Stella Yi

Nativity, Language Spoken at Home, Length of Time in the United States, and Race/Ethnicity: Associations with Self-Reported Hypertension

BACKGROUND Characterization of health conditions in recent immigrant subgroups, including foreign-born whites and Asians, is limited but important for identifying emerging health disparities. Hypertension, a major modifiable risk factor for cardiovascular disease, has been shown to be associated with acculturation, but the acculturative experience varies for different racial/ethnic groups. Assessing the impact of race/ethnicity on the relationship between acculturation-related factors and hypertension is therefore of interest. METHODS Data from the 2005-2008 waves (n = 36,550) of the NYC Community Health Survey were combined to estimate self-reported hypertension prevalence by nativity, language spoken at home, and time spent in the United States. Multivariable analyses were used to assess (i) the independent associations of acculturation-related factors and hypertension and (ii) potential effect modification by race/ethnicity. Sensitivity analysis recalibrating self-reported hypertension using measured blood pressures from a prior NYC population-based survey was performed. Prevalence was also explored by country of origin. RESULTS Being foreign vs. US born was associated with higher self-reported hypertension in whites only. Speaking Russian vs. English at home was associated with a 2-fold adjusted odds of self-reported hypertension. Living in the United States for ≥10 years vs. less time was associated with higher self-reported hypertension prevalence in blacks and Hispanics. Hypertension prevalence in Hispanics was slightly lower when using a recalibrated definition, but other results did not change substantively. CONCLUSIONS Race/ethnicity modifies the relationship between acculturation-related factors and hypertension. Consideration of disease prevalence in origin countries is critical to understanding health patterns in immigrant populations. Validation of self-reported hypertension in Hispanic populations is indicated.

Independent associations of sodium intake with measures of body size and predictive body fatness

Observational studies highlight a possible relationship between sodium intake and obesity. This investigation explores the cross‐sectional relationships between sodium intake and measures of body size and fatness (body mass index [BMI], weight, waist circumference, predictive body fatness).

Highlighting the ratio of sodium to potassium in population-level dietary assessments: cross-sectional data from New York City, USA.

OBJECTIVE To contrast mean values of Na:K with Na and K mean intakes by demographic factors, and to calculate the prevalence of New York City (NYC) adults meeting the WHO guideline for optimal Na:K (<1 mmol/mmol, i.e. <0·59 mg/mg) using 24 h urinary values. DESIGN Data were from the 2010 Community Health Survey Heart Follow-Up Study, a population-based, representative study including data from 24 h urine collections. SETTING Participants were interviewed using a dual-frame sample design consisting of random-digit dial telephone exchanges that cover NYC. Data were weighted to be representative of NYC adults as a whole. SUBJECTS The final sample of 1656 adults provided 24 h urine collections and self-reported health data. RESULTS Mean Na:K in NYC adults was 1·7 mg/mg. Elevated Na:K was observed in young, minority, low-education and high-poverty adults. Only 5·2 % of NYC adults had Na:K in the optimal range. CONCLUSIONS Na intake is high and K intake is low in NYC adults, leading to high Na:K. Na:K is a useful marker and its inclusion for nutrition surveillance in populations, in addition to Na and K intakes, is indicated.

Potassium and fruit and vegetable intakes in relation to social determinants and access to produce in New York City

BACKGROUND Potassium-rich diets are inversely associated with blood pressure. Potassium intake before this study had not been objectively measured by using potassium excretion in a population-based sample in the United States. OBJECTIVES The objectives of the analysis were to 1) report mean potassium excretion in a diverse urban population by using 24-h urine collections, 2) corroborate potassium excretion by using self-reported fruit and vegetable consumption, and 3) characterize associations between potassium excretion and socioeconomic indicators and access to produce. DESIGN Participants were from the 2010 Community Health Survey Heart Follow-Up Study-a population-based study including data from 24-h urine collections. The final sample of 1656 adults was weighted to be representative of New York City (NYC) adults as a whole. RESULTS Mean urinary potassium excretion was 2180 mg/d, and mean self-reported fruit and vegetable intake was 2.5 servings/d. Adjusted urinary potassium excretion was 21% lower in blacks than in whites (P < 0.001), 13% lower in non-college graduates than in college graduates (P < 0.001), and 9% lower in the lowest-income than in the highest-income group (P = 0.03). Potassium excretion was correlated with fruit and vegetable intake. Most NYC residents reported a <10-min walk to fresh fruit and vegetables; this indicator of access was not associated with potassium excretion or fruit and vegetable intake. CONCLUSIONS Potassium intake is low in NYC adults, especially in lower socioeconomic groups. Innovative programs that increase fruit and vegetable intake may help increase dietary potassium and reduce hypertension-related disease. This trial is registered at clinicaltrials.gov as NCT01889589.

Integrating Self Blood Pressure Monitoring Into the Routine Management of Uncontrolled Hypertension: Translating Evidence to Practice

Improving hypertension control is a public health priority and could reduce health disparities. Self blood pressure monitoring (SBPM) is effective but not widely integrated into clinical care. A pragmatic study distributing blood pressure (BP) monitors was conducted to assess its effectiveness in the management of uncontrolled hypertension under conditions consistent with clinic resources. Patients, predominantly black and Hispanic adults from clinics in low‐income, medically underserved communities with uncontrolled BP were enrolled. Follow‐up assessments were conducted 9 months after enrollment. Approximately half (53%) of the patients had controlled hypertension at follow‐up. Systolic and diastolic BP decreased by 18.7 mm Hg and 8.5 mm Hg, respectively, at follow‐up. Although attenuated, decreases persisted after adjustment for regression to the mean. Clinicians were supportive of the program, although collecting follow‐up data from enrolled patients was a common challenge. The integration of SBPM into routine management of uncontrolled hypertension demonstrated substantial improvements in control. Systems to identify and track patients who are self‐monitoring may increase impact. J Clin Hypertens (Greenwich). 2013;00:00–00. ©2013 Wiley Periodicals, Inc.