Recent Submissions

  • The Relationship Among Predisposing and Enabling Factors or Barriers in Nurses Provision of Tobacco Control Interventions

    Daniel, Sandra D.; Georgia Prevention Institute (2003-05)
    The control o f tobacco use. the single most preventable cause o f disease in the U.S., is a national health priority. An estimated 70% o f smokers desire to quit; however, only 7% who quit remain abstinent one year later. It is recommended that all clinicians assess and document smoking status as the fifth vital sign. There is a demand for nurses, comprising the largest discipline of health care providers, to systematically incorporate tobacco control clinical practice guidelines in their practice as a means to lower tobacco related disease morbidity and mortality. There is a paucity o f knowledge on (a) the extent to which RNs deliver tobacco control interventions, (b) their educational preparation in tobacco control, and (3) factors that are associated with nurses tobacco control interventions. The purpose o f this study was to determine the relationship among predisposing factors and enabling factors or barriers in recently licensed registered nurses’ delivery of tobacco control interventions. The Educational and Ecological Assessment phase o f Green and Kreuter's PRECEDE-PROCEED Model served as the theoretical framework underpinning this study. A descriptive correlational cross-sectional design was utilized. RNs who received initial licensure in Georgia during 1999.2000. and 2001 were sampled utilizing a probability sampling method, stratified random sampling, to obtain a sample size o f approximately 10% o f the population within each year of licensure. The final sample consisted o f 468 participants. Findings indicated nurses’ performance in tobacco control interventions (ask. advise, assess, assist, arrange) was low, with the average score being only 37%. Thirty-percent o f RNs provided no tobacco control interventions. The majority had received no clinical experiences in smoking cessation techniques (78%) or tobacco prevention (70%). Univariable analyses found attitudes, beliefs in the importance o f tobacco control, tobacco education, extent o f education in tobacco cessation techniques, use o f clinical practice guideline, perceived importance of tobacco policy, prevention interventions, and peer barriers were significantly associated (p<.05) with nurses delivery o f tobacco control interventions. Multiple regression analyses utilizing a general linear model found attitudes, belief in importance o f tobacco control, tobacco education, prevention interventions, peer barriers, and institution barriers (negative correlation) accounted for significant variances (p<.05) in the tobacco control intervention scores.
  • Impaired Volume Regulation in Cardiovascular Disease in Two Distinct Populations

    Beavers, Melinda L. C.; Georgia Prevention Institute (2012-05)
    Volume dysregulation leads to congestive heart failure and death. The condition has been well-documented in both obesity-related cardiovascular disease and congenital heart disease. Our hypotheses are as follows: 1) Volume dysregulation, in the form of elevated systolic blood pressure and left ventricular mass index, is related to adiposity and aldosterone in adolescent boys but not girls. 2) Volume dysregulation, in the form of decreased nocturnal decline in blood pressure (non-dipping) is present in patients with tetralogy of Fallot, and is related to decreased left and right ventricular function. To test our first hypothesis, 100 healthy adolescents, recruited from area schools, were studied. Subjects were placed on a sodium-controlled diet for 4 days. Blood and urine samples were collected after one hour of rest. The protocol was repeated twice for each individual. Data were averaged between visits for greater statistical power. Adiposity and echocardiography measures were collected within 1 month of testing. Stepwise regression indicated that race and adiposity both contributed to the effects of aldosterone. For example, body mass index and race contributed to the model for aldosterone (Adjusted R2=0.303, p=0.002). In the aldosterone-hypertension risk relationship, stepwise regression indicated that only aldosterone contributed to the model for systolic blood pressure (Adjusted R2=0.098, p=0.023). To test our second hypothesis, 20 patients with repaired tetralogy of Fallot were recruited from clinic. Subjects completed a submaximal exercise test (modified Bruce) with echocardiography, and then wore an ambulatory blood pressure monitor for 24 hours. Of the 20 subjects with tetralogy of Fallot, 60% were 'non-dippers'. Race was significantly different between the dippers and non-dippers, with 1 of 8 African Americans being a dipper, and the remaining 7 African Americans being non-dippers (t=2.188, p=0.042). Right ventricular stroke volume (t=2.392, p=0.028) and ejection fraction (t=3.484, p=0.003) were significantly different between dippers and non-dippers. In a population of healthy adolescents with a well-distributed range of adiposity, increasing adiposity is associated with increasing aldosterone levels in boys but not girls. This is related to increasing systolic blood pressure and left ventricular mass in boys, but not in girls. These results may indicate an underlying volume dysregulation that contributes to hypertension and cardiovascular disease as a result of prolonged exposure to increased adiposity. In a population of 20 adolescents and young adults with repaired tetralogy of Fallot, nondipping is associated with decreased right ventricular stroke volume and ejection fraction, but is not associated with decreased left ventricular function. Patients with repaired tetralogy of Fallot and non-dipping may be at greater risk for failure due to the combination of pulmonary regurgitation with increased nocturnal pressures.
  • Effects of regular exercise vs sedentary after school program on mood and quality of life of overweight children

    Davis, Catherine L.; Bustamonte, Eduardo E.; Williams, Celestine; Waller, Jennifer L.; Georgia Regents University (2014)
  • Screening using alanine aminotransferase may overestimate prevalence of fatty liver in overweight black children

    Davis, Catherine L.; Pollock, Norman; Elam, Rachel; Zhu, Haidong; Bassali, Reda; Patel, Priya; Elmore, Stephen; Vos, Miriam; Department of Pediatrics; Department of Radiology; et al. (2014)
  • Prevention and Treatment of Cardiovascular Disease in Adolescents and Adults through the Transcendental Meditation(®) Program: A Research Review Update.

    Barnes, Vernon A.; Orme-Johnson, David W; Georgia Prevention Institute (2012-08)
    The pathogenesis and progression of cardiovascular diseases are thought to be exacerbated by stress. Basic research indicates that the Transcendental Meditation(®) technique produces acute and longitudinal reductions in sympathetic tone and stress reactivity. In adolescents at risk for hypertension, the technique has been found to reduce resting and ambulatory blood pressure, left ventricular mass, cardiovascular reactivity, and to improve school behavior. Research on adults with mild or moderate essential hypertension has reported decreased blood pressure and reduced use of anti-hypertensive medication. The technique has also been reported to decrease symptoms of angina pectoris and carotid atherosclerosis, to reduce cardiovascular risk factors, including alcohol and tobacco use, to markedly reduce medical care utilization for cardiovascular diseases, and to significantly decrease cardiovascular and all-cause morbidity and mortality. These findings have important implications for inclusion of the Transcendental Meditation program in efforts to prevent and treat cardiovascular diseases and their clinical consequences.(®)Transcendental Meditation and TM are trademarks registered in the US. Patent and Trademark Office, licensed to Maharishi Vedic Education Development Corporation and are used with permission.
  • Impact of Transcendental Meditation on Left Ventricular Mass in African American Adolescents

    Barnes, Vernon A.; Kapuku, Gaston K.; Treiber, Frank A.; Georgia Institute for Prevention of Human Diseases and Accidents; Department of Pediatrics (2012-05-22)
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  • Differential Impact of Stress Reduction Programs upon Ambulatory Blood Pressure among African American Adolescents: Influences of Endothelin-1 Gene and Chronic Stress Exposure

    Gregoski, Mathew J.; Barnes, Vernon A.; Tingen, Martha S.; Dong, Yanbin; Zhu, Haidong; Treiber, Frank A.; Georgia Institute for Prevention of Human Diseases and Accidents; Department of Pediatrics (2011-11-24)
    Stress-activated gene * environment interactions may contribute to individual variability in blood pressure reductions from behavioral interventions. We investigated effects of endothelin-1 (ET-1) LYS198ASN SNP and discriminatory stress exposure upon impact of 12-week behavioral interventions upon ambulatory BP (ABP) among 162 prehypertensive African American adolescents. Following genotyping, completion of questionnaire battery, and 24-hour ABP monitoring, participants were randomized to health education control (HEC), life skills training (LST), or breathing awareness meditation (BAM). Postintervention ABP was obtained. Significant three-way interactions on ABP changes indicated that among ET-1 SNP carriers, the only group to show reductions was BAM from low chronic stress environments. Among ET-1 SNP noncarriers, under low chronic stress exposure, all approaches worked, especially BAM. Among high stress exposure noncarriers, only BAM resulted in reductions. If these preliminary findings are replicated via ancillary analyses of archival databases and then via efficacy trials, selection of behavioral prescriptions for prehypertensives will be edging closer to being guided by individual's underlying genetic and environmental factors incorporating the healthcare model of personalized preventive medicine.
  • Cardiometabolic Biomarkers in Young Black Girls: Relations to Body Fatness and Aerobic Fitness, and Effects of a Randomized Physical Activity Trial

    Gutin, Bernard; Harris, Ryan A.; Howe, Cheryl A.; Johnson, Maribeth H.; Zhu, Haidong; Dong, Yanbin; Georgia Institute for Prevention of Human Diseases and Accidents; Department of Pediatrics; Department of Biostatistics and Epidemiology (2011-10-11)
    There is little evidence from randomized trials showing that physical activity alone influences biomarker profiles in youths. This study tested two hypotheses: (i) that elevated body fatness and poor fitness would be associated with unfavorable levels of cardiometabolic biomarkers in 8- 12-y-old black girls (n = 242) and (ii) that a 10-mo PA intervention would have favorable effects on the fatness-related cardiometabolic biomarkers. At baseline, all fatness indices (i.e., percent body fat, visceral adipose tissue, BMI, and waist circumference) were significantly (P < 0.05) associated with unfavorable levels of insulin, glucose, systolic BP, diastolic BP, triglycerides, C-reactive protein (CRP), and fibrinogen. Aerobic fitness was significantly (P < 0.05) associated with favorable levels of insulin, CRP, fibrinogen, and HDL2. The PA intervention had significant and favorable effects on fitness, fatness, and two biomarkersâ resting heart rate and LDL cholesterol. More research is needed to clarify what types of interventions can enhance the cardiometabolic health of youths.
  • Relations of diet and physical activity to bone mass and height in black and white adolescents

    Gutin, Bernard; Stallmann-Jorgensen, Inger S.; Le, Anh H.; Johnson, Maribeth H.; Dong, Yanbin; Georgia Institute for Prevention of Human Diseases and Accidents (2011-06-16)
    Because the development of healthy bodies during the years of growth has life-long health consequences, it is important to understand the early influences of diet and physical activity (PA). One way to generate hypotheses concerning such influences is to conduct cross-sectional studies of how diet and PA are related to different components of body composition. The subjects were 660 black and white adolescents. Total body bone mineral content (BMC) was measured with dual-energy X-ray absorptiometry; free-living diet and PA were assessed with 4â 7 separate 24-h recalls. The main dietary variables investigated were: total energy intake, macronutrient distribution (%), dairy servings, vitamin D, and calcium. The main PA variables were hours of moderate PA (3â 6 METs) and vigorous PA (>6 METs). BMC was higher in blacks than in whites (P<0.01) and it increased more in boys than in girls (age by sex interaction) as age increased (P<0.01). After adjustment for age, race and sex, higher levels of BMC were associated with higher levels of energy intake, dairy servings, calcium, vitamin D, and vigorous PA (all P 's<0.05). In the multivariable model, significant and independent proportions of the variance in BMC were explained by race, the age by sex interaction, calcium, and vigorous PA (all P 's<0.01). When height was used as the outcome variable, similar diet results were obtained; however, there was a sex by vigorous PA interaction, such that vigorous PA was associated with height only in the girls. These data are consistent with the hypothesis that the bone mass and height of growing youths are positively influenced by higher dietary intake of energy and dairy foods, along with sufficient amounts of vigorous PA. This hypothesis needs to be tested in randomized controlled trials.
  • Serum 25-hydroxyvitamin D and Ethnic Differences in Arterial Stiffness and Endothelial Function

    Alvarez, Jessica A.; Gower, Barbara A.; Calhoun, David A.; Judd, Suzanne E.; Dong, Yanbin; Dudenbostel, Tanja; Scholl, Jenni; Ashraf, Ambika P.; Georgia Institute for Prevention of Human Diseases and Accidents (2012-05-15)
    Background: Vitamin D reportedly influences vascular function, which is worse in African Americans (AAs) relative to European Americans (EAs). It is not clear if ethnic differences in 25(OH)D mediate differences in vascular function. This study examined the relationships of serum 25-hydroxyvitamin D (25(OH)D) with indicators of vascular function among healthy, young AA and EA adults.
  • Beyond Genome-Wide Association Studies: New Strategies for Identifying Genetic Determinants of Hypertension

    Wang, Xiaoling; Prins, Bram P.; Sõber, Siim; Laan, Maris; Snieder, Harold; Georgia Institute for Prevention of Human Diseases and Accidents; Department of Pediatrics (2011-12-28)
    Keywords: Linkage analysis
  • Obesity related methylation changes in DNA of peripheral blood leukocytes

    Wang, Xiaoling; Zhu, Haidong; Snieder, Harold; Su, Shaoyong; Munn, David H.; Harshfield, Gregory; Maria, Bernard L.; Dong, Yanbin; Treiber, Frank A.; Gutin, Bernard; et al. (2010-12-21)
    Background: Despite evidence linking obesity to impaired immune function, little is known about the specific mechanisms. Because of emerging evidence that immune responses are epigenetically regulated, we hypothesized that DNA methylation changes are involved in obesity induced immune dysfunction and aimed to identify these changes.
  • Impact of stress reduction on negative school behavior in adolescents.

    Barnes, Vernon A.; Bauza, Lynnette B; Treiber, Frank A.; Georgia Institute for Prevention of Human Diseases and Accidents; Department of Pediatrics; Department of Psychiatry and Health Behavior (2008-01-16)
    BACKGROUND: The purpose of this study was to determine the effect of stress reduction via the Transcendental Meditation program on school rule infractions in adolescents. METHODS: Forty-five African American adolescents (ages 15-18 years) with high normal systolic blood pressure were randomly assigned to either Transcendental Meditation (n = 25) or health education control (n = 20) groups. The meditation group engaged in 15-min sessions at home and at school each day for 4 months. The control group was presented 15-min sessions of health education at school each day for 4 months. Primary outcome measures were changes in absenteeism, school rule infractions and suspension days during the four-month pretest period prior to randomization compared with the four-month intervention period. RESULTS: Comparing the pretest and intervention periods, the meditation group exhibited a mean decrease of 6.4 absentee periods compared to an increase of 4.8 in the control group (p <.05). The meditation group exhibited a mean decrease of 0.1 infractions over the four months compared to an increase of 0.3 in the control group (p <.03). There was a mean reduction of 0.3 suspension days due to behavior-related problems in the meditation group compared to an increase of 1.2 in the control group (p <.04). CONCLUSION: These findings demonstrate that the Transcendental Meditation program conducted in the school setting has a beneficial impact upon absenteeism, rule infractions, and suspension rates in African American adolescents.
  • Heritability of insulin sensitivity and lipid profile depend on BMI: evidence for gene-obesity interaction.

    Wang, X; Ding, Xiuhua; Su, S; Spector, T D; Mangino, M; Iliadou, Anastasia; Snieder, H; Georgia Institute for Prevention of Human Diseases and Accidents (2010-01-21)
    AIMS/HYPOTHESIS: Evidence from candidate gene studies suggests that obesity may modify genetic susceptibility to type 2 diabetes and dyslipidaemia. On an aggregate level, gene-obesity interactions are expected to result in different heritability estimates at different obesity levels. However, this hypothesis has never been tested. METHOD: The present study included 2,180 British female twins. BMI was used as an index of general obesity. Outcome measures were insulin sensitivity (indexed by quantitative insulin-sensitivity check index [QUICKI]) and fasting plasma lipid profile. Structural equation modelling was used to test whether BMI interacted with latent genetic and environmental effects to impact on the outcome measures. RESULTS: Genetic influences on triacylglycerol increased with BMI (p < 0.001) whereas the unique environmental influence on QUICKI decreased with BMI (p < 0.001), resulting in a higher heritability estimate for both measures at higher BMI levels. This was further illustrated by stratified analysis in twin pairs concordant for normal weight and twin pairs concordant for overweight. Heritability was 19 percentage points higher for triacylglycerol (p < 0.001) and 31 percentage points higher for QUICKI (p < 0.01) among twins concordant for overweight than among twins concordant for normal weight. BMI had no moderator effect on the latent genetic and environmental factors for total cholesterol and HDL-cholesterol. CONCLUSIONS/INTERPRETATION: Our results suggest that the expression of genes influencing triacylglycerol and insulin sensitivity can vary as a function of obesity status. The substantial increases in the genetic contribution to the total variance in insulin sensitivity and triacylglycerols at higher BMIs may prove extremely valuable in the search for candidate genes.
  • FTO variant rs9939609 is associated with body mass index and waist circumference, but not with energy intake or physical activity in European- and African-American youth.

    Liu, Gaifen; Zhu, Haidong; Lagou, Vasiliki; Gutin, Bernard; Stallmann-Jorgensen, Inger S; Treiber, Frank A.; Dong, Yanbin; Snieder, Harold; Georgia Institute for Prevention of Human Diseases and Accidents (2010-05-05)
    BACKGROUND: Genome-wide association studies found common variants in the fat mass and obesity-associated (FTO) gene associated with adiposity in Caucasians and Asians but the association was not confirmed in African populations. Association of FTO variants with insulin resistance and energy intake showed inconsistent results in previous studies. This study aimed to assess the influence of FTO variant rs9939609 on adiposity, insulin resistance, energy intake and physical activity in European - (EA) and African-American (AA) youth. METHODS: We conducted a cross-sectional study in EA and AA youths. One thousand, nine hundred and seventy-eight youths (48.2% EAs, 47.1% male, mean age 16.5 years) had measures of anthropometry. Percent body fat (%BF) was measured by dual-energy X-ray absorptiometry, visceral adipose tissue (VAT) and subcutaneous abdominal adipose tissue (SAAT) by magnetic resonance imaging. Energy intake and physical activity were based on self report from up to 7 24-hour recalls. Physical activity was also measured by accelerometry. RESULTS: FTO rs9939609 was significantly associated with body mass index (BMI) (P = 0.01), weight (P = 0.03) and waist circumference (P = 0.04), with per-allele effects of 0.4 kg/m2, 1.3 kg and 0.8 cm, respectively. No significant association was found between rs9939609 and %BF, VAT, SAAT or insulin resistance (P > 0.05), or between rs9939609 and energy intake or vigorous physical activity (P > 0.05). No significant interactions of rs9939609 with ethnicity, gender, energy intake or physical activity were observed (P > 0.05). CONCLUSIONS: The FTO variant rs9939609 is modestly associated with BMI and waist circumference, but not with energy intake or physical activity. Moreover, these effects were similar for EAs and AAs. Improved understanding of the effect of the FTO variant will offer new insights into the etiology of excess adiposity.