Stella S. Yi

Sodium Intake in a Cross-Sectional, Representative Sample of New York City Adults

OBJECTIVESnWe estimated sodium intake, which is associated with elevated blood pressure, a major risk factor for cardiovascular disease, and assessed its association with related variables among New York City adults.nnnMETHODSnIn 2010 we conducted a cross-sectional, population-based survey of 1656 adults, the Heart Follow-Up Study, that collected self-reported health information, measured blood pressure, and obtained sodium, potassium, and creatinine values from 24-hour urine collections.nnnRESULTSnMean daily sodium intake was 3239 milligrams per day; 81% of participants exceeded their recommended limit. Sodium intake was higher in non-Hispanic Blacks (3477 mg/d) and Hispanics (3395 mg/d) than in non-Hispanic Whites (3066 mg/d; both Pu2009<u2009.05). Higher sodium intake was associated with higher blood pressure in adjusted models, and this association varied by race/ethnicity.nnnCONCLUSIONSnHigher sodium intake among non-Hispanic Blacks and Hispanics than among Whites was not previously documented in population surveys relying on self-report. These results demonstrate the feasibility of 24-hour urine collection for the purposes of research, surveillance, and program evaluation.

Commentary: Persistence and Health-Related Consequences of the Model Minority Stereotype for Asian Americans.

Fifty years ago, the term model minority was coined to describe the extraordinary ability of Asian Americans to overcome hardship to succeed in American society. Less well-known is how the model minority stereotype was cultivated within the context of Black-White race relations during the second half of the 20th century, and how this stereotype, in turn, has contributed to the understanding and prioritization of health disparities experienced by Asian Americans. The objectives of this article are to define the model minority stereotype, present its controversies, and provide examples of its social and health-related consequences (ie, implications for obesity and tobacco) across multiple levels of society and institutions. A salient theme throughout the examples provided is the limitation of data presented at the aggregate level across all Asian subgroups which masks meaningful disparities. The intent is to increase the visibility of Asian Americans as a racial/ethnic minority group experiencing chronic disease health disparities and deserving of health-related resources and consideration.

Increasing access to fruits and vegetables: perspectives from the New York City experience.

Broad recognition now exists that price, availability, and other structural factors are meaningful barriers to fruit and vegetable consumption, particularly among low-income adults. Beginning in 2005, the New York City Department of Health and Mental Hygiene used the social-ecological model to develop a multifaceted effort to increase fruit and vegetable access citywide, with emphasis in low-income neighborhoods. Overall, the percentage of New York City adults who reported consuming no fruits and vegetables in the previous day decreased slightly over a 10-year period (2002: 14.3% [95% confidence intervalu2009=u200913.4%, 15.2%]; 2012: 12.5% [95% confidence intervalu2009=u200911.4%, 13.6%]; P for trend <u2009.001). Our approach hypothesizes that complementary initiatives, implemented simultaneously, will create a citywide food environment that fuels changes in social norms and cultural preferences, increases consumer demand, and supports sustainable access to affordable produce.

Weighing in on the hidden Asian American obesity epidemic.

According to national estimates, obesity prevalence is lower in Asian Americans compared to other racial/ethnic groups, but this low prevalence may be misleading for three reasons. First, a lower body mass index (BMI) cutoff as proposed by the World Health Organization may be more appropriate to use in Asian populations. However, evidence is limited to substantiate the potential costs and burden of adopting these cutoffs. Increasing BMI in Asians (as in other racial/ethnic groups) should be considered across the spectrum of BMI, with a minimum awareness of these lower cutoffs among healthcare researchers. Second, the need for disaggregated data across Asian American subgroups is illustrated by the higher obesity (and diabetes) prevalence estimates observed in South Asian Americans. Third, prevalence of obesity should be placed in the larger context of immigration and globalization through cross-national comparisons and examination of acculturation-related factors. However these types of studies and collection of salient variables are not routinely performed. Data from a metropolitan area where many Asian Americans settle is presented as a case study to illustrate these points. Clear evidence that incorporates these three considerations is necessary for program planning and resource allocation for obesity-related disparities in this rapidly growing and diverse population.

Self-Blood Pressure Monitoring in an Urban, Ethnically Diverse Population A Randomized Clinical Trial Utilizing the Electronic Health Record

Background—Hypertension is a leading risk factor for cardiovascular disease. Although control rates have improved over time, racial/ethnic disparities in hypertension control persist. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with limited resources. Methods and Results—The New York City Health Department in partnership with community clinic networks implemented a randomized clinical trial (n=900, 450 per arm) to investigate the effectiveness of self-blood pressure monitoring in medically underserved and largely black and Hispanic participants. Intervention participants received a home blood pressure monitor and training on use, whereas control participants received usual care. After 9 months, systolic blood pressure decreased (intervention, 14.7 mm Hg; control, 14.1 mm Hg; P=0.70). Similar results were observed when incorporating longitudinal data and calculating a mean slope over time. Control was achieved in 38.9% of intervention and 39.1% of control participants at the end of follow-up; the time-to-event experience of achieving blood pressure control in the intervention versus control groups were not different from each other (logrank P value =0.91). Conclusions—Self-blood pressure monitoring was not shown to improve control over usual care in this largely minority, urban population. The patient population in this study, which included a high proportion of Hispanics and uninsured persons, is understudied. Results indicate these groups may have additional meaningful barriers to achieving blood pressure control beyond access to the monitor itself. Clinical Trial Registration:http://clinicaltrials.gov. Unique Identifier: NCT01123577

Racial/ethnic residential segregation, neighborhood poverty and urinary biomarkers of diet in New York City adults

Consuming less sodium and more potassium are components of a healthy diet and reduced cardiovascular disease risk. Racial/ethnic segregation and poverty are both associated with dietary habits, but data linking dietary intake to neighborhood characteristics are limited, particularly in Hispanic and Asian American ethnic enclaves. This study presents relationships between neighborhood-level segregation, poverty and biologic indicators of sodium and potassium consumption. Data were from the 2010 Heart Follow-Up Study, a cross-sectional health survey, which included 24-h urine collections and self-reported health status (n = 1656). Black, Hispanic, and Asian segregated areas and neighborhood poverty were defined for aggregated zip-code areas. Multivariable models assessed the association between neighborhood segregation and poverty and sodium and potassium intake, after adjustment for individual-level covariates. In unadjusted models, potassium intake (a marker of fruit and vegetable consumption) was lower in high-versus low-Hispanic segregated neighborhoods, and the sodium-potassium ratio was higher in high-versus low black and Hispanic segregated neighborhoods, and in high-versus low-poverty neighborhoods; the sodium-potassium ratio was lower in high-versus low Asian segregated neighborhoods. Segregation and poverty were not independently associated with nutrition biomarkers after adjustment for demographics and for each other; however, practical consideration of neighborhood race/ethnic composition may be useful to understand differences in consumption.

Construct validity of a single-item, self-rated question of diet quality.

OBJECTIVEnTo provide evidence of the construct validity of a single-item overall diet question with a nomological network of self-rated and biometric measures of dietary intake and outcomes.nnnMETHODSnThe authors conducted a secondary analysis of survey and biometric data from a cross-sectional sample of urban-dwelling adults. In addition to self-rated diet quality, they examined dietary behaviors, biomarkers of intake, and related outcomes. Self-rated diet quality was treated as a continuous variable to calculate P for trend using regression analysis.nnnRESULTSnSelf-rated diet quality was significantly associated with variation in both subjective and objective measures of dietary intake (fruit and vegetable intake, Pxa0<xa0.001; sugar-sweetened beverage intake, Pxa0<xa0.001; sodium to potassium ratio, Pxa0<xa0.001), behavior (frequency of fast-food dining, Pxa0<xa0.001), and related outcomes (systolic blood pressure, Pxa0=xa0.010; diastolic blood pressure, Pxa0<xa0.001; and body mass index, Pxa0<xa0.001).nnnCONCLUSIONS AND IMPLICATIONSnEvidence supports the construct validity of a single-item measure of diet quality. This single-item question may be a useful proxy for more burdensome measures of overall diet quality.

Disparities in meeting physical activity guidelines for Asian-Americans in two metropolitan areas in the United States

PURPOSEnPhysical activity (PA) levels in Asian-American adults may be lower than other racial or ethnic groups. This analysis tested the hypothesis that Asian-Americans are less likely to meet PA guidelines than other racial or ethnic groups regardless of location of residence.nnnMETHODSnThe New York City (NYC) Community Health Survey (2010, 2012) and Los Angeles County (LAC) Health Survey (2011) are cross-sectional surveys conducted with similar sampling strategies (NYC: nxa0=xa017,462; LAC: nxa0=xa08036). Meeting PA guidelines was calculated using self-reported moderate or vigorous minutes per week; multivariable regression models adjusted for demographics, insurance, nativity and language spoken at home. Data were weighted to be representative of their respective geographies.nnnRESULTSnIn both areas, Asian-Americans had a low prevalence of meeting PA guidelines (NYC: 42.7 [39.2-46.3]; LAC: 55.8 [51.2-60.2]). Other racial or ethnic groups were more likely to meet PA guidelines versus Asian-Americans after adjustment for covariates in NYC (white odds ratio [OR]: 1.35 [1.09-1.68]; black OR: 1.61 [1.28-2.02]; Hispanic OR: 2.14 [1.74-2.62]) and in LAC (white OR: 1.45 [1.13-1.86]; Hispanic OR: 1.71 [1.32-2.22]).nnnCONCLUSIONSnAsian-Americans were less likely to meet PA guidelines compared with other racial or ethnic groups in NYC and LAC. Description of cultural and neighborhood-level factors and of types of PA in specific Asian subgroups is needed.

Clinical Characteristics and Lifestyle Behaviors in a Population-Based Sample of Chinese and South Asian Immigrants With Hypertension

BACKGROUNDnAsian Americans are the fastest growing racial/ethnic group in the United States. Chinese Americans and their counterparts in Chinese countries have been shown to have an elevated risk of stroke compared to non-Hispanic Whites, while South Asian Americans and their counterparts in South Asian countries have an elevated risk of heart disease. Exactly how cardiovascular disease morbidity varies by Asian subgroup, however, is not well understood. The purpose of this analysis was to identify differences in clinical presentation and lifestyle behaviors between Chinese and South Asian American immigrants vs. non-Hispanic Whites in a representative sample of adults with self-report of physician-diagnosed hypertension.nnnMETHODSnData on adults with self-reported hypertension were obtained from the New York City Community Health Survey 2009-2013 (Chinese: n = 555; South Asian: n = 144; non-Hispanic White: n = 5,987).nnnRESULTSnCompared to non-Hispanic Whites with hypertension, foreign-born Chinese adults with hypertension were of a much lower socioeconomic profile and less likely to have private health insurance, and foreign-born Chinese and South Asian adults with hypertension had lower body mass index (BMI) values (25.3, 26.0 vs. 28.7kg/m(2); P < 0.001). South Asians were younger than non-Hispanic Whites (mean age: 49.5 vs. 62.1 years; P < 0.001) and had poorer diet quality. BMI and diet quality results persisted in multivariable regression models.nnnCONCLUSIONSnFindings from this study highlight important clinical distinctions in hypertensive Chinese and South Asian immigrant communities with respect to age and body size. Whether targeted and culturally appropriate approaches would reduce cardiovascular disease-related mortality in these groups needs further study.

Perceptions and the role of group exercise among New York City adults, 2010-2011: an examination of interpersonal factors and leisure-time physical activity.

OBJECTIVEnTo examine associations of descriptive norms (i.e., behaviors of social group members) and exercising with a partner or as a part of a group on weekly leisure-time physical activity.nnnMETHODSnT-tests and adjusted multivariable linear models were used to test the associations between descriptive norms and exercising with a partner or as a part of a group with self-reported leisure-time physical activity using the cross-sectional, population-based New York City Physical Activity and Transit (PAT) Survey 2010-2011 (n=3806).nnnRESULTSnOverall, 70.6% of adult New Yorkers reported having physically active friends. Having active friends was associated with increased leisure-time physical activity; however, the effect varied by sex. Compared to those who did not have active friends, males with active friends reported two times more activity (56 min/week) and women reported two and a half times more activity (35 min/week) (both p-values<0.001). Physically active males and females who usually engaged in leisure-time activities as a part of a group reported 1.4 times more activity than those who exercised alone (both p-values<0.03).nnnCONCLUSIONSnDescriptive norms and group exercise were associated with leisure-time physical activity among adults. Based on these associations, encouraging group exercise may be an effective strategy for increasing leisure-time physical activity among certain subgroups.