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Introduction: Persons of Hispanic origin are a growing share of the U.S. population but include diverse ethnic groups with unique cultures, lifestyles, exposures, and countries of origin. Hispanics are disproportionately affected by cardiovascular disease (CVD) risk factors in comparison to non-Hispanics. However, few studies have examined the heterogeneity in their burden of CVD risk. Hypothesis: We hypothesized that there would be significant heterogeneity in the prevalence of CVD risk factors among ethnic subgroups of Hispanic adults. Methods: We used a cross-sectional design to examine the prevalence of CVD risk factors, defined per national guidelines, among Hispanic adults in the 2010-2018 National Health Interview Surveys. Generalized linear models using Poisson distribution were fitted to obtain adjusted predicted probabilities and risk of self-reported hypertension, overweight/obesity, diabetes, high cholesterol, physical inactivity, and current smoking by Hispanic ethnic subgroup. Results: We included 185,511 participants with mean(±sd) age 31(0.2) years and 50% male. Most were Mexican (65.1%) whereas, few were Dominican (3.0%). Prevalence of hypertension (28.4%), diabetes (12.9%), high cholesterol (25.0%), and current smoking (6.1%) was highest among Puerto Ricans. Prevalence of overweight/obesity was highest among Mexicans (74.5%) and physical inactivity was highest among Dominicans (62.3%). Compared to Mexicans, Central Americans were less likely to smoke and have hypertension, overweight/obesity, and diabetes (psTable ) Conclusion: We observed striking heterogeneity in the prevalence of CVD risk factors across Hispanic ethnic subgroups, especially for diabetes, physical inactivity, and smoking. These results suggest that aggregating data on Hispanics may mask differences in CVD risk and hinder efforts to reduce health disparities in this population. Our findings provide actionable information on CVD risk factors for specific Hispanic ethnic subgroups.

Introduction: Research on cardiovascular health (CVH) and risk factors among immigrants has been well-documented. Less is known about social influences on CVH, among black immigrants. Despite having the largest population of black immigrants in the U.S., Afro-Caribbean (AC) immigrants have been underrepresented in health research. We examined the social determinants of CVH among AC immigrants (Guyanese, Haitian and Jamaican) in New York City (NYC). Hypothesis: We hypothesized that social determinants of CVH will vary among the three ethnic sub-groups of AC immigrants. Methods: We included 1691 AC immigrants who reported their race as non-Hispanic Black and country of birth (COB) as Guyana (n= 369), Haiti (n= 291) or Jamaica (n= 1031) in the 2010-2014 administrations of the New York City Community Health Survey. Logistic regression analysis was performed to assess the association between social determinants and CVH (ideal vs intermediate/poor) using AHA’s CVH metrics. Results: The majority of the sample was female (59.2%) and reported high school education or less (53.9%). Most AC immigrants reported to have ideal CVH (71.3%). Education was significantly associated with CVH only among Jamaican immigrants. Jamaican immigrants with ≤ high school education were more likely to have intermediate/poor CVH compared to those with ≥ some college education. Conclusions: These findings suggest that social determinants influencing CVH differ among AC immigrant sub-groups in NYC. These findings suggest that social determinants influencing CVH differ among AC immigrant sub-groups in NYC. National surveillance efforts should obtain more complete data on country of origin and oversample racial/ethnic minority groups in order to better understand their CVH outcomes. Future research should examine other social factors that may influence CVH among black immigrants.

Background: Obesity is a heterogeneous condition, and there is debate about whether adults with “metabolically healthy obesity” (MHO) are protected from health complications. It is also unclear if MHO is a transient state. Objective: To examine transition from the MHO to metabolically unhealthy obese (MUO) phenotype during 6 years of follow-up among middle-aged adults. Methods: We conducted a prospective analysis of 9,672 adults in the ARIC Study who were free of cardiovascular disease (CVD) at Visit 2 (1990-1992) and attended Visit 4 (1996-1998). Obesity phenotypes were cross-classified using two body mass index subgroups 18.5-29.9 kg/m 2 (non-obese) and ≥ 30 kg/m 2 (obese). The NCEP Adult Treatment Panel III criteria were used to define metabolic health (without waist circumference). We used logistic regression to evaluate risk factors for transition from MHO at Visit 2 to MUO at Visit 4 among those with MHO at Visit 2(N=692). Results: At baseline (mean age 57, 21% black, 57% female), 18%, 54%, 7%, and 21% were metabolically healthy non-obese, metabolically unhealthy non-obese, MHO, and MUO, respectively. More adults with the MHO phenotype transitioned to MUO (48.3%) than maintained MHO status (43.4%) during the 6-year period). Most (71%) of those who transitioned from MHO to MUO were women. Adults with higher waist-to-hip ratio were more likely to transition to MUO (HR 2.67, 95% CI 1.09-6.58) than those who maintained their metabolic health during follow-up. (Table) . Conclusions: Almost 50% of adults who are MHO will transition to higher cardiometabolic risk over 6 years. High waist-to-hip ratio, lower socioeconomic status and smoking were linked to greater likelihood of transition to MUO. Persons with MHO should receive early behavioral interventions to prevent worsening metabolic health.

Introduction: The differences in the risk of cardiovascular disease (CVD) among Black ethnic groups in the U.S. remain largely unexplained. African immigrants are particularly likely to have high rates of hypertension and diabetes, and less likely to be screened, diagnosed or receive treatment. Objective: To examine the association between social determinants of health (SDoH) and hypertension and diabetes among African immigrants. Methods: The African Immigrant Health Study was a cross-sectional study of 465 African immigrants living in the Baltimore-Washington metropolitan area. Data collection was performed through a combination of physical examinations and questionnaires. The outcomes were self-reported hypertension and diabetes. Elements of SDoH collected were education, income, health insurance, employment and marital status. Logistic regression analyses were used to assess the association between SDoH and hypertension/diabetes. Results: The mean age of participants was 46.8(±11.5) years and 60% were women; 64% had ≥ college degree, 83% were employed, 67% had health insurance, and 70% were married/co-habiting. Mean body mass index was 30.7 (±18.3) kg/m 2 . The prevalence of hypertension and diabetes was 32%, and 13% respectively. The odds of diabetes were higher amongst those who were unemployed [aOR: 2.86 (1.39-5.56)] ( Table ). Education, health insurance, income and marital status were not associated with hypertension or diabetes after accounting for age and sex. Conclusion: Among African immigrants, we observed that those who were unemployed had a higher likelihood of self-reported diabetes than those who were employed. Additional studies are needed to further study the contributions of social determinants of hypertension and diabetes as well as and developing health policy and interventions to improve cardiovascular health.

Background The association between anthropometric variables and cardiovascular disease (CVD) risk among Africans is unclear. We examined the discriminative ability of anthropometric variables and estimate cutoffs for predicting CVD risk among Africans. Methods The Research on Obesity and Diabetes among African Migrants (RODAM) study was a multisite cross-sectional study of Africans in Ghana and Europe. We calculated AHA/ACC Pooled Cohort Equations (PCE) scores for 3661 participants to ascertain CVD risk, and compared a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Relative Fat Mass (RFM), and Waist to Height Ratio (WHtR). Logistic regression and receiver operating curve analyses were performed to derive cutoffs for identifying high predicted CVD risk (PCE score ≥7.5%). Results Among men, WC (adjusted Odds Ratio (aOR): 2.25, 95% CI; 1:50–3:37) was strongly associated with CVD risk. Among women, WC (aOR: 1.69, 95% CI: 1:33–2:14) also displayed the strongest association with CVD risk in the BMI-adjusted model but WHR displayed the strongest fit. All variables were superior discriminators of high CVD risk in men (c-statistic range: 0.887–0.891) than women (c-statistic range: 0.677–0.707). The optimal WC cutoff for identifying participants at high CVD risk was 89 cm among men and identified the most cases (64%). Among women, the recommended WC cutoff of 94 cm or WHR cutoff of 0.90 identified the most cases (92%). Conclusions Anthropometric variables were stronger discriminators of high CVD risk in African men than women. Greater WC was associated with high CVD risk in men while WHR and WC were associated with high CVD risk in women.

In the United States (U.S.), Blacks have higher morbidity and mortality from cardiovascular disease (CVD) than other racial groups. The Black racial group includes African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans (ACs); however, little research examines how social determinants differentially influence CVD risk factors in each ethnic subgroup. We analyzed the 2010-2014 National Health Interview Survey, a cross-sectional, nationally representative survey of non-institutionalized civilians. We included 40,838 Blacks: 36,881 AAs, 1660 AIs, and 2297 ACs. Age- and sex-adjusted hypertension prevalence was 37, 22, and 21% in AAs, ACs, and AIs, respectively. Age- and sex-adjusted diabetes prevalence was 12, 10, and 7% in AAs, ACs, and AIs, respectively. In the multivariable logistic regression analyses, social determinants of hypertension and diabetes differed by ethnicity. Higher income was associated with lower odds of hypertension in AAs (aOR 0.86, 95% CI 0.77-0.96) and ACs (aOR 0.55, 95% CI 0.37-0.83). In AAs, those with some college education (aOR 0.79, 95% CI 0.68-0.92) and college graduates (aOR 0.62, 95% CI 0.53-0.73) had lower odds of hypertension than those with < high school education. In AIs, having health insurance was associated with higher odds of hypertension (aOR 1.59, 95% CI 1.04-2.42) and diabetes (aOR 3.22, 95% CI 1.29-8.04) diagnoses. We observed that the social determinants associated with hypertension and diabetes differed by ethnicity. Socioeconomic factors of health insurance and income were associated with a disparate prevalence of hypertension by ethnic group. Future research among Blacks should stratify by ethnicity to adequately address the contributors to health disparities.

The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N = 253) were aged 35-74 years and resided in Baltimore-Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05-14.35) and eightfold (95% CI 2.09-30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04-6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18-0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants' CVD risk.

In 2018, the Task Force convened the writing committee to begin the process of revising the existing performance measures set for hypertension that had been released in 2011.3 The writing committee also was charged with the task of developing new measures to evaluate the care of patients in accordance with the 2017 Hypertension Clinical Practice Guidelines.4 The writing committee developed a comprehensive measure set for the diagnosis and treatment of high blood pressure (HBP) that includes 22 new measures: 6 performance measures, 6 process quality measures, and 10 structural quality measures. In conceptualizing these measures, the writing committee paid very close attention to the current Class of Recommendation (COR) and Level of Evidence (LOE) guideline classification scheme used by ACC and AHA in all of its guidelines, as shown in Table 1. Table 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care (Updated August 2015)*

Global migration from Africa to more economically developed regions such as the United States, Europe, the Middle East, and Australia has reached unprecedented rates in the past five decades. The size of the African immigrant population in the United States has roughly doubled every decade since 1970. However, research has not kept up with the growing size of this vulnerable population. Data from African immigrants have not traditionally been reported sepa­rately from Blacks/African Americans. There is growing interest in increasing the partici­pation of African immigrants in research to understand their unique health needs and the full spectrum of factors impacting their health, ranging from racial, social, environ­mental, and behavioral factors, to individual biological and genetic factors which may also inform health challenges. This line of inquiry may also inform our understanding of health disparities among their African American counterparts. However, little is known about effective community engage­ment and recruitment strategies that may increase the participation of this popula­tion in research studies. The purpose of this commentary is to: 1) describe lessons learned from our experiences engaging Afri­can immigrants in research in the Baltimore, Washington, DC, and Atlanta metropolitan areas; 2) discuss strategies for successful re­cruitment; and 3) consider future directions of research and opportunities to translate research findings into health policy for this population. Ethn Dis. 2019;29(4):617-622; doi:10.18865/ed.29.4.617

Disparities in health outcomes for heart, lung, blood, and sleep-related health conditions are pervasive in the United States, with an unequal burden experienced among structurally disadvantaged populations. One reason for this disparity is that despite the existence of effective interventions that promote health equity, few have been translated and implemented consistently in the healthcare system. To achieve health equity, there is a dire need to implement and disseminate effective evidence-based interventions that account for the complex and multilayered social determinants of health among marginalized groups across healthcare settings. To that end, the National Heart, Lung, and Blood Institute's Center for Translation Research and Implementation Science invited early stage investigators to participate in the inaugural Saunders-Watkins Leadership Workshop in May of 2018 at the National Institutes of Health. The goals of the workshop were to: (1) present an overview of health equity research, including areas which require ongoing investigation; (2) review how the fields of health equity and implementation science are related; (3) demonstrate how implementation science could be utilized to advance health equity; and (4) foster early stage investigator career success in heart, lung, blood, and sleep-related research. Herein, we highlight key themes from the 2-day workshop and offer recommendations for the future direction of health equity and implementation science research in the context of heart, lung, blood, and sleep-related health conditions.

Background: It is unclear whether the “metabolically healthy” obese phenotype has low cardiovascular disease (CVD) risk. High-sensitivity cardiac troponin T (hs-cTnT), a biomarker of myocardial damage, characterizes subclinical CVD risk. We categorized obesity phenotypes and studied their cross-sectional and prospective associations with subclinical and clinical CVD. Methods: We included 11,844 adults in the Atherosclerosis Risk in Communities (ARIC) Study. We used ATP III metabolic syndrome criteria and BMI to define obesity phenotypes as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Results: At baseline (1990-1992), mean age was 56 years, 56% were female and 23% black. The MHO group was more likely to have detectable hs-cTnT (≥ 6 ng/L) than the MHNO (OR 1.23, 1.02-1.49). During over 26 years of follow-up, 3,560 participants developed CVD. The metabolically unhealthy and obese phenotypes had higher CVD risk than MHNO (Table). Detectable hs-cTnT was associated with higher CVD risk in all phenotypes; MHO had CVD risk, which was intermediate between MHNO and MUO regardless of hs-cTnT (Table). Conclusion: Our results show that metabolically “healthy” obesity is associated with substantial excess burden of subclinical and clinical CVD. Lifestyle modification among obese adults, regardless of metabolic status, is vital to prevent CVD. Disclosure Y. Commodore-Mensah: None. M. Lazo: None. O. Tang: None. J.B. Echouffo Tcheugui: None. C.E. Ndumele: None. V. Nambi: Other Relationship; Self; Dynamed, Merck & Co., Inc., Roche Diagnostic USA. C.M. Ballantyne: Consultant; Self; Abbott, Akcea Therapeutics, Amarin Corporation, Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Esperion, Gilead Sciences, Inc., Matinas BioPharma, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Regeneron Pharmaceuticals, Roche Diagnostic USA, Sanofi. Research Support; Self; Abbott, Akcea Therapeutics, Amarin Corporation, Amgen Inc., Esperion, Novartis Pharmaceuticals Corporation, Regeneron Pharmaceuticals, Roche Diagnostic USA, Sanofi. Other Relationship; Self; Roche Diagnostic USA. D. Wang: None. E. Selvin: None. Funding National Institutes of Health (5KL2TR001077-05)

Background: Food insecurity (FI), defined as limited access to nutritious foods, hampers dietary management of dysglycemia. We examined the prevalence of and risk factors for FI among adults with dysglycemia. Methods: We performed a cross-sectional analysis of data among adults with dysglycemia from the 2013-2017 National Health Interview Survey. We defined dysglycemia as self-reported prediabetes or diabetes diagnosis. FI was defined by an affirmative response on ≥3 questions on the 10-item Food Security Scale. We used Poisson regression and multivariable logistic regressions to estimate the prevalence of and risk factors for FI. Results: We included 26,960 adults with dysglycemia; mean age was 61 years, and 56% were female. The prevalence of FI among those with dysglycemia was 10%. Risk factors for FI identified included being Nnon-Hispanic black (OR: 1.30; 95% CI: 1.11-1.53), Other race (OR: 1.72; 95% CI: 1.12-2.62); having some college (OR: 1.17; 95% CI: 1.01-1.35), unemployed (OR: 1.57; 95% CI: 1.35-1.83), benefiting from the Supplemental Nutrition Assistance Program (OR: 2.31; 95% CI: 2.02-2.65), and insured (OR:1.51; 95% CI: 1.20-1.91) (Table). Conclusion: Developing targeted interventions and health policy for improving access to nutritious foods among adults with dysglycemia with risk factors for FI may improve glycemic control in this population. Disclosure L. Francis: None. R.N. Turkson-Ocran: None. E. Spaulding: None. B. Koirala: None. D. Baptiste: None. J.B. Echouffo Tcheugui: None. Y. Commodore-Mensah: None. Funding National Institute of Nursing Research (to R-A.N.T-O.), (F31DR017328, T32NR012704 to E.S.); National Institute of Diabetes and Digestive and Kidney Diseases (T32NR012704, 3T32DK062707 to R-A.N.T-O.); Ruth L. Kirschstein National Research Service Award (to E.S.); Johns Hopkins Clinical Research Scholars Program (5KL2TR001077-05 to Y.C.M.)

Introduction: Cardiovascular disease (CVD) is the leading cause of death globally and in the US. Blacks have a higher burden of CVD compared to other racial/ethnic groups. However, Blacks are not monolithic and include both foreign-born and US-born individuals. West African immigrants (WAIs)—a sub-group of US Blacks—are a growing immigrant population. It is unknown whether depressive symptoms are associated with CVD risk factors among WAIs. Hypothesis: We hypothesized that depressive symptoms will be associated with having ≥2 CVD risk factors among WAIs. Methods: We included WAIs born in Ghana, Nigeria, Liberia, Sierra Leone and Cameroon who participated in the African Immigrant Health Study in Baltimore-Washington D.C. The main predictor was depression scores on the Patient Health Questionnaire (PHQ-8). The main outcome variable was CVD risk defined as having ≥2 risk factors, including body mass index, self-reported diabetes, hypertension, and hyperlipidemia. Multivariable logistic regression was used to examine the association between depressive symptoms and CVD risk adjusting for age, sex, household income, marital status, and level of education. Results: A total of 326 WAIs were included. The mean age (±SD) was 46 (±10.6) years. Females made up approximately 60% of the sample (n=194). Approximately half of participants reported residing in the US for ≥10 years. Also, 31% were diagnosed with hypertension, 88% were overweight/obese, 20% were diagnosed with high cholesterol and 13% were diagnosed with diabetes. Overall, 41% of participants (n=133) had ≥2 CVD risk factors and 7% (n=22) had moderate/severe depression (PHQ-8 scores ≥10). WAIs who had mild to severe depression were 2.31 (95%CI: 1.2-4.4) times more likely to have ≥2 CVD risk factors compared to those without reported minimal depression levels in the adjusted analyses. Conclusion: We observed a positive association between symptoms of depression and CVD risk factors. WAIs with elevated symptoms of depression had a higher likelihood of having ≥2 CVD risk factors than those reporting minimal depressive symptomology. Targeted behavioral health interventions are needed to help address psychosocial determinants of cardiovascular health among WAIs residing in the US.

Introduction: Coronary heart disease (CHD) and stroke are leading causes of morbidity and mortality in the U.S. Over 92 million Americans have been diagnosed with CHD/stroke and have more costly emergency department (ED) visits to manage acute and chronic symptoms. These visits are often attributed to poor access to primary care, advanced age, and poor social support. Social determinants of health (SDoH) have been suggested for a variety of health outcomes, yet their relation to healthcare utilization such as ED visits among individuals with CHD/stroke is unclear. Hypothesis: We hypothesized that SDoH would be associated with having ≥1 ED visit(s) in the prior 12 months among patients with CHD and stroke. Methods: A cross-sectional analysis of the 2010-2016 National Health Interview Survey was conducted among those who self-reported CHD/stroke diagnosis. Logistic regression analyses were performed with the outcome reporting ≥ 1 ED visit for any reason in the prior 12 months. SDoH examined were race, employment status, poverty, insurance status, and marital status. Results: We included 6,930 participants with diagnosis of CHD/stroke. The mean age (±sd) was 67.09 (±0.10) years. After adjusting for age, sex, perceived health status, Blacks (OR: 1.27, (95%CI: 1.14-1.41) and unmarried persons (OR: 1.21, 95% CI: 1.11-1.31) were more likely to report having at ≥ 1 ED visits than their White and married counterparts (Table) . Compared to Whites, Asians (OR: 0.65, 95%CI: 0.51-0.81) had lower odds of having ≥ 1 ED visit. Those who were employed were less likely (OR: 0.75, 95%CI: 0.67-0.83) to have ED visits compared to those who were unemployed. Those who were not poor/near poor (OR: 0.86, 95%CI: 0.78-0.96) had lower odds of ED visits than the poor. Conclusions: Being Black, poor, unemployed and unmarried were associated with a higher odds of ED visits in the prior 12 months among those with CHD/stroke. Targeted and culturally-appropriate strategies that address SDoH among this vulnerable, high risk population may help prevent costly ED visits.

Introduction: African-Americans bear a disproportionate burden of atherosclerotic cardiovascular disease than other racial/ethnic groups in the U.S. With current globalization trends, Black immigrants from Africa and Caribbean Islands contribute to the ethnic diversity of Blacks in the U.S. Despite the diversity in socioeconomic status, culture and genetic admixture, Black immigrants are traditionally combined with African Americans, therefore limiting opportunities to understand the health of Black immigrants. Hypothesis: Ethnic differences in coronary heart disease (CHD) and stroke prevalence exist among African-Americans (AAs), African-immigrants (AIs) and Afro-Caribbean (ACs). Methods: We conducted a cross-sectional study of the 2010-2016 National Health Interview Survey. CHD and stroke diagnoses were self-reported. We performed a descriptive and multivariable logistic regression analyses adjusting for demographic and health characteristics and stratified by sex. Results: We included 34,513 participants who were AAs (N=30,516), AIs (N=1,371) and ACs (N=2,626). Significant differences in sociodemographic characteristics were observed. AIs were the youngest (39 years) with the highest proportion of college graduates (51%). AAs (42%) were more likely to report hypertension diagnosis than AIs (19%) and ACs (36%) (p(Table) Conclusion: Ethnic differences were noted in the prevalence of CHD and stroke diagnosis and risk among Blacks. Future studies should examine the health advantage of AIs and ACs to inform interventions and policy to improve the health of AAs and maintain the health of foreign-born Blacks.

Introduction: African immigrants make up a growing share of Blacks in the US. However, little is known about their cardiovascular health because data are combined with African Americans, despite cultural, socioeconomic, and genetic differences. Hypothesis: There will be significant differences in hypertension prevalence, treatment, and control between samples of African immigrants and African Americans. Methods: We included participants in the African Immigrant Health Study, a community-engaged study of African immigrants in Baltimore-Washington, D.C. Participants ≥ 30 years old were recruited from community groups and religious institutions from 2017-2018. They were English-speaking and born in West Africa. We compared them to a weighted sample of African Americans who were ≥ 30 years old from the 2015-2016 NHANES. We used t-test and chi-squared tests to compare hypertension prevalence, treatment, and control between the groups. Results: We compared 326 African immigrants (mean age 46; 60% women) to 928 African Americans (mean age 51; 56% women). African immigrants (60%) were more likely to have ≥ college education than African Americans (22%). African Americans (87%) were more likely to be insured than African immigrants (58%) and less likely (12%) to report a household income of ≥ $100,000 than African immigrants (21%). Age-standardized hypertension prevalence was higher in African Americans than African immigrants ( Table ). However, among those with hypertension, African Americans were more likely to be treated and controlled. Both groups had similar high rates of overweight/obesity; diabetes prevalence was higher in African Americans. Conclusions: Hypertension prevalence among African immigrants was lower than African Americans. However, hypertension treatment and control rates were lower in African immigrants and this may be due to poor healthcare access. Future studies may further elucidate reasons for differences among Black ethnic groups in hypertension prevalence, treatment, and control.

Introduction: Stress alters the cardiometabolic and inflammatory systems. Allostatic load, a measure of chronic and cumulative stress is associated with cardiovascular events and mortality. Immigration is known to be a stressful experience; however, it is unclear how length of stay, a proxy for acculturation, is associated with allostatic load in US immigrants. Hypothesis: We hypothesized that greater length of stay will be associated with higher allostatic load among US immigrants. Methods: We used a cross-sectional design to examine the 2011-2016 National Health and Nutrition Examination Surveys. Allostatic load was defined by a count of the number of high-risk classifications for 10 cardiovascular, metabolic, and immune system biomarkers: systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, glycated hemoglobin, albumin, creatinine clearance, body mass index, waist circumference, and white blood cells. Logistic regression was used to examine the odds of a high allostatic load score (≥ 4) as in previous literature, adjusting for survey weights. Results: We included 7318 immigrants with mean age (±se) 44(±0.52); 49% were male. Half of the sample was of Mexican/Hispanic origin, 26% were Asian and 7% were Black. The median allostatic load score was 2.2. The odds of high allostatic load decreased with longer stay in the US. After adjusting for age, race, education, income, insurance status, and routine place for healthcare, those who had resided in the US for 10 to 20 years were 45% (95% CI: 1.1-1.9) more likely to have a high allostatic load than those who had been in the US Conclusion: Length of stay in immigrants is associated with having a high allostatic load. The odds of increased allostatic load declines with longer length of US residence. Additional research is needed to further understand the process and impact of cumulative stress among immigrants to reduce racial/ethnic health disparities.

Introduction: Afro-Caribbean (AC) immigrants are the largest black immigrant group in the U.S. and generally display better physical health than United States (U.S.) born blacks. Cardiovascular health (CVH) disparities among AC immigrant sub-groups are poorly understood. We examined the prevalence of CVH factors among AC immigrants (Guyanese, Haitian and Jamaican) relative to U.S. born blacks residing in New York City. We hypothesized that some AC immigrant sub-groups will have higher rates of CVH factors than U.S. born blacks. Methods: We performed a cross-sectional analysis of pooled data from the 2010-2014 New York City Community Health Survey administrations to estimate the prevalence of CVH and differences among AC immigrant sub-groups. We included 7678 non-Hispanic black participants from Haiti (n=291), Jamaica (n=1031), Guyana (n=369) and U.S. born blacks (5987). Logistic regression was used to examine the association between country of birth and CVH factors. The CVH factors were determined from the AHA’s CVH metrics. We adjusted the models for significant covariates using backward sequential selection. Results: In final adjusted models, in comparison to U.S. born blacks, Jamaican immigrants were more likely to self-report diabetes but were less likely to be overweight/obese. Guyanese immigrants were also less likely to be overweight/obese than U.S. born blacks. There were no significant differences between Haitian immigrants and U.S. born blacks for CVH factors. Conclusions: Although AC immigrants depict superior health status compared to U.S. born blacks, ethnic differences exist in CVH among AC immigrant sub-groups. Efforts to address cardiovascular health factors among black populations in the U.S. should consider ethnic differences that may provide information about the most at-risk populations for disease-specific programmatic or policy interventions.

Discrimination is implicated in the disproportionate burden of disease and health disparities in racial/ethnic minorities. This qualitative descriptive study explored the experiences of discrimination and its impact on the health of older African immigrants. Semi-structured interviews were conducted with 15 participants. Three main themes and six sub-themes were identified. These included: 1) types of discrimination: a) accent-based, b) unfair treatment during routine activities, c) experience with police and other systems; 2) costs of discrimination; 3) surviving and thriving with discrimination: a) “blind eye to it”, b) reacting to it, c) avoiding it. These themes describe common forms of discrimination that these older adults have experienced, current strategies used to deal with discrimination, and the impact of discrimination on the wellbeing of this sample. To improve the emotional and mental health of older African immigrants, providers serving them should assess for perceived discrimination, and refer participants with any concerns for treatment.

Cardiovascular disease (CVD) disproportionately affects non-Hispanic blacks (NHB) in the United States (U.S.). Afro-Caribbean (AC) immigrants comprise over 50% of the immigrant black population and are critical in understanding the health trajectories of blacks in the U.S. We assessed the relationship between length of residence (proxy measure for acculturation) and cardiovascular health (CVH) based on the American Heart Association’s (AHA) seven ideal cardiovascular health components among AC immigrants in New York City (NYC). CVH scores were categorized into poor/intermediate CVH (0–3 components) or ideal CVH (≥ 4 components). Multivariable logistic regression was used to examine the association between length of residence in the U.S. and poor/intermediate CVH. In adjusted models, the odds of poor/intermediate CVH were significantly higher for Guyanese (OR = 3.51; 95% CI 1.03–11.95) and Haitian immigrants (OR = 8.02; 95% CI 1.88–34.12) residing in the U.S. for ≥ 10 years than for those living in the U.S. for

Background: Overweight/obesity—a national epidemic affecting more than 70% of U.S. adults—is defined as Body Mass Index (BMI) ≥ 25kg/m 2 . It is associated with hypertension, diabetes, and cardiovascular disease. Overweight/obesity may be associated with depression which has been linked to poor health behaviors. The prevalence of overweight/obesity is disproportionally high among U.S. Blacks However, limited information is known about differences in the relationship between overweight/obesity and depression among Black U.S. born and foreign-born adults. We hypothesized that BMI would be associated with depression among a sample of Black adults in the U.S., and nativity would be an effect modifier of this association. Methods: We analyzed data on Black adults who participated in the 2009-2014 National Health and Nutrition Examination Surveys. The main predictor variable was depression on the Patient Health Questionnaire (PHQ-9). The main outcome variable was BMI. Linear regressions were performed to examine the relationship between BMI and depression adjusting for known confounders. Results were stratified by nativity (i.e., U.S. born versus foreign-born). Results: A total of 1,974 Black adults were included in this study. The mean age (±SD) was 46.8 (±17.9), nearly half (49.2%; n=972) were female, and 13.7% (n=270) identified as foreign-born. Overall, 79.8% (n=1360) of U.S. born and 83.1% (n-226) of U.S. foreign-born were overweight/obese. Additionally, 10.6% (n= 180) U.S. born and 6.7% (n=18) of foreign-born adults met criteria for mild, moderate, and moderately severe depression. After adjusting for age, sex, household income, and level of education, depression was a significant predictor of BMI among Black U.S. born and foreign-born adults (F (5, 1816) = 22.851, p2 =.386). We fitted an interaction term for nativity and BMI which was significant (p Conclusion: In Black adults residing in the U.S., we observed a positive association between depression scores and BMI with nativity status modifying this association. While depression was associated with BMI for females in both categories, depression was only associated with BMI in foreign-born Black males and not U.S. born Black males. Unique experiences among foreign-born populations may help explain the co-morbidity between depression and BMI, particularly among foreign-born males. Behavioral health interventions should be developed to account for differences among foreign-born Blacks that may increase risk for depression and associated health outcomes.

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide and in the United States (US). Foreign-born (FB) persons in the US are a rapidly increasing population. Despite increased awareness of important sex differences in CVD risk factors (CVDRF), few studies have examined this phenomenon among FB- and US-born adults Hypothesis: We hypothesize that sex differences exist in the prevalence of overweight/obesity, hypertension, diabetes, and hypercholesterolemia among FB- and US-Born participants. Methods: A retrospective cross-sectional design was used to examine the 2011-2016 National Health and Nutrition Examination Surveys. A generalized linear model using Poisson distribution was fitted to obtain age-adjusted predicted probabilities and risk of overweight/obesity, hypertension, diabetes, and hypercholesterolemia by place of birth. These CVD risk factors were defined according to national guidelines. Results: A total of 22429 participants were included with 29.68% (6658/22429) FB and 69.3% (15771/22429) US-born. The mean age was 47.5(±18.6 SD) years; 48.5% (10875/22429) were male. Overall, US-borns had higher prevalence of overweight/obesity (69.8% vs 63.8.0%; p Conclusion: Males were more likely to be overweight/obese and be hypertensive than females regardless of place of birth. US-born males were more likely to be diabetic but less likely to have hypercholesterolemia compared to their female counterparts. It is important to consider place of birth when examining sex-differences in CVD risk in the US population.

OBJECTIVES: Hypertension is a major burden among African migrants, but the extent of the differences in prevalence, treatment, and control among similar African migrants and nonmigrants living in different contexts in high-income countries and rural and urban Africa has not yet been assessed. We assessed differences in hypertension prevalence and its management among relatively homogenous African migrants (Ghanaians) living in three European cities (Amsterdam, London, and Berlin) and nonmigrants living in rural and urban Ghana. METHODS: A multicenter cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25-70 years. Comparisons between sites were made using prevalence ratios with adjustment for age, education, and BMI. RESULTS: The age-standardised prevalence of hypertension was 22 and 28% in rural Ghanaian men and women. The prevalence was higher in urban Ghana [men, 34%; adjusted prevalence ratio = 1.37, 95% confidence interval (CI), 1.10-1.70]; and much higher in migrants in Europe, especially in Berlin (men, 57%; prevalence ratio = 2.21, 1.78-2.73; women, 51%; prevalence ratio = 1.74, 1.45-2.09) than in rural Ghana. Hypertension awareness and treatment levels were higher in Ghanaian migrants than in nonmigrant Ghanaians. However, adequate hypertension control was lower in Ghanaian migrant men in Berlin (20%; prevalence ratio = 0.43 95%, 0.23-0.82), Amsterdam (29%; prevalence ratio = 0.59, 0.35-0.99), and London (36%; prevalence ratio = 0.86, 0.49-1.51) than rural Ghanaians (59%). Among women, no differences in hypertension control were observed. About 50% of migrants to 85% of rural Ghanaians with severe hypertension (Blood pressure > 180/110) were untreated. Antihypertensive medication prescription patterns varied considerably by site. CONCLUSION: Hypertension prevalence, awareness, and treatment levels were generally higher in African migrants, but blood pressure control level was lower in Ghanaian migrant men compared with their nonmigrant peers. Further work is needed to identify key underlying factors to support prevention and management efforts.Supplement Figure 1, http://links.lww.com/HJH/A831.

Background: Psychological distress, a leading cause of disability globally, is highly prevalent in people diagnosed with diabetes. Blacks in the U.S. are disproportionately affected by chronic conditions such as diabetes. Taken together, psychological distress and diabetes constitute an immense health burden and result in poor health outcomes, increased mortality and decreased quality of life. While the association between psychological distress and diabetes is documented among U.S.-born Blacks, this relationship remains poorly examined among the growing foreign-born Black population in the U.S. Hypothesis: We hypothesized that psychological distress (non-specific) would be associated with a higher prevalence of diabetes among a sample of foreign-born Blacks in the U.S. Methods: We analyzed data on adult foreign-born Blacks in the 2010-2014 National Health Interview Survey which is a national in-person survey of non-institutionalized persons in the U.S. The main independent variable was psychological distress which was defined as a score of ≥ 12 on the Kessler Psychological Distress Scale (K-6 Scale) . The main outcome variable was diabetes. Multivariable logistic regression was performed to examine the association between psychological distress and diabetes prevalence adjusting for known confounders. Results: A total of 2,974 foreign-born Blacks were included in this study. The mean age (±SE) was 43.9 (±15.3)and nearly half (53.3%) were female. Among the individuals who received the K-6 Scale, 13.3% indicated experiencing symptoms of depression within the last 30 days and 10% had diabetes. After adjusting for age, sex, body mass index, poverty status, and marital status, we observed that foreign-born Blacks with higher levels of psychological distress had 2.30 (95% CI: 1.69-3.12) higher odds of being diabetic in comparison to those without psychological distress. Conclusion: In a sample of contemporary foreign-born Blacks in the U.S., we observed that psychological distress was associated with prevalence of diabetes, such that individuals with elevated levels of psychological distress were twice as likely to be diabetic. Additional barriers may be associated with managing diabetes when a co-morbid mental health condition such as depression is present. Thus, culturally-tailored behavioral health interventions should be developed and utilized among foreign-born Black sub-populations to help promote adherence to complex behavioral and medical regimens associated with diabetes management.

Rapid changes in health care delivery require nurses to attain advanced knowledge, skills, and attitudes in biostatistics to provide high-quality, safe patient care. Advances in educational technologies support the delivery of graduate nursing education in online formats. Given the diversity of learning styles among graduate nursing students and the specific challenges in delivering biostatistics content in traditional formats, it is vital to include different delivery formats to engage and meet the learning needs of graduate nursing students who take biostatistics courses online. This article describes the pioneering approach of one graduate nursing program to implementing best practices for delivering an online biostatistics course to help master’s-prepared nurses attain both statistical literacy and statistical communication skills. [ J Nurs Educ . 2014;53(4):229–232.]

Context: There is a growing prevalence of cardiovascular disease (CVD) risk factors in West Africa and among its migrants to industrialized countries. Despite this, no study has reviewed CVD risk factor prevalence among West Africans in Africa and industrialized countries. Objective: To appraise studies on the prevalence of two CVD risk factors (hypertension and overweight/obesity) among two major West African populations (Ghanaians and Nigerians) in Africa and industrialized countries. Methods: A comprehensive literature search from 1996 to July 2012 was undertaken to identify quantitative studies on hypertension and overweight/obesity among adult Ghanaians and Nigerians in West Africa and industrialized countries. Results: Twenty studies were included with 10 conducted in Ghana, six conducted in Nigeria and four in industrialized countries. Studies in Ghana and Nigeria reported a hypertension prevalence of 19.3–54.6% with minimal differences between rural, urban, semi-urban, and mixed populations. Of the hypertensive patients, 14–73% were aware of their condition, 3–86% were on treatment, and 2–13% had controlled blood pressures. Overweight/obesity prevalence in Ghana and Nigeria ranged from 20 to 62% and 4 to 49%, respectively. The four studies in industrialized countries reported a hypertension prevalence of 8.4–55% and overweight/obesity prevalence of 65.7–90%. Conclusion: Hypertension and overweight/obesity are highly prevalent conditions in West Africa and in its migrants residing in industrialized countries. Urgent measures are needed to prevent CVD risk factors and halt the clinical sequelae.

Health behavior theories state that social environments influence health behaviors, but theories of how this occurs are relatively underdeveloped. This article systematically surveys community social capital concepts in health behavior literature and proposes a conceptual framework that integrates these concepts into existing behavioral theory. Fifty-three studies tested associations between community social capital concepts and physical activity (38 studies), smoking (19 studies), and diet (2 studies). Trustworthiness of community members was consistently associated with more health-promoting and less disease-promoting behaviors in 19 studies. Neighborly reciprocity showed mixed results in 10 studies. Reporting a good sense of community was associated with more physical activity in only 5 of 16 studies. Neighborhood collective efficacy, which includes social cohesion and informal social control, was inconsistently associated with behaviors in 22 studies. Behavioral social norms were associated with smoking and physical activity in 2 of 6 studies, and neighborhood modeling of physical activity was associated with increased activity in 12 of 17 studies, with 1 opposing result. This review identifies several community social capital–related concepts that are, at times, associated with both health-promoting and disease-promoting behaviors and often have no associations. Theory explains these findings by describing the relationships and interactions among these concepts. Using these findings, this article proposes a conceptual framework that integrates community social capital concepts into existing behavioral theory. Iterative empirically based theory development is needed to address these concepts, which affect behaviors. These results can also inform theoretically based community-based and socially tailored interventions.

Obesity is a highly prevalent cardiovascular disease risk factor globally and in African-descent populations. A cross-sectional study of obesity among a Nigerian immigrant sample population in the United States was conducted. Data was obtained through a web-based survey. Spearman's correlation and logistic regression were used to determine sociodemographic and behavioral determinants of obesity. The results showed no significant relationship between obesity and education, socioeconomic status, length of stay, and level of physical activity. However, we identified a significant association between weekly consumption of alcohol and all obesity (OR 1.78, 95 % CI 1.091, 2.919), and moderate/morbid obesity (OR 2.46, 95 % CI 1.213, 4.999), and between gender and moderate/morbid obesity-men were less likely (OR .030, 95 % CI .001, .733) to be obese. These findings provide strong evidence to inform targeted screening for excessive alcohol consumption along with other primary prevention strategies that may reduce the prevalence of obesity among the Nigerian immigrant population.

Background: The burden of cardiometabolic disease and associated risk factors including overweight/obesity, diabetes and hypertension is high in ethnic minorities in the United States (US). The size of the immigrant population in the US continues to grow rapidly. It has been posited that acculturation to the US society results in an elevation or reduction of risk for cardiometabolic disease in immigrants. Hypothesis: We hypothesized that increased years of US residence (proxy measure for acculturation) would be associated with a higher prevalence of overweight/obesity, diabetes and hypertension, known risk factors for cardiometabolic disease, in US immigrants. Methods: We analyzed data on adult US immigrants in the National Health Interview Survey (NHIS) from 2010-2014. The immigrants were from the following 9 regions of birth: Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, India, Central and Southeast Asia. The main independent variable was length of US residence; Results: Of the 54,984 immigrants, 62% were overweight/obese, 20 % had hypertension and 8% had diabetes. The mean age (± SE) was 43 (±0.15) years. Half were females and those who had resided in the US for ≥10 years were more likely to have health insurance coverage (70% vs 54%, p Conclusion: In an ethnically diverse sample of contemporary US immigrants, we found that increased length of US residence (acculturation) was associated with overall presence of cardiometabolic risk factors. Culturally-tailored public health strategies should be developed and implemented in immigrant sub-populations in the US to prevent the development of cardiometabolic disease.

Background Cardiometabolic risk ( CMR ) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. Methods and Results Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010–2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors. The mean ( SE ) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with P OR ], 1.19; 95% CI , 1.10–1.29), diabetic ( OR , 1.43; 95% CI , 1.17–1.73), and hypertensive ( OR , 1.18; 95% CI , 1.05–1.32) than those residing in the United States for Conclusions In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR .

Background The number of African immigrants in the United States grew 40‐fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease ( CVD ) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States. Methods and Results This cross‐sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35–74 years in the Baltimore–Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m 2 ) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/ dL . In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033–0.29) and 0.25 (95% CI 0.09–0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83–0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%. Conclusions The prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men.

Cardiovascular disease (CVD) remains the leading cause of death in the United States (US). African-descent populations bear a disproportionate burden of CVD risk factors. With the increase in the number of West African immigrants (WAIs) to the US over the past decades, it is imperative to specifically study this new and substantial subset of the African-descent population and how acculturation impacts their CVD risk. The Afro-Cardiac study, a community-based cross-sectional study of adult WAIs in the Baltimore-Washington metropolis. Guided by the PRECEDE-PROCEED model, we used a modification of the World Health Organization Steps survey to collect data on demographics, socioeconomic status, migration-related factors and behaviors. We obtained physical, biochemical, acculturation measurements as well as a socio-demographic and health history. Our study provides critical data on the CVD risk of WAIs. The framework used is valuable for future epidemiological studies addressing CVD risk and acculturation among immigrants.

In the 20th century, Africans in Sub-Saharan Africa had lower rates of cardiometabolic disease than Africans who migrated. How­ever, in the 21st century, beyond infectious diseases, the triple epidemics of obesity, diabetes and hypertension have taken hold in Africa. Therefore, Africans are acquiring these chronic diseases at different rates and different intensity prior to migration. To ensure optimal care and health outcomes, the United States practice of grouping all African-descent populations into the “Black/ African American” category without regard to country of origin masks socioeconomic and cultural differences and needs re-evalu­ation. Overall, research on African-descent populations would benefit from a shift from a racial to an ethnic perspective. To dem­onstrate the value of disaggregating data on African-descent populations, the epide­miologic transition, social, economic, and health characteristics of African immigrants are presented. Ethn Dis. 2015;25(3):373- 380.

Introduction: There are research gaps on cardiovascular disease (CVD) risk of the burgeoning West-African immigrants (WAI) in the United States (US) because they are lumped into the racial category of “Black/African-American”. The epidemiological transition in Africa suggests that WAI may be at high risk for CVD prior to migration, which may worsen with increased years of US residence. We sought to examine the global CVD risk using the 10-year Framingham CVD score (FRS10), CVD risk factors and identify independent predictors of increased CVD risk, among WAI. Methods: The “AFRO-CardiAC” study is a community-based cross-sectional study among first generation WAI aged 35-74 years, born in Ghana/Nigeria and residing in the Washington, D.C metropolis. Cardiovascular disease risk factors (total cholesterol, HDL cholesterol, hypertension (HTN), diabetes, smoking and body mass index) and health behaviors were determined according to AHA guidelines. Descriptive statistics were performed on participant’s FRS10 and CVD risk factors with comparison by sex. Participants with FRS10 below 10% were deemed low risk and those at ≥ 10% were classified as high risk. A multivariate logistic regression was fitted to identify independent risk factors associated with high CVD risk. Results: A total of 145 participants have been recruited to date; aged 50±8.5years and 61% female. The majority (72%; 104/145) have resided in the US for more than 10 years. The overall prevalence of HTN was 53% with no significant difference between males (46%) and females (57%)[p=0.201]. The prevalence of overweight/obesity was 94% in females and 82% in males (p Conclusion: In conclusion, this preliminary analysis of an ongoing study shows a high prevalence of major CVD risk factors in relatively young WAI. Males had a significantly higher global CVD risk although females had a striking prevalence of overweight/obesity. Employment was protective against high CVD risk while lower income and longer stay in the US were associated with higher CVD risk. These data suggest a need for CVD prevention strategies that are tailored to the needs of the WAI with consideration of socioeconomic status and gender.

BACKGROUND Adequate self-care is crucial for blood pressure control. A number of hypertension (HBP) self-care instruments are available, but existing tools do not capture all the critical domains of HBP self-care and have limited evidence of reliability and validity. OBJECTIVE The purpose of this study was to develop and validate a new tool--the HBP Self-Care Profile (HBP SCP)--in a sample of inner-city residents. METHODS The HBP SCP encompasses comprehensive domains of HBP self-care behaviors. Guided by 2 validated theoretical approaches--Orem's self-care model and Motivational Interviewing--the HBP SCP includes 3 scales that can be used together or independently: Behavior, Motivation, and Self-efficacy. The sample included 213 English-speaking inner-city residents with HBP (mean age, 68.6 years; 76.1% women; 81.7% African American). RESULTS Item-total correlations ranged from 0.20 to 0.63 for Behavior, 0.46 to 0.70 for Motivation, and 0.40 to 0.74 for Self-efficacy, meeting the cutoff set a priori at 0.15. Internal consistency reliability coefficients ranged from 0.83 to 0.93. Concurrent and construct validities of the HBP SCP were achieved by significant correlations between HBP SCP scales and theoretically selected instruments (P < .05 for all correlation coefficients). The HBP SCP-Behavior scale also successfully discriminated between those with or without blood pressure control (P < .05). CONCLUSIONS The reliability and validity of the HBP SCP were supported in this sample of inner-city residents with HBP. The high reliability estimates and strong evidence of validity should allow researchers to use the HBP SCP to assess and identify gaps in HBP self-care behavior, motivation, and self-efficacy. Future research is warranted to evaluate the HBP SCP in diverse ethnic and age samples of hypertensive patient populations.

Cardiovascular disease (CVD) is especially prevalent among vulnerable populations. This health disparity is true across all vulnerable populations from ethnic minority 1, to low-income2–4, to income poor neighborhoods5,6 and high risk geographic regions in the United States (US) 7,8. Corresponding disparities also exist for CVD risk factors, such as obesity, hypertension, smoking and sedentary lifestyles 1–3. Further, despite US prioritization of addressing the health needs of these vulnerable populations1,9, cardiovascular disparities in the US have generally worsened over the past three decades4,10. Reasons for this disparity in CVD include, but are not limited to, fewer socioeconomic resources11, limited English proficiency 12 and differences in quality of care for vulnerable populations13–17 even when health access is accounted for12,13,17. Davis and colleagues18 conducted a systematic review of health care interventions from 1995 to 2006, focusing specifically on cardiovascular health in racial/ethnic minority populations. They concluded that high-quality research specifically addressing reduction of cardiovascular racial and ethnic disparities is virtually nonexistent. Their review however, did not include interventions that were exclusively community focused, such as faith- and school based programs, which have increasingly been shown to produce positive effects in improving physical activity, weight loss, and blood pressure (BP) control. Furthermore, the review only focused on racial/ethnic minority populations, one segment of the population who may be disproportionately vulnerable to CVD. Therefore, the purpose of this paper was to conduct a systematic review of community based cardiovascular health interventions in vulnerable populations. Reviewing the existing literature is especially important with the Affordable Health Care Act providing access to individuals from more vulnerable populations. Improving access however, is not sufficient to reduce cardiovascular disparities as it is critical to determine what approaches work well for specific populations. This review adds to the analysis by Davis and colleagues18 by analyzing interventions with a community-based component. Further, this review includes research with vulnerable low-income populations irrespective of race or ethnicity. Vulnerable populations are defined in various ways. Vulnerability can be broadly defined as, “the susceptibility to harm 19 (p. 1220).” The literature is often defined by the way vulnerability is identified, most often as people who are from rural, poor, racial or ethnic minority or special groups such as veterans, uninsured without health insurance, disabled, homeless, or the elderly with numerous coexisting chronic illnesses19. Additionally, vulnerability is often measured using broad dichotomies- i.e. a population of vulnerable/non-vulnerable people. However, evolving conceptualizations of vulnerability view it as a multidimensional construct, resulting from numerous individual as well as community level factors 20, and this is the viewpoint guiding the inclusion of studies in this paper. Health outcomes observed as a result of this approach to defining vulnerability would need to consider both individual and community level factors in order to identify health disparity patterns. Consequently, interventions that extend beyond a single risk factor to target multiple risk factors would likely be more efficacious20. In 2010, the American Heart Association (AHA), the leading voluntary health organization in CVDs and stroke, changed its focus from reducing the burden of CVD to promoting cardiovascular health21. It defined ideal cardiovascular health as the simultaneous presence of ideal health behaviors (nonsmoking, body mass index

Tobacco smoking remains a prevalent behavior in people living with HIV infection (PLWHs) and is associated with impaired immune functioning, increased cardiovascular risk, and decreased response to antiretroviral therapy. This review presents a critique and synthesis of evidence on effective smoking-cessation interventions for PLWHs. A comprehensive search identified nine peer-reviewed intervention studies published between 1989 and 2012. The highest likelihood of smoking cessation (range of odds ratios 4.33-5.6) were in two randomized controlled trial interventions using cell phone technology. Clinically significant reductions in systolic blood pressure, weight gain, and increased CD4+ T-cell count were reported in participants who ceased smoking in three of the nine studies. Overall, multistrategy smoking-cessation interventions, delivered over multiple sessions, were effective. However, the most effective interventions were tailored to the unique individual needs of PLWHs, including assessment of and intervention for polysubstance abuse and mental health issues, as well as the inclusion of access-promoting elements. © 2014 Association of Nurses in AIDS Care.

This study sought to examine assumption between having ever used non-cigarette tobacco or smokeless tobacco, and a diagnosis of hypertension among a sample of 13, 086 United States adults participating in the National Health Interview Series from 2012-2014. A pseudo-panel analysis of data extracted from the Integrated Health Interview Series Survey was conducted. The generalized linear mixed model was used to quantify the effect of a history of non-cigarette tobacco, smokeless tobacco, and socio-demographic predictor variables on the response variable, a diagnosis of hypertension. The transformed data, based on the pseudo-panel technique, resulted in fifty-seven (57) birth cohorts and followed in 2012, 2013, and 2014. The mean age was 51.6 years (±12.4). The findings of this study revealed that the odds of hypertension diagnosis for non-cigarette tobacco users was 0.8846 times lower (95% CI: 0.7907, 0.9896) than non-users after adjusting for possible confounders such as age, language, education, income and years of smoking. Our study suggested that the association between the use of non-cigarette tobacco and the diagnosis of hypertension among the sample population is consistent enough to assume a less plausible association between the two variables.