Disparities in adult awareness of heart attack warning signs and symptoms--14 states, 2005

In 2005, approximately 920,000 persons in the United States had a myocardial infarction (i.e., heart attack); in 2004, approximately 157,000 heart attacks were fatal. One study indicated that approximately half of cardiac deaths occur within 1 hour of symptom onset, before patients reach a hospital. Timely access to emergency cardiac care, receipt of advanced treatment, and potential for surviving a heart attack all depend on 1) early recognition of warning signs and symptoms of a heart attack by persons who are having a heart attack and bystanders and 2) immediately calling 9-1-1. Healthy People 2010 includes an objective to increase from 46% to 50% the proportion of adults aged > or =20 years who are aware of the early warning signs and symptoms of a heart attack and the importance of accessing rapid emergency care by calling 9-1-1 (objective 12-2). To update estimates of public awareness of heart attack warning signs and symptoms and knowledge of the importance of calling 9-1-1, CDC analyzed 2005 Behavioral Risk Factor Surveillance System (BRFSS) data from the 14 states that included questions on signs and symptoms of a heart attack. This report describes the results of that analysis, which indicated that although the awareness of certain individual warning signs was as high as 93% (i.e., for shortness of breath), awareness of all five warning signs was 31%, underscoring the need for public health measures to increase public awareness of heart attack warning signs and symptoms. In addition, disparities in awareness were observed by race/ethnicity, sex, and level of education, suggesting that new public health measures should target populations with the lowest levels of awareness.     

Cardiovascular disease knowledge among culturally Deaf patients in Chicago

BACKGROUND: Deaf persons experience communication barriers that may impact on their knowledge of cardiovascular disease (CVD); however, data measuring this deficit are limited. A comprehensive health survey of Deaf adults included questions on CVD knowledge. METHODS: Between November 2002 and March 2003, 203 Deaf adults participated in the survey, which was conducted via face-to-face interviews in American Sign Language. Questions assessed knowledge of heart attack and stroke symptoms, risk factors, and emergency response. RESULTS: Forty percent of respondents could not list any symptoms of a heart attack, while over 60% could not list any symptoms of a stroke. Less than half of respondents identified chest pain/pressure as a symptom of a heart attack. Only 61% reported that they would call 911 in response to cardiovascular disease symptoms. The median number of risk factors correctly identified by respondents was 3 of 6. CONCLUSIONS: Knowledge of cardiovascular disease among Deaf respondents is low, and considerably lower than that of the general hearing population. The need to develop health education materials and programs for Deaf individuals is evident. Health care providers should be educated on Deaf culture and barriers in communication. Finally, efforts need to be made to assure that 911 is deaf-accessible.     

Symptom severity and perceptions in subjects with panic attacks

OBJECTIVES: To (1) identify aspects that defined the self-perceived worst panic attack, (2) determine how subjects with panic attacks perceive symptoms compared with control subjects, and (3) determine the role of symptom perceptions in seeking care for the worst panic attack. DESIGN: Cross-sectional survey. SETTING: Community-based. PATIENTS OR OTHER PARTICIPANTS: Ninety-seven subjects with panic attacks as defined by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (with or without panic disorder), and 97 demographically matched controls. INTERVENTION: None. MAIN OUTCOME MEASURES: Subjects and controls completed the Symptom Perception Scales, and subjects with panic attacks completed the Acute Panic Inventory and a questionnaire concerning care-seeking behavior for their self-perceived worst attack. RESULTS: Compared with controls, subjects with panic attacks perceived many symptoms as more embarrassing but differed little in their perceptions of need for treatment, threat to life, and disruption of functioning. Particular symptoms (ie, dyspnea, fear, dizziness, and faintness) tended to differ in most perceptions. However, symptom perceptions did not play a significant role in care-seeking behavior for the worst attack. CONCLUSIONS: Subjects with panic attacks perceive symptoms as more embarrassing than controls, and have different perceptions about particular symptoms. Cognitive approaches addressing negative patient perceptions may reduce anxiety, inappropriate use of health care services, and adverse outcomes. Arch Fam Med. 2000;9:1028-1035     

Too many of us have gone early - priorities in heart health education for Aboriginal people

Aboriginal people have a higher burden of cardiovascular risk factors and heart disease and poorer outcomes after heart attacks when compared with other Australians. Indigenous status is also a risk factor for delayed response to heart attack symptoms. A community DVD about preventing and managing heart disease was made at the Aboriginal Medical Service Western Sydney in 2005. The aim of this article is to reflect on the process of making the DVD as a community driven health promotion activity and to explore questions raised and insights gained about heart health education for Aboriginal people in the context of the existing literature. The importance of education about heart attack symptom recognition and prompt hospital presentation, as well as risk factor management, by general practitioners and other health practitioners working with Aboriginal people, is highlighted.     

Knowledge of Cardiovascular Health Among Chinese, Korean and Vietnamese Immigrants to the US

Cardiovascular disease (CVD) is the leading cause of death among Asian Americans, the majority of whom are foreign-born. However, CVD and risk factor data is sparse for specific Asian immigrant populations. To assess knowledge and understanding of CVD and risk factors within Chinese, Korean and Vietnamese immigrant populations, we conducted eight focus groups of 77 participants between 36 and 84?years old. Participants correctly identified signs and symptoms for heart attacks while knowledge about stroke was incomplete. While poor diet, lack of exercise, older age, and high cholesterol were frequently discussed as risk factors, mechanisms perceived as contributing to heart disease were influenced primarily by non-Western paradigms. Non-Western remedies were discussed in detail among Chinese and Vietnamese participants. All participants desired more information, and identified barriers to effective communication with healthcare providers. A deeper understanding of beliefs and barriers faced by Asian immigrants can help guide health promotion efforts.     

African–American Solo Grandparents Raising Grandchildren: A Representative Profile of Their Health Status

The objective of this study is to document the health profile of 252 African-American grandparents raising their grandchildren solo, compared with 1552 African-American single parents. The 2012 Behavior Risk Factor Surveillance System is used to compare the specific physical and mental health profiles of these two family groups. The findings suggest solo grandparents have prevalence of many health conditions, including arthritis (50.3?%), diabetes (20.1?%), heart attack (16.6?%) and coronary heart disease (16.6?%). Logistic regression analyses suggest that solo grandparents have much higher odds of several chronic health disorders in comparison with single parents, but this difference is largely explained by age. Although solo grandparents have good access to health care insurance and primary care providers, a substantial percentage (44?%) rate their health as fair or poor. Practice interventions to address African American solo grandparents’ health needs are discussed.     

Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies

CONTEXT: EMS is an integral part of health care and is especially important in less densely populated areas. What is known about EMS in rural areas is limited because of fragmentation in the system and rudimentary data collection efforts. PURPOSE: The goal of this study is to identify important issues faced by rural EMS systems and describe the support of rural EMS providers by state EMS agencies. METHODS: A telephone survey of state EMS directors (response rate 95.7%) asked questions regarding issues in medical direction, programs, and initiatives by state EMS agencies that target rural and volunteer EMS providers, integration initiatives, and anticipated effects of the new Medicare fee schedule. FINDINGS: Medical direction in rural EMS was identified as a major issue for a majority of states. Integration in EMS is seen as a possible solution but does not occur very commonly. The survey found substantial variation in the state approach to EMS issues. Less than a third of the states in the study have a statewide EMS plan. State EMS agencies address rural EMS provider needs in a limited manner. EMS state agencies focus on regulation and funding of EMS providers, with only approximately a third providing technical assistance to EMS providers. CONCLUSIONS: The range in approaches to EMS issues at the state level will need to be taken into account in formulating national EMS policy. The limited provision of technical assistance leaves a void that may be addressed by other agencies and organizations in some states. In the absence of major federal funding initiatives, the development of EMS has become a state and local issue. A new national initiative may help address EMS issues and stimulate the development of EMS as a system beyond its current fragmented state.     

Emergency Medical Service Providers' Perception of Health-Threatening Stressors in Emergency Missions: A qualitative Study

BackgroundUnknown and unpredictable situations cause emergency medical service (EMS) providers to experience various stressful factors. These factors are affected by sociocultural conditions and expectations of the casualty and affect EMS providers'' performance and health at the incident scene. The present study was conducted to explore EMS providers'' perception of stressful and health-threatening factors in emergency missions.MethodThis qualitative conventional content analysis was conducted in 2020. The participants included 16 EMS providers working at the Emergency Medical Services Department in Hamadan Province, Iran. The participants were selected using purposive sampling and underwent semi-structured interviews until data saturation. Data were analyzed using the Graneheim and Lundman method.ResultsAnalysis of the interview data yielded six subcategories (i.e., incident scene hazards, violence-related injuries, physical injuries caused by patient care/handling, ambulance crash-related injuries, emotional impact of patients'' suffering and ailments, and highly stressful missions), two main categories (i.e., physical injuries and psychological tensions), and a theme of occupational injuries.ConclusionsAccording to the results, in addition to having concerns about caring for patients and saving the injured, EMS providers also worry about potential threats to their own health. The present study identified and described some major stressors in emergency missions. Thus, for a better and more effective efficiency, the present study results can be used to reduce or modify stressors in EMS providers.     

The impact of certificate of need laws on heart attack mortality: Evidence from county borders

Certificate of need (CON) regulations requires that health care providers obtain state approval before offering a new service or expanding existing facilities. The purported goal of CON regulations is to reduce health care costs by generating regional economies of scale and reducing redundant investments resulting from excessive competition. Critics of CON regulations note that the regulatory environment increases the costs of expansion and may incentivize health care providers to forgo capital investment, which can have a negative effect on health outcomes. To estimate the net effect of CON regulations, I use a border discontinuity design to measure within-regional heart attack mortality spanning 1968 to 1982. I estimate that CON regulations led to an increase in heart attack deaths, by 6%-10%, three years after the policy was enacted.     

Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults

Background

Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.

Methods

Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.

Results

The weighted n for this study overall was 103,262,115 U.S. adults?>?=18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR?=?1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR?=?1.353 95%CI 1.352-1.354), >65 years of age (OR?=?1.369 95%CI 1.368-1.371), African American (OR?=?1.892 95%CI 1.889-1.894), not educated beyond high school (OR?=?1.400 955CI 1.399-1.402), uninsured (OR?=?1.308 95%CI 1.3-6-1.310), without a HCP (OR?=?1.216 95%CI 1.215-1.218), and living in a household with an annual income of?<?$50,000 (OR?=?1.429 95%CI 1.428-1.431).

Conclusions

Analysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.

     

A Community-Based Qualitative Assessment of Knowledge,Barriers, and Promoters of Communicating about Family Cancer History among African-Americans

ABSTRACT

Family cancer history (FCH) can shape prevention and early detection behaviors to decrease cancer risk. However, many individuals are unaware of increased risk for cancers based on family patterns. For some African-American communities, communication about FCH is rare and barriers have not been well studied. To optimize the use of FCH, it is crucial to understand how patients gather and share FCH with relatives and healthcare providers. We conducted four focus groups (n = 40) and seven key informant interviews (n = 9) to investigate knowledge, experiences, and barriers/promoters of FCH in the East Baltimore African-American community. Thematic analysis identified 14 distinct themes across six communication domains: participants’ understanding of FCH, past FCH communication with family and providers, barriers to FCH communication, promoters of FCH communication, suggestions for future communication, and community health priorities. FCH was most often defined by narratives of family cancer experiences, and the majority of participants had shared little FCH with family members. Five psychosocial domains were commonly reported as barriers to sharing FCH: fear/denial, pride/dignity, selflessness/self-sacrifice, cancer fatalism, and distrust/skepticism of medical care. Diagnosis/death and caregiving/social support promoted FCH communication and encouraged cancer prevention behaviors such as screening. Although most participants had experienced cancer in their families, communication about FCH was low and psychosocial barriers were common. Understanding these communication domains in minority populations is crucial to developing interventions to address disparities in cancer prevention and control, particularly where effective screening and care recommendations exist for those with positive family histories.     

Symptom recognition of heart attack and stroke in nine European countries: a representative survey

Background Cardiovascular diseases are the number one cause of death and a source of chronic disability. Objectives To assess recognition of and reaction to symptoms of heart attack and stroke, and how recognition is related to the frequency of consulting physicians and other information sources. Design Face‐to‐face computer‐assisted personal interviews. Participants Representative sample of 10 228 persons in Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain and UK, aged 14–98. Main Outcome Variables Recognition of heart attack and stroke symptoms and proper reaction to symptoms. Results Chest pain was the only heart attack symptom recognized by more than 50% of participants. Eight percent knew no symptoms. Of 14 stroke symptoms, none was recognized by more than 50% of participants; 19% could not identify any symptom. For both heart attack and stroke, Germans and Austrians recognized the largest number of symptoms. Persons in Italy, Poland, Russia and Spain knew only about half as many symptoms as in Germany or Austria. Only 51% of Europeans would call an ambulance when someone suffers a stroke, the fewest (33 and 34%) in Germany and Austria. In most countries, people who consulted their physician more frequently had no better recognition of heart attack or stroke symptoms. Conclusions The majority of persons in nine European countries recognize few heart attack and stroke symptoms; many do not know how to react. This low level of knowledge constitutes a major health risk and likely leads to delay in treatment, contributing to the high mortality and morbidity from these diseases.     

Women’s knowledge about heart disease: Differences among ethnic and cultural groups in the Israeli Women’s Health in Midlife Study

Abstract

The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45–64 years were conducted during 2004–2006 within three population groups: long-term Jewish residents (LTR), immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity, and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about “warning signs of a heart attack” and “family history.” Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients’ personal status by health providers.     

Knowledge, Attitudes, and Interest in Breast-Ovarian Cancer Gene Testing: A Survey of a Large African-American Kindred with a BRCA1 Mutation

BACKGROUND: This study assessed counseling and testing needs from the perspective of adult members of a large African-American kindred with a BRCA1 mutation. METHODS: Interviews were conducted with 95 male and female kindred members to elicit information on sociodemographics, attitudes toward health care providers, breast cancer screening behaviors, and religious/spiritual beliefs, as well as to evaluate psychological distress, beliefs, knowledge, and attitudes related to genetic testing. RESULTS: Knowledge about breast and ovarian cancer genetics was limited. Adherence to screening recommendations was low among females with no personal breast or ovarian cancer history. The majority (67%) wished to discuss risk factors with a health care provider. Most participants (82%) indicated that they would have a genetic test if it were available. Significant predictors of intent to undergo testing were having at least one first-degree relative with breast and/or ovarian cancer (OR = 5.1; 95% CI = 1.2-20.9) and perceived risk of being a gene carrier > or =50% (OR = 64.3; 95% CI = 5.1-803.9) or reporting that they did not know their risk of being a gene carrier (OR = 10.9; 95% CI = 2.1-57.7). Cited barriers to testing included cost and availability. CONCLUSION: There is a high interest level in genetic testing despite limited knowledge about cancer genetics among these high-risk African Americans. Our study provides information for designing a genetic education and counseling intervention for this and similar families.     

Health knowledge about symptoms of heart attack and stroke in adult survivors of childhood acute lymphoblastic leukemia

PURPOSE: Children with acute lymphoblastic leukemia (ALL), the most common pediatric malignancy, have a 5-year survival rate of better than 80%. Long-term survivors of childhood ALL, however, carry an elevated risk of early mortality from cardiac events and stroke and a disproportionately high prevalence of dyslipidemia and obesity, presumably as an adverse effect of treatment. METHODS: As part of a clinical follow-up study of 70 young adult survivors of childhood ALL, we evaluated the degree to which this high-risk group differed in knowledge about symptoms of heart attack and stroke from that of a population-based comparison group frequency-matched by age, sex, and body mass index. Questions from the Behavioral Risk Factor Surveillance System were used to assess health knowledge. RESULTS: Survivors of ALL scored considerably worse on symptom knowledge than did their population counterparts. The strongest association was observed for chest pain as a symptom of heart attack: ALL survivors were 14-fold more likely than the comparison group to answer the question incorrectly. Seventy-seven percent of survivors failed to identify pain in the jaw, neck, or back as a heart attack symptom. CONCLUSIONS: These results indicate an important gap in knowledge and underscore the need for health education among survivors of childhood leukemia that includes information about symptoms of myocardial infarction and stroke.     

Opportunities for oral cancer screening among older African-American women

BACKGROUND: Older persons with smoking histories are important targets for oral cancer screening. Although older persons in low-income communities often lack regular dental care, little is known about the characteristics of groups at greatest risk for poor screening. METHODS: Survey data from 576 African-American women aged 45-93 were used to identify predictors of smoking and recency and type of dental care. RESULTS: Fifty-nine percent of respondents were current or former smokers, and 62% reported dental care within the past 3 years. Among smokers, no recent dental care was associated with older age, worse health, not working, no regular medical provider, and no recent mammography. CONCLUSIONS: These results suggest that episodic visits to non dentist providers offer opportunities for oral screening in high-risk populations.     

Rural Women and Osteoporosis: Awareness and Educational Needs

CONTEXT: Little is known about rural women's knowledge about osteoporosis. PURPOSE: To explore what women from high-prevalence rural communities know about osteoporosis and to assess their learning preferences. METHODS: We surveyed 437 women in rural Washington and Oregon. FINDINGS: The response rate was 93% (N = 406). The mean age of respondents was 63 years (range 16-95) and 74% (n = 301) of women were postmenopausal. While 27% over age 40 (n = 111) reported having a fracture as an adult, less than half of this group (42%, n = 47) considered themselves at risk for osteoporosis. Of the 42% (n = 171) who rated their knowledge of osteoporosis good or excellent, only 18% (n = 30) answered calcium and vitamin D questions correctly. About half (53%; n = 214) exercised 3 or more times per week. Reported sources of osteoporosis information included television, magazines, health care providers, and personal contacts. Over half of the women in this study wanted more information about osteoporosis, most wanted it before age 50, and health care providers were a preferred source. Less than half of participants reported having Internet access. CONCLUSIONS: While many participants underestimated their osteoporosis risk, most women wanted to learn more about osteoporosis and health care providers remain a preferred source of information.     

African-American men's perceptions about prostate cancer: implications for designing educational interventions

This qualitative study explores African-American men's perceptions about prostate cancer (CaP) screening and assesses the acceptability of various strategies and settings for interventions to promote informed decision-making. We conducted four focus groups among healthy men (n=37) and two groups among CaP survivors (n=14) aged 35-70 in the greater Boston area, USA. Also, we conducted 14 in-depth interviews with key community informants. The audio-taped focus groups and interviews were transcribed, coded, and analyzed for emergent themes. Except for survivors, men had insufficient information about the prostate, the elevated cancer risk among African-Americans, and the controversy concerning screening. Key informants and focus group participants cited inadequate access to services, mistrust of the health system, poor relationships with medical providers, and perceived threats to male sexuality as major barriers to receiving prostate care. They recommended that interventions be embedded in community settings, address men's overall health, and be administered by culturally competent providers, and repeatedly emphasized trust building and a sustained presence in the community. Efforts to present balanced information about CaP screening may be hindered by lingering mistrust of the medical system, poor relationships between patients and providers, and enthusiastic support for screening on the part of CaP survivors. Implications for interventions are discussed.     

Eating Patterns among Emergency Medical Service Providers in the United States: A Qualitative Interview Study

Emergency medical service (EMS) providers experience demanding work conditions in addition to shift work, which increases risk for nutrition related chronic disease such as metabolic syndrome, diabetes, obesity, and cardiovascular disease. The high stress, emergent, and unpredictable nature of EMS may interfere with healthy eating patterns on and off shift, however little is known about how these conditions impact dietary patterns among EMS providers. This study aimed to understand factors impacting dietary patterns through semi-structured interviews with 40 EMS providers throughout the United States. Interviews were conducted virtually via Zoom video conference. Inductive coding was used to identify themes throughout the interviews. Salient factors mentioned in the interviews included hunger, fatigue, stress, coworker influence, ambulance posting, geographical location, agency policy, and culture. Factors were grouped into 4 domains: physiological factors, psychosocial factors, physical environment, and organizational environment, represented by an adapted version of the social ecological model of health behaviors to include factors influencing eating patterns specific to EMS, which may contribute to overall health. Various barriers to healthy eating exist within EMS, and future studies should explore interventions at each level of our proposed model to improve conditions and reduce nutrition related disease risk in this essential population.     

On the front lines: family physicians' preparedness for bioterrorism

OBJECTIVE: The events of September 11, 2001, and the nation's recent experience with anthrax assaults made bioterrorism preparedness a national priority. Because primary care physicians are among the sentinel responders to bioterrorist attacks, we sought to determine family physicians' beliefs about their preparedness for such an attack. STUDY DESIGN: In October 2001 we conducted a national survey of 976 family physicians randomly selected from the American Academy of Family Physicians' active membership directory. POPULATION: 614 (63%) family physicians responded to the survey. OUTCOMES MEASURED: Physicians' self-reported ability to "know what to do as a doctor in the event of a suspected bioterrorist attack, recognize signs and symptoms of an illness due to bioterrorism, and know where to call to report a suspected bioterrorist attack." RESULTS: Ninety-five percent of physicians agreed that a bioterrorist attack is a real threat within the United States. However, only 27% of family physicians believed that the US health care system could respond effectively to a bioterrorist attack; fewer (17%) thought that their local medical communities could respond effectively. Twenty-six percent of physicians reported that they would know what to do as a doctor in the event of a bioterrorist attack. Only 18% had previous training in bioterrorism preparedness. In a multivariate analysis, physicians reported that preparedness for a bioterrorist attack was significantly associated with previous bioterrorism preparedness training (OR 3.9 [95% CI 2.4-6.3]) and knowing how to obtain information in the event of a bioterrorist attack (OR 6.4 [95% CI 3.9-10.6]). CONCLUSIONS: Only one quarter of family physicians felt prepared to respond to a bioterrorist event. However, training in bioterrorism preparedness was significantly associated with physicians' perceived ability to respond effectively to an attack. Primary care physicians need more training in bioterrorism preparedness and easy access to public health and medical information in the event of a bioterrorist attack.