Preventive medicine
-
Preventive medicine · Jul 2021
Race and gender differences in abnormal blood glucose screening and clinician response to prediabetes: A mixed-methods assessment.
The projected three-fold increase in diabetes burden by 2060 in the United States will affect certain race and gender groups disproportionately. The objective of this mixed-methods study was to assess differences in prediabetes screening and clinician response to prediabetes by patient race and gender. We utilized data from 18,742 patients seen between 11/1/15 and 4/30/17 who met criteria for blood glucose screening by the 2015 US Preventive Service Task Force recommendation and had at least one visit to a primary care practice within a large, academic health system located in North Carolina. ⋯ There were no significant differences in clinician response to prediabetes by patient race or gender. Qualitatively, physicians reported a non-systematic approach to prediabetes screening and follow-up care related to: 1) System-level barriers to screening and treatment; 2) Implicit bias; 3) Patient factors; and 4) Physician preferences for prediabetes treatment. Targeted risk-based screening for prediabetes along with increased treatment for prediabetes are critical for preventing diabetes and reducing diabetes-related disparities.
-
Preventive medicine · Jul 2021
Understanding socioeconomic differences in incident metabolic syndrome among adults: What is the mediating role of health behaviours?
The incidence of metabolic syndrome (MetS) strongly varies by socioeconomic position (SEP), but little is known about the mediating role of health behaviours in this association. This study examines the associations between the SEP measures, education, income and occupational prestige, and incident MetS and whether the associations are mediated by health behaviours, including physical activity, smoking, alcohol intake and diet quality. ⋯ Individuals with more years of education or a higher occupational prestige had a lower risk to develop MetS. This was mainly because of non-smoking, less excessive alcohol intake and a higher diet quality. However, individuals with a higher SEP were more often physically inactive.
-
Preventive medicine · Jul 2021
The association of fitness and fatness with intermediate hyperglycemia incidence in women: A cohort study.
The purpose of this study was to examine the associations of cardiorespiratory fitness, general adiposity, and central adiposity with incident intermediate hyperglycemia (IH) in women. We conducted a prospective cohort study of 1534 women aged 20-79 years old who had an annual health check-up with no history of major chronic diseases. At baseline, fitness was assessed by a Balke graded exercise test, and the estimated metabolic equivalents were used to create quartile groups. ⋯ Overall, 18.1% (n = 277) of the women developed IH during an average follow-up of 5.06 years. Fitness, body mass index, and waist-to-height ratio at baseline were the independent predictors of the IH incidence in separate age-adjusted models; yet when all three variables were included in the same model along with confounding variables, only fitness remained significant and demonstrated a clear inverse association with incident IH (P-for-trend <0.001). Health promotion efforts should focus on improving fitness for the prevention of IH in women.
-
Preventive medicine · Jul 2021
Chronic high risk of intimate partner violence against women in disadvantaged neighborhoods: An eight-year space-time analysis.
We conducted a small-area ecological longitudinal study to analyze neighborhood contextual influences on the spatio-temporal variations in intimate partner violence against women (IPVAW) risk in a southern European city over an eight-year period. We used geocoded data of IPVAW cases with associated protection orders (n = 5867) in the city of Valencia, Spain (2011-2018). The city's 552 census block groups were used as the neighborhood units. ⋯ Areas of stable low risk and with increasing or decreasing risk were also identified. Our findings link neighborhood disadvantage to the existence and persistence over time of spatial inequalities in IPVAW risk, showing that high risk of IPVAW can become chronic in disadvantaged neighborhoods. Our analytic approach provides specific risk estimates at the small-area level that are informative for intervention purposes, and can be useful to assess the effectiveness of prevention efforts in reducing IPVAW.
-
Preventive medicine · Jul 2021
Smoking behavior in 18-20 year-olds after tobacco 21 policy implementation in California: A difference-in-differences analysis with other states.
In June 2016, California implemented a Tobacco 21 (T21) policy that increased the minimum sale age of tobacco products from 18 to 21. This study examined the association between California's T21 policy and smoking behavior (ever, current, daily, and nondaily) in 18-20 year-olds using data from the 2012-2019 Behavioral Risk Factor Surveillance System (n = 15,863). The annual change in odds of smoking among 18-20 year-olds post-policy (July 2016-December 2019) was compared with the pre-policy period (January 2012 - June 2016) 1) within California and 2) compared with states without a T21 policy. ⋯ Results for current smoking were similar. For daily smoking, there was an 8% annual decrease before the policy and a 26% annual decrease after the policy among 18-20 year-olds in California; D-I-D estimates were 0.80 (95% CI: 0.57, 1.14) using referent states as the comparison and 0.62 (95% CI: 0.41, 0.95) using 21-23 year-olds in California as the comparison. There was an association between California's T21 policy and a decrease in daily smoking among 18-20 year-olds, compared with 21-23 year-olds, more than three years post-implementation.