Kelly Ylitalo - Academia.edu (original) (raw)
Papers by Kelly Ylitalo
Life
Metabolic syndrome (MetS) is associated with decreased renal function and chronic kidney disease ... more Metabolic syndrome (MetS) is associated with decreased renal function and chronic kidney disease (CKD). To date, no research regarding the sixteen possible constellations resulting in the diagnosis of MetS has been elucidated. The purpose of this study is to report renal function in sixteen metabolic constellations grouped into four metabolic clusters. Individuals (n = 2767; representing 86,652,073 individuals) from the 2013–2018 National Health and Nutrition Examination Surveys who met the criteria for MetS were included. Sixteen possible constellations of three or more risk factors were analyzed for renal function. Four metabolic clusters representing MetS with hyperglycemia (Cluster I), MetS with hypertension (Cluster II), MetS with hyperglycemia and hypertension (Cluster III), or MetS with normoglycemia and normotension (Cluster IV) were assessed for renal function and CKD status. Cluster III had the highest odds of CKD (OR = 2.57, 95% CL = 1.79, 3.68). Clusters II and III had t...
Innovation in Aging, 2021
Metabolic syndrome (MetS) is a cluster of factors (hypertension, abdominal obesity, impaired fast... more Metabolic syndrome (MetS) is a cluster of factors (hypertension, abdominal obesity, impaired fasting glucose, low high-density lipoprotein, hypertriglyceridemia). How midlife MetS impacts future physical functioning is uncertain. We hypothesized that higher midlife MetS components are associated with poorer physical performance in early late life for multi-ethnic women. MetS status from 1996-2011 (8 visits) and objective physical performance (2015/16; short physical performance battery (SPPB; 0-12), 40-foot walk (m/s), 4-meter gait speed (m/s), chair stands (sec), stair climb (sec)) were assessed in the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% Black, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified trajectory groups distinguishable by number of MetS components: none (23.9%), 1=low-MetS (28.7%), 2=mid-MetS (30.9%), >3=high-MetS (16.5%). High-MetS versus none had higher body mass index, pain, fin...
Therapeutic Comparison of Equine Movement and Therapeutic Riding as Interventions for Children with Autism: A Crossover Trial
The International Journal of Interdisciplinary Social and Community Studies, 2021
Innovation in Aging, 2021
This study evaluated the relationship between individual and combined sensory impairments (vision... more This study evaluated the relationship between individual and combined sensory impairments (vision, hearing, peripheral nerve (PN)) with recurrent falls in the past year among 1951 women (mean age 65.6 years) from the Study of Women’s Health Across the Nation. Sensory impairments were defined as self-reported vision difficulty, hearing loss, or ≥4 on the Michigan Neuropathy Screening Instrument. Recurrent falls were defined as ≥2 self-reported falls. Hearing was the most commonly reported impairment (39.2%), followed by vision (22.1%) and PN (16.0%). Among those with any impairments, 7.0% of women reported impairments in all domains. Recurrent falls were more common among women with vision (19.4%), hearing (17.3%), or PN impairments (24.7%) as compared to women without sensory impairments (7.0%). The greatest burden of recurrent falls was among women with all three sensory impairments; one-third (34.6%) of women with vision, hearing and PN impairment were recurrent fallers. In an adj...
Supplemental Material, sj-pdf-1-jah-10.1177_0898264320988405 for Association of Physical Activity... more Supplemental Material, sj-pdf-1-jah-10.1177_0898264320988405 for Association of Physical Activity and Physical Functioning Phenotypes With Fall Risk Among Women by Kelly R. Ylitalo, Carrie A. Karvonen-Gutierrez, Barbara Sternfeld and Kelley Pettee Gabriel in Journal of Aging and Health
International Journal of Environmental Research and Public Health, 2021
Mexican-heritage children often achieve less physical activity (PA) than their counterparts and a... more Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers’ perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas–Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for famil...
The Journals of Gerontology: Series A, 2021
BackgroundLittle is known about how adverse, midlife metabolic profiles affect future physical fu... more BackgroundLittle is known about how adverse, midlife metabolic profiles affect future physical functioning. We hypothesized that a higher number of midlife metabolic syndrome (MetS) components are associated with poorer physical performance in early old age for multiethnic women.MethodsMetS status from 1996 to 2011 (8 visits) and objective physical performance in 2015/2016 (Short Physical Performance Battery [SPPB; 0–12], 40-foot walk [meter/second], 4-meter gait speed [meter/second], chair stands [seconds], stair climb [seconds]) were assessed in the Study of Women’s Health Across the Nation (SWAN; n = 1722; age 65.4 ± 2.7 years; 26.9% African American, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified MetS component trajectory groups: none (23.9%), 1 = low-MetS (28.7%), 2 = mid-MetS (30.9%), and ≥3 = high-MetS (16.5%). Adjusted linear regression related MetS groups to physical performance outcomes.ResultsHigh-MetS versus none had higher ...
Preventive Medicine Reports, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Life, 2021
Rising rates of metabolic syndrome, obesity, and mortality from chronic kidney disease (CKD) have... more Rising rates of metabolic syndrome, obesity, and mortality from chronic kidney disease (CKD) have prompted further investigation into the association between metabolic phenotypes and CKD. Purpose: To report the frequency of strictly defined metabolic phenotypes, renal function within each phenotype, and individual risk factors associated with reduced renal function. We utilized the 2013–2018 National Health and Nutrition Examination Surveys (NHANES) and complex survey sample weighting techniques to represent 220 million non-institutionalized U.S. civilians. Metabolic health was defined as having zero of the risk factors defined by the National Cholesterol Education Program with the exception of obesity, which was defined as BMI ≥ 30 kg/m2 in non-Asians and BMI ≥ 25 kg/m2 in Asians. The metabolically healthy normal (MUN) phenotype comprised the highest proportion of the population (38.40%), whereas the metabolically healthy obese (MHO) was the smallest (5.59%). Compared to the MHN re...
Women's Health, 2020
Objectives: The transition to motherhood is associated with declines in physical activity in wome... more Objectives: The transition to motherhood is associated with declines in physical activity in women. Working mothers may be particularly at-risk for low levels of physical activity, since they have to balance the competing interests of work and family life, and exercise often takes a backseat to more seemingly pressing concerns. The potential benefits working mothers can experience from physical activity are numerous. The objectives of this study were to evaluate the percentage of working mothers from the United States who met the World Health Organization’s and the American College of Sports Medicine’s recommended guidelines for weekly physical activity and investigate the associations between physical activity, quality of life, and self-rated work productivity in this sample of working mothers. Methods: Participants were 334 working mothers from the United States (mean age = 35.00 years; standard deviation (SD) = 5.85; 77.8% White) recruited from a Qualtrics research panel. To be e...
Innovation in Aging, 2019
Physical activity (PA) is positively associated with physical functioning, but relations of domai... more Physical activity (PA) is positively associated with physical functioning, but relations of domain-specific PA with falls is less clear. In 2015, women (n=1,962) self-reported fall history and PA. The Kaiser Physical Activity Survey (KPAS) assessed sports, non-sports leisure, household/caregiving, and total activity. Risk ratios (RR) were generated from poisson regression. One-third (29.7%) of women (mean age=65.1 years [SD 2.7]) reported ≥1 fall and 18.3% reported ≥1 fall injury in the previous 12 months. Women in the highest quartile of sports activity had an increased risk of ≥1 fall (RR=1.19;95%CI:1.00,1.41;p=0.049). Women in the highest quartile of total activity had an increased risk of injurious falls (RR=1.31;95%CI:1.04,1.65;p=0.021), but there was no association for domain-specific indices. KPAS may identify women and activity domains, such as sports, at high risk for falls and injuries. Future work should incorporate device-based PA assessments within domains to understand...
Innovation in Aging, 2019
Physical activity improves quality of life and prevents or delays chronic disease, but most adult... more Physical activity improves quality of life and prevents or delays chronic disease, but most adults in the United States are inactive. Consultation and planning with a health care provider, specifically with an exercise “prescription,” may increase physical activity, but utilization patterns and success of such programs are not well understood. This study assessed the initial 6 months of an exercise prescription program at a large, federally-qualified health center during 2018 whereby adult patients were referred via prescription to personalized health coaching by a fitness advisor. A census of all adults (n=512) who received an exercise prescription was combined with attendance data from the on-site exercise facility to classify patients as never attended, 1 to 3 visits, and ≥4 visits. Ordinal logistic regression was used to examine patient characteristics from the electronic health record that influenced exercise facility attendance. Only 30.2% of adults (mean age 44.7 years (SD 14...
BMC Public Health, 2019
Background: Shared genetic and environmental factors suggest that family relationships are import... more Background: Shared genetic and environmental factors suggest that family relationships are important predictors of obesity-related behaviors, yet little is known about how siblings influence physical activity and sedentary behaviors. This study examined physical activity and sedentary behavior between sibling dyads across summer and fall time points and determined if birth order and gender modify the relationship between sibling behaviors. Methods: Mexican-heritage families residing in colonias along the United States-Mexico border were recruited using promotoras de salud to participate in summer and school year surveys. Eighty-seven sibling dyads had complete data for the physical activity sub-study: 21 older brother-younger brother, 21 older brother-younger sister, 23 older sisteryounger brother, and 22 older sister-younger sister dyads. Physical activity and sedentary behavior were measured using a validated 7-day recall instrument to create summary measures of weekly active, moderate-to-vigorous physical activity (MVPA) metabolic equivalents (MET), sitting, and screen time minutes. We used linear regression analyses to examine changes over time and the association between older and younger sibling behavior. Results: During summer, older siblings (mean age = 11.2 years) reported 1069 active minutes and 1244 sitting minutes per week; younger siblings (mean age = 8.3 years) reported 1201 active minutes and 1368 sitting minutes per week. Younger brothers reported fewer active minutes (mean = − 459.6; p = 0.01) and fewer MVPA MET-minutes (mean = − 2261.7; p = 0.02) of physical activity during the fall. Within all 87 dyads, older sibling physical activity was significantly associated with younger sibling active minutes (B = 0.45;p = 0.004) and MET-minutes (B = 0.45;p = 0.003) during summer but not fall; older sibling sedentary behavior was significantly associated with younger sibling sitting (B = 0.23; p = 0.01) and screen time minutes (B = 0.23;p = 0.004) during fall but not summer. After stratifying by gender dyad groups, younger brother behavior was strongly associated with older brother behavior at both time points. Conclusion: Younger siblings appear to emulate the physical activity behaviors of their older siblings during nonschool summer months and sedentary behaviors of older siblings during school-time fall months, especially older brother-younger brother dyads. Family-based interventions to increase physical activity and decrease sedentary behavior are growing in popularity, but more work is needed to understand the role of sibling influences.
Medicine, 2018
Adults with limited health literacy have difficulty managing chronic conditions, higher hospitali... more Adults with limited health literacy have difficulty managing chronic conditions, higher hospitalization rates, and more healthcare expenditures. Simple screening tools have been developed, but limited work has evaluated instruments among low-income populations. This study assessed health literacy among primary care patients of a federally qualified health center, and compared a single screening question about perceived difficulty completing medical forms. A cross-sectional survey was administered to English-speaking patients ≥40 years. Both the Newest Vital Sign (NVS), a 6-item questionnaire, and a single-item screening question about perceived difficulty with completing medical forms, assessed health literacy. Logistic regression was used to identify predictors of inadequate health literacy and receiver operator curves compared the NVS and single-item question. Participants (n = 406) were, on average, aged 58.5 years (±11.3), 72.2% female, and identified as Hispanic/Latino (19.2%), non-Hispanic white (31.0%), non-Hispanic black (40.9%), or other (8.9%). Of the 406 participants, 335 (82.5%) completed the NVS. Patients who declined NVS were more likely to be older (P < .001) and male (P = .01). Only 13.7% had adequate health literacy. Older adults, Hispanic and non-Hispanic black patients, patients with missed office visits, and those reporting less confidence completing medical forms were significantly more likely to have inadequate health literacy. Perceived confidence completing medical forms demonstrated low sensitivity but high specificity at multiple thresholds. This is the first investigation to compare the NVS and confidence completing medical forms question. Many patients declined health literacy assessments, but health literacy screening may identify patients who need additional health education and resources.
The Journal of clinical endocrinology and metabolism, Jan 25, 2018
Cardiometabolic conditions increase in midlife but early customized prevention strategies are not... more Cardiometabolic conditions increase in midlife but early customized prevention strategies are not established for such women. To characterize, and identify factors related to, constellations of cardiometabolic risk components longitudinally in multi-racial/ethnic midlife women. We conducted a prospective longitudinal, multi-ethnic cohort study of 3,003 midlife women, undergoing the menopausal transition (MT). Metabolic syndrome (MetS) meant having at least 3 of 5 components: high fasting triglyceride (hTG), low high density lipoprotein cholesterol (lHDL), high fasting plasma glucose (hGluc), large waist circumference (Ob), and hypertension (HTN). We described the patterns of constellations and estimated hazard ratios (HRs) for constellations at 1) incident MetS and 2) recovery from MetS, using multivariable-adjusted Cox regression. Seven U.S. sites. 1412 non-Hispanic White, 851 Black, 272 Japanese, 237 Hispanic, 231 Chinese women. Race/ethnicity, lifestyle factors, MT stage. Cardiom...
Innovation in Aging, 2018
One-third of older adults fall annually, and falls are a leading cause of hospitalization, disabi... more One-third of older adults fall annually, and falls are a leading cause of hospitalization, disability and mortality. The number of falls among mid-life adults (age 40-65 years) is comparable to estimates among older adults but it is unknown whether mid-life adults experience the same adverse consequences. Using data from the National Health and Nutrition Examination Survey (NHANES) III, we evaluated whether falling during mid-life was associated with an increased risk of mortality in the next 10 years. Participants (n=1,295) were age 60-64.9 years of age. Using surveyweighted Cox regression models, hazard ratios (HR) and corresponding 95% confidence intervals (CI) of mortality among recurrent fallers (fell 2+ times) versus those that fell once or less were calculated. The 10-year mortality risk was 16.6% overall. Among those that died within 10 years, 20% were recurrent fallers as compared to only 5.5% among participants who survived. Recurrent fallers were more likely to be women and those with cardiovascular disease, stroke, and more prescription medications. Among women, in models adjusted for race/ethnicity, body mass index, smoking, education, cardiovascular disease, stroke, diabetes, cancer and number of medications, recurrent fallers had more than a 4-fold increased hazard of death in 10 years (HR=4.07, 95% CI: 1.99,8.31). In parallel models among men, the association was much weaker and not statistically significant (HR=1.72, 95% CI 0.66,4.50). Women experiencing multiple falls during the mid-life period may be at higher risk for premature mortality. Future work should examine the mechanisms underlying observed sex-specific risk of recurrent falls in women.
Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis
The Journal of Rural Health, 2017
This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Ac... more This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Accountable Care Organization (ACO) setting. The study used electronic medical record data from 8 rural ACO clinics in Nebraska. The final sample included 15,866 average-risk patients aged 50-75 years who visited participating clinics at least once from June 2014 to May 2015. Logistic regression was conducted to examine simultaneous effects of patient, provider, and county characteristics on CRC screening after accounting for provider-county-level correlation using a generalized estimating equations method. The results indicated that patients aged 65 years and older, non-Hispanic white, whose preferred language was English, who had insurance, who had a wellness visit in the past year, and who had chronic conditions were more likely to be up-to-date on CRC screening. Patients were also more likely to be up-to-date when their primary care provider was a female medical doctor who was aware of clinic CRC screening protocols or who manually checked patient CRC screening status during the patient visit. Patients in a county with no gastroenterologist, a high poverty rate, and low insurance coverage were less likely to be up-to-date on CRC screening. A variety of patient, provider, and county characteristics were associated with CRC screening. Effective strategies to promote CRC screening should address multilevel factors, including: targeting patients with identified individual barriers, modifying physician and clinical practices, and focusing on communities with low socioeconomic status or low levels of medical resources.
Evaluation and program planning, Jan 22, 2016
Insufficient physical activity and unhealthy eating behaviors are major contributors to the obesi... more Insufficient physical activity and unhealthy eating behaviors are major contributors to the obesity epidemic in the United States. Identifying health behaviors and disparities in underserved communities is needed to guide the development of targeted interventions. The Community Assessment for Public Health Emergency Response (CASPER) is a set of tools designed for public health emergencies, but the utility of CASPER in non-emergency settings has not been explored. The purpose of this study was to use CASPER to obtain information on household-based behaviors of and barriers to fruit/vegetable consumption and physical activity, and explore the utility of these methods for future health assessments. Cross-sectional survey data included households (n=100) in a low-income neighborhood. Half of adults did not meet recommendations for fruit/vegetable consumption and 20% reported no physical activity during the previous week. Cost was significantly associated with healthy eating and physica...
Social Science & Medicine, 2013
In the United States, race and ethnicity are considered key social determinants of health because... more In the United States, race and ethnicity are considered key social determinants of health because of their enduring association with social and economic opportunities and resources. An important policy and research concern is whether the U.S. is making progress toward reducing racial/ethnic inequalities in health. While race/ethnic disparities in infant and adult outcomes are well documented, less is known about patterns and trends by race/ethnicity among children. Our objective was to determine the patterns of and progress toward reducing racial/ethnic disparities in child health. Using nationally representative data from 1998 to 2009, we assessed 17 indicators of child health, including overall health status, disability, measures of specific illnesses, and indicators of the social and economic consequences of illnesses. We examined disparities across five race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic Asian, and non-Hispanic other). We found important racial/ethnic disparities across nearly all of the indicators of health we examined, adjusting for socioeconomic status, nativity, and access to health care. Importantly, we found little evidence that racial/ethnic disparities in child health have changed over time. In fact, for certain illnesses such as asthma, black-white disparities grew significantly larger over time. In general, black children had the highest reported prevalence across the health indicators and Asian children had the lowest reported prevalence. Hispanic children tended to be more similar to whites compared to the other race/ethnic groups, but there was considerable variability in their relative standing.
Life
Metabolic syndrome (MetS) is associated with decreased renal function and chronic kidney disease ... more Metabolic syndrome (MetS) is associated with decreased renal function and chronic kidney disease (CKD). To date, no research regarding the sixteen possible constellations resulting in the diagnosis of MetS has been elucidated. The purpose of this study is to report renal function in sixteen metabolic constellations grouped into four metabolic clusters. Individuals (n = 2767; representing 86,652,073 individuals) from the 2013–2018 National Health and Nutrition Examination Surveys who met the criteria for MetS were included. Sixteen possible constellations of three or more risk factors were analyzed for renal function. Four metabolic clusters representing MetS with hyperglycemia (Cluster I), MetS with hypertension (Cluster II), MetS with hyperglycemia and hypertension (Cluster III), or MetS with normoglycemia and normotension (Cluster IV) were assessed for renal function and CKD status. Cluster III had the highest odds of CKD (OR = 2.57, 95% CL = 1.79, 3.68). Clusters II and III had t...
Innovation in Aging, 2021
Metabolic syndrome (MetS) is a cluster of factors (hypertension, abdominal obesity, impaired fast... more Metabolic syndrome (MetS) is a cluster of factors (hypertension, abdominal obesity, impaired fasting glucose, low high-density lipoprotein, hypertriglyceridemia). How midlife MetS impacts future physical functioning is uncertain. We hypothesized that higher midlife MetS components are associated with poorer physical performance in early late life for multi-ethnic women. MetS status from 1996-2011 (8 visits) and objective physical performance (2015/16; short physical performance battery (SPPB; 0-12), 40-foot walk (m/s), 4-meter gait speed (m/s), chair stands (sec), stair climb (sec)) were assessed in the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% Black, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified trajectory groups distinguishable by number of MetS components: none (23.9%), 1=low-MetS (28.7%), 2=mid-MetS (30.9%), >3=high-MetS (16.5%). High-MetS versus none had higher body mass index, pain, fin...
Therapeutic Comparison of Equine Movement and Therapeutic Riding as Interventions for Children with Autism: A Crossover Trial
The International Journal of Interdisciplinary Social and Community Studies, 2021
Innovation in Aging, 2021
This study evaluated the relationship between individual and combined sensory impairments (vision... more This study evaluated the relationship between individual and combined sensory impairments (vision, hearing, peripheral nerve (PN)) with recurrent falls in the past year among 1951 women (mean age 65.6 years) from the Study of Women’s Health Across the Nation. Sensory impairments were defined as self-reported vision difficulty, hearing loss, or ≥4 on the Michigan Neuropathy Screening Instrument. Recurrent falls were defined as ≥2 self-reported falls. Hearing was the most commonly reported impairment (39.2%), followed by vision (22.1%) and PN (16.0%). Among those with any impairments, 7.0% of women reported impairments in all domains. Recurrent falls were more common among women with vision (19.4%), hearing (17.3%), or PN impairments (24.7%) as compared to women without sensory impairments (7.0%). The greatest burden of recurrent falls was among women with all three sensory impairments; one-third (34.6%) of women with vision, hearing and PN impairment were recurrent fallers. In an adj...
Supplemental Material, sj-pdf-1-jah-10.1177_0898264320988405 for Association of Physical Activity... more Supplemental Material, sj-pdf-1-jah-10.1177_0898264320988405 for Association of Physical Activity and Physical Functioning Phenotypes With Fall Risk Among Women by Kelly R. Ylitalo, Carrie A. Karvonen-Gutierrez, Barbara Sternfeld and Kelley Pettee Gabriel in Journal of Aging and Health
International Journal of Environmental Research and Public Health, 2021
Mexican-heritage children often achieve less physical activity (PA) than their counterparts and a... more Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers’ perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas–Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for famil...
The Journals of Gerontology: Series A, 2021
BackgroundLittle is known about how adverse, midlife metabolic profiles affect future physical fu... more BackgroundLittle is known about how adverse, midlife metabolic profiles affect future physical functioning. We hypothesized that a higher number of midlife metabolic syndrome (MetS) components are associated with poorer physical performance in early old age for multiethnic women.MethodsMetS status from 1996 to 2011 (8 visits) and objective physical performance in 2015/2016 (Short Physical Performance Battery [SPPB; 0–12], 40-foot walk [meter/second], 4-meter gait speed [meter/second], chair stands [seconds], stair climb [seconds]) were assessed in the Study of Women’s Health Across the Nation (SWAN; n = 1722; age 65.4 ± 2.7 years; 26.9% African American, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified MetS component trajectory groups: none (23.9%), 1 = low-MetS (28.7%), 2 = mid-MetS (30.9%), and ≥3 = high-MetS (16.5%). Adjusted linear regression related MetS groups to physical performance outcomes.ResultsHigh-MetS versus none had higher ...
Preventive Medicine Reports, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Life, 2021
Rising rates of metabolic syndrome, obesity, and mortality from chronic kidney disease (CKD) have... more Rising rates of metabolic syndrome, obesity, and mortality from chronic kidney disease (CKD) have prompted further investigation into the association between metabolic phenotypes and CKD. Purpose: To report the frequency of strictly defined metabolic phenotypes, renal function within each phenotype, and individual risk factors associated with reduced renal function. We utilized the 2013–2018 National Health and Nutrition Examination Surveys (NHANES) and complex survey sample weighting techniques to represent 220 million non-institutionalized U.S. civilians. Metabolic health was defined as having zero of the risk factors defined by the National Cholesterol Education Program with the exception of obesity, which was defined as BMI ≥ 30 kg/m2 in non-Asians and BMI ≥ 25 kg/m2 in Asians. The metabolically healthy normal (MUN) phenotype comprised the highest proportion of the population (38.40%), whereas the metabolically healthy obese (MHO) was the smallest (5.59%). Compared to the MHN re...
Women's Health, 2020
Objectives: The transition to motherhood is associated with declines in physical activity in wome... more Objectives: The transition to motherhood is associated with declines in physical activity in women. Working mothers may be particularly at-risk for low levels of physical activity, since they have to balance the competing interests of work and family life, and exercise often takes a backseat to more seemingly pressing concerns. The potential benefits working mothers can experience from physical activity are numerous. The objectives of this study were to evaluate the percentage of working mothers from the United States who met the World Health Organization’s and the American College of Sports Medicine’s recommended guidelines for weekly physical activity and investigate the associations between physical activity, quality of life, and self-rated work productivity in this sample of working mothers. Methods: Participants were 334 working mothers from the United States (mean age = 35.00 years; standard deviation (SD) = 5.85; 77.8% White) recruited from a Qualtrics research panel. To be e...
Innovation in Aging, 2019
Physical activity (PA) is positively associated with physical functioning, but relations of domai... more Physical activity (PA) is positively associated with physical functioning, but relations of domain-specific PA with falls is less clear. In 2015, women (n=1,962) self-reported fall history and PA. The Kaiser Physical Activity Survey (KPAS) assessed sports, non-sports leisure, household/caregiving, and total activity. Risk ratios (RR) were generated from poisson regression. One-third (29.7%) of women (mean age=65.1 years [SD 2.7]) reported ≥1 fall and 18.3% reported ≥1 fall injury in the previous 12 months. Women in the highest quartile of sports activity had an increased risk of ≥1 fall (RR=1.19;95%CI:1.00,1.41;p=0.049). Women in the highest quartile of total activity had an increased risk of injurious falls (RR=1.31;95%CI:1.04,1.65;p=0.021), but there was no association for domain-specific indices. KPAS may identify women and activity domains, such as sports, at high risk for falls and injuries. Future work should incorporate device-based PA assessments within domains to understand...
Innovation in Aging, 2019
Physical activity improves quality of life and prevents or delays chronic disease, but most adult... more Physical activity improves quality of life and prevents or delays chronic disease, but most adults in the United States are inactive. Consultation and planning with a health care provider, specifically with an exercise “prescription,” may increase physical activity, but utilization patterns and success of such programs are not well understood. This study assessed the initial 6 months of an exercise prescription program at a large, federally-qualified health center during 2018 whereby adult patients were referred via prescription to personalized health coaching by a fitness advisor. A census of all adults (n=512) who received an exercise prescription was combined with attendance data from the on-site exercise facility to classify patients as never attended, 1 to 3 visits, and ≥4 visits. Ordinal logistic regression was used to examine patient characteristics from the electronic health record that influenced exercise facility attendance. Only 30.2% of adults (mean age 44.7 years (SD 14...
BMC Public Health, 2019
Background: Shared genetic and environmental factors suggest that family relationships are import... more Background: Shared genetic and environmental factors suggest that family relationships are important predictors of obesity-related behaviors, yet little is known about how siblings influence physical activity and sedentary behaviors. This study examined physical activity and sedentary behavior between sibling dyads across summer and fall time points and determined if birth order and gender modify the relationship between sibling behaviors. Methods: Mexican-heritage families residing in colonias along the United States-Mexico border were recruited using promotoras de salud to participate in summer and school year surveys. Eighty-seven sibling dyads had complete data for the physical activity sub-study: 21 older brother-younger brother, 21 older brother-younger sister, 23 older sisteryounger brother, and 22 older sister-younger sister dyads. Physical activity and sedentary behavior were measured using a validated 7-day recall instrument to create summary measures of weekly active, moderate-to-vigorous physical activity (MVPA) metabolic equivalents (MET), sitting, and screen time minutes. We used linear regression analyses to examine changes over time and the association between older and younger sibling behavior. Results: During summer, older siblings (mean age = 11.2 years) reported 1069 active minutes and 1244 sitting minutes per week; younger siblings (mean age = 8.3 years) reported 1201 active minutes and 1368 sitting minutes per week. Younger brothers reported fewer active minutes (mean = − 459.6; p = 0.01) and fewer MVPA MET-minutes (mean = − 2261.7; p = 0.02) of physical activity during the fall. Within all 87 dyads, older sibling physical activity was significantly associated with younger sibling active minutes (B = 0.45;p = 0.004) and MET-minutes (B = 0.45;p = 0.003) during summer but not fall; older sibling sedentary behavior was significantly associated with younger sibling sitting (B = 0.23; p = 0.01) and screen time minutes (B = 0.23;p = 0.004) during fall but not summer. After stratifying by gender dyad groups, younger brother behavior was strongly associated with older brother behavior at both time points. Conclusion: Younger siblings appear to emulate the physical activity behaviors of their older siblings during nonschool summer months and sedentary behaviors of older siblings during school-time fall months, especially older brother-younger brother dyads. Family-based interventions to increase physical activity and decrease sedentary behavior are growing in popularity, but more work is needed to understand the role of sibling influences.
Medicine, 2018
Adults with limited health literacy have difficulty managing chronic conditions, higher hospitali... more Adults with limited health literacy have difficulty managing chronic conditions, higher hospitalization rates, and more healthcare expenditures. Simple screening tools have been developed, but limited work has evaluated instruments among low-income populations. This study assessed health literacy among primary care patients of a federally qualified health center, and compared a single screening question about perceived difficulty completing medical forms. A cross-sectional survey was administered to English-speaking patients ≥40 years. Both the Newest Vital Sign (NVS), a 6-item questionnaire, and a single-item screening question about perceived difficulty with completing medical forms, assessed health literacy. Logistic regression was used to identify predictors of inadequate health literacy and receiver operator curves compared the NVS and single-item question. Participants (n = 406) were, on average, aged 58.5 years (±11.3), 72.2% female, and identified as Hispanic/Latino (19.2%), non-Hispanic white (31.0%), non-Hispanic black (40.9%), or other (8.9%). Of the 406 participants, 335 (82.5%) completed the NVS. Patients who declined NVS were more likely to be older (P < .001) and male (P = .01). Only 13.7% had adequate health literacy. Older adults, Hispanic and non-Hispanic black patients, patients with missed office visits, and those reporting less confidence completing medical forms were significantly more likely to have inadequate health literacy. Perceived confidence completing medical forms demonstrated low sensitivity but high specificity at multiple thresholds. This is the first investigation to compare the NVS and confidence completing medical forms question. Many patients declined health literacy assessments, but health literacy screening may identify patients who need additional health education and resources.
The Journal of clinical endocrinology and metabolism, Jan 25, 2018
Cardiometabolic conditions increase in midlife but early customized prevention strategies are not... more Cardiometabolic conditions increase in midlife but early customized prevention strategies are not established for such women. To characterize, and identify factors related to, constellations of cardiometabolic risk components longitudinally in multi-racial/ethnic midlife women. We conducted a prospective longitudinal, multi-ethnic cohort study of 3,003 midlife women, undergoing the menopausal transition (MT). Metabolic syndrome (MetS) meant having at least 3 of 5 components: high fasting triglyceride (hTG), low high density lipoprotein cholesterol (lHDL), high fasting plasma glucose (hGluc), large waist circumference (Ob), and hypertension (HTN). We described the patterns of constellations and estimated hazard ratios (HRs) for constellations at 1) incident MetS and 2) recovery from MetS, using multivariable-adjusted Cox regression. Seven U.S. sites. 1412 non-Hispanic White, 851 Black, 272 Japanese, 237 Hispanic, 231 Chinese women. Race/ethnicity, lifestyle factors, MT stage. Cardiom...
Innovation in Aging, 2018
One-third of older adults fall annually, and falls are a leading cause of hospitalization, disabi... more One-third of older adults fall annually, and falls are a leading cause of hospitalization, disability and mortality. The number of falls among mid-life adults (age 40-65 years) is comparable to estimates among older adults but it is unknown whether mid-life adults experience the same adverse consequences. Using data from the National Health and Nutrition Examination Survey (NHANES) III, we evaluated whether falling during mid-life was associated with an increased risk of mortality in the next 10 years. Participants (n=1,295) were age 60-64.9 years of age. Using surveyweighted Cox regression models, hazard ratios (HR) and corresponding 95% confidence intervals (CI) of mortality among recurrent fallers (fell 2+ times) versus those that fell once or less were calculated. The 10-year mortality risk was 16.6% overall. Among those that died within 10 years, 20% were recurrent fallers as compared to only 5.5% among participants who survived. Recurrent fallers were more likely to be women and those with cardiovascular disease, stroke, and more prescription medications. Among women, in models adjusted for race/ethnicity, body mass index, smoking, education, cardiovascular disease, stroke, diabetes, cancer and number of medications, recurrent fallers had more than a 4-fold increased hazard of death in 10 years (HR=4.07, 95% CI: 1.99,8.31). In parallel models among men, the association was much weaker and not statistically significant (HR=1.72, 95% CI 0.66,4.50). Women experiencing multiple falls during the mid-life period may be at higher risk for premature mortality. Future work should examine the mechanisms underlying observed sex-specific risk of recurrent falls in women.
Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis
The Journal of Rural Health, 2017
This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Ac... more This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Accountable Care Organization (ACO) setting. The study used electronic medical record data from 8 rural ACO clinics in Nebraska. The final sample included 15,866 average-risk patients aged 50-75 years who visited participating clinics at least once from June 2014 to May 2015. Logistic regression was conducted to examine simultaneous effects of patient, provider, and county characteristics on CRC screening after accounting for provider-county-level correlation using a generalized estimating equations method. The results indicated that patients aged 65 years and older, non-Hispanic white, whose preferred language was English, who had insurance, who had a wellness visit in the past year, and who had chronic conditions were more likely to be up-to-date on CRC screening. Patients were also more likely to be up-to-date when their primary care provider was a female medical doctor who was aware of clinic CRC screening protocols or who manually checked patient CRC screening status during the patient visit. Patients in a county with no gastroenterologist, a high poverty rate, and low insurance coverage were less likely to be up-to-date on CRC screening. A variety of patient, provider, and county characteristics were associated with CRC screening. Effective strategies to promote CRC screening should address multilevel factors, including: targeting patients with identified individual barriers, modifying physician and clinical practices, and focusing on communities with low socioeconomic status or low levels of medical resources.
Evaluation and program planning, Jan 22, 2016
Insufficient physical activity and unhealthy eating behaviors are major contributors to the obesi... more Insufficient physical activity and unhealthy eating behaviors are major contributors to the obesity epidemic in the United States. Identifying health behaviors and disparities in underserved communities is needed to guide the development of targeted interventions. The Community Assessment for Public Health Emergency Response (CASPER) is a set of tools designed for public health emergencies, but the utility of CASPER in non-emergency settings has not been explored. The purpose of this study was to use CASPER to obtain information on household-based behaviors of and barriers to fruit/vegetable consumption and physical activity, and explore the utility of these methods for future health assessments. Cross-sectional survey data included households (n=100) in a low-income neighborhood. Half of adults did not meet recommendations for fruit/vegetable consumption and 20% reported no physical activity during the previous week. Cost was significantly associated with healthy eating and physica...
Social Science & Medicine, 2013
In the United States, race and ethnicity are considered key social determinants of health because... more In the United States, race and ethnicity are considered key social determinants of health because of their enduring association with social and economic opportunities and resources. An important policy and research concern is whether the U.S. is making progress toward reducing racial/ethnic inequalities in health. While race/ethnic disparities in infant and adult outcomes are well documented, less is known about patterns and trends by race/ethnicity among children. Our objective was to determine the patterns of and progress toward reducing racial/ethnic disparities in child health. Using nationally representative data from 1998 to 2009, we assessed 17 indicators of child health, including overall health status, disability, measures of specific illnesses, and indicators of the social and economic consequences of illnesses. We examined disparities across five race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic Asian, and non-Hispanic other). We found important racial/ethnic disparities across nearly all of the indicators of health we examined, adjusting for socioeconomic status, nativity, and access to health care. Importantly, we found little evidence that racial/ethnic disparities in child health have changed over time. In fact, for certain illnesses such as asthma, black-white disparities grew significantly larger over time. In general, black children had the highest reported prevalence across the health indicators and Asian children had the lowest reported prevalence. Hispanic children tended to be more similar to whites compared to the other race/ethnic groups, but there was considerable variability in their relative standing.