Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control.

BACKGROUND: In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control. METHODS: We used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. RESULTS: We determined that the mean number of QALYs would be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Most simulation results indicated that intensive treatment would be cost-effective (51 to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76 to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime. CONCLUSIONS: In this simulation study, intensive systolic blood-pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness-to-pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or persisted for the patient's remaining lifetime. (Funded by the National Heart, Lung, and Blood Institute and others; SPRINT ClinicalTrials.gov number, NCT01206062 .).

A Brief Inpatient Intervention Using a Short Video to Promote Reduction of Child Tobacco Smoke Exposure.

OBJECTIVES: Tobacco smoke exposure (TSE) increases the risk for respiratory-related disease and hospitalizations. The hypothesis of this study was that a brief intervention (which included a motivational video) provided to parents and caregivers during their child's hospitalization would be associated with improved knowledge and behavior changes that may reduce the child's TSE. METHODS: Parents and caregivers of children hospitalized for respiratory illnesses with TSE were recruited between June and December 2012. They completed a questionnaire to determine baseline knowledge regarding the health effects of smoke exposure. The intervention included a motivational video, written smoking cessation materials, and referral to the state quitline. The questionnaire was repeated after the intervention; telephone follow-up at 1 and 3 months included knowledge questions and assessed behavior changes. Paired t tests were used to compare preintervention and postintervention knowledge scores. RESULTS: A total of 167 parents/caregivers were enrolled. The mean preintervention knowledge score was high at 5.4 of 6, which improved for 60 parents/caregivers (36%, P < .001) after the intervention and was sustained at follow-up. Follow-up was obtained from 123 (74%) parents/caregivers, and 90% reported behavior changes to reduce TSE. There was a 13% reported quit rate among the 99 parents/caregivers who smoked (95% confidence interval: 7-21). Other behavior changes reported included initiating home and vehicle smoking bans, discussing reduction of the child's smoke exposure, and showing the video to others. Improvement in knowledge after this brief intervention was associated with reported initiation of home and vehicle smoking bans (P < .01). CONCLUSIONS: Parents and caregivers of smoke-exposed children hospitalized for respiratory illnesses had high baseline knowledge of the effects of TSE. A brief intervention that included a motivational video was associated with reported behavior changes in parents/caretakers that decreased second- and third-hand smoke. Improvement of knowledge was associated with institution of home and vehicle smoking bans.

Physical Activity Patterns of Latina Immigrants Living in Alabama.

BACKGROUND: Latinos are the fastest growing minority group in the Southeastern USA. Latinos living in the USA have a higher prevalence of obesity, metabolic diseases, and physical inactivity compared to non-Latino Whites, particularly Latina women. The objective of this study is to assess the patterns of physical activity (PA) in overweight Latina immigrants in Alabama using a self-report and an accelerometer. METHODS: Participants included foreign-born Latina women age ≥19 years with BMI ≥25 kg/m(2). The Global Physical Activity Questionnaire was used to assess self-reported physical activity. Accelerometers were used as an objective measure of physical activity. RESULTS: Among 44 overweight/obese Latina immigrants (mean age 36.6 years and BMI 33.3 kg/m(2)), 36.4 % met PA recommendations by self-report while only 20.5 % met recommendations according to the accelerometer. Self-report sedentary activity was underestimated (186 min/day self-report vs. 575 min/day accelerometer) while moderate activity was overestimated (34 min/day self-report vs. 15 min/day accelerometer). While the number of years living in the USA was positively associated with vigorous activity (r=0.32, p= 0.03), the number of years living in Alabama tended to be positively associated with sedentary activity and negatively associated with moderate activity. CONCLUSIONS: Latina immigrants living in Alabama overestimated the amount of time spent in moderate PA and underestimated time spent in sedentary activity.

A focus group study of Mexican immigrant men's perceptions of weight and lifestyle.

OBJECTIVE: Despite interest in family-centered obesity and diabetes prevention programs for Latinos, few studies have assessed men's perspectives on obesity-related behaviors. The objective of this study was to explore Mexican immigrant men's perspectives regarding weight, diet, and physical activity as they relate to the individual and the family. DESIGN AND SAMPLE: This was a focus group study with a convenience sample of Mexican immigrant men (n = 16). MEASURES: A moderator's guide was used to elicit perceptions of personal and family behaviors influencing weight and lifestyle. RESULTS: Mean age of participants was 41 years (SD ± 12.7), and 100% were born in Mexico. Mean time in Alabama was 8 years. Perceived benefits of a healthy weight included improved mobility and decreased morbidities. Perceived barriers to a healthy lifestyle included demanding work schedules and an environment not conducive to walking. Participants described immigration as having a negative impact on family unity and established meal structures. CONCLUSION: Previous studies among Latinas cite husband resistance as a barrier to sustained diet and lifestyle change; however, men in this study voiced openness to programs for obesity and diabetes prevention. Future family centered programs should engage men and promote communication within the family on common goals related to health and illness prevention.