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O'Leary ST, Spina CI, Spielvogle H, Robinson JD, Garrett K, Perreira C, Pahud B, Dempsey AF, Opel DJ. Development of PIVOT with MI: A motivational Interviewing-Based vaccine communication training for pediatric clinicians. Vaccine 2023; 41:1760-1767. [PMID: 36775776 DOI: 10.1016/j.vaccine.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/04/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Delay or refusal of childhood vaccines is common and may be increasing. Pediatricians are parents' most trusted source for vaccine information, yet many struggle with how to communicate with parents who resist recommended vaccines. Evidence-based communication strategies for vaccine conversations are lacking. In this manuscript, we describe the development and perceived usefulness of a curriculum to train clinicians on a specific vaccine communication strategy as part of the PIVOT with MI study, a cluster randomized trial testing the effectiveness of this communication strategy on increasing childhood vaccination uptake among 24 pediatric practices in Colorado and Washington. The communication strategy is based on the existing evidence-based communication strategies of a presumptive format for initiating vaccine conversations and use of motivational interviewing if hesitancy persists. Focus groups and semi-structured interviews with pediatric clinicians helped inform the development of the training curriculum, which consisted of an introductory video module followed by 3 training sessions. Between September 2019 and January 2021, 134 pediatric clinicians (92 pediatricians, 42 advanced practice providers) participated in the training as part of the PIVOT with MI study. Of these, 92 % viewed an introductory video module, 93 % attended or viewed a baseline synchronous training, 82 % attended or viewed a 1st refresher training, and 77 % attended or viewed a 2nd refresher training. A follow-up survey was administered August 2020 through March 2021; among respondents (n = 100), >95 % of participants reported that each component of the training program was very or somewhat useful. These data suggest that the PIVOT with MI training intervention is a useful vaccine communication resource with the potential for high engagement among pediatric clinicians.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Christine I Spina
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, OR, United States
| | - Kathleen Garrett
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cathryn Perreira
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Barbara Pahud
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Amanda F Dempsey
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States; Seattle Children's Research Institute, Seattle, WA, United States
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Alonso-Cabezas M, Pollán M, Alonso-Ledesma I, Fernández de Larrea-Baz N, Lucas P, Sierra Á, Castelló A, Pino MN, Pérez-Gómez B, Martínez-Cortés M, Lope V, Ruiz-Moreno E. Sociodemographic and Lifestyle Determinants of Adherence to Current Dietary Recommendations and Diet Quality in Middle-Aged Spanish Premenopausal Women. Front Nutr 2022; 9:904330. [PMID: 35774550 PMCID: PMC9237508 DOI: 10.3389/fnut.2022.904330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/05/2022] [Indexed: 12/31/2022] Open
Abstract
Background A healthy diet when approaching menopause could prevent some of the symptoms associated with the climacteric. Few studies examine adherence to current healthy dietary recommendations in middle-aged premenopausal women. Our objective was to analyze the diet quality and the adherence to the Spanish Society of Community Nutrition (SENC) dietary recommendations in middle-aged Spanish premenopausal women, and to identify the associated sociodemographic and lifestyle factors. Methods This is a cross-sectional study based on 1251 premenopausal women, aged 39–50, who attended to Madrid City Council Medical Diagnostic Center. Women completed an epidemiological and a food frequency questionnaire. Degree of adherence to the SENC recommendations was estimated with a score that evaluated null (0 points) and full (1 point) adherence of each specific recommendation. Associations were explored using an ordinal logistic multivariable regression model. Results Regarding food groups, the worst adherence was found for sweets, red/processed meat, olive oil and eggs. Most of the participants exceeded the recommended caloric intake from proteins and fats, and practically all of them showed vitamin D intake deficiency. The overall score ranged from 2 to 12 (out of 15), with a median of 6.0 (interquartile range: 5.0–7.0). Former smokers (OR: 1.38; 95%CI: 1.08–1.78), as well as those with higher educational level (ORSSecondary:1.68; 95%CI: 0.97–2.93, ORUniversity:1.82; 95%IC: 1.05–3.14), with two or more children (OR: 1.31; 95%IC: 1.00-1.72), with higher caloric intake (OR>2188.2kcal/day: 8.22; 95%CI: 6.19–10.92) and with greater physical activity (OR≥21METS−h/week: 1.29; 95%CI: 0.95-1.76) showed greater adherence. Conclusions Almost two-thirds of middle-aged premenopausal participants showed low or moderate compliance with SENC recommendations. Education, smoking, parity, and physical activity were associated with the degree of adherence to these recommendations.
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Affiliation(s)
- Marina Alonso-Cabezas
- Department of Nutrition and Food Sciences, Faculty of Farmacy, Complutense University of Madrid, Madrid, Spain
| | - Marina Pollán
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Alonso-Ledesma
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Nerea Fernández de Larrea-Baz
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Lucas
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ángeles Sierra
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Adela Castelló
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Marina Nieves Pino
- Servicio de Prevención y Promoción de la Salud, Madrid Salud, Ayuntamiento de Madrid, Madrid, Spain
| | - Beatriz Pérez-Gómez
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Martínez-Cortés
- Servicio de Prevención y Promoción de la Salud, Madrid Salud, Ayuntamiento de Madrid, Madrid, Spain
| | - Virginia Lope
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Virginia Lope
| | - Emma Ruiz-Moreno
- Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Physical Activity, Healthy Behavior and Its Motivational Correlates: Exploring the Spillover Effect through Stages of Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106161. [PMID: 35627697 PMCID: PMC9140983 DOI: 10.3390/ijerph19106161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/10/2022]
Abstract
On the basis of the spillover or transfer effect and the transtheoretical model of change, this study assessed the association between amount of physical activity, healthy and unhealthy weight control behaviors, and motivational types, as well as their variability across stages of change. A total of 1219 randomly selected Mexican adults from 18 to 65 years old, representative of the city of Monterrey (México), participated in the study. Correlation analyses, differences by gender, and multivariate analyses of variance, controlling for age, were performed. We found that in the maintenance stage, there is higher frequency of physical activity more healthy weight control behaviors, as well as higher autonomous motivation. In the contemplation stage, there is less physical activity, a higher frequency of unhealthy weight control behaviors, higher controlled motivation, and amotivation. Relationships were found between the healthy behaviors studied and the interaction dynamics observed across the stages of change, highlighting the key role of the contemplation and maintenance stages in weight control change. Physical activity as a targeted intervention objective could be a gateway to healthier weight control behavior, as well as higher autonomous motivation.
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Bloom EL, Bogart A, Dubowitz T, Collins RL, Ghosh-Dastidar B, Gary-Webb TL, Troxel W. Longitudinal Associations Between Changes in Cigarette Smoking and Alcohol Use, Eating Behavior, Perceived Stress, and Self-Rated Health in a Cohort of Low-Income Black Adults. Ann Behav Med 2022; 56:112-124. [PMID: 33970236 PMCID: PMC8691395 DOI: 10.1093/abm/kaab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Black adults in the U.S. experience significant health disparities related to tobacco use and obesity. Conducting observational studies of the associations between smoking and other health behaviors and indicators among Black adults may contribute to the development of tailored interventions. PURPOSE We examined associations between change in cigarette smoking and alcohol use, body mass index, eating behavior, perceived stress, and self-rated health in a cohort of Black adults who resided in low-income urban neighborhoods and participated in an ongoing longitudinal study. METHODS Interviews were conducted in 2011, 2014, and 2018; participants (N = 904) provided at least two waves of data. We fit linear and logistic mixed-effects models to evaluate how changes in smoking status from the previous wave to the subsequent wave were related to each outcome at that subsequent wave. RESULTS Compared to repeated smoking (smoking at previous and subsequent wave), repeated nonsmoking (nonsmoking at previous and subsequent wave) was associated with greater likelihood of recent dieting (OR = 1.59, 95% CI [1.13, 2.23], p = .007) and future intention (OR = 2.19, 95% CI [1.61, 2.98], p < .001) and self-efficacy (OR = 1.64, 95% CI [1.21, 2.23], p = .002) to eat low calorie foods, and greater odds of excellent or very good self-rated health (OR = 2.47, 95% CI [1.53, 3.99], p < .001). Transitioning from smoking to nonsmoking was associated with greater self-efficacy to eat low calorie foods (OR = 1.89, 95% CI [1.1, 3.26], p = .021), and lower perceived stress (β = -0.69, 95% CI [-1.34, -0.05], p = .036). CONCLUSIONS We found significant longitudinal associations between smoking behavior and eating behavior, perceived stress, and self-rated health. These findings have implications for the development of multiple behavior change programs and community-level interventions and policies.
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Affiliation(s)
| | | | | | | | | | - Tiffany L Gary-Webb
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Leopold JA, Antman EM. Ideal Cardiovascular Health in Former Smokers. J Clin Med 2021; 10:jcm10112450. [PMID: 34205862 PMCID: PMC8198985 DOI: 10.3390/jcm10112450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022] Open
Abstract
Former smokers remain at increased risk for cardiovascular diseases compared to never smokers, but have lower risk than current smokers. We therefore hypothesized that former smokers would have an ideal cardiovascular health phenotype that was intermediate between current and never smokers. Differences in ideal cardiovascular health between never (n = 1025), former (n = 428), and current (n = 108) smokers were evaluated in the My Research Legacy study, which collected cardiovascular health data from the Life’s Simple 7 survey and digital health devices. Former smokers had a higher burden of prevalent cardiovascular disease, hypertension, diabetes mellitus, and hypercholesterolemia compared to current and never smokers (all p < 0.01). Former smokers’ Life’s Simple 7 Health Scores, a measure of ideal cardiovascular health, were intermediate between current and never smokers (4.9 ± 1.3 vs. 6.3 ± 1.5 vs. 7.0 ± 1.4, p < 0.01). As former smokers shared similarities with both current and never smokers, we performed a cluster analysis, which identified two phenogroups of former smokers. The phenogroups differed significantly across all 7 cardiovascular health and behavior categories (all p < 0.01). These findings suggest that former smokers are a heterogeneous group and increased attention to cardiovascular health factors and behaviors is warranted to achieve ideal cardiovascular health.
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Affiliation(s)
- Jane A. Leopold
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, NRB630K, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-525-4846
| | - Elliott M. Antman
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;
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Brewer SE, Cataldi JR, Fisher M, Glasgow RE, Garrett K, O'Leary ST. Motivational Interviewing for Maternal Immunisation (MI4MI) study: a protocol for an implementation study of a clinician vaccine communication intervention for prenatal care settings. BMJ Open 2020; 10:e040226. [PMID: 33203635 PMCID: PMC7674098 DOI: 10.1136/bmjopen-2020-040226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Vaccination against influenza and pertussis in pregnancy offers a 'two-for-one' opportunity to protect mother and child. Pregnant patients have increased risk of severe disease from influenza and newborns have increased risk of severe disease from both influenza and pertussis. Obstetricians need communication tools to support their self-efficacy and effectiveness in communicating the importance of immunisation during pregnancy and ultimately improving maternal vaccination rates. METHODS AND ANALYSIS We describe the protocol for a pragmatic study testing the feasibility and potential impact of a clinician communication strategy on maternal vaccination uptake. This study will be conducted in five prenatal care settings in Colorado, USA. The Motivational Interviewing for Maternal Immunisation strategy involves training prenatal care providers to use motivational interviewing in the vaccine conversation with pregnant patients. Our primary outcomes will be the adoption and implementation of the intervention measured using the Enhanced RE-AIM/Practical Robust Implementation and Sustainability Model for dissemination and implementation. Secondary outcomes will include provider time spent, fidelity to Motivational Interviewing and self-efficacy measured through audio recorded visits and provider surveys, patients' visit experience based on audio recorded visits and follow-up interviews, and maternal vaccine uptake as measured through chart reviews. ETHICS AND DISSEMINATION This study is approved by the following institutional review boards: Colorado Multiple Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations. TRIAL REGISTRATION NUMBER NCT04302675.
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Affiliation(s)
- Sarah E Brewer
- Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica R Cataldi
- Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Fisher
- Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Russell E Glasgow
- Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kathleen Garrett
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Lee MH, Matthews AK, Park CG, Vincent C, Hsieh K, Savage TA. Relationships among parenting stress, health-promoting behaviors, and health-related quality of life in Korean mothers of children with cerebral palsy. Res Nurs Health 2020; 43:590-601. [PMID: 32990995 DOI: 10.1002/nur.22074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/07/2022]
Abstract
Health-promoting behaviors have been shown to enhance the quality of life across diverse populations. In this study, we examined the indirect effects of several health-promoting behaviors on the relationship between parenting stress and health-related quality of life in mothers of children with cerebral palsy (CP). A convenience sample of Korean mothers (N = 180) of children aged 10 months to 12 years with CP was recruited from clinical and school settings. Health-promoting behaviors were measured using the health-promoting lifestyle profile II, which is comprised of six subscales: health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Multiple mediation analyses were conducted to examine the mediating role of these behavioral categories. Spiritual growth (β = .56, p < .05) had an indirect effect on the relationship between parenting stress and physical health-related quality of life while spiritual growth (β = -1.00, p < .01) and stress management (β = -.80, p < .05) were found to mediate the association between parenting stress and mental health-related quality of life. The findings of multiple mediation analyses provide evidence of the influence of specific health-promoting behaviors on health-related quality of life, thereby informing the development of intervention programs for mothers of children with disabilities.
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Affiliation(s)
- Meen Hye Lee
- School of Nursing at UNCW, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Alicia K Matthews
- College of Nursing at UIC, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chang Gi Park
- College of Nursing at UIC, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Catherine Vincent
- College of Nursing at UIC, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kelly Hsieh
- Disability and Human Development at UIC, College of Applied Health Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Teresa A Savage
- College of Nursing at UIC, University of Illinois at Chicago, Chicago, Illinois, USA
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Opel DJ, Robinson JD, Spielvogle H, Spina C, Garrett K, Dempsey AF, Perreira C, Dickinson M, Zhou C, Pahud B, Taylor JA, O'Leary ST. 'Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing' (PIVOT with MI) trial: a protocol for a cluster randomised controlled trial of a clinician vaccine communication intervention. BMJ Open 2020; 10:e039299. [PMID: 32784263 PMCID: PMC7418671 DOI: 10.1136/bmjopen-2020-039299] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION A key contributor to underimmunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents' minds. Improving clinician communication with VHPs is critical to increasing childhood vaccine uptake. METHODS AND ANALYSIS We describe the protocol for a cluster randomised controlled trial to test the impact of a novel, multifaceted clinician vaccine communication strategy on child immunisation status. The trial will be conducted in 24 primary care practices in two US states (Washington and Colorado). The strategy is called Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI), and involves clinicians initiating the vaccine conversation with all parents of young children using the presumptive format, and among those parents who resist vaccines, pivoting to using MI. Our primary outcome is the immunisation status of children of VHPs at 19 months, 0 day of age expressed as the percentage of days underimmunised from birth to 19 months for 22 doses of eight vaccines recommended during this interval. Secondary outcomes include clinician experience communicating with VHPs, parent visit experience and clinician adherence to the PIVOT with MI communication strategy. ETHICS AND DISSEMINATION This study is approved by the following institutional review boards: Colorado Multiple Institutional Review Board, Washington State Institutional Review Board and Swedish Health Services Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations. TRIAL REGISTRATION NUMBER NCT03885232.
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Affiliation(s)
- Douglas J Opel
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, Oregon, USA
| | | | - Christine Spina
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Kathleen Garrett
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Amanda F Dempsey
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Cathryn Perreira
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Miriam Dickinson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Barbara Pahud
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - James A Taylor
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sean T O'Leary
- Children's Hospital Colorado, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
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Maugeri A, Barchitta M, Kunzova S, Bauerova H, Agodi A, Vinciguerra M. The association of social and behavioral factors with dietary risks in adults: Evidence from the Kardiovize Brno 2030 study. Nutr Metab Cardiovasc Dis 2020; 30:896-906. [PMID: 32249142 DOI: 10.1016/j.numecd.2020.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Uncovering the main determinants of diet quality is one of the greatest challenges for Public Health, since it could guide future strategies and interventions against cardiovascular diseases (CVDs). The present cross-sectional analysis of the Kardiovize cohort evaluates the prevalence of dietary risk factors for CVDs and their association with social and behavioural characteristics in a random sample of 1536 adults (aged 25-64 years) from Brno, Czech Republic. METHODS AND RESULTS A face-to-face health interview guided by structured questionnaires was carried out on socio-demographic characteristics (age, sex, educational level, employment, marital status, income, and household size) and behaviours (smoking status, physical activity, and sleep habits). Twelve dietary risk factors covered by the Global Burden of Diseases comparative risk assessment framework were assessed using a Food Frequency Questionnaire. In general, we observed that the consumption of nearly all healthy foods and nutrients was suboptimal, and that it was also aggravated by high intake of foods and nutrients that constituted dietary risk factors. Moreover, we found several associations of social and behavioural characteristics with specific dietary risk factors. Particularly, being male (β = 0.466; SE = 0.079; p < 0.001), increasing household size (β = 0.130; SE = 0.047; p = 0.006), low income (β = 0.192; SE = 0.091; p = 0.035), and decreasing physical activity level (β = 0.172; SE = 0.054; p = 0.002) were associated with increasing number of dietary risk factors. CONCLUSION Thus, our study raises an urgent need for Public Health strategies promoting healthy eating in adulthood, which should be based on traditional and novel determinants of dietary risk.
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Affiliation(s)
- A Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy; International Clinical Research Center (FNUSA-ICRC), St. Anne's University Hospital, Brno, Czech Republic.
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - S Kunzova
- International Clinical Research Center (FNUSA-ICRC), St. Anne's University Hospital, Brno, Czech Republic
| | - H Bauerova
- International Clinical Research Center (FNUSA-ICRC), St. Anne's University Hospital, Brno, Czech Republic
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - M Vinciguerra
- International Clinical Research Center (FNUSA-ICRC), St. Anne's University Hospital, Brno, Czech Republic
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Maugeri A, Barchitta M, Fiore V, Rosta G, Favara G, La Mastra C, La Rosa MC, Magnano San Lio R, Agodi A. Determinants of Adherence to the Mediterranean Diet: Findings from a Cross-Sectional Study in Women from Southern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162963. [PMID: 31426512 PMCID: PMC6720012 DOI: 10.3390/ijerph16162963] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/03/2019] [Accepted: 08/16/2019] [Indexed: 11/16/2022]
Abstract
The Mediterranean diet (MD)—the dietary pattern usually consumed by Mediterranean populations—can help promote a favorable health status and better quality of life. Uncovering the main factors associated with the adherence to MD may be useful in understanding and counteracting the global shift toward a Western diet, which has been documented also in the Mediterranean region. Here, we evaluated the adherence to MD and its major social and behavioral determinants in women from Catania, Southern Italy. This cross-sectional study included 841 women, aged 25–64 years, with no history of severe diseases. Adherence to MD was assessed by the Food Frequency Questionnaire and Mediterranean Diet Score (MDS). Associations between variables were tested by multivariable logistic regression analysis and expressed as an odds ratio (OR) with a 95% confidence interval (CI). Among social factors, medium and high educational levels were associated with an ideal intake of alcohol (OR = 4.059; 95%CI = 1.311–12.570; p = 0.015; OR = 4.258 95%CI = 1.068–16.976; p = 0.040; respectively), living in a couple with ideal intake of cereals (OR = 2.801 95%CI = 1.188–6.602; p = 0.018), and having children with an ideal intake of fruits (OR = 3.149; 95%CI = 1.245–7.762; p = 0.015). With respect to behaviors, current smoking was negatively associated with an ideal intake of meat (OR = 0.449; 95%CI = 0.0220–0.917; p = 0.028), while more engagement in physical activity was associated with an ideal intake of vegetables (OR = 6.148; 95%CI = 1.506–25.104; p = 0.011) and legumes (OR = 5.832; 95%CI = 1.414–24.063; p = 0.015). In line with these findings, moderately or highly physically active women were more likely to show medium or high adherence to MD than those who performed less physical activity (OR = 6.024; 95%CI = 1.192–30.440; p = 0.040; OR = 9.965 95%CI = 1.683–58.993; p = 0.011; respectively). Our results confirm an urgent need for public health strategies, which should take into account determinants of diet quality. Particularly, our study indicates that more engagement in physical activity is a major positive determinant of the adherence to MD.
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Affiliation(s)
- Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Valerio Fiore
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Giuliana Rosta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Claudia La Mastra
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Maria Clara La Rosa
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Roberta Magnano San Lio
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123 Catania, Italy.
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11
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Lindson N, Thompson TP, Ferrey A, Lambert JD, Aveyard P. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD006936. [PMID: 31425622 PMCID: PMC6699669 DOI: 10.1002/14651858.cd006936.pub4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to stop smoking. OBJECTIVES To evaluate the efficacy of MI for smoking cessation compared with no treatment, in addition to another form of smoking cessation treatment, and compared with other types of smoking cessation treatment. We also investigated whether more intensive MI is more effective than less intensive MI for smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies using the term motivat* NEAR2 (interview* OR enhanc* OR session* OR counsel* OR practi* OR behav*) in the title or abstract, or motivation* as a keyword. We also searched trial registries to identify unpublished studies. Date of the most recent search: August 2018. SELECTION CRITERIA Randomised controlled trials in which MI or its variants were offered to smokers to assist smoking cessation. We excluded trials that did not assess cessation as an outcome, with follow-up less than six months, and with additional non-MI intervention components not matched between arms. We excluded trials in pregnant women as these are covered elsewhere. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RR) and 95% confidence intervals (CI) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We extracted data on mental health outcomes and quality of life and summarised these narratively. MAIN RESULTS We identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. MI was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. We judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case - our analysis comparing higher to lower intensity MI.We found low-certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). We judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low-certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results.Mental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well-being. AUTHORS' CONCLUSIONS There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation. It is also unclear whether more intensive MI is more effective than less intensive MI. All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency. Consequently, future trials are likely to change these conclusions. There is almost no evidence on whether MI for smoking cessation improves mental well-being.
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Affiliation(s)
- Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Tom P Thompson
- University of PlymouthFaculty of Medicine and DentistryPlymouthDevonUK
| | - Anne Ferrey
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | | | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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12
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How Do Physical Activity and Health Vary Among Younger, Middle-Aged, and Older Adults With and Without Disability? J Aging Phys Act 2019; 27:234-241. [DOI: 10.1123/japa.2017-0215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Brostow DP, Warsavage TJ, Abbate LM, Starosta AJ, Brenner LA, Plomondon ME, Valle JA. Mental illness and obesity among Veterans undergoing percutaneous coronary intervention: Insights from the VA CART program. Clin Obes 2019; 9:e12300. [PMID: 30793500 DOI: 10.1111/cob.12300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 12/22/2022]
Abstract
Mental illness and obesity are highly prevalent in patients with coronary disease and are frequently comorbid. While mental illness is an established risk factor for major adverse cardiac and cerebrovascular events (MACCEs), prior studies suggest improved outcomes in people with obesity. It is unknown if obesity and mental illness interact to affect cardiac outcomes or if they independently influence MACCE. We identified 55 091 patients undergoing percutaneous coronary intervention (PCI) between 2009 and 2014, using the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program. Cox methods were used to assess the risk of MACCE by weight status and psychiatric diagnosis, and assessed for interaction. Compared to normal weight status, higher weight was associated with reduced MACCE events after PCI (mean follow-up of 2 years) for both stable angina and acute coronary syndromes (ACSs; reduction of >13% in stable angina, >17% in ACS; P < 0.01 for both after adjustment). Having a non-substance abuse mental illness diagnosis increased risk of MACCE compared to patients without mental illness in stable angina over 17%; P < 0.05, but not in ACS. When analysed for interaction, obesity and mental illness did not significantly impact MACCE over their independent influences. These results suggest that mental illness along with weight status have significant impact on MACCE, post-PCI. Clinicians should be aware of patients' mental health status as a significant cardiovascular risk factor after PCI, independent of weight status.
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Affiliation(s)
- Diana P Brostow
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
| | - Theodore J Warsavage
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
| | - Lauren M Abbate
- Geriatric Research, Education, and Clinical Center, Rocky Mountain VA Medical Center, Aurora, CO, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lisa A Brenner
- Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
- Rocky Mountain VA Medical Center, Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
- Department of Psychiatry, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Neurology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
| | - Mary E Plomondon
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
| | - Javier A Valle
- Division of Cardiology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
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Sarma EA, Moyer A, Messina CR, Laroche HH, Snetselaar L, Van Horn L, Lane DS. Is There a Spillover Effect of Targeted Dietary Change on Untargeted Health Behaviors? Evidence From a Dietary Modification Trial. HEALTH EDUCATION & BEHAVIOR 2019; 46:569-581. [PMID: 30808245 DOI: 10.1177/1090198119831756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The gateway behavior hypothesis posits that change in a health behavior targeted for modification may promote positive changes in other untargeted health behaviors; however, previous studies have shown inconsistent results. Aims. To examine the patterns and predictors of change in untargeted health behaviors in a large health behavior change trial. Method. Using repeated-measures latent class analysis, this study explored patterns of change in untargeted physical activity, alcohol consumption, and smoking behavior during the first year of the Women's Health Initiative dietary modification trial that targeted total fat reduction to 20% kcal and targeted increased fruit and vegetable intake. Participants were healthy postmenopausal women who were randomly assigned to either the low-fat dietary change intervention (n = 8,193) or a control (n = 12,187) arm. Results. Although there were increases in untargeted physical activity and decreases in alcohol consumption and smoking in the first year, these changes were not consistently associated with study arm. Moreover, although the results of the repeated-measures latent class analysis identified three unique subgroups of participants with similar patterns of untargeted health behaviors, none of the subgroups showed substantial change in the probability of engagement in any of the behaviors over 1 year, and the study arms had nearly identical latent class solutions. Discussion and Conclusion. These findings suggest that the dietary intervention did not act as a gateway behavior for change in the untargeted behaviors and that researchers interested in changing multiple health behaviors may need to deliberately target additional behaviors.
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Affiliation(s)
| | - Anne Moyer
- 1 Stony Brook University, Stony Brook, NY, USA
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15
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Cutuli D, de Guevara-Miranda DL, Castilla-Ortega E, Santín L, Sampedro-Piquero P. Highlighting the Role of Cognitive and Brain Reserve in the Substance use Disorder Field. Curr Neuropharmacol 2019; 17:1056-1070. [PMID: 31204624 PMCID: PMC7052825 DOI: 10.2174/1570159x17666190617100707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/17/2019] [Accepted: 05/31/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cognitive reserve (CR) refers to the ability of an individual to cope with brain pathology remaining free of cognitive symptoms. This protective factor has been related to compensatory and more efficient brain mechanisms involved in resisting brain damage. For its part, Brain reserve (BR) refers to individual differences in the structural properties of the brain which could also make us more resilient to suffer from neurodegenerative and mental diseases. OBJECTIVE This review summarizes how this construct, mainly mediated by educational level, occupational attainment, physical and mental activity, as well as successful social relationships, has gained scientific attention in the last years with regard to diseases, such as neurodegenerative diseases, stroke or traumatic brain injury. Nevertheless, although CR has been studied in a large number of disorders, few researches have addressed the role of this concept in drug addiction. METHODS We provide a selective overview of recent literature about the role of CR and BR in preventing substance use onset. Likewise, we will also discuss how variables involved in CR (healthy leisure, social support or job-related activities, among others) could be trained and included as complementary activities of substance use disorder treatments. RESULTS Evidence about this topic suggests a preventive role of CR and BR on drug use onset and when drug addiction is established, these factors led to less severe addiction-related problems, as well as better treatment outcomes. CONCLUSION CR and BR are variables not taken yet into account in drug addiction. However, they could give us a valuable information about people at risk, as well as patient's prognosis.
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Affiliation(s)
| | | | | | - L.J. Santín
- Address correspondence to these authors at the Instituto de Investigación Biomédica de Málaga (IBIMA), Doctor Miguel Díaz Recio, 28 Málaga 29010, Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos S/N, 29071 Málaga, Spain; E-mails: (P. Sampedro-Piquero) and (L.J. Santín)
| | - P. Sampedro-Piquero
- Address correspondence to these authors at the Instituto de Investigación Biomédica de Málaga (IBIMA), Doctor Miguel Díaz Recio, 28 Málaga 29010, Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos S/N, 29071 Málaga, Spain; E-mails: (P. Sampedro-Piquero) and (L.J. Santín)
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16
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Quiñones AR, Nagel CL, Newsom JT, Huguet N, Sheridan P, Thielke SM. Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States. BMC Geriatr 2017; 17:48. [PMID: 28178927 PMCID: PMC5299693 DOI: 10.1186/s12877-017-0438-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US. METHODS We use longitudinal data from the Health and Retirement Study (HRS 1992-2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers. RESULTS The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19-0.99) and Latino (OR = 0.26, 95% CI: 0.11-0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05-6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes. CONCLUSIONS A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.
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Affiliation(s)
- Ana R Quiñones
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. .,Portland VA Medical Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Corey L Nagel
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.,School of Nursing, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, P.O. Box 751, Portland, OR, 97207, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Paige Sheridan
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Stephen M Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, 1660 South Columbian Way, Seattle, WA, 98108, USA.,Psychiatry and Behavioral Sciences, University of Washington, 1959 Pacific Avenue, Seattle, WA, 98195, USA
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17
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Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2016; 3:CD008286. [PMID: 27009521 PMCID: PMC10042551 DOI: 10.1002/14651858.cd008286.pub3] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Both behavioural support (including brief advice and counselling) and pharmacotherapies (including nicotine replacement therapy (NRT), varenicline and bupropion) are effective in helping people to stop smoking. Combining both treatment approaches is recommended where possible, but the size of the treatment effect with different combinations and in different settings and populations is unclear. OBJECTIVES To assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take-up of treatment. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in July 2015 for records with any mention of pharmacotherapy, including any type of NRT, bupropion, nortriptyline or varenicline. SELECTION CRITERIA Randomized or quasi-randomized controlled trials evaluating combinations of pharmacotherapy and behavioural support for smoking cessation, compared to a control receiving usual care or brief advice or less intensive behavioural support. We excluded trials recruiting only pregnant women, trials recruiting only adolescents, and trials with less than six months follow-up. DATA COLLECTION AND ANALYSIS Search results were prescreened by one author and inclusion or exclusion of potentially relevant trials was agreed by two authors. Data was extracted by one author and checked by another.The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS Fifty-three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%).The pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community-based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take-up of treatment. AUTHORS' CONCLUSIONS Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care. Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate. Although trials differed in the details of their populations and interventions, we did not detect any factors that modified treatment effects apart from the recruitment setting. We did not find evidence from indirect comparisons that offering more intensive behavioural support was associated with larger treatment effects.
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Affiliation(s)
- Lindsay F Stead
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | | | - Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Tim Lancaster
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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19
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Peterson AB, Abel JM, Lynch WJ. Dose-dependent effects of wheel running on cocaine-seeking and prefrontal cortex Bdnf exon IV expression in rats. Psychopharmacology (Berl) 2014; 231:1305-14. [PMID: 24173624 DOI: 10.1007/s00213-013-3321-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022]
Abstract
RATIONALE Physical activity, and specifically exercise, has shown promise as an intervention for drug addiction; however, the exercise conditions that produce the most efficacious response, as well as its underlying mechanism, are unknown. OBJECTIVE In this study, we examined the dose-dependent effects of wheel running, an animal model of exercise, during abstinence on subsequent cocaine-seeking and associated changes in prefrontal cortex (PFC) brain-derived neurotrophic factor (Bdnf) exon IV expression, a marker of epigenetic regulation implicated in cocaine relapse and known to be regulated by exercise. METHODS Cocaine-seeking was assessed under a within-session extinction/cue-induced reinstatement procedure following extended access cocaine or saline self-administration (24-h/day, 4 discrete trials/h, 10 days, 1.5 mg/kg/infusion) and a 14-day abstinence period. During abstinence, rats had either locked or unlocked running wheel access for 1, 2, or 6 h/day. Bdnf exon IV expression was assessed using quantitative real-time polymerase chain reaction. RESULTS Cocaine-seeking was highest under the locked wheel condition, and wheel running dose dependently attenuated this effect. Cocaine increased Bdnf exon IV expression, and wheel running dose dependently attenuated this increase, with complete blockade in rats given 6-h/day access. Notably, the efficacy of exercise was inversely associated with Bdnf exon IV expression, and both its efficacy and its effects on Bdnf exon IV expression were mimicked by treatment during abstinence with sodium butyrate, a histone deacetylase inhibitor that, like exercise, modulates gene transcription, including Bdnf exon IV expression. CONCLUSION Taken together, these results indicate that the efficacy of exercise is dose dependent and likely mediated through epigenetic regulation of PFC Bdnf.
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Affiliation(s)
- Alexis B Peterson
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1670 Discovery Drive, Charlottesville, VA, 22911, USA
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Lynch WJ, Peterson AB, Sanchez V, Abel J, Smith MA. Exercise as a novel treatment for drug addiction: a neurobiological and stage-dependent hypothesis. Neurosci Biobehav Rev 2013; 37:1622-44. [PMID: 23806439 PMCID: PMC3788047 DOI: 10.1016/j.neubiorev.2013.06.011] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/29/2013] [Accepted: 06/13/2013] [Indexed: 12/11/2022]
Abstract
Physical activity, and specifically exercise, has been suggested as a potential treatment for drug addiction. In this review, we discuss clinical and preclinical evidence for the efficacy of exercise at different phases of the addiction process. Potential neurobiological mechanisms are also discussed focusing on interactions with dopaminergic and glutamatergic signaling and chromatin remodeling in the reward pathway. While exercise generally produces an efficacious response, certain exercise conditions may be either ineffective or lead to detrimental effects depending on the level/type/timing of exercise exposure, the stage of addiction, the drug involved, and the subject population. During drug use initiation and withdrawal, its efficacy may be related to its ability to facilitate dopaminergic transmission, and once addiction develops, its efficacy may be related to its ability to normalize glutamatergic and dopaminergic signaling and reverse drug-induced changes in chromatin via epigenetic interactions with brain-derived neurotrophic factor (BDNF) in the reward pathway. We conclude with future directions, including the development of exercise-based interventions alone or as an adjunct to other strategies for treating drug addiction.
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Affiliation(s)
- Wendy J Lynch
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1670 Discovery Drive, Charlottesville, VA 22911, USA.
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O'Brien MJ, Davey A, Alos VA, Whitaker RC. Diabetes-related behaviors in Latinas and non-Latinas in California. Diabetes Care 2013; 36:355-61. [PMID: 22961569 PMCID: PMC3554295 DOI: 10.2337/dc12-0548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Certain dietary and physical activity behaviors have been associated with the risk of developing type 2 diabetes, yet little is known about the prevalence of these behaviors among Latinas (Latino women). The purpose of this cross-sectional study was to compare the prevalence of diabetes-related behaviors in Latinas and non-Latinas. RESEARCH DESIGN AND METHODS Using data from the 2009 California Health Interview Survey, we compared self-reported diabetes-related behaviors of Latinas (n = 4,321) to non-Latinas (n = 21,112) after excluding women who were pregnant or had diabetes. For six behaviors, we determined the cut point for the least healthy tertile: walking, doing moderate to vigorous physical activity, and consuming fried potatoes, sugar-sweetened beverages (SSBs), desserts, and fast food. We used logistic regression to examine the association between Latina ethnicity and being in the least healthy tertile compared with the other two tertiles for each of these behaviors. RESULTS In multivariate models adjusted for age, income, education, marital status, health status, smoking, and acculturation, Latinas had a higher risk (odds ratio [95% CI]) of being in the least healthy tertile for the consumption of fast food (1.94 [1.63-2.31]), SSBs (1.53 [1.29-1.82]), and fried potatoes (1.32 [1.18-1.67]), and lower risk for desserts (0.82 [0.70-0.95]). Latinas and non-Latinas had similar physical activity levels. CONCLUSIONS Dietary differences between Latinas and non-Latinas (particularly in the consumption of fast food and SSBs) may be the focus of interventions to prevent diabetes in Latinas. Further research among Latinas is needed to understand and modify these dietary behaviors.
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Affiliation(s)
- Matthew J O'Brien
- Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA.
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Abstract
BACKGROUND Both behavioural support (including brief advice and counselling) and pharmacotherapies (including nicotine replacement therapy (NRT), varenicline and bupropion) are effective in helping people to stop smoking. Combining both treatment approaches is recommended where possible, but the size of the treatment effect with different combinations and in different settings and populations is unclear. OBJECTIVES To assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take-up of treatment. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in July 2012 for records with any mention of pharmacotherapy, including any type of NRT, bupropion, nortriptyline or varenicline. SELECTION CRITERIA Randomized or quasi-randomized controlled trials evaluating combinations of pharmacotherapy and behavioural support for smoking cessation, compared to a control receiving usual care or brief advice or less intensive behavioural support. We excluded trials recruiting only pregnant women, trials recruiting only adolescents, and trials with less than six months follow-up. DATA COLLECTION AND ANALYSIS Search results were prescreened by one author and inclusion or exclusion of potentially relevant trials was agreed by both authors. Data was extracted by one author and checked by the other.The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS Forty-one studies with a total of more than 20,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the three studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 40 studies (15,021 participants) there was good evidence for a benefit of combination pharmacotherapy and behavioural treatment compared to usual care or brief advice or less intensive behavioural support (RR 1.82, 95% CI 1.66 to 2.00) with moderate statistical heterogeneity (I² = 40%). The pooled estimate for 31 trials that recruited participants in healthcare settings (RR 2.06, 95% CI 1.81 to 2.34) was higher than for eight trials with community-based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Pooled estimates were lower in a subgroup of trials where the behavioural intervention was provided by specialist counsellors versus trials where counselling was linked to usual care (specialist: RR 1.73, 95% CI 1.55 to 1.93, 28 trials; usual provider: RR 2.41, 95% CI 1.91 to 3.02, 8 trials) but this was largely attributable to the small effect size in two trials using specialist counsellors where the take-up of the planned intervention was low, and one usual provider trial with alarge effect. There was little indirect evidence that the relative effect of an intervention differed according to whether participants in a trial were required to be motivated to make a quit attempt or not. There was only weak evidence that studies offering more sessions had larger effects and there was not clear evidence that increasing the duration of contact increased the effect, but there was more evidence of a dose-response relationship when analyses were limited to trials where the take-up of treatment was high. AUTHORS' CONCLUSIONS Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care. Further trials would be unlikely to change this conclusion. We did not find strong evidence from indirect comparisons that offering more intensive behavioural support was associated with larger treatment effects but this could be because intensive interventions are less likely to be delivered in full.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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