BACKGROUND:Organ Procurement and Transplantation Network (OPTN) policy requires 2 years of follow-up for living kidney donors (LKDs); however, many transplant hospitals struggle to meet this requirement. We developed and tested a mobile health (mHealth) system for LKD follow-up in a pilot randomized-controlled trial (RCT). METHODS:LKDs were randomly assigned to either the intervention (mHealth + standard of care) or control arm (standard of care). We assessed OPTN policy-defined completeness and timeliness of 6-month, 1-year, and 2-year follow-ups. Four hundred LKDs were enrolled in the study (June 2018 to February 2021). RESULTS:At 6-month follow-up, a higher proportion of the intervention arm participants completed composite visits (97.5% vs. 91.5%, p = 0.01). Both arms had similar compliance rates at 1- and 2-year follow-up (92.0% vs. 89.5%, p = 0.49, and 66.5% vs. 65.0%, p = 0.83). Intervention arm participants completed 6-month follow-up 11 days earlier than their counterparts (p = 0.009). CONCLUSION:mHealth technologies improved 6-month follow-up, but did not impact 1- and 2-year LKD follow-up in this single-center RCT. Other strategies, such as providing services beyond data collection, may be necessary to improve donor engagement and support LDK's long-term follow-up.

BACKGROUND:Pediatric (age < 18 years) kidney transplant (KT) candidates face increasingly complex choices. The 2014 kidney allocation system nearly doubled wait times for pediatric recipients. Given longer wait times and new ways to optimize compatibility, more pediatric candidates may consider kidney-paired donation (KPD). Motivated by this shift and the potential impact of innovations in KPD practice, we studied pediatric KPD procedures in the US from 2008 to 2021. METHODS:We describe the characteristics and outcomes of pediatric KPD recipients with comparison to pediatric non-KPD living donor kidney transplants (LDKT), pediatric LDKT recipients, and pediatric deceased donor (DDKT) recipients. RESULTS:Our study cohort includes 4987 pediatric DDKTs, 3447 pediatric non-KPD LDKTs, and 258 pediatric KPD transplants. Fewer centers conducted at least one pediatric KPD procedure compared to those that conducted at least one pediatric LDKT or DDKT procedure (67, 136, and 155 centers, respectively). Five centers performed 31% of the pediatric KPD transplants. After adjustment, there were no differences in graft failure or mortality comparing KPD recipients to non-KPD LDKT, LDKT, or DDKT recipients. DISCUSSION:We did not observe differences in transplant outcomes comparing pediatric KPD recipients to controls. Considering these results, KPD may be underutilized for pediatric recipients. Pediatric KT centers should consider including KPD in KT candidate education. Further research will be necessary to develop tools that could aid clinicians and families considering the time horizon for future KT procedures, candidate disease and histocompatibility characteristics, and other factors including logistics and donor protections.

Background: The geographical environments within which individuals conduct their daily activities may influence health behaviors, yet little is known about individual-level geographic mobility and specific, linked behaviors in rural low- and middle-income settings. Objective: Nested in a 3-month ecological momentary assessment intervention pilot trial, this study aims to leverage mobile health app user GPS data to examine activity space through individual spatial mobility and locations of reported health behaviors in relation to their homes. Methods: Pilot trial participants were recruited from the Rakai Community Cohort Study-an ongoing population-based cohort study in rural south-central Uganda. Participants used a smartphone app that logged their GPS coordinates every 1-2 hours for approximately 90 days. They also reported specific health behaviors (alcohol use, cigarette smoking, and having condomless sex with a non-long-term partner) via the app that were both location and time stamped. In this substudy, we characterized participant mobility using 3 measures: average distance (kilometers) traveled per week, number of unique locations visited (deduplicated points within 25 m of one another), and the percentage of GPS points recorded away from home. The latter measure was calculated using home buffer regions of 100 m, 400 m, and 800 m. We also evaluated the number of unique locations visited for each specific health behavior, and whether those locations were within or outside the home buffer regions. Sociodemographic information,mobility measures, and locations of health behaviors were summarized across the sample using descriptive statistics. Results: Of the 46 participants with complete GPS data, 24 (52%) participants were men, 30 (65%) participants were younger than 35 years, and 33 (72%) participants were in the top 2 socioeconomic status quartiles. On median, participants traveled 303(IQR 152-585) km per week. Over the study period, participants on median recorded 1292 (IQR 963-2137) GPS points-76%(IQR 58%-86%) of which were outside their 400-m home buffer regions. Of the participants reporting drinking alcohol, cigarette smoking, and engaging in condomless sex, respectively, 19 (83%), 8 (89%), and 12 (86%) reported that behavior at least once outside their 400-m home neighborhood and across a median of 3.0 (IQR 1.5-5.5), 3.0 (IQR 1.0-3.0), and 3.5 (IQR 1.0-7.0) unique locations, respectively. Conclusions: Among residents in rural Uganda, an ecological momentary assessment app successfully captured high mobilityand health-related behaviors across multiple locations. Our findings suggest that future mobile health interventions in similarsettings can benefit from integrating spatial data collection using the GPS technology in mobile phones. Leveraging suchindividual-level GPS data can inform place-based strategies within these interventions for promoting healthy behavior change

Rationale & Objective: Understanding national attitudes about living kidney donation will enable us to identify and address existing disincentives to living kidney donation. We performed a national survey to describe living kidney donation perceptions, perceived factors that affect the willingness to donate, and analyzed differences by demographic subgroups. Study Design: The survey items captured living kidney donation awareness, living kidney donation knowledge, willingness to donate, and barriers and facilitators to living kidney donation. Setting & Population: We surveyed 802 US adults (aged 25-65 years) in June 2021, randomly selected from an online platform with diverse representation. Analytical Approach: We developed summed, scaled indices to assess the association between the living kidney donation knowledge (9 items) and the willingness to donate (8 items) to self -reported demographic characteristics and other variables of interest using analysis of variance. All other associations for categorical questions were calculated using Pearson's chi 2 and Fisher exact tests. We inductively evaluated free -text responses to identify additional barriers and facilitators to living kidney donation. Results: Most (86.6%) of the respondents reported that they might or would definitely consider donating a kidney while they were still living. Barriers to living kidney donation included concerns about the risk of the surgery, paying for medical expenses, and potential health effects. Facilitators to living kidney donation included having information on the donation surgery's safety, knowing that the donor would not have to pay for medical expenses related to the donation, and hearing living kidney donation success stories. Awareness of the ability to participate in kidney -paired donation was associated with a higher willingness to donate. Limitations: Potential for selection bias resulting from the use of survey panels and varied incentive amounts, and measurement error related to respondents' attention level. Conclusions: Most people would consider becoming a living kidney donor. Increased rates of living kidney donation may be possible with investment in culturally competent educational interventions that address risks associated with donating, policies that reduce financial disincentives, and communication campaigns that raise awareness of kidney -paired donation and living kidney donation.

Background The geographical environments within which individuals conduct their daily activities may influence health behaviors, yet little is known about individual-level geographic mobility and specific, linked behaviors in rural low- and middle-income settings. Objective Nested in a 3-month ecological momentary assessment intervention pilot trial, this study aims to leverage mobile health app user GPS data to examine activity space through individual spatial mobility and locations of reported health behaviors in relation to their homes. Methods Pilot trial participants were recruited from the Rakai Community Cohort Study—an ongoing population-based cohort study in rural south-central Uganda. Participants used a smartphone app that logged their GPS coordinates every 1-2 hours for approximately 90 days. They also reported specific health behaviors (alcohol use, cigarette smoking, and having condomless sex with a non–long-term partner) via the app that were both location and time stamped. In this substudy, we characterized participant mobility using 3 measures: average distance (kilometers) traveled per week, number of unique locations visited (deduplicated points within 25 m of one another), and the percentage of GPS points recorded away from home. The latter measure was calculated using home buffer regions of 100 m, 400 m, and 800 m. We also evaluated the number of unique locations visited for each specific health behavior, and whether those locations were within or outside the home buffer regions. Sociodemographic information, mobility measures, and locations of health behaviors were summarized across the sample using descriptive statistics. Results Of the 46 participants with complete GPS data, 24 (52%) participants were men, 30 (65%) participants were younger than 35 years, and 33 (72%) participants were in the top 2 socioeconomic status quartiles. On median, participants traveled 303 (IQR 152-585) km per week. Over the study period, participants on median recorded 1292 (IQR 963-2137) GPS points—76% (IQR 58%-86%) of which were outside their 400-m home buffer regions. Of the participants reporting drinking alcohol, cigarette smoking, and engaging in condomless sex, respectively, 19 (83%), 8 (89%), and 12 (86%) reported that behavior at least once outside their 400-m home neighborhood and across a median of 3.0 (IQR 1.5-5.5), 3.0 (IQR 1.0-3.0), and 3.5 (IQR 1.0-7.0) unique locations, respectively. Conclusions Among residents in rural Uganda, an ecological momentary assessment app successfully captured high mobility and health-related behaviors across multiple locations. Our findings suggest that future mobile health interventions in similar settings can benefit from integrating spatial data collection using the GPS technology in mobile phones. Leveraging such individual-level GPS data can inform place-based strategies within these interventions for promoting healthy behavior change.

Background: A trial found that a community health worker (CHW) strategy using “Health Scouts” improved HIV care uptake and ART coverage. To better understand outcomes and areas for improvement, we conducted an implementation science evaluation. Methods: Using the RE-AIM framework, quantitative methods included analyses of a community-wide survey (n = 1903), CHW log books, and phone application data. Qualitative methods included in-depth interviews (n = 72) with CHWs, clients, staff, and community leaders. Results: Thirteen Health Scouts logged 11,221 counseling sessions; 2532 unique clients were counseled. 95.7% (1789 of 1891) of residents reported awareness of the Health Scouts. Overall, reach (self-reported receipt of counseling) was 30.7% (580 of 1891). Unreached residents were more likely to be male and HIV seronegative ( P < 0.05). Qualitative themes included the following: (1) reach was promoted by perceived usefulness but deterred by busy client lifestyles and stigma, (2) effectiveness was enabled through good acceptability and consistency with the conceptual framework, (3) adoption was facilitated by positive impacts on HIV service engagement, and (4) implementation fidelity was initially promoted by the CHW phone application but deterred by mobility. Maintenance showed consistent counseling sessions over time. The findings suggested the strategy was fundamentally sound but had suboptimal reach. Future iterations could consider adaptations to improve reach to priority populations, testing the need for mobile health support, and additional community sensitization to reduce stigma. Conclusions: A CHW strategy to promote HIV services was implemented with moderate success in an HIV hyperendemic setting and should be considered for adoption and scale-up in other communities as part of comprehensive HIV epidemic control efforts. Trial registration: ClinicalTrials.gov Trial Number NCT02556957.

Hispanic/Latinos have been underrepresented in genome-wide association studies (GWAS) for anthropometric traits despite their notable anthropometric variability, ancestry proportions, and high burden of growth stunting and overweight/obesity. To address this knowledge gap, we analyzed densely imputed genetic data in a sample of Hispanic/Latino adults to identify and fine-map genetic variants associated with body mass index (BMI), height, and BMI-adjusted waist-to-hip ratio (WHRadjBMI). We conducted a GWAS of 18 studies/consortia as part of the Hispanic/Latino Anthropometry (HISLA) Consortium (stage 1, n = 59,771) and generalized our findings in 9 additional studies (stage 2, n = 10,538). We conducted a trans-ancestral GWAS with summary statistics from HISLA stage 1 and existing consortia of European and African ancestries. In our HISLA stage 1 + 2 analyses, we discovered one BMI locus, as well as two BMI signals and another height signal each within established anthropometric loci. In our trans-ancestral meta-analysis, we discovered three BMI loci, one height locus, and one WHRadjBMI locus. We also identified 3 secondary signals for BMI, 28 for height, and 2 for WHRadjBMI in established loci. We show that 336 known BMI, 1,177 known height, and 143 known WHRadjBMI (combined) SNPs demonstrated suggestive transferability (nominal significance and effect estimate directional consistency) in Hispanic/Latino adults. Of these, 36 BMI, 124 height, and 11 WHRadjBMI SNPs were significant after trait-specific Bonferroni correction. Trans-ancestral meta-analysis of the three ancestries showed a small-to-moderate impact of uncorrected population stratification on the resulting effect size estimates. Our findings demonstrate that future studies may also benefit from leveraging diverse ancestries and differences in linkage disequilibrium patterns to discover novel loci and additional signals with less residual population stratification.

Background. Few reports have focused on newer coronavirus disease 2019 (COVID-19) therapies (remdesivir, dexamethasone, and convalescent plasma) in solid organ transplant recipients; concerns had been raised regarding possible adverse impact on allograft function or secondary infections. Methods. We studied 77 solid organ transplant inpatients with COVID-19 during 2 therapeutic eras (Era 1: March-May 2020, 21 patients; and Era 2: June-November 2020, 56 patients) and 52 solid organ transplant outpatients. Results. In Era 1, no patients received remdesivir or dexamethasone, and 4 of 21 (19.4%) received convalescent plasma, whereas in Era 2, remdesivir (24/56, 42.9%), dexamethasone (24/56, 42.9%), and convalescent plasma (40/56, 71.4%) were commonly used. Mortality was low across both eras, 4 of 77 (5.6%), and rejection occurred in only 2 of 77 (2.8%) inpatients; infections were similar in hypoxemic patients with or without dexamethasone. Preexisting graft dysfunction was associated with greater need for hospitalization, higher severity score, and lower survival. Acute kidney injury was present in 37.3% of inpatients; renal function improved more rapidly in patients who received remdesivir and convalescent plasma. Post-COVID-19 renal and liver function were comparable between eras, out to 90 d. Conclusions. Newer COVID-19 therapies did not appear to have a deleterious effect on allograft function, and infectious complications were comparable.

HomeJournal of the American Heart AssociationVol. 11, No. 5American Heart Association EPI|Lifestyle Scientific Sessions: 2021 Meeting Highlights Open AccessNewsPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toSupplementary MaterialsOpen AccessNewsPDF/EPUBAmerican Heart Association EPI|Lifestyle Scientific Sessions: 2021 Meeting Highlights Ruth‐Alma Turkson‐Ocran, PhD, MPH, RN, FNP‐BC, Kathryn Foti, PhD, MPH, Anika L. Hines, PhD, MPH, Debora Kamin Mukaz, PhD, MS, Hyunju Kim, PhD, MPH, Samantha Martin, PhD, Anum Minhas, MD, MHS, Faye L. Norby, PhD, MPH, Oluwabunmi Ogungbe, MPH, RN, Alexander C. Razavi, MD, PhD, MPH, Mary R. Rooney, PhD, MPH, Elisabeth L. P. Sattler, PhD, RPh, Jewel Scott, PhD, RN, NP‐C, Alvin G. Thomas, MSPH, Curtis Tilves, PhD, Amelia S. Wallace, MS, Frances M. Wang, MS, Mingyu Zhang, MHS, Pamela L. Lutsey, PhD, MPH and Kristie J. Lancaster, PhD, RDN Ruth‐Alma Turkson‐OcranRuth‐Alma Turkson‐Ocran https://orcid.org/0000-0001-9932-052X , General Internal Medicine, , Johns Hopkins University, , Baltimore, , MD, , Kathryn FotiKathryn Foti * Correspondence to: Kathryn Foti, PhD, MPH, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2400 E. Monument St., Suite 2‐600, Baltimore, MD 21205. E‐mail: E-mail Address: [email protected] https://orcid.org/0000-0002-6380-2735 , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Anika L. HinesAnika L. Hines https://orcid.org/0000-0003-3502-5606 , General Internal Medicine, , Johns Hopkins University, , Baltimore, , MD, , Department of Health Behavior and Policy, , Virginia Commonwealth University School of Medicine, , Richmond, , VA, , Debora Kamin MukazDebora Kamin Mukaz https://orcid.org/0000-0001-5573-2573 , Department of Medicine, , Larner College of Medicine at The University of Vermont, , Burlington, , VT, , Hyunju KimHyunju Kim https://orcid.org/0000-0002-1707-7018 , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Samantha MartinSamantha Martin , Department of Nutrition Sciences, , University of Alabama at Birmingham, , AL, , Anum MinhasAnum Minhas https://orcid.org/0000-0001-6680-0404 , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Division of Cardiology, , Johns Hopkins University School of Medicine, , Baltimore, , MD, , Faye L. NorbyFaye L. Norby https://orcid.org/0000-0002-1975-0405 , Department of Cardiology, , Smidt Heart Institute, , Cedars‐Sinai Health System, , Los Angeles, , CA, , Oluwabunmi OgungbeOluwabunmi Ogungbe https://orcid.org/0000-0003-1813-0906 , Johns Hopkins School of Nursing, , Baltimore, , MD, , Alexander C. RazaviAlexander C. Razavi https://orcid.org/0000-0002-3213-0876 , Department of Medicine, , Emory University School of Medicine, , Atlanta, , GA, , Mary R. RooneyMary R. Rooney https://orcid.org/0000-0002-5607-4848 , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Elisabeth L. P. SattlerElisabeth L. P. Sattler , Department of Clinical and Administrative Pharmacy, , College of Pharmacy, , University of Georgia, , Athens, , GA, , Department of Nutritional Sciences, , College of Family and Consumer Sciences, , University of Georgia, , Athens, , GA, , Jewel ScottJewel Scott https://orcid.org/0000-0001-5103-6087 , Department of Psychiatry, , University of Pittsburgh, , PA, , Alvin G. ThomasAlvin G. Thomas https://orcid.org/0000-0003-4911-8192 , Department of Epidemiology, , University of North Carolina, , Chapel Hill, , NC, , Department of Surgery, , Johns Hopkins University, , Baltimore, , MD, , Curtis TilvesCurtis Tilves https://orcid.org/0000-0003-0281-5986 , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Amelia S. WallaceAmelia S. Wallace https://orcid.org/0000-0002-1466-3791 , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Frances M. WangFrances M. Wang https://orcid.org/0000-0003-4950-582X , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Mingyu ZhangMingyu Zhang https://orcid.org/0000-0003-3628-0983 , Department of Epidemiology, , Johns Hopkins University, , Baltimore, , MD, , Pamela L. LutseyPamela L. Lutsey https://orcid.org/0000-0002-1572-1340 , Division of Epidemiology & Community Health, , University of Minnesota, , Minneapolis, , MN, and Kristie J. LancasterKristie J. Lancaster , Department of Nutrition and Food Studies, , New York University, , New York, , NY, Originally published18 Feb 2022https://doi.org/10.1161/JAHA.121.024765Journal of the American Heart Association. 2022;11:e024765Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 18, 2022: Ahead of Print The annual American Heart Association (AHA) EPI|Lifestyle Scientific Sessions for 2021 was held in a virtual format from May 20 to 21, 2021. The AHA EPI|Lifestyle Scientific Sessions were combined meetings of the Council on Epidemiology and Prevention (EPI) and the Council on Lifestyle and Cardiometabolic Health. The 2021 conference's theme was Health Equity and Social Justice and highlighted keynote sessions on health equity, structural racism, and COVID‐19 and cardiovascular disease (CVD) research. Results from observational studies and randomized controlled trials were presented at the meeting, including research on topics such as social determinants of health, maternal and child health, omics, nutrition, physical activity, and sleep. Participants of the virtual conference included clinicians, public health professionals, and trainees. Over 600 people took part in this year's event, which hosted 212 poster presentations, 66 moderated posters, and 80 oral presentations. The meeting chair representing the Council on Lifestyle and Cardiometabolic Health was Dr Kristie Lancaster from New York University, and Dr Pamela Lutsey from the University of Minnesota represented the EPI council. The vice chairs were Dr Marie‐France Hivert from Harvard University representing the Council on Lifestyle and Cardiometabolic Health, and Dr Alvaro Alonso representing the EPI council.Conference Theme: Health Equity and Social JusticeIn welcoming remarks, Dr Mitchell Elkind, AHA president, recognized that 2020 was a year characterized by a pandemic and an increased focus on structural racism, social justice, and the impacts of social determinants of health. To address the COVID‐19 crisis, the AHA created a rapid special response grant mechanism, and studies are ongoing. Additionally, as a result of the Presidential Advisory on Structural Racism published in November 2020,1 the AHA is committing $100 million over the next 5 years toward health equity and structural racism research.Keynote SessionsHealth Equity and Social JusticeThe opening keynote session, Health Equity and Social Justice, featured Drs Olajide Williams and LaPrincess Brewer, and was moderated by Dr Kristie Lancaster. Dr Olajide Williams from Columbia University presented an overview of the relationship between racism and poor health. Intense amygdala activation and greater startle response occur when unfamiliar Black male faces are shown, and this is associated with higher unconscious bias, starting in early adolescence. The effects of racism have seeped into every sector of US society. In working to prevent the detrimental effects of racism on cardiovascular health, Dr Williams used Dr Camara Jones' cliff analogy.2 If a group of people are at the edge of a cliff of good health, secondary and tertiary prevention strategies would focus on treating those who fall off, for instance by providing medical care to those who have fallen off the cliff (tertiary prevention) or positioning a trampoline halfway down the cliff to soften the fall (secondary prevention, safety‐net program). Primary prevention strategies would aim to prevent people from falling in the first place. Even more effective, however, would be to implement primordial prevention strategies that move people back from the edge of the cliff face. Furthermore, interventions to address the determinants of equity would address the unequal distribution of populations at the edge of the cliff and resources for prevention. In the context of cardiovascular health, Dr Williams discussed the importance of addressing structural racism and racism in all its forms.Dr LaPrincess Brewer from the Mayo Clinic spoke about community‐based participatory research to address cardiovascular disparities. Dr Brewer is the principal investigator of fostering African‐American improvement in total health (FAITH!), a culturally tailored mobile health intervention that integrated community‐based participatory research approaches to address cardiovascular health disparities within Black communities.3 Dr Brewer highlighted the importance of engaging community members in the research process when conducting studies addressing cardiovascular disparities. According to Dr Brewer, successful community‐based participatory research (1) is a partnership between community members, organizations and academics (of the people), (2) obtains community input and support from the beginning of the research (by the people), and (3) supports sustainability and dissemination for long‐term population health (for the people).COVID‐19The second day of the conference featured keynote lectures on COVID‐19 and cardiovascular health, and was moderated by Dr Pamela Lutsey. The first speaker was Dr Scott D. Solomon from Brigham and Women's Hospital who presented on COVID‐19 and the cardiovascular system. Cardiovascular risk factors and comorbidities are associated with severe COVID‐19. Endothelial damage may be the link between cardiovascular complications/risk factors and severe COVID‐19. Additionally, symptoms of postacute sequalae of COVID‐19 are linked to various organ systems including the cardiovascular system. Unfortunately, the extent of cardiovascular consequences of postacute sequalae of COVID‐19 are not yet fully known, and further rigorous epidemiologic research is needed.The second speaker was Dr Mercedes Carnethon from Northwestern University. Dr Carnethon presented on how disparities in cardiometabolic and cardiovascular morbidities contributed to the disproportionate burden of severe COVID‐19. Structural racism and its effects on social determinants of health increase the risk of both COVID‐19 infection and cardiometabolic and cardiovascular conditions, which are associated with severe COVID‐19 outcomes. As a result, across the spectrum of COVID‐19, from infection to postacute sequalae of COVID‐19, marginalized groups, including communities of color, have disproportionately suffered. To address COVID‐19 disparities, it would be important to expand access to health care, establish equitable care models, and address social determinants of health.David Kritchevsky Memorial LectureshipThe David Kritchevsky Memorial Lectureship was created in 2007 in honor of Dr David Kritchevsky for his important influence on our understanding of the role of diet in the pathophysiology of atherosclerosis.4 This year's honoree was Dr Serge Hercberg from the University of Sorbonne, Paris, France. Dr Hercberg began his lecture by acknowledging previous honorees, all of whom have made significant contributions to the field of nutritional science. His talk focused on the Nutri‐Score, a summary, graded, color‐coded, front‐of‐pack nutrition label first adopted in France in 2017 and subsequently in several other European countries.5 The Nutri‐Score rating system is designed to help consumers make healthier food choices at the point of purchase and incentivize manufacturers to reformulate their products. Dr Hercberg presented a summary of evidence used to support the implementation of the Nutri‐Score system, including understanding of Nutri‐Score among European consumers, comparisons with other front‐of‐pack labels on consumer purchase intentions, validation of the nutrient profile system underlying the Nutri‐Score, and associations of Nutri‐Score scores with prospective health outcomes. For example, consumption of foods in the poorest quartile of the Nutri‐Score rating conferred a 61% higher risk of CVD.6Oral Abstract PresentationsFollowing the keynote and named lecture sessions, oral abstracts were presented on a broad range of topics, described below. Moderated poster presentations are detailed in Data S1.Health Equity and Social JusticeAbstracts presented in this session, moderated by Dr Bertha Hidalgo from the University of Alabama at Birmingham aligned with the conference theme of health equity and social justice and highlighted research among Hispanic and Latinx, South Asian, and Black adults, incarcerated persons, and individuals living in rural communities.Jonathan Oxman from the Albert Einstein College of Medicine examined the relationship of perceived discrimination with cardiac structure and function in the HCHS/SOL (Hispanic Community Health Study/Study of Latinos): ECHO/SOL (Echocardiographic Study of Latinos) ancillary study. Stigmatization/devaluation and experiencing discrimination at work or school predicted left arterial volume index, and total discrimination score predicted left ventricular ejection fraction.7 Dr Alex Montiel Ishino from the National Institute on Minority Health and Health Disparities presented data from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study. Using a syndemic framework, findings showed that the latent profile at the highest risk of cardiometabolic disease was more likely to use an assimilation acculturation strategy.8Research by Dr Shabatun Islam from Emory University examined the relationship of neighborhood characteristics with arterial stiffness among participants from Jackson, Mississippi, and Atlanta, Georgia.9 Social cohesion and activity with neighbors were associated with better arterial health in both settings, whereas lower violence was associated with improved arterial health in Jackson, and improved food access was associated with better arterial health in Atlanta. Dr Chelsea Singleton from the University of Illinois presented research showing physical inactivity and obesity were associated with higher violent crime rates in majority Black or Hispanic census tracts, but not majority White census tracts in Chicago, Illinois.10Among women with a history of breast and gynecologic cancers, Dr Duke Appiah from the Texas Tech University Health Sciences Center found that the prevalence of cardiovascular mortality was higher among women living in rural compared with urban areas, which could be explained by individual‐ and neighborhood‐level factors. Dr Stephen Clarkson from the University of Alabama at Birmingham discussed predictors of establishing care in an interprofessional heart failure clinic following heart failure hospitalization at a hospital in Birmingham, Alabama. Black individuals residing in rural areas were least likely to establish care and more likely to have other comorbidities such as hypertension and alcohol use disorder than urban dwellers.11 Ary Spilkin from Northern Arizona University examined dietary content in a rural Southwest jail in comparison to guidelines for a heart‐healthy pregnancy. Sodium and saturated fat exceeded recommended amounts, whereas whole grains were inadequate.12Cardiovascular Outcomes and Risk PredictionIn the session on risk prediction, moderated by Dr Alvaro Alonso from Emory University, multiple presentations leveraged machine‐learning approaches. Dr Zhi Yu from the Broad Institute used data from the ARIC (Atherosclerosis Risk in Communities) study to address the impact of time‐varying risk factors on predicting the risk of sudden cardiac death using a novel machine‐learning approach.13 Dr Matthew Matheson from Johns Hopkins University tested the ability of random survival forest algorithms to identify the most important markers for incident CVD among 155 108 Japanese adults >40 years of age.14The value of longitudinal, cardiovascular cohorts was also displayed. Dr Rebecca Song from Boston University explored the prognostic usefulness of subclinical disease measures, such as coronary artery calcium score, left ventricular hypertrophy, and microalbuminuria, in the Framingham Offspring and Third Generation cohorts.15 Dr Mercedes Sotos‐Prieto of Universidad Autónoma de Madrid hypothesized that the Healthy Heart Score, a lifestyle‐based score, would improve the prediction of cardiovascular risk in the Jackson Heart Study, but it did not improve prediction of midlife CVD events beyond age alone.16 Using data from 6 US population‐based cohorts, Dr Priya Freaney from Northwestern University found Black women are 3 times more likely to experience premature natural menopause (<40 years) than White women, which was associated with a 40% higher risk of coronary heart disease in both Black and White women, emphasizing premature menopause should be assessed as a risk‐enhancing variable in clinical prevention decisions.17 Using data from the ARIC study, Dr Scott Mu from Johns Hopkins University found that the lowest mean value of self‐rated health occurred 1 year after hospitalization, and that poor self‐rated health was strongly associated with adverse outcomes, including a 4‐fold greater risk of mortality compared with excellent self‐rated health.18 Dr Zakaria Almuwaqqat from Emory University showed there was a synergistic association of posttraumatic stress disorder and mental stress‐induced myocardial ischemia on the risk of adverse cardiovascular outcomes in a cohort of individuals with stable coronary artery disease.19Diabetes and ObesityDr Justin Echouffo‐Tcheugui from Johns Hopkins University moderated the session on diabetes and obesity. Based on maternal birth record data for live births from 2016 to 2018, Dr Natalie Cameron from Northwestern University observed that the proportion of women with favorable prepregnancy cardiometabolic health (normal body mass index, no smoking, no diabetes, and no hypertension), has declined, with the lowest rates in the Southern and Midwestern states.20 Dr Ambarish Pandey from University of Texas Southwestern presented on the risk of heart failure for different measures of body composition and observed that higher fat mass and waist circumference were associated with a higher risk of heart failure among people with diabetes or prediabetes.21 Dr Di Zhao from Johns Hopkins University used a mobile application to evaluate the effect of time‐restricted eating on weight, and found that a higher number of medium or large meals was associated with weight gain, whereas a higher number of snacks was associated with decreased weight trajectory.22 Based on data from the action for health in diabetes (Look AHEAD) trial, Dr Mike Bancks from Wake Forest University found that the effect of the intensive lifestyle intervention on cardiovascular disease prevention may differ according to diabetes subgroup. Dr Rikuta Hamaya from Brigham and Women's Hospital used data from the Women's Health Study to identify modifiable lifestyle factors for serum levels of branched‐chain amino acids, which are associated with insulin resistance and type 2 diabetes.23 Body mass index was the only risk factor that explained a substantial portion of the variation in serum branched‐chain amino acid levels. Dr Xiang Gao from Colorado State University examined moderators and mediators of the relationship between the vasoconstrictor endothelin 1 and risk for diabetes in Black adults in the Jackson Heart Study.24 Dr Carolina Ochoa‐Rosales from Erasmus University found the beneficial effect of coffee on type 2 diabetes risk was partially mediated by improvements in systemic inflammation, as reflected in C‐reactive protein and adiponectin levels.25NutritionDr David Jacobs from the University of Minnesota moderated the nutrition session, which featured several presentations on dietary patterns. Fenglei Wang from Harvard University reported that among 10 684 participants of the Nurses' Health Study, Nurses' Health Study II, and the Health Professionals Follow‐Up Study, metabolomic signatures of plant‐based diets were associated with a significant 18% lower risk of incident type 2 diabetes.26 Dr Stephen Juraschek from Beth Israel Deaconess Medical Center presented a secondary analysis of the dietary approaches to stop hypertension (DASH)‐Sodium trial, which showed that compared with the control diet, participants randomized to a combined low‐sodium and DASH diet had lower levels of high‐sensitivity cardiac troponin I, N terminal pro‐B‐type natriuretic peptide, and high‐sensitivity C‐reactive protein.27 Dr Sun Young Jeong, an internal medicine resident at Beth Israel Deaconess Medical Center, demonstrated that individuals randomized to a DASH diet or a diet more broadly emphasizing fruits and vegetables had an average 10% and 11% reduction, respectively, in their 10‐year arteriosclerotic cardiovascular disease risk compared with those randomized to a control diet over an 8‐week period.28 Dr Marialaura Bonaccio from IRCCS Neuromed showed that individuals with greater adherence to a Mediterranean diet over 12.7 years experienced a reduction in inflammatory markers, including the granulocyte‐to‐lymphocyte ratio, compared with those with lower adherence.29 Dr Kathy Trieu from the George Institute for Global Health presented systematic review data suggesting that higher levels of dairy fat biomarkers (15:0 and 17:0) were associated with a lower risk of incident arteriosclerotic cardiovascular disease.30Novel CVD Risk FactorsIn this oral abstract session, moderated by Dr Deepak Gupta from Vanderbilt University, a variety of novel environmental, endogenous, and behavioral CVD risk factors were presented.Fan He of Pennsylvania State University used 24‐hour individual‐level acute particulate matter PM2.5 monitors and concurrently measured 24‐hour ECG recordings in the Penn State Child Cohort, and found that within 2 hours of exposure, every 10‐µg/m3 increase in PM2.5 was associated with a 5% increase in counts of premature ventricular contractions.31 Dr Erin Richard from the University of California San Diego used a Mendelian randomization approach to investigate the associations of various kidney function biomarkers and cognitive function in adults from the UK Biobank study, and found no evidence of causal effects for genetically determined levels of serum uric acid, creatinine‐based estimated glomerular filtration rate, or cystatin C‐based estimated glomerular filtration rate with cognitive performance.32 Dr Brandilyn Peters‐Samuelson from the Albert Einstein College of Medicine examined the impact of menopause on the microbiome and related associations with metabolic syndrome in the HCHS/SOL. There were similarities in the microbiomes of men and postmenopausal women, with a reduced abundance of potentially pathogenic bacteria Escherichia coli and Shigella dysenteriae.33Adam Haines from the Albert Einstein College of Medicine found that use of nonbenzodiazepine gamma‐aminobutyric acid receptor agonists, but not other prescription hypnotic use, was associated with increased risks of incident CVD and all‐cause mortality in older women with known sleep disturbances in the WHI (Women's Health Initiative).34 Yifei Lu from the University of North Carolina presented research from the ARIC study showing both higher midlife metabolic dysregulation and greater changes in metabolic dysregulation over time were associated with reduced later‐life physical function.35Dr Megan Nelson from the University of Idaho showed that over a 3‐hour bout of uninterrupted sitting, both physically active and inactive adults experienced negative physiological effects, including a worsening hemodynamic profile and increased levels of biomarkers interleukin‐6 and endothelin‐1.36 Dr Steven Nguyen from the University of California San Diego used ARIC data to examine the association of GrimAge, a DNA methylation‐based measure of aging that predicts all‐cause mortality, with incident heart failure and its potential usefulness for risk prediction.37SleepDr Chandra Jackson from the National Institute of Environmental Health Sciences moderated the session on sleep. Using data from the Nurses' Health Study and the Health Professionals Follow‐Up Study, Dr Marta Guasch‐Ferré from Harvard University found that a healthy lifestyle score including sleep duration was associated with lower incidence of total CVD, coronary heart disease, and stroke. Adding sleep duration to the traditional lifestyle score improved the model's prediction.38 Dr Faris Zuraikat from Columbia University presented a randomized crossover outpatient trial of adequate sleep versus sleep restriction characterized by a 1.5‐hour delay in bedtime. Chronic short sleep patterns were associated with greater sedentary time and lower physical activity, particularly among women.39Vivian Cao from Columbia University presented results of a cross‐sectional analysis of a diverse cohort of women, which showed a history of weight cycling (weight loss and regain) was associated with shorter sleep duration, poorer sleep quality, greater insomnia severity index, more sleep disturbances, and daytime dysfunction.40 Dr Julio Fernandez‐Mendoza from Pennsylvania State University presented findings showing that cumulative exposure to sleep‐disordered breathing over 15 years was associated with increased risk of endothelial dysfunction in young adults in the Penn State Child Cohort.41 Dr Adam Knowlden from the University of Alabama used National Health and Nutrition Examination Survey data to determine whether short sleep and insomnia represented independent constructs and if these constructs predicted obesity, hypertension, and diabetes.42 Claire Zhang from the University of California, San Diego discussed a novel, low‐cost tool that passively captures respiration during sleep via mechanical sensors placed under the legs of a bed to enable long‐term home investigation of periodic breathing.43COVID‐19 and CVDThis session included timely individual‐ and community‐level investigations related to COVID‐19 and CVD, and was moderated by Dr Elizabeth Oelsner from Columbia University.Dr Joshua Elliott from Imperial College presented data from the UK Biobank cohort of 473 574 participants at risk for COVID‐19 from January 2020. Age, male sex, Black race, low income, CVDs, hypertension, diabetes, autoimmune disease, history of steroid use, and cystatin C jointly predicted COVID‐19 mortality.44 In a population‐based sample of COVID‐19 cases and controls from the OneFlorida research consortium, Dr Osama Dasa from the University of Florida found there was a significantly higher prevalence of cardiovascular comorbidities in Black compared with White individuals with COVID‐19 infection.45Ashwin Sunderaj from Northwestern University examined the associations of community‐level factors, including social vulnerability (eg, crowded living conditions and limited food access) and socially protective factors (eg, having a primary care provider) with COVID‐19 mortality across 77 community areas in Chicago.46 Dr Alexander Ivanov from Wake Forest Baptist Medical Center presented findings from a serological substudy of 5000 randomly selected participants included in the COVID‐19 Community Research Partnership cohort and highlighted the independent association of heart failure with SARS‐CoV‐2 seroconversion.47 Eugenia Wong from the University of North Carolina used data from North Carolina disease event tracking and epidemiologic collection tool (NC DETECT), the state's syndromic surveillance system, to document an abrupt decrease in overall emergency department volume and acute myocardial infarction and stroke/transient ischemic attack emergency department visits following announcements of the state‐wide stay‐at‐home order.48 Dr Hanna Moon from Yonsei University Severance Hospital presented a systematic review on the characteristics and outcomes of in‐hospital cardiac arrest among patients with COVID‐19.49 Finally, Dr Gregory Heath from the University of Tennessee, Chattanooga discussed the use of geospatial data and subsequent intersectoral collaboration to eliminate disparities in COVID‐19 testing.50Maternal and Child HealthThis session, moderated by Dr Marie‐France Hivert from Harvard University featured several presentations aimed at addressing disparities in maternal and child health.Dr Michelle Ogunwole from Johns Hopkins University examined disparities in gestational diabetes among US‐ versus foreign‐born women by analyzing data from the 2016 to 2017 National Health Interview Survey.51 Dr Samantha E. Parker from Boston University found 1 in 10 women in a diverse safety‐net hospital population with normotensive pregnancies developed de novo hypertension within 12 months postpartum; risk factors included identifying as non‐Hispanic Black, delivery via cesarean section, preterm delivery, or multiparous gestation.52 Dr Angela Malek from the Medical University of South Carolina investigated the associations of hypertensive disorders of pregnancy and prepregnancy hypertension with incident maternal embolism within 5 years of delivery overall and by race and ethnicity using data from a retrospective cohort study in South Carolina.53Using data from the Boston Birth Cohort, Dr Anum Minhas from Johns Hopkins University found greater adherence to a Mediterranean style diet was associated with lower odds of preeclampsia.54 Dr Adebamike A. Oshunbade from the University of Mississippi Medical Center evaluated the relationship between hypertensive diseases in pregnancy and biomarkers of hemodynamic stress later in life in the Genetic Epidemiol

Valid, reliable behavioral data and contextually meaningful interventions are necessary for improved health outcomes. Ecological Momentary Assessment and Intervention (EMAI), which collects data as behaviors occur to deliver real-time interventions, may be more accurate and reliable than retrospective methods. The rapid expansion of mobile technologies in low-and-middle-income countries allows for unprecedented remote data collection and intervention opportunities. However, no previous studies have trialed EMAI in sub-Saharan Africa. We assessed EMAI acceptability and feasibility, including participant retention and response rate, in a prospective, parallel group, randomized pilot trial in Rakai, Uganda comparing behavioral outcomes among adults submitting ecological momentary assessments (EMA) versus EMAI. After training, participants submitted EMA data on five nutrition and health risk behaviors over a 90-day period using a smartphone-based application utilizing prompt-based, participant-initiated, and geospatial coordinate data collection, with study coordinator support and incentives for >50% completion. Included behaviors and associated EMAI-arm intervention messages were selected to pilot a range of EMAI applications. Acceptability was measured on questionnaires. We estimated the association between high response rate and participant characteristics and conducted thematic analysis characterizing participant experiences. Study completion was 48/50 participants. Median prompt response rate was 66.5% (IQR: 60.0%-78.6%). Prior smartphone app use at baseline (aPR 3.76, 95%CI: 1.16–12.17, p = 0.03) and being in the intervention arm (aPR 2.55, 95% CI: 1.01–6.44, p = 0.05) were significantly associated with the top response rate quartile (response to >78.6% of prompts). All participants submitted self-initiated reports, covering all behaviors of interest, including potentially sensitive behaviors. Inconsistent phone charging was the most reported feasibility challenge. In this pilot, EMAI was acceptable and feasible. Response rates were good; additional strategies to improve compliance should be investigated. EMAI using mobile technologies may support improved behavioral data collection and intervention approaches in low and middle-income settings. This approach should be tested in larger studies.

BACKGROUND Effective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health worker-delivered, theory-based (situated Information, Motivation, and Behavior Skills), motivational interviewing-informed, and mobile phone application-supported counseling strategy called "Health Scouts" to promote engagement in HIV treatment and prevention services. METHODS AND FINDINGS The study community was divided into 40 contiguous, randomly allocated clusters (20 intervention clusters, n = 1,054 participants at baseline; 20 control clusters, n = 1,094 participants at baseline). From September 2015 to December 2018, the Health Scouts were deployed in intervention clusters. Community-wide, cross-sectional surveys of consenting 15 to 49-year-old residents were conducted at approximately 15 months (mid-study) and at approximately 39 months (end-study) assessing the primary programmatic outcomes of self-reported linkage to HIV care, antiretroviral therapy (ART) use, and male circumcision, and the primary biologic outcome of HIV viral suppression (<400 copies/mL). Secondary outcomes included HIV testing coverage, HIV incidence, and consistent condom use. The primary intent-to-treat analysis used log-linear binomial regression with generalized estimating equation to estimate prevalence risk ratios (PRR) in the intervention versus control arm. A total of 2,533 (45% female, mean age: 31 years) and 1,903 (46% female; mean age 32 years) residents completed the mid-study and end-study surveys, respectively. At mid-study, there were no differences in outcomes between arms. At end-study, self-reported receipt of the Health Scouts intervention was 38% in the intervention arm and 23% in the control arm, suggesting moderate intervention uptake in the intervention arm and substantial contamination in the control arm. At end-study, intention-to-treat analysis found higher HIV care coverage (PRR: 1.06, 95% CI: 1.01 to 1.10, p = 0.011) and ART coverage (PRR: 1.05, 95% CI: 1.01 to 1.10, p = 0.028) among HIV-positive participants in the intervention compared with the control arm. Male circumcision coverage among all men (PRR: 1.05, 95% CI: 0.96 to 1.14, p = 0.31) and HIV viral suppression among HIV-positive participants (PRR: 1.04, 95% CI: 0.98 to 1.12, p = 0.20) were higher in the intervention arm, but differences were not statistically significant. No differences were seen in secondary outcomes. Study limitations include reliance on self-report for programmatic outcomes and substantial contamination which may have diluted estimates of effect. CONCLUSIONS A novel community health worker intervention improved HIV care and ART coverage in an HIV hyperendemic setting but did not clearly improve male circumcision coverage or HIV viral suppression. This community-based, implementation strategy may be a useful component in some settings for HIV epidemic control. TRIAL REGISTRATION ClinicalTrials.gov NCT02556957.

Introduction: Poor lung function and aortic stiffness often co-occur, but causal and temporal relationships are equivocal. Investigating relationships between mid-life lung function and arterial stiffness later in life may highlight modifiable targets to slow arterial aging. Objective: Assess whether lung function in mid-life is associated with central artery stiffness later in life, and whether this relationship is modified by baseline smoking status, hypertension, or diabetes. Methods: We included 3,529 ARIC cohort participants (60% women; 22% Black; mean baseline age 51.4 (SD: 4.9)) who attended visits 1 (1987-1989) and 5 (2011-2013). Spirometry included forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) of high-quality grades. Central artery stiffness (carotid-femoral pulse wave velocity (cfPWV)) was measured at visit 5. Associations of mid-life lung function with later-life central artery stiffness (cfPWV>75 th percentile) were evaluated by multivariable Poisson and logistic regressions adjusted for covariates. Sensitivity analyses excluded participants with chronic obstructive pulmonary disease identified from surveillance of hospitalizations occurring in follow up (N=109). Results: Mean FEV1 at visit 1 was 3.04 L (SD: 0.73) and FVC was 3.99 L (SD: 0.96). Lung function varied by thoracic height. Visits 1 and 5 were a mean of 23.8 years apart, and mean cfPWV at visit 5 was 1167 cm/s (SD: 379). Lung function at visit 1 was inversely associated with adjusted prevalence and odds of later cfPWV>75 th percentile among those present at visit 5 (Table). Stratum-specific estimates suggested modification by baseline smoking status, hypertension, and diabetes, but were not nominally statistically different. Sensitivity analyses did not alter inferences. Conclusion: Lung function at mid-life is inversely associated with central artery stiffness in later life. Whether change in mid-life pulmonary function is associated with arterial stiffness later in life warrants further examination.

BACKGROUND:Low levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the low physiologic range, surrogate markers for reduced liver metabolic function, are associated with cerebral hypometabolism, impairment in neurotransmitter production and synaptic maintenance, and a higher prevalence of dementia. It is unknown whether a prospective association exists between low liver enzyme levels and incident dementia.OBJECTIVE:To determine whether low levels of ALT and AST are associated with higher risk of incident dementia.METHODS:Plasma ALT and AST were measured on 10,100 study participants (mean age 63.2 years, 55% female, 22% black) in 1996-1998. Dementia was ascertained from comprehensive neuropsychological assessments, annual contact, and medical record surveillance. Cox proportional hazards regression was used to estimate the association.RESULTS:During a median follow-up of 18.3 years (maximum 21.9 years), 1,857 individuals developed dementia. Adjusted for demographic factors, incidence rates of dementia were higher at the lower levels of ALT and AST. Compared to the second quintile, ALT values <10th percentile were associated with a higher risk of dementia (hazard ratio [HR] 1.34, 95% CI 1.08-1.65). The corresponding HR was 1.22 (0.99-1.51) for AST.CONCLUSION:Plasma aminotransferases <10th percentile of the physiologic range at mid-life, particularly ALT, were associated with greater long-term risk of dementia, advocating for attention to the putative role of hepatic function in the pathogenesis of dementia.