tbuckley/cabot-search huggingface dataset:
Abstract P1150: Self-Efficacy is Associated with Health Behaviors Related to Cardiovascular Risk among Hispanic/Latinx and Somali Immigrants to the United States
Authors: Brianna Tranby, Irene Sia, Matthew Clark, Paul Novotny, Abby M Lohr, Laura Suarez Pardo, Christi Patten, Sheila Iteghete, Katherine Zeratsky, Thomas Rieck, Luz Molina, Maria de la Luz Graciela Porraz Capetillo, Yahye Amed, Hana Dirie, Mark Wieland
Journal: Circulation (2025)

Introduction: Despite being healthier than the general population on arrival, immigrants to the US often face systemic barriers to healthy lifestyle behaviors and increased risk of cardiovascular disease (CVD). Self-efficacy has been associated with healthy diet and physical activity behaviors, but associations and construct validity have not been well studied in large samples of immigrant populations. Hypothesis: Self-efficacy for a healthy diet and physical activity will be associated with better dietary quality and intake and more physical activity, respectively. We also assessed the construct validity of measurement scales in this population. Methods: Set in southeast Minnesota and embedded with the Rochester Healthy Community Partnership, a 20-year community-based participatory research partnership, the Healthy Immigrant Community study enrolled Hispanic/Latinx and Somali immigrants into a randomized intervention to reduce obesity and CVD risks. Baseline assessments included biometric measures and self-reports of dietary intake, physical activity, and quality of life in English, Spanish, or Somali. Two self-efficacy items (“How confident are you that you can eat a healthy diet?”; “How confident are you that you can participate in regular exercise or physical activity?”) were rated as a percentage interval (0%=not at all confident; 25%; 50%=somewhat confident; 75%; 100%=very confident). Results: In total, 451 participants, 268 (59%) Hispanic/Latinx and 183 (41%) Somali, completed baseline assessments for this analysis. The mean age was 45 years (range=18-87), 59% were female, and 37% lacked health insurance over ≤12 months. Participants reporting more confidence to eat a healthy diet were more likely to eat fruits and vegetables as snacks ( p =&lt;0.001), and less likely to drink fruit drinks or sports drinks ( p =0.02) or regular soda ( p =&lt;0.001). Those reporting more confidence to be physically active were also reported higher levels of physical activity ( p =0.001). Validated self-efficacy scales had a wide distribution of scores, suggesting that the measures can be appropriately used among these immigrant communities. Conclusion: Higher self-efficacy for a healthy diet and physical activity were significantly associated with healthier eating and physical activity behaviors. Lifestyle interventions to reduce CVD risk may benefit from incorporating culturally tailored strategies to enhance self-confidence and support health equity in immigrant communities.
Abstract P3142: Moderating Role of Psychosocial Risk and Resilience in the Relationship Between Neighborhood Disadvantage and Incident Cardiovascular Disease Across Ethnoracial Groups: MESA Cohort 2000-2019
Authors: Hannah Pleasants, Ganga Bey, James Pike
Journal: Circulation (2025)

Introduction: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the U.S., with neighborhood disadvantage as a well-established risk factor. Emerging evidence indicates a role for psychosocial risk and resilience factors in influencing these relationships, but the interplay between environmental and psychosocial factors across ethnoracial groups is poorly understood. This study examined whether psychosocial factors moderated the relationship between neighborhood disadvantage and person-level incident CVD in a multiracial, multiethnic cohort. Methods: We examined data from 4,326 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study who were free of CVD at baseline and were assessed between July 17, 2000 and February 4, 2012. The exposure was neighborhood disadvantage quantified by the Area Deprivation Index. Moderators were optimism measured by the Life Orientation Test revised and anger measured by the State-Trait Anger Expression Inventory which includes subscales state anger, trait anger temperament, and trait anger reaction. We used covariate-adjusted, cause-specific, multilevel Cox models to generate hazard ratios and 95% CI for four self-identified ethnoracial groups—Black, Chinese, Hispanic/Latino[g1] , and White. Results: Mean age at baseline was 62.6 years old (10.0 SD) and 53.2% of participants were female. Only among Black participants did higher optimism levels mitigate the effect of neighborhood disadvantage on incident CVD ( Figure 1 ). In Black and Hispanic/Latino participants, higher levels of state anger and trait anger reactivity magnified the association between neighborhood disadvantage and incident CVD, while among Chinese participants, a more angry temperament exhibited a similar effect. The interaction between environmental and psychosocial factors was not statistically significant among White participants. Conclusion: Our findings support the need for CVD interventions that address neighborhood socioeconomic and psychosocial characteristics while considering the sociocultural differences between ethnoracial groups.
Abstract 064: Fairness Heterogeneity of the PREVENT Equations in US Young Adults
Authors: Abigail Gauen, Lucia Petito, Mengnan Zhou, Hui Zhou, Jaejin An, Yiyi Zhang, Kristi Reynolds, Donald Lloyd-Jones, Norrina Allen
Journal: Circulation (2025)

Background: In 2023, the AHA published Predicting Risk of cardiovascular disease EVENTs (PREVENT), a new set of race-agnostic risk prediction equations that estimate 10-year risk of cardiovascular disease (CVD) in US adults ages 30-79 years. Equations include a base model and a model adding social deprivation index (SDI). Aim: To evaluate fairness of the base and SDI-enhanced PREVENT equations across race/ethnicity and sex groups in US young adults. Methods: We included adults aged 20-39 years enrolled between 2008-2009 without a history of CVD from Kaiser Permanente Southern California. From the eligible sample of 266,378, we randomly selected 50,000 young adults for computational efficiency. Primary outcome was incident CVD (defined as myocardial infarction, fatal coronary heart disease, fatal and nonfatal stroke, and heart failure) at 10 years. We estimated 10-year CVD risk using the PREVENT base and SDI-enhanced models. To assess race-sex specific model performance, we used Brier score, Harrell’s C, and mean calibration in each group. Overall algorithmic fairness was evaluated by (1) fair calibration, which measures whether agreement between predicted and observed risk is equally accurate across groups using Hosmer-Lemeshow goodness-of-fit and pairwise Wilcoxon signed-rank tests, and (2) concordance imparity, which measures the largest deviation of discriminative abilities across racial and ethnic groups by taking the difference between maximum and minimum Harrell’s C across groups. Results: We included 50,000 young adults who were mean (SD) age 31.7 (5.4) years, 61.3% female, and 51.1% Hispanic, who had 312 incident CVD events by 10 years. Performance metrics were similar in the base and SDI-enhanced equations. Models were under-calibrated in Black and White females and Asian and Black males, indicating observed risk was higher than predicted risk. Agreement between predicted and observed risk was not equally accurate across racial and ethnic groups in males or females (biased calibrated). Discriminative abilities also varied across groups, with Harrell’s C highest in Black males and lowest in Asian females. Concordance imparity was similar in the base and SDI-enhanced models (0.097 vs. 0.095). Conclusion: The PREVENT equations may not provide consistent risk predictions for young adults across race/ethnicity and sex groups, which could lead to unequal CVD prevention efforts. Addition of SDI to the PREVENT equations did not provide improvement in fairness.
Abstract P1071: Training in motivational interviewing for pediatricians was associated with a higher uptake of wellness coaching: Results from the KP Wellness Coaching for Families and Kids (WC4K) Program
Authors: Corinna Koebnick, Eden Moore, Jessica Vallejo, Margo Sidell, Xia Li, Emerson Delacroix, Deborah Young, Poornima Kunani, Ken Resnicow
Journal: Circulation (2025)

Objective: To determine the association between motivational interviewing (MI) training for pediatricians and the parental or guardian’s uptake of wellness coaching during the Wellness Coaching for Kids implementation. Methods: Pediatricians from 24 (of 49) randomly assigned pediatric clinics across Southern California were trained in MI to motivate eligible parents and children to engage in health coaching to improve health behaviors. Eligible children were 3 to 8 years at referral, with a body mass index (BMI) ≥85th percentile for age. Two years after the program started, we analyzed the proportion of parents/guardians who engaged in wellness coaching after referral by the MI-training status of pediatricians. Results: Among 233 pediatricians from 24 intervention clinics, 53% (n=123) participated in MI training, and 44% (n=102) referred at least one parent to wellness coaching. Out of 19,888 eligible children with a well-child visit, 10.3% (n=2045) were referred to wellness coaching (=reached). The reach was higher in MI-trained compared to untrained pediatricians (20.4±10.1% and 7.0±10.2%, respectively, p=0.003). Among those referred, 49.9% (n=1021) scheduled a coaching appointment, and 43.3% (n=886) received at least one coaching call (=uptake). The uptake of patients with MI-trained pediatricians was significantly higher (aOR 2.3; 95%CI 1.4, 3.6) than the uptake of patients with untrained pediatricians from intervention practices. Conclusion: Parental uptake of wellness coaching was higher when referred by MI-trained pediatricians suggesting MI can be successful for brief interventions to engage patients to initiate health behaviors and lifestyle change treatment related to childhood obesity in primary care.
Abstract P3138: Experiences of Discrimination in the Healthcare Setting and the Impact on Healthcare Utilization among Black Adults with Hypertension
Authors: Yendelela Cuffee, Alexandra Wynn, Angelina Ng, Elena Lynn, Alyssa Brown, Portia Jackson Preston
Journal: Circulation (2025)

Introduction: Experiencing discrimination in healthcare settings negatively impacts health care utilization and outcomes, contributing to health disparities. Discrimination is a psychosocial stressor, and when experienced in healthcare is linked with distrust of healthcare providers, fewer preventive screenings, and poorer physical well-being. These effects are particularly concerning for individuals with hypertension who require regular treatment from medical professionals. The objective of this study is to examine healthcare utilization among Black adults with hypertension who have experienced racial discrimination in healthcare settings. Hypothesis: We hypothesize that Black adults with hypertension, individuals that have experienced racial discrimination in the healthcare setting may be less likely to utilize the healthcare system. Methods: We conducted a cross-sectional analysis using 2020 California Health Interview Survey data. Participants were Black adults aged 18 or older with self-reported hypertension. To assess healthcare utilization we utilized survey items, including delays in seeking medical care, visits to the emergency room, and delays in prescriptions. Data was analyzed using descriptive statistics, chi-square tests, and ordinal logistic regression using STATA Version 18. Results: The study sample included 532 participants with an average age of 55 and the majority identified as women (62.4%). Eleven percent of participants reported experiencing discrimination in the healthcare setting. Approximately 15.7% of participants reported delays in seeking medical care in the past 12 months and 12.4% reported delays in refilling prescriptions. The adjusted analysis did not reveal a statistically significant relationship between discrimination in the healthcare setting and prescriptions delays (OR 1.11, p = 0.782) or having a usual source of health care (OR 0.79, p = 0.683). The findings revealed that participants reporting no delays in seeking medical care within the past 12 months (OR 3.19, p = &lt;0.001) were less likely to experience discrimination in the healthcare setting. Conclusion: Within this sample of Black adults with hypertension, discrimination was associated with utilization of the ER and delays in medical care. In conclusion, the study findings underscore the persistent effects of racial discrimination and highlights a need for addressing discrimination in healthcare settings to create meaningful improvements in quality of care for Black patients.
Abstract P1007: Detecting Physical Frailty Phenotype Using Wearable Device
Authors: Lingsong Kong, Kuan-Yuan Wang, Kailin Xu, Yuchen Liu, Joel Miscione, Jillian Qua, Eric Regina, Dae Kim, Amanda Paluch
Journal: Circulation (2025)

Introduction: Identifying and monitoring frailty can inform optimal care for older adults. This study aimed to detect frailty using wearable device-measured movement behaviors (MBs). Hypothesis: We hypothesized that random forest models were able to detect frailty using MBs. Methods: This cross-sectional study included 44 older adults living in the community (79.6±9.3 years old; 84% females). The Fried Frailty Phenotype (FFP) was defined as having 3 or more of unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. Participants wore a thigh-worn ActivPAL for 10 consecutive days. MBs were quantified as: 1) overall activity (activity score, daily steps and number of sit-to-stand), 2) time in postures (standing, stepping, sitting and lying), 3) time in bed, 4) time in sitting bouts over 30 min and 60 min, 5) stepping counts and time in &lt;1, 1-5, 5-10 and 10-20 min bouts, 6) stepping counts and time in cadences &gt;75 and &gt;100, and 7) peak stepping counts in 10 seconds, 2, 6, and 10 min. Random forest models were developed to classify FFP and its 5 individual components, with age, sex, BMI, and MBs as predictor variables. Results: Eleven (25%) participants were frail. The average ActivPAL wear time was 9.14±1.49 days. The model achieved an AUC [95% CI] of 0.85 [0.71-0.99] for FFP. The 5 most important predictors were time in standing, stepping time in &lt; 1 min bouts, time in stepping, stepping counts in 10-20 min bouts, and stepping counts in 1-5 min bouts (Table). The models for individual FFP components also achieved AUC [95% CI] of 0.90 [0.77-1.00] for unintentional weight loss, 0.89 [0.78-1.00] for exhaustion, 0.88 [0.76-0.99] for slowness, 0.81 [0.63-0.99] for low physical activity, and 0.94 [0.87-1.00] for weakness (Table). Conclusions: A thigh-worn wearable device can detect FPP with high accuracy. Once validated in an independent sample, our algorithm can be useful for frailty assessment and monitoring.
Abstract P1078: Association of Poverty with Pharmacy Access in Minnesota
Authors: Jeremy Van't Hof, Katherine Knowles, David Van Riper, Pamela Lutsey, Paul Drawz, Wendy St Peter
Journal: Circulation (2025)

Background: Pharmacy access is important for medication adherence and may be a modifiable factor which could improve health equity in the management of cardiovascular disease risk factors. Methods: We geocoded all MN pharmacies in 2022 and determined the population weighted, mean drive times from each census tract to the nearest pharmacies. Census tracts were stratified by urban and rural status and divided into quartiles by poverty defined as the proportion of families living below the 75% poverty line. Poverty quartiles were characterized by demographic and income data from the 2016-2019 American Community Survey. We evaluated differences in pharmacy access by poverty quartile using one-way ANOVA. Results: In both rural and urban quartiles, the lowest poverty quartile (Q1) was majority white (96% and 83% respectively) with more college graduates (30% and 50% respectively) compared to the highest poverty quartile (Q4, 20% and 31% respectively). Q4 was more racially diverse – rural 88% white, 1% Black, 5% Hispanic; urban 61% white, 18% Black, 10% Asian, 10% Hispanic. Among urban census tracts Q1-Q3 had similar pharmacy drive times (3.3-3.5 min, Table) while Q4 (highest poverty) had a shorter mean drive time (2.8 min) and more pharmacies available within 10 and 15 min drive times compared to Q1 (Table, p&lt;0.01 for all pharmacy access measures). Among rural census tracts, drive time to the nearest pharmacy was shortest in Q1 and Q4. Compared to Q1, rural residents in Q4 had a longer drive to the 2 nd nearest pharmacy (15.5 min vs 13.1 min) and fewer pharmacies within 15 min drive time (2.6 vs 5.9; Table, p&lt;0.01 for all measures). Conclusion: Pharmacy access may be an important factor in low income rural communities. However, restricted pharmacy access did not correlate strongly with under-resourced neighborhoods in urban communities. Barriers to medication access are likely multifactorial and may differ between urban and rural areas
Abstract P2124: Association between accelerometer-corrected physical activity and the prevalence of hypertension, diabetes, and obesity: Results from Korea National Health and Nutrition Examination Survey, 2014-2017
Authors: Woo Young Shin, Ji-Yeob Choi, Hyo Lee, Miyoung Lee
Journal: Circulation (2025)

Background: Self-reported measurements have been used as a monitoring approach because it is difficult to objectively assess physical activity levels at a population level. Our aims were to assess the validity of self-reported physical activity data compared with accelerometer-based measurements in adults and to investigate the association between self-reported physical activity (Study 1) and the prevalence risk of hypertension, diabetes, and obesity, had physical activity been measured by accelerometer instead (Study 2). Methods: We used data from the 2014-2017 Korea National Health and Nutrition Examination Survey, which involved a nationally representative sample of n=20,059 Korean adults aged 20-79 years. Participants in our Global Physical Activity Questionnaire (GPAQ) survey wore an accelerometer (Actigraph GT3X+) for a period of seven days. We used a regression model to calculate validity coefficients and attenuation factors using accelerometer-measured physical activity as the criterion measure. Associations between moderate-to-vigorous physical activity status and the prevalence of hypertension, diabetes, and obesity were determined using multiple logistic regression calibration method. Results: The results from Study 1 showed that participants tended to overreport their physical activity levels when measured through GPAQ, with this tendency being more pronounced among those with lower levels of physical activity. Additionally, women and individuals with higher education or income were more accurate in reporting their physical activity levels than others. Study 2 revealed that the associations between the prevalence of hypertension, diabetes, and obesity and adjusted physical activity were considerably deattenuated, after correcting for measurement error in self-reported physical activity. The prevalence ratio (PR) for hypertension and diabetes for higher levels of self-reported physical activity, using the inverse hyperbolic sine function (IHS) transformation, was 0.79 (95% CI: 0.78, 0.80) and 0.75 (95% CI: 0.74, 0.77), respectively. Conclusions: The associations between physical activity and the prevalence risk of hypertension, and diabetes are significantly attenuated by the overestimation of self-reported physical activity, suggesting that the beneficial effects of physical activity may have been underestimated in the past. Further research will analyze the association between physical activity and mortality.
Abstract MP28: Healthy Eating for the Planet, Cardiovascular Health, and Longevity: An Observational Study
Authors: Jiaqi Yang, Valerie Sullivan, Casey Rebholz
Journal: Circulation (2025)

Introduction: There is insufficient evidence on the impact of the environmentally sustainable diet proposed by the EAT- Lancet Commission on cardiovascular disease (CVD) and mortality in the US population. Methods: Dietary intake was assessed by a 66-item food frequency questionnaire at visit 1 (1987-1989) and visit 3 (1993-1995) in the Atherosclerosis Risk in Communities (ARIC) study. The Planetary Health Diet Index (PHDI) was used to assess adherence to the EAT -Lancet reference diet. Incident CVD was a composite outcome of coronary heart disease (CHD), stroke, and heart failure. CVD mortality and all-cause mortality were defined as deaths based on International Classification of Diseases codes and National Death Index. Participants were followed until December 31, 2021. Associations between PHDI and CVD outcomes and mortality were analyzed using Cox proportional hazards models and adjusted for covariates. Results: In 13,095 US adults, participants in the highest quintile of PHDI had a lower risk of total CVD (HR 0.84; 95%CI 0.77, 0.93; P -trend &lt; 0.001) in the multivariable-adjusted model, compared with those in the lowest quintile ( Figure ). The inverse association was consistently observed across CVD subtypes (CHD: HR 0.83; 95%CI 0.72, 0.96; P -trend = 0.007; stroke: HR 0.77; 95%CI 0.65, 0.92; P -trend = 0.003; heart failure: HR 0.87; 95%CI 0.78, 0.98; P -trend = 0.01). Participants in the highest versus lowest quintile of PHDI had a 16% and 13% lower risk of CVD mortality and all-cause mortality, respectively (both P -trend &lt; 0.005). Conclusions: Higher adherence to PHDI was consistently associated with a lower risk of total CVD, CVD subtypes, CVD mortality, and all-cause mortality in a general population of US adults.