Cardiovascular Health and Needs Assessment in Washington D.C.

National Heart, Lung, And Blood Institute

Investigators

Linked publications, trials & patents

Abstract

We used qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and web-based technology by predominantly African-American, church-based populations in resource-limited Washington, DC, neighborhoods. At the recommendation of the community advisory board, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the CV Health and Needs Assessment. We demonstrated the feasibility of online account usage, wristband utilization and measurement of objective PA data. When implementing technology-based interventions in resource-limited communities, engaging the targeted community may aid in early identification of issues, suggestions and preferences. We also explored user characteristics of PA-tracking, wearable technology among the health and needs assessment population. DC CV Health and Needs Assessment participants received a mobile health (mHealth) PA monitor and wirelessly uploaded PA data weekly to church data collection hubs. Findings suggested that mHealth systems with a wearable device and data-collection hub may feasibly target PA in resource-limited communities. Community-based behavioral interventions targeting CV health in resource-limited communities should consider incorporation of wearable mHealth technology. Efforts to reduce barriers to using mHealth technology in resource-limited settings may aid in decreasing CV health disparities in at-risk populations. We also examined the acceptability and feasibility of digital food records among health and needs assessment participants using a mixed methods approach. Overall, the participants accepted the digital food record by demonstrating satisfaction with the tool and intent to continue the use. Furthermore, of the 17 participants, 15 photodocumented at least 1 meal during the study period and 3 fully complied with the digital food record instructions. This study demonstrated digital food records as an acceptable tool in CBPR and identified contributors and barriers to the feasibility of digital food records for future research. We have also developed tools assessing the relationship between the neighborhood built environment and health behaviors or outcomes for the target populations in the DC CV Health and Needs Assessment. We evaluated a scoring method for virtual neighborhood audits utilizing the Active Neighborhood Checklist (ANC), a neighborhood audit measure, and assessed street segment representativeness in lower-income neighborhoods. We found that this scoring method adequately captured neighborhood features in lower-income, residential areas and may aid in delineating impact of specific built environment features on health behaviors and outcomes. We also examined associations of perceived and objective neighborhood environment (NE) with sedentary time (ST) in the DC CV Health and Needs Assessment. Participants reported NE perceptions, including sidewalks, recreational areas, and crime presence. Factor analysis was used to explore pertinent constructs; factor sums were combined as Total Perception Score (TPS) (higher score=more favorable perception). Objective NE was assessed using Google Maps and the Active Neighborhood Checklist (ANC). ST was self-reported. Among those in lower median-income areas, there was a negative association between TPS and ST that remained after covariate adjustment; this was not observed in higher median-income areas. There was no association between ANC scores and ST. Poorer NE perception was associated with greater ST for those in lower income areas, while objective environment was not related to ST. Multi-level interventions are needed to improve NE perceptions in lower-median income areas, reduce ST, and improve CV health. We also used data from the DC CV Health and Needs Assessment to quantify the impact of crime on physical activity location accessibility, leisure-time physical activity (LTPA) and obesity among African-American women. Our simulations with an agent-based model representing resource-limited DC communities and their populations showed that reducing crime through multilevel interventions (i.e. economic development initiatives to increase time available for physical activity and subsidized health care) may promote greater than linear declines in obesity prevalence. Crime prevention strategies alone can help prevent obesity, but combining such efforts with other ways to encourage physical activity can yield even greater benefits. We also compared relationships between perceived and objective neighborhood characteristics, depressive symptoms, and CVD markers within the DC CV Health and Needs Assessment. Depressive symptoms were defined by the revised Center for Epidemiologic Studies Depression Scale (CESD-R), where a higher score equated to more depressive symptoms. Objective neighborhood characteristics were measured by geospatially-derived Walk Score, Bike Score, Transit Score, and Personal/Property Crime Scores based on home address data. There was a 0.2 unit decrease in CESD-R scores for every one unit-improvement in overall perceptions. Perceived physical/social environment and social cohesion were related to CESD-R while perceived violence was not. Of objective environment measures, only property crime score was associated with CESD-R. For CVD risk biomarkers, higher CESD-R scores were associated with increasing IL-1beta and IL-18. This finding suggested biological pathways by which neighborhood social environment can lead to poor CV health by way of depressive symptoms. We also worked with the Mehta lab at NHLBI to examine the relationship between chronic stress-related neural activity as a marker of chronic psychosocial stress and arterial inflammation as measured by aortic vascular FDG uptake in a subset of the DC CV Health and Needs Assessment cohort. We found that amygdala activity as a marker of chronic stress-related neural activity was associated with vascular FDG uptake, after adjustment for CVD risk factors. We also found that this relationship was in part mediated by the hematopoietic system. These findings suggested a potential mechanism by which chronic psychosocial stress, including stress in adverse social conditions, can increase CV risk in resource-limited populations. Finally, we worked in collaboration with the Wallen laboratory at the NIH Clinical Center to explore relationships between neighborhood deprivation index (NDI) and the microbial metabolite, trimethylamine-N-oxide (TMAO) in a subset of the CV Health and Needs Assessment participants, given that the connection between neighborhood environment and the microbiome in relation to CVD risk has not been fully explored. US census-based NDI measures (at the census-tract level) were determined. Serum samples were analyzed for CVD risk factors, cytokines, and the microbial metabolite, TMAO. Adjusting for CVD risk factors and BMI, NDI was positively associated with TMAO. Using mediation analysis, the relationship between NDI and TMAO was significantly mediated by TNF-alpha and interleukin (IL)-1 beta. When controlling for clustering within neighborhoods, the NDI-TMAO association was no longer significant. However, the association between NDI and IL-1 beta and TNF-alpha remained. Thus, among a small sample of African-American adults with CVD risk, there was a significant positive relationship with NDI and TMAO mediated by inflammation; these findings must be confirmed in larger studies.