Nicole Redmond | National Institutes of Health (original) (raw)
Papers by Nicole Redmond
Dr. Syed (quratulain.syed@emory.edu; @anniesyed3), assistant professor of medicine, Division of G... more Dr. Syed (quratulain.syed@emory.edu; @anniesyed3), assistant professor of medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine. Dr. Redmond (Nicole.Redmond@nih.gov), medical officer, National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Bussey-Jones (jcbusse@emory.edu), professor of medicine, chief, Grady Section General Medicine and Geriatrics, co-director, Urban Health Initiative, Division of General Medicine and Geriatrics, Emory University School of Medicine. Dr. Price-Haywood (eboni.pricehaywood@ochsner.org), director, Center for Applied Health Services Research Ochsner Health System. Dr. Genao (inginia.genao@yale.edu), associate chair, Diversity and Inclusion, Department of Medicine, associate professor, Yale University School of Medicine.
crimination against physicians have been prevalent for quite some time, social and electronic med... more crimination against physicians have been prevalent for quite some time, social and electronic media have given Drs. Tamika Cross, Suzanne Barakat, and many other physicians a venue to share their experiences, leading to increased awareness and debate on this issue. In a survey of 214 mother-daughter physicians, both mothers and daughters reported similarly high rates and severity of sexual harassment prior to medical school, during their training years, and in work settings by both teachers and supervisors. There is also a high prevalence of workplace harassment and discrimination among physicians belonging to racial and ethnic minorities and the LGBTQ community, leading to poor career satisfaction and increased job turnover. This article is the first in a series highlighting types of harassment, discrimination and aggression towards physiciansāparticularly among racial, ethnic, gender and sexual minoritiesā and dissemination of best practices to foster physician resilience. For thi...
Background: Cardiovascular disease (CVD) remains the leading cause of death for African-American ... more Background: Cardiovascular disease (CVD) remains the leading cause of death for African-American (AA) adults. There is a low prevalence of ideal cardiovascular health (CVH) (as defined by the Ameri...
JACC: Cardiovascular Imaging
Coronary artery calcium (CAC) is considered a useful test for enhancing risk assessment in the pr... more Coronary artery calcium (CAC) is considered a useful test for enhancing risk assessment in the primary prevention setting. Clinical trials are under consideration. The National Heart, Lung, and Blood Institute convened a multidisciplinary working group on August 26 to 27, 2019, in Bethesda, Maryland, to review available evidence and consider the appropriateness of conducting further research on coronary artery calcium (CAC) testing, or other coronary imaging studies, as a way of informing decisions for primary preventive treatments for cardiovascular disease. The working group concluded that additional evidence to support current guideline recommendations for use of CAC in middle-age adults is very likely to come from currently ongoing trials in that age group, and a new trial is not likely to be timely or cost effective. The current trials will not, however, address the role of CAC testing in younger adults or older adults, who are also not addressed in existing guidelines, nor will existing trials address the potential benefit of an opportunistic screening strategy made feasible by the application of artificial intelligence. Innovative trial designs for testing the value of CAC across the lifespan were strongly considered and represent important opportunities for additional research, particularly those that leverage existing trials or other real-world data streams including clinical computed tomography scans. Sex and racial/ethnic disparities in cardiovascular disease morbidity and mortality, and inclusion of diverse participants in future CAC trials, particularly those based in the United States, would enhance the potential impact of these studies.
Journal of Women's Health
Journal of Urban Health
Perceived discrimination based on criminal record is associated with social determinants of healt... more Perceived discrimination based on criminal record is associated with social determinants of health such as housing and employment. However, there is limited data on discrimination based on criminal record within health care settings. We examined how perceived discrimination based on criminal record within health care settings, among individuals with a history of incarceration, was associated with self-reported general health status. We used data from individuals recruited from 11 sites within the Transitions Clinic Network (TCN) who were released from prison within the prior 6 months, had a chronic health condition and/or were age 50 or older, and had complete information on demographics, medical history, self-reported general health status, and self-reported perceived discrimination ( n = 743). Study participants were mostly of minority racial and ethnic background (76%), and had a high prevalence of self-reported chronic health conditions with half reporting mental health conditions and substance use disorders (52% and 50%, respectively), and 85% reporting one or more chronic medical conditions. Over a quarter (27%, n = 203) reported perceived discrimination by health care providers due to criminal record with a higher proportion of individuals with fair or poor health reporting discrimination compared to those in good or excellent health (33% vs. 23%; p = .002). After adjusting for age and reported chronic conditions, participants reporting discrimination due to criminal record had 43% increased odds of reporting fair/poor health (AOR 1.43, 95% CI 1.01ā2.03). Race and ethnicity did not modify this relationship. Participants reporting discrimination due to criminal record had increased odds of reporting fair/poor health. The association between perceived discrimination by health care providers due to criminal record and health should be explored in future longitudinal studies among individuals at high risk of incarceration. Clinical Trial Registration : NCT01863290
Journal of Urban Health
Returning to the community after incarceration is a particularly vulnerable time with significant... more Returning to the community after incarceration is a particularly vulnerable time with significantly increased risk of death in the first 2 weeks. The elevated risk of death persists as long as 2 years, with cardiovascular disease (CVD) among the leading causes. African-Americans, especially African-American men, have higher rates of incarceration and community supervision (e.g., probation and parole) and an earlier onset of hypertension compared to Whites. Few studies have objectively assessed the cardiovascular health profile of criminal justice involved individuals. This study is designed to determine the cardiovascular health profile among men in community corrections and/or transitional housing, identify the prevalence of key CVD risk factors, and assess if risk varies by race/ethnicity. We recruited 100 adult men (mean age = 42.7, SD = 11.35, 60% White, 40% non-Hispanic White) with a history of incarceration in jail or prison of ā„ 6 months during their most recent incarceration and enrolled in a community corrections program. Using the American Heart Associationās Lifeās Simple 7ā¢ (LS-7), measures of each of the LS-7 components (body mass index, blood pressure, lipids, blood glucose, smoking, diet, and physical activity) were obtained, and LS-7 scores were generated for each measure using AHA-defined categories of poor (1 point), intermediate (2 points), and ideal (3 points) and summed to yield a total score ranging from poor for all (7 points) to ideal for all (21 points). Mann-Whitney U tests were performed to assess differences in LS-7 scores (poor, intermediate, ideal) by race/ethnicity. Additionally, an independent samples t test was conducted for race/ethnicity and LS-7 total score. Mann-Whitney U tests for LS-7 categories and race/ethnicity indicated a greater number of non-Whites had poor blood pressure (p < .01) and diet (p < .05) as compared to Whites. The independent samples t test demonstrated significantly lower LS-7 scores for non-Whites compared to Whites. To our knowledge, this is the first study to evaluate cardiovascular health among individuals with a history of incarceration using the LS-7 metric, which included objective measures for four of the seven LS-7 metrics. Non-Whites, which included African-Americans, Hispanics, and American Indians, were more likely than Whites to fall into the poor category for both diet and blood pressure and had significantly lower total LS-7 scores than Whites, indicating they have worse scores across all seven of the LS-7 measures. Similar to what is found among non-incarcerated samples, non-Whites with incarceration histories are at elevated risk for cardiovascular events relative to their White peers.
Circulation Research
Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventa... more Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventable deaths worldwide. The dominant modifiable risk factors and the social and environmental determinants that increase cardiovascular risk are known, and collectively, are as important in racial and ethnic minority populations as they are in majority populations. Their prevention and treatment remain the foundation for cardiovascular health promotion and disease prevention. Genetic and epigenetic factors are increasingly recognized as important contributors to cardiovascular risk and provide an opportunity for advancing precision cardiovascular medicine. In this review, we explore emerging concepts at the interface of precision medicine and cardiovascular disease in racial and ethnic minority populations. Important among these are the lack of racial and ethnic diversity in genomics studies and biorepositories; the resulting misclassification of benign variants as pathogenic in minorities...
American Journal of Preventive Medicine
INTRODUCTION This community-based participatory research pilot study explored multilevel percepti... more INTRODUCTION This community-based participatory research pilot study explored multilevel perceptions and strategies for developing future faith-based organization blood pressure interventions for young black men. METHODS Community partners recruited the sample through two, southeastern U.S. urban churches as potential intervention hubs; academic partners conducted phone interviews with church leader key informants, and three focus groups with black men aged 18-50 years. Qualitative content analysis helped generate themes from: key informant questions assessing organizational assets and capacities, and factors influencing participation; and focus group questions assessing lifestyle and self-management behaviors. Questions assessing themes on blood pressure intervention strategies were asked. Data were collected in 2016 and analyzed in 2016-2017. RESULTS The sample included 21 key informants and 19 young black men. Key informants' leadership experience averaged 16.6 (SD=12.1) years and 28.6% were male. Focus group participants were primarily single (55.6%), college educated (61.1%), and employed (77.8%). Mean blood pressure was 131.1 (SD=15.3)/79.5 (SD=11.2) mmHg, 33.3% self-reported having hypertension, 88.9% report a family history of hypertension, and 88.9% see a provider annually. For key informants, young black men lack understanding of hypertension despite available resources, and pastors are important role models and advocates. For focus group participants, hidden sodium and stressful, busy schedules impact lifestyle behaviors; and church support for busy schedules are important. Common strategies included incentive-laden, activity-integrated programs, and male social context (testimonials, peer mentoring, engagement outside of the church). CONCLUSIONS Findings and lessons learned will help design future community-based participatory research, faith-based organization-led blood pressure interventions relevant to young black men. SUPPLEMENT INFORMATION This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
Circulation Research
I t is an exciting time for the Division of Cardiovascular Sciences (DCVS) to develop its impleme... more I t is an exciting time for the Division of Cardiovascular Sciences (DCVS) to develop its implementation plan for the National Heart, Lung, and Blood Institutes (NHLBI) strategic vision. 1 In line with the mission of the National Institutes of Health (NIH), the mission of DCVS is turning discovery into cardiovascular health (CVH). Ongoing successes in pursuit of that mission are reflected in the decline in mortality from coronary heart disease and stroke in the United States has seen in recent decades. 2 Yet challenges persist, including evidence that coronary heart disease mortality rates for young adults might be leveling off, 3 and the continuing burden of cardiovascular diseases (CVD) such as hypertension, heart failure, and vascular dementia, particularly among the elderly and other disadvantaged groups. 2,4 At the same time, innovations in fields such as computational biology, regenerative medicine, omics technology, mobile health, telemedicine, clinical informatics, and data science offer exciting opportunities in biomedical, behavioral, and social medicine. To leverage The views expressed in this article are those of the authors and do not necessarily represent the views of the
Journal of the American Heart Association, Jan 5, 2018
Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple ... more Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple 7 [LS7]) are suboptimal among blacks, which results in high risk of cardiovascular disease. We examined the association of multiple stressors with LS7 components among blacks. Using a community-based cohort of blacks (N=4383), we examined associations of chronic stress, minor stressors, major life events, and a cumulative stress score with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting plasma glucose) and an LS7 composite score. Multivariable logistic regression assessed the odds of achieving intermediate/ideal levels of cardiovascular health adjusted for demographic, socioeconomic, behavioral, and biomedical factors. The LS7 components with the lowest percentages of intermediate/ideal cardiovascular health levels were diet (39%), body mass index (47%), and physical activity (51%). Higher chronic, minor, and cumulative st...
Family medicine, 2017
Health disparities education is required during residency training. However, residency program di... more Health disparities education is required during residency training. However, residency program directors cite numerous barriers to implementing disparities curricula, and few publications describing successful disparities curricula exist in the literature. In this report, we describe the development, implementation, and early evaluation of a longitudinal health disparities curriculum for resident physicians. We provide resource references, process, and didactic toolkits to facilitate use by other residency programs. We used a standard, six-step model for curricular design, implementation, and evaluation. We assessed feasibility of curricular development including practicality (program cost and time requirements) and demand (resident engagement). We also assessed program and learner outcomes, including number of didactic and clinic sessions delivered and resident preparedness, attitudes, and skill in caring for vulnerable patients. We designed, implemented, and evaluated our curricul...
Journal of the American College of Cardiology, Jan 20, 2017
Currently, 2.2 million individuals are incarcerated, and more than 11 million have been released ... more Currently, 2.2 million individuals are incarcerated, and more than 11 million have been released from U.S. correctional facilities. Individuals with a history of incarceration are more likely to be of racial and ethnic minority populations, poor, and have higher rates of cardiovascular risk factors, especially smoking and hypertension. Cardiovascular disease is a leading cause of death among incarcerated individuals, and those recently released have a higher risk of being hospitalized and dying of cardiovascular disease compared with the general population, even after accounting for differences in racial identity and socioeconomic status. In this review, the authors: 1) present information on the cardiovascular health of justice-involved populations, and unique prevention and care conditions in correctional facilities; 2) identify knowledge gaps; and 3) propose promising areas for research to improve the cardiovascular health of this population. An Executive Summary of a National He...
Circulation, Nov 25, 2014
Introduction: In 2010, the AHA developed LS7 as a metric to define ideal cardiovascular (CV) heal... more Introduction: In 2010, the AHA developed LS7 as a metric to define ideal cardiovascular (CV) health. LS7 is being used to track health over time. However, data on discriminating within-person change in LS7 scores over time from random variability are limited. Hypothesis: We determined the minimal detectable within-person change in LS7 using data from the subset of Third National Health and Nutrition Examination Survey participants who completed two study examinations. Methods: Each LS7 component (cigarette smoking, physical activity, diet, body mass index, blood pressure (BP), cholesterol and glucose) was determined during an interview or study visit and re-assessed at the second clinic examination conducted a median of 17 days later (range 3-48 days). We included 613 participants without a history of CV disease. Each LS7 component was assigned a score of 0 (ideal), 1 (intermediate) and 2 (poor) and these scores were summed to achieve an overall score ranging from 7 (better health) to 21 (worse health). Results: For the overall population, the mean LS7 score was identical at each visit (13.5 SD+2.2). Overall, 54% of participants had no change in their LS7 score and 20%, 5% and Conclusions: In conclusion, within-person changes on LS7 of >3 points over time may represent a real change in health.
Circulation, Mar 10, 2015
Background: Masked hypertension (MHT), defined as non-elevated clinic blood pressure (CBP) and el... more Background: Masked hypertension (MHT), defined as non-elevated clinic blood pressure (CBP) and elevated blood pressure on ambulatory blood pressure (ABP) monitoring (ABPM), and prehypertension (PHT) are individually associated with increased cardiovascular disease (CVD) risk. The degree of diagnostic overlap between PHT and MHT and their associations with subclinical CVD including left ventricular mass index (LVMI) or common carotid intima-media thickness (CCIMT) is poorly characterized among African-Americans (AAs). Methods: In the Jackson Heart Study (JHS), a large community-based cohort of AAs in Jackson, MS, CBP measurements and 24-hour ABPM were obtained at baseline (2000-2004) using standardized protocols. Analyses were restricted to 391 participants who were not taking antihypertensive medications with complete data for CBP, ABPM, LVMI measured with 2D echocardiography, and CCIMT taken from carotid ultrasound. Clinic hypertension (HTN) was defined as ā„140/90 mmHg. Non-elevated CBP was defined as Results: Of the 391 participants, 74 (18.9%) had HTN. Among the 317 participants with non-elevated CBP, 185 (58.4%) had PHT and 68 (21.5%) had MHT; 68 (21.5%) had MHT (59 in those with PHT, and 9 in those with normal CBP). In a fully-adjusted model (see Table), compared to participants with both PHT and MHT, LVMI and CCIMT was less among participants with non-elevated CBP (including those with normal CBP and PHT) and without MHT. There was no difference in LVMI and CCIMT in individuals with PHT and MHT vs. those with normal CBP and MHT. Conclusions: For AAs with non-elevated CBP, LVMI and CCIMT were the highest among individuals with MHT, regardless of whether PHT was present. This finding supports using ABPM to detect MHT among AAs with non-elevated CBP.
Circulation, Nov 26, 2013
Background: Studies examining the relationship between depression and presence of metabolic syndr... more Background: Studies examining the relationship between depression and presence of metabolic syndrome (MetS) show mixed findings. Previous longitudinal studies do not account for the possibility that participantsā metabolic syndrome status or depressive symptoms status could change across examinations. Objective: To longitudinally examine effects of depressive symptoms and changes in depressive symptoms over time on metabolic syndrome in black and white men and women. Methods: Participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study who participated in the Year 10 exam in 1995 and had depressive symptoms and metabolic syndrome scores measured between 1995 and 2010 were included in the analysis (n=3,892). Depressive symptoms were determined using the Centers for Epidemiologic Study Depression score (CES-D). Anthropometric and cardiovascular risk factors were measured; MetS was defined using NCEP/ATPIII criteria. Repeated measures regression models adjusted for age, income, alcohol intake, physical activity, smoking status and antidepressant use. Results: At baseline (Year 10), participantsā mean age was 35 years (SD=3.7), mean depressive symptoms score was 10.7 (SD=8.2), and 11% had metabolic syndrome. Participants with higher average depressive symptom scores were more likely to have metabolic syndrome (OR 1.03, CI: 1.02, 1.04 per 1 unit higher). However, when stratified by race and gender, associations were found in black (OR 1.03, CI: 1.01, 1.04) and white women (OR 1.05, CI: 1.03, 1.07), whereas there was no association among black (OR 1.01, CI: 0.99, 1.03) or white (OR 1.02, CI: 1.00, 1.05) men. Changes in depressive symptoms over time were not associated with MetS (OR 0.99, CI: 0.99, 1.00). Conclusion: Depressive symptoms were associated with metabolic syndrome among women but not men; race did not influence the relationship. In conclusion, depressive symptoms may contribute to the presence of metabolic syndrome, an established risk factor for CHD and diabetes, particularly in women.
The Annals of pharmacotherapy, Jan 18, 2016
Mixed evidence suggests that second-generation antidepressants may increase the risk of cardiovas... more Mixed evidence suggests that second-generation antidepressants may increase the risk of cardiovascular and cerebrovascular events. To assess whether antidepressant use is associated with acute coronary heart disease (CHD), stroke, cardiovascular disease (CVD) death, and all-cause mortality. Secondary analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study were conducted. Use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, bupropion, nefazodone, and trazodone was measured during the baseline (2003-2007) in-home visit. Outcomes of CHD, stroke, CVD death, and all-cause mortality were assessed every 6 months and adjudicated by medical record review. Cox proportional hazards time-to-event analysis followed patients until their first event on or before December 31, 2011, iteratively adjusting for covariates. Among 29 616 participants, 3458 (11.7%) used an antidepressant of interest. Intermedi...
Journal of the American Heart Association
Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have ... more Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2āday workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although...
Dr. Syed (quratulain.syed@emory.edu; @anniesyed3), assistant professor of medicine, Division of G... more Dr. Syed (quratulain.syed@emory.edu; @anniesyed3), assistant professor of medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine. Dr. Redmond (Nicole.Redmond@nih.gov), medical officer, National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Bussey-Jones (jcbusse@emory.edu), professor of medicine, chief, Grady Section General Medicine and Geriatrics, co-director, Urban Health Initiative, Division of General Medicine and Geriatrics, Emory University School of Medicine. Dr. Price-Haywood (eboni.pricehaywood@ochsner.org), director, Center for Applied Health Services Research Ochsner Health System. Dr. Genao (inginia.genao@yale.edu), associate chair, Diversity and Inclusion, Department of Medicine, associate professor, Yale University School of Medicine.
crimination against physicians have been prevalent for quite some time, social and electronic med... more crimination against physicians have been prevalent for quite some time, social and electronic media have given Drs. Tamika Cross, Suzanne Barakat, and many other physicians a venue to share their experiences, leading to increased awareness and debate on this issue. In a survey of 214 mother-daughter physicians, both mothers and daughters reported similarly high rates and severity of sexual harassment prior to medical school, during their training years, and in work settings by both teachers and supervisors. There is also a high prevalence of workplace harassment and discrimination among physicians belonging to racial and ethnic minorities and the LGBTQ community, leading to poor career satisfaction and increased job turnover. This article is the first in a series highlighting types of harassment, discrimination and aggression towards physiciansāparticularly among racial, ethnic, gender and sexual minoritiesā and dissemination of best practices to foster physician resilience. For thi...
Background: Cardiovascular disease (CVD) remains the leading cause of death for African-American ... more Background: Cardiovascular disease (CVD) remains the leading cause of death for African-American (AA) adults. There is a low prevalence of ideal cardiovascular health (CVH) (as defined by the Ameri...
JACC: Cardiovascular Imaging
Coronary artery calcium (CAC) is considered a useful test for enhancing risk assessment in the pr... more Coronary artery calcium (CAC) is considered a useful test for enhancing risk assessment in the primary prevention setting. Clinical trials are under consideration. The National Heart, Lung, and Blood Institute convened a multidisciplinary working group on August 26 to 27, 2019, in Bethesda, Maryland, to review available evidence and consider the appropriateness of conducting further research on coronary artery calcium (CAC) testing, or other coronary imaging studies, as a way of informing decisions for primary preventive treatments for cardiovascular disease. The working group concluded that additional evidence to support current guideline recommendations for use of CAC in middle-age adults is very likely to come from currently ongoing trials in that age group, and a new trial is not likely to be timely or cost effective. The current trials will not, however, address the role of CAC testing in younger adults or older adults, who are also not addressed in existing guidelines, nor will existing trials address the potential benefit of an opportunistic screening strategy made feasible by the application of artificial intelligence. Innovative trial designs for testing the value of CAC across the lifespan were strongly considered and represent important opportunities for additional research, particularly those that leverage existing trials or other real-world data streams including clinical computed tomography scans. Sex and racial/ethnic disparities in cardiovascular disease morbidity and mortality, and inclusion of diverse participants in future CAC trials, particularly those based in the United States, would enhance the potential impact of these studies.
Journal of Women's Health
Journal of Urban Health
Perceived discrimination based on criminal record is associated with social determinants of healt... more Perceived discrimination based on criminal record is associated with social determinants of health such as housing and employment. However, there is limited data on discrimination based on criminal record within health care settings. We examined how perceived discrimination based on criminal record within health care settings, among individuals with a history of incarceration, was associated with self-reported general health status. We used data from individuals recruited from 11 sites within the Transitions Clinic Network (TCN) who were released from prison within the prior 6 months, had a chronic health condition and/or were age 50 or older, and had complete information on demographics, medical history, self-reported general health status, and self-reported perceived discrimination ( n = 743). Study participants were mostly of minority racial and ethnic background (76%), and had a high prevalence of self-reported chronic health conditions with half reporting mental health conditions and substance use disorders (52% and 50%, respectively), and 85% reporting one or more chronic medical conditions. Over a quarter (27%, n = 203) reported perceived discrimination by health care providers due to criminal record with a higher proportion of individuals with fair or poor health reporting discrimination compared to those in good or excellent health (33% vs. 23%; p = .002). After adjusting for age and reported chronic conditions, participants reporting discrimination due to criminal record had 43% increased odds of reporting fair/poor health (AOR 1.43, 95% CI 1.01ā2.03). Race and ethnicity did not modify this relationship. Participants reporting discrimination due to criminal record had increased odds of reporting fair/poor health. The association between perceived discrimination by health care providers due to criminal record and health should be explored in future longitudinal studies among individuals at high risk of incarceration. Clinical Trial Registration : NCT01863290
Journal of Urban Health
Returning to the community after incarceration is a particularly vulnerable time with significant... more Returning to the community after incarceration is a particularly vulnerable time with significantly increased risk of death in the first 2 weeks. The elevated risk of death persists as long as 2 years, with cardiovascular disease (CVD) among the leading causes. African-Americans, especially African-American men, have higher rates of incarceration and community supervision (e.g., probation and parole) and an earlier onset of hypertension compared to Whites. Few studies have objectively assessed the cardiovascular health profile of criminal justice involved individuals. This study is designed to determine the cardiovascular health profile among men in community corrections and/or transitional housing, identify the prevalence of key CVD risk factors, and assess if risk varies by race/ethnicity. We recruited 100 adult men (mean age = 42.7, SD = 11.35, 60% White, 40% non-Hispanic White) with a history of incarceration in jail or prison of ā„ 6 months during their most recent incarceration and enrolled in a community corrections program. Using the American Heart Associationās Lifeās Simple 7ā¢ (LS-7), measures of each of the LS-7 components (body mass index, blood pressure, lipids, blood glucose, smoking, diet, and physical activity) were obtained, and LS-7 scores were generated for each measure using AHA-defined categories of poor (1 point), intermediate (2 points), and ideal (3 points) and summed to yield a total score ranging from poor for all (7 points) to ideal for all (21 points). Mann-Whitney U tests were performed to assess differences in LS-7 scores (poor, intermediate, ideal) by race/ethnicity. Additionally, an independent samples t test was conducted for race/ethnicity and LS-7 total score. Mann-Whitney U tests for LS-7 categories and race/ethnicity indicated a greater number of non-Whites had poor blood pressure (p < .01) and diet (p < .05) as compared to Whites. The independent samples t test demonstrated significantly lower LS-7 scores for non-Whites compared to Whites. To our knowledge, this is the first study to evaluate cardiovascular health among individuals with a history of incarceration using the LS-7 metric, which included objective measures for four of the seven LS-7 metrics. Non-Whites, which included African-Americans, Hispanics, and American Indians, were more likely than Whites to fall into the poor category for both diet and blood pressure and had significantly lower total LS-7 scores than Whites, indicating they have worse scores across all seven of the LS-7 measures. Similar to what is found among non-incarcerated samples, non-Whites with incarceration histories are at elevated risk for cardiovascular events relative to their White peers.
Circulation Research
Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventa... more Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventable deaths worldwide. The dominant modifiable risk factors and the social and environmental determinants that increase cardiovascular risk are known, and collectively, are as important in racial and ethnic minority populations as they are in majority populations. Their prevention and treatment remain the foundation for cardiovascular health promotion and disease prevention. Genetic and epigenetic factors are increasingly recognized as important contributors to cardiovascular risk and provide an opportunity for advancing precision cardiovascular medicine. In this review, we explore emerging concepts at the interface of precision medicine and cardiovascular disease in racial and ethnic minority populations. Important among these are the lack of racial and ethnic diversity in genomics studies and biorepositories; the resulting misclassification of benign variants as pathogenic in minorities...
American Journal of Preventive Medicine
INTRODUCTION This community-based participatory research pilot study explored multilevel percepti... more INTRODUCTION This community-based participatory research pilot study explored multilevel perceptions and strategies for developing future faith-based organization blood pressure interventions for young black men. METHODS Community partners recruited the sample through two, southeastern U.S. urban churches as potential intervention hubs; academic partners conducted phone interviews with church leader key informants, and three focus groups with black men aged 18-50 years. Qualitative content analysis helped generate themes from: key informant questions assessing organizational assets and capacities, and factors influencing participation; and focus group questions assessing lifestyle and self-management behaviors. Questions assessing themes on blood pressure intervention strategies were asked. Data were collected in 2016 and analyzed in 2016-2017. RESULTS The sample included 21 key informants and 19 young black men. Key informants' leadership experience averaged 16.6 (SD=12.1) years and 28.6% were male. Focus group participants were primarily single (55.6%), college educated (61.1%), and employed (77.8%). Mean blood pressure was 131.1 (SD=15.3)/79.5 (SD=11.2) mmHg, 33.3% self-reported having hypertension, 88.9% report a family history of hypertension, and 88.9% see a provider annually. For key informants, young black men lack understanding of hypertension despite available resources, and pastors are important role models and advocates. For focus group participants, hidden sodium and stressful, busy schedules impact lifestyle behaviors; and church support for busy schedules are important. Common strategies included incentive-laden, activity-integrated programs, and male social context (testimonials, peer mentoring, engagement outside of the church). CONCLUSIONS Findings and lessons learned will help design future community-based participatory research, faith-based organization-led blood pressure interventions relevant to young black men. SUPPLEMENT INFORMATION This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
Circulation Research
I t is an exciting time for the Division of Cardiovascular Sciences (DCVS) to develop its impleme... more I t is an exciting time for the Division of Cardiovascular Sciences (DCVS) to develop its implementation plan for the National Heart, Lung, and Blood Institutes (NHLBI) strategic vision. 1 In line with the mission of the National Institutes of Health (NIH), the mission of DCVS is turning discovery into cardiovascular health (CVH). Ongoing successes in pursuit of that mission are reflected in the decline in mortality from coronary heart disease and stroke in the United States has seen in recent decades. 2 Yet challenges persist, including evidence that coronary heart disease mortality rates for young adults might be leveling off, 3 and the continuing burden of cardiovascular diseases (CVD) such as hypertension, heart failure, and vascular dementia, particularly among the elderly and other disadvantaged groups. 2,4 At the same time, innovations in fields such as computational biology, regenerative medicine, omics technology, mobile health, telemedicine, clinical informatics, and data science offer exciting opportunities in biomedical, behavioral, and social medicine. To leverage The views expressed in this article are those of the authors and do not necessarily represent the views of the
Journal of the American Heart Association, Jan 5, 2018
Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple ... more Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple 7 [LS7]) are suboptimal among blacks, which results in high risk of cardiovascular disease. We examined the association of multiple stressors with LS7 components among blacks. Using a community-based cohort of blacks (N=4383), we examined associations of chronic stress, minor stressors, major life events, and a cumulative stress score with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting plasma glucose) and an LS7 composite score. Multivariable logistic regression assessed the odds of achieving intermediate/ideal levels of cardiovascular health adjusted for demographic, socioeconomic, behavioral, and biomedical factors. The LS7 components with the lowest percentages of intermediate/ideal cardiovascular health levels were diet (39%), body mass index (47%), and physical activity (51%). Higher chronic, minor, and cumulative st...
Family medicine, 2017
Health disparities education is required during residency training. However, residency program di... more Health disparities education is required during residency training. However, residency program directors cite numerous barriers to implementing disparities curricula, and few publications describing successful disparities curricula exist in the literature. In this report, we describe the development, implementation, and early evaluation of a longitudinal health disparities curriculum for resident physicians. We provide resource references, process, and didactic toolkits to facilitate use by other residency programs. We used a standard, six-step model for curricular design, implementation, and evaluation. We assessed feasibility of curricular development including practicality (program cost and time requirements) and demand (resident engagement). We also assessed program and learner outcomes, including number of didactic and clinic sessions delivered and resident preparedness, attitudes, and skill in caring for vulnerable patients. We designed, implemented, and evaluated our curricul...
Journal of the American College of Cardiology, Jan 20, 2017
Currently, 2.2 million individuals are incarcerated, and more than 11 million have been released ... more Currently, 2.2 million individuals are incarcerated, and more than 11 million have been released from U.S. correctional facilities. Individuals with a history of incarceration are more likely to be of racial and ethnic minority populations, poor, and have higher rates of cardiovascular risk factors, especially smoking and hypertension. Cardiovascular disease is a leading cause of death among incarcerated individuals, and those recently released have a higher risk of being hospitalized and dying of cardiovascular disease compared with the general population, even after accounting for differences in racial identity and socioeconomic status. In this review, the authors: 1) present information on the cardiovascular health of justice-involved populations, and unique prevention and care conditions in correctional facilities; 2) identify knowledge gaps; and 3) propose promising areas for research to improve the cardiovascular health of this population. An Executive Summary of a National He...
Circulation, Nov 25, 2014
Introduction: In 2010, the AHA developed LS7 as a metric to define ideal cardiovascular (CV) heal... more Introduction: In 2010, the AHA developed LS7 as a metric to define ideal cardiovascular (CV) health. LS7 is being used to track health over time. However, data on discriminating within-person change in LS7 scores over time from random variability are limited. Hypothesis: We determined the minimal detectable within-person change in LS7 using data from the subset of Third National Health and Nutrition Examination Survey participants who completed two study examinations. Methods: Each LS7 component (cigarette smoking, physical activity, diet, body mass index, blood pressure (BP), cholesterol and glucose) was determined during an interview or study visit and re-assessed at the second clinic examination conducted a median of 17 days later (range 3-48 days). We included 613 participants without a history of CV disease. Each LS7 component was assigned a score of 0 (ideal), 1 (intermediate) and 2 (poor) and these scores were summed to achieve an overall score ranging from 7 (better health) to 21 (worse health). Results: For the overall population, the mean LS7 score was identical at each visit (13.5 SD+2.2). Overall, 54% of participants had no change in their LS7 score and 20%, 5% and Conclusions: In conclusion, within-person changes on LS7 of >3 points over time may represent a real change in health.
Circulation, Mar 10, 2015
Background: Masked hypertension (MHT), defined as non-elevated clinic blood pressure (CBP) and el... more Background: Masked hypertension (MHT), defined as non-elevated clinic blood pressure (CBP) and elevated blood pressure on ambulatory blood pressure (ABP) monitoring (ABPM), and prehypertension (PHT) are individually associated with increased cardiovascular disease (CVD) risk. The degree of diagnostic overlap between PHT and MHT and their associations with subclinical CVD including left ventricular mass index (LVMI) or common carotid intima-media thickness (CCIMT) is poorly characterized among African-Americans (AAs). Methods: In the Jackson Heart Study (JHS), a large community-based cohort of AAs in Jackson, MS, CBP measurements and 24-hour ABPM were obtained at baseline (2000-2004) using standardized protocols. Analyses were restricted to 391 participants who were not taking antihypertensive medications with complete data for CBP, ABPM, LVMI measured with 2D echocardiography, and CCIMT taken from carotid ultrasound. Clinic hypertension (HTN) was defined as ā„140/90 mmHg. Non-elevated CBP was defined as Results: Of the 391 participants, 74 (18.9%) had HTN. Among the 317 participants with non-elevated CBP, 185 (58.4%) had PHT and 68 (21.5%) had MHT; 68 (21.5%) had MHT (59 in those with PHT, and 9 in those with normal CBP). In a fully-adjusted model (see Table), compared to participants with both PHT and MHT, LVMI and CCIMT was less among participants with non-elevated CBP (including those with normal CBP and PHT) and without MHT. There was no difference in LVMI and CCIMT in individuals with PHT and MHT vs. those with normal CBP and MHT. Conclusions: For AAs with non-elevated CBP, LVMI and CCIMT were the highest among individuals with MHT, regardless of whether PHT was present. This finding supports using ABPM to detect MHT among AAs with non-elevated CBP.
Circulation, Nov 26, 2013
Background: Studies examining the relationship between depression and presence of metabolic syndr... more Background: Studies examining the relationship between depression and presence of metabolic syndrome (MetS) show mixed findings. Previous longitudinal studies do not account for the possibility that participantsā metabolic syndrome status or depressive symptoms status could change across examinations. Objective: To longitudinally examine effects of depressive symptoms and changes in depressive symptoms over time on metabolic syndrome in black and white men and women. Methods: Participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study who participated in the Year 10 exam in 1995 and had depressive symptoms and metabolic syndrome scores measured between 1995 and 2010 were included in the analysis (n=3,892). Depressive symptoms were determined using the Centers for Epidemiologic Study Depression score (CES-D). Anthropometric and cardiovascular risk factors were measured; MetS was defined using NCEP/ATPIII criteria. Repeated measures regression models adjusted for age, income, alcohol intake, physical activity, smoking status and antidepressant use. Results: At baseline (Year 10), participantsā mean age was 35 years (SD=3.7), mean depressive symptoms score was 10.7 (SD=8.2), and 11% had metabolic syndrome. Participants with higher average depressive symptom scores were more likely to have metabolic syndrome (OR 1.03, CI: 1.02, 1.04 per 1 unit higher). However, when stratified by race and gender, associations were found in black (OR 1.03, CI: 1.01, 1.04) and white women (OR 1.05, CI: 1.03, 1.07), whereas there was no association among black (OR 1.01, CI: 0.99, 1.03) or white (OR 1.02, CI: 1.00, 1.05) men. Changes in depressive symptoms over time were not associated with MetS (OR 0.99, CI: 0.99, 1.00). Conclusion: Depressive symptoms were associated with metabolic syndrome among women but not men; race did not influence the relationship. In conclusion, depressive symptoms may contribute to the presence of metabolic syndrome, an established risk factor for CHD and diabetes, particularly in women.
The Annals of pharmacotherapy, Jan 18, 2016
Mixed evidence suggests that second-generation antidepressants may increase the risk of cardiovas... more Mixed evidence suggests that second-generation antidepressants may increase the risk of cardiovascular and cerebrovascular events. To assess whether antidepressant use is associated with acute coronary heart disease (CHD), stroke, cardiovascular disease (CVD) death, and all-cause mortality. Secondary analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study were conducted. Use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, bupropion, nefazodone, and trazodone was measured during the baseline (2003-2007) in-home visit. Outcomes of CHD, stroke, CVD death, and all-cause mortality were assessed every 6 months and adjudicated by medical record review. Cox proportional hazards time-to-event analysis followed patients until their first event on or before December 31, 2011, iteratively adjusting for covariates. Among 29 616 participants, 3458 (11.7%) used an antidepressant of interest. Intermedi...
Journal of the American Heart Association
Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have ... more Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2āday workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although...