The Association of Hypertension Diagnosis with Smoking Cessation: Application of Multiple Logistic Regression Using Biostatistical and Epidemiological Methods by LaTonia A. Clay Under the Direction of Yu-Sheng Hsu, PhD. ABSTRACT Hypertension and smoking are two major issues threatening the nation’s health. Previous studies examining their relationship have resulted in conflicting reports. The aim of this study is to determine if a relationship exists between smoking cessation and hypertension diagnosis. Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used in this investigation. Physical examination measurements of blood pressure and self-reported diagnosis and smoking behavior were used to define hypertension and smoking status. The odds of prior hypertension diagnosis associated with smoking cessation was estimated from a multivariate logistic regression model, adjusting for gender, age, ethnicity, BMI, physical activity, HDL cholesterol, and alcohol use. Results of the investigation found that unsuccessful smoking cessation was associated with a decreased odds of prior hypertension diagnosis, adjusting for the presence of confounders (OR=0.816, p<.001). Thus, hypertension diagnosis may indeed lead to the decision to quit smoking. Future studies on this finding are encouraged. INDEX WORDS: hypertension, smoking, cessation, diagnosis, logistic regression, NHANES

Background: There has been a concern regarding the masking of vitamin B-12 deficiency in the post-fortification period (after January 1, 1998). Objective: The objective of this study was to investigate the potential masking of vitamin B-12 deficiency by comparing the proportion of individuals with low serum B-12 without macrocytosis between pre- and post-fortification periods using data from the National Health and Nutrition Examination Survey (NHANES). Methods: The study included 7242 individuals from NHANES III (pre-fortification group) and combined NHANES 1999-2000, 2001-2002, 2003-2004, 2005-2006 (post-fortification group). Vitamin B-12 deficiency and macrocytosis were defined as having <148 pmol/L of serum vitamin B-12 and mean corpuscular volume (MCV) of>98 fL, respectively. A multivariate logistic regression was performed to estimate the likelihood of being low serum B-12 without macrocytosis in the post-fortification period in relation to the pre-fortification period. Results: Between pre- and post-fortification periods, there was no significant difference in the proportion of individuals with low serum vitamin B-12 without macrocytosis. However, odds of having low serum vitamin B-12 without macrocytosis in the post fortification era increased in men (OR=2.65, 1.24-5.65), non-Hispanic blacks (OR=3.12, 1.04-9.35), Non-smokers (OR=4.63, 1.90-11.27), and those aged 55 and older (OR=2.183, 1.01-4.74) compared their respective counterparts in the pre-fortification period. Conclusions: No significant difference in the proportion of individuals with vitamin B-12 deficiency without macrocytosiss was seen between the pre and post-fortification periods suggesting no making of vitamin B-12 deficiency. In the post-fortification period, serum folate was found to be a predictor of the masking effect. The impact of increased folic acid intake in the post-fortification period needs to be evaluated on a periodic basis especially, in non-target population.

Using data from the National Health and Nutrition Examination Survey (NHANES) self-reported surveys from 2007-2012, this research explored the relationship between four healthy lifestyle characteristics - healthy weight, adequate daily fruit and vegetable intake, regular moderate to vigorous physical activity and not smoking - with food behaviors of low-income, food insecure women. The study examined three specific food behaviors (the use of SNAP, consumption of fast foods, and the utilization of community emergency food programs) to determine if these behaviors had a significant impact on low-income, food insecure women to follow healthy lifestyle characteristics. A secondary data analysis was conducted using binary logistic regression for the analysis. The study sample included low-income, food insecure women ages 18 and above. Once missing data were removed, the total sample size was 589. Results of this study indicate there are no significant relationships between adherence to two or more of the four healthy lifestyle characteristics with: (1) the use of SNAP, (2) the consumption of fast foods or (3) the utilization of community emergency food programs. This study illustrates the importance of understanding the food behaviors of low-income, food insecure woman in order to aid in the prevention of diseases caused by obesity. Although the research results from this study were not significant, it was clearly demonstrated that most Americans do not adhere to the four healthy lifestyle characteristics. The implications of this research enable social workers and other health professionals to understand how food behaviors may be a key factor in reducing or eliminating food insecurity and obesity of low-income, food insecure women in the US.

The purpose of this dissertation is to test how growth, reproduction, and immune functioning interact in two populations of adult women residing in vastly different socio-economic and ecological environments, the Kalunga quilombo in Brazil, and the United States of America. The presence of life history trade-offs was tested to determine how the different envirnonments, and socio-ecological contexts of the populations were creating differential risks for health and reproductive outcomes, and life history trade-offs. I hypothesized that the Kalunga people, living in very difficult and harsh conditions, would experience greater amounts of, and more severe, life history trade-offs than the U.S. women. I also hypothesized that in both populations, syndemic interactions between health outcomes, and the larger macro-social conditions, would influence stature, immune functioning, and reproduction. Additionally, these syndemic interactions would perpetuate poor health and reproductive outcomes within the entire Kalunga population, and portions of the U.S. population. I collaborated with the University of Brasilia to collect data adult women from in the Kalunga quilombo in Goiás State, Brazil (n=38) via semi-structured interviews in 2016. In addition, these data were compiled with reproductive, demographic, anthropometric, biological, and socio-economic data collected from adult Kalunga women in 2015 by the University of Brasilia’s Department of Genetics and Morphology. Demographic, anthropometric, biological, and socio-economic data recorded in the National Health and Nutrition Examination Survey (NHANES) 2005-2006 from adult U.S. women was also analyzed. Life history traits were measured through stature (cm), Immunoglobulin E (IgE; kU/l), and reproductive variables (fertility, and reproductive ages) for both populations. My results demonstrated that life history trade-offs impact diverse populations. I found evidence to support life history trade-offs occurred between stature and fertility, and stature and reproductive ages, in both populations. However, my results also indicated that the socio-economic, and ecological, conditions of both populations heavily influenced stature and reproduction in the women. Life history trade-offs were not observable between immune functioning and fertility in the Kalunga population, and not readily evident in the U.S. sample. The positive associations between IgE and fertility in the U.S. women indicate that while life history trade-offs may be suggested, other biocultural variables including: low income, ethnicity, education, and body size, are stronger influences on immune functioning, and fertility, in the U.S. women. Though the Kalunga women had a history of infectious and parasitic diseases, and lived in conditions of poor sanitation and poverty, they had multiple ways of mitigating the stresses of their everyday life. The shared socio-ecological conditions of their community decreased the deprivations they experienced, reduced the disabilities they felt from their health statuses, and was reflected in relative homogeneity of their lived experience. In contrast, the U.S. population was dictated by disparities. Poor health and reproductive outcomes were concentrated disproportionately in low-income, less educated, and/or minority ethnicity status, women. The findings of this dissertation have important implications for applied anthropology and the study of life history theory. My results demonstrate that Western lifestyles must be considered as instigators of life history trade-offs, and life history scholarship in humans must also focus on populations living in these conditions. Additionally, the secular changes resulting in lowered ages of menarche in U.S. women could lead to future poor health outcomes. As the Kalunga transitions into a more Western lifestyle, they are at risk for disparities within their population. It is imperative for applied anthropologists to be engaged in addressing the immune, nutritional, and psychosocial stressors within populations that perpetuate disparities, and instigate and/or exacerbate life history trade-offs.

Breast cancer is the second leading cause of death in women in the U.S. The CDC estimates that between 2010 and 2020, there will be an increase in breast cancer in women in the United States by 21%, or greater 900,000 new cases per year. (CDC) Women are at increased risk for breast cancer due to the fact that some breast cancers have cells which are responsive to the hormone estrogen. Further, the risk of developing cancer increases as women age. Women who experience menopause after age 55 have an increased risk of developing breast cancer. (Surakasula et al., 2014) Phytoestrogens, which include isoflavones, are compounds found in plants and processed foods, which structurally and functionally mimic the hormone estrogen. Soy is frequently found in processed foods regularly consumed in the average American diet and is a source of isoflavones, including genistein, daidzein, and daidzein’s metabolite, equol. Phytoestrogens can bind to the estrogen receptor and change the expression of genes that respond to estrogen, such as the oncogene c-Fos, a protein in breast cancer cells which can suppress breast cancer cell growth when it is mutated (Lu et al., 2005). Phytoestrogens have been shown to reduce the severity and frequency of some of the symptoms of menopause, including a reduction in hot flashes and other estrogen deficiency-related symptoms of menopause. (Chen et al., 2015). Phytoestrogens have been used therapeutically in menopausal women, as they can compensate for lower levels of estrogen in the body. There is, however, limited research regarding the consumption of soy and increased risk for cancer in postmenopausal women. The objective of this study was to determine whether increasing levels of urinary phytoestrogen are correlated with a decreased risk of postmenopausal breast cancer. The analysis observes 2,439 postmenopausal female subjects equal to or greater than 45 years of age who had urinary phytoestrogen and reproductive health data in the 1999-2010 National Health and Nutrition Examination Survey database. The dietary data was obtained from the U.S. Department of Agriculture’s Agricultural Research Service database. Logistic regression models constructed using SAS were used to assess the change in the relative risk for cancer across low, medium, and high levels of urinary daidzein, genistein, and equol. Variables of interest, including demographic, body measures, dietary patterns, and lab measures, were compared to a base model, which adjusts for age only. It was found that the relative risk for postmenopausal breast cancer was not significantly different in the tertiles and quintiles of urinary phytoestrogens. The greatest increase in the likelihood of postmenopausal breast cancer was found to be 1.53 times in the second tertile of daidzein, increasing the risk by 53%. There was no significant protective effect of increasing levels of urinary phytoestrogens against postmenopausal breast cancer.

This cross-sectional study aims to evaluate the association of caffeine intake with renal function among adults between ages 18-55. Participants of the National Health and Nutritional Examination Survey (NHANES) survey for the three consecutive years (2013-2014, 2015-2016, and 2017-2018) were used. A weighted multivariable linear regression analysis of the caffeine concentration was conducted. Greater intake was associated with lowered renal function. This association persisted when limiting the daily caffeine intake to 2000 mg/day or less. Among younger adults, ages 18 to 39 the beta coefficient was about 50 percent larger than the beta coefficient for individuals ages 40 to 55. This suggests that caffeine intake may have a greater impact on renal function among younger adults. While greater caffeine intake was associated with reduced renal function in this cross-sectional study, further investigation such as an experimental study should be performed to confirm the findings of this thesis. / Epidemiology

Metabolic Syndrome (MetS) is a condition affecting over one third of U.S. adults and is characterized by risk factors that promote inflammation and result in chronic disease. Indicated by high visceral adiposity, dyslipidemia, insulin resistance and hypertension, MetS has been associated with increased risk for future cardiovascular disease, type 2 diabetes mellitus, and all-cause mortality. Recognizing the need for population-specific dietary and lifestyle guidance is crucial for reversing the exponential growth in chronic diseases. Self-reported behavior and directly measured anthropometric and laboratory data from 4,627 adults in the 2007-2010 National Health and Nutrition Examination Survey were analyzed. The objectives were 1) determine the prevalence of MetS using the AHA/NHLBI criteria for specific cohorts in U.S. adults 2) determine whether macronutrient composition, micronutrient adequacy and energy balance differ between adults age 20-59 with and without MetS 3) investigate dietary patterns reported using food groups and their relationships with MetS in adults age 20-59. Agejusted prevalence of MetS was 36.8 percent (95 percent CI 34.7 percent-39.0 percent). Prevalence increased with age groups and BMI categories. Odds Ratios (OR) for MetS compared to normal weight were 4.33 (95 percent CI 3.43-5.47) for overweight individuals and 17.98 (95 percent CI 13.29-24.31) for obese individuals. Average daily moderate activity was 45 minutes less in adults with MetS (p<0.05). Within races, black women had a higher prevalence of MetS than black men (p<0.05) and white men had a higher prevalence than white women (p<0.05). Overall, there were few clinically significant differences in nutrient intake between those with and without MetS in race/gender cohorts, however nutrient intake differed between cohorts. Nutrient intake relative to caloric needs was lower in those with MetS, which may suggest lower metabolic rate than predicted. White men and women consumed more of most food groups than the other races. Women with MetS consumed more meat, seafood and eggs, and solid fat and less legumes, nuts, and seeds and grains than women without MetS (p<0.05). Men without MetS consumed more alcohol than men with MetS (p<0.05). Dietary intake was not predictive of MetS, however total volume of physical activity and BMI are factors that can be modified.

Higher levels of allostatic load (AL), a composite measure of the impact of chronic stress on the body, are found among socially marginalized groups compared to privileged groups. AL is associated with premature aging and death, as well as a variety of chronic health conditions that impact quality of life. Effects of AL may be offset by physical activity (PA). Queer populations (including those who identify as lesbian, gay, or bisexual) may be at risk for elevated AL due to repeated exposure to discrimination in the form of sexual minority stress. There is mixed literature on sexual orientation differences in PA and research on AL among queer populations is limited. This study describes sexual orientation differences in the 1) prevalence of PA and mean AL levels and 2) association between PA and AL. Data from the 2001-2015 National Health and Nutrition Examination Survey were used to fit sex-stratified linear regression models assessing sexual orientation (heterosexual, gay/lesbian, bisexual, and heterosexual with same-sex experience) differences as well as sexual orientation-specific associations in PA and AL. AL was assessed using 8 biomarkers, while PA was assessed using metabolic equivalent of task (MET)-hours/week calculated from the Global Physical Activity Questionnaire. Models were adjusted for race/ethnicity, income, education, relationship status, veteran status, and citizenship status. Overall, heterosexual adults reported more PA than their same-sex queer counterparts. Gay men had lower (0.8), while bisexual men had higher AL scores (1.9) than heterosexual men (1.2). Among women, AL score was similar across sexual orientation groups. Overall, more PA was associated with lower AL scores among men and women (badjusted = -0.00508, padjusted=-0.00505, punadjusted =-0.00934, punadjusted =-0.03269, p=0.04), and heterosexual women with same-sex experience (bunadjusted =-0.01059, p=0.02). After adjusting for covariates the association was no longer statistically significant. Consistent with previous work, PA was inversely associated with AL score. PA may be an important modifiable behavior to mitigate some sexual orientation disparities in health.

Data from the National Health and Nutrition Examination Survey (NHANES) 2001-2002 were used to examine demographic factors and BMI as it related to household food security status of women 16-85 years of age. Four designations were used to classify households: fully food secure, marginally food secure, food insecure without hunger, and food insecure with hunger. Significant relationships exist between food security and age, education, ethnicity, poverty income ratio and BMI. Women from food insecure households with hunger were at greater risk of becoming overweight. Households of compromised food security status most likely had an income between 0-130% of the poverty level. Women in households at 100-130% of the poverty level had a higher risk of obesity/morbid obesity. The more years of education women completed, the less risk they had for overweight and food insecurity. Women under 40 had a higher risk of marginal food security and food insecurity without hunger.

No description available.