Patten, Christi A.

Background The first year of military service in the United States Air Force (USAF) is a high-risk time for tobacco use. Previous studies have demonstrated the effectiveness of a tobacco ban during Basic Military Training (BMT). However, no studies have examined the effect of increasing the protracted ban for an additional 4 weeks. Understanding the patterns of initiation and reinitiation following the protracted ban will inform future intervention and policy efforts. Methods The current study examines patterns of cigarette smoking among a sample of 2188 USAF personnel at baseline and after their first year of service. Results One year after BMT, we observed that 65.0% of USAF enlistees remained never smokers, 9.6% remained abstinence from cigarettes, 9.3% initiated cigarette smoking, and 16.1% reinitiated cigarette smoking. Despite the extended tobacco ban in BMT and Technical Training, 12.6% of individual who never smoked initiated cigarette smoking and 62.6% of individuals who formerly smoked reinitiated. Over half (54.2%) of Airmen who reported smoking cigarettes at follow-up reported initiating or reinitiating during Technical Training. Conclusions Our findings indicate that although the increased ban prevents additional individuals who smoked cigarettes prior to joining the Air Force from reinitiating, it has no effect on initiation among individuals who report never using prior to military service. Additional research is needed to understand what may be leading to these high rates of initiation and reinitiation in Technical Training following the ban.

Introduction: African American women are 5 times less likely than white women to meet at least 5 or more ideal cardiovascular health metrics as defined by the American Heart Association Life’s Simple 7 (LS7) components (smoking, diet, physical activity, BMI, blood pressure, total cholesterol, and glucose). There are few studies probing the influence of sociocultural factors, such as body image dissatisfaction (BID), on these disparities. A better understanding of the impact of BID on cardiovascular health could assist in the design of more effective behavior change interventions for African American women. Hypothesis: We hypothesized that BID would have a negative association with cardiovascular health in overweight and obese African American women. Methods: We enrolled 32 women (mean age 49 years [SD 12.9]), from 5 predominantly African American churches participating in a larger community-based participatory study (FAITH! App Pilot Study) of a mobile health lifestyle intervention among African American women and men. We conducted a cross-sectional analysis of baseline data to evaluate the association between BID and both cardiovascular health and select psychosocial factors (e.g. motivation for healthy eating, diet self-regulation). A LS7 composite score was calculated as a measure of overall cardiovascular health (range 0-14). The Pulvers scale, consisting of images of women across the BMI spectrum, was used to measure perceived current and goal body size (rating of figures, 1-9; underweight to very obese). A BID score was calculated as the difference between perceived current and desired body image (range -8-8; BID < 0 [desire to be heavier], BID > 0 [desire to be thinner], BID = 0 [no dissatisfaction]). The BID score range for our cohort was 0-4. Thus, we categorized BID as no/low BID (BID score 0-1) or high BID (BID score 2-4). Results: Twenty-two percent (7/32) of women were overweight (BMI 25-29.9) and 78% (25/32) were obese (BMI (≥ 30). Forty-four percent (14/32) had no/low BID and 56% (18/32) had high BID. Those with high BID were more likely to be obese as compared to no/low BID (94% (17/18) versus 57% (8/14), p=0.03). Although not statistically significant, the mean LS7 composite score was 1 point higher among those with no/low BID, versus high BID (8.83 versus 7.76, p=0.25). Compared to women with high BID, those with no/low BID were more likely to have greater: intrinsic motivation (P=0.01) and integrated regulation for healthy eating (P=0.007), and self-regulation to reduce fat and caloric intake (P=0.01). Conclusion: Ultimately, although small, our study suggests that African-American women with obesity are more likely to have high BID. High BID was associated with lower motivation and self-regulation, which predict cardiovascular health. BID and other psychosocial factors for behavior change are potential targets for culturally-tailored lifestyle interventions in this group.

Abstract Introduction Diversifying the workforce is an important strategy to reducing health disparities. Since 2007, the Society for Research on Nicotine and Tobacco (SRNT) Health Disparities Network has funded a travel scholarship to promote inclusion, professional development, and diversity among investigators interested in tobacco-related health disparities research. This study examined indicators of productivity among former scholarship recipients. Methods: Scholarship recipients between 2007 and 2014 were invited to complete a survey online. The survey assessed demographic characteristics, academic productivity, and perceived professional benefit resulting from the scholarship. Results: Of the 117 scholarships recipients, 89 (77%) responded. Respondents were 67% female and had a mean age of 37.8 years. Twenty eight percent were African American, 25% Asian American, and 17% Latino. Most respondents worked in academia (80%) and nearly three-quarters (74%) reported publishing manuscripts on tobacco-related disparities, with a mean of 3.8 (SD 4.4) disparities-related publications since receiving the scholarship. Respondents’ work focused on a wide range of health disparities topics and nearly all respondents reported that the scholarship removed barriers to attending the meeting and reported professional benefit from receiving the travel scholarship. Following receipt of the SRNT travel scholarship, a diverse group of scientists demonstrated scholarly productivity, professional development, and advancement of health disparities research. Similar efforts are encouraged in other professional societies. Implications This study examines the productivity of early career recipients of the SRNT Health Disparities Scholarship. Results suggest that the investment in annual travel scholarships by a professional organization is an important support system for emerging scientists from diverse backgrounds. This investment may help to advance the science of health disparities and engage researchers in an area where there are critical gaps in the research workforce.

Introduction: Lack of health equity ultimately leads to unequal treatment of diverse patients and contributes to the growing disparities seen in national health. Academic medical centers should consider providing health care providers and biomedical researchers training on how to identify and address health disparities. Methods: The authors led an introductory health disparities course for graduate students and research and clinical fellows at an academic medical center in the Midwest. We compared pre/postcourse assessments to determine changes in learners’ perceptions and knowledge of health disparities using an unpaired analysis to permit inclusion of responses provided only at baseline. Results: Sixty-two learners completed preassessment, with 56 completing the postassessment (90%). In the postcourse assessment, learners reported an increase in knowledge of disparities and had changes in their perceptions of health disparities linked to treatment of different patient groups based on demographic characteristics. There was a statistically significant difference in learners’ perceptions of how patients are treated based on gender identity (P=0.02) and sexual orientation (P=0.04). Conclusions: The results detail how an academic medical center can provide training on health disparities for diverse learners. This study underscores the influence of health disparities from the perspective of learners who conduct biomedical research and patient care. This course serves a model for introductory-level health disparities courses.

Background Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple 7 [LS7]) are suboptimal among blacks, which results in high risk of cardiovascular disease. We examined the association of multiple stressors with LS7 components among blacks. Methods and Results Using a community‐based cohort of blacks (N=4383), we examined associations of chronic stress, minor stressors, major life events, and a cumulative stress score with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting plasma glucose) and an LS7 composite score. Multivariable logistic regression assessed the odds of achieving intermediate/ideal levels of cardiovascular health adjusted for demographic, socioeconomic, behavioral, and biomedical factors. The LS7 components with the lowest percentages of intermediate/ideal cardiovascular health levels were diet (39%), body mass index (47%), and physical activity (51%). Higher chronic, minor, and cumulative stress scores were associated with decreased odds (odds ratio [OR]) of achieving intermediate/ideal levels for smoking (OR [95% confidence interval], 0.80 [0.73–0.88], 0.84 [0.75–0.94], and 0.81 [0.74–0.90], respectively). Participants with more major life events had decreased odds of achieving intermediate/ideal levels for smoking (OR, 0.84; 95% confidence interval, 0.76–0.92) and fasting plasma glucose (OR, 0.90; 95% confidence interval, 0.82–0.98). Those with higher scores for minor stressors and major life events were less likely to achieve intermediate or ideal LS7 composite scores (OR [95% confidence interval], 0.89 [0.81–0.97] and 0.91 [0.84–0.98], respectively). Conclusions Blacks with higher levels of multiple stress measures are less likely to achieve intermediate or ideal levels of overall cardiovascular health (LS7 composite score), specific behaviors (smoking), and biological factors (fasting plasma glucose).