Community perspectives on AI/ML and health equity: AIM-AHEAD nationwide stakeholder listening sessions.

Artificial intelligence and machine learning (AI/ML) tools have the potential to improve health equity. However, many historically underrepresented communities have not been engaged in AI/ML training, research, and infrastructure development. Therefore, AIM-AHEAD (Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity) seeks to increase participation and engagement of researchers and communities through mutually beneficial partnerships. The purpose of this paper is to summarize feedback from listening sessions conducted by the AIM-AHEAD Coordinating Center in February 2022, titled the "AIM-AHEAD Community Building Convention (ACBC)." A total of six listening sessions were held over three days. A total of 977 people registered with AIM-AHEAD to attend ACBC and 557 individuals attended the listening sessions across stakeholder groups. Facilitators led the conversation based on a series of guiding questions, and responses were captured through voice and chat via the Slido platform. A professional third-party provider transcribed the audio. Qualitative analysis included data from transcripts and chat logs. Thematic analysis was then used to identify common and unique themes across all transcripts. Six main themes arose from the sessions. Attendees felt that storytelling would be a powerful tool in communicating the impact of AI/ML in promoting health equity, trust building is vital and can be fostered through existing trusted relationships, and diverse communities should be involved every step of the way. Attendees shared a wealth of information that will guide AIM-AHEAD's future activities. The sessions highlighted the need for researchers to translate AI/ML concepts into vignettes that are digestible to the larger public, the importance of diversity, and how open-science platforms can be used to encourage multi-disciplinary collaboration. While the sessions confirmed some of the existing barriers in applying AI/ML for health equity, they also offered new insights that were captured in the six themes.

Cardiovascular risk and communication among early stage breast cancer survivors.

OBJECTIVE: African American (AA) women have disproportionately high rates of cardiovascular (CV) risk factors that, coupled with potentially cardiotoxic breast cancer (BC) therapies, place them at risk of adverse CV outcomes. The purpose of this study was to assess CV risk factors among white and AA BC survivors and perceptions of patient-provider CV-related communication and post-treatment information needs. METHODS: Early-stage, English-speaking BC survivors were recruited through community-based survivorship organizations/clinics in New Jersey. Qualitative, semi-structured interviews and a brief survey of socio-demographics and comorbidities were conducted. RESULTS: BC survivors reported high rates of CV risk factors. Most reported their health as good/excellent despite their cancer history and CV risk profile. Approximately half of overweight/obese BC survivors reported no weight-related conversation with their health care team and, among those who reported discussion, 36% indicated it was self-initiated and dismissed. More than half of BC survivors' reported a desire for lifestyle-related information and guidance. CONCLUSION: BC survivors may not understand how their separate, yet cumulative, health issues can impact their CV risk. PRACTICE IMPLICATIONS: Patient-provider communication on behavioral risk factor modification and CV risk is needed, particularly among at-risk subgroups such as AA and obese BC survivors, to improve BC and CV outcomes.

Perceptions of Cancer Risk: Differences by Weight Status.

Despite the strong link between obesity and cancer development, individuals are less likely to identify obesity as a risk factor for cancer than family history. Family history of cancer has been documented to influence perceived risk of developing cancer, yet it is unclear if excess weight impacts cancer risk perceptions. The purpose of this study was to examine absolute and relative risk perceptions for cancer by weight status. Cross-sectional data were obtained from the National Cancer Institute's 2011 Health Information National Trends Survey (n = 2585). Demographics, anthropometric data, family history of cancer, health behaviors, and absolute and relative cancer risk perceptions were evaluated. The effect of weight and family history on absolute and relative cancer risk perceptions was analyzed through weighted descriptive and logistic regression analyses. 22.8 and 28.6 % of subjects reported that they were very unlikely/unlikely to develop cancer in their lifetime (absolute risk) and when compared to others their age (relative risk), respectively. Findings indicated differences in risk perceptions between those with and without a family history of cancer (p < 0.0001). No significant differences were found between BMI categories for absolute cancer risk perceptions despite stratification by family history. Obese subjects were more likely to have an increased relative risk perception of cancer compared to healthy weight subjects (p = 0.0066); this association remained significant when stratified by family history (p = 0.0161). Educating individuals, especially those who are overweight/obese, about the impact of excess weight on cancer risk may improve risk accuracy and promote cancer risk reduction through weight management.

Perceptions of Primary Care Among Breast Cancer Survivors: The Effects of Weight Status.

BACKGROUND: Obese breast cancer survivors (BCSs) are impacted by diminished quality of life (QOL), multiple comorbid conditions, and poor disease outcomes. Despite national guidelines recommending a healthy weight to improve QOL and outcomes posttreatment, support and education are not routinely provided to BCSs in primary care. To fill this gap, we assessed perceptions of primary care received among BCSs by weight status. METHODS: Cross-sectional surveys were administered to early-stage BCSs (N = 188) from 2 New Jersey cancer centers between May 2012 and July 2013. Sociodemographics, medical history, functional health status, perceived satisfaction with one's primary care provider (PCP), and PCP involvement in follow-up care were assessed. RESULTS: In total, 82% of overweight BCSs and 30% of obese BCSs reported not being told by their doctor that they were overweight or obese, despite these conditions being highly prevalent (35% and 35%, respectively). Obese BCSs were more likely than healthy weight BCSs to be African American, have a higher comorbidity score, poorer functional health, and greater satisfaction with their PCPs. CONCLUSION: The PCP-patient encounter may represent an opportunity for PCPs to correct misperceptions and promote weight reduction efforts among BCSs, thus improving QOL and disease outcomes.

Working together to solve disparities: Latina/o parents' contributions to the adaptation of a preventive intervention for childhood conduct problems.

Left untreated, conduct problems can have significant and long-lasting negative effects on children's development. Despite the existence of many effective interventions, U.S. Latina/o children are less likely to access or receive evidence-based services. Seeking to build the foundation to address these service disparities, the current study used a Community-Based Participatory Research approach to examine U.S. Latina/o parents' perceptions of the need for interventions to prevent childhood disruptive behaviors in their community in general, and of an existing evidence-based intervention-parent-child interaction therapy (PCIT)-in particular. Results suggest that parents recognize a need for prevention resources in their community and value most of the core features of PCIT. Nevertheless, important directions for potential adaptation and expansion of PCIT into a prevention approach were identified. Results point to several goals for future study with the potential to ameliorate the unmet mental health needs experienced by U.S. Latina/o families with young children at risk for developing conduct problems.

Exploring the role of Natural Helpers in efforts to address disparities for children with conduct problems.

The incorporation of natural helpers into services has been suggested as an innovative strategy to address disparities for historically underserved children with conduct problems. In order to inform incorporation efforts, this study examined the perceptions of natural helpers serving one U.S. Latina/o community regarding need for services for children with conduct problems, their reactions to a specific parent training intervention, and the training and support needed to deliver this intervention successfully. Participants identified a need for culturally-responsive services for children with conduct problems, and felt that parent training would be appropriate for the families they serve. Participants further identified specific training and support that they would require in order to deliver parent training with fidelity and effectiveness. Findings support the suggestion that natural helpers have the potential to address service disparities among Latina/o children with conduct problems. Recommendations from natural helpers should guide the development of culturally-adapted preventive interventions that help address existing service disparities.

Coping style as a mediator of the relationship between depressive symptoms and deliberate self-harm.

BACKGROUND: Deliberate self-harm (DSH) occurs with high frequency among clinical and nonclinical youth populations. Although depression has been consistently linked with the behavior, not all depressed individuals engage in DSH. AIMS: The current study examined maladaptive coping strategies (i.e., self-blame, distancing, and self-isolation) as mediators between depression and DSH among undergraduate students. METHODS: 202 students from undergraduate psychology courses at a private university in Southern California (77.7% women) completed anonymous self-report measures. RESULTS: A hierarchical regression model found no differences in DSH history across demographic variables. Among coping variables, self-isolation alone was significantly related to DSH. A full meditational model was supported: Depressive symptoms were significantly related to DSH, but adding self-isolation to the model rendered the relationship nonsignificant. LIMITATIONS: The cross-sectional study design prevents determination of whether a casual relation exists between self-isolation and DSH, and obscures the direction of that relationship. CONCLUSIONS: Results suggest targeting self-isolation as a means of DSH prevention and intervention among nonclinical, youth populations.

A randomized clinical trial of secondary prevention among women hospitalized with coronary heart disease.

BACKGROUND: Secondary prevention improves survival, yet implementation is suboptimal. We tested the impact of a systematic hospital-based educational intervention vs. usual care to improve rates of adherence to secondary prevention guidelines among women hospitalized with coronary heart disease (CHD), according to their ethnic status. METHODS: Women (n = 304, 52% minorities) hospitalized with CHD were randomly assigned to a systematic secondary prevention educational intervention vs. usual care. Adherence to goals for smoking cessation, weight management, physical activity, blood pressure <140/90 mm Hg, low-density lipoprotein cholesterol (LDL-C) <100 mg/dL (2.59 mmol/L), and use of aspirin/anticoagulants, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors were assessed at 6 months. RESULTS: On admission, minority women were less likely than white women to meet the goals for blood pressure (OR = 0.46, 95% CI 0.26-0.80), LDL-C (OR = 0.57, CI 0.33-0.94), and weight management (OR = 0.40, 95% CI 0.20-0.82). There was no difference between the intervention and usual care groups in a summary score of goals met at study completion; however, minority women in the intervention group were 2.4 times more likely (95% CI 1.13-5.03) to reach the blood pressure goal at 6 months compared with minority women in usual care. White women in the intervention group were 2.86 times more likely (95% CI 1.06-7.68) to report use of beta-blockers at 6 months compared with white women in usual care. In a logistic regression model, the interaction term for ethnic status and group assignment was significant for achieving the blood pressure goal (p = 0.009). CONCLUSIONS: A healthcare systems approach to educate women about secondary prevention and blood pressure control may differentially benefit ethnic minority women compared with white women.

Association of acculturation status with beliefs, barriers, and perceptions related to cardiovascular disease prevention among racial and ethnic minorities.

Acculturation has been correlated with traditional cardiovascular disease risk factors. The purpose of this study was to examine the association between acculturation and health beliefs, barriers, and perceptions related to cardiovascular disease prevention. Racial/ethnic minority participants in the Family Intervention Trial for Heart Health were included in this analysis. Less acculturated minorities were more likely to have health beliefs that may impede prevention, have greater perceived susceptibility to disease, and believe in an external locus of control. Evaluating acculturation in clinical practice may be an opportunity to promote awareness, healthy behaviors, and prevention among immigrants.

Waist circumference, body mass index, and their association with cardiometabolic and global risk.

Total body fat and adipose tissue distribution are associated with cardiometabolic risk, yet there are conflicting data as to whether waist circumference (WC) or body mass index (BMI) is a better predictor of cardiovascular risk. To determine whether WC or BMI was more strongly associated with cardiometabolic risk, family members of patients with cardiac disease were studied (N=501; mean age, 48 years; 66% female; 36% nonwhite). Height, weight, WC, BMI, blood pressure, high-density lipoprotein cholesterol, triglycerides, glucose, high-sensitivity C-reactive protein, and lipoprotein-associated phospholipase A(2) were systematically measured. Global risk was calculated using the Framingham function. Increased WC and BMI were equally strong predictors of cardiometabolic and global risk. The prevalence of cardiometabolic risk factors and their correlation with WC and BMI varied by race/ethnicity. Our data support inclusion of WC and BMI in screening guidelines for diverse populations to identify individuals at increased cardiometabolic risk.

Influence of caregiving on lifestyle and psychosocial risk factors among family members of patients hospitalized with cardiovascular disease.

BACKGROUND: Few data have evaluated the relationship between caregiving and cardiovascular disease (CVD) risk. OBJECTIVE: The purpose of this study was to determine the prevalence and predictors of caregiver strain and to evaluate the association between caregiving and CVD lifestyle and psychosocial risk factors among family members of recently hospitalized CVD patients. DESIGN AND PARTICIPANTS: Participants in the NHLBI Family Intervention Trial for Heart Health (FIT Heart) who completed a 6-month follow-up were included in this analysis (n = 263; mean age 50 +/- 14 years, 67% female, 29% non-white). MEASUREMENTS: At 6 months, standardized information was collected regarding depression, social support, and caregiver strain (high caregiver strain = > or =7). Information on lifestyle risk factors, including obesity, physical activity, and diet, were also collected using standardized questionnaires. Logistic regression models on the association between caregiving and CVD risk factors were adjusted for significant confounders. RESULTS: The prevalence of serving as a CVD patient's primary caregiver or caring for the patient most of the time was 50% at 6 months. Caregivers (primary/most) were more likely to be women (81% vs 19%, p < .01), married/living with someone (p < .01), >50 years old (p < .01), have < or = high school education (p < .01), be unemployed (p < .01), get less physical activity (p < .01), and have a higher waist circumference (p < .01) than non-caregivers (some/occasional/none). Mean caregiver strain scores were significantly higher among those with depressive symptoms (p < .01) and low social support (p < .01) in a multivariable adjusted model. CONCLUSIONS: Caregivers of cardiac patients may be at increased risk themselves for CVD morbidity and mortality compared to non-caregivers due to suboptimal lifestyle and psychosocial risk factors.

A novel family-based intervention trial to improve heart health: FIT Heart: results of a randomized controlled trial.

BACKGROUND: Family members of patients with cardiovascular disease (CVD) may be at increased risk due to shared genes and lifestyle. Hospitalization of a family member with CVD may represent a "motivational moment" to take preventive action. METHODS AND RESULTS: A randomized, controlled clinical trial was conducted in healthy adult family members (N=501; 66% female; 36% nonwhite; mean age, 48 years) of patients hospitalized with CVD to evaluate a special intervention (SI) with personalized risk factor screening, therapeutic lifestyle-change counseling, and progress reports to physicians versus a control intervention (CIN) on the primary outcome, mean percent change in low-density lipoprotein cholesterol (LDL-C), and other risk factors. Validated dietary assessments and standardized risk factors were obtained at baseline and 1 year (94% follow-up). At baseline, for 93% of subjects, saturated fat comprised > or = 7% of total caloric intake, and 79% had nonoptimal LDL-C levels (of which 50% were unaware). There was no difference in the SI versus the CIN with respect to the mean percent change in LDL-C (-1% versus -2%, respectively; P=0.64), owing to a similar significant reduction in LDL-C in both groups (-4.4 mg/dL and -4.5 mg/dL, respectively). Diet score significantly improved in the SI versus the CIN (P=0.04). High-density lipoprotein cholesterol declined significantly in the CIN but not in the SI (-3.2% [95% CI, -5.1 to -1.3] versus +0.3% [95% CI, -1.7 to +2.4]; P=0.01). At 1 year, SI subjects were more likely than controls to exercise >3 days per week (P=0.04). CONCLUSIONS: The SI was not more effective than the CIN in reducing the primary end point, LDL-C. The screening process identified many family members of hospitalized patients with CVD who were unaware of their risk factors, and further work is needed to develop and test interventions to reduce their CVD risk.

Nine-year trends and racial and ethnic disparities in women's awareness of heart disease and stroke: an American Heart Association national study.

BACKGROUND: The purpose of this study was to evaluate trends in women's awareness, knowledge, and perceptions related to cardiovascular disease (CVD) since 1997, when the American Heart Association initiated a national campaign for women. METHODS AND RESULTS: A nationally representative sample of 1,005 women identified through random digit dialing (mean age 50 years, 71% white) was surveyed in 2006, and results were compared with results of similar surveys conducted in 2003, 2000, and 1997. Awareness, knowledge, and perceptions related to CVD were evaluated using a standardized interviewer-assisted questionnaire. In 2006, awareness of heart disease as the leading cause of death among women was 57%; significantly higher than in prior surveys (p < 0.001). Awareness was lower among black and Hispanic women compared with white women (31% and 29% vs. 68%, p < 0.05), and the racial/ethnic difference has not appreciably changed over time. More than twice as many women felt uninformed about stroke compared to heart disease in 2006 (23% vs. 11%, p < 0.05). Hispanic women were more likely than white women to report that there is nothing they can do to keep themselves from getting CVD (22% vs. 11%, p < 0.05). The majority of respondents (> or = 50%) reported confusion related to basic CVD prevention strategies. CONCLUSIONS: CVD awareness has increased significantly among women since 1997, yet the racial/ethnic gap in awareness has not narrowed. Educational efforts to increase heart disease and stroke awareness should be targeted to racial/ethnic minorities, especially Hispanics. Methods to reinforce basic CVD prevention strategies are needed.

Predictors of quality of life among women with coronary heart disease.

BACKGROUND: Health-related quality of life (HRQOL) is an increasingly relevant outcome as the population ages and associated morbidities increase. The purpose of this study was to evaluate predictors of HRQOL among ethnically diverse women hospitalized for coronary heart disease (CHD) and determine the impact of a brief, educational intervention on HRQOL 6 months post-hospitalization. METHODS: Women (n = 160; mean age 63 years, 53% minority) admitted for CHD at three academic hospitals who completed a 6 month secondary prevention trial were studied. The SF-36 was administered at admission and 6 months. Multiple linear regressions were used to identify significant independent predictors of 6 month HRQOL. RESULTS: Significant improvements in HRQOL were noted from admission to 6 months post-hospitalization. Subjects reporting better HRQOL at 6 months included those who were employed, married, physically active, enrolled in cardiac rehabilitation, and not depressed. Women who received an educational intervention had significantly less bodily pain at 6 months compared with usual care in a model adjusted for baseline HRQOL and physical activity goal adherence (p = 0.04). CONCLUSIONS: Baseline HRQOL (8 SF-36 subscales), physical activity (3 SF-36 subscales) and marital status (1 SF-36 subscale) were the major determinants of HRQOL at 6 months post-hospitalization. Future interventions and preventive efforts should be targeted to women with CHD who have impaired HRQOL and may be at increased risk of poor clinical outcomes.

Quality of cardiovascular disease preventive care and physician/practice characteristics.

BACKGROUND: Quality of cardiovascular disease (CVD) preventive care is suboptimal. Recent data correlated increasing years in practice for physicians with lower-quality health care. OBJECTIVE: The purpose of this study was to assess physician awareness/adherence to national blood pressure, cholesterol, and CVD prevention guidelines for women according to physician/practice characteristics. DESIGN: Standardized online survey and experimental case studies were administered to 500 randomly selected U.S. physicians. Multivariable regression models tested physician age, gender, specialty, and practice type as independent predictors of guideline awareness/adherence. RESULTS: Compared with older physicians (50+ years), younger physicians (<50 years) reported a lower level of awareness of cholesterol guidelines (P=.04) and lower incorporation of women's guidelines (P=.02). Yet, older physicians were less likely to recommend weight management for high-risk cases (P=.03) and less confident in helping patients manage weight (P=.045) than younger physicians. Older physicians were also less likely to identify a low-density lipoprotein<100 mg/dL as optimal versus younger physicians (P=.01), as were solo versus nonsolo practitioners (P=.02). Solo practitioners were less aware of cholesterol guidelines (P=.04) and were more likely to prescribe aspirin for low-risk female patients than nonsolo practitioners (P<.01). Solo practitioners rated their clinical judgment as more effective than guidelines in improving patient health outcomes (P<.01) and more frequently rated the patient as the greatest barrier to CVD prevention versus nonsolo practitioners (P<.01). CONCLUSIONS: Though guideline awareness is high, efforts to promote their utilization are needed and may improve quality outcomes. Targeted education and support for CVD prevention may be helpful to older and solo physicians.

National study of women's awareness, preventive action, and barriers to cardiovascular health.

BACKGROUND: There is growing awareness of cardiovascular disease (CVD) as the leading cause of death in women, but whether this greater awareness is associated with increased action by women to lower their personal or family's risk is unknown. METHODS AND RESULTS: A nationally representative sample of 1008 women selected through random-digit dialing were given a standardized questionnaire about history of CVD/risk factors, awareness of leading cause of death, knowledge of healthy and personal levels of CVD risk factors, self-reported actions taken to reduce risk, and barriers to heart health. The rate of awareness of CVD as the leading cause of death has nearly doubled since 1997 (55% versus 30%) was significantly greater for whites compared with blacks and Hispanics (62% versus 38% and 34%, respectively) and was independently correlated with increased physical activity (odds ratio, 1.35; 95% CI, 1.00 to 1.83) and weight loss (odds ratio, 1.47; 95% CI, 1.14 to 2.02) in the previous year in logistic regression models. Fewer than half of the respondents were aware of healthy levels of risk factors. Awareness that personal level was not healthy was positively associated with action. Most women took steps to lower risk in family members and themselves. The most frequently cited barriers for heart health were confusion in the media (49%), the belief that health is determined by a higher power (44%), and caretaking responsibilities (36%). CONCLUSIONS: General awareness of CVD risk among women is associated with preventive action. Educational interventions need to be targeted at racial/ethnic minority women.

Waist circumference predicts cardiometabolic and global Framingham risk among women screened during National Woman's Heart Day.

PURPOSE: To evaluate the cardiometabolic risk profiles of 6938 women (mean age 49.2 +/- 14.6 years) attending the 2005 Sister to Sister: Everyone Has a Heart Foundation free public health standardized cardiovascular disease (CVD) risk factor screening events in 12 cities across the United States by race/ethnicity and waist circumference. MAIN FINDINGS: Among women without a history of CVD or diabetes (n = 6327), 90% were found to have at least one major modifiable CVD risk factor, with one-third of women having three or more major risk factors. Nearly half of all women with elevated total cholesterol (> or = 200 mg/dL) or low high-density lipoprotein (HDL)-cholesterol (< 50 mg/dL) did not report a known history of abnormal cholesterol. Among women with no history of hypertension, 16% had a blood pressure > or = 140/90 mm Hg. Unrecognized diabetes and glucose intolerance were striking among fasting women (n = 1218; 9% had a blood glucose > or = 126 mg/dL and 43% had a blood glucose > or = 100 mg/dL). In adjusted logistic regression models, women with a waist circumference > or = 35 inches were more likely to have blood pressure > or = 140/90 (OR = 1.9, p < 0.0001), total cholesterol > or = 200 mg/dL (OR = 1.2, p = 0.006), HDL-cholesterol < 50 mg/dL (OR = 2.5, p < 0.0001), fasting glucose > or = 100 mg/dL (OR = 2.0, p < 0.0001), and Framingham global risk score > or = 10%, CVD or diabetes (OR = 2.0, p < 0.0001). Waist circumference was significantly correlated with Framingham global risk (r = 0.24, p < 0.001) and number of risk factors (r = 0.24, p < 0.0001). Increased clustering of risk factors was predictive of waist size > or = 35 inches vs. < 35 inches in logistic models (p for trend > 0.0001). Among a subsample of women who underwent standardized screening for stress and depression, 62% had stress levels associated with increased cardiac risk, and 27% met criteria for clinical depression. CONCLUSIONS: Hypertension, dyslipidemia, and/or impaired fasting glucose were newly identified in approximately half the women screened. Waist size significantly correlated with clustering of risk factors, global Framingham risk score, CVD and diabetes, suggesting it may be an easily measured surrogate for women at increased risk of future cardiovascular clinical events who may benefit from further assessment and intervention.

Coronary heart disease in ethnically diverse women: risk perception and communication.

OBJECTIVES: To assess perceived vs calculated risk of coronary heart disease (CHD), preferred methods of communicating risk, and the effect of brief educational intervention to improve accurate perceptions of personal risk. SUBJECTS AND METHODS: Of 1858 women who underwent screening mammography between April and September 2003 at the Columbia University Medical Center in New York, NY, we assessed 125 women with no history of cardiovascular disease who participated in a risk factor screening and education program. Demographic variables were evaluated by interviewer-assisted standardized questionnaires. Absolute 10-year CHD risk was calculated using the Framingham global risk assessment. Perceived 10-year risk and preferred method of communicating risk were evaluated systematically. RESULTS: Among 110 research participants who were eligible for risk estimation, 59% had a 10-year risk of less than 10%. However, only half of those women accurately perceived their risk as low. After a brief educational intervention, the women's ability to correctly categorize their personal CHD risk improved significantly. Preferred methods to communicate risk varied by level of education and age. Older women (> or = 65 years) and those with a high school education or less were more likely to prefer simple methods of having CHD risk communicated compared with their counterparts. CONCLUSIONS: These data underscore the need to determine preferences for providing risk information and to test various formats for communicating CHD risk to improve awareness and management of CHD risk factors, especially among women of different age groups and education levels.