Addie L. Fortmann

Wipe Sampling for Nicotine as a Marker of Thirdhand Tobacco Smoke Contamination on Surfaces in Homes, Cars, and Hotels

INTRODUCTION Secondhand smoke contains a mixture of pollutants that can persist in air, dust, and on surfaces for months or longer. This persistent residue is known as thirdhand smoke (THS). Here, we detail a simple method of wipe sampling for nicotine as a marker of accumulated THS on surfaces. METHODS We analyzed findings from 5 real-world studies to investigate the performance of wipe sampling for nicotine on surfaces in homes, cars, and hotels in relation to smoking behavior and smoking restrictions. RESULTS The intraclass correlation coefficient for side-by-side samples was 0.91 (95% CI: 0.87-0.94). Wipe sampling for nicotine reliably distinguished between private homes, private cars, rental cars, and hotels with and without smoking bans and was significantly positively correlated with other measures of tobacco smoke contamination such as air and dust nicotine. The sensitivity and specificity of possible threshold values (0.1, 1, and 10 μg/m(2)) were evaluated for distinguishing between nonsmoking and smoking environments. Sensitivity was highest at a threshold of 0.1 μg/m(2), with 74%-100% of smoker environments showing nicotine levels above threshold. Specificity was highest at a threshold of 10 μg/m(2), with 81%-100% of nonsmoker environments showing nicotine levels below threshold. The optimal threshold will depend on the desired balance of sensitivity and specificity and on the types of smoking and nonsmoking environments. CONCLUSIONS Surface wipe sampling for nicotine is a reliable, valid, and relatively simple collection method to quantify THS contamination on surfaces across a wide range of field settings and to distinguish between nonsmoking and smoking environments.

Associations of chronic stress burden, perceived stress, and traumatic stress with cardiovascular disease prevalence and risk factors in the hispanic community health study/study of latinos sociocultural ancillary study

Objective The current study examined multiple stress indicators (chronic, perceived, traumatic) in relation to prevalent coronary heart disease, stroke, and major cardiovascular disease (CVD) risk factors (i.e., diabetes, dyslipidemia, hypertension, and current smoking) in the multisite Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (2010–2011). Methods Participants were 5313 men and women 18 to 74 years old, representing diverse Hispanic/Latino ethnic backgrounds, who underwent a comprehensive baseline clinical examination and sociocultural examination with measures of stress. Results Chronic stress burden was related to a higher prevalence of coronary heart disease after adjusting for sociodemographic, behavioral, and biological risk factors (odds ratio [OR; 95% confidence interval], 1.22 [1.10–1.36]) and related to stroke prevalence in the model adjusted for demographic and behavioral factors (OR [95% confidence interval], 1.26 [1.03–1.55]). Chronic stress was also related to a higher prevalence of diabetes (OR = 1.20 [1.11–1.31]) and hypertension (OR = 1.10 [1.02–1.19]) in individuals free from CVD (n = 4926). Perceived stress (OR = 1.03 [1.01-1.05]) and traumatic stress (OR = 1.15 [1.05–1.26]) were associated with a higher prevalence of smoking. Participants who reported a greater number of lifetime traumatic events also unexpectedly showed a lower prevalence of diabetes (OR = 0.89 [0.83–0.97]) and hypertension (OR = 0.88 [0.82–0.93]). Effects were largely consistent across age and sex groups. Conclusions The study underscores the advantages of examining multiple indicators of stress in relation to health because the direction and consistency of associations may vary across distinct stress conceptualizations. In addition, the study suggests that chronic stress is related to higher CVD risk and prevalence in Hispanics/Latinos, the largest US ethnic minority group.

Support for disease management, depression, self-care, and clinical indicators among Hispanics with type 2 diabetes in San Diego County, United States of America

This study used a social-ecological framework to examine predictors of depression, diabetes self-management, and clinical indicators of health risk among Hispanics with type 2 diabetes residing in the United States (U.S.)-Mexico border region in San Diego County, California, United States of America. Important links were observed between greater social-environmental support for disease management and less depression, better diabetes self-management, and lower body mass index and serum triglyceride concentrations. Less depressive symptomatology was also related to lower hemoglobin A1c levels. Findings suggest that programs aiming to improve diabetes self-management and health outcomes in Hispanics with type 2 diabetes should consider multilevel, social, and environmental influences on health, behavior, and emotional well-being.

Individual and Neighborhood Socioeconomic Status and Inflammation in Mexican-American Women: What is the Role of Obesity?

Objective Inflammation may represent a biological mechanism underlying associations of socioeconomic status (SES) with cardiovascular disease. We examined relationships of individual and neighborhood SES with inflammatory markers in Mexican American women and evaluated contributions of obesity and related heath behaviors to these associations. Methods Two hundred eighty-four Mexican American women (mean age = 49.74 years) were recruited from socioeconomically diverse South San Diego communities. Women completed measures of sociodemographic characteristics and health behaviors, and underwent a physical examination with fasting blood draw for assay of plasma C-reactive protein (CRP), interleukin 6 (IL-6), and soluble intercellular adhesion molecule 1 (sICAM-1). Neighborhood SES was extracted from the US Census Bureau 2000 database. Results In multilevel models, a 1-standard deviation higher individual or neighborhood SES related to a 27.35% and 23.56% lower CRP level (p values < .01), a 7.04% and 5.32% lower sICAM-1 level (p values < .05), and a 10.46% (p < .05) and 2.40% lower IL-6 level (not significant), respectively. Controlling for individual SES, a 1-standard deviation higher neighborhood SES related to a 18.05% lower CRP level (p = .07). Differences in body mass index, waist circumference, and dietary fat consumption contributed significantly to SES-inflammation associations. Conclusions The findings support a link between SES and inflammatory markers in Mexican American women and implicate obesity and dietary fat in these associations. Additional effects of neighborhood SES were not statistically significant; however, these findings should be viewed tentatively due to the small sample size to evaluate contextual effects. Trial Registration ClinicalTrials.gov identifier: NCT00387166. Abbreviations BMI = body mass index CRP = C-reactive protein CVD = cardiovascular disease IL-6 = interleukin 6 MESA = Multi-Ethnic Study of Atherosclerosis SD = standard deviation SES = socioeconomic status sICAM-1 = soluble intercellular adhesion molecule 1 WC = waist circumference

Socioeconomic Status, Psychosocial Resources and Risk, and Cardiometabolic Risk in Mexican-American Women

OBJECTIVES The current study examined the contributions of psychosocial factors to the association between socioeconomic status (SES) and metabolic syndrome (MetSyn) risk, in a randomly selected community cohort of 304 middle-aged (40-65 years old) Mexican-American women, a population at elevated cardiometabolic risk. METHODS Participants underwent a clinical exam and measures of demographic factors and psychosocial resource (i.e., personal and social resources) and risk (i.e., negative emotions and cognitions) variables. Confirmatory factor analysis (CFA) and structural equation models (SEMs) were performed in the total sample and in more- and less-U.S.-acculturated women (defined by language preference) separately. RESULTS CFAs revealed single latent constructs for SES (i.e., income, education) and psychosocial resources/risk. Three-factor solution was identified, with blood pressure (systolic diastolic), lipids (high-density lipoprotein cholesterol triglycerides), and metabolic variables (glucose waist circumference) forming separate factors. SEMs showed that an indirect effects model with SES relating to MetSyn factors through psychosocial resources/risk provided a reasonable descriptive and statistical fit in the full and more-acculturated sample (root mean square error of approximation [RMSEA] and standardized root-mean-square residual < .08); fit in the less-acculturated sample was marginal according to RMSEA = .09. A significant mediated path from low SES to higher waist circumference/fasting glucose via lower psychosocial resources/higher psychosocial risk was identified in the overall and more-acculturated samples (p < .05). CONCLUSIONS In this cohort of healthy, middle-aged Mexican-American women, contributions of psychosocial factors to SES-MetSyn associations were limited to the core underlying metabolic mechanisms, and to more-U.S.-acculturated women.

Allostatic load and the assessment of cumulative biological risk in biobehavioral medicine: challenges and opportunities.

Allostatic load provides a useful framework for conceptualizing the multisystem physiological impact of sustained stress and its effects on health and well-being. Research across two decades shows that allostatic load indices predict health outcomes including all-cause mortality and vary with stress and related psychosocial constructs. The study by Slopen and colleagues in this issue provides an example both of the utility of the allostatic load framework and of limitations in related literature, such as inconsistencies in conceptualization and measurement across studies, and the frequent application of cross-sectional designs. The current article describes these limitations and provides suggestions for further research to enhance the value and utility of the allostatic load framework in biobehavioral medicine research.

Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/Study of Latinos enrolled a cohort of Hispanic/Latino adults (N=16,415) 18-74years of age at the time of recruitment, from four US metropolitan areas, between March 2008 and June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking were associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention.

Community-Created Programs: Can They Be the Basis of Innovative Transformations in Our Health Care Practice? Implications from 15 Years of Testing, Translating, and Implementing Community-Based, Culturally Tailored Diabetes Management Programs

D iabetes prevalence is predicted to rise dramatically during the next 20 years, and associated spending is expected to increase threefold.1–3 Cultural barriers contribute to this burden by preventing optimal care among diverse ethnic groups that are at elevated risk for high-cost complications.4–10 Culturally appropriate, clinically sound, and cost-effective models are needed to respond to the growing and diverse populations affected by diabetes worldwide. Chronic disease now accounts for 75% of the

Patient perspectives on whole-genome sequencing for undiagnosed diseases

2 trillion in annual medical costs in the Untied States, and adherence to prescription regimens among those with chronic conditions is estimated to range from 20 to 50%.11,12 Nonadherence to medications accounts for ~

Pilot Test of a Culturally Appropriate Diabetes Prevention Intervention for At-Risk Latina Women

100 billion in annual health care costs.13,14 Health care reform is a driving force to identify low-cost and clinically effective interventions to improve health care quality and reduce costs. Nontraditional care management models, innovative technologies to improve patient adherence to prescribed medical regimens, and use of adherence-enhancing strategies in clinical practice would greatly enhance the health impact of efficacious treatments and prevention efforts and consequently reduce the burden of nonadherence-related health care costs. The most recognized approach for improving care through the current health care delivery system is the Chronic Care Model (CCM) developed by Ed Wagner et al.15–18 This model recognizes that a substantial portion of chronic care management takes place outside of formal health delivery settings. Patient self-management, delivery system design (including information systems and decision-support tools), and community resources are crucial components of this model. The CCM has been used successfully in staff-model health maintenance organizations, large group practices, and community health clinics, and its implementation has been shown in numerous studies to improve care in diabetes and other chronic diseases.19 The medical home model …