Health Disparities

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    Mapping, Characterization and Description of HIV-APPE Rotations at ACPE Accredited Colleges of Pharmacy
    (2018-03-14) Hall, Brenton; Thomas, Drew; Suzuki, Sumihiro; Clay, Patrick; Rivera, Mivielis
    Background: Despite aggressive HIV testing programs and the introduction of preventative antiretroviral regimens (PrEP), the number of persons living with HIV in the United States (US) continues to increase by over 30,000 every year. As over 50% of PLWH are now over the age of 50, they represent an especially challenging population to provide care as they develop co-morbid conditions consistent with their non-PLWH counterparts of the same age, gender, race and ethnicity. In order for healthcare teams to optimally care for this population, pharmacists with focused training in this disease state are required. Accredited colleges of pharmacy, federal training programs and other large healthcare systems must first be knowledgeable of where to send trainees, yet no comprehensive database of HIV-specialized pharmacist training sites currently exists. Objective: This study's primary aims were to (1) create a map of US-based pharmacy student training sites, then describe (2) the training environment and (3) qualifications of the trainer present. Methods/Materials: A forced-choice, logic, algorithm based, Qualtrics™ survey was developed, validated, IRB-approved and deployed using a four-pronged approach. From October to November 2017, this anonymous survey was distributed through (1) professional organizations membership lists (pharmacy and medicine, HIV and non-HIV focused), (2) ACPE accredited pharmacy schools' experiential coordinators, and (3) a nationwide pharmacy chain. The 4th prong was via grassroots, snowball distribution whereby recipients forwarded it to their contacts. Results: Of 170 survey respondents, 143 consented to participate. Not all responded to each question. Results reflect proportion of question responses. Respondents reported 65% (n=94) primarily provide care for PLWH, 48% have at least 100 HIV patients served annually, and 79% (n=143) receive some form of government funding. Of the 143, 78 (59%) are APPE sites, 55 of which take over 6 students annually. Most students (93%) engaged 10 patients per week and 8 of 10 patients were PLWH. While 60 (42%) of these APPE sites report affiliation with at least 1 college of pharmacy, 18 states were not captured, including areas with high prevalence of PLWH. Conclusion: The survey successfully identified predominantly high patient volume HIV training sites, with experienced preceptors in 32 states. Serial deployment with enhanced marketing is needed to identify the regions not represented. Research Area: HIV Training Presentation Type: Poster
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    Impact of a Randomized Church-based, Lifestyle Intervention on Allostatic Load in African American Women in Dallas
    (2018-03-14) Mamun, Md Abdullah; Kitzman-Carmichael, Heather; Dodgen, Leilani; Tan, Marissa
    Purpose: African American women have higher rates of cardiovascular risk factors and greater than 50% higher mortality from cardiovascular disease than White women. This disparity may be explained by the uniquely higher allostatic load found in African American women. Allostatic load represents the physiologic cost to adapting to chronic and significant stressors throughout the life-course. Though poor nutrition and physical inactivity have shown inconsistent correlations with allostatic load in African American women, there have been no studies testing the effect of lifestyle interventions on allostatic load in this group. Our objectives are to (1) assess the change in allostatic load following a lifestyle intervention, (2) explore the role of health behavior changes and allostatic load, (3) evaluate how socioeconomic (SES) variables including neighborhood SES influence these relationships. Methods: Study participants were non-diabetic (48.8±11.2y) AA women (n=221) randomized to a church-based, standard diabetes prevention program (DPP) or a faith-enhanced DPP. Allostatic Load (AL) score was calculated at baseline and 4-month follow-up using the high-risk quartile method of 9 biomarkers: systolic and diastolic blood pressure, total cholesterol to high-density lipoprotein (HDL) ratio, HDL, triglycerides, hemoglobin A1c, body mass index, salivary cortisol, and waist circumference. We assessed perceived stress, neighborhood disadvantage, individual SES, physical activity, and other lifestyle variables. Multinomial logistic regression model was used to estimate the effect of lifestyle factors, perceived stress, and neighborhood disadvantage on change in AL. Results: AL was reduced (-0.12±0.99, p=0.04) from baseline to 4-month. 39% of participants had lower AL and 19.5% had increased AL. After adjusting for age and intervention effects, low level of education (high school degree or less) (OR:0.037, CI:0.004–0.379) and alcohol consumption (OR:0.091, CI:0.020–0.421) contributed to increased AL. Other variables were positively, but not statistically associated, with decreased AL. Conclusions: More research is necessary to determine the roles of perceived stress, physical activity, and weight loss in reducing AL. Lower education levels and alcohol consumption may dampen the effect of positive lifestyle behaviors in reducing AL.
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    Does Alcohol Use Affect the Relationship Between Social Support and Depression? An Examination of Permanent Supportive Housing (PSH) Residents in Fort Worth, Texas
    (2018-03-14) Walters, Scott; Suzuki, Sumihiro; Tan, Zhengqi
    Background: Social support tends to be protective against depression in a wide variety of groups. However, relatively little is known about how alcohol use might affect this relationship over time, especially among supportive housing residents, who are at risk for both depression and poor social support. Purpose: This study examined whether the association between social support and depression was modified by alcohol consumption among permanent supportive housing (PSH) residents in Fort Worth, Texas. Methods: We used the baseline and 6-month follow-up data from the Mobile Community Health Assistance for Tenants ( program, collected during 2014-2017. was a technology-assisted health coaching program for people with mental health conditions residing in PSH in Fort Worth, Texas. Participants’ current levels of depression and social support were measured using Patient Health Questionnaire-9 (PHQ-9) and Interpersonal Support Evaluation List (ISEL), respectively; alcohol consumption was measured via a self-report frequency measure that ranged from “0” (never) to “4” (more than 4 times a week). The association between social support and depression was studied using generalized estimating equation (GEE) models including alcohol use as an effect modifier and sex, age, race, marital status and perceived physical health as a priori covariates. This analysis included 567 participants. Results: At baseline, about 38.2% of participants reported some alcohol consumption in the past 90 days. Greater baseline social support was associated with improvements in depression severity. One unit increase in the baseline ISEL score predicted a 4.3% reduction (95%CI: 2.6%, 6.1%) in depression scores over time. Greater baseline alcohol consumption predicted an 11.9% increase (95%CI: 0.8%, 21.6%) in depression scores over time. We did not find a significant interaction between alcohol consumption and social support and changes in depression severity after adjusting for sex, age, race, marital status and perceived physical health. Conclusions: Among PSH residents in Fort Worth, Texas, greater social support was associated with a reduction in depression scores. Higher alcohol consumption was associated with an increase in depression scores. The protective effect of social support did not differ by alcohol consumption level. These findings can be used to design more robust health coaching programs for formerly homeless persons that integrate positive social support.
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    Sex Differences in the Effect of Physical Activity on Teen Sleep Patterns
    (2018-03-14) Roane, Brandy; Corral, Guilherme
    Introduction: Insufficient sleep durations, irregular sleep patterns, and poor sleep quality predict obesity including adverse changes to obesity-related outcomes like decreased physical activity (PA). In turn, increasing PA positively impacts sleep durations and quality. The transition from childhood to adolescence brings a decrease in PA with females showing a more significant decrease. This decrease in PA may be a contributing factor to the high rates of insufficient sleep and irregular sleep patterns in teens. To better understand these connections, we examined how PA influenced sleep duration and quality in teens. We expected that higher PA durations would predict longer sleep durations, more regular sleep patterns, and better sleep efficiency. We also explored sex differences to better understand how these connections play out during adolescence. Methods: Current analyses utilized baseline data from the initial week of a larger project (PI: Roane) that examined sleep and obesity-related behaviors in teens. Teens and caregivers provided informed consent/assent. Teens were given activity monitors to continuously capture sleep and physical activity. After one week, height and weight were measured for BMI %tile calculation. Sleep duration, sleep efficiency (SE), and physical activity were calculated from retrieved activity monitor data. Regression analyses examined mean physical activity duration as a predictor with BMI %tile as a covariate for (a) mean sleep duration, (b) sleep duration variability, (c) mean sleep efficiency, and (d) sleep efficiency variability. Results: Teens (n=26) were age 15 years, 27% Hispanic, 42% African American, and 73% female. Mean BMI %tile was 65th (female[f]: 71st, male[m]: 48th) and PA duration was 91 min (f: 82, m: 117). Mean sleep duration was 433 min (f: 429, m: 444); sleep duration variability was 78 min (f: 79, m: 74); SE was 95 (f: 95, m: 93); and SE variability was 5 (f: 5, m: 5). Regression analyses found PA duration predicted mean sleep duration. Analyses by sex indicated PA duration accounted for 74% of the variance in sleep duration for males only. All other findings were not statistically significant. Conclusions: Our analysis showed higher PA predicted longer sleep duration in males. These data provide further support for sex driven differences in how sleep contributes to obesity. Further study with a larger sample is warranted to better understand sex differences in the connection between sleep and obesity.