyses (P < 0.001). Individuals in the treatment group showed significant changes in appointment keeping. In conclusion, a community-based intervention delivered by CHWs can help improve BP and related factors among Filipino Americans with hypertension in NYC.