BACKGROUND Poor medication adherence is a significant problem in hypertensive African Americans. Although motivational interviewing (MINT) is effective for adoption and maintenance of health behaviors in patients with chronic diseases, its effect on medication adherence remains untested in this population. METHODS This randomized controlled trial tested the effect of a practice-based MINT counseling versus usual care (UC) on medication adherence and blood pressure (BP) in 190 hypertensive African Americans (88% women; mean age 54 years). Patients were recruited from two community-based primary care practices in New York City. The primary outcome was adherence measured by electronic pill monitors; the secondary outcome was within-patient change in office BP from baseline to 12 months. RESULTS Baseline adherence was similar in both groups (56.2% and 56.6% for MINT and UC respectively, p = 0.94). Based on intent-to-treat analysis using mixed effects regression, a significant time X group interaction with model-predicted post-treatment adherence rates of 43% and 57% were found in the UC and MINT groups, respectively (p = 0.027), with a between-group difference of 14% (95% CI, −0.2% to −27%). The between-group difference in systolic and diastolic BP was −6.1 mm Hg (p = .065) and −1.4 mm Hg (p = .465), respectively, in favor of the MINT group. CONCLUSIONS A practice-based MINT counseling led to steady maintenance of medication adherence over time, compared to significant decline in adherence for UC patients. This effect was associated with a clinically meaningful net reduction in systolic BP in favor of the MINT group.

Preliminary evidence indicates that asthma patients limit exercise and healthy lifestyle activities to avoid respiratory symptoms. This self-imposed decrease in activity, even among those with mild disease, may predispose to long-term general health risks. The objectives of this qualitative study were to determine patients' views about exercise and lifestyle activities and to determine if these views varied depending on asthma characteristics. During in-person interviews, 60 patients were asked open-ended questions about asthma and perceived barriers and facilitators to exercise and lifestyle activities, particularly walking. Responses were coded and corroborated by independent investigators and then compared according to asthma severity, knowledge, self-efficacy, and attitudes. Although most patients acknowledged the importance of exercise, many either limited or did not participate in exercise because of asthma and other conditions. Patients cited both internal and external barriers to exercise, such as lack of motivation, time constraints, and extreme weather affecting asthma. Patients identified multiple facilitators, such as social support and the desire to be healthy. Lifestyle activities were preferred over formal exercise regimens. Patients with more severe disease were more likely to believe that exercise was not good for asthma. Patients with less knowledge, less self-efficacy, and worse attitudes toward asthma also were more likely to have negative perspectives about exercise. In conclusion, for many patients, asthma is a deterrent to physical activity and predisposes to inactivity. Developing interventions to foster prudent lifestyle activities and exercise among asthma patients should be a priority to decrease long-term health risks.

Background Outcomes following heart failure ( HF ) hospitalizations are poor, with 90‐day mortality rates of 15% to 20%. Although prior studies found associations between individual social determinants of health ( SDOH ) and post‐discharge mortality, less is known about how an individuals’ total burden of SDOH affects 90‐day mortality. Methods and Results We included participants of the REGARDS ( Re asons for Geographic and Racial Differences in Stroke) Study who were Medicare beneficiaries aged ≥65 years discharged alive after an adjudicated HF hospitalization. Guided by the Healthy People 2020 Framework, we examined 9 SDOH . First, we examined age‐adjusted associations between each SDOH and 90‐day mortality; those associated with 90‐day mortality were used to create an SDOH count. Next, we determined the hazard of 90‐day mortality by the SDOH count, adjusting for confounders. Over 10 years, 690 participants were hospitalized for HF at 440 unique hospitals in the United States; there were a total of 79 deaths within 90 days. Overall, 28% of participants had 0 SDOH , 39% had 1, and 32% had ≥2. Compared with those with 0, the age‐adjusted hazard ratio for 90‐day mortality among those with 1 SDOH was 2.89 (95% CI, 1.46–5.72) and was 3.06 (1.51–6.19) among those with ≥2 SDOH . The adjusted hazard ratio was 2.78 (1.37–5.62) and 2.57 (1.19–5.54) for participants with 1 SDOH and ≥2, respectively. Conclusions While having any of the SDOH studied here markedly increased risk of 90‐day mortality after an HF hospitalization, a greater burden of SDOH was not associated with significantly greater risk in our population.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the disease coronavirus 2019 (COVID-19), has ravaged the United States since the first case was documented in Washington State in January 2020. By early March, the first case of COVID-19 was confirmed in New York. From the very first case to present day, it has become increasingly clear that densely populated cities bear the brunt of this disease. In New York City as of July 7, 2020, approximately 214 000 cases and 18 000 deaths have been documented. While COVID-19 has had a worldwide impact, suspicions about its disproportionate effects on minority populations have now been confirmed with the release of data stratified by race and ethnicity. Within New York, we are witnessing 2 distinct trajectories and risk groups defined along the lines of race and socioeconomic status. As of July 7, 2020, the age-adjusted death rate for Hispanic and Black patients is twice that of White patients. 1 Additionally, the Bronx, Queens, and Brooklyn each have twice the number of cases per 100 000 individuals as Manhattan and 3 to 4 times the number of cases as Staten Island. The reasons for these disparities have been discussed at length and include rates of preexisting comorbidities, a majority of the population employed in essential bluecollar jobs, living conditions, health literacy, and access to health care. 2 The impact of these changes on already wellestablished cancer care disparities is unknown but potentially devastating. At this time, oncologists have had to make difficult decisions weighing the benefits of treatment against the risks of COVID-19 infection and the increased risk of death among patients with cancer. Surgeries have been postponed, and chemotherapy and radiotherapy regimens have been delayed or altered to expedite treatment and minimize risk of exposure to coronavirus. It remains unclear the extent to which active or prior cancer diagnosis influences one's risk of COVID-19 infection. In a study of 1099 Chinese patients, cancer patients comprised 1% of COVID-19 cases. However, in initial reports from New York City, patients with cancer represent 6% of COVID-19 cases and 8% to 9% of those deemed critically ill or requiring mechanical ventilation. Moreover, patients with non-small cell lung cancer comprised more than half of COVID-19 cancer cases, suggesting differing susceptibilities based on the primary disease. 3 Nationwide, the breast cancer mortality rate is 40% higher for Black patients compared with White patients. In New York City, this inequity has worsened over time, increasing from 19% to 27% between 2005 to 2014. Similarly, the cervical cancer mortality rate is 23% higher for Hispanic women and 71% higher for Black women as well as for those residing in poorer neighbor-VIEWPOINT

Participants who are unconnected to health or social services or government health insurance are less likely to have been vaccinated in the past although these persons are willing to receive vaccine if it were available.

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ObjectiveTo examine social network member characteristics associated with weight loss.MethodsCross-sectional examination of egocentric network data from 245 Black and Hispanic adults with BMI ≥ 25 kg/m2 enrolled in a small change weight loss study. The relationship between weight loss at 12 months and characteristics of helpful and harmful network members (relationship, contact frequency, living proximity and body size) were examined.ResultsThere were 2,571 network members identified. Mean weight loss was -4.8 (±11.3) lbs. among participants with network help and no harm with eating goals vs. +3.4 (±7.8) lbs. among participants with network harm alone. In a multivariable regression model, greater weight loss was associated with help from a child with eating goals (p=.0002) and coworker help with physical activity (p=.01). Weight gain was associated with having network members with obesity living in the home (p=.048) and increased network size (p=.002).ConclusionsThere was greater weight loss among participants with support from children and coworkers. Weight gain was associated with harmful network behaviors and having network members with obesity in the home. Incorporating child and co-worker support, and evaluating network harm and the body size of network members should be considered in future weight loss interventions.