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Background: Cardiovascular disease (CVD) is the leading cause of death in the US, and a high prevalence of CVD risks has been observed among Black young adults. Physical activity (PA) and healthy eating (HE) are essential components of lowering CVD risk. Therefore, this study explored the barriers, facilitators, behavior change activities, and health communication channels that can inform the development of a multimedia campaign to promote heart health (i.e., PA and HE) among Black young adults. Between September and November 2019, three focus group discussions (FGDs) with a total of 30 students were conducted at a Historically Black College and University (HBCU) campus within the southern region of the US. Lack of time, body shaming in the gym, and limited HE options on campus were identified as some of the barriers to PA and HE. Knowledge of family health history, Instagram influencers, access to a peer trainer and a dietitian were mentioned as facilitators to PA and HE. Participants suggested various activities to promote heart healthy behaviors, including providing factual health information, teaching healthy food preparation skills, and promoting/creating healthy food options events through social media and print as the communication channels. The focus group findings identified barriers, facilitators, health behavior activity ideas, and the communication channels to encourage PA and HE among Black young adults. The results of this study can be used to inform the development of a multimedia campaign to reduce CVD risk among Black young adults.

The objective of this study was to describe the increasing incidence and risk of cardiovascular disease among persons living with HIV (PLWH) in Sub-Saharan Africa. We also used data to compare hypertension (a common NCD among PLWH) outcomes between PLWH and HIV-uninfected individuals among older adults in Northwestern Tanzania.Hypertension is increasingly common in Sub-Saharan Africa and a leading cause of cardiovascular disease for PLWH. Among those with hypertension, PLWH have a 50% higher risk of incident myocardial infarction compared to the general population. In response to the rising incidence of these non-communicable diseases (NCDs) among PLWH, recently, the Joint United Nations Program on HIV/AIDS supported the integration of NCD care into routine clinical care for HIV. However, data are lacking on levels of awareness of hypertension status, diagnosis, and antihypertensive medication adherence. Given the higher likelihood of elevated blood pressure among PLWH, there is an urgent need to implement interventions to improve blood pressure control in this population. Researchers should evaluate treatment barriers at multiple levels including health system, healthcare providers, and patients' level and tailor evidence-based interventions to increase achievement of blood pressure control for PLWH.

The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are clinically based, effective treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori key questions.

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) “What are effective clinically based treatments for obesity?” and (KQ2) “What is the risk of comorbidities among children with obesity?” See Appendix 1 for the conceptual framework and a priori Key Questions.

Background Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV (PLHIV). PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care. The objective of this study was to examine the relationship between out-of-pocket (OOP) health expenditures and the likelihood of missing appointments. Method Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres (CTC) in Northern Tanzania were enrolled in the study. Clinic attendance and clinical characteristics were abstracted from medical records. Information on OOP health expenditures, demographics, and socio-economic factors were self-reported by the participants. We used a hurdle model. The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings (TZS) increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period. Results Among these 618 participants, 242 (39%) had at least one missed clinic appointment in the past year. OOP expenditure was not significantly associated with the number of missed clinic appointments. The median amount of OOP paid was 5 100 TZS per visit, about 7% of the median monthly income. Participants who were separated from their partners (adjusted odds ratio [AOR] = 1.83, 95% confidence interval [CI]:1.11‒8.03) and those aged above 50 years (AOR = 2.85, 95% CI: 1.01‒8.03) were significantly associated with missing an appointment. For those who had at least one missed appointment over the study period, the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC (P = 0.49, 95% CI: 0.88‒0.09) and aged between > 25‒35 years (P = 0.90, 95% CI: 0.11‒1.69). Conclusion Interventions focused on improving compliance to clinic appointments should target public CTCs, PLHIV aged between > 25‒35 years, above 50 years of age and those who are separated from their partners.

OBJECTIVE: This study examined the prevalence of food insecurity (FI) among students attending Historically Black Colleges and Universities (HBCUs) in the Southeastern United States. PARTICIPANTS: Students attending four HBCUs (N=351) completed an anonymous Web-based survey. METHODS: Food insecurity was assessed using the 2-item Hunger Vital Sign Tool. Summary statistics were used to quantify FI experiences. Logistic regression was conducted to determine if student demographic characteristics were significantly associated with FI outcomes. RESULTS: Nearly 3 in 4 students (72.9%) reported some level of FI in the past year. Students representing all levels of postsecondary education reported FI. Meal plan participation did not prevent FI. CONCLUSIONS: Students attending HBCUs experience FI at levels that exceed estimates reported among students attending predominantly White institutions. More work is needed to understand the lived experience of food-insecure HBCU students as a means to ensure institution-level food policies support student academic success and wellbeing.

This study reports on food insecurity (FI) amidst the COVID-19 pandemic.College students in four regions of the US completed the two-item validated Hunger Vital Sign™ screening tool on Qualtrics.FI increased significantly after March 2020 among US students (worry about food running out: 25% to 35%; food did not last: 17% to 21%) with significant regional increase in the Midwest and South. An adjusted multivariable logistic regression model indicated students that ran out of food were significantly at greater odds of experiencing hardship with paying bills (AOR: 5.59, 95% CI =3.90-8.06).The findings identified an increase in the prevalence of FI among college students during the pandemic. Suggestions of how to address FI are discussed.

OBJECTIVE: To understand the distribution of healthy and unhealthy food stores near historically black colleges and universities (HBCUs). PARTICIPANTS AND METHODS: Using ArcGIS Pro’s network analysis tools and ReferenceUSA database, this study characterized the healthy (favorable) and unhealthy (unfavorable) retail food stores within a 5-mile radius, 15-min driving, and 15-min walking distance from each HBCU in North Carolina. RESULTS: Most retail food stores within a 5-mile buffer radius of the 10 HBCUs in North Carolina were unfavorable. Within 15-min driving from each HBCU, 1082 stores (76.0%) were unfavorable food stores, while 332 (24.0%) were favorable. Additionally, there were four favorable and 35 unfavorable retail food stores within the 15-min walking distance of each HBCU. CONCLUSIONS: Favorable food retail stores around HBCUs in North Carolina are limited. Researchers, policy makers, and community stakeholders should work together to improve food environments surrounding HBCUs.

Students at higher institutions of learning are more susceptible to psychosocial problems compared to the general public. These may further be exacerbated by the measures put in place to curb the spread of COVID-19. This mixed methods study examined the factors associated with the psychosocial impact of COVID-19 on students’ financial stability, interpersonal relationships and worries related to achieving academic milestones. Data comprised of a series of closed and open-ended questions collected via Qualtrics from students in the United States and Africa (Central and West). The quantitative data were analyzed using frequency counts, percentages and chi-square, while the qualitative data was analyzed using thematic content analysis. More than 90% of the students resided in the United States, 72.5% were females and 78.4% were undergraduates. Financial hardship was experienced by 26.4% of the students, 55.8% indicated that COVID-19 negatively affected their relationship with friends and over 40% worried over delays in achieving academic milestones. Continent of residence, employment status and financial hardship were significantly associated with the negative impact of COVID-19 on one or more of the students’ relationships and with worries about achieving academic milestones. Qualitative data support the findings that financial hardship contributed to experience of psychological distress by students. It also revealed negative (compromised relationships – broken or fractured relationships and loneliness) and positive (bonding) impact of COVID-19 on interpersonal relationships. School administrators should provide students with resources to access economic relief packages and tele-counseling services to help meet their financial and psychosocial support needs amidst COVID-19. Article visualizations

Background: Due to marginal efforts to increase living donor kidney transplantation, it is unclear whether interventions to improve African Americans’ interest and pursuit of living donation should be tailored to address patients’ exposure to or familiarity with dialysis or transplant settings. Design, Setting, and Participants: We conducted a cross-sectional secondary analysis of baseline data from 3 separate randomized clinical trials among African Americans with varying degrees of experience with dialysis or transplantation (predialysis, on dialysis but not on transplant list, and on transplant wait-list) settings. Methods: Interest in living donation was described using a 0 to 10 scale and pursuit of living donor kidney transplantation by achievement of at least 1 pursuant behavior. In multivariable logistic regression analyses, we assessed the association of knowledge, health literacy, and trust in health care with interest in or pursuit of living donation. Results: Interest among the 3 study cohorts was high (predialysis, 62.9%; dialysis, 67.4%; and transplant wait-list, 74.2%). The dialysis and transplant wait-list study cohorts pursued living donation more readily than those not on dialysis (73%, 92%, and 45%, respectively). Interest and pursuit were not statistically significantly associated with knowledge, health literacy, or the 3 factors reflecting medical mistrust. Conclusion: Interest and pursuit of living donation were greater among study participants with greater exposure to dialysis or transplant settings. Efforts to promote patients’ early interest and pursuit of living donor transplants may consider novel strategies to educate patients with less experience about the benefits of living donor kidney transplantation.

Background African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients’ pursuit of LDKT. Methods Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients’ Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients’ actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants’ attitudes, concerns, and perceptions of interventions’ usefulness. Results Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit. Conclusions Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT. Trial registration ClinicalTrials.gov [NCT01439516] [August 31, 2011].

The novel coronavirus disease of 2019 (COVID-19) caused disruptions in the delivery of higher education around the globe. To understand how universities and students are dealing with the sudden change from in-person course delivery to online format, this cross-sectional mixed-method study aimed to (a) ascertain the impact of the COVID-19 pandemic on students’ ability to access online learning; (b) examine how college students adapted to changes in the learning/teaching environment; and (c) explore the students’ perspective on measures that institutions of higher learning could have adopted to ease the abrupt transition to online learning. Results indicate a majority of participants in the US reported access to internet and computers for off-campus learning during the COVID-19 pandemic. A little over half of participants from Africa reported internet access during the COVID-19 pandemic (82% of participants from Nigeria and 66.7% from Ghana). Participants from Cameroon reported the lowest percentage of access to online learning at 59.1%. Participants from Africa reported challenges in adapting to online format due to inadequate access to necessary technological resources such as a reliable internet and computer. Participants identified internal and external resources that could have been adopted to better deal with the transition to online learning. Institutions of higher learning can learn from their initial response to the COVID-19 pandemic to formulate and adjust policies that provide flexibility to effectively transition to online learning while catering to the social, educational and health needs of their students.

PURPOSE OF REVIEW: This study aims to review the evidence on telehealth interventions in rural communities that use primary, secondary, or tertiary strategies for the prevention and management of cardiovascular disease (CVD). RECENT FINDINGS: Studies focused on the reduction of CVD risk factors and mitigation of disease progression among rural populations using telehealth are limited in number but appear to be increasing in the last 5 years. These studies suggest primary-, secondary-, and tertiary-level interventions can impact CVD risk and management. The current review found more studies addressing primary CVD intervention strategies, although the evidence for efficacy at all intervention levels is in the early stages. SUMMARY: Leveraging prevention strategies via telehealth may be an effective vehicle to facilitate improved CVD outcomes among populations traditionally marginalized by geographic location.

PURPOSE OF REVIEW: To review current literature on the use of telehealth at different stages of the hypertension control cascade in sub-Saharan Africa (SSA) and to discuss opportunities to harness information and communication technology infrastructure to improve population level hypertension control. RECENT FINDINGS: There are a limited number of telehealth studies at the different stages of the hypertension control cascade. The small body of evidence suggests several promising innovations. These innovations include the use of interactive text messaging, smartphone applications, and telephone calls demonstrated significant reduction in mean systolic blood pressure and increase in the proportion of hypertensives with blood pressure control. Interventions that included text messaging with educational content had the potential to improve hypertension knowledge and also influence behavioral modification and health-seeking behavior. SUMMARY: There is a need for studies on feasibility, acceptability, and scaling up of telehealth interventions with rigorous study designs.

Many patients struggle to take their prescription medications as prescribed. Multiple interacting factors influence medication nonadherence. The cost of medications, particularly a patient's out-of-pocket cost, spans several of these domains. One proposed option for reducing a patient's out-of-pocket cost involves directly sharing manufacturer rebates with patients to lower their out-of-pocket costs at the pharmacy counter. Rebates are widely used across industries (eg, pharmaceutical manufacturers, tourism taxes, automobile manufacturers) in negotiations between sellers and buyers for a particular product. Medication rebates play an important role in the current US pharmaceutical marketplace. However, rebate contract terms are not publicly reported, so it is difficult for patients to determine if, and how, a rebate is reflected in their out-of-pocket costs. This commentary addresses the role of rebates in the current US healthcare landscape and their relationship with medication adherence.

Compared to white patients in the United States, people of racial and ethnic minority groups face higher rates of chronic disease including diabetes, obesity, stroke, cardiovascular disease and cancer. Minority groups are also less likely to receive medication therapy to manage complications of chronic disease as well as be adherent to these therapies. A recently announced proposed rule by the Department of Health and Human Services Office of the Inspector General (HHS OIG), which would discourage rebates between manufacturers and payers in favor of discounts directly provided to patients, has received significant attention for its anticipated impact on prescription drug pricing and reimbursement in Medicare. This commentary describes the proposed rule and how it may impact adherence among patients of racial minority groups through an illustrative case study and discussion.

Cancer is the second leading cause of death in the United States. The objectives of this study were to evaluate cancer prevention programs and participants satisfaction in 51 disparities projects in Florida. This three-phase evaluation included evaluability assessment, process, immediate outcome and impact evaluation using qualitative assessment, case study, document analysis, face-to-face interviews, and survey. In 2006-2007, a total of 3,165, and in 2008-2009, a total of 1,632 individuals participated in the programs respectively. In breast and cervical cancer prevention programs, change of proportion of African-American and Haitian recruitment significantly increased from 2006-2008 to 2007-2009 (-11.3 to 3.4). Among other services, all means of outreach such as mobile vans, faith-based activities, health fairs, and small-group education sessions also increased by 5.3%, 7.9%, 5.5%, and 9.4% respectively. In participants' satisfaction the majority of respondents (N=231) were 35-54 years old (46.7%), non-Hispanic Black (81.7%), female (70.3%), high school and some college educated (58.8%), and with income less than $25,000 (65.5%). The majority of the participants were very satisfied with the program staff's training, cultural sensitivity, language skills, resources, education materials, referral system, and changing behavior (mean score: 4.5-4.7) and with the overall project and the project's role in improving their quality of life.

The growing prevalence and progression of chronic kidney disease (CKD) raises concerns about our capacity to manage its economic burden to patients, caregivers, and society. The societal direct and indirect costs of CKD and end-stage renal disease are substantial and increase throughout disease progression. There is significant variability in the evidence about direct and indirect costs attributable to CKD and end-stage renal disease, with the most complete evidence concentrated on direct health care costs of patients with advanced to end-stage CKD. There are substantial gaps in evidence that need to be filled to inform clinical practice and policy.

Background Community pharmacist involvement in health communication could assist in ameliorating health disparities in a number of areas. One such area is the early detection of prostate cancer in patients. Objectives The primary goal of this study was to explore the role of pharmacists as health educators and risk communicators in the prevention of prostate cancer mortality. The study objectives were to (1) describe community pharmacists' attitudes and beliefs related to serving as health educators and risk communicators on prostate cancer; and (2) assess community pharmacists' knowledge about prostate cancer. Methods A cross-sectional survey methodology was used to collect data from pharmacists present at the Florida Pharmacy Association 115th Annual Meeting. Eighty-nine pharmacists were administered a survey to measure their knowledge, attitudes, and beliefs using a structured survey form. Descriptive statistics and multiple regression analyses were used to analyze participants' responses. Results The mean age of participants was 45 years and they were mostly male, White (non-Hispanic) with B.S. Pharmacy as the highest degree. The face validity of the survey instrument was established through pilot test. Participants' views about offering prostate cancer education for patients were generally positive; however, participants' score on the general prostate cancer knowledge scale for patients was lower than expected for health care professionals, with approximately 45% of the participating pharmacists scoring less than 80% on the Odedina Prostate Cancer Screening Behavior Scale. Based on multiple regression analyses, participants' gender and disease state management status were found to be significantly associated with prostate cancer knowledge, whereas prostate cancer knowledge, technician staffing, and the type of pharmacy significantly predicted pharmacists' interest in prostate cancer education. Conclusions Although the community pharmacists in this study were willing to take on responsibilities in the prevention and detection of prostate cancer, their knowledge base may serve as an impediment to action. Future research may identify means by which to educate pharmacists and enable their involvement.

Objective To explore the perspectives of various stakeholders on whether an HBCU has the resources to establish a farm-to-university program that can improve fruits and vegetables intake among African American students. Additionally, this study assessed students' satisfaction with fruits and vegetables served in University dining halls, and their desire for changes in policies to increase local fruits and vegetables access on campus. Methods This study employed a mixed method data collection strategy. Semi-structured interviews were used to explore the stakeholders' perspectives and self-administered questionnaires were used to assess students' satisfaction with fruits and vegetables and desire for policy changes. Results Barriers reported by both food service administrators and farmers were cost and variation in supply and demand. Students expressed lack of satisfaction with fresh produce served in campus dining halls and a desire for change in policies to increase local fruits and vegetables access on campus. Conclusion While there is student desire for improved access to fresh produce on campus, there are perceived barriers to overcome. University partnerships are needed to address the desired nutritional improvements.

Objective To explore causal explanations of obesity among African-American women of diverse weight across the life spectrum. Methods In-depth interviews were conducted with adult African-American women of healthy weight (N = 10), overweight (N = 10), and obese weight (N = 20) to evaluate the relationship between causal explanations of obesity and weight. Results Generally overlooked dimensions of health definitions were discovered. Differences in weight definitions were detected between women of different weights. Terminology, symptoms, and solutions to obesity were detected between the women of different weights and public health recommendations. Conclusion Identified causal discrepancies will help bridge the disconnection between public health recommendations and African-American women's perceptions with tailored interventions.