Recruitment of American Indians in epidemiologic research: the Strong Heart Study

This paper describes the methods used to recruit American Indian (AI) populations for the Strong Heart Study (SHS), a community-based study of cardiovascular disease (CVD) and its risk factors in AI men and women. Recruitment strategies included personal contact by recruiters and drivers/recruiters in remote areas, SHS staff participation in community activities, and mass media. A total of 4,549 participants aged 45-74 years were recruited from 13 American Indian tribes and communities. Overall participation rates were 72&percnt, 55&percnt, and 62&percnt, respectively, for the three study centers (Arizona, the Dakotas, and Oklahoma). Participant feedback and educational material related to risk factor reduction and promoting a healthy lifestyle were emphasized. Participants were likely to be female, young, and nonsmokers. Barriers to recruitment included lack of telephones in a large proportion of households, conflicting beliefs about health/health care/research, fears, taboos, and occasional rumors about study examination procedures. Participants were referred for follow-up of health problems detected by the study. The strong commitment of the participating communities helped to insure the success of the SHS, which can be considered a model for recruitment in future American Indian population-based studies. Success was facilitated by the use of a variety of recruitment techniques.     

Correlates of social support in older American Indians: the Native Elder Care Study

Objectives: This study examined social support and identified demographic and health correlates among American Indians aged 55 years and older.

Methods: Data were derived from the Native Elder Care Study, a cross-sectional study of 505 community-dwelling American Indians aged ≥55 years. Social support was assessed using the Medical Outcomes Study Social Support Survey measure (MOS-SSS) of which psychometric properties were examined through factor analyses. Logistic regression analyses were used to identify associations between age, sex, educational attainment, marital status, depressive symptomatology, lower body physical functioning, and chronic pain and social support.

Results: Study participants reported higher levels of affectionate and positive interaction social support (88.2% and 81.8%, respectively) than overall (75.9%) and emotional (69.0%) domains. Increased age, being married/partnered, and female sex were associated with high social support in the final model. Decreased depressive symptomatology was associated with high overall, affectionate, and positive interaction support, and decreased chronic pain with affectionate support. The count of chronic conditions and functional disability were not associated with social support.

Conclusions: Overall, we found high levels of social support for both men and women in this population, with the oldest adults in our study exhibiting the highest levels of social support. Strong cultural values of caring for older adults and a historical tradition of community cooperation may explain this finding. Future public health efforts may be able to leverage social support to reduce health disparities and improve mental and physical functioning.     

Respondent bias in the collection of alcohol and tobacco data in American Indians: the Strong Heart Study

This study addresses the impact of assessment method (interviewer-administered questionnaire vs. self-administered questionnaire) and interviewers demographic characteristics (gender, ethnicity, and residency) on responses to alcohol and tobacco questions. The study population included 1,522 men and women aged 45 to 74 from the Dakota Center of the Strong Heart Study (SHS), a multi-center study of cardiovascular disease in American Indians. Assessment method effects were greater for alcohol than tobacco but did not differ by interviewer characteristics.     

Atherosclerosis risk factors in American Indians with Alzheimer disease: preliminary findings

Factors predisposing to and associated with atherosclerosis may impact the onset and progression of Alzheimer disease (AD). The high prevalence of atherosclerosis and associated risk factors in American Indians makes them ideal subjects to test this association. We compared frequency of history of hypertension, myocardial infarction, stroke, diabetes, and high cholesterol in 34 American Indians with AD with 34 age-matched American Indian controls, and 34 age-matched whites with probable AD. We also measured waist size, height, and weight, and acquired blood for determination of plasma homocysteine and apolipoprotein E genotype. The 3 groups did not differ significantly in age or sex. History of hypertension and diabetes was significantly more common among American Indian AD patients than Indian controls or whites with AD. The 3 groups did not differ in history of stroke or myocardial infarction. Body mass index was significantly greater in both Indian groups than the white AD group. Plasma homocysteine levels were greater, but not significantly so, in the Indian AD than the Indian control group. Thus, there is preliminary evidence of a modest association between history of hypertension and diabetes and AD in a small sample of American Indians. This suggests that changes in lifestyle factors could influence the expression of AD in American Indians.     

Independent associations of alexithymia and social support with depression in hemodialysis patients

OBJECTIVE: The influences of alexithymia and social support on depression among chronically ill patients were examined prospectively. METHODS: The study population was 230 outpatients receiving chronic hemodialysis (HD) therapy. The Beck Depression Inventory-II (BDI-II), the 20-item Toronto Alexithymia Scale (TAS-20), and two subscales of the Social Support Questionnaire were given to the subjects. The BDI-II was readministered after a 6-month interval, and subjects who showed deterioration in their depression score above the level predicted from their baseline score were identified. Multivariate logistic analysis adjusted for age, gender, cause of dialysis, and psychosocial variables were performed. RESULTS: Baseline depression was significantly and independently associated with alexithymia and low satisfaction with available support. Deterioration of depression after 6 months was predicted by alexithymia and poor available support. CONCLUSIONS: Alexithymia and reduced social support might have independent associations with the presence and the prognosis of depression among HD patients.     

Psychological well-being and mortality: longitudinal findings from Lithuanian middle-aged and older adults study

Social Psychiatry and Psychiatric Epidemiology - The study aimed to examine whether after confounding by possible socio-demographic and other risk factors, psychological well-being is independently...     

Compliance with ambulatory saliva sampling in the Chicago Health, Aging, and Social Relations Study and associations with social support

Background: Noncompliance with instructed saliva sampling times in ambulatory settings can compromise resulting cortisol findings.Purpose and Methods: Here, the impact of noncompliance on the cortisol awakening response (CAR), an established marker for hypothalamic-pituitary-adrenal axis activity, was examined over 3 sampling days in middle- and older-age participants in the Chicago Health, Aging, and Social Relations Study.Results: Noncompliant participants had a significantly lower cortisol rise after awakening (assessed by an awakening sample and a 30-min after awakening sample) on 2 of the 3 sampling days (Day 1, ns; Days 2 & 3, ps<.02). Furthermore, social support measured by the Interpersonal Support Evaluation List correlated negatively with the number of “noncompliant” samples (r=−.19, p<.05), indicating that participants reporting more social support had more “compliant” samples.Conclusion: The results confirm that nonadherence to saliva sampling in ambulatory settings can exert a significant impact on the resulting CAR. Furthermore, the data raise the idea that the extent of nonadherence might be systematically associated with psychosocial factors like social support. For future studies on the relationship between CAR and psychological factors, we therefore recommend controlling for saliva sampling adherence because noncompliance might be systematically associated with the phenomenon being investigated. Funding was provided by the National Institute of Aging Grant No. PO1 AG18911 and the John Templeton Foundation. Brigitte M. Kudielka was supported by grants from the German Research Foundation (DFG grant KU 1401/3-1 and KU 140/4-1).     

Sleep disordered breathing in community dwelling elderly: associations with cardiovascular disease, impaired systolic function, and mortality after a six-year follow-up

Introduction

Sleep disordered breathing (SDB), cardiovascular disease (CVD) and impaired cardiac function are common in elderly people. We investigated the association of SDB and mortality in a community dwelling elderly population, considering CVD and objectively measured impaired cardiac function have been poorly studied thus far.

Aim

To investigate whether SDB is a factor that affects mortality in elderly people, with a focus on those with CVD and/or signs of impaired cardiac function.

Methods

A prospective cohort design was used and 331 community dwelling elderly aged 71–87 years underwent one-night polygraphic recordings in the subjects’ homes. CVD and systolic function were objectively established. Mortality data were collected after 6 years.

Results

In the total population there were no significant associations between mortality and SDB. In those with CVD and impaired systolic function, as measured by NT-proBNP, oxygen desaturation index (ODI) ?10 was associated with mortality. The hazard ratio of 3.0 (CI 95% 1.1–8.6, p = 0.03) remained statistically significant after adjustments for age, gender, diabetes and plasma values of NT-proBNP.

Conclusion

SDB in community dwelling elderly has no overall association to mortality irrespective of degree of SDB. However, hypoxic events (i.e., ODI ?10) were associated with mortality in the group who had CVD in combination with impaired systolic function.     

Creutzfeldt-Jakob disease among American Indians and Alaska Natives in the United States

The occurrence of Creutzfeldt-Jakob disease (CJD) among American Indians and Alaska Natives in the United States was evaluated using national multiple cause-of-death data and medical information obtained from state health departments. Twelve CJD deaths were identified for 1981 through 2002, and the average annual age-adjusted death rate was 0.47 per million population. This rate was significantly lower than that for whites and similar to the rate for African Americans.     

Psychological risk factors and the metabolic syndrome in patients with coronary heart disease: Findings from the Heart and Soul Study

Psychological factors, such as depression and anxiety, are independently associated with an increased risk of both diabetes mellitus and cardiovascular disease, but the reasons for these associations are unknown. We sought to determine whether psychological factors were associated with a greater prevalence of the metabolic syndrome in patients with coronary heart disease, and the extent to which such an association may be explained by socioeconomic status, health behaviors, and biological mediators. We conducted a cross-sectional study of 1024 outpatients with stable coronary heart disease. Psychological factors, including depressive and anxiety symptoms, hostility, anger, and optimism–pessimism, were assessed using validated standardized questionnaires. The presence or absence of the metabolic syndrome was determined using the criteria outlined by the National Cholesterol Education Program, Adult Treatment Panel III. Higher levels of depression, anger expression, hostility, and pessimism were significantly associated with increased prevalence of the metabolic syndrome. These associations were explained by differences in socioeconomic status and health behaviors. Additional adjustment for potential biological mediators had little impact. Further research is needed to determine whether addressing socioeconomic and behavioral factors in people with depression or high levels of anger or hostility could reduce the burden of the metabolic syndrome.     

Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association

Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two thirds of all deaths in the United States and about 700 billion dollars in direct and indirect economic costs each year. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity-the major risk factors for these diseases-and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases. In this article, the ACS, ADA, and AHA review strategies for the prevention and early detection of cancer, cardiovascular disease, and diabetes, as the beginning of a new collaboration among the three organizations. The goal of this joint venture is to stimulate substantial improvements in primary prevention and early detection through collaboration between key organizations, greater public awareness about healthy lifestyles, legislative action that results in more funding for and access to primary prevention programs and research, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment.     

Psychological distress and infectious disease mortality in the general population

There is a paucity of studies examining the relation between high psychological distress and infectious disease in the general population. We examined this association in a large multi-cohort study drawn from the general population. The analytic sample comprised 104,923 men and women (age, 47.3 ± 17.4 year; 45.7% men) in which psychological distress symptoms was assessed using the 12-item version of the General Health Questionnaire. There were 1535 deaths attributed to infectious diseases during 971,220 person-years of follow up (mean 9.3; range 0.1–17.1 years). A dose-response association between GHQ-12 score and all infectious disease mortality was observed after adjusting for age, sex, survey year, occupational social class, longstanding illness, smoking, alcohol, and physical activity (per SD increase, hazard ratio = 1.24; 95% CI, 1.20–1.28). A similar pattern was apparent for viral infections (1.23; 1.14, 1.33) and pneumonia (1.20; 1.13, 1.28), but weaker for bacterial infections (1.09; 1.00, 1.19). In conclusion, psychological distress is associated with higher risk of infectious disease.     

Depression and onset of cardiovascular disease in the US middle-aged and older adults

Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults.

Methods: The study sample came from 1992–2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51–61 years old in 1992 with no CVD history. A score of ≥3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan–Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity.

Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27% (hazard ratio [HR] = 1.27, 95% confidence interval = 1.17–1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose–response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant.

Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.