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A community-specific intervention to reduce obesity and related health risksRamukumba, Tendani Sarah. January 2012 (has links)
Thesis (D.Tech. degree in Nursing)--Tshwane University of Technology, 2012. / While obesity has reached epidemic levels worldwide, it is not regarded as negative or unacceptable among South African black socio-cultural groups. It is estimated that 29% of men and 56% of women in South Africa are obese. Variations in worldview create differences between perceived weight and actual weight which influence obesity levels and interventions. This makes it necessary to develop culturally congruent weight reduction interventions so that they are acceptable to targeted communities. The objective of the study was to develop, implement and evaluate a weight reduction intervention in Thulamela in the Vhembe District of the Limpopo Province.
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A proposed pathophysiological role for TNFa in obesity induced cardiac hypertrophyRostami, Maryam 03 1900 (has links)
The a of TNFa in title is the Greek alpha. / Thesis (MSc)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Background: Cardiac hypertrophy is an adaptive process occurring in response to
mechanical overload or tissue injury. The stimuli for cardiac hypertrophy are diverse
and vary from increased afterload on the heart to cardiac remodeling in response to
cytokines. Amongst others, obesity is characterized by excessive body weight
resulting in metabolic disorders. This excess body weight necessitates an increased
blood and oxygen delivery to the peripheral tissues, which is achieved by an elevated
cardiac output. Total blood volume is also increased in the obese due to the
increased tissue volume and vascularity. With time, the obesity induced increase in
cardiac preload results in left ventricular hypertrophy and dilatation. Obesity is also
associated with complications such as hypertension, insulin resistance and impaired
glucose metabolism.
In addition, adipose tissue has been implicated to contribute to elevated circulating
TNFa levels in obesity and may contribute to the pathophysiology of the heart in
obese individuals. The heart is a major cytokine-producing organ that generates
amongst others tumor necrosis factor a (TNFa). TNFa is a proinflammatory cytokine,
which acts to increase its own production, has cytotoxic and cytostatic effects on
certain tumor cells and influences growth and differentiation in virtually all cell types
including cardiomyocytes. Elevated levels of TNFa are detected peripherally in
almost all forms of cardiac injury and in hypertrophic cardiomyopathy. These
elevations are proposed to be deleterious to the heart, although an adaptive role for
low levels of TNFa has been proposed. Aim: The aim of the study was to determine whether there is a correlation between
obesity and serum, myocardial, and adipose tissue TNFa levels and cardiac
hypertrophy. We also wished to determine whether the hearts from the obese
animals functioned normally under normoxic conditions and whether they responded
differently to ischaemia/reperfusion when compared with their concurrent controls.
Materials and Methods: Male Sprague-Dawley rats (n=100) were fed a high caloric
diet (HCD) containing 33% rat chow, 33% condensed milk, 7% sucrose and 27%
water, or standard laboratory rat chow for 6-12 weeks. Food consumption, body
weight gain, heart weight and tibia length were measured. Serum glucose, insulin
and lipid levels were also determined. Hearts were excised and perfused on the
isolated Working Heart perfusion apparatus and cardiac function was monitored and
documented. Hearts were then subjected to 15 minutes of total global ischaemia at
370C, and reperfused for 30 minutes. Cardiac function was again documented.
A separate series of hearts were freeze-clamped at different time points during the
experimental protocol and stored in liquid nitrogen for the determination of myocardial
TNFa and cGMP levels. Serum TNFa levels were determined after 12 weeks on the
high caloric or normal/control diet. After 12 weeks on the diet myocardial TNFa levels
of the HCD fed animals and their concurrent controls were determined before and
during ischaemia. Adipose tissue and myocardial tissue TNFa levels were also
determined after 6, 9 and 12 weeks on the respective diets. Myocardial cGMP levels
were measured in the HCD fed rats and the control rats after 6, 9, and 12 weeks.
These data were used as an indirect index to determine whether the myocardial NOcGMP
pathway was activated in the normoxic hearts on the respective diets. Results: The body weight of the HCO fed animals was significantly higher compared
with their respective controls after 12 weeks on the diet (459.9 ± 173.8 g and 271.5 ±
102.6 g respectively (p<0.05». The HCO fed animals also had heart weight to body
weight ratios that were significantly greater compared with the controls (4.2 ± 0.1
mglg and 3.7 ± 0.1 mglg respectively (p<0.05».
The plasma glucose levels of the HCO fed animals were higher than their respective
controls (9.2 ± 0.3 mmoiII and 7.8 ± 0.3 mmoiII respectively (p<0.05)), but their insulin
levels were similar (12.87 ± 1.02 IlIUlml and 12.42 ± 5.06 IlIU/ml). Plasma lipid
profiles (plasma cholesterol, high density lipoprotein (HOL) cholesterol and plasma
triacylglyceride (TAG)) were abnormal in the HCO fed animals compared with the
control rats. Plasma TAG levels in the HCO fed animals were significantly higher
compared with the control rats (0.664 ± 0.062 mmoiII and 0.503 ± 0.043 (p<0.05»,
while plasma cholesterol levels (1.794 ± 0.058 mmoIII and 2.082 ± 0.062 mmoiII
(p<0.05» and HOL cholesterol levels were significantly lower (1.207 ± 0.031 mmoiII
and 1.451 ± 0.050 mmoiII (p<0.05».
Cardiac mechanical function was similar for both groups before ischaemia, but the
percentage aortic output recovery was lower for the hearts from the HCO fed animals
when compared with their controls (47.86 ± 7.87% and 66.67 ± 3.76 % respectively
(p<0.05».
Serum TNFa levels of the HCO fed animals were higher compared with the control
animals (51.04 ± 5.14 AU and 31.46 ± 3.72 AU respectively (p<0.05», but myocardial
TNFa levels remained lower in these animals (312.0 ± 44.7 pglgram ww and 571.4 ± 132.9 pg/gram ww respectively (p<0.05)). During ischaemia these myocardial TNFa
levels increased above those of the controls (442.9 ± 12.4 pg/gram ww and 410.0 ±
12.5 pg/gram ww respectively (p<0.05)). The adipose tissue TNFa levels were
significantly increased after 12 weeks on the high caloric diet compared with the
control animals (4.4 ± 0.4 pg/gram ww and 2.5 ± 0.3 pg/gram ww respectively
(p<0.05)). There was no significant difference in the myocardial cGMP levels of the
HCD rats compared with the conrol rats after 6, 9 and 12 weeks.
Conclusion: 1) The high caloric diet induced obesity, which lead to cardiac
hypertrophy in this study. 2) There was a strong correlation between elevated
adipose tissue and serum TNFa levels, and cardiac hypertrophy. 3) Elevated serum
TNFa levels did not lead to activation of the myocardial NO-cGMP pathway in the
normoxic hearts in this model. 4) The hypertrophied hearts from the HCD fed animals
had poorer post-ischaemie myocardial functions than their concurrent controls. / AFRIKAANSE OPSOMMING: Agtergrond: Miokardiale hipertrofie is In aanpassing wat gebeur as In gevolg van
meganiese oorbelading of weefsel beskadiging. Verskillende stimuli kan tot
miokardiale hipertrofie aanleiding gee soos byvoorbeeld In verhoging in nalading, of
miokardiale hermodellering in respons op sitokiene. Verhoging van voorbelading in
vetsug mag ook tot hipertrofie aanleiding gee. Vetsug word gekenmerk deur In
oormatige liggaamsmassa wat tot metaboliese versteurings lei. Die oormatige
liggaamsmassa vereis In verhoging in bloed- en suurstofverskaffing aan die perifere
weefsel wat deur In verhoging in die kardiale uitset vermag kan word. Die bloed
volume van In vetsugtige individu word ook verhoog as gevolg van In verhoging in
weefselvolume en vaskulariteit en met verloop van tyd induseer die verhoogde
kardiale voorbelading linker ventrikulêre hipertrofie en dilatasie. Vetsug word ook met
verskeie ander siekte toestande soos hipertensie, insulien weerstandigheid en
versteurde glukose metabolisme, geassosieer.
Vetweefsel dra ook by tot verhoging van tumor nekrose faktor alfa (TNFa) vlakke in
die bloed, wat op sy beurt tot miokardiale hipertrofie mag bydra. TNFa is In proinflammatoriese
sitokien wat sy eie produksie kan stimuleer. Dit het ook sitotoksiese
en sitostatiese effekte op sekere tumor selle en kan groei en differensiasie in bykans
alle seltipes, insluitende kardiomiosiete, stimuleer. Die hart kan ook TNFa produseer
en verhoogde TNFa vlakke word feitlik in alle vorms van miokardiale besering en
hipertrofiese kardiomiopatie waargeneem. Daar word voorgestel dat verhoogde
TNFa vlakke vir die hart nadelig is, ten spyte van die vermoeding dat die sitokien In
potensiële aanpassings rol by laer vlakke het. Doelstelling: Die doel van hierdie studie was om vas te stelof daar 'n verband tussen
vetsug en serum, miokardiale en vetweefsel TNFa vlakke en miokardiale hipertrofie,
bestaan. Ons het ook gepoog om te bepaal of harte van vetsugtige diere normaal
funksioneer en of die response van sulke harte op isgemie-herperfusie van die van
ooreenstemmende kontroles verskil.
Materiaal en tegnieke: Manlike Sprague-Dawley rotte (n=100) is vir 6-12 weke op 'n
hoë kalorie dieët (HKD) geplaas. Die HKD het uit 33% rotkos, 33% gekondenseerde
melk, 7% sukrose en 27% water bestaan. Kontrole diere het standaard laboratorium
rotkos ontvang. Voedselinname, liggaamsmassa toename, serum insulien, glukose
en lipied vlakke is ook bepaal. Harte is geïsoleer en geperfuseer volgens die Werk
Hart perfusie metode en hart funksie is gemonitor en gedokumenteer. Harte is
vervolgens aan 15 minute globale isgemie by 3rC blootgestel en daarna weer vir 30
minute geherperfuseer waartydens hartfunksie weer gedokumenteer is. 'n Aparte
groep harte is op spesifieke tydsintervalle gedurende die eksperimentele protokol
gevriesklamp en in vloeibare stikstof gestoor vir die bepaling van miokardiale TNFa
en sGMP vlakke.
Serum TNFa vlakke is bepaal na 12 weke op die dieët. Na die diere 12 weke op die
HKD was, is hierdie diere en hulooreenstemmende kontroles se miokardiale TNFa
vlakke voor en na isgemie bepaal. Vetweefsel en miokardiale TNFa vlakke is ook
onderskeidelik na 6, 9 en 12 weke bepaal. Miokardiale sGMP vlakke is in die HKD
diere en in die kontrole diere na 6, 9 en 12 weke bepaal. sGMP vlakke is gebruik as
'n indirekte indeks van aktivering van die miokardiale NO-sGMP boodskapper pad. Resultate: Na 12 weke op die dieët was die liggaamsmassa van die HKD diere
beduidend hoër in vergeleke met hulooreenstemmende kontroles (459.9 ± 173.8 g
en 271.5 ± 102.6 g (p<0.05)). Die HKD diere se hart massa tot liggaam massa
verhouding was ook beduidend hoër in vergelyking met die van kontroles (4.2 ± 0.1
mglg en 3.7 ± 0.1 mglg (p<0.05)).
Alhoewel insulien vlakke dieselfde was (12.42 ± 5.06 j.lIU/ml en 12.87 ± 1.02 j.lIU/ml),
was serum glukose vlakke van die HKD diere hoër as die van die ooreenstemmende
kontroles (9.2 ± 0.3 mmoiii en 7.8 ± 0.3 mmoiii (p<0.05)). Plasma lipied profiele (HOL
cholesterol, plasma cholesterol en trigliseriede) was abnormaal in die HKD diere.
Plasma TAG vlakke in die HKD diere was beduidend hoër as die van die kontroles
(0.664 ± 0.062 mmoiii en 0.503 ± 0.043 (p<0.05)), terwyl plasma cholesterol vlakke
(1.794 ± 0.058 mmoiii en 2.082 ± 0.062 mmoiii (p<0.05)) en HOL cholesterol vlakke
beduidend laer was (1.207 ± 0.031 mmoiii en 1.451 ± 0.050 mmoiii (p<0.05)).
Miokardiale meganiese funksie was dieselfde vir beide groepe voor isgemie, maar
die persentasie aorta omset herstel tydens herperfusie was laer in die HKD diere in
vergelyking met die van kontrole diere (47.86 ±. 7.87% en 66.67 ± 3.76% (p<0.05)).
Serum TNFa vlakke van die HKD diere was beduidend hoër as die van kontrole diere
(51.04 ± 5.14 AU en 31.46 ± 3.72 AU (p<0.05)), maar miokardiale TNFa vlakke was
laer (312.0 ± 44.7 pglgram nat gewig en 571.4 ± 132.9 pglgram nat gewig (p<0.05)).
Die vetweefsel TNFa vlakke was ook beduidend verhoog na 12 weke op "n hoë
kalorie dieët wanneer dit vergelyk word met die van kontrole diere (4.4 ± 0.4 pglgram
nat gewig en 2.5 ± 0.3 pglgram nat gewig respektiewelik (p<0.05)). Daar was geenbeduidende verskille in die miocardiale vlakke van sGMP in die HKD diere in
vergelyking met die kontroles na 6, 9 en 12 weke.
Gevolgtrekkings: 1) "n Hoë kalorie dieët het in dié studie vetsug geïnduseer en tot
miokardiale hipertrofie gelei. 2) Daar was "n positiewe korrelasie tussen verhoogde
vetweefsel en serum TNFa vlakke, en miokardiale hipertrofie. 3) Verhoogde serum
TNFa vlakke het nie tot die aktivering van die miokardiale NO-sGMP pad in hierdie
model gelei nie. 4) Die hipertrofiese harte het tydens herperfusie ná isgemie swakker
as hulooreenstemmende kontroles gefunksioneer.
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Relationships of fibroblast growth factor 21 with inflammation and insulin resistance in response to acute exercise in obese individualsUnknown Date (has links)
Obesity is associated with elevated levels of the pro-inflammatory cytokines
interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), contributing to systemic
insulin resistance. Fibroblast growth factor 21 (FGF21) is a vital metabolic and
inflammatory regulator, however circulating FGF21 concentrations are elevated in obese
individuals. Acute aerobic exercise increases systemic FGF21 in normal-weight
individuals, however the effect of acute aerobic exercise on plasma FGF21 response and
the relationships with inflammation (IL-6 and TNF-α), insulin resistance, and energy
expenditure in obese individuals is unknown. Following 30 minutes of treadmill running
at 75% VO2max, plasma FGF21 response, as indicated by area-under-the-curve “with
respect to increase” (AUCi) analyses, was attenuated in 12 obese compared to 12 normalweight
subjects. Additionally, FGF21 AUCi positively correlated with glucose AUCi,
total relative energy expenditure, and relative VO2max, suggesting that cardiorespiratory fitness levels may predict FGF21 response, contributing to the enhanced regulation of
glucose and energy metabolism. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection
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Obesity and Comorbid Diseases as a Host Determinants of Staphylococcus aureus ColonizationBefus, Montina Bernadette January 2016 (has links)
The etiology of obesity is heterogeneous as are the cardio-metabolic complications, associated with it. The cardio-metabolic profile of obese individuals places them at risk of a range of chronic metabolic diseases including diabetes. Paradoxically, a subset of the population classified as obese based on established methods present with few metabolic abnormalities, whereas a subset classified as non-obese present with a wide range of abnormalities. The observed heterogeneity suggests not only that excess adiposity is likely one of many determinant of metabolic complications, but also that our methods of measuring obesity might not be fully capturing the underlying biological mechanisms at play. The heterogeneity by which obesity presents itself in the general population is becoming more pertinent to the field of infectious diseases as findings increasingly implicate obesity in impaired host defenses and increased susceptibility to a range of different infectious organisms, one of which is Staphylococcus aureus.
S. aureus is an opportunistic pathogen with significant infectious burdens in clinical, community as well as incarcerated settings. The organism also asymptomatically colonizes human mucosal surfaces, particularly the anterior nares. The anterior nares of approximately 25-30% of US adults are colonized at any given time, and prior colonization serves as a strong predictor of subsequent infection. Obese females have been consistently shown to be at elevated risk of S. aureus colonization, however, findings amongst obese males have been inconsistent. The mechanism by which obesity increases risk of colonization remain unclear, however, many cite the underlying metabolic dysfunction that frequently accompanies obesity. Given the global burden of obesity and increasing evidence that it impairs host defenses, understanding how obesity increases host colonization with S. aureus is imperative. The overall objective of this dissertation was therefore to evaluate the influence of obesity and metabolic abnormalities on S. aureus colonization among New York State Maximum-Security prison inmates. The objective of the dissertation was met using three aims.
First a systematic review was conducted to assess the different definitions used to define persistent S. aureus colonization in community dwelling adults, as well as the reported prevalence estimates associated with those definitions. The study demonstrated that a considerable amount of variation existed in the way persistent colonization was defined in the extant literature. Despite the variation however, the prevalence of persistent S. aureus carriage remained relatively consistent after categorizing the different definitions into four general groups. The review also demonstrated that two groups of persistent carriers might exist. Therefore, differentiating strain persistence carriers from species persistence carriers may reconcile some of the inconsistencies with regard to length of strain carriage reported in the literature.
Second, the influence of metabolic heath (a measure incorporating both body mass index (BMI) and metabolic abnormalities) was assessed. A significantly higher probability of S. aureus colonization of the anterior nares and/or oropharynx was observed among metabolically abnormal normal weight (BMI < 25 kg/m²) as well metabolically abnormal obese (BMI ≥ 30 kg/m²) females when compared to metabolically healthy females. No significant association was observed between the categories of metabolic health and the prevalence of S. aureus colonization among males. We did, however observe a significant decline in exclusive oropharyngeal colonization among obese male inmates with metabolic abnormalities.
Lastly, factors associated with persistent S. aureus carriage were evaluated in the third aim. Approximately 27% of the population was persistent carriers at the species level and 17% were persistent carriers at the strain level. Obesity was independently associated with species persistent carriage but not strain persistent carriage. Correspondence analysis evaluating strain compositional differences between exclusive persistent anterior nares carriers, exclusive persistent oropharynx carriers, exclusive persistent carriers at both the anterior nares and oropharynx and intermittent carriers suggested compositional differences existed between the different groups. More specifically, the relative abundance of certain S. aureus strains appeared more prominent among exclusive nasal carriers as compared to all other carriage/mucosal site types (exclusive oropharynx, both nasal and oropharynx.
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Obesity, a risk factor for patients infected with 2009 pandemic influenza A (H1N1): a systematic reviewLiu, Yuanyuan, 刘媛媛 January 2011 (has links)
published_or_final_version / Public Health / Master / Master of Public Health
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A life course approach to potentially modifiable risk factors for poor semen qualityKahn, Linda Gross January 2016 (has links)
Poor semen quality is an indicator of male infertility and is also associated with a variety of adverse health outcomes in men. It is therefore important from both clinical and public health perspectives to discover predictors of poor semen quality, especially those that are potentially modifiable. My dissertation research focuses on two of these potential risk factors: adiposity and stress. Unlike most studies to date, which have only considered the relationship between these exposures and semen quality cross-sectionally, my research takes a life course approach. I explore associations between birth weight, adiposity in both childhood and adulthood, and allostatic load—a construct representing the effect of cumulative stress on the body’s regulatory systems—and three commonly-used semen outcome parameters: sperm concentration, percent progressive motility, and percent normal morphology. The logic that underlies this approach is that while sperm are constantly being produced from sperm stem cells in the testes, which would argue in favor of cross-sectional studies, the sperm stem cells themselves and the Sertoli and Leydig cells that stimulate and nurture that metamorphosis are laid down in the fetal period and undergo important developmental and proliferative phases during early childhood and puberty that affect their number and functional health in adulthood.
Using data from 193 participants in the Study of the Environment and Reproductive health follow-up to the Child Health and Development Studies birth cohort, I was able to calculate birth weight for gestational age percentile (bw/ga) and six age-appropriate adiposity measures (at 4 months, 12 months, and 4 years, and in participants’ 20s, 30s, and at the time of semen collection), then test for their independent, critical period, and cumulative associations with the three semen outcomes as well as a combined outcome measure of subfertility based on World Health Organization reference levels. While bw/ga was positively associated with sperm concentration, subsequent childhood adiposity measures showed increasingly negative associations, and none of the adult measures were significantly associated with concentration. By contrast, only adult measures were associated with motility and morphology. This suggests that there may be critical periods in childhood when adiposity negatively affects sperm concentration by interfering with the development and proliferation of Sertoli and Leydig cells. Accumulation of oxidative stress in the testes due to overweight/obesity may explain the negative relationships between adult adiposity and sperm motility and morphology.
To investigate allostatic load’s relationship to semen quality, I conducted a pilot study at Columbia University’s Center for Women’s Reproductive Care that enrolled 61 men who were having their initial diagnostic semen analysis and blood draw on the same day. Blood samples were analyzed for 7 biomarkers associated with homeostatic regulation across several physiologic domains. I then created an allostatic load scale in which participants were assigned 1 point for being in the high-risk quartile for systolic blood pressure, diastolic blood pressure, body mass index, or any of the biomarkers. In regression analyses, allostatic load was not associated with either sperm concentration or morphology, but showed an unexpected positive association with motility. This association was entirely driven by the six participants who scored 0 on the allostatic load scale and who did not differ from the rest of the sample in any way that could plausibly be linked to reduced motility. I therefore concluded that this was a spurious finding. In further analysis of the allostatic load variable itself, I found that few of its individual components were correlated with the semen outcomes. This contrasts with other studies of allostatic load and adverse health outcomes, but these have generally been conducted in either elderly or stressed populations, neither of which described my cohort. Allostatic load may not be a reliable measure of stress in reproductive age populations and may not capture regulatory systems appropriate to reproductive health outcomes.
My dissertation highlights the value and challenges of conducting semen quality research from a life course perspective. Future studies should consider collecting longitudinal data on adiposity and stress, as well as repeated semen samples beginning in adolescence in order to further our understanding of the natural progression of semen quality across the reproductive life span and provide the opportunity to explore whether modifying these risk factors affects semen quality.
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Black women's perceptions of obesity as a health riskNdlovu, Phumzile Pureen., Ndlovu, Phumzile Pureen 10 September 2012 (has links)
M.Cur. / Community nurses have a very important role to play in the planning of health promotion programmes and implementation of the necessary interventions for patients and groups with obesity problems. Obesity is one of the health problems that requires signficant behavioural changes in one's lifestyle as part of such interventions. The research study sought to explore the perceptions of both the patients and the community nurses of the phenomenon of obesity as a health risk, and to identify any areas that could give rise to problems when health promotion actions were planned for obese people. It was specifically important to obtain the perceptions of the community nurse of obesity, since the level of knowledge of the health problem as well as her personal attitude towards this problem, will be crucial in the manner and quality of her interventions. The study explored patients' and nurses' perceptions about obesity as a health risk (Phase I and 2). Factors in the internal and external environments of the obese individual were identified and analysed into categories and subcategories. The study is qualitative and explorative in nature, data was collected through the use of semistructured interviews, and Giorgi's method of data analysis was used. Literature control was done to examine how existing literature compared with data obtained from semistructured interviews on the nature of obesity as a health problem. Obesity is clearly a health risk and affects the person's totality of life experiences as demonstrated by the resultant patterns of interactions between the internal and external environments of an obese person. Results of the data analysis and literature control gave rise to the need to structure recommendations to give the community nurse the capacity and support that was identified as necessary for her to be able to carry out her nursing intervention.
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Social Determinants of Cardiovascular Health among Sexual Minority AdultsSharma, Yashika January 2023 (has links)
Cardiovascular disease (e.g., myocardial infarction, stroke, coronary artery disease) is the leading cause of death and disability worldwide. There is a growing body of literature that indicates sexual minority (e.g., gay, lesbian, bisexual, queer) adults are at a higher risk of cardiovascular disease than their heterosexual counterparts. The aim of this dissertation was to identify factors that contribute to the cardiovascular health (CVH) disparities that have been observed among sexual minority individuals.
Guided by an adaptation of the minority stress model of CVH among sexual minority individuals, this dissertation includes three studies. In the first study (i.e., Chapter 2), we conducted a scoping review of the literature that investigated social determinants of cardiovascular health among sexual minority adults. Although findings were mixed, several social determinants of health were found to influence the CVH of sexual minority adults. For instance, sexual minority adults who lived in environments that were more supportive of sexual and gender minority people had lower odds of being overweight or obese.
In the second study (i.e., Chapter 3), we used data from a racially and ethnically diverse sample of sexual minority women to examine the associations of family-related factors (i.e., sexual identity disclosure and family social support) with self-reported incident hypertension. Additionally, we examined whether these associations were moderated by race/ethnicity and sexual identity, or mediated by depressive symptoms. We found that higher levels of family social support were associated with lower levels of depressive symptoms among sexual minority women. However, family-related factors were not associated with self-reported incident hypertension. Further, race/ethnicity and sexual identity did not moderate the associations between family-related factors and reported incident hypertension.
In the third study (i.e., Chapter 4), we used data from a nationally representative sample of adults to investigate sexual identity differences in ideal CVH (as defined by the American Heart Association’s Life Simple 7) and whether these associations were mediated by depressive symptoms. Compared to exclusively heterosexual women, mostly heterosexual and lesbian women were less likely to meet ideal criteria for tobacco use. In contrast, lesbian women were more likely to meet ideal criteria for glycosylated hemoglobin than exclusively heterosexual women. Among men, relative to exclusively heterosexual men, mostly heterosexual men were less likely to meet ideal criteria for tobacco use. Gay and bisexual men were less likely to meet ideal criteria for physical activity, whereas gay men were more likely to meet ideal criteria for body mass index compared to exclusively heterosexual men. Bisexual men were less likely to meet ideal criteria for blood pressure relative to exclusively heterosexual men. Depressive symptoms were found to partially mediate the association between sexual identity and physical activity only among mostly heterosexual women.
Overall, these dissertation findings highlight CVH disparities among sexual minority adults. Clinicians should be educated about the CVH disparities that have been documented among sexual minority adults to provide personalized and culturally competent care. Results also indicate there is a need to develop behavioral interventions tailored specifically to the needs of sexual minority adults to improve their CVH outcomes and reduce CVH-related disparities.
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