Arsham Alamian

A comprehensive view of sex-specific issues related to cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.

Clustering of chronic disease behavioral risk factors in Canadian children and adolescents.

OBJECTIVE We assessed the prevalence, socioeconomic distribution and clustering of five major chronic disease behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking and high body mass index) in a representative sample of Canadian children and adolescents aged 10-17 years. METHODS Cross-sectional data (n=4724) from Cycle 4 (2000/2001) of the National Longitudinal Survey of Children and Youth were used. Clustering was assessed using an observed to expected ratio method. RESULTS Overall, 65% of Canadian youth had two or more behavioral risk factors compared to only 10% with none of the five risk factors. The prevalence of having multiple behavioral risk factors was greater among older youth and those from low socioeconomic status families. Behavioral risk factors clustered in multiple combinations. Specifically, the simultaneous occurrence of all five risk factors was 120% greater in males (Observed/Expected ratio: 2.20; 95% CI: 1.31-3.09) and 94% greater in females (Observed/Expected ratio: 1.94; 95% CI: 1.24-2.64) than expected. Ever smoking and ever drinking showed the strongest association among the pairwise clusters. CONCLUSIONS Multiple chronic disease behavioral risk factors are frequent and occur more often than expected among Canadian children and adolescents. Early prevention programs targeting clusters of behavioral risk factors in youth are needed.

Correlates of multiple chronic disease behavioral risk factors in Canadian children and adolescents.

The authors assessed individual, social, and school correlates of multiple chronic disease behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a representative sample of Canadian youth aged 10-15 years (mean = 12.5 years) attending public schools. Cross-sectional data (n = 1,747) from cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth were used. Ordinal regression models were constructed to investigate associations between selected covariates and multiple behavioral risk-factor levels (0/1, 2, 3, or 4/5 risk factors). Older age (odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.21, 3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09, 2.03), reporting that most/all of ones peers smoked (OR = 7.31, 95% CI: 4.00, 13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18, 6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31, 2.88) increased the likelihood of having multiple behavioral risk factors. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85, 0.99) and youth from families with postsecondary education (OR = 0.58, 95% CI: 0.41, 0.82) were less likely to have a higher number of risk factors. Although several individual and social characteristics were associated with multiple behavioral risk factors, no school-related correlates emerged. These variables should be considered when planning prevention programs.

Individual and social determinants of multiple chronic disease behavioral risk factors among youth.

BackgroundBehavioral risk factors are known to co-occur among youth, and to increase risks of chronic diseases morbidity and mortality later in life. However, little is known about determinants of multiple chronic disease behavioral risk factors, particularly among youth. Previous studies have been cross-sectional and carried out without a sound theoretical framework.MethodsUsing longitudinal data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children who are followed biennially, the present study examines the influence of a set of conceptually-related individual/social distal variables (variables situated at an intermediate distance from behaviors), and individual/social ultimate variables (variables situated at an utmost distance from behaviors) on the rate of occurrence of multiple behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a sample of children aged 10-11 years at baseline. Multiple behavioral risk factors were assessed using a multiple risk factor score. All statistical analyses were performed using SAS, version 9.1, and SUDAAN, version 9.01.ResultsMultivariate longitudinal Poisson models showed that social distal variables including parental/peer smoking and peer drinking (Log-likelihood ratio (LLR) = 187.86, degrees of freedom (DF) = 8, p < .001), as well as individual distal variables including low self-esteem (LLR = 76.94, DF = 4, p < .001) increased the rate of occurrence of multiple behavioral risk factors. Individual ultimate variables including age, sex, and anxiety (LLR = 9.34, DF = 3, p < .05), as well as social ultimate variables including family socioeconomic status, and family structure (LLR = 10.93, DF = 5, p = .05) contributed minimally to the rate of co-occurrence of behavioral risk factors.ConclusionsThe results suggest targeting individual/social distal variables in prevention programs of multiple chronic disease behavioral risk factors among youth.

Factors Associated With Provision of Addiction Treatment Information by Community Pharmacists

Community pharmacists in the United States have significant opportunity to engage in community-level prescription substance abuse prevention and treatment efforts, including dissemination of information specific to available addiction treatment options. Our cross-sectional study of Tennessee community pharmacists noted that 26% had previously provided addiction treatment facility information to one or more patients in the past. The purpose of this study was to employ multivariate modeling techniques to investigate associations between community pharmacist and community pharmacy factors and past provision of addiction treatment information to pharmacy patients. Multivariate logistic regression indicated having addiction treatment facility information in a pharmacy setting (aOR=8.19; 95% CI=4.36-15.37), having high confidence in ability to discuss treatment facility options (aOR=4.16; 95% CI=2.65-6.52), having participated in prescription opioid abuse-specific continuing education (aOR=2.90; 95% CI=1.70-4.97), being male (aOR=2.23; 95% CI=1.38-3.59), and increased hours per week in the practice setting (aOR=1.02; 95% CI=1.004-1.05) were all significantly associated with provision of information about addiction treatment. Dissemination of addiction treatment information, improvements in communicative self-efficacy beliefs, and dissemination of prescription opioid abuse-specific continuing education are modifiable factors significantly associated with increased provision of addiction treatment information by community pharmacists.

Use of Dietary Supplements Among Women at High Risk of Hereditary Breast and Ovarian Cancer (HBOC) Tested for Cancer Susceptibility

Abstract: Although use of dietary supplements among women with breast cancer is high, use among women at high risk of hereditary breast and ovarian cancer (HBOC) is unknown. This study assesses the prevalence of use of dietary supplements and identifies characteristics associated with use among women at high risk of HBOC who underwent genetic testing for cancer susceptibility. Participants were 303 women who underwent BRCA1/2 testing as part of Interdisciplinary Health Research International Team on Breast Cancer Susceptibility. Dietary supplements use was measured 12 mo post-disclosure. Potential determinants of use included personal cancer history, test result, psychological distress, cancer genetics knowledge, and health-related behaviors. Globally, 51% of participants used at least one dietary supplement. Calcium (26%), multivitamins (17%), vitamins D (14%), E (12%), and C (10%) were most frequently reported. Women ≥ 50 yr were more likely to be using dietary supplements (P < 0.0001). Women with an inconclusive test result were more likely to use mineral supplements than noncarriers [odds ratio (OR) = 2.6; 95% confidence interval (CI) = 1.3-5.3]. Cigarette smoking was negatively associated with use of vitamin supplements (OR = 0.3; 95% CI = 0.1-0.7). Use of dietary supplements among women at high risk of HBOC who underwent BRCA1/2 testing is as frequent as use among patients with other types of tumors or use among individuals from the general population.

Prevalence and Correlates of Indoor Tanning and Sunless Tanning Product Use among Female Teens in the United States.

Background Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens. Methods Teenage females (N = 778) aged 12–18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP use. Results Approximately 16% of female teens engaged in IT behavior and 25% engaged in using STPs. Female teens living in non-metropolitan areas were 82% more likely to indoor tan compared to those in metropolitan areas (OR = 1.82, 95% CI: 1.07–3.10). Age, geographic regions, and race increased the likelihood of IT and STP use. Conclusions Results indicate a significant proportion of teen females engage in IT and STP use. There was evidence that in teens that have never used IT before, STP use precedes IT initiation. Given the evidence for increased IT in rural populations, research focused on rural tanning bed use is needed.

Independent and joint effects of prenatal maternal smoking and maternal exposure to second-hand smoke on the development of adolescent obesity: a longitudinal study.

To examine associations of prenatal maternal smoking and second‐hand smoke (SHS) exposure with the development of adolescent obesity.

Investigation of residents' health literacy status and its risk factors in Jiangsu Province of China.

Health literacy has become an important public health concern. Multistage cluster random sampling was used to select 12 450 individuals. Using the 2009 Chinese Health Literacy questionnaire, participants were divided into groups with poor or not poor health literacy status. The knowledge rates for 6 areas of health literacy were determined with the following results: science concept of health (60.0%), literacy for preventing acute infectious disease (66.8%), literacy for preventing noncommunicable chronic disease (51.9%), safety and first aid (66.8%), obtaining and making use of basic medical care (55.3%), and comprehensive health literacy (52.5%). Multiple logistic regression showed that living in a rural area, fewer individuals in a household, younger age, low education, agricultural or rural migrant occupation workers, and low family income were associated with a poor health literacy status. Our results support the use of health education and promotion interventions to improve health literacy in this high-risk population in China.

Prescription Disposal Practices: A 2-Year Ecological Study of Drug Drop Box Donations in Appalachia

OBJECTIVES We quantified controlled substance donations via permanent drug donation boxes over 2 years in a region with high prescription abuse, assessing medication characteristics, time between dispensing and donation, and weight of medications donated per capita. METHODS In partnership with Drug Enforcement Administration and local law enforcement, we analyzed permanent drug donation box collections in 8 Northeast Tennessee locations from June 2012 to April 2014. We recorded controlled substance dosage units along with the product dispensing date. RESULTS We collected 4841 pounds of pharmaceutical waste, 4.9% (238.5 pounds) of which were controlled substances, totaling 106,464 controlled substance doses. Analysis of dispensing dates for controlled substances indicated a median of 34 months lapsed from dispensing to donation (range = 1-484 months). The mean controlled substance donation rate was 1.39 pounds per 1000 residents. Communities with fewer than 10,000 residents had a statistically higher controlled substance donation rate (P = .002) compared with communities with 10,000 or more residents. CONCLUSIONS Permanent drug donation boxes can be an effective mechanism to remove controlled substances from community settings. Rural and urban community residents should be provided convenient and timely access to drug disposal options.