Objectives

To evaluate a faith-based intervention (Sisters in Motion) intended to increase walking in older, sedentary African-American women.

Design

Randomized controlled trial using within-church randomization.

Setting

Three Los Angeles churches.

Participants

Sixty-two African-American women aged 60 and older who reported being active less than 30 minutes three times per week and walked less than 35,000 steps per week as measured using a baseline pedometer reading.

Intervention

Intervention participants received a multicomponent curriculum including scripture readings, prayer, goal-setting, a community resource guide, and walking competitions. Intervention and control participants both participated in physical activity sessions.

Measurements

The primary outcome was change in weekly steps walked as measured using the pedometer. Secondary outcomes included change in systolic blood pressure (SBP). Outcomes were assessed at baseline and 6 months after the intervention.

Results

Eighty-five percent of participants attended at least six of eight sessions. Intervention participants averaged 12,727 steps per week at baseline, compared with 13,089 steps in controls. Mean baseline SBP was 156 mmHg for intervention participants and 147 mmHg for controls (P=.10). At 6 months, intervention participants had increased their weekly steps by 9,883 on average, compared with an increase of 2,426 for controls (P=.02); SBP decreased on average by 12.5 mmHg in intervention participants and only 1.5 mmHg in controls (P=.007).

Conclusion

The Sisters in Motion intervention led to an increase in walking and a decrease in SBP at 6 months. This is the first randomized controlled trial of a faith-based physical activity program to increase physical activity in older African-American women and represents an attractive approach to stimulate lifestyle change in this population.

We developed and conducted a community based randomized controlled trial to evaluate the impact of an intervention to promote retirement saving among low and moderate income, predominantly Spanish speaking Hispanics, who do not have access to an employer sponsored retirement account. Our educational intervention provided participants with key information related to financial planning for retirement in Spanish and made use of "behavioral nudges" to encourage participants to open a federal sponsored retirement saving account, my Retirement Account (myRA). Among 142 participants (70 and 72 in control and treatment groups, respectively), we found a significant difference-in-difference (DD) on the proportion of those who opened a myRA. In the treatment group we had 14 percent of participants opened myRA, while in the control group we had no one. Results from a DD regression show that after controlling for observable and unobservable characteristics through our design as a randomized controlled trial, the effect of our intervention is 12 percent. When we restrict our sample to those participants who had a bank account at some point of the study, we find that the effect of our intervention is higher (17 percent). We also found that our intervention is effective increasing self-reported knowledge related to retirement saving and preparedness.

We conducted a qualitative study on retirement preparedness among middle-aged and older low-income Hispanics in Los Angeles. Data were derived from four focus groups conducted in the greater Los Angeles area. Findings demonstrate how behavioral and cultural factors-family experiences, religiosity, and denial of retirement-explain the lack of savings and preparedness for retirement. Findings also indicate that the majority of participants want to be economically independent and to keep working until they are unable to do so. Participants helped their parents financially but did not feel comfortable asking their own children for help. Instead, participants placed their survival in retirement "in God's hands."

For this study, we conducted seven focus groups in the Los Angeles area with a total of 70 participants (42 Latinos and 28 African Americans) recruited from three senior centers and a church. There was a wide variety of responses in relation to the usage of financial services among participants. We found that although some participants seem to participate more in the formal financial sector and show a higher level of sophistication when managing their finances, other participants' use of formal financial institutions is minimal. Among African American participants, we found several instances in which individuals feel very comfortable using banks. Lower levels of participation in the formal financial sector were found among the lower income Latino participants. In relation to barriers to participate in the financial sector, supply was not an issue, but demand and behavioral factors seem more important. Overall, no participants saved very much on a regular basis. We also find that participants in general do not want to ask their children for money, and also do not want to save and accumulate wealth to leave to their children.

Purpose of review

The purposes of this review are to identify population characteristics of important risk factors for the development and progression of diabetic kidney disease (DKD) in the United States and to discuss barriers and opportunities to improve awareness, management, and outcomes in patients with DKD.

Recent findings

The major risk factors for the development and progression of DKD include hyperglycemia, hypertension, and albuminuria. DKD disproportionately affects minorities and individuals with low educational and socioeconomic status. Barriers to effective management of DKD include the following: (a) limited patient and healthcare provider awareness of DKD, (b) lack of timely referrals of patients to a nephrologist, (c) low patient healthcare literacy, and (d) insufficient access to healthcare and health insurance. Increased patient and physician awareness of DKD has been shown to enhance patient outcomes. Multifactorial and multidisciplinary interventions targeting multiple risk factors and patient/physician education may provide better outcomes in patients with DKD.

We examine the association of patient activation and physical activity and fruit and vegetable consumption among obese safety net patients. Adult obese patients (n = 198) of three safety net clinics completed a survey assessing patient activation, physical activity, fruit and vegetable consumption, care experiences, and health status. Multivariate logistic regression models incrementally assessed the adjusted relation of patient activation and physical activity and fruit and vegetable consumption. In adjusted analyses, higher activated patients had higher odds [Odds ratio (OR) 1.58, p < 0.01] of consuming fruits and vegetables daily than less activated patients. There was no significant association between patient activation and regular physical activity. Engaging in regular physical activity appears to be difficult, even for highly activated patients. In contrast, additional fruit and vegetable consumption is a relatively easier change. Patient activation was inconsistently associated with two positive health behaviors among obese safety net patients.

Background

To determine if requiring Dual Eligible Special Need Plans (D-SNPs) to receive approval from the National Committee of Quality Assurance and contract with state Medicaid agencies impacts healthcare utilization.

Methods

We use a Multiple Interrupted Time Series to examine the association of D-SNP regulations with dichotomized measures of emergency room (ER) and hospital utilization. Our treatment group is elderly D-SNP enrollees. Our comparison group is near-elderly (ages 60-64) beneficiaries enrolled in Medicaid Managed Care plans (N = 360,405). We use segmented regression models to estimate changes in the time-trend and slope of the outcomes associated with D-SNP regulations, during the post-implementation (2012-2015) period, relative to the pre-implementation (2010-2011) period. Models include a treatment-status indicator, a monthly time-trend, indicators and splines for the post-period and the interactions between these variables. We conduct the following sensitivity analyses: (1) Re-estimating models stratified by state (2) Estimating models including interactions of D-SNP implementation variables with comorbidity count to assess for differential D-SNP regulation effects across comorbidity level. (3) Re-estimating the models stratifying by race/ethnicity and (4) Including a transition period (2012-2013) in the model.

Results

We do not find any statistically significant changes in ER or hospital utilization associated with D-SNP regulation implementation in the broad D-SNP population or among specific racial/ethnic groups; however, we do find a reduction in hospitalizations associated with D-SNP regulations in New Jersey (DD level = - 3.37%; p = 0.02)/(DD slope = - 0.23%; p = 0.01) and among individuals with higher, relative to lower levels of co-morbidity (DDD slope = - 0.06%; p = 0.01).

Conclusions

These findings suggest that the impact of D-SNP regulations varies by state. Additionally, D-SNP regulations may be particularly effective in reducing hospital utilization among beneficiaries with high levels of co-morbidity.

Study objective

To determine the association between enrollment in the Medicare Part D low-income subsidy (LIS) program, which reduces out-of-pocket medication costs, and fill adherence to the antiplatelet drug clopidogrel after coronary stent placement.

Design

Retrospective cohort study.

Data source

Pharmacy claims database of a large national Medicare Part D insurer.

Patients

We selected a total of 2967 beneficiaries of a national Medicare Part D plan who had a coronary stent placed between April and December 2006 and were prescribed clopidogrel but were not preexisting users of clopidogrel. Of these patients, 504 were enrolled in the LIS program and 2463 were not.

Measurements and main results

We defined LIS status as enrollment in the LIS program at any point during the 12 months after the procedure. We examined the association between LIS status and good medication fill adherence to clopidogrel, defined as proportion of days covered of 80% or more, or discontinuation of clopidogrel over the 12-month window starting from the date of their stent placement. We also identified patients with claims-based diagnoses of major bleeding events while taking clopidogrel. For those patients, we calculated fill adherence only for the period between medication initiation and the onset of major bleeding and/or did not classify them as having inappropriately discontinued the medication. We created a propensity score predicting the propensity of being eligible for the LIS benefit and used inverse propensity score weighting with regression adjustment to generate estimates of the effect parameters. LIS enrollment was associated with a higher predicted likelihood of good clopidogrel fill adherence after stent placement (54.8% for LIS enrollees vs 47.6% for non enrollees; p=0.008). No significant difference was noted between the two groups in predicted risk of discontinuing clopidogrel after stent placement (18.3% for LIS enrollees vs 21.0% for non enrollees; p=0.21).

Conclusion

The LIS benefit was associated with better clopidogrel fill adherence after stent placement. Although clopidogrel is now available in generic form, our work underscores the need for efforts to identify and enroll patients in the LIS benefit who require costly antiplatelet medications for coronary heart disease.