Christina Buelna

Sexual Relationship Power as a Mediator Between Dating Violence and Sexually Transmitted Infections Among College Women

This study examined relationship power as a possible mediator of the relationship between dating violence and sexually transmitted infections (STIs). The proposed mediation model was based on the theory of gender and power as well as previous research on intimate partner violence and STI risk. Survey results from a sample of 290 single, undergraduate women indicated that 85% experienced at least one form of dating violence victimization in the past year, 5.9% tested positive for an STI, and 5.2% received treatment for an STI. Results revealed that women with lower levels of sexual relationship power had higher rates of dating violence victimization and STIs; also, sexual relationship power partially mediated the relationship between dating violence victimization and STIs. Future dating violence and STI-prevention interventions targeting young women may want to use an empowerment approach to decrease their likelihood of dating violence victimization and STI risk.

Objectively Measured Sedentary Time and Cardiometabolic Biomarkers in US Hispanic/Latino Adults: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Background— Sedentary behavior is recognized as a distinct construct from lack of moderate-vigorous physical activity and is associated with deleterious health outcomes. Previous studies have primarily relied on self-reported data, whereas data on the relationship between objectively measured sedentary time and cardiometabolic biomarkers are sparse, especially among US Hispanics/Latinos. Methods and Results— We examined associations of objectively measured sedentary time (via Actical accelerometers for 7 days) and multiple cardiometabolic biomarkers among 12 083 participants, aged 18 to 74 years, from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Hispanics/Latinos of diverse backgrounds (Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American) were recruited from 4 US cities between 2008 and 2011. Sedentary time (<100 counts/min) was standardized to 16 hours/d of wear time. The mean sedentary time was 11.9 hours/d (74% of accelerometer wear time). After adjustment for moderate-vigorous physical activity and confounding variables, prolonged sedentary time was associated with decreased high-density lipoprotein cholesterol (P=0.04), and increased triglycerides, 2-hour glucose, fasting insulin, and homeostatic model assessment of insulin resistance (all P<0.0001). These associations were generally consistent across age, sex, Hispanic/Latino backgrounds, and physical activity levels. Even among individuals meeting physical activity guidelines, sedentary time was detrimentally associated with several cardiometabolic biomarkers (diastolic blood pressure, high-density lipoprotein cholesterol, fasting and 2-hour glucose, fasting insulin and homeostatic model assessment of insulin resistance; all P<0.05). Conclusions— Our large population-based, objectively derived data showed deleterious associations between sedentary time and cardiometabolic biomarkers, independent of physical activity, in US Hispanics/Latinos. Our findings emphasize the importance of reducing sedentary behavior for the prevention of cardiometabolic diseases, even in those who meet physical activity recommendations.Background— Sedentary behavior is recognized as a distinct construct from lack of moderate-vigorous physical activity and is associated with deleterious health outcomes. Previous studies have primarily relied on self-reported data, whereas data on the relationship between objectively measured sedentary time and cardiometabolic biomarkers are sparse, especially among US Hispanics/Latinos. Methods and Results— We examined associations of objectively measured sedentary time (via Actical accelerometers for 7 days) and multiple cardiometabolic biomarkers among 12 083 participants, aged 18 to 74 years, from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Hispanics/Latinos of diverse backgrounds (Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American) were recruited from 4 US cities between 2008 and 2011. Sedentary time (<100 counts/min) was standardized to 16 hours/d of wear time. The mean sedentary time was 11.9 hours/d (74% of accelerometer wear time). After adjustment for moderate-vigorous physical activity and confounding variables, prolonged sedentary time was associated with decreased high-density lipoprotein cholesterol ( P =0.04), and increased triglycerides, 2-hour glucose, fasting insulin, and homeostatic model assessment of insulin resistance (all P <0.0001). These associations were generally consistent across age, sex, Hispanic/Latino backgrounds, and physical activity levels. Even among individuals meeting physical activity guidelines, sedentary time was detrimentally associated with several cardiometabolic biomarkers (diastolic blood pressure, high-density lipoprotein cholesterol, fasting and 2-hour glucose, fasting insulin and homeostatic model assessment of insulin resistance; all P <0.05). Conclusions— Our large population-based, objectively derived data showed deleterious associations between sedentary time and cardiometabolic biomarkers, independent of physical activity, in US Hispanics/Latinos. Our findings emphasize the importance of reducing sedentary behavior for the prevention of cardiometabolic diseases, even in those who meet physical activity recommendations. # CLINICAL PERSPECTIVE {#article-title-49}

Spiritual well-being and depressive symptoms among cancer survivors.

PurposeDepression is common among patients diagnosed with cancer and may be inversely associated with spiritual well-being. While numerous strategies are employed to manage and cope with illness, spiritual well-being has become increasingly important in cancer survivorship research. This study examined the association between spiritual well-being and depressive symptoms.MethodsThis cross-sectional study utilized self-report data from 102 diverse cancer survivors recruited from peer-based cancer support groups in San Diego County. Depression was measured with the Patient Health Questionnaire-8 (PHQ-8) and spiritual well-being was measured with the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp) comprised of two subscales (Meaning/Peace and Faith).ResultsHierarchal regression analysis indicated that Meaning/Peace significantly predicted depressive symptoms after adjusting for socio-demographics, cancer stage, time since diagnosis, and Faith (p < .001).ConclusionsFindings suggest that Spiritual Well-Being is a valuable coping mechanism and that Meaning/Peace has a unique advantage over Faith in protecting cancer survivors from the effects of depression symptoms; therefore, turning to Faith as source of strength may improve psychological well-being during survivorship.ImplicationsFuture programs and healthcare providers should be cognizant of the influential role of spiritual well-being in depression symptoms in an effort to improve psychological well-being among cancer survivors.

Measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D 10): Findings from HCHS/SOL.

The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used self-report measure of depression symptomatology. This study evaluated the reliability, validity, and measurement invariance of the CES-D 10 in a diverse cohort of Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The sample consisted of 16,415 Hispanic/Latino adults recruited from 4 field centers (Miami, FL; San Diego, CA; Bronx, NY; Chicago, IL). Participants completed interview administered measures in English or Spanish. The CES-D 10 was examined for internal consistency, test–retest reliability, convergent validity, and measurement invariance. The total score for the CES-D 10 displayed acceptable internal consistencies (Cronbach’s alpha’s = .80–.86) and test–retest reliability (r values = .41–.70) across the total sample, language group and ethnic background group. The total CES-D 10 scores correlated in a theoretically consistent manner with the Spielberger State–Trait Anxiety Inventory, r = .72, p < .001, the Patient Health Questionnaire-9 depression measure, r = .80, p < .001, the Short Form-12’s Mental Component Summary, r = −.65, p < .001, and Physical Component Summary score, r = −.25, p < .001. A confirmatory factor analysis showed that a 1-factor model fit the CES-D 10 data well (CFI = .986, RMSEA = .047) after correlating 1 pair of item residual variances. Multiple group analyses showed the 1-factor structure to be invariant across English and Spanish speaking responders and partially invariant across Hispanic/Latino background groups. The total score of the CES-D 10 can be recommended for use with Hispanics/Latinos in English and Spanish.

Accelerometer-measured sedentary time among Hispanic adults: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Excessive sedentary behavior is associated with negative health outcomes independent of physical activity. Objective estimates of time spent in sedentary behaviors are lacking among adults from diverse Hispanic/Latino backgrounds. The objective of this study was to describe accelerometer-assessed sedentary time in a large, representative sample of Hispanic/Latino adults living in the United States, and compare sedentary estimates by Hispanic/Latino background, sociodemographic characteristics and weight categories. This study utilized baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) that included adults aged 18–74 years from four metropolitan areas (N = 16,415). Measured with the Actical accelerometer over 6 days, 76.9% (n = 12,631) of participants had > 10 h/day and > 3 days of data. Participants spent 11.9 h/day (SD 3.0), or 74% of their monitored time in sedentary behaviors. Adjusting for differences in wear time, adults of Mexican background were the least (11.6 h/day), whereas adults of Dominican background were the most (12.3 h/day), sedentary. Women were more sedentary than men, and older adults were more sedentary than younger adults. Household income was positively associated, whereas employment was negatively associated, with sedentary time. There were no differences in sedentary time by weight categories, marital status, or proxies of acculturation. To reduce sedentariness among these populations, future research should examine how the accumulation of various sedentary behaviors differs by background and region, and which sedentary behaviors are amenable to intervention.

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.

Objectively Measured Sedentary Time and Cardiovascular Risk Factor Control in US Hispanics/Latinos With Diabetes Mellitus: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background Cardiovascular disease (CVD) risk factor control is a cornerstone of diabetes mellitus management. Little is known about relationships of objectively measured sedentary time and physical activity with major CVD risk factor control in individuals with diabetes mellitus. We examined associations of objectively measured sedentary time and moderate‐to‐vigorous physical activity with reaching major CVD risk factor control goals among US Hispanic/Latino adults with diabetes mellitus. Methods and Results This cross‐sectional analysis included 1699 participants with diabetes mellitus from the Hispanic Community Health Study/Study of Latinos (2008–2011). Logistic regression models were used to estimate the odds ratios (ORs) of meeting the following 5 major CVD risk factor control goals: hemoglobin A1c <7.0%; systolic/diastolic blood pressure <140/80 mm Hg; triglycerides <150 mg/dL; low‐density lipoprotein cholesterol <100 mg/dL; and high‐density lipoprotein cholesterol >40/50 mg/dL for men/women. After adjustment for covariates including moderate‐to‐vigorous physical activity, less sedentary time was associated with increased odds of reaching hemoglobin A1c (OR=1.76 [95% CI: 1.10, 2.82]) and triglyceride control goals (OR=2.16 [1.36, 3.46]), and reaching ≥3 CVD risk factor control goals (OR=2.08 [1.34, 3.23]) (all ORs for comparisons of extreme tertiles of sedentary time). Moderate‐to‐vigorous physical activity was not associated with reaching any CVD risk factor control goals. Substituting 60‐min/day of sedentary time with light‐intensity physical activity was associated with increased odds of reaching hemoglobin A1c (OR=1.18 [1.04, 1.35]), high‐density lipoprotein cholesterol (OR=1.17 [1.04, 1.32]), and triglyceride (OR=1.20 [1.05, 1.36]) control goals. Conclusions Among US Hispanic/Latino adults with diabetes mellitus, less sedentary time, but not moderate‐to‐vigorous physical activity, was associated with improved CVD risk factor control, specifically in reaching hemoglobin A1c and triglyceride control goals.

Prolonged, Uninterrupted Sedentary Behavior and Glycemic Biomarkers Among US Hispanic/Latino Adults: The HCHS/SOL (Hispanic Community Health Study/Study of Latinos)

Background: Excessive sedentary time is ubiquitous in developed nations and is associated with deleterious health outcomes. Few studies have examined whether the manner in which sedentary time is accrued (in short or long bouts) carries any clinical relevance. The purpose of this study was to examine the association of prolonged, uninterrupted sedentary behavior with glycemic biomarkers in a cohort of US Hispanic/Latino adults. Methods: We studied 12 083 participants from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a population-based study of Hispanic/Latino adults 18 to 74 years of age. Homeostatic model assessment of insulin resistance and glycosylated hemoglobin were measured from a fasting blood sample, and 2-hour glucose was measured after an oral glucose tolerance test. Sedentary time was objectively measured with a hip-mounted accelerometer. Prolonged, uninterrupted sedentariness was expressed as mean sedentary bout length. Results: After adjustment for potential confounders and moderate to vigorous physical activity, longer sedentary bout duration was dose-dependently associated with increased homeostatic model assessment of insulin resistance (P for trend<0.001) and 2-hour glucose levels (P for trend=0.015). These associations were not independent of total sedentary time; however, a significant interaction between sedentary bout duration and total sedentary time was observed. Evaluation of the joint association of total sedentary time and sedentary bout duration showed that participants in the upper quartile for both sedentary characteristics (ie, high total sedentary time and high sedentary bout duration) had the highest levels of homeostatic model assessment of insulin resistance (P<0.001 versus low group for both sedentary characteristics) and 2-hour glucose (P=0.002 versus low group for both sedentary characteristics). High total sedentary time or high sedentary bout duration alone were not associated with differences in any glycemic biomarkers. Conclusions: Accruing sedentary time in prolonged, uninterrupted bouts may be deleteriously associated with biomarkers of glucose regulation.

Youth and caregiver physical activity and sedentary time: HCHS/SOL Youth

OBJECTIVES We examined associations between youth and caregiver moderate/ vigorous physical activity (MVPA) and sedentary (SED) time, using accelerometery, in the Hispanic Community Health Study/Study of Latino Youth (HCHS/ SOL) Youth. METHODS Participants were 623 caregivers and 877 youth 8-16 years old, enrolled in 2012-2014. Associations of youth and caregiver MVPA time, SED time, and meeting MVPA recommendations ( 150 min/week, adults; 420 min/week, youth) were examined in regression models that controlled for sample weights, design effects, and demographic and health covariates. RESULTS Youth whose caregivers met MVPA recommendations were nearly twice as likely to meet these recommendations themselves when compared to youth whose caregivers did not meet MVPA recommendations (OR = 1.9, 95 CI 1.1, 3.3). Youth and caregiver SED time also were significantly related (p .05). A similar pattern of findings was observed in analyses limited to relationships in which the caregiver was a biological parent of the youth (N = 485 caregivers; N = 795 youth). CONCLUSIONS MVPA and SED are correlated within Latino families as observed by statistically significant relationships of youth and caregiver activity. Additional research is needed to understand underlying genetic and environmental factors that explain these findings.

Occupational Physical Activity and Body Mass Index: Results from the Hispanic Community Health Study/Study of Latinos.

Purpose To examine the associations between overweight/obesity and occupation among Hispanics/Latinos, the largest minority population in the U.S. Methods This study included 7,409 employed individuals in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective study of Hispanic/Latino individuals aged 18–74 in four communities in the U.S. We independently examined the relationships between BMI, Occupational Activity (OA), and Total Hours Worked, quantified via self-reported hours worked per week and occupation-assigned Metabolic Equivalents (METs). Results More than three quarters of the participants were either overweight (39.3%) or obese (37.8%). Individuals with a primary occupation and those employed in a secondary occupation worked an average of 36.8 and 14.6 hrs/wk, respectively. The overall adjusted odds for being obese compared to normal weight were 3.2% (AOR = 1.03, 95% CI 1.01, 1.05) and 14.4% (AOR = 1.14 95% Cl 1.07, 1.23) greater for each 10 MET•hrs/wk unit of increased OA, and each 10-hrs/wk unit of Total Hours Worked, respectively. Conclusion This study presents the first findings on the association between OA with overweight/obesity among Hispanic/Latino individuals in the U.S. Increasing OA and Total Hours Worked per week were independently associated with increasing odds of overweight/obesity suggesting that the workplace is only one part of the overall energy expenditure dynamic. Our findings point to the need to emphasize engaging employed individuals in greater levels of PA outside of the work environment to impact overweight/obesity.