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The Strong Black Woman (SBW) schema is described as a statue of unrelenting strength, resilience, and self-sufficiency, serving as a shield of protection and cultural adaptation to suppress and control manifestations of racial and gender oppression. Stemming from superwoman syndrome, a conceptual model exploring the multifactorial roles women hold and their impact, the SBW extends beyond gender roles to the sociopolitical context of the Black woman's lived experience. Endorsement of the SBW posits risk for health disparities including stress, anxiety, depression, and obesity. This review was conducted to explore the SBW schema and experiences of Black women who endorse it, to delineate how Black women describe themselves in relation to the SBW persona, and to inform further inquiry, nursing practice, and clinical approaches to improving health outcomes of this population. A systematic review of qualitative studies was conducted with a literature search from CINAHL, APA PsycINFO, MEDLINE, PubMed, and SocINDEX databases yielding seven relevant papers for this analysis. Studies using the superwoman schema and the SBW schema with participants who identified as Black women were included in the review. Consistent with the SBW phenomenon, many participants described examples and consequences of being an SBW. While most women identified with SBW, not all endorsed the persona entirely, challenging its ideal and reinforcing positive self-care. Themes include (a) Strength by nature, not choice, (b) Suppressed emotion, (c) Success over everything, and (d) Prioritizing others over self. Additional emerging themes are also included. Black women increasingly recognize the negative impacts of the SBW schema, pinpointing how their internal feelings manifest in their external world. The conceptual framework itself is an anomaly, incongruently impacting both the mental and physical health of Black women, further contributing to the long-term health and sociopolitical disparities that Black women experience. Simply acknowledging and understanding these experiences by healthcare practitioners are not enough to prevent or eliminate the risks involved with the endorsement of the SBW schema but rather intentionally addressing these as a contributing social determinant of health that predisposes them to long-term chronic conditions. [ABSTRACT FROM AUTHOR]

People experiencing homelessness (PEH) have stated that impersonal care and feelings of discrimination are barriers to accessing healthcare which is associated with poor health outcomes amongst PEH. This study examined whether patient‐centred care (PCC) mediates the relationship between access to care and subjective health outcomes. Using the 2014–15 Healthcare Center Patient Survey, we identified 1873 homeless and vulnerably housed adults. Items related to the delay or inability to receive primary or mental healthcare, PCC provided by healthcare providers, general health status, and the Kessler‐6 psychological distress scale were selected. Ordinary least squares analyses were used to perform mediation analysis. We found that both access to primary care and access to mental healthcare were positively associated with physical health status (β = 0.492, p < 0.001; β = 0.311, p < 0.001) and negatively associated with psychological distress (β = −2.53, p < 0.001; β = −1.85, p < 0.001). PCC partially mediated all associations, but the mediation was stronger in the relationships between access to primary care and health outcomes (ab = 0.25, 95% CI [0.002, 0.052]; ab = −0.21, 95% CI [−0.37, −0.07]) compared to mental healthcare (ab = 0.02, 95% CI [0.01, 0.04]; ab = −0.14, 95% CI [−0.25, −0.06]). The results of this study indicated access to primary and mental healthcare is important in the patient‐centred health outcomes of PEH. Additionally, the partial mediation of PCC in these relationships indicated that participants' perception of collaborative, trustworthy, respectful care from healthcare providers impacted the relationship between access to healthcare and health outcomes. [ABSTRACT FROM AUTHOR]

Objectives Guided by the social convoy model, this study investigated the association between friendship and cognitive functioning among older Chinese adults, as well as the moderating effect of marital status (married vs widowed). We also explored whether depression might account for the link between friendship and cognitive functioning. Methods We used data from the China Longitudinal Aging Social Survey in 2014 (N = 8,482). Cognitive functioning was measured with the Mini-Mental State Examination instrument and friendship was assessed with a 3-item Lubben Social Network Scale. Linear regression and path analyses within a structural equation modeling framework were performed to examine the hypotheses. Results Results indicated that friendship was significantly related to better cognitive functioning among older Chinese adults (β = 0.083, p <.001) and marital status moderated this association (β = −0.058, p <.01). In addition, depression partially mediated the relationship between friendship and cognitive functioning (β = 0.015, p <.001). Discussion The results implied that friendship is important for maintaining cognitive functioning in later life and widowed older Chinese adults may benefit more from friendship in its relationship to cognitive functioning than married older Chinese adults. Further, one potential pathway linking friendship to cognitive functioning may be through depression; however, more research is needed to support this finding. Intervention programs aimed at building friendship opportunities may be one way to achieve better cognitive aging. [ABSTRACT FROM AUTHOR]

Clinical trials (CTs) test new medical products for safety and effectiveness. Despite federal policy aimed at generating greater inclusivity of people of color (POC) in CTs, disparity in (CT) enrollment persists. Non-Hispanic White patients comprise the majority of CT participants while Black and Hispanic patient participation has declined over the past decade. The scope of Clinical Research Nurses (CRNs) includes recruitment of participants for CTs. The aim of this phenomenological study was to describe adult oncology CRNs' lived experiences of recruiting POC cancer patients to participate in CTs. The first paper for this study identified three major themes regarding how CRNs view their role in caring for POC considering or enrolling onto cancer clinical trials (CCTs): CRNs act as advocates, care coordinators and educators. This paper focuses on two additional major themes regarding how CRNs view the unique needs of POC in clinical research: establishing and maintaining trusting relationships and recruitment infrastructure. Nineteen nurses participated in semi-structured one-to-one interviews and data analysis was based on Colaizzi's method. CRNs described a history of past research injustices, disparate access to care, inadequate cultural training, a physician-driven recruitment structure and provider-based implicit biases that hinder POC enrollment in CTs. Diversity in CCT enrollment requires CRNs to establish trust with POC, advocate for POC when implicit biases are observed and become competent practitioners of culturally sensitive care. Further, meaningful policy change at both federal and organizational levels must occur to ensure equitable access to novel cancer therapies. [ABSTRACT FROM AUTHOR]

To identify components of efficacious interventions for multiple health behavior change (MHBC) in adult cancer survivors or adults at high risk for cancer. Methods: A systematic review of MHBC interventions was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Results: Ten studies met inclusion criteria. Most studies changed at least 2 health behaviors. Diet, exercise, and smoking cessation were consistently changed with in-person interventions. Longer duration interventions using phone or mail contact had a positive association with changing diet and exercise. Conclusions: MHBC interventions positively influenced behavior change in adults with cancer and those at high risk for cancer. Future studies should focus on increasing dissemination and implementation of efficacious interventions. [ABSTRACT FROM AUTHOR]

Objective: This study explored perspectives held by parents of elementary schoolchildren regarding wellness policy regulation of classroom celebrations. Methods: Parents in a predominately Latino community completed a survey about past practice and current thoughts regarding policies regulating classroom celebrations. Results: Most parents surveyed (N = 124) opposed banning celebrations, but were in favor of policy regulation of the events. Those who completed a Spanish version of the survey were significantly more likely than those completing an English version to be unsure of the existence of wellness policies. Conclusion: Many schools need to address policy regulation of classroom celebrations and parental perspective is an important component to explore. Improving communication of policy guidelines to non-English speaking parents is needed. [ABSTRACT FROM AUTHOR]

Clinical trials (CTs) are the established research mechanism designed to examine how new medical therapies are tested for safety and effectiveness. Specifically, non-Hispanic White patients still account for most CT participants and Black patient participation has declined over the past decade. Clinical Research Nurses (CRNs) whose scope of practice includes the recruitment of participants for CTs, have the potential to significantly increase minority patients participation in cancer clinical trials (CCTs). The aim of this phenomenological study was to describe adult oncology CRNs' lived experiences of recruiting minority cancer patients to participate in CTs. A total of 19 nurses participated in semi-structured one-to-one interviews and data analysis was based on Colaizzi's method. The role of CRNs was described as advocates who coordinate care, establish trust, and provide education for CT patients within physician-driven recruitment structures. The CRN's role was also described as self-taught or learn on the go with no formalized recruitment training and lack of robust cultural training. To achieve diverse patient enrollment in CCTs, CRNs and study staff need to receive training on culturally competent clinical research care and the diversity of CRNs and study teams must be increased. Further, meaningful federal and hospital policy change must occur so that minority patients have equitable access to novel cancer therapies and the role of the CRN is delineated from other healthcare staff to optimize research patient care. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate pain severity and distribution in relation to sleep difficulty in older adults. DESIGN: Population-based cross-sectional study. SETTING: Community within a 5-mile radius of the study center at the Institute for Aging Research, Hebrew SeniorLife (HSL), Boston. PARTICIPANTS: Seven hundred sixty-five participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study aged 64 and older. MEASUREMENTS: Pain severity was measured using the Brief Pain Inventory (BPI) Pain Severity Subscale. Musculoskeletal pain distribution was grouped according to no pain, single site, two or more sites, and widespread pain (upper and lower extremities and back pain). Three aspects of sleep difficulty were measured using items from the Center for Epidemiologic Studies Depression Scale, Revised (trouble getting to sleep, sleep more than usual, and restless sleep). RESULTS: Prevalence of trouble getting to sleep according to BPI severity was 17.8%, 19.7%, 32.0%, and 37.0% for the lowest to highest pain severity quartiles, respectively. Similar relationships between pain and sleep were observed across sleep measures according to pain severity and distribution. Adjusted for sociodemographic characteristics, chronic conditions, and health behaviors, chronic pain was strongly associated with trouble sleeping (≥1 d/wk) (single-site pain, odds ratio (OR)=1.77, 95% confidence interval (CI)=1.10-2.87; multisite pain, OR=2.38, 95% CI=1.48-3.83; widespread pain, OR=2.55, 95% CI=1.43-4.54, each compared with no pain). Similar associations were observed for restless sleep and sleeping more than usual. For specific pain sites alone or in combination with other sites of pain, only modest associations were observed with sleep problems. CONCLUSION: Widespread or other multisite pain and moderate to severe pain are strongly associated with sleep difficulty in older adults. Further research is needed to better understand the burden and consequences of pain-related sleep problems in older adults. [ABSTRACT FROM AUTHOR]

The article discusses cardiovascular disease (CVD), prevention targeted at health behaviors, and guidelines for preventing CVD. The author explores studies that provide the evidence for practice guidelines in prevention and management, such as the Diabetes Prevention Program clinical trial. Reduction of risk in minority populations is also explained.

The article presents a speech given by Laura L. Hayman at the 27th Annual Meeting of the Society of Behavioral Medicine with the theme "Behavioral Medicine Across the Lifespan," held in San Francisco, California on March 22-25, 2007. Hayman discussed the life course approach to the prevention of cardiovascular disease.

Purpose: Current literature indicates that childhood obesity is associated with family structure type. For example, children living in grandparent-headed households are more likely to be obese compared to children living in two-parent headed households. However, little is known about the conditions that might interact with family structure to influence children's obesity. Since family protective factors are known to directly influence childhood obesity, we examined whether two specific family protective factors might moderate the association between family structure type and childhood obesity. Methods: We utilized data from the 2017-2018 National Survey of Children's Health (n=24,800). Multivariable logistic regressions were used to assess the moderating effect of "family resilience" and families eating meals (7 vs. < 7 days/week). We controlled for child's sex, age, race/ethnicity, health insurance, number of adverse childhood experiences, and physical activity level. We tested the moderating effect of family resilience and family meals as dichotomous variables, on the association between family structure type and obesity. Results: In the fully adjusted models, we observed no significant moderating effect of family resilience on the association between family structure type and childhood obesity. There was a moderating effect of the family meal variable: In grandparent-headed households (compared to two-parent headed households), children were significantly less likely to be obese when families ate meals together 7 days/week (adjusted odds ratio [aOR] =0.95) vs. < 7 days/week (aOR = 2.55). In single-parent headed households, the association did not differ significantly by that variable (aOR =1.02 vs. 1.46). Conclusion: Our results provide evidence that eating meals together is one family protective factor that could be important considerations when developing family-based obesity interventions for children living with their grandparents. Disclosure: M. Song: None. L. L. Hayman: None. N. Dieckmann: None. C. Musil: None. [ABSTRACT FROM AUTHOR]

AbstractThe purpose of this study was to identify the relationship between parents and children in measuring children’s acute and delayed nausea and vomiting induced by cancer chemotherapy. Twenty parent–child dyads participated in the study. Both instruments: Adapted Rhodes Index of Nausea and Vomiting by parent and by child (8–18 years old) were used every 12 h. The reliability and validity of these instruments have been established. There were significantly moderate to strong associations between parents and children in measuring these symptoms from Day 1 to Day 3 (total scores: r = 0.85–0.93; nausea scores: r = 0.67–0.93; and vomiting scores: r = 0.91–0.99, all P < 0.01). Therefore, parents’ observation of their children’s symptoms was strongly associated with their child’s self-report of symptoms. Parents were able to assess their children’s acute and delayed nausea and vomiting because in this sample almost all parents accompanied their children all day long. [ABSTRACT FROM AUTHOR]

Describes the role of the family coordinator in longitudinal research. Strategies for dealing with issues in longitudinal family research; Reluctance to participate; Family changes/crises; Situational stressors; Skills required by a nurse specialist in the family coordinator role.

There is no single accepted definition used in policy or research for the concepts of homelessness and vulnerably housed. Neuman's systems model (NSM) was the framework for this mixed-studies review, with the client system defined as these social issues and categorized as environmental stressors. Eighteen unique definitions of the concepts were identified in 30 studies. Extrapersonal stressors included housing history, interpersonal stressors included dependence on others for housing, and intrapersonal stressors included self-identification. Each level of stressor should be considered when defining these populations for inclusion in future research. Proposed definitions were formulated from the analysis of the results. [ABSTRACT FROM AUTHOR]

Background: Because of the COVID-19 pandemic, our research team quickly pivoted from planned face-to-face interaction with participants to virtual interactions. During this transition, we discovered invaluable new practices for conducting research remotely, including collecting physiological data. Objective: Our objective was to describe the methodological challenges we encountered when conducting this research virtually with grandparent-grandchild dyads and describe the strategies we developed to overcome those challenges. Of primary focus were procedures for finger-stick blood sample collection. Of secondary focus were procedures for conducting virtual-based research with older adults and across multiple generations. Methods : During an observational study utilizing a virtual platform with 11 grandparent-grandchild dyads (mean age: 64.2 +/- 5.0 years for grandparents and 9.3 +/- 1.9 years for grandchildren), we documented lessons learned (based on the discussion within our team and feedback we have received from participants) that could be applicable for other, similar research endeavors. Results : We found several challenges in collecting blood samples, including staff were unfamiliar with providing online instruction and participants needed to develop familiarity with the blood sample collection process (without having in-person assistance), and we had to develop methods for delivering blood sample collection kits to participants safely. We also found that it took longer than expected to run procedures-a challenge that might be encountered when conducting any type of dyadic research utilizing a virtual platform-particularly involving older adults and across multiple generations. In addition, it was challenging to keep child participants engaged in the virtual interactions. We document how we employed targeted strategies to overcome those obstacles. Recommendations for strategies from our team include to provide comprehensive and clear instruction/materials on blood sampling procedure, offer generous support throughout the blood collection process, be prepared to divide study visits into more than one session as needed, proactively anticipate potential roadblocks, and carefully consider the participants' developmental stages and attention span. Discussion : The insights we gained will help inform future research with grandparent-grandchild dyads in remote or rural populations utilizing virtual platforms. [ABSTRACT FROM AUTHOR]

Physicalinactivity has been a public health problem worldwide for more than a decade. Of those who are physically active, a substantial percentage engage solely in low or very low physical activity (PA) levels. In the last 3 decades, the prevalence of PA in the United States has decreased with approximately 80% of adults not meeting the recommended guidelines for aerobic and muscle strengthening PA. The PA levels of youth have dramatically decreased with 85% of adolescents reporting no PA. Regular PA participation can aid in preventing chronic diseases. A strong inverse dose‐response relationship exists between PA and the incidence of cardiovascular disease, all‐cause and cardiovascular mortality. Moreover, low cardiorespiratory fitness levels are a risk factor for cardiovascular diseases: the leading cause of death and disability globally. Conversely, high amounts of moderate‐to‐vigorous intensity PA at levels 3–5 times recommended in guidelines reduce risk for all cause mortality. Socio‐ecological determinants of PA are essential considerations for promoting across the life course. In health care and community settings, public health nurses have opportunities to promote PA through a socio‐ecological approach across the life course of individuals and diverse populations. [ABSTRACT FROM AUTHOR]

Cardiometabolic risk is increasing in prevalence across the life span with disproportionate ramifications for youth at socioeconomic disadvantage. Established risk factors and associated disease progression are harder to reverse as they become entrenched over time; if current trends are unchecked, the consequences for individual and societal wellness will become untenable. Interrelated root causes of ectopic adiposity and insulin resistance are understood but identified late in the trajectory of systemic metabolic dysregulation when traditional cardiometabolic risk factors cross current diagnostic thresholds of disease. Thus, children at cardiometabolic risk are often exposed to suboptimal metabolism over years before they present with clinical symptoms, at which point life-long reliance on pharmacotherapy may only mitigate but not reverse the risk. Leading-edge indicators are needed to detect the earliest departure from healthy metabolism, so that targeted, primordial, and primary prevention of cardiometabolic risk is possible. Better understanding of biomarkers that reflect the earliest transitions to dysmetabolism, beginning in utero, ideally biomarkers that are also mechanistic/causal and modifiable, is critically needed. This scientific statement explores emerging biomarkers of cardiometabolic risk across rapidly evolving and interrelated "omic" fields of research (the epigenome, microbiome, metabolome, lipidome, and inflammasome). Connections in each domain to mitochondrial function are identified that may mediate the favorable responses of each of the omic biomarkers featured to a heart-healthy lifestyle, notably to nutritional interventions. Fuller implementation of evidence-based nutrition must address environmental and socioeconomic disparities that can either facilitate or impede response to therapy. [ABSTRACT FROM AUTHOR]

Introduction: Although resistance training (RT) can lead to acute improvements in psychological, physiological and psychosocial outcomes, prevalence rates remain low in college-age females likely due to perceived barriers. This study compared the effects of an acute bout of both a functional RT (FRT) and traditional RT (TRT) session on affect, state anxiety enjoyment and physiological measures. Methods: Females (n = 34, mean age = 27 ± 4.5 yr) not currently meeting American College of Sports Medicine RT guidelines completed four sessions (2 FRT, 2 TRT) within 4 wk in a randomized crossover design. Session 1 familiarized participants to the RT exercises. Session 2 consisted of 2 × 10 moderate intensity repetitions. Outcome measures included affect and state anxiety (preexercise, postexercise, and 15 min postexercise); enjoyment (post), and manipulation measures of session RPE and HR). Results: Between-condition comparisons indicate change scores in state anxiety pre- to post-15 (P = 0.028) and enjoyment levels post- (P = 0.02) were significantly greater in FRT than TRT. Within-condition analyses revealed pre- to post-15 changes in affect were positive and greater in FRT (d = 0.79) than TRT (d = 0.53, P = 0.47), and greater in decreases in state anxiety (FRT, d = −0.58; TRT, d = −0.37, P = 0.028). Mean session RPE was not significantly different between conditions (FRT 6 ± 1.2 units; TRT 6.3 ± 1.1 units; P = 0.11), though average percent of age-predicted maximum HR (FRT 68.7 ± 7.6; TRT 57.1 ± 8.4) was significantly different (P < 0.01). Conclusions: Findings suggest that compared with TRT, FRT is associated with higher acute positive psychological states, higher levels of enjoyment, and greater energy expenditure. Future studies are recommended to examine additional measures of affect and in-task timepoints to determine how these responses relate to maintenance and adherence, thereby potentially increasing the proportion of college females meeting American College of Sports Medicine RT and moderate-to-vigorous physical activity guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Early detection and improved treatment have increased lung cancer survival. Lung cancer survivors have more symptom distress and lower function compared with other cancer survivors; however, few interventions are available to improve health-related quality of life (HR-QOL). Lifestyle risk reduction interventions have improved HR-QOL in other cancer survivors. The purpose of this study was to explore lung cancer survivor perspectives on making behavioral changes in the context of a lifestyle risk reduction intervention.Methods: Twenty-two lung cancer survivors participated in interviews after completing the Healthy Directions (HD) intervention. Interviews were audiotaped, transcribed, and analyzed using inductive content analysis. Demographic and clinical characteristics were gathered through a survey and analyzed using descriptive statistics.Results: Five main themes were identified: (1) the diagnosis was a motivator for behavior change, (2) participants had to deal with disease consequences, (3) the coach provided guidance, (4) strategies for change were initiated, and (5) social support sustained behavioral changes. Other important subthemes were the coach helped interpret symptoms, which supported self-efficacy and goal setting, and survivors employed self-monitoring behaviors. Several participants found the recommended goals for physical activity were difficult and were discouraged if unable to attain the goal. Findings underscore the need for individualized prescriptions of physical activity, especially for sedentary survivors.Conclusions: Lung cancer survivors described the benefits of coaching to enhance their engagement in behavioral change. Additional research is needed to validate the benefit of the HD intervention to improve HR-QOL among this vulnerable and understudied group of cancer survivors. [ABSTRACT FROM AUTHOR]

Background/Purpose: Asthma is a prevalent chronic condition with excess disease burden in school-aged, minority children from low income inner-city communities. Conceptualized within a nursing and socio-ecological framework, the purpose of this secondary analysis of inner-city school-aged children with asthma was to quantify how parental characteristics and local environment affect stress and health knowledge that, in turn, encourage or discourage better parent asthma management behaviors (AMB). Theoretical Framework: Dorothea Orem's Self-Care Framework and Albert Bandura's Social Cognitive Theory were used. Methods: A prospective, correlational study with a longitudinal design of inner-city, school-aged children with asthma was conducted. The sample included 351 school-aged children (7.9 years old, SD= 1.9 years; 53.0% male; 95.7% minority). Parents reported race, education, income, stress, housing, family and neighborhood characteristics, as well as AMBs (including medication administration, routine healthcare visits, smoke and pest exposure) at baseline. Smoke and pest exposure was also measured at four follow-up points every 3 months. Logistic regression was used for each AMB model. Logistic generalized estimation regression was used for children's smoke and pest exposure due to the repeated quarterly wave nature of the data. Results: Controlling for demographics and inner-city characteristics, parents with high stress were more likely to have children with passive smoke exposure (OR=1.6, p=.04) and miss healthcare appointments (OR=5.2, p=.05). Parents who missed their child's healthcare appointments and have pests in their home were both more likely to live in an unmaintained neighborhood (OR=7.6, p=.001; OR=1.8, p=.002) and have more family members in their home (OR=5.0, p=.01; OR=2.0, p=.000). Lastly, parents with asthma knowledge were more likely to administer medications regularly (OR=15.2, p=.01). Conclusions/Implications: Parents with high stress and who reside with large families in unmaintained neighborhoods are at higher risk for not performing AMBs that support the best outcomes for their child with asthma. Implementation of nationally recommended, evidence-based interventions for child homes and parent education of asthma through transdisci-plinary healthcare providers for this inner-city population are needed. Research on the implementation science of these interventions and role of parent stress on the effectiveness of these interventions in the inner-city population is necessary. [ABSTRACT FROM AUTHOR]

Asian American individuals make up the fastest growing racial and ethnic group in the United States. Despite the substantial variability that exists in type 2 diabetes and atherosclerotic cardiovascular disease risk among the different subgroups of Asian Americans, the current literature, when available, often fails to examine these subgroups individually. The purpose of this scientific statement is to summarize the latest disaggregated data, when possible, on Asian American demographics, prevalence, biological mechanisms, genetics, health behaviors, acculturation and lifestyle interventions, pharmacological therapy, complementary alternative interventions, and their impact on type 2 diabetes and atherosclerotic cardiovascular disease. On the basis of available evidence to date, we noted that the prevalences of type 2 diabetes and stroke mortality are higher in all Asian American subgroups compared with non-Hispanic White adults. Data also showed that atherosclerotic cardiovascular disease risk is highest among South Asian and Filipino adults but lowest among Chinese, Japanese, and Korean adults. This scientific statement discusses the biological pathway of type 2 diabetes and the possible role of genetics in type 2 diabetes and atherosclerotic cardiovascular disease among Asian American adults. Challenges to provide evidence-based recommendations included the limited data on Asian American adults in risk prediction models, national surveillance surveys, and clinical trials, leading to significant research disparities in this population. The large disparity within this population is a call for action to the public health and clinical health care community, for whom opportunities for the inclusion of the Asian American subgroups should be a priority. Future studies of atherosclerotic cardiovascular disease risk in Asian American adults need to be adequately powered, to incorporate multiple Asian ancestries, and to include multigenerational cohorts. With advances in epidemiology and data analysis and the availability of larger, representative cohorts, furthering refining the Pooled Cohort Equations, in addition to enhancers, would allow better risk estimation in segments of the population. Last, this scientific statement provides individual- and community-level intervention suggestions for health care professionals who interact with the Asian American population. [ABSTRACT FROM AUTHOR]

Background: Although public health programs have led to a substantial decrease in the prevalence of tobacco smoking, the adverse health effects of tobacco smoke exposure are by no means a thing of the past. In the United States, 4 of 10 school-aged children and 1 of 3 adolescents are involuntarily exposed to secondhand tobacco smoke (SHS), with children of minority ethnic backgrounds and those living in low-socioeconomic-status households being disproportionately affected (68% and 43%, respectively). Children are particularly vulnerable, with little control over home and social environment, and lack the understanding, agency, and ability to avoid SHS exposure on their own volition; they also have physiological or behavioral characteristics that render them especially susceptible to effects of SHS. Side-stream smoke (the smoke emanating from the burning end of the cigarette), a major component of SHS, contains a higher concentration of some toxins than mainstream smoke (inhaled by the smoker directly), making SHS potentially as dangerous as or even more dangerous than direct smoking. Compelling animal and human evidence shows that SHS exposure during childhood is detrimental to arterial function and structure, resulting in premature atherosclerosis and its cardiovascular consequences. Childhood SHS exposure is also related to impaired cardiac autonomic function and changes in heart rate variability. In addition, childhood SHS exposure is associated with clustering of cardiometabolic risk factors such as obesity, dyslipidemia, and insulin resistance. Individualized interventions to reduce childhood exposure to SHS are shown to be at least modestly effective, as are broader-based policy initiatives such as community smoking bans and increased taxation. Purpose: The purpose of this statement is to summarize the available evidence on the cardiovascular health consequences of childhood SHS exposure; this will support ongoing efforts to further reduce and eliminate SHS exposure in this vulnerable population. This statement reviews relevant data from epidemiological studies, laboratory-based experiments, and controlled behavioral trials concerning SHS and cardiovascular disease risk in children. Information on the effects of SHS exposure on the cardiovascular system in animal and pediatric studies, including vascular disruption and platelet activation, oxidation and inflammation, endothelial dysfunction, increased vascular stiffness, changes in vascular structure, and autonomic dysfunction, is examined. Conclusions: The epidemiological, observational, and experimental evidence accumulated to date demonstrates the detrimental cardiovascular consequences of SHS exposure in children. Implications: Increased awareness of the adverse, lifetime cardiovascular consequences of childhood SHS may facilitate the development of innovative individual, family-centered, and community health interventions to reduce and ideally eliminate SHS exposure in the vulnerable pediatric population. This evidence calls for a robust public health policy that embraces zero tolerance of childhood SHS exposure. [ABSTRACT FROM AUTHOR]

Abstract: During the past 2 decades, life-course social-ecological frameworks have emerged across health, developmental, social, behavioral, and public health disciplines as useful models for explaining how health trajectories develop over an individual''s lifetime and how this knowledge can guide and inform new approaches to clinical and public health practice, multilevel policies, and research. Viewed from this perspective, and with emphasis on global cardiovascular health promotion and prevention of cardiovascular disease (CVD), this article summarizes evidence on the early origins and progression of CVD processes across the life course of individuals and diverse populations. Current evidence-based guidelines for CVD prevention are summarized, and recommendations for future research are suggested. [Copyright &y& Elsevier]

It has been reported that stress can induce depression, with the patient's age and sex as moderating factors. Associations between depression and lifestyle in Korean adults have not been addressed. This study was designed to examine if the relationships among stress, problem drinking, exercise, and depression differ by age and sex. For this study, the Korea health panel data was utilized, and a structural equation model using AMOS was employed. The major findings were as follows: women were more likely to experience stress and depression than men. Individuals over 40 showed a higher tendency toward stress and depression than those under 40. Age- and sex-specific paths from stress to problem drinking, exercise, and depression were positively inter-correlated; the path from exercise to depression indicated an inverse association. These results indicate the need for evidence-based stress-management programs for the psychological well-being of Korean adults. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined dietary data or objective measures of physical activity (PA) and sedentary behavior among metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Thus, the purpose is to determine whether PA, sedentary behavior and/or diet differ between MHO and MUO in a sample of young women. Methods: Forty-six overweight/obese (BMI ≥25 kg/m2) African American and Caucasian women 19–35 years were classified by cardiometabolic risk factors, including elevated blood pressure, triglyceride, glucose and C-reactive protein, low high density lipoprotein, and insulin resistance (MUO ≥2; MHO, <2). Time (mins/day) in light, moderate, vigorous PA, and sedentary behavior were estimated using an accelerometer (≥3 days; ≥8 hrs wear time). Questionnaires were used to quantify sitting time, TV/computer use and usual daily activity. The Block Food Frequency Questionnaire assessed dietary food intake. Differences between MHO and MUO for lifestyle behaviors were tested with linear regression (continuous data) or logistic regression (categorical data) after adjusting for age, race, BMI, smoking and accelerometer wear and/or total kilocalories, as appropriate. Results: Women were 26.7±4.7 years, with a mean BMI of 31.1±3.7 kg/m2, and 61% were African American. Compared to MUO (n = 9), MHO (n = 37; 80%) spent less mins/day in sedentary behavior (difference: -58.1±25.5, p = 0.02), more mins/day in light PA (difference: 38.2±16.1, p = 0.02), and had higher daily METs (difference: 0.21±0.09, p = 0.03). MHO had higher fiber intakes (g/day of total fiber, soluble fiber, fruit/vegetable fiber, bean fiber) and daily servings of vegetables; but lower daily dairy servings, saturated fat, monounsaturated fat and trans fats (g/day) compared to MUO. Conclusion: Compared to MUO, MHO young women demonstrate healthier lifestyle habits with less sedentary behavior, more time in light PA, and healthier dietary quality for fat type and fiber. Future studies are needed to replicate findings with larger samples that include men and women of diverse race/ethnic groups. [ABSTRACT FROM AUTHOR]

Objective: To determine whether dietary quality differs between metabolically-healthy-obese (MHO) and metabolically-abnormal-obesity (MAO) in a nationally representative sample. Methods: National Health and Nutrition Examination Survey (NHANES) data (2007-2008; 2009-2010) were used to identify obese adolescents (≥ 95th body mass index (BMI) %tile) and adults (≥ 30 kg/m2). MHO was defined as < 2 abnormal cardiometabolic risk factors (elevated blood pressure, triglycerides, glucose, low high density lipoprotein cholesterol (HDL-C); or on medications). Healthy Eating Index 2005 (HEI-2005) scores were calculated from 24-hour recall data. General linear regression models determined whether HEI-2005 scores differed between MHO and MAO after controlling for age, race, gender, NHANES wave, BMI, physical activity and health status by age group (12-18; 19-44; 45-85 years). Results: Compared with MAO, MHO adolescents (n = 133) had higher total HEI-2005 score, higher milk scores, and higher scores from calories from solid fats, alcohol beverages and added sugars. MHO women 19-44 years (n = 240) had higher total HEI-2005, higher whole fruit, higher whole grain and higher meat and bean scores compared with MAO. No significant differences were observed between MHO and MAO for HEI-2005 total scores in men 19-44 years, or adults 45-85 years. Conclusion: MHO adolescents and women 19-44 years have better dietary compliance to the U.S. guidelines when compared with MAO, suggesting potential intervention targets to improve cardiometabolic risk within obesity. [ABSTRACT FROM AUTHOR]

Attempts to increase nurses' knowledge of communicable childhood disease, varicella. Causes of chicken pox; Signs and symptoms; Diagnosis and treatment of chicken pox; Nursing interventions.

In this article, the authors focus on reducing the risk of cardiovascular disease (CVD) in children and adolescents. They state that the development of atherosclerotic CVD is due to hypertension, dyslipidemia, diabetes mellitus smoking and obesity. They further discuss the methods for reducing the risk factors of the disease with emphasis on diet, physical activity and blood pressure. A table on the schedule for the promotion of integrated cardiovascular in children is also presented.

To address the complexity of issues surrounding childhood obesity, the Society of Behavioral Medicine identified childhood obesity as a special focus of its 2007 Annual Meeting. The purpose of this paper was to provide a brief summary of the content of these sessions, promising practices that were presented, and recommendations for behavioral medicine research and practice professionals to facilitate reversing the current trends in childhood obesity. A social-ecological perspective was used to discuss views on biological and genetic perspectives, the need for policy and environmental approaches, and the need to expand the types of research and practice being conducted. Recommendations included the need to (1) conduct a broader examination of potential policy, program, and practice strategies across social ecological levels, (2) use team approaches to science that include multiple disciplines and perspectives, (3) expand the methods and metrics used to demonstrate the value of childhood obesity treatment or prevention interventions, (4) use integrated research and practice partnerships, and (5) explicitly assess the potential of intervention strategies to reduce health disparities. [ABSTRACT FROM AUTHOR]

Sedentary behaviors, low levels of physical activity (PA), and low body image quality of life have been identified during college years and associated with poor health outcomes. Public health efforts have recently focused on decreasing sedentary time by increasing light physical activity, both of which have been associated with body image quality of life, though mainly through self-report. In this cross-sectional study, we examined objective actigraphy and survey data from 404 of 459 young adults with overweight and obesity (mean age 23.3 ± 4.4 years, 78.4% female, 55.4% white). PA was measured using an accelerometer worn during waking hours for >10 h/day for four days. Body image quality of life was assessed using the Body Image Quality of Life Inventory Scale. Body image was positively correlated with light PA (r = 0.15) and inversely correlated with BMI (Pearson's r = −0.20) and sedentary time (r = −0.10), but not moderate PA, vigorous PA, or MVPA. Light PA and sedentary time were significantly inversely correlated (r = −0.38). When controlling for covariates, higher body image quality of life was significantly associated with higher levels of light PA (β = 0.39; p < 0.01) and lower sedentary time (β = −0.39; p = 0.02). Participants with lower body image quality of life enrolled in weight loss interventions may benefit from prescriptions of light PA in conjunction with decreasing sedentary behaviors. [ABSTRACT FROM AUTHOR]

Presents steps on how to achieve change of poor nursing practice in a nursing unit. Identification of the problem; Determination of the possibility of change in the hospital; Recruitment of staff nurse volunteers to take on responsible roles; Formulation of goals; Possible effect of change on different personalities.

Introduction: There is a paucity of information on the clustering of cardiometabolic risk factors in young adults and how this clustering may vary based on whether or not they perform sufficient levels of physical activity. Methods: We analyzed baseline data from 346 young adults (23.3 ± 4.4 yr) participating in the Healthy Body Healthy U clinical trial from 2015 to 2018. Cardiometabolic risk factors were measured according to standard procedures and moderate- to vigorous-intensity physical activity (MVPA) was determined by accelerometry. A cardiometabolic clustering score (ranging from 0 to 5) was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded (0, no; 1, yes): abdominal circumference (>102 cm (men) or >88 cm (women)), hemoglobin A1c (≥5.7%), HDL cholesterol (<40 mg·dL−1 (men) or <50 mg·dL−1 (women)), systolic blood pressure (≥130 mm Hg), and diastolic blood pressure (≥85 mm Hg). Cardiometabolic dysregulation (CD) was defined as a cardiometabolic clustering score ≥3. Multiple logistic regression determined the independent association between level of MVPA and CD, while adjusting for sex, race/ethnicity, sedentary time, and smoking. Results: The prevalence of CD was 18% (22% in men, 17% in women). We observed a nonlinear graded association between MVPA and CD. Participants performing 150–300 min·wk−1 of MVPA significantly lowered their odds of CD by 66% (odds ratio, 0.34; 95% confidence interval, 0.16–0.75), whereas those exceeding 300 min·wk−1 lowered their odds by 61% (odds ratio, 0.39; 95% confidence interval, 0.18–0.86) compared with those performing <150 min·wk−1, independent of obesity and the other covariables. Conclusion: Recommended levels of moderate-intensity physical activity is significantly associated with lower odds of CD and thus may prevent or diminish the need for expensive pharmaceutical treatment over the remainder of the life-span. [ABSTRACT FROM AUTHOR]

Homelessness among older individuals is increasing and women experiencing homelessness have been previously shown to have poorer health outcomes than their male counterparts. To address these concerns, the Bridges to Elders (BTE) program was developed to improve health and social outcomes for older women experiencing or at risk for homelessness. BTE consisted of a nurse practitioner (NP) and community health worker (CHW) dyad who provided intensive case management services for women 55+ with housing instability. This evaluation used a pretest/posttest design to examine three main outcomes from BTE: change in housing status, enrollment with a primary care provider (PCP), and diagnosis of uncontrolled chronic condition. The sample included 96 BTE participants enrolled from January 2017 to December 2018. The average age of participants was 66 years and had a mean BTE enrollment time of 7.6 months. Statistically significant improvements were achieved in all three outcomes measured: 17% (p < .009) increase in stable housing, 35% (p < .001) increase in PCP enrollment, and 47% (p < .001) decrease in the diagnosis of an uncontrolled chronic condition. The results indicated an NP/CHW dyad improved housing status, primary care access, and targeted health outcomes for older women who are experiencing or at risk for homelessness. Future studies examining the impact of NP/CHW dyads on additional social determinants of health and their impact on health outcomes are recommended. [ABSTRACT FROM AUTHOR]

The article examines the impact of Healthy Directions intervention on lifestyle adherence and health-related quality of life in non-small cell lung cancer survivors. Topics mentioned the percentage of patients who able to meet all lifestyle recommendations at baseline, improvement in mental and physical health of the cancer survivors following adherence to lifestyle behaviors, and the need for a randomized controlled trial to establish the efficacy of such intervention.

The purpose of this study was to examine associations between the Walk Score and physical activity in young, overweight/obese urban women. Project Health included 45 White or African American women (BMI 31.5±3.9 kg/m2; age 26.5±4.6 years; 62% African American) living in the Boston area. An accelerometer estimated steps/day and mins/day in light physical activity (100–2019 counts-per-minute) and moderate-to-vigorous-physical activity (≥2020 cpm). Walk Score was used to estimate the walkability of home address by analyzing proximity to nearby amenities. General linear regression models estimated associations between total Walk Score and physical activity (light physical activity, moderate-to-vigorous-physical activity, steps, total activity counts, METs), adjusting for body mass index, age, race/ethnicity, seasonality, wear time, employment and student status. For physical activity variables that had significant associations with Walk Score (steps/day and steps/min), regression models were estimated for Walk Score sub-scores (parks, grocery, errands, shopping, dining/drinking, culture/entertainment and schools). Logistic regression models estimated the odds of meeting the guidelines for steps (≥10,000/day) and moderate-to-vigorous-physical activity (≥150mins MVPA/week) based on Walk Score. Participants had a Walk Score of 63.9±26.4, took 14,143±3,934 steps/day, and spent 206.2±66.0 mins/day in light physical activity and 46.7±17.5 mins/day in moderate-to-vigorous- physical activity. Walk Score was significantly and positively associated with steps/day (β = 51.4, p = 0.01) and steps/min (β = 0.06, p = 0.009) but was not associated with mins/day of light physical activity, moderate-to-vigorous-physical activity, total activity counts or METs. Parks, grocery, errands, shopping, dining/drinking, and culture/entertainment Walk Score sub-scores were significantly associated with steps and steps/min (all p<0.05), but not significantly associated for schools. Participants who lived in higher Walk Score neighborhoods were more likely to meet the step guidelines (OR, 95% CI: 1.59, 1.04–2.99) and moderate-to-vigorous-physical activity guidelines (1.63, 1.06–3.02), respectively, per 10-unit increase in Walk Score. These results indicate that living in a more walkable neighborhood may support walking behavior in young, urban-dwelling overweight/obese women and provide further evidence for the expanded use of urban planning and transportation policies to improve the walkability of urban neighborhoods. [ABSTRACT FROM AUTHOR]

The non-lab Framingham algorithm, which substitute body mass index for lipids in the laboratory based (lab-based) Framingham algorithm, has been validated among African Americans (AAs). However, its cost-effectiveness and economic tradeoffs have not been evaluated. This study examines the incremental cost-effectiveness ratio (ICER) of two cardiovascular disease (CVD) prevention programs guided by the non-lab versus lab-based Framingham algorithm. We simulated the World Health Organization CVD prevention guidelines on a cohort of 2690 AA participants in the Atherosclerosis Risk in Communities (ARIC) cohort. Costs were estimated using Medicare fee schedules (diagnostic tests, drugs & visits), Bureau of Labor Statistics (RN wages), and estimates for managing incident CVD events. Outcomes were assumed to be true positive cases detected at a data driven treatment threshold. Both algorithms had the best balance of sensitivity/specificity at the moderate risk threshold (>10% risk). Over 12years, 82% and 77% of 401 incident CVD events were accurately predicted via the non-lab and lab-based Framingham algorithms, respectively. There were 20 fewer false negative cases in the non-lab approach translating into over $900,000 in savings over 12years. The ICER was -$57,153 for every extra CVD event prevented when using the non-lab algorithm. The approach guided by the non-lab Framingham strategy dominated the lab-based approach with respect to both costs and predictive ability. Consequently, the non-lab Framingham algorithm could potentially provide a highly effective screening tool at lower cost to address the high burden of CVD especially among AA and in resource-constrained settings where lab tests are unavailable. [ABSTRACT FROM AUTHOR]

Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child’s bodily integrity, family, or social structures, are known to be associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life. [ABSTRACT FROM AUTHOR]

Objective: The aims of this feasibility study of an adapted lifestyle intervention for adults with lung cancer were to (1) determine rates of enrollment, attrition, and completion of 5 nurse-patient contacts; (2) examine demographic characteristics of those more likely to enroll into the program; (3) determine acceptability of the intervention; and (4) identify patient preferences for the format of supplemental educational intervention materials.Methods: This study used a single-arm, pretest and posttest design. Feasibility was defined as ≥20% enrollment and a completion rate of 70% for 5 nurse-patient contact sessions. Acceptability was defined as 80% of patients recommending the program to others. Data was collected through electronic data bases and phone interviews. Descriptive statistics, Fisher's exact test and Wilcoxon rank sum test were used for analyses.Results: Of 147 eligible patients, 42 (28.6%) enrolled and of these, 32 (76.2%) started the intervention and 27 (N = 27/32; 84.4%; 95% CI, 67.2%-94.7%) completed the intervention. Patients who were younger were more likely to enroll in the study (P = .04) whereas there were no significant differences by gender (P = .35). Twenty-three of the 24 (95.8%) participants' contacted posttest recommended the intervention for others. Nearly equal numbers of participants chose the website (n = 16, 50%) vs print (n = 14, 44%).Conclusion: The intervention was feasible and acceptable in patients with lung cancer. Recruitment rates were higher and completion rates were similar as compared to previous home-based lifestyle interventions for patients with other types of cancer. Strategies to enhance recruitment of older adults are important for future research. [ABSTRACT FROM AUTHOR]

Purpose Understanding parents' perceptions of their child's health status is important as parents are drivers of healthcare utilization in the pediatric setting. Understanding parent-perceived disease-severity and its effects on a child's health-related quality of life (HRQOL) in children with congenital heart disease (CHD) is necessary to evaluate outcomes of care, improve care coordination, and inform policies focused on advancing family-centered care for pediatric cardiac patients. The impact of CHDs and disease-severity on the child's HRQOL has been investigated with inconsistent results. The overall aim of this study was to examine parents' perceptions of HRQOL in their school-age child with CHD, and to compare HRQOL among patients with CHD across severity categories. Design This was a descriptive correlational study design. Methods A total of 71 parents of school-age children aged 5-12 years completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL) (including total, physical health, and psychosocial health summary scores) and cardiac-specific HRQOL Scale (PedsQL 3.0). PedsQL scores among CHD severity categories were compared by analysis of variance. Results School-age children with CHDs had an overall good HRQOL with significant differences among disease severity categories for all scores. Parents reported lower scores on their HRQOL of older children compared to younger children across severity groups ( p < .01) and for those children with more severe disease ( p < .01). Practice implications Based on the results of this study, interventions should focus on targeting psychosocial health in older children with CHD and physical health in younger children with CHD. This information is useful in providing practical recommendations in caring for children with CHDs while informing relevant policies. [ABSTRACT FROM AUTHOR]

Background The transitional period from late adolescence to early adulthood is a vulnerable period for weight gain, with a twofold increase in overweight/obesity during this life transition. In the United States, approximately one-third of young adults have obesity and are at a high risk for weight gain. Purpose To describe the design and rationale of a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored randomized, controlled clinical trial, the Healthy Body Healthy U (HBHU) study, which compares the differential efficacy of three interventions on weight loss among young adults aged 18–35 years. Methods The intervention is delivered via Facebook and SMS Text Messaging (text messaging) and includes: 1) targeted content (Targeted); 2) tailored or personalized feedback (Tailored); or 3) contact control (Control). Recruitment is on-going at two campus sites, with the intervention delivery conducted by the parent site. A total of 450 students will be randomly-assigned to receive one of three programs for 18 months. We hypothesize that: a) the Tailored group will lose significantly more weight at the 6, 12, 18 month follow-ups compared with the Targeted group; and that b) both the Tailored and Targeted groups will have greater weight loss at the 6, 12, 18 month follow-ups than the Control group. We also hypothesize that participants who achieve a 5% weight loss at 6 and 18 months will have greater improvements in their cardiometabolic risk factors than those who do not achieve this target. We will examine intervention costs to inform implementation and sustainability other universities. Expected study completion date is 2019. Conclusions This project has significant public health impact, as the successful translation could reach as many as 20 million university students each year, and change the current standard of practice for promoting weight management within university campus communities. ClinicalTrial.gov : NCT02342912 [ABSTRACT FROM AUTHOR]

Objective: To examine social and environmental factors that affect moderate to vigorous physical activity (MVPA) in mid‐adolescent Hispanic females. Design and Sample: Secondary data analysis to examine social and environmental level factors related to MVPA levels in (n = 897) mid‐adolescent Hispanic females. Measures: Data were retrieved from the National Survey of Children's Health (2011/12). Logistic regression was used to estimate associations for factors with MVPA. Results: Significant mid‐adolescent predictors were English speaking, OR 1.64 (95% CI, 1.03–2.61); parental attendance of activities, OR 0.50 (95% CI, 0.31–0.81); peer support, OR 2.74 (95% CI, 1.75–4.29); supportive neighborhood, OR 1.52 (95% CI, 1.03–2.32); and safe school environment, OR 1.67 (95% CI, 1.01–2.74). Conclusion: Findings highlight the need for the development of age and culturally appropriate interventions to aid the improvement of participation levels in MVPA among the Latina adolescent population. Additionally, findings suggest recommendations for policy and future research. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated associations involving a combination of healthy lifestyle factors and adults’ long-term change in cardiometabolic disease (CMD) risk. Methods: We included 431 participants from the National Heart, Lung and Blood Institute Lipid Research Clinics (LRC) and Princeton Follow-up Studies (PFS). Results: Compared to those without healthy lifestyle practices, participants with one, 2, and ≥ 3 healthy lifestyle factors have 35%, 62% and 59% lower risk of CMD respectively. These health benefits were similar for both men and women. Conclusion: Combined healthy lifestyle factors were associated with a reduced likelihood of long-term CMD risk for both men and women. Maintaining or adopting healthy lifestyle behaviors, even later in life, may be beneficial for cardiometabolic health. [ABSTRACT FROM AUTHOR]

Background: American Heart Association (AHA) public policy advocacy strategies are based on its Strategic Impact Goals. The writing group appraised the evidence behind AHA's policies to determine how well they address the association's 2020 cardiovascular health (CVH) metrics and cardiovascular disease (CVD) management indicators and identified research needed to fill gaps in policy and support further policy development. Methods and Results: The AHA policy research department first identified current AHA policies specific to each CVH metric and CVD management indicator and the evidence underlying each policy. Writing group members then reviewed each policy and the related metrics and indicators. The results of each review were summarized, and topic-specific priorities and overarching themes for future policy research were proposed. There was generally close alignment between current AHA policies and the 2020 CVH metrics and CVD management indicators; however, certain specific policies still lack a robust evidence base. For CVH metrics, the distinction between policies for adults (age ≥20 years) and children (<20 years) was often not considered, although policy approaches may differ importantly by age. Inclusion of all those <20 years of age as a single group also ignores important differences in policy needs for infants, children, adolescents, and young adults. For CVD management indicators, specific quantitative targets analogous to criteria for ideal, intermediate, and poor CVH are lacking but needed to assess progress toward the 2020 goal to reduce deaths from CVDs and stroke. New research in support of current policies needs to focus on the evaluation of their translation and implementation through expanded application of implementation science. Focused basic, clinical, and population research is required to expand and strengthen the evidence base for the development of new policies. Evaluation of the impact of targeted improvements in population health through strengthened surveillance of CVD and stroke events, determination of the cost-effectiveness of policy interventions, and measurement of the extent to which vulnerable populations are reached must be assessed for all policies. Additional attention should be paid to the social determinants of health outcomes. Conclusions: AHA's public policies are generally robust and well aligned with its 2020 CVH metrics and CVD indicators. Areas for further policy development to fill gaps, overarching research strategies, and topic-specific priority areas are proposed. [ABSTRACT FROM AUTHOR]

Background. Although 80% of the burden of cardiovascular disease (CVD) is in developing countries, the 2010 global burden of disease (GBD) estimates have been cited to support a premise that sub-Saharan Africa (SSA) is exempt from the CVD epidemic sweeping across developing countries. The widely publicized perspective influences research priorities and resource allocation at a time when secular trends indicate a rapid increase in prevalence of CVD in SSA by 2030. Purpose. To explore methodological challenges in estimating trends and burden of CVD in SSA via appraisal of the current CVD statistics and literature. Methods. This review was guided by the Critical review methodology described by Grant and Booth. The review traces the origins and evolution of GBD metrics and then explores the methodological limitations inherent in the current GBD statistics. Articles were included based on their conceptual contribution to the existing body of knowledge on the burden of CVD in SSA. Results/Conclusion. Cognizant of the methodological challenges discussed, we caution against extrapolation of the global burden of CVD statistics in a way that underrates the actual but uncertain impact of CVD in SSA. We conclude by making a case for optimal but cost-effective surveillance and prevention of CVD in SSA. [ABSTRACT FROM AUTHOR]

Background: Less than 45% of U.S. children meet the 60 min.d-1 physical activity (PA) guideline. Structured after-school PA programing is one approach to help increase activity levels. This study aimed to evaluate the feasibility and short-term impact of a supervised after-school PA and nutrition education program on activity levels. Methods: Forty-two 3rd-5th graders from an inner-city school in Boston, MA were randomly assigned to a 10-wk after-school program of either: 1) weekly nutrition education, or 2) weekly nutrition education plus supervised PA 3 d.wk-1 at a community-based center. At baseline and follow-up, PA was measured using accelerometry and fitness (VO2max) was estimated using the PACER 15-m shuttle run. Additional measures obtained were non-fasting finger stick total cholesterol (TC) and glucose levels, waist circumference (WC), body mass index (BMI), percent body fat (%BF), and blood pressure (BP). Values are presented as mean±SE, unless noted otherwise. Results: Thirty-six participants completed the study (mean±SD; age 9.7±0.9 years). Participants attended >80% of the sessions. After adjusting for accelerometer wear time and other design factors, light and moderate-to-vigorous PA (MVPA) increased in the nutrition+PA group (+21.5±14.5 and +8.6±8.0 min.d-1, respectively) and decreased in the nutrition only group (-35.2±16.3 and -16.0±9.0 min.d-1, respectively); mean difference between groups of 56.8±21.7 min.d-1 (light PA, p = 0.01) and 24.5±12.0 min.d-1 (MVPA, p = 0.04). Time spent in sedentary behaviors declined in the nutrition+PA group (-14.8±20.7 min.d-1) and increased in the nutrition only group (+55.4±23.2 min.d-1); mean difference between groups of -70.2±30.9 min.d-1 (p = 0.02). Neither group showed changes in TC, BP, WC, %BF, BMI percentile, or fitness (p>0.05). Conclusions: The supervised afterschool community-based nutrition and PA program was well accepted and had high attendance. The changes in light PA and MVPA has potential to promote weight maintenance in inner-city elementary school children, however longer term studies with larger samples are needed. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND We examined the differential impact of a well-established human immunodeficiency virus ( HIV)/sexually transmitted infections ( STIs) curriculum, Be Proud! Be Responsible!, when taught by school nurses and health education classroom teachers within a high school curricula. METHODS Group-randomized intervention study of 1357 ninth and tenth grade students in 10 schools. Twenty-seven facilitators (6 nurses, 21 teachers) provided programming; nurse-led classrooms were randomly assigned. RESULTS Students taught by teachers were more likely to report their instructor to be prepared, comfortable with the material, and challenged them to think about their health than students taught by a school nurse. Both groups reported significant improvements in HIV/ STI/condom knowledge immediately following the intervention, compared to controls. Yet, those taught by school nurses reported significant and sustained changes (up to 12 months after intervention) in attitudes, beliefs, and efficacy, whereas those taught by health education teachers reported far fewer changes, with sustained improvement in condom knowledge only. CONCLUSIONS Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students; however, teaching the technical (eg, condom use) and interpersonal (eg, negotiation) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have. [ABSTRACT FROM AUTHOR]

Some evidence suggests that phytoestrogens, such as soy-derived isoflavones, may have beneficial effects on cardiovascular health and glycemic control. These data are mainly limited to postmenopausal women or individuals at elevated cardiometabolic risk. There is a lack of data for pregnant women who have elevated estrogen levels and physiologically altered glucose and lipid metabolism. We analyzed data from 299 pregnant women who participated in the NHANES 2001-2008 surveys. Multivariable linear regression analyses were used to examine the association between urinary concentrations of isoflavonoids and cardiometabolic risk markers, adjusted for body mass index, pregnancy trimester, total energy intake, dietary intake of protein, fiber, and cholesterol, and demographic and lifestyle factors. Cardiometabolic risk markers were log-transformed, and geometric means were calculated by quartiles of urinary concentrations of isoflavonoids. Comparing women in the highest vs. lowest quartiles of urine total isoflavone concentrations, we observed significant, inverse associations with circulating concentrations of fasting glucose (79 vs. 88 mg/dL, P-trend = 0.0009), insulin (8.2 vs. 12.8 µU/mL, P-trend = 0.03), and triglyceride (156 vs. 185mg/dL, P-trend = 0.02), and the homeostasis model assessment of insulin resistance (1.6 vs. 2.8, P-trend = 0.01), but not for total, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. The concentrations of individual isoflavonoids, daidzein, equol, and O-desmethylangolensin were inversely associated with some cardiometabolic risk markers, although no clear pattern emerged. These data suggest that there may be a relation between isoflavone intake and cardiometabolic risk markers in pregnant women. [ABSTRACT FROM AUTHOR]

Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks. [ABSTRACT FROM AUTHOR]