Bernadette Boden-Albala

Bernadette Boden-Albala
Bernadette Boden-Albala

Senior Associate Dean of Research and Program Development

Interim Chair, Department of Epidemiology

Professor of Epidemiology

Professional overview

Dr. Bernadette Boden-Albala is an internationally recognized expert in the social epidemiology of stroke and cardiovascular disease. Dr. Boden-Albala utilizes epidemiologic tools and models to describe and link social, demographic, and behavioral risk factors (e.g., culture, race, ethnicity, socioeconomic status, social support, stress, and multi-level behaviors) to disease outcomes, such as vascular and oral diseases. She specializes in the design of intervention strategies for prevention and preparedness of stroke and vascular risk factor reduction and the interpretation of social determinants in risk reduction strategies.

Through Dr. Boden-Albala’s commitment to community inclusion and collaboration between research and practice, she has produced a wealth of knowledge on community health interventions that support stroke prevention. Dr. Boden-Albala’s unparalleled ability to conduct interventions in minority and underserved populations established interventions to reduce blood pressure in rural communities among Alaska Natives, as well as a collaborative effort between the American Heart Association and the Grenada Ministry of Health.  With the support of the World Health Organization, she seeks to identify the optimum social networks promoting health policy dialogue in Moldova. As the Principal Investigator of the National Initiative for Minority Involvement in Neurological Clinical Trials, Dr. Boden-Albala is identifying barriers to inclusion of racial-ethnic minorities and women in neurological clinical trials,  establishing best practice guidelines, and building a toolkit of materials to improve participation rates among these populations. As the Principal Investigator of the New York Collaborative Regional Coordinating Center, her research will provide New York communities greater access to stroke research and clinical trials focused on primary and secondary stroke prevention, acute stroke treatment, and stroke recovery.

Over the last 20 years, Dr. Boden-Albala has held leadership roles on national and local committees and task forces to improve vascular health and reduce disease, including the American Heart Association Nutrition and Physical Activity Behavioral Task Force, National American Heart Association Stroke Advisory Council, and the Clinical and Translational Science Award Community Engagement Key Member Leadership. She has also taught and worked at the Icahn School of Medicine at Mount Sinai, Columbia University, and NYU College of Dentistry.

As Associate Dean, she has co-created innovative courses with UNICEF and the United Nation's World Food Program to innovate solutions to Ebola and Polio response and explore a system's approach to food access. She has also developed the Cross-Continental MPH, a one-year program that combines classroom learning, collaborative research with faculty mentors, and public health practice experience across three continents.

Education

MPH, Columbia University, New York, NY
PhD, Columbia University, New York, NY

Areas of research and study

Epidemiology
International Health
Minority Health
Social Determinants of Health
Stroke and Cardiovascular Disease
Women's Health
World Health Organization

Publications

Publications

Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort: The Stroke Warning Information and Faster Treatment Study

-Boden-Albala, B., Stillman, J., Roberts, E. T., Quarles, L. W., Glymour, M. M., Chong, J., Moats, H., Torrico, V., & Parides, M. C.

Publication year

2015

Journal title

Stroke

Volume

46

Issue

7

Page(s)

1806-1812
Abstract
BACKGROUND AND PURPOSE: Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window. Stroke Warning Information and Faster Treatment (SWIFT) compared an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors.METHODS: A single-center randomized controlled trial (2005-2011) randomized participants to EE (bilingual stroke preparedness materials) or II (EE plus in-hospital sessions). We assessed differences by randomization in the proportion arriving to emergency department <3 hours, prepost intervention arrival <3 hours, incidence rate ratio for total events, and stroke knowledge and preparedness capacity.RESULTS: SWIFT randomized 1193 participants (592 EE, 601 II): mean age 63 years; 50% female, 17% black, 51% Hispanic, 26% white. At baseline, 28% arrived to emergency department <3 hours. Over 5 years, first recurrent stroke (n=133), transient ischemic attacks (n=54), or stroke mimics (n=37) were documented in 224 participants. Incidence rate ratio=1.31 (95% confidence interval=1.05-1.63; II to EE). Among II, 40% arrived <3 hours versus 46% EE (P=0.33). In prepost analysis, there was a 49% increase in the proportion arriving <3 hours (P=0.001), greatest among Hispanics (63%, P<0.003). II had greater stroke knowledge at 1 month (odds ratio=1.63; 1.23-2.15). II had higher preparedness capacity at 1 month (odds ratio=3.36; 1.86, 6.10) and 12 months (odds ratio=7.64; 2.49, 23.49).CONCLUSIONS: There was no difference in arrival <3 hours overall between II and EE; the proportion arriving <3 hours increased in both groups and in race-ethnic minorities.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415389.

Dietary Interventions to Lower the Risk of Stroke

-Boden-Albala, B., Southwick, L., & Carman, H.

Publication year

2015

Journal title

Current Neurology and Neuroscience Reports

Volume

15

Issue

4
Abstract
Stroke is a major cause of death and permanent disability in the USA; primary prevention and risk reduction are a critical health concern. A wealth of research investigated stroke risk factors, including primary hypertension, diabetes, and atrial fibrillation. Research has expanded to examine lifestyle factors, such as diet/dietary patterns, physical activity, cigarette smoking, and obesity distribution, as critical modifiable risk factors. Emerging evidence suggests diet/dietary patterns may lead to heightened risk of stroke. Despite a growing literature, research has yet to implement dietary interventions to explore this relationship within a US sample. This review discusses available clinical research findings reporting on the relationship among diet/dietary patterns, cardiovascular disease, and risk of stroke. We will assess challenges, limitations, and controversies, and address future research directions.

Discharge educational strategies for reduction of vascular events (DESERVE): Design and methods

Lord, A. S., Carman, H. M., Roberts, E. T., Torrico, V., Goldmann, E., Ishida, K., Tuhrim, S., Stillman, J., Quarles, L. W., & -Boden-Albala, B.

Publication year

2015

Journal title

International Journal of Stroke

Volume

10

Page(s)

151-154
Abstract
Rationale: Stroke and vascular risk factors disproportionately affect minority populations, with Blacks and Hispanics experiencing a 2·5- and 2·0-fold greater risk compared with whites, respectively. Patients with transient ischemic attacks and mild, nondisabling strokes tend to have short hospital stays, rapid discharges, and inaccurate perceptions of vascular risk. Aim: The primary aim of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial is to evaluate the efficacy of a novel community health worker-based multilevel discharge intervention vs. standard discharge care on vascular risk reduction among racially/ethnically diverse transient ischemic attack/mild stroke patients at one-year postdischarge. We hypothesize that those randomized to the discharge intervention will have reduced modifiable vascular risk factors as determined by systolic blood pressure compared with those receiving usual care. Sample size estimates: Given 300 subjects per group and alpha of 0·05, the power to detect a 6mmHg reduction in systolic blood pressure is 89%. Design: DESERVE trial is a prospective, randomized, multicenter clinical trial of a novel discharge behavioral intervention. Patients with transient ischemic attack/mild stroke are randomized during hospitalization or emergency room visit to intervention or usual care. Intervention begins prior to discharge and continues postdischarge. Study outcomes: The primary outcome is difference in systolic blood pressure reduction between groups at 12 months. Secondary outcomes include between-group differences in change in glycated hemoglobin, smoking rates, medication adherence, and recurrent stroke/transient ischemic attack at 12 months. Discussion: DESERVE will evaluate whether a novel discharge education strategy leads to improved risk factor control in a racially diverse population.

Examining Barriers and Practices to Recruitment and Retention in Stroke Clinical Trials

-Boden-Albala, B., Carman, H., Southwick, L., Parikh, N. S., Roberts, E., Waddy, S., & Edwards, D.

Publication year

2015

Journal title

Stroke

Volume

46

Issue

8

Page(s)

2232-2237
Abstract
BACKGROUND AND PURPOSE: The National Institutes of Health policy calls for the inclusion of under-represented groups, such as women and minorities, in clinical research. Poor minority recruitment and retention in stroke clinical trials remain a significant challenge limiting safety and efficacy in a general population. Previous research examines participant barriers to clinical trial involvement, but little is known about the investigator perspective. This study addresses this gap and examines researcher-reported barriers and best practices of minority involvement in stroke clinical trials.METHODS: Quantitative and qualitative methods, including surveys, focus groups, and key informant interviews were used.RESULTS: In a survey of 93 prominent stroke researchers, 43 (51.2%; 70% response rate) respondents reported proactively setting recruitment goals for minority inclusion, 29 respondents (36.3%) reported requiring cultural competency staff training, and 44 respondents (51.2%) reported using community consultation about trial design. Focus groups and key informant interviews highlighted structural and institutional challenges to recruitment of minorities, including mistrust of the research/medical enterprise, poor communication, and lack of understanding of clinical trials. Researcher-identified best practices included using standardized project management procedures and protocols (eg, realistic budgeting to support challenges in recruitment, such as travel/parking reimbursement for participants), research staff cultural competency and communication training, and developing and fostering community partnerships that guide the research process.CONCLUSIONS: This study's formative evaluation contributes a new dimension to the literature as it highlights researcher-reported barriers and best practices for enhancing participation of minority populations into stroke clinical trials.

Itemized NIHSS subsets predict positive MRI strokes in patients with mild deficits

Yaghi, S., Herber, C., Willey, J. Z., Andrews, H. F., Boehme, A. K., Marshall, R. S., Lazar, R. M., & -Boden-Albala, B.

Publication year

2015

Journal title

Journal of the Neurological Sciences
Abstract
Background: While imaging is useful in confirming the diagnosis of ischemic stroke, negative diffusion weighted imaging (DWI) is reported in up to 25% of patients. Our aim was to identify predictors of MRI-positive stroke from the itemized NIHSS. Methods: Data were derived from the Stroke Warning Information and Faster Treatment study from February 2006 to February 2010 among patients with mild deficits (NIHSS 0-5) and a final diagnosis of stroke by a vascular neurologist. All MRI sequences were reviewed for the presence or absence of an acute infarct on DWI. Multivariate logistic regression assessed factors predicting DWI-positive strokes; p. <. 0.05 was considered significant. Results: 894 patients had a discharge diagnosis of stroke; 709 underwent MRI and 28.0% were DWI negative. All patients with visual field deficits or neglect were DWI positive. On multivariate analysis including total NIHSS (0-2 vs. 3-5) and itemized NIHSS score subsets, predictors of a positive DWI were NIHSS score of 3-5 (OR=3.3, 95% CI: 1.8-6.1), motor deficits (OR=1.7, 95% CI: 1.1-2.8), ataxia (OR=1.9, 95% CI: 1.0-3.5), and absence of sensory deficits (OR=1.7, 95% CI: 1.0-2.7). We developed the NIHSS-m score that predicts DWI positivity in patients with mild deficits in the absence of neglect or visual field deficits. Conclusion: NIHSS score subsets predict DWI positivity in mild strokes. The presence of neglect or visual field deficits on the NIHSS subsets is most likely to have an MRI correlate even in patients with low NIHSS.

Prevalence of Hypertension and Associated Risk Factors in Western Alaska Native People: The Western Alaska Tribal Collaborative for Health (WATCH) Study

Jolly, S. E., Koller, K. R., Metzger, J. S., Day, G. M., Silverman, A., Hopkins, S. E., Austin, M. A., -Boden-Albala, B., Ebbesson, S. O., Boyer, B. B., Howard, B. V., & Umans, J. G.

Publication year

2015

Journal title

Journal of Clinical Hypertension

Volume

17

Issue

10

Page(s)

812-818
Abstract
Hypertension is a common chronic disease and a key risk factor in the development of cardiovascular disease. The Western Alaska Tribal Collaborative for Health study consolidates baseline data from four major cohorts residing in the Norton Sound and Yukon-Kuskokwim regions of western Alaska. This consolidated cohort affords an opportunity for a systematic analysis of high blood pressure and its correlates in a unique population with high stroke rates over a wide age range. While the prevalence of hypertension among western Alaska Native people (30%, age-standardized) is slightly less than that of the US general population (33%), cardiovascular disease is a leading cause of mortality in this rural population. The authors found that improvement is needed in hypertension awareness as about two thirds (64%) of patients reported awareness and only 39% with hypertension were controlled on medication. Future analyses assessing risk and protective factors for incident hypertension in this population are indicated.

The association between online health information-seeking behaviors and health behaviors among hispanics in New York city: A community-based cross-sectional study

Lee, Y. J., -Boden-Albala, B., Jia, H., Wilcox, A., & Bakken, S.

Publication year

2015

Journal title

Journal of Medical Internet Research

Volume

17

Issue

11
Abstract
Background: Hispanics are the fastest-growing minority group in the United States and they suffer from a disproportionate burden of chronic diseases. Studies have shown that online health information has the potential to affect health behaviors and influence management of chronic disease for a significant proportion of the population, but little research has focused on Hispanics. Objective: The specific aim of this descriptive, cross-sectional study was to examine the association between online health information-seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics. Methods: Data were collected from a convenience sample (N=2680) of Hispanics living in northern Manhattan by bilingual community health workers in a face-to-face interview and analyzed using linear and ordinal logistic regression. Variable selection and statistical analyses were guided by the Integrative Model of eHealth Use. Results: Only 7.38% (198/2680) of the sample reported online health information-seeking behaviors. Levels of moderate physical activity and fruit, vegetable, and alcohol consumption were low. Among individuals taking hypertension medication (n=825), adherence was reported as high by approximately one-third (30.9%, 255/825) of the sample. Controlling for demographic, situational, and literacy variables, online health information-seeking behaviors were significantly associated with fruit (β=0.35, 95% CI 0.08-0.62, P=.01) and vegetable (β=0.36, 95% CI 0.06-0.65, P=.02) consumption and physical activity (β=3.73, 95% CI 1.99-5.46, P

Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American heart association/American stroke association

Meschia, J. F., Bushnell, C., -Boden-Albala, B., Braun, L. T., Bravata, D. M., Chaturvedi, S., Creager, M. A., Eckel, R. H., Elkind, M. S., Fornage, M., Goldstein, L. B., Greenberg, S. M., Horvath, S. E., Iadecola, C., Jauch, E. C., Moore, W. S., & Wilson, J. A.

Publication year

2014

Journal title

Stroke

Volume

45

Issue

12

Page(s)

3754-3832
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidencebased recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Methodology for a community-based stroke preparedness intervention: The acute stroke program of interventions addressing racial and ethnic disparities study

-Boden-Albala, B., Edwards, D. F., Clair, S. S., Wing, J. J., Fernandez, S., Gibbons, M. C., Hsia, A. W., Morgenstern, L. B., & Kidwell, C. S.

Publication year

2014

Journal title

Stroke

Volume

45

Issue

7

Page(s)

2047-2052
Abstract
BACKGROUND AND PURPOSE - : Acute stroke education has focused on stroke symptom recognition. Lack of education about stroke preparedness and appropriate actions may prevent people from seeking immediate care. Few interventions have rigorously evaluated preparedness strategies in multiethnic community settings. METHODS - : The Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) project is a multilevel program using a community-engaged approach to stroke preparedness targeted to underserved black communities in the District of Columbia. This intervention aimed to decrease acute stroke presentation times and increase intravenous tissue-type plasminogen activator utilization for acute ischemic stroke. RESULTS - : Phase 1 included (1) enhancement of focus of emergency medical services on acute stroke; (2) hospital collaborations to implement and enrich acute stroke protocols and transition District of Columbia hospitals toward primary stroke center certification; and (3) preintervention acute stroke patient data collection in all 7 acute care District of Columbia hospitals. A community advisory committee, focus groups, and surveys identified perceptions of barriers to emergency stroke care. Phase 2 included a pilot intervention and subsequent citywide intervention rollout. A total of 531 community interventions were conducted, reaching >10 256 participants; 3289 intervention evaluations were performed, and 19 000 preparedness bracelets and 14 000 stroke warning magnets were distributed. Phase 3 included an evaluation of emergency medical services and hospital processes for acute stroke care and a year-long postintervention acute stroke data collection period to assess changes in intravenous tissue-type plasminogen utilization. CONCLUSIONS - : We report the methods, feasibility, and preintervention data collection efforts of the ASPIRE intervention.

Moving Towards a More Comprehensive Investigation of Racial/Ethnic Differences in Cognitive Disability Among US Adults

Benn, E. K., Fox, A., Fei, K., Roberts, E., & -Boden-Albala, B.

Publication year

2014

Journal title

Journal of Immigrant and Minority Health

Volume

17

Issue

4

Page(s)

1105-1113
Abstract
We examined racial/ethnic differences in cognitive disability and the contribution of sociodemographic factors to these differences. Using logistic regression, we measured the association between race/ethnicity and cognitive disability after adjustment for sociodemographic covariates, including agegroup, sex, education, nativity, region, marital status, and occupation among 2009 American Community Survey respondents (≥25 years). Effect modification was also explored. Cognitive disability was self-reported by 6 % of respondents. The proportion with cognitive disability was highest for Blacks and Native American/Pacific Islanders. Statistically significant effect modification was observed for all sociodemographic covariates, except sex. Although most sociodemographic modifiers revealed a more convoluted relationship between race/ethnicity and cognitive disability, the cognitive benefits of higher education, foreign born nativity, and top-tier occupations were observed among most racial/ethnic groups. The observed interplay between sociodemographics and race/ethnicity highlight a complex relationship between race/ethnicity and cognitive disability. Future research should examine mechanisms for this induced complexity.

Multiple metabolic risk factors and mammographic breast density

Tehranifar, P., Reynolds, D., Fan, X., -Boden-Albala, B., Engmann, N. J., Flom, J. D., & Terry, M. B.

Publication year

2014

Journal title

Annals of Epidemiology

Volume

24

Issue

6

Page(s)

479-483
Abstract
Purpose: We examined whether obesity and a history of diabetes, hypertension, and elevated cholesterol, individually and in combination, are associated with breast density, a strong risk factor for breast cancer. Methods: We measured percent density and dense area using a computer-assisted method (n = 191; age range = 40-61 years). We used linear regression models to examine the associations of each metabolic condition and the number of metabolic conditions (zero, one, two, and three or four conditions) with breast density. Results: Among individual metabolic conditions, only high blood cholesterol was inversely associated with percent density (β = -5.4, 95% confidence interval [CI]: -8.5, -2.2) and dense area (β = -6.7, 95% CI = -11.1, -2.4). Having multiple metabolic conditions was also associated with lower breast density, with two conditions and three or four conditions versus zero conditions associated with 6.4% (95% CI: -11.2, -1.6) and 7.4% (95% CI: -12.9, -1.9) reduction in percent density and with 6.5 cm2 (95% CI: -13.1, -0.1) and 9.5 cm2 (95% CI: -17.1, -1.9) decrease in dense area. Conclusions: A history of high blood cholesterol and multiple metabolic conditions were associated with lower relative and absolute measures of breast density. The positive association between metabolic abnormalities and breast cancer risk may be driven by pathways unrelated to mammographic breast density.

Online health information seeking behaviors of hispanics in new york city: A community-based cross-sectional study

Lee, Y. J., -Boden-Albala, B., Larson, E., Wilcox, A., & Bakken, S.

Publication year

2014

Journal title

Journal of Medical Internet Research

Volume

16

Issue

7
Abstract
The emergence of the Internet has increased access to health information and can facilitate active individual engagement in health care decision making. Hispanics are the fastest-growing minority group in the United States and are also the most underserved in terms of access to online health information. A growing body of literature has examined correlates of online health information seeking behaviors (HISBs), but few studies have included Hispanics. Objective: The specific aim of this descriptive, correlational study was to examine factors associated with HISBs of Hispanics. Methods: The study sample (N=4070) was recruited from five postal zip codes in northern Manhattan for the Washington Heights Inwood Informatics Infrastructure for Comparative Effectiveness Research project. Survey data were collected via interview by bilingual community health workers in a community center, households, and other community settings. Data were analyzed using bivariate analyses and logistic regression. Results: Among individual respondents, online HISBs were significantly associated with higher education (OR 3.03, 95% CI 2.15-4.29, P<.001), worse health status (OR 0.42, 95% CI 0.31-0.57, P<.001), and having no hypertension (OR 0.60, 95% CI 0.43-0.84, P=.003). Online HISBs of other household members were significantly associated with respondent factors: female gender (OR 1.60, 95% CI 1.22-2.10, P=.001), being younger (OR 0.75, 95% CI 0.62-0.90, P=.002), being married (OR 1.36, 95% CI 1.09-1.71, P=.007), having higher education (OR 1.80, 95% CI 1.404-2.316, P<.001), being in worse health (OR 0.59, 95% CI 0.46-0.77, P<.001), and having serious health problems increased the odds of their household members' online HISBs (OR 1.83, 95% CI 1.29-2.60, P=.001). Conclusions: This large-scale community survey identified factors associated with online HISBs among Hispanics that merit closer examination. To enhance online HISBs among Hispanics, health care providers and policy makers need to understand the cultural context of the Hispanic population. Results of this study can provide a foundation for the development of informatics-based interventions to improve the health of Hispanics in the United States.

Sleep duration is associated with white matter hyperintensity volume in older adults: The Northern Manhattan Study

Ramos, A. R., Dong, C., Rundek, T., Elkind, M. S., -Boden-Albala, B., Sacco, R. L., & Wright, C. B.

Publication year

2014

Journal title

Journal of Sleep Research

Volume

23

Issue

5

Page(s)

524-530
Abstract
Self-reports of long or short sleep durations have indicated an association with cardiovascular morbidity and mortality, but there are limited data evaluating their association with white matter hyperintensity volume (WMHV), a marker of cerebral small vessel disease. We conducted a cross-sectional analysis of self-reported sleep duration to test for a correlation with white matter hyperintensities, measured by quantitative magnetic resonance imaging (MRI), in the Northern Manhattan Study. We used multivariable linear regression models to assess associations between both short (<6 h) and long (≥9 h) sleep durations and log-transformed WMHV, adjusting for demographic, behavioural and vascular risk factors. A total of 1244 participants, mean age 70 ± 9 years, 61% women and 68% Hispanics were analysed with magnetic resonance brain imaging and self-reported sleep duration. Short sleep was reported by 23% (n = 293) and long sleep by 10% (n = 121) of the sample. Long sleep (β = 0.178; P = 0.035), but not short sleep (β = -0.053; P = 0.357), was associated with greater log-WMHV in fully adjusted models. We observed an interaction between sleep duration, diabetes mellitus and log-WMHV (P = 0.07). In fully adjusted models, stratified analysis showed that long sleep duration was associated with greater WMHV only in those with diabetes (β = 0.78; P = 0.0314), but not in those without diabetes (β = 0.022; P = 0.2), whereas short sleep was not associated with white matter hyperintensities in those with or without diabetes. In conclusion, long sleep duration was associated with a greater burden of white matter lesions in this stroke-free urban sample. The association was seen mainly among those with diabetes mellitus.

Association between sleep duration and the mini-mental score: The northern manhattan study

Ramos, A. R., Dong, C., Elkind, M. S., -Boden-Albala, B., Sacco, R. L., Rundek, T., & Wright, C. B.

Publication year

2013

Journal title

Journal of Clinical Sleep Medicine

Volume

9

Issue

7

Page(s)

669-673
Abstract
Background: Short and long sleep duration are associated with increased mortality and worse global cognitive function, but is unclear if these relations persist after accounting for the risk of sleep disordered breathing (SDB). The aim of our study is determine the association between short and long sleep duration with worse global cognitive function in a racially/ethnically diverse elderly cohort. Methods: We examined sleep hours and global cognitive function cross-sectionally within the population-based Northern Manhattan Study cohort. We conducted nonparametric and logistic regression to examine associations between continuous, short (< 6 h) and long (≥ 9 h) sleep hours with performance on the Mini Mental State Examination (MMSE). Results: There were 927 stroke-free participants with data on self-reported sleep hours and MMSE scores (mean age 75 ± 9 years, 61% women, 68% Hispanics). The median (interquartile range) MMSE was 28 (10-30). Sleep hours (centered at 7 h) was associated with worse MMSE (β = -0.01; SE [0.004], p = 0.0113) adjusting for demographics, vascular risk factors, medications, and risk for SDB. Reporting long sleep (≥ 9 h) compared to 6 to 8 h of sleep (reference) was significantly and inversely associated with MMSE (adjusted β = -0.06; SE [0.03], p = 0.012), while reporting short sleep was not significantly associated with MMSE performance. Long sleep duration was also associated with low MMSE score when dichotomized (adjusted OR: 2.4, 95% CI: 1.1-5.0). Conclusion: In this cross-sectional analysis among an elderly community cohort, long sleep duration was associated with worse MMSE performance.

Education strategies for stroke prevention

-Boden-Albala, B., & Quarles, L. W.

Publication year

2013

Journal title

Stroke

Volume

44

Predictors of risk and protection for hypertension in Yup'ik people from Southwest Alaska.

-Boden-Albala, B., Roberts, E. T., Hopkins, S., Allen, J., & Boyer, B. B.

Publication year

2013

Journal title

Ethnicity and Disease

Volume

23

Issue

4

Page(s)

484-491
Abstract
Hypertension (HTN) contributes to vascular disease, and is increasingly common in non-western, rural contexts, such as the Yup'ik people of Southwestern Alaska. While much is known regarding HTN risk factors in western contexts, little is known about their relevance to non-western populations. We explore an American Heart Association risk factor model for HTN in predicting risk and protection from HTN among Yup'ik people. Using data from 1015 Yup'ik individuals residing in remote Southwestern Alaska, we explore age, sex, education, waist circumference, physical activity, tobacco, social support, and cultural identification in multinomial logistic regressions comparing pre-hypertension (pre-HTN; systolic 120 to 129 mm Hg), and hypertension (HTN; systolic > or = 130 mm Hg) to optimal blood pressure (opt-BP; systolic < 120 mm Hg). We find positive associations between age (2%, 5% greater odds respectively), waist circumference (3%, 5% greater odds respectively) and hypertension medication usage (60%, 85% greater odds respectively) with both pre-HTN and HTN. We also find men have 86% greater odds of pre-HTN, people with fasting blood glucose > or = 110 mg/dL have 52% increased odds of pre-HTN, and married persons have 19% lower odds of having pre-HTN compared to having opt-BP. Bicultural identification mitigates age related increases in BP and deleterious effects of low formal education. While model continuities are noted in our Yup'ik study, important points of divergence are also noted. Future research on cultural identification and social support has promising implications for guiding responsive interventions.

Daytime sleepiness and risk of stroke and vascular disease: Findings from the Northern Manhattan Study (NOMAS)

-Boden-Albala, B., Roberts, E. T., Bazil, C., Moon, Y., Elkind, M. S., Rundek, T., Paik, M. C., & Sacco, R. L.

Publication year

2012

Journal title

Circulation: Cardiovascular Quality and Outcomes

Volume

5

Issue

4

Page(s)

500-507
Abstract
Background-Recent studies have suggested that poor quality and diminished quantity of sleep may be independently linked to vascular events although prospective and multiethnic studies are limited. This study aimed to explore the relationship between daytime sleepiness and the risk of ischemic stroke and vascular events in an elderly, multiethnic prospective cohort. Methods and Results-As part of the Northern Manhattan Study, the Epworth Sleepiness Scale was collected during the 2004 annual follow-up. Daytime sleepiness was trichotomized using previously reported cut points of no dozing, some dozing, and significant dozing. Subjects were followed annually for a mean of 5.1 years. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for stroke, myocardial infarction, and death outcomes. We obtained the Epworth Sleepiness Scale on 2088 community residents. The mean age was 73.5 ± 9.3 years; 64% were women; 17% were white, 20% black, 60% Hispanic, and 3% were other. Over 44% of the cohort reported no daytime dozing, 47% some dozing, and 9% significant daytime dozing. Compared with those reporting no daytime dozing, individuals reporting significant dozing had an increased risk of ischemic stroke (hazard ratio, 2.74 [95% confidence interval, 1.38-5.43]), all stroke (3.00 [1.57-5.73]), the combination of ischemic stroke, myocardial infarction, and vascular death (2.38 [1.50-3.78]), and all vascular events (2.48 [1.57-3.91]), after adjusting for medical comorbidities. Conclusions-Daytime sleepiness is an independent risk factor for stroke and other vascular events. These findings suggest the importance of screening for sleep problems at the primary care level.

Feasibility of using the LOINC semantic structure to integrate community-based survey items into a concept-based enterprise data dictionary to support comparative effectiveness research

Manuel, C., -Boden-Albala, B., Quarles, L. W., Wilcox, A., & Bakken, S.

Publication year

2012

Journal title

Nurs. Inform.

Page(s)

113-115

Mediterranean diet and white matter hyperintensity volume in the Northern Manhattan study

Gardener, H., Scarmeas, N., Gu, Y., -Boden-Albala, B., Elkind, M. S., Sacco, R. L., DeCarli, C., & Wright, C. B.

Publication year

2012

Journal title

Archives of Neurology

Volume

69

Issue

2

Page(s)

251-256
Abstract
Objective: To examine the association between a Mediterranean-style diet (MeDi) and brain magnetic resonance imaging white matter hyperintensity volume (WMHV). Design: A cross-sectional analysis within a longitudinal population-based cohort study. A semiquantitative food frequency questionnaire was administered, and a score (range, 0-9) was calculated to reflect increasing similarity to the MeDi pattern. Setting: The Northern Manhattan Study. Participants: A total of 1091 participants, of whom 966 had dietary information (mean age, 72 years; 59.3% women, 64.6% Hispanic, 15.6% white, and 17.5% black). Main Outcome Measures: The WMHV was measured by quantitative brain magnetic resonance imaging. Linear regression models were constructed to examine the association between the MeDi score and the log-transformed WMHV as a proportion of total cranial volume, controlling for sociodemographic and vascular risk factors. Results: On the MeDi scale, 11.6% scored 0 to 2, 15.8% scored 3, 23.0% scored 4, 23.5% scored 5, and 26.1% scored 6 to 9. Each 1-point increase in MeDi score was associated with a lower log WMHV (β=-.04, P=.01). The only MeDi score component that was an independent predictor of WMHV was the ratio of monounsaturated to saturated fat (β=-.20, P=.001). Conclusions: A MeDi was associated with a lower WMHV burden, a marker of small vessel damage in the brain. However, white matter hyperintensities are etiologically heterogenous and can include neurodegeneration. Replication by other population-based studies is needed.

Poor long-term blood pressure control after intracerebral hemorrhage

Zahuranec, D. B., Wing, J. J., Edwards, D. F., Menon, R. S., Fernandez, S. J., Burgess, R. E., Sobotka, I. A., German, L., Trouth, A. J., Shara, N. M., Gibbons, M. C., -Boden-Albala, B., & Kidwell, C. S.

Publication year

2012

Journal title

Stroke

Volume

43

Issue

10

Page(s)

2580-2585
Abstract
BACKGROUND AND PURPOSE-: Hypertension is the most important risk factor associated with intracerebral hemorrhage. We explored racial differences in blood pressure (BP) control after intracerebral hemorrhage and assessed predictors of BP control at presentation, 30 days, and 1 year in a prospective cohort study. METHODS-: Subjects with spontaneous intracerebral hemorrhage were identified from the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was compared by race at each time point. Multivariable linear regression was used to determine predictors of presenting mean arterial pressure, and longitudinal linear regression was used to assess predictors of mean arterial pressure at follow-up. RESULTS-: A total of 162 patients were included (mean age, 59 years; 53% male; 77% black). Mean arterial pressure at presentation was 9.6 mm Hg higher in blacks than whites despite adjustment for confounders (P=0.065). Fewer than 20% of patients had normal BP (<120/80 mm Hg) at 30 days or 1 year. Although there was no difference at 30 days (P=0.331), blacks were more likely than whites to have Stage I/II hypertension at 1 year (P=0.036). Factors associated with lower mean arterial pressure at follow-up in multivariable analysis were being married at baseline (P=0.032) and living in a facility (versus personal residence) at the time of BP measurement (P=0.023). CONCLUSIONS-: Long-term BP control is inadequate in patients after intracerebral hemorrhage, particularly in blacks. Further studies are needed to understand the role of social support and barriers to control to identify optimal approaches to improve BP in this high-risk population.

Predictors of health information-seeking behaviors in hispanics

Lee, Y., -Boden-Albala, B., Quarles, L. W., Wilcox, A., & Bakken, S.

Publication year

2012

Journal title

Nurs. Inform.

Page(s)

243

Research data collection methods: From paper to tablet computers

Wilcox, A. B., Gallagher, K. D., -Boden-Albala, B., & Bakken, S. R.

Publication year

2012

Journal title

Medical Care

Volume

50
Abstract
Background: Primary data collection is a critical activity in clinical research. Even with significant advances in technical capabilities, clear benefits of use, and even user preferences for using electronic systems for collecting primary data, paper-based data collection is still common in clinical research settings. However, with recent developments in both clinical research and tablet computer technology, the comparative advantages and disadvantages of data collection methods should be determined. Objective: To describe case studies using multiple methods of data collection, including next-generation tablets, and consider their various advantages and disadvantages. MATERIALS AND Methods: We reviewed 5 modern case studies using primary data collection, using methods ranging from paper to next-generation tablet computers. We performed semistructured telephone interviews with each project, which considered factors relevant to data collection. We address specific issues with workflow, implementation and security for these different methods, and identify differences in implementation that led to different technology considerations for each case study. Results and Discussion: There remain multiple methods for primary data collection, each with its own strengths and weaknesses. Two recent methods are electronic health record templates and next-generation tablet computers. Electronic health record templates can link data directly to medical records, but are notably difficult to use. Current tablet computers are substantially different from previous technologies with regard to user familiarity and software cost. The use of cloud-based storage for tablet computers, however, creates a specific challenge for clinical research that must be considered but can be overcome.

Safety of thrombolysis in patients over the age of 80

Willey, J. Z., Petersen, N., Dhamoon, M. S., Stillman, J., -Boden-Albala, B., Elkind, M. S., & Marshall, R. S.

Publication year

2012

Journal title

Neurologist

Volume

18

Issue

2

Page(s)

99-101
Abstract
BACKGROUND: The safety of intravenous thrombolysis (IVT) in patients with acute ischemic stroke over the age of 80 is unclear. We hypothesized that patients over the age of 80 can be safely treated with IVT. METHODS: Admission and discharge data were collected on all patients at a single tertiary care center presenting within 12 hours of onset. Collected data included treatment with IVT, demographics, pretreatment National Institutes of Health Stroke Scale score, length of stay, mortality, and discharge disposition. Analyses were restricted to patients over the age of 80, and the primary outcome was in-hospital mortality. Logistic regression was used to examine whether IVT was associated with mortality. RESULTS: Between January 1, 2005 and May 30, 2010, 112 patients over the age of 80 presented within 3 hours of ischemic stroke onset, and 31 received IVT. There were 15 deaths. In multivariable models adjusted for age, sex, race-ethnicity, and National Institutes of Health Stroke Scale, treatment with IVT, compared with no treatment, was not associated with in-hospital death (adjusted odds ratio, 1.2; 95% confidence interval, 0.3-4.3). CONCLUSIONS: Treating ischemic stroke patients over 80 years with IVT was not associated with an increase in mortality in an urban tertiary care center.

Too good to treat? Outcomes in patients not receiving thrombolysis due to mild deficits or rapidly improving symptoms

Willey, J. Z., Stillman, J., Rivolta, J. A., Vieira, J., Doyle, M. M., Linares, G., Marchidann, A., Elkind, M. S., -Boden-Albala, B., & Marshall, R. S.

Publication year

2012

Journal title

International Journal of Stroke

Volume

7

Issue

3

Page(s)

202-206
Abstract
Introduction: Among ischemic stroke patients arriving within the treatment window, rapidly improving symptoms or having a mild deficit (i.e. too good to treat) is a common reason for exclusion. Several studies have reported poor outcomes in this group. We addressed the question of early neurological deterioration in too good to treat patients in a larger prospective cohort study. Methods: Admission and discharge information were collected prospectively in acute stroke patients who presented to the emergency room within three-hours from onset. The primary outcome measure was change in the National Institutes of Health Stroke Scale from baseline to discharge. Secondary outcomes were discharge National Institutes of Health Stroke Scale >4, not being discharged home, and discharge modified Rankin scale. Results: Of 355 patients who presented within three-hours, 127 (35·8%) had too good to treat listed as the only reason for not receiving thrombolysis, with median admission National Institutes of Health Stroke Scale=1 (range=0 to 19). At discharge, seven (5·5%) showed a worsening of National Institutes of Health Stroke Scale ≥1, and nine (7·1%) had a National Institutes of Health Stroke Scale >4. When excluding prior stroke (remaining n=97), discharge status was even more benign: only five (5·2%) had a discharge National Institutes of Health Stroke Scale >4, and two (2·1%) patients were not discharged home. Conclusion: We found that a small proportion of patients deemed too good to treat will have early neurological deterioration, in contrast to other studies. Decisions about whether to treat mild stroke patients depend on the outcome measure chosen, particularly when considering discharge disposition among patients who have had prior stroke. The decision to thrombolyze may ultimately rest on the nature of the presentation and deficit.

Association between social isolation and left ventricular mass

Rodriguez, C. J., Elkind, M. S., Clemow, L., Jin, Z., Di Tullio, M., Sacco, R. L., Homma, S., & -Boden-Albala, B.

Publication year

2011

Journal title

American Journal of Medicine

Volume

124

Issue

2

Page(s)

164-170
Abstract
Background: Social isolation is associated with progression of cardiovascular disease, with the most socially isolated patients being at increased risk. Increased left ventricular mass is a predictor of cardiovascular morbidity and mortality. It is not yet clear whether social isolation is a determinant of increased left ventricular mass. Methods: We performed a cross-sectional study of Northern Manhattan Study participants who were free of clinical cardiovascular disease and had obtained transthoracic echocardiograms (n = 2021) and a baseline questionnaire on social habits. Social isolation was defined as the lack of friendship networks (knowing fewer than 3 people well enough to visit within their homes). Echocardiographic left ventricular mass was indexed to height2.7, analyzed as a continuous variable and compared between exposure groups. Results: The prevalence of social isolation was 13.5%. The average left ventricular mass was significantly higher (50.2 gm/m 2.7) in those who were, as compared with those who were not (47.6 gm/m2.7), socially isolated (P < .05). Higher prevalence of social isolation was found among those less educated, uninsured, or unemployed. There were no significant race-ethnic differences in the prevalence of social isolation. In multivariate analysis, there was a trend toward an association between social isolation and increased left ventricular mass in the total cohort (P = .09). Among Hispanics, social isolation was significantly associated with greater left ventricular mass. Hispanics who were socially isolated averaged 3.9 gm/ht2.7 higher left ventricular mass compared with those not socially isolated (P = .002). This relationship was not present among non-Hispanic blacks or whites. Conclusion: In this urban tri-ethnic cohort, social isolation was prevalent and associated with indices of low socioeconomic status. Hispanics who were socially isolated had a greater risk for increased left ventricular mass.

Contact

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