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  • 1
    Online Resource
    Online Resource
    Design of the Equity in Prevention and Progression of Hypertension by Addressing Barriers to Nutrition and Physical Activity Study: A Cluster Randomized Trial
    Oxford University Press (OUP) ; 2023
    In:  American Journal of Hypertension Vol. 36, No. 5 ( 2023-04-15), p. 248-255
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 36, No. 5 ( 2023-04-15), p. 248-255
    Abstract: High rates of hypertension and poverty in the rural south contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults, underscoring the need to identify prevention strategies. Methods The equity in prevention and progression of hypertension by addressing barriers to nutrition and physical activity (EPIPHANY) study is a cluster randomized controlled trial testing a multilevel intervention to reduce barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. Health education fairs offered to 20 churches in the Alabama Black Belt are being used to screen and enroll adults with elevated BP or stage 1 hypertension (systolic BP 120–139 mmHg and diastolic BP & lt; 90 mmHg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/American Heart Association BP guideline. Participants (n = 240) in churches randomized to the control condition are offered access to online resources including cooking and exercise classes. Participants (n = 240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as church champions to deliver training for church members on lifestyle modification. We will employ a Type 1 hybrid implementation-effectiveness design to assess effectiveness and implementation. Conclusions The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support.
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpad011
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1479505-X
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  • 2
    Online Resource
    Online Resource
    S292 Socioeconomic Status: An Important Determinant for Follow-Up for Surveillance Colonoscopy After Endoscopic Mucosal Resection
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  American Journal of Gastroenterology Vol. 117, No. 10S ( 2022-10), p. e211-e212
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 117, No. 10S ( 2022-10), p. e211-e212
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000857808.89710.30
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 3
    Online Resource
    Online Resource
    Blood Pressure Control Among US Adults, 2009 to 2012 Through 2017 to 2020
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Hypertension Vol. 79, No. 9 ( 2022-09), p. 1971-1980
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 79, No. 9 ( 2022-09), p. 1971-1980
    Abstract: The National Health and Nutrition Examination Survey data indicate that the proportion of US adults with hypertension that had controlled blood pressure (BP) declined from 2013 to 2014 through 2017 to 2018. We analyzed data from National Health and Nutrition Examination Survey 2009 to 2012, 2013 to 2016, and 2017 to 2020 to confirm this finding. Methods: Hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or antihypertensive medication use. BP control among those with hypertension was defined as systolic BP 〈 140 mm Hg and diastolic BP 〈 90 mm Hg. Results: The age-adjusted prevalence of hypertension was 31.5% (95% CI, 30.3%–32.8%), 32.0% (95% CI, 30.6%–33.3%), and 32.9% (95% CI, 31.0%–34.7%) in 2009 to 2012, 2013 to 2016, and 2017 to 2020, respectively ( P trend=0.218). The age-adjusted prevalence of hypertension increased among non-Hispanic Asian adults from 27.0% in 2011 to 2012 to 33.5% in 2017 to 2020 ( P trend=0.003). Among Hispanic adults, the age-adjusted prevalence of hypertension increased from 29.4% in 2009 to 2012 to 33.2% in 2017 to 2020 ( P trend=0.029). In 2009 to 2012, 2013 to 2016, and 2017 to 2020, 52.8% (95% CI, 50.0%–55.7%), 51.3% (95% CI, 47.9%–54.6%), and 48.2% (95% CI, 45.7%–50.8%) of US adults with hypertension had controlled BP ( P trend=0.034). Among US adults taking antihypertensive medication, 69.9% (95% CI, 67.8%–72.0%), 69.3% (95% CI, 66.6%–71.9%), and 67.7% (95% CI, 65.2%–70.3%) had controlled BP in 2009 to 2012, 2013 to 2016, and 2017 to 2020, respectively ( P trend=0.189). Among all US adults with hypertension and those taking antihypertensive medication, a decline in BP control between 2009 to 2012 and 2017 to 2020 occurred among those ≥75 years, women, and non-Hispanic black adults. Conclusions: These data confirm that the proportion of US adults with hypertension who have controlled BP has declined.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.122.19222
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2094210-2
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  • 4
    Online Resource
    Online Resource
    147 A Digital Approach to Syphilis Infection Prevention
    Cambridge University Press (CUP) ; 2023
    In:  Journal of Clinical and Translational Science Vol. 7, No. s1 ( 2023-04), p. 45-45
    Details
    In: Journal of Clinical and Translational Science, Cambridge University Press (CUP), Vol. 7, No. s1 ( 2023-04), p. 45-45
    Abstract: OBJECTIVES/GOALS: The goal of this study is to explore the effectiveness of a digital health education curriculum aimed at increasing syphilis beliefs and screening behavior among young African American females residing in Jefferson County, AL. METHODS/STUDY POPULATION: Study Population: African American, cis-gender women, aged 18-29, who reside in Jefferson County, AL Sample Size: N = 50 Measurements: 1) Champion Health Belief Model scale adapted for measuring syphilis perceptions and syphilis screening behavior Analysis Plan: IBM SPSS Statistics 29 will be used to analyze intervention data. Pre-and post-intervention data will be analyzed to calculate a screening request rate for each period. We will use Cohen’s D effect sizes to measure screening requests rate differences post intervention completion. The small sample size and exploratory nature of this project make the descriptive statistics valuable. RESULTS/ANTICIPATED RESULTS: We anticipate that the digital syphilis prevention intervention will positively influence participants’ beliefs regarding syphilis and their syphilis screening behaviors. DISCUSSION/SIGNIFICANCE: Innovative preventive approaches to reducing syphilis disease spread is a national priority as rates have risen annually throughout the last decade. African American women experience the greatest disease burdens associated with syphilis. This study leverages tailored strategies to effectively address this ailment in the target population.
    Type of Medium: Online Resource
    ISSN: 2059-8661
    URL: Article
    DOI: 10.1017/cts.2023.228
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2898186-8
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  • 5
    Online Resource
    Online Resource
    Abstract P378: Design of the Equity in Prevention and Progression of Hypertension by Addressing Barriers to Nutrition and Physical Activity (EPIPHANY) Study: A Cluster Randomized Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 147, No. Suppl_1 ( 2023-02-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Introduction: High rates of hypertension and poverty in the rural South contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults. Clinical trials have shown that lifestyle interventions like the Dietary Approaches to Stop Hypertension diet and increasing physical activity reduce the risk for hypertension. However, suboptimal implementation indicates a need to identify mechanisms of prevention in rural populations impacted by negative social determinants of health that can make achieving healthy lifestyle behaviors more challenging. Methods and Results: The EPIPHANY (Equity in Prevention and Progression of Hypertension by Addressing barriers to Nutrition and Physical activitY) Study is a cluster randomized controlled trial testing a multilevel intervention designed to reduce community and individual barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. EPIPHANY is enrolling and randomizing 20 churches in the Black Belt region of Alabama. Health education fairs offered to all churches are being used to screen and enroll Black adults with elevated BP or stage 1 hypertension (120-139 mm Hg and diastolic BP 〈 90 mm Hg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/ American Heart Association BP guideline. Participants (n=240) in churches randomized to the control condition are offered access to online resources including cooking demonstrations and exercise classes. Participants (n=240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification, goal setting and problem solving; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as peer health advocates to deliver training for church members on lifestyle modification. We will employ a Type 1 Hybrid Implementation-effectiveness design to assess the effectiveness and implementation of this multi-level intervention, using the RE-AIM framework. BP, social determinants of health, psychosocial factors, physical activity and diet are being assessed. The EPIPHANY trial began recruitment in August 2022 and has enrolled 18 and 25 Black adults in the first two churches randomized to the control and intervention conditions, respectively, and recruited four churches for the next wave of screenings. Conclusion: The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support. The study could provide evidence for a feasible, scalable and sustainable approach to preventing hypertension in rural, underserved communities.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.P378
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
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  • 6
    Online Resource
    Online Resource
    Abstract 59: Social Determinants of Health and Incident Apparent Treatment Resistant Hypertension in a National Cohort of Black and White US Adults
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 147, No. Suppl_1 ( 2023-02-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Background: Identifying social determinants of health (SDOH) associated with incident apparent treatment resistant hypertension (aTRH) may guide interventions to reduce the incidence of aTRH and its associated cardiovascular disease risk. Methods: We analyzed data from 2,769 White and 2,254 Black US adults from the REasons for Geographic and Racial Differences in Stroke study taking antihypertensive medication with controlled blood pressure (BP) at baseline to estimate the association of SDOH with incident aTRH. SDOH were guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment and healthcare access. Incident aTRH was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease, while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication regardless of BP level, at a follow-up visit. Results: Over a median 9.5 years of follow-up, 16.1% of White versus 23.7% of Black adults developed aTRH. After age and sex adjustment, the SDOH associated with incident aTRH (hazard ratio; 95% CI) included having less than a high school education (1.51; 1.22 - 1.87), being a high school graduate (1.30; 1.10 - 1.53), and attending some college (1.29; 1.10 - 1.52) versus college graduate; annual household income 〈 $20,000 (1.83; 1.46 - 2.30), $20,000 to 〈 $35,000 (1.53; 1.23 - 1.90) and $35,000 to 〈 $75,000 (1.24; 1.00 - 1.53) versus ≥$75,000; having no one to care for you if ill (1.29; 1.08 - 1.55); living in a disadvantaged neighborhood in quartiles 1 (1.72; 1.42 - 2.08) and 2 (1.48; 1.22 - 1.80) versus 4, or a high poverty zip code (1.26; 1.09 - 1.47); not having health insurance (1.36; 1.06 - 1.74) and residing in a state with low public health infrastructure (1.17; 1.02 - 1.33). Results stratified by race are presented in the Table. Conclusion: SDOH were associated with transitioning from controlled BP to incident aTRH among White and Black adults.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.59
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
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  • 7
    Online Resource
    Online Resource
    A Qualitative Assessment of the Living Donor Navigator Program to Identify Core Competencies and Promising Practices for Implementation
    SAGE Publications ; 2020
    In:  Progress in Transplantation Vol. 30, No. 1 ( 2020-03), p. 29-37
    Details
    In: Progress in Transplantation, SAGE Publications, Vol. 30, No. 1 ( 2020-03), p. 29-37
    Abstract: The best strategy to increase awareness of and access to living kidney donation remains unknown. To build upon the existing strategies, we developed the Living Donor Navigator program, combining advocacy training of patient advocates with enhanced health-care systems training of patient navigators to address potential living donor concerns during the evaluation process. Herein, we describe a systematic assessment of the delivery and content of the program through focus group discussion. Methods: We conducted focus groups with 9 advocate participants in the Living Donor Navigator program to identify knowledge, skills, and abilities needed for both advocates and navigators. We focused on 2 organizational levels: (1) the participant level or the advocacy training of the advocates and (2) the programmatic level or the support role provided by the navigators and administration of the program. Findings: From 4 common themes (communication, education, support, and commitment), we identified several core competencies and promising practices, at both the participant and programmatic levels. These themes highlighted the potential for several improvements of program content and delivery, the importance of cultural sensitivity among the Living Donor navigators, and the opportunity for informal caregiver support and accountability provided by the program. Discussion: These competencies and promising practices represent actionable strategies for content refinement, optimal training of advocates, and engagement of potential living donors through the Living Donor Navigator program. These findings may also assist with program implementation at other transplant centers in the future.
    Type of Medium: Online Resource
    ISSN: 1526-9248 , 2164-6708
    URL: Article
    DOI: 10.1177/1526924819892919
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2864264-8
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  • 8
    Online Resource
    Online Resource
    Enhanced Advocacy and Health Systems Training Through Patient Navigation Increases Access to Living-donor Kidney Transplantation
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Transplantation Vol. 104, No. 1 ( 2020-01), p. 122-129
    Details
    In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 104, No. 1 ( 2020-01), p. 122-129
    Abstract: To date, no living donation program has simultaneously addressed the needs of both transplant candidates and living donors by separating the advocacy role from the candidate and improving potential donor comfort with the evaluation process. We hypothesized that the development of a novel program designed to promote both advocacy and systems training among transplant candidates and their potential living kidney donors would result in sustained increases in living-donor kidney transplantation (LDKT). To this end, we developed and implemented a Living Donor Navigator (LDN) Program at the University of Alabama at Birmingham. Methods. We included adult patients awaiting kidney-only transplant in a retrospective cohort analysis. Using time-varying Cox proportional hazards regression, we explored likelihood of living donor screening and approval by participation in the LDN program. Results. There were 56 LDN participants and 1948 nonparticipants (standard of care). LDN was associated with a 9-fold increased likelihood of living donor screenings (adjusted hazard ratio, 9.27; 95% confidence interval, 5.97-14.41, P 〈 0.001) and a 7-fold increased likelihood of having an approved living donor (adjusted hazard ratio, 7.74; 95% confidence interval, 3.54-16.93; P 〈 0.001) compared with the standard of care. Analyses by participant race demonstrated higher likelihood of screened donors and a similar likelihood of having an approved donor among African Americans compared with Caucasians. Conclusions. These data suggest that both advocacy and systems training are needed to increase actual LDKT rates, and that LDN programs may mitigate existing racial disparities in access to LDKT.
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/TP.0000000000002732
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2035395-9
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  • 9
    Online Resource
    Online Resource
    S633 The Association of Patient Demographics and Socioeconomic Status With Advanced Neoplasia in Endoscopic Mucosal Resection
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  American Journal of Gastroenterology Vol. 117, No. 10S ( 2022-10), p. e438-e439
    Details
    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 117, No. 10S ( 2022-10), p. e438-e439
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000859172.35200.e8
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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