Prev Chronic Dis
· 2025 Jun · PMID 40471850
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The preservice education of public health professionals often includes thorough, community-engaged learning experiences. One critical element of public health work is program evaluation - an essential function for suppor...The preservice education of public health professionals often includes thorough, community-engaged learning experiences. One critical element of public health work is program evaluation - an essential function for supporting evidence-based practice. However, the literature on how to prepare future public health professionals to integrate community-engaged evaluation work is lean, although lessons may be learned from the literature on service-learning. Analyzing students' reflections in their "key learning experience" essays from an introductory program evaluation course incorporating service-learning may address this gap, helping educators identify the most effective elements of their course design and implementation. This illustrative evaluation used existing educational frameworks grounded in andragogic principles and significant learning experiences to deductively analyze 146 graduate students' reflections on their service-learning course experience. Deductive analysis suggested that community engagement is a key element of students' learning experience. Sixty-two (42.5%) student reflections were about community engagement, whereas 84 (57.5%) were about other topics the students found memorable. A program evaluation course that integrates service-learning may be a viable vehicle for teaching public health students about community engagement.
Smarsh BL, Park YS, Lee SH
… +2 more, Harris DM, Blanck HM
Prev Chronic Dis
· 2025 May · PMID 40402856
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INTRODUCTION: Municipalities can improve access to food through transit planning. The primary objective of this study was to describe the prevalence of public transit supports for food access among a sample of US municip...INTRODUCTION: Municipalities can improve access to food through transit planning. The primary objective of this study was to describe the prevalence of public transit supports for food access among a sample of US municipalities and their association with the municipalities' sociodemographic characteristics. METHODS: This study used a nationally representative sample (N = 1,956) of US municipalities with a population of at least 1,000 that responded to the 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. We assessed 4 outcomes: public transit availability and planning, presence of demand responsive transportation (DRT), DRT services to food retail destinations (farmers markets and supermarkets), and consideration of these locations in transit planning. We used χ tests to compare the prevalence of outcomes by municipal characteristics and multivariable logistic regression to calculate odds ratios to assess the relationship between municipal characteristics and having DRT. RESULTS: Approximately half (weighted 53.2%) of municipalities reported having or planning for public transit, of which 27.1% and 52.6% reported considering service to farmers markets or supermarkets, respectively. Approximately one-third (35.5%) of municipalities reported having DRT, of which 52.0% and 84.4% reported services to farmers markets or supermarkets, respectively. All outcomes significantly differed by municipal characteristics. We found higher odds of having DRT in municipalities with 2,500 to 50,000 people or more (vs <2,500 people); those with 50% or less of the population being non-Hispanic White (vs >50% non-Hispanic White); and municipalities containing low-income/low-access tracts. The odds of having DRT were lower in rural (vs urban) municipalities and in those in Northeast and South (vs the Midwest). CONCLUSION: Results suggest opportunities for municipalities to use transit planning to improve food access, especially in northeastern, southern, smaller, or rural communities.
Mora Pinzon M, Fernandez de Cordova S, Flores Diaz V
… +9 more, Rosales MDC, Argandoña R, Bermudez N, Caro B, Caro T, Martinez MC, Salazar Y, Green-Harris G, Phelps K
Prev Chronic Dis
· 2025 May · PMID 40402855
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We outline a practical approach to engaging Latino communities in dementia care research by establishing a community advisory board (CAB). Acknowledging the historical underrepresentation of Latinos in health research, w...We outline a practical approach to engaging Latino communities in dementia care research by establishing a community advisory board (CAB). Acknowledging the historical underrepresentation of Latinos in health research, we aimed to ensure that Latino perspectives and concerns were central to our research endeavors. As an initial step we adapted the Patient Advisor Toolkit 1: Orientation for Patient Advisory Committees (PAT-1) created by the Wisconsin Network for Research Support at the University of Wisconsin - Madison School of Nursing to the needs of Latino/a/e/x populations. We describe the CAB formation process, from initial outreach to community members and organizations to the recruitment, engagement, and retention of CAB members. CAB members provided guidance on the legibility and clarity of study materials and assisted with strategic planning for outreach initiatives related to healthy aging, brain health, and dementia risk reduction. Our enduring connections with CAB members and community partners have ensured that our research activities address community needs, provide benefits to the community, and inform our approach to connecting with Latinos in a culturally appropriate way. To foster successful CAB engagement and retention, we recommend 1) building trust with partners, 2) establishing clear expectations, 3) ensuring inclusive communication formats, 4) maintaining open communication, 5) offering honoraria and recognition, 6) affirming CAB members' contributions, 7) understanding power dynamics between the academic institution and the community, and 8) ensuring adequate staff and programmatic support. This approach fosters trust-based relationships and meaningful engagement that advances health equity.
Zimmermann K, Ford C, Carnahan L
… +4 more, Jefferies P, Curtis P, Magallon C, Khare M
Prev Chronic Dis
· 2025 May · PMID 40373368
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Low-income, uninsured women are disproportionately affected by cardiovascular disease (CVD). Facilitating primary and secondary prevention of CVD in this population requires supports beyond clinical and public health age...Low-income, uninsured women are disproportionately affected by cardiovascular disease (CVD). Facilitating primary and secondary prevention of CVD in this population requires supports beyond clinical and public health agencies. The Illinois WISEWOMAN Program (IWP) provides CVD prevention, screening, and management for women who lack health insurance in Illinois, including the use of referral systems to link clients to needed services. To support these efforts, the 7 local agencies implementing IWP developed linkages to facilitate participant referrals for health promotion, clinical services, and programs addressing social needs. The IWP evaluation team implemented a community resource assessment (CRA) process to describe partnerships and facilitate partnership expansion. To conduct the process, we developed a CRA template, which IWP agencies completed in 2019, 2021, and 2023 to describe community organizations that offer IWP-related resources, their relationships with these organizations, and plans to develop or maintain relationships. We tabulated data on the number of partnerships at each agency and across resource types, mapped findings, and compared data across years. We also consolidated and shared strategies for partnership development. The number of partnerships increased from 2019 (N = 179) to 2021 (N = 225), then decreased slightly to 214 by 2023. In 2023, several IWP agencies reported that partners had discontinued services due to the COVID-19 pandemic. The CRA process provides a formal structure for public health agencies to document their partners and gaps and plan for new partnerships. Additionally, the CRA process contributes to understanding the diverse contexts in which public health programs are offered and how external factors, such as COVID-19, can indirectly affect the availability of community resources.
Chen M, Miao G, Roman MJ
… +7 more, Devereux RB, Fabsitz RR, Zhang Y, Umans JG, Cole SA, Fiehn O, Zhao J
Prev Chronic Dis
· 2025 May · PMID 40338792
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INTRODUCTION: Peripheral artery disease (PAD) and dyslipidemia are both independent predictors of cardiovascular disease, but the association between individual lipid species and subclinical PAD, assessed by ankle-brachi...INTRODUCTION: Peripheral artery disease (PAD) and dyslipidemia are both independent predictors of cardiovascular disease, but the association between individual lipid species and subclinical PAD, assessed by ankle-brachial index (ABI), is lacking in large-scale longitudinal studies. METHODS: We used liquid chromatography-mass spectrometry to repeatedly measure 1,542 lipid species from 1,886 American Indian adults attending 2 clinical examinations (mean ~5 years apart) in the Strong Heart Family Study. We used generalized estimating equation models to identify baseline lipid species associated with change in ABI and the Cox frailty regression to examine whether lipids associated with change in ABI were also associated with incident coronary heart disease (CHD). We also examined the longitudinal association between change in lipid species and change in ABI and the cross-sectional association of individual lipids with ABI. All models were adjusted for age, sex, body mass index, smoking, alcohol use, hypertension, estimated glomerular filtration rate, diabetes, and lipid-lowering medication. RESULTS: Baseline levels of 120 lipid species, including glycerophospholipids, glycerolipids, fatty acids, and sphingomyelins, were associated with change in ABI. Among these, higher baseline levels of 3 known lipids (phosphatidylinositol[16:0/20:4], triacylglycerol[48:2], triacylglycerol[55:1]) were associated with a lower risk of CHD (hazard ratios [95% CIs] ranged from 0.67 [0.46-0.99] to 0.76 [0.58-0.99]), while cholesterol was associated with a higher risk of CHD (hazard ratio [95% CI] = 1.37 [1.00-1.87]). Longitudinal changes in 32 lipids were significantly associated with change in ABI during 5-year follow-up. Plasma levels of glycerophospholipids, triacylglycerols, and glycosylceramides were significantly associated with ABI in the cross-sectional analysis. CONCLUSION: Altered plasma lipidome is significantly associated with subclinical PAD in American Indians beyond traditional risk factors. If validated, the identified lipid species may serve as novel biomarkers for PAD in this high-risk but understudied population.
Russell NG, Rodney T, Peterson JK
… +2 more, Baker A, Francis L
Prev Chronic Dis
· 2025 May · PMID 40310895
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INTRODUCTION: Mental health conditions such as anxiety, depression, and suicidal ideation or suicide are prevalent among college students and are a growing public health concern. The COVID-19 pandemic exacerbated this cr...INTRODUCTION: Mental health conditions such as anxiety, depression, and suicidal ideation or suicide are prevalent among college students and are a growing public health concern. The COVID-19 pandemic exacerbated this crisis. Nurses are a vital component of college health services and may be the first or only health care provider to evaluate college students experiencing a mental health condition. However, the literature has limited evidence on the nurse's role and its impact on college mental health. Our systematic review examines nurse-led mental health interventions for college students. METHODS: We conducted a comprehensive search for nurse-led interventions in college mental health by using PubMed, Embase, CINAHL, PsycInfo, and ERIC databases. A total of 2,814 articles were identified, and 2,290 were screened after removal of 524 duplicates. Thirty-five studies were reviewed for eligibility, and 16 were included in this review. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Hierarchy of Evidence Guide and Appraisal Tools were used to rate the strength and quality of the evidence, and the selected articles were generally of good quality. RESULTS: The 16 articles came from institutions in North America (n = 5), southeastern Europe (n = 3), and Asia (n = 8). The studies focused on samples with a pre-existing mental health diagnosis or on mental health symptoms and interventions aimed at addressing mental health concerns. The interventions were facilitated by nurses and included various approaches, including experimental, quality improvement, and educational strategies. CONCLUSION: This review underscores the crucial role of nurses in addressing mental health issues among college students. Despite variability in approaches, nurse-led interventions offer promise in enhancing student well-being. Further studies are essential to gauge effectiveness and shape policies for supporting the nurse's unique role in higher education. Integrating these findings into practice and policy will equip college health services to meet students' evolving needs. Leveraging the expertise of nurses can enhance student mental well-being, leading to improved academic outcomes and overall quality of life.
Patterson KP, Gold AO, Spratlen MJ
… +6 more, Umans JG, Fretts AM, Goessler W, Zhang Y, Navas-Acien A, Nigra AE
Prev Chronic Dis
· 2025 Apr · PMID 40272946
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INTRODUCTION: Uranium is common in drinking water, soil, and dust in American Indian communities. Hypertension is a cardiovascular risk factor affecting American Indians. We evaluated the association between uranium expo...INTRODUCTION: Uranium is common in drinking water, soil, and dust in American Indian communities. Hypertension is a cardiovascular risk factor affecting American Indians. We evaluated the association between uranium exposure and incident hypertension and changes in blood pressure among Strong Heart Family Study participants. METHODS: We included 1,453 participants ≥14 years with baseline visits in 1998-1999 or 2001-2003, and follow-up in 2001-2003 and/or 2006-2009. We estimated the association of urinary uranium with changes in systolic and diastolic blood pressure levels over time and hypertension incidence; we accounted for family clustering. RESULTS: Median (IQR) baseline urinary uranium levels were 0.029 (0.013-0.059) μg/g creatinine; 17.4% (n = 253) of participants developed hypertension. In the comparison of the urinary uranium quartile 4 (highest concentration) and quartile 1 (lowest concentration), the multi-adjusted risk ratio (95% CI) of incident hypertension was 1.44 (1.04-1.99). The associations between urinary uranium with changes in systolic and diastolic blood pressure were null and nonlinear, respectively. Both associations were modified by study site, and diastolic blood pressure showed a positive association beyond 5 µg/g creatinine. The association between urinary uranium and change in systolic blood pressure was inverse in Arizona and Oklahoma, and positive in North Dakota/South Dakota at higher ends of the uranium distribution. CONCLUSION: Findings suggest a higher risk for hypertension at uranium levels typical of the Southwest and Great Plains than at levels in other regions (<0.01 µg/g creatinine); the associations with changes in systolic and diastolic blood pressure levels were consistent with a positive association with higher uranium exposure. Prospective research is critical to characterize the cardiovascular effects of uranium and develop preventive strategies for US Indigenous communities disproportionately exposed.
Watson KB, Wiltz JL, Nhim K
… +3 more, Kaufmann RB, Thomas CW, Greenlund KJ
Prev Chronic Dis
· 2025 Apr · PMID 40245168
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INTRODUCTION: Chronic conditions are costly and major causes of death and disability. Addressing conditions earlier in adulthood can slow disease progression and improve well-being across the lifespan. We estimated, by l...INTRODUCTION: Chronic conditions are costly and major causes of death and disability. Addressing conditions earlier in adulthood can slow disease progression and improve well-being across the lifespan. We estimated, by life stage, 10-year trends among US adults in the prevalence of 1 or more chronic conditions, multiple chronic conditions (MCC; ≥2 conditions), and 12 selected chronic conditions. METHODS: We analyzed data from the 2013-2023 (odd years) Behavioral Risk Factor Surveillance System (N = 2,673,529). We estimated the prevalence of 1 or more conditions, MCC, and each of 12 conditions, by life stage: young (18-34 y), midlife (35-64 y), and older (≥65 y) adults. We used polynomial contrasts to analyze 10-year trends. RESULTS: In 2023, 76.4% (representing 194 million) of US adults reported 1 or more chronic conditions, including 59.5%, 78.4%, and 93.0% of young, midlife, and older adults, respectively. Moreover, 51.4% (representing 130 million) of US adults reported MCC, including 27.1%, 52.7%, and 78.8% of young, midlife, and older adults, respectively. Among young adults, from 2013 to 2023, prevalence increased significantly from 52.5% to 59.5% for 1 or more conditions and from 21.8% to 27.1% for MCC. CONCLUSION: Approximately 6 in 10 young, 8 in 10 midlife, and 9 in 10 older US adults report 1 or more chronic conditions. Trends in conditions worsened among young adults during 2013-2023. Recognizing the burden of chronic disease throughout life stages, especially earlier in life, practitioners and partners may consider prevention and management approaches critical for addressing costs, care, and health outcomes. Practitioners may also consider tailoring these approaches to unique roles, transitions, and challenges in different life stages.
Reese JA, Davis E, Fretts AM
… +6 more, Ali T, Lee ET, Umans JG, Yarden R, Zhang Y, Peck JD
Prev Chronic Dis
· 2025 Apr · PMID 40179031
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INTRODUCTION: We aimed to describe the prevalence of vitamin D deficiency among American Indian adolescents and determine its association with cardiovascular disease (CVD) risk factors. METHODS: Our study population cons...INTRODUCTION: We aimed to describe the prevalence of vitamin D deficiency among American Indian adolescents and determine its association with cardiovascular disease (CVD) risk factors. METHODS: Our study population consisted of 307 adolescents (aged ≤20 years) participating in the Strong Heart Family Study with serum 25-hydroxyvitamin D (25[OH]D) measured on samples collected during baseline examinations (2001-2003). We defined baseline prevalence of vitamin D deficiency as 25(OH)D ≤20 ng/mL. We evaluated outcomes related to obesity (BMI, waist circumference, wait-to-hip ratio, and body fat percentage), diabetes, cholesterol, and metabolic syndrome. We used generalized estimating equations to determine whether the prevalence of the outcomes differed according to vitamin D deficiency status, while controlling for covariates. To determine incidence, we conducted a follow-up examination a median 5.8 years after baseline (2006-2009) and a second follow-up a median of 13.3 years after baseline (2014-2018). We calculated incidence rates (IR) per 100 person-years for the total group and stratified by vitamin D deficiency status at baseline. Finally we used shared frailty cox proportional hazards models to determine if the risk of the outcomes differed according to vitamin D deficiency status, while controlling for covariates. RESULTS: The prevalence of vitamin D deficiency was 50.8% at baseline, and it was associated with the prevalence of obesity, low HDL-C, and metabolic syndrome, while controlling for covariates. By the first follow-up, the IRs per 100 person-years were the following: obesity (5.03), diabetes (1.07), any dyslipidemia (10.80), and metabolic syndrome (3.31). By the second follow-up, the IR of diabetes was significantly higher among those with (vs without) baseline vitamin D deficiency (1.32 vs 0.68 per 100 person-years; P = .02), although the association was not significant after adjusting for covariates. CONCLUSION: Vitamin D deficiency in adolescence may be associated with the CVD risk factors obesity, low HDL-C, and metabolic syndrome and may also contribute to the development of diabetes later in life.
Willmott H, Gochanour C, Ding K
… +3 more, Reese J, Lee E, Zhang Y
Prev Chronic Dis
· 2025 Mar · PMID 40146657
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Researchers need applicable tools to analyze and account for familial relatedness when working with family study data. In this brief article, we describe the application of 2 modeling strategies for studying the associat...Researchers need applicable tools to analyze and account for familial relatedness when working with family study data. In this brief article, we describe the application of 2 modeling strategies for studying the association between leukocyte telomere length and incident stroke based on data collected in the Strong Heart Family Study: the shared frailty model and the marginal Cox proportional hazards model. Although these modeling strategies are based on different theoretical frameworks, their results were similar. Future simulation study may help us to better understand the limitations and performance of each strategy in a controlled environment.
Prev Chronic Dis
· 2025 Mar · PMID 40080691
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PURPOSE AND OBJECTIVES: Although progress has been made in scaling up the National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP), innovative engagement strategies are needed. INTERVENTION APPROA...PURPOSE AND OBJECTIVES: Although progress has been made in scaling up the National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP), innovative engagement strategies are needed. INTERVENTION APPROACH: This implementation evaluation leveraged and combined technology, behavior change theory, and community-based participatory design approaches to develop, deploy, and evaluate a 6-month, bilingual, tailored text message-delivered program (bRIght communities) to increase 1) readiness to engage in key behaviors for diabetes prevention, 2) engagement in services that address health-related social needs to reduce barriers to participation, and 3) readiness to enroll in the National DPP LCP. EVALUATION METHODS: We implemented a statewide, multichannel recruitment strategy from May through October 2022 and recruited 432 community members (62.3% White, 26.0% Hispanic, 6.2% Black) who received up to 6 months of tailored text messages. Six months postenrollment, 273 participants completed an online follow-up survey. Among those who did not complete the survey, responses from the last texting session were used for pre/post comparisons. RESULTS: Matched pre/post analyses (using t tests and McNemar tests) indicated that bRIght communities had a significant impact on daily consumption of fruits and vegetables (d = 0.43); weekly physical activity minutes (d = 0.48); resilience (d = 0.26); food insecurity (P < .001); transportation concerns (P < .001); and perceptions of feeling unsafe exercising in one's neighborhood (P < .001). Nearly 68% of participants with or at risk for prediabetes were in the precontemplation stage for enrolling in the National DPP. Overall, 30.3% of participants in bRIght communities moved forward at least 1 stage of change. IMPLICATIONS FOR PUBLIC HEALTH: Interactive, theoretically driven tailored text messaging represents a promising approach to increasing awareness of prediabetes risk, readiness to enroll in the National DPP LCP, participant engagement, and health behavior change. Providing links to existing geographically matched community resources reduced health-related social needs that can present barriers to participating in the National DPP LCP. The results also provide insights to inform the design and development of other population-based tailored text-delivered interventions.
Zhou X, Park J, Rolka DB
… +3 more, Holliday C, Choi D, Zhang P
Prev Chronic Dis
· 2025 Jan · PMID 40048368
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INTRODUCTION: The association between various disparity factors and cardiovascular disease (CVD) prevalence among older US adults with diabetes has not been comprehensively explored. We examined disparities in CVD preval...INTRODUCTION: The association between various disparity factors and cardiovascular disease (CVD) prevalence among older US adults with diabetes has not been comprehensively explored. We examined disparities in CVD prevalence among Medicare beneficiaries with diabetes. METHODS: Data were from the 2015-2019 Medicare Current Beneficiary Survey. Diabetes and CVD conditions - myocardial infarction (MI), stroke, and heart failure - were self-reported. We estimated the adjusted prevalence ratios (APRs) of CVD by race and ethnicity, education, income-to-poverty ratio (IPR), urbanicity, food insecurity, and social vulnerability using logistic regressions that controlled for these factors as well as age and sex. RESULTS: Annually, an estimated 9.2 million Medicare beneficiaries aged 65 years or older had diabetes. Among them, 16.7% had MI, 13.7% had stroke, and 12.5% had heart failure. Beneficiaries who were food insecure, socially vulnerable, with an IPR less than or equal to 135%, and residing in rural areas had a higher crude CVD prevalence. After controlling for other factors, low IPR and food insecurity were linked to a higher prevalence of CVD. Hispanic beneficiaries had lower stroke and heart failure prevalence than non-Hispanic (NH) White and NH Black beneficiaries. NH Black beneficiaries had lower MI prevalence but higher heart failure prevalence compared with NH White beneficiaries. Female respondents with an IPR less than or equal to 135% had higher MI and stroke prevalence; this was not seen in male respondents. CONCLUSION: Low IPR and food insecurity were associated with higher MI, stroke, and heart failure prevalence among Medicare beneficiaries with diabetes. Our findings can inform targeted interventions to reduce CVD disparities in these populations.
Alexander DS, Saelee R, Rodriguez B
… +5 more, Koyama AK, Cheng YJ, Tang S, Rutkowski RE, Bullard KM
Prev Chronic Dis
· 2025 Feb · PMID 39993145
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National prevalence of diabetes distress is unknown among US adults. This cross-sectional study examined the prevalence among US adults with diabetes using 2021 National Health Interview Survey data. Multivariable multin...National prevalence of diabetes distress is unknown among US adults. This cross-sectional study examined the prevalence among US adults with diabetes using 2021 National Health Interview Survey data. Multivariable multinomial logistic regressions were used to estimate adjusted prevalence and prevalence ratios for diabetes distress. Adjusted prevalence of moderate and severe diabetes distress was 24.3% (95% CI, 22.5%-26.1%) and 6.6% (95% CI, 5.6%-7.8%), respectively. Prevalence was higher among people aged 18 to 64 years, women, and those with lower incomes. Findings highlight the importance of examining economic and social factors and integrating diabetes distress screening into diabetes management and services.
Khavjou O, Tayebali Z, Cho P
… +2 more, Myers K, Zhang P
Prev Chronic Dis
· 2025 Jan · PMID 39819894
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INTRODUCTION: We assessed state-level disparities in diabetes prevalence among adults in rural and urban areas in the United States. METHODS: We estimated state-specific diabetes prevalence in rural and urban areas in 41...INTRODUCTION: We assessed state-level disparities in diabetes prevalence among adults in rural and urban areas in the United States. METHODS: We estimated state-specific diabetes prevalence in rural and urban areas in 41 states with applicable data from the 2021 Behavioral Risk Factor Surveillance System. Rural areas were defined based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme. We estimated diabetes odds ratios (ORs) in rural versus urban areas in each state by using logistic regressions adjusted for sociodemographic characteristics and obesity status. Analyses were conducted in 2023. RESULTS: In rural areas, diabetes prevalence was 14.3%, ranging from 8.4% in Colorado to 21.3% in North Carolina. In urban areas, the prevalence was 11.2%, ranging from 6.9% in Colorado to 15.5% in West Virginia. Unadjusted diabetes ORs in rural versus urban areas were significant (P < .05) and greater than 1 for 19 states. After adjusting for age, sex, race, and ethnicity, the ORs were significant and greater than 1 for 7 states (Florida, Illinois, Kentucky, Maryland, North Carolina, Oregon, and Virginia). With additional adjustment for education, income, and obesity status, diabetes ORs in rural versus urban areas remained significant and greater than 1 for 2 states (North Carolina and Oregon). CONCLUSION: Our findings reveal significant geographic disparities in diabetes prevalence between rural and urban areas in 19 states. The differences in most states may have been explained by rural-urban differences in sociodemographic characteristics and obesity rates. Our findings could inform decision makers to identify effective ways to reduce rural-urban disparities within states.
Santoni S, Kernic MA, Malloy K
… +4 more, Ali T, Zhang Y, Cole SA, Fretts AM
Prev Chronic Dis
· 2025 Jan · PMID 39819893
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INTRODUCTION: Compared with White Americans, American Indian adults have disproportionately high depression rates. Previous studies in non-American Indian populations report depression as common among people with uncontr...INTRODUCTION: Compared with White Americans, American Indian adults have disproportionately high depression rates. Previous studies in non-American Indian populations report depression as common among people with uncontrolled hypertension, potentially interfering with blood pressure control. Few studies have examined the association of depressive symptoms with hypertension development among American Indians despite that population's high burden of depression and hypertension. We examined the association of depressive symptoms with incident hypertension in a large cohort of American Indians. METHODS: We studied 1,408 American Indian participants in the Strong Heart Family Study, a longitudinal, ongoing, epidemiologic study assessing cardiovascular disease and its risk factors among American Indian populations. Depressive symptoms were assessed by using the Center for Epidemiological Studies-Depression (CES-D) scale, 2001-2003. At each study examination in 2001-2003 and 2007-2009, blood pressure was measured 3 times. The average of the last 2 measurements taken at baseline and follow-up examinations was used for analyses. Incident hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or use of hypertension medications at follow-up. To account for within-family correlation, we used generalized estimating equations to examine the association of depressive symptoms with incident hypertension. RESULTS: During follow-up, 257 participants developed hypertension. Participants with symptoms consistent with depression (CES-D ≥16) at baseline had 54% higher odds of developing hypertension during follow-up (OR = 1.54; 95% CI, 1.06-2.23) compared with those without depression (CES-D <16) at baseline after adjustment for other risk factors. CONCLUSION: These data suggest that participants who experienced symptoms consistent with depression were at increased odds of incident hypertension.