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Clark, Cheryl

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Clark

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Cheryl

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Clark, Cheryl
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Now showing 1 - 6 of 6
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    Television Viewing Time, Physical Activity, and Mortality Among African Americans
    (Centers for Disease Control and Prevention, 2018) Imran, Tasnim F.; Ommerborn, Mark; Clark, Cheryl; Correa, Adolfo; Dubbert, Patricia; Gaziano, John; Djousse, Luc
    Background: Prolonged television viewing time, a marker of sedentary activity, is independently associated with increased all-cause mortality; however, this association has rarely been studied in African Americans. The objective of our study was to examine the association between television viewing time and mortality among African Americans by using data from the Jackson Heart Study (JHS). Methods: We studied 5,289 participants from the JHS study who reported television viewing time (h/day) in the JHS baseline questionnaire from 2000 through 2004. Using multivariable Cox regression models adjusted for age, sex, smoking, alcohol use, physical activity, nutrition, prevalent coronary heart disease, chronic kidney disease, diabetes, and hypertension, we computed hazard ratios to examine the association between television viewing time (≤2 h/day, 2–4 h/day, and ≥4 h/day) and mortality. Results: Participants had a mean age of 55 years, and 64% were women. After a median follow-up of 9.9 years (interquartile range, 9.0–10.7), 615 deaths occurred (data analysis conducted in 2017). Hazard ratios for mortality were 1.08 (0.86–1.37) for television time of 2 to 4 hours per day and 1.48 (95% CI: 1.19–1.83) for television time of greater than or equal to 4 hours per day when compared with those who watched television less than 2 hours per day (P trend = .002). When we restricted analyses to those who performed leisure-time activities, the hazard ratios for mortality were 1.10 (95% CI, 0.84–1.45) for television viewing of 2 to 4 hours per day and 1.45 (95% CI, 1.13–1.86) for more than 4 hours per day compared with the less than 2 hours per day. Conclusion: Our findings suggest that greater television viewing time, even among those who perform leisure-time physical activities, is associated with increased all-cause mortality among African Americans. Thus, it may serve as an indicator of a sedentary lifestyle with potential for intervention.
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    State Medicaid Eligibility and Care Delayed Because of Cost
    (New England Journal of Medicine (NEJM/MMS), 2013) Clark, Cheryl; Ommerborn, Mark; Coull, Brent; Pham, Do Quyen; Haas, Jennifer
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    Association between features of patient-provider discussions and routine prostate-specific antigen testing
    (Public Library of Science, 2017) Liao, Joshua M.; Ommerborn, Mark J.; Clark, Cheryl
    Introduction: Although the US Preventive Services Task Force recommends against routine prostate cancer screening with prostate-specific antigen (PSA) testing, specialty organizations support screening via shared decision making between providers and selected patients. While discussions about advantages and disadvantages of testing are a feature of patient-centered care, it is unclear how provider recommendations and the presence of a personal doctor influence testing in the presence of such discussions. Materials and methods We used the 2013 Behavioral Risk Factor Surveillance System to identify 1,737 male respondents surveyed about their PSA testing decisions. We describe the prevalence of provider recommendations and utilize weighted multivariable logistic regression models to examine the impact of provider recommendations and presence of a personal doctor on routine testing while accounting for patient-provider discussions about advantages and disadvantages. Results: The majority (70.4%) of respondents reported some form of discussion with providers about testing and most underwent screening in accordance with provider recommendations. In multivariable analyses, men whose providers had never recommended PSA test were less likely to receive screening [OR 0.03, 95% CI (0.02–0.05)], and patients who did not identify a personal doctor in their care were less likely to undergo testing [OR 0.12, 95% CI (0.04–0.32)]. Discussion Provider recommendations and having a personal doctor are associated with routine PSA testing. These findings suggest that providers and policymakers should be aware of how the content and context of communication with patients, beyond discussions of risks and benefits, can influence routine PSA testing behaviors.
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    Cardiovascular Inflammation in Healthy Women: Multilevel Associations with State-Level Prosperity, Productivity and Income Inequality
    (BioMed Central, 2012) Clark, Cheryl; Ridker, Paul; Ommerborn, Mark J; Huisingh, Carrie E; Coull, Brent; Buring, Julie; Berkman, Lisa
    Background: Cardiovascular inflammation is a key contributor to the development of atherosclerosis and the prediction of cardiovascular events among healthy women. An emerging literature suggests biomarkers of inflammation vary by geography of residence at the state-level, and are associated with individual-level socioeconomic status. Associations between cardiovascular inflammation and state-level socioeconomic conditions have not been evaluated. The study objective is to estimate whether there are independent associations between state-level socioeconomic conditions and individual-level biomarkers of inflammation, in excess of individual-level income and clinical covariates among healthy women. Methods: The authors examined cross-sectional multilevel associations among state-level socioeconomic conditions, individual-level income, and biomarkers of inflammation among women (n = 26,029) in the Women's Health Study, a nation-wide cohort of healthy women free of cardiovascular diseases at enrollment. High sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1) and fibrinogen were measured between 1993 and 1996. Biomarker levels were examined among women within quartiles of state-level socioeconomic conditions and within categories of individual-level income. Results: The authors found that favorable state-level socioeconomic conditions were correlated with lower hsCRP, in excess of individual-level income (e.g. state-level real per capital gross domestic product fixed effect standardized Βeta coefficient [Std B] -0.03, 95% CI -0.05, -0.004). Individual-level income was more closely associated with sICAM-1 (Std B -0.04, 95% CI -0.06, -0.03) and fibrinogen (Std B -0.05, 95% CI -0.06, -0.03) than state-level conditions. Conclusions: We found associations between state-level socioeconomic conditions and hsCRP among healthy women. Personal household income was more closely associated with sICAM-1 and fibrinogen than state-level socioeconomic conditions. Additional research should examine these associations in other cohorts, and investigate what more-advantaged states do differently than less-advantaged states that may influence levels of cardiovascular inflammation among healthy women.
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    Lessons Learned Obtaining Informed Consent in Research with Vulnerable Populations in Community Health Center Settings
    (BioMed Central, 2012) Riden, Heather E; Grooms, Kya N; Clark, Cheryl; Cohen, Laura R; Gagne, Joshua; Tovar, Dora A; Ommerborn, Mark J; Orton, Piper S; Johnson, Paula
    Background: To improve equity in access to medical research, successful strategies are needed to recruit diverse populations. Here, we examine experiences of community health center (CHC) staff who guided an informed consent process to overcome recruitment barriers in a medical record review study. Methods: We conducted ten semi-structured interviews with CHC staff members. Interviews were audiotaped, transcribed, and structurally and thematically coded. We used NVivo, an ethnographic data management software program, to analyze themes related to recruitment challenges. Results: CHC interviewees reported that a key challenge to recruitment included the difficult balance between institutional review board (IRB) requirements for informed consent, and conveying an appropriate level of risk to patients. CHC staff perceived that the requirements of IRB certification itself posed a barrier to allowing diverse staff to participate in recruitment efforts. A key barrier to recruitment also included the lack of updated contact information on CHC patients. CHC interviewees reported that the successes they experienced reflected an alignment between study aims and CHC goals, and trusted relationships between CHCs and staff and the patients they recruited. Conclusions: Making IRB training more accessible to CHC-based staff, improving consent form clarity for participants, and developing processes for routinely updating patient information would greatly lower recruitment barriers for diverse populations in health services research.
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    Perceived Neighborhood Safety and Incident Mobility Disability Among Elders: The Hazards of Poverty
    (BioMed Central, 2009) Clark, Cheryl; Kawachi, Ichiro; Ryan, Louise; Ertel, K; Fay, Martha; Berkman, Lisa
    Background: We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 – 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards. Methods: We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level. Results: At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 – 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group. Conclusion: Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.