Incorporation of a genetics-based information module into standardized diabetes patient education.

OBJECTIVE: The purpose of this study is to investigate the effectiveness of a genetics educational module created to improve understanding about the genetics of diabetes, assess motivation to engage in healthy lifestyle behaviors, and gauge interest in genetic testing for diabetes. METHODS: Participants were recruited from the Multidisciplinary Comprehensive Diabetes Clinic at the University of Alabama at Birmingham. Participants completed a pre-survey to assess three domains: (1) knowledge about diabetes etiology and testing, (2) healthy lifestyle behaviors, and (3) interest in genetic testing. Participants viewed a short, recorded educational module, then completed a post-survey to re-assess the domains. RESULTS: Participants increased knowledge about genetics of diabetes (p < 0.0001) and genetic testing (p = 0.0184), demonstrated motivation to adopt healthy behaviors (p < 0.0001), and decreased interest in genetic testing (p = 0.0833) after viewing the module. CONCLUSIONS: The educational module increased understanding of diabetes and increased motivation to adopt healthy behaviors. The need for patient-friendly educational modules explaining the genetics of diabetes will likely increase with continued discoveries of how genetics contributes to diabetes risk and outcomes. This short, educational module has the potential to provide genetic information in an effective way that is easily adapted in a routine clinic setting.

The Influence of Neighborhood Crime on Increases in Physical Activity during a Pilot Physical Activity Intervention in Children.

The purpose of this study was to examine whether neighborhood crime moderated the response (increases in steps) to a pilot intervention to increase physical activity in children. Twenty-seven insufficiently active children aged 6-10 years (mean age = 8.7 years; 56 % female; 59 % African American) were randomly assigned to an intensive intervention group (IIG) or minimal intervention group (MIG). Change in average daily number of steps from baseline was regressed against an index of neighborhood crime in a multilevel repeated-measures model that included a propensity score to reduce confounding. Safer neighborhoods were associated with higher increases in steps during the pilot intervention (interaction p = 0.008). Children in the IIG living in low-crime neighborhoods significantly increased their physical activity (5275 ± 1040 steps/day) while those living in high-crime neighborhoods did not (1118 ± 1007) (p for difference = 0.046). In the IIG, the increase in daily steps was highly correlated with neighborhood crime (r = 0.58, p = 0.04). These findings suggest the need for physical activity interventions to account for participants' environments in their design and/or delivery. To promote healthy behaviors in less-supportive environments, future studies should seek to understand how environments modify intervention response and to identify mediators of the relationship between environment and intervention.

A qualitative inquiry of the financial concerns of couples opting to use preimplantation genetic diagnosis to prevent the transmission of known genetic disorders.

Preimplantation genetic diagnosis (PGD) is an innovative prenatal testing option because the determination of whether a genetic disorder or chromosomal abnormality is evident occurs prior to pregnancy. However, PGD is not covered financially under the majority of private and public health insurance institutions in the United States, leaving couples to decide whether PGD is financially feasible. The aim of this qualitative study was to understand the role of finances in the decision-making process among couples who were actively considering PGD. In-depth, semi-structured interviews were completed with 18 genetic high-risk couples (36 individual partners). Grounded theory guided the analysis, whereby three themes emerged: 1) Cost is salient, 2) Emotions surrounding affordability, and 3) Financial burden and sacrifice. Ultimately, couples determined that the opportunity to avoid passing on a genetic disorder to a future child was paramount to the cost of PGD, but expressed financial concerns and recognized financial access as a major barrier to PGD utilization.

Elevated C-reactive protein in children from risky neighborhoods: evidence for a stress pathway linking neighborhoods and inflammation in children.

BACKGROUND: Childhood socioeconomic status is linked to adult cardiovascular disease and disease risk. One proposed pathway involves inflammation due to exposure to a stress-inducing neighborhood environment. Whether CRP, a marker of systemic inflammation, is associated with stressful neighborhood conditions among children is unknown. METHODS AND RESULTS: The sample included 385 children 5-18 years of age from 255 households and 101 census tracts. Multilevel logistic regression analyses compared children and adolescents with CRP levels >3 mg/L to those with levels ≤ 3 mg/L across neighborhood environments. Among children living in neighborhoods (census tracts) in the upper tertile of poverty or crime, 18.6% had elevated CRP levels, in contrast to 7.9% of children living in neighborhoods with lower levels of poverty and crime. Children from neighborhoods with the highest levels of either crime or poverty had 2.7 (95% CI: 1.2-6.2) times the odds of having elevated CRP levels when compared to children from other neighborhoods, independent of adiposity, demographic and behavioral differences. CONCLUSIONS: Children living in neighborhoods with high levels of poverty or crime had elevated CRP levels compared to children from other neighborhoods. This result is consistent with a psychosocial pathway favoring early development of cardiovascular risk that involves chronic stress from exposure to socially- and physically-disordered neighborhoods characteristic of poverty.