Communities in Action

Abstract

Background: Given indications of widening disparities in mortality for people with serious mental illness, understanding and reducing their risk of cardiovascular disease (CVD) and improving health-related quality of life is an urgent public health priority. This study examined CVD risk factor clustering, health-related quality of life (HRQoL), and their correlates among people with SMI who were overweight/obese (i.e., BMI ≥ 25) and living in supportive housing. Methods: Baseline data were used from participants enrolled in a clinical trial examining the effectiveness of a peer-led healthy lifestyle program. univariate analyses were used to describe the distribution of individual risk factors and the cumulative number of CVD risk factors. Bivariate and regression analyses were used to explore correlates of individual CVD risk factors, the cumulative number of risk factors, and HRQoL Physical and Mental Health Composite Scores. Results: Participants were 48.7 years old, on average (sd = 11.6) and the majority identi ed as male (57.3%) and as racial/ethnic minorities (82%; primarily non-Hispanic black). Most participants (75.4%) had at least two co-occurring CVD risk factors and almost half (46.7%) had three or more, most commonly obesity, smoking, and hypertension. Prevalence of individual risk factors, particularly smoking and diabetes, varied by demographic and clinical characteristics. Identifying as female, older age, and taking second generation antipsychotic medication were associated with having more co-occurring CVD risk factors, while having completed high school was associated with fewer risks. Number of co-occurring CVD risk factors, identifying as female, and greater psychiatric symptoms were negatively associated with physical HRQoL. Older age, lower psychiatric symptoms, and greater internal locus of control were positively associated with mental HRQoL. Conclusion: Even when compared to other studies examining CVD risk among individuals diagnosed with schizophrenia, our study sample generally had higher rates of clustering of multiple risk factors, highlighting the need for urgent intervention among those living in supportive housing. Demographic and clinical factors further identify those who may have the highest risk as well as factors that may adversely affect perceived health status and functioning. Reducing CVD risk and improving HRQoL will likely require expanding access to quality care, adapting intervention approaches to subpopulations, and providing increased support to facilitate health behavior change and perceived control for modi able risk factors. Trial Registration: This trial was registered through ClinicalTrials.gov on June 26, 2014. The registration number is NCT02175641.

Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

“…6,7 While the two concepts are intertwined, health equity has roots in social justice and human rights, defined as "the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance." 7,8 It can be seen as assurance of the conditions for optimal health for all people 9 and represents a striving for the best possible standard of health. 6,10 Health disparities are typically the metrics by which two different groups are compared.…”

Using social and behavioural science to support COVID-19 pandemic response

“…Issues of economic disadvantage intersect with issues of race and ethnicity. Members of minority communities (such as blacks, Latinos, and American Indians/Alaska Natives in the U.S.) are disproportionately found among the homeless 59 , the detained, the workers in high public contact but low-benefit occupations 65 , and those with prior health conditions that make them more vulnerable 66,67 . Because social networks tend to be racially differentiated 68 , members of minority communities who contract the disease may become vectors of transmission to others in their racial and ethnic communities 69 .…”

How Growing Geographic and Racial Disparities Inhibit the Ability to Live Longer and Healthier Lives: Report 1: National Level Analysis

“…to national averages. 7 Counties with a higher percentage of residents of color could also have a higher number of segregated neighborhoods and communities. While racial mix of neighborhood does not determine overall livability, racially concentrated communities are generally associated with poorer health because segregated communities can concentrate poverty-resulting in the exclusion and isolation of many residents from mainstream resources necessary for economic mobility, such as good schools, good jobs and access to banks and capital for business development.…”