Bettina M. Beech

Social Environmental Stressors, Psychological Factors, and Kidney Disease

Kidney disease is one of the most striking examples of health disparities in American public health. Disparities in the prevalence and progression of kidney disease are generally thought to be a function of group differences in the prevalence of kidney disease risk factors such as diabetes, hypertension, and obesity. However, the presence of these comorbidities does not completely explain the elevated rate of progression from chronic kidney disease (CKD) to end-stage renal disease among high-risk populations such as African Americans. We believe that the social environment is an important element in the pathway from CKD risk factors to CKD and end-stage renal disease. This review of the literature draws heavily from social science and social epidemiology to present a conceptual frame specifying how social, economic, and psychosocial factors interact to affect the risks for and the progression of kidney disease.

Hepatitis B and C infections among homeless adolescents.

&NA; The lifestyle of homeless adolescents places them at high risk for contracting serious illnesses. This study sought to determine the hepatitis status and predictors of hepatitis infection among 150 homeless adolescents. Each participant took a psychosocial survey and provided a venous blood sample. Most respondents (95%) had engaged in sexual intercourse; approximately 36% indicated they had exchanged sex for food, shelter, or drugs. Youth reported a high rate of consistent condom use, however, 22% tested positive for hepatitis B or C. Homeless youth should be considered a high‐risk group for hepatitis B or C virus infection. As hepatitis B vaccination programs have been targeted at school‐based youth, most homeless youth are missed by these efforts. Targeted programs are needed to immunize this high‐risk group.

“Health is the Ability to Manage Yourself Without Help”: How Older African American Men Define Health and Successful Aging

ObjectivenFew studies have explored how older African American men understand the relationship between health and successful aging. The goal of this study was to examine how older African American mens conceptions and definitions of health and notions of successful aging are interrelated.nnnMethodnUsing data from 22 semistructured individual interviews with African American men ages 55-76, we examine how cultural and normative ideals about health map onto the core components of Rowe and Kahns (1997) definition of successful aging. We also explore how these notions influence factors that have implications for health.nnnResultsnConsistent with prior research, we found that older African American men operationalized notions of health in ways that mapped onto three elements of successful aging: (a) the absence of disease and disability, (b) the ability to maintain physical and cognitive functioning, and (c) meaningful social engagement in life. A fourth theme, what men actually do, emerged to highlight how regular health practices were key components of how men define health.nnnConclusionsnThese findings highlight key elements of how older African American men conceptualize health in ways that are interrelated with yet expand notions of successful aging in ways that are critical for health promotion research and interventions.

Bridging the Gap between Family-Based Treatment and Family-Based Research in Childhood Obesity

The treatment of pediatric obesity has been greatly informed by research as well as by expert opinion.1 The challenge remains to discover novel treatment approaches and translate these findings into clinical care. As with compassionate use of therapeutics in oncology, there is an urgent need to provide best-practice treatment to the millions of children presently struggling with obesity, particularly at the most advanced stages.2 In 2007, Wake Forest University School of Medicine and Brenner Childrens Hospital founded Brenner FIT (Families In Training), a multidisciplinary, family-based pediatric weight management program. From the outset, Brenner FIT integrated quality healthcare principles into program development activities. From this, three innovative programs have been developed. In a somewhat reverse direction of traditional translational research, these three successful clinical programs have informed a larger research initiative and have led to the establishment of a unique and promising research center.

Weight Status and Blood Pressure among Adolescent African American Males: The Jackson Heart KIDS Pilot Study

BACKGROUNDnObesity had not been considered a significant factor contributing to high levels of hypertension among African American males until recently. Epidemiologic research on heart disease among males has primarily focused on adults; however, the significant rise in obesity and hypertension prevalence among African American boys indicates that studies examining the relationship between excess body weight and elevated blood pressure among this high-risk population are critically needed. The purpose of our study was to examine the degree to which weight status has implications for elevated blood pressure among young African American males.nnnMETHODSnThe data for this cross-sectional study were drawn from adolescent males (N=105), aged 12-19 years and who participated in the Jackson Heart KIDS Pilot Study - an offspring cohort study examining cardiovascular disease risks among adolescent descendants of Jackson Heart Study participants. Blood pressure was the primary outcome of interest and weight status was a key independent variable. Other covariates were fruit and vegetable consumption, physical activity, sleep, and stress.nnnRESULTSnApproximately 49% of adolescent males in the study were overweight or obese. Bivariate and multiple variable analyses suggest that obesity may be correlated with elevated diastolic blood pressure (DBP) levels among African American boys. Results from ordinary least squared regression analysis indicate that the DBP for boys carrying excess weight was 4.2 mm Hg (P<.01) higher than the corresponding DBP for their normal weight counterparts, after controlling for age, fruit and vegetable consumption, physical activity, and sleep.nnnCONCLUSIONSnAdditional studies are needed to specify the manner through which excess weight and weight gain can accelerate the development and progression of CVD-related diseases among African American males over the life course, thereby providing evidenced-based information for tailored interventions that can reduce risks for premature morbidity, disability, and mortality among this group.

Children’s Perceptions of Obesity and Health: A Focus Group Study with Hispanic Boys

OBJECTIVEnHispanic boys are one of the most at-risk groups for the development of obesity, yet few effective interventions have been reported. The objective of this study was to assess Hispanic boys perceptions of health and obesity to inform future, targeted interventions.nnnMETHODSnThis is a qualitative and quantitative study of Hispanic boys aged 8 to 12 years in Forsyth County, North Carolina (n = 25). Three focus groups were conducted combined with anthropometrics and measures of body image. Interview guides were developed to elicit childrens perceptions of obesity, nutrition, physical activity, and family influences over health behaviors. Focus group comments were recorded and transcribed. Transcripts were coded using a multistage inductive approach, and grounded theory was used to analyze responses.nnnRESULTSnThe following 6 themes emerged: boys had a limited and superficial understanding of health, nutrition, and activity; perceptions of health were based on muscular appearance, frequency of exercise, and media messages; boys had negative perceptions of overweight children and physical performance; family meals were infrequent and unstructured; boys prefer restaurants with fast food, buffets, and entertainment; and neighborhood safety influences activity participation. Boys did not mention parents as influencers of health and habits.nnnCONCLUSIONSnFrom their findings, the authors have outlined several key areas that will inform clinicians and researchers in the prevention and treatment of obesity in this highly vulnerable population.

The Jackson Heart KIDS Pilot Study: Theory-Informed Recruitment in an African American Population

Recruitment for large cohort studies is typically challenging, particularly when the pool of potential participants is limited to the descendants of individuals enrolled in a larger, longitudinal “parent” study. The increasing complexity of family structures and dynamics can present challenges for recruitment in offspring. Few best practices exist to guide effective and efficient empirical approaches to participant recruitment. Social and behavioral theories can provide insight into social and cultural contexts influencing individual decision-making and facilitate the development strategies for effective diffusion and marketing of an offspring cohort study. The purpose of this study was to describe the theory-informed recruitment approaches employed by the Jackson Heart KIDS Pilot Study (JHKS), a prospective offspring feasibility study of 200 African American children and grandchildren of the Jackson Heart Study (JHS)—the largest prospective cohort study examining cardiovascular disease among African American adults. Participant recruitment in the JHKS was founded on concepts from three theoretical perspectives—the Diffusion of Innovation Theory, Strength of Weak Ties, and Marketing Theory. Tailored recruitment strategies grounded in participatory strategies allowed us to exceed enrollment goals for JHKS Pilot Study and develop a framework for a statewide study of African American adolescents.

Racial Disparities in Sugar-Sweetened Beverage Consumption Change Efficacy Among Male First-Year College Students

Racial disparities in weight-related outcomes among males may be linked to differences in behavioral change efficacy; however, few studies have pursued this line of inquiry. The purpose of this study was to determine the degree to which self-efficacy associated with changing sugar-sweetened beverage (SSB) consumption intake varies by race among male first-year college students. A self-administered, cross-sectional survey was completed by a subsample of freshmen males (N = 203) at a medium-sized southern university. Key variables of interest were SSB intake and self-efficacy in reducing consumption of sugared beverages. African American and Whites had similar patterns of SSB intake (10.2 ± 2.8 vs. 10.1 ± 2.6); however, African Americans had lower proportions of individuals who were sure they could substitute sugared beverages with water (42.2% vs. 57.5%, p < .03). The results from logistic regression models suggest that self-efficacy to reduce SSB intake among males vary by race. African American males were less likely to assert confidence in their ability to change behaviors associated with SSB (odds ratio = 0.51; confidence interval [0.27, 0.95]) in the full model adjusting for weight-related variables including SSB consumption. The findings suggest that weight loss and weight prevention interventions targeting young African American males require components that can elevate self-efficacy of this group to facilitate behavioral modifications that reduce SSB consumption and their risk for obesity-related diseases.

Knowledge and Perceptions about Clinical Trial Participation among African American and Caucasian College Students

ObjectivesThe objectives of the study were to examine knowledge and perceptions of undergraduate and graduate students regarding participation in clinical trials and explore the degree to which knowledge and perceptions about research participation can vary by race.MethodsA cross-sectional survey was administered to undergraduate and graduate students between 18 and 35xa0years of age at a public minority-serving institution and a private, predominately-white university in the Southern United States. A total of 171 African American students and 119 Caucasian students completed the survey.ResultsDescriptive analyses were conducted and T- and chi-square tests were used to assess racial differences across key indicators. Fifty-nine percent of respondents were African American and 41xa0% were male. African American and Caucasian participants had similar experiences with research participation and had comparable knowledge about research participation. Racial differences were found in two areas. African American students with no prior research experience were more willing to participate in a future clinical trial (33 vs 22xa0%, pu2009<u20090.0001) and had a higher average perception of clinical research score (29.7 vs 27.4xa0%, pu2009<u20090.001).ConclusionsThe results from this study suggest that the gap between African American and Caucasian knowledge and perceptions about research may be closing and additional studies are needed to explore how generational differences can impact these factors among underrepresented groups. A deeper understanding of key influences associated with knowledge and perceptions among hard-to-reach populations would go a long way toward the development of culturally relevant and respectful clinical trial education programs that would inform potential participants before recruitment.

Church attendance, allostatic load and mortality in middle aged adults

Importance Religiosity has been associated with positive health outcomes. Hypothesized pathways for this association include religious practices, such as church attendance, that result in reduced stress. Objective The objective of this study was to examine the relationship between religiosity (church attendance), allostatic load (AL) (a physiologic measure of stress) and all-cause mortality in middle-aged adults. Design, setting and participants Data for this study are from NHANES III (1988–1994). The analytic sample (n = 5449) was restricted to adult participants, who were between 40–65 years of age at the time of interview, had values for at least 9 out of 10 clinical/biologic markers used to derive AL, and had complete information on church attendance. Main outcomes and measures The primary outcomes were AL and mortality. AL was derived from values for metabolic, cardiovascular, and nutritional/inflammatory clinical/biologic markers. Mortality was derived from a probabilistic algorithm matching the NHANES III Linked Mortality File to the National Death Index through December 31, 2006, providing up to 18 years follow-up. The primary predictor variable was baseline report of church attendance over the past 12 months. Cox proportional hazard logistic regression models contained key covariates including socioeconomic status, self-rated health, co-morbid medical conditions, social support, healthy eating, physical activity, and alcohol intake. Results Churchgoers (at least once a year) comprised 64.0% of the study cohort (n = 3782). Non-churchgoers had significantly higher overall mean AL scores and higher prevalence of high-risk values for 3 of the 10 markers of AL than did churchgoers. In bivariate analyses non-churchgoers, compared to churchgoers, had higher odds of an AL score 2–3 (OR 1.24; 95% CI 1.01, 1.50) or ≥4 (OR 1.38; 95% CI 1.11, 1.71) compared to AL score of 0–1. More frequent churchgoers (more than once a week) had a 55% reduction of all-cause mortality risk compared with non-churchgoers. (HR 0.45, CI 0.24–0.85) in the fully adjusted model that included AL. Conclusions and relevance We found a significant association between church attendance and mortality among middle-aged adults after full adjustments. AL, a measure of stress, only partially explained differences in mortality between church and non-church attendees. These findings suggest a potential independent effect of church attendance on mortality.