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Yan H, Gonzalo-Encabo P, Wilson RL, Christopher CN, Cannon JD, Kang DW, Gardiner J, Perez M, Norris MK, Gundersen D, Hayman LL, Freedman RA, Rebbeck TR, Shi L, Dieli-Conwright CM. Testing home-based exercise strategies in underserved minority cancer patients undergoing chemotherapy (THRIVE) trial: a study protocol. Front Oncol 2024; 14:1427046. [PMID: 39351353 PMCID: PMC11439870 DOI: 10.3389/fonc.2024.1427046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/23/2024] [Indexed: 10/04/2024] Open
Abstract
Background Higher rates of physical inactivity and comorbid conditions are reported in Hispanic/Latinx and Black cancer patients receiving chemotherapy compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in exercise oncology clinical trials are low among disadvantaged and racial and ethnic minority groups. Here, we will examine the effect of an exercise intervention using a novel, accessible, and cost-effective home-based exercise approach among Hispanic/Latinx and Black cancer patients receiving chemotherapy on exercise participation and cardiovascular disease risk. Methods The THRIVE trial is an 8-month prospective, three-arm study of 45 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control (AC) group. Eligible patients include those with breast, colorectal, or prostate cancer, who are sedentary, overweight or obese, self-identify as Hispanic/Latinx or Black, and plan to receive chemotherapy. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. Patients randomized to the AC group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at post-intervention. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8. Discussion The THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT05327452, identifier (NCT#05327452).
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Affiliation(s)
- Huimin Yan
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Madrid, Spain
| | - Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Cami N Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - James D Cannon
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - John Gardiner
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Michelle Perez
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mary K Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Daniel Gundersen
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Laura L Hayman
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Rachel A Freedman
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Timothy R Rebbeck
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Ling Shi
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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2
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Tidwell Torres M, Bailey A, Riscia PM, Kang AW. A Systematic Narrative Review of Recent Obesity Interventions with Black Women in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02026-9. [PMID: 38771451 DOI: 10.1007/s40615-024-02026-9] [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: 02/04/2024] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES This study is to comprehensively review recent obesity interventions for Black women in the United States. METHODS We searched PubMed and EBSCOhost for articles published between 2013 and 2022 using a comprehensive search strategy. Two reviewers screened titles, abstracts, and full texts. Data from the included articles were extracted. Qualitative themes related to the intervention designs were identified across studies. RESULTS Fifty-two studies were included in the review. Interventions typically aimed to reduce weight by targeting diet and/or physical activity. Intervention activities were delivered virtually and in-person via several formats including didactic content and interactive sessions. Outcomes were assessed through a variety of research designs. Across papers, we identified six key themes of intervention design: integration of technology, centering community and culture, personalization of content, use of social support, skill-building through intervention activities, and addressing comorbid health conditions. CONCLUSIONS To address the obesity epidemic, future research can build upon key lessons learned from recent interventions tailored to Black women.
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Affiliation(s)
- Melina Tidwell Torres
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
| | - Amelia Bailey
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Patricia Markham Riscia
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Augustine W Kang
- Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA.
- Stanford University School of Medicine, Stanford, CA, USA.
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3
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Monroe CM, Zosel K, Stansbury M, Younginer N, Davis RE, Dutton G, Newton RL, Cai B, West DS. A focus group study among insufficiently physically active African American adults regarding technology-delivered team-based gamification for physical activity promotion. Mhealth 2024; 10:3. [PMID: 38323152 PMCID: PMC10839515 DOI: 10.21037/mhealth-23-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024] Open
Abstract
Background Gamification represents a promising approach for facilitating positive social interactions among groups of individuals and is increasingly being leveraged in physical activity (PA) interventions to promote enhanced intervention engagement and PA outcomes. Although African American (AA) adults experience disparities associated with health conditions that can be ameliorated with increased PA, little is known about how best to culturally target PA gamification strategies for this population. The purpose of this study was to gather perspectives from AA adults residing in the Southeast United States and subsequently identify themes to help inform the cultural adaptation of an existing electronic and mobile health (e/mHealth) gamification- and theory-based PA intervention for teams of insufficiently active AA adults. Methods An AA moderator facilitated six online focus groups among AA adults (n=42; 93% female; 45.09±9.77 years; 34.40±57.38 minutes/week of reported moderate-intensity equivalent PA), using a semi-structured focus group guide. Drawing from a content analysis approach, transcripts were coded and salient themes were identified. Results The focus groups revealed the following seven themes: (I) motivation (team-based gamification motivating); (II) accountability (team-based gamification promotes accountability); (III) competition (competitive elements attractive); (IV) weekly challenges (prefer to choose weekly PA challenges); (V) leaderboard feedback (preference for viewing steps and active minutes via a leaderboard); (VI) cultural relevancy (prefer elements reflective of their race and culture that promote team unity); (VII) teammate characteristics (mixed preferences regarding ideal sociodemographic characteristics and starting PA level of teammates). Conclusions Integrating team-based gamification in an e/mHealth-based PA intervention may be acceptable among AA adults. The identification of specific design preferences and perceptions of the value of the social environment points to the need to consider surface-level and deep structure cultural targeting when developing and further exploring best practices regarding gamified PA interventions for insufficiently active AAs.
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Affiliation(s)
- Courtney M. Monroe
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kristen Zosel
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Melissa Stansbury
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nicholas Younginer
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Rachel E. Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Gareth Dutton
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert L. Newton
- Population and Public Health, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Delia Smith West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Joseph RP, Ainsworth BE, Vega-López S, Adams MA, Todd M, Gaesser GA, Keller C. Cardiometabolic Risk Factors Among Insufficiently Active African American Women With Obesity: Baseline Findings From Smart Walk. J Cardiovasc Nurs 2023; 38:198-204. [PMID: 35794781 PMCID: PMC9813275 DOI: 10.1097/jcn.0000000000000930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low moderate-to-vigorous physical activity (MVPA) levels and obesity are associated with increased cardiometabolic disease risk. OBJECTIVE The aim of this study was to describe MVPA and cardiometabolic risk characteristics of insufficiently active African American women with obesity (N = 60) enrolled in a culturally tailored MVPA intervention. METHODS We assessed accelerometer-measured and self-reported MVPA, blood pressure, serum lipid profiles, cardiorespiratory fitness (VO 2 peak), and aortic pulse wave velocity. RESULTS Participants (mean age, 38.4; mean body mass index, 40.6 kg/m 2 ) averaged 15 min/d of accelerometer-measured MVPA and 30 min/wk of self-reported MVPA. Systolic and diastolic blood pressure levels were elevated (135.4 and 84.0 mm Hg, respectively). With the exception of low-density lipoprotein cholesterol (121.4 mg/dL) and high-density lipoprotein cholesterol (47.6 mg/dL), lipid profiles were within reference ranges. Compared with normative reference values, average VO 2 peak was low (18.7 mL/kg/min), and pulse wave velocity was high (7.4 m/s). CONCLUSIONS Our sample of insufficiently active African American women with obesity was at an elevated risk for cardiometabolic disease.
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Affiliation(s)
- Rodney P. Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Barbara E. Ainsworth
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
- Department of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | - Marc A. Adams
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Glenn A. Gaesser
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Colleen Keller
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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5
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Zhou Z, Tian H, Luo S, Wang Y, Shi D. Artistic gymnastics mirror teaching approach efficacy for improving interpersonal skills of college students. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zan Zhou
- Department of Physical Education, College of Education, Shaoxing University, Shaoxing, China
| | - Haibo Tian
- Department of Physical Education, College of Education, Shaoxing University, Shaoxing, China
| | - Siwei Luo
- Department of Physical Education, College of Education, Shaoxing University, Shaoxing, China
| | - Yao Wang
- Department of Physical Education, College of Education, Shaoxing University, Shaoxing, China
| | - Dan Shi
- School of Art, Zhejiang Yuexiu University, Shaoxing, China
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Power S, Rowley N, Flynn D, Duncan M, Broom D. Home-based exercise for adults with overweight or obesity: A rapid review. Obes Res Clin Pract 2022; 16:97-105. [PMID: 35183471 PMCID: PMC9817080 DOI: 10.1016/j.orcp.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/13/2021] [Accepted: 02/07/2022] [Indexed: 01/11/2023]
Abstract
The COVID-19 pandemic has impacted the ability of people globally to consistently engage in their typical physical activity and exercise behaviour, contributing to the rising number of people living with overweight and obesity. The imposed government lockdowns and quarantine periods saw an increase in social media influencers delivering their own home-based exercise programmes, but these are unlikely to be an evidence-based, efficacious, long-term solution to tackle sedentary behaviour and increase physical activity. This rapid review aims to conceptualise home-based exercise and physical activity programmes, by extracting relevant programme characteristics regarding the availability of evidence and effectiveness of home-based exercise programmes. Fifteen studies met the inclusion criteria, of which there were varied reports of significant positive effects of the exercise programme on weight management and related outcomes. The two most common measures were Body Mass Index and body mass, as of which almost all reported a trend of post intervention reduction. Some programmes reported qualitative data, identifying barriers to physical activity and preferred programme components, highlighting a need to consider factors outside of physiological measures. The findings provide guidance and direction for the development of future home-based physical activity and exercise programmes for adults living with overweight and obesity.
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Affiliation(s)
- Sofie Power
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK
| | - Nikita Rowley
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK
| | - Darren Flynn
- Coventry University Library, Coventry University, Coventry CV1 5DD, UK
| | - Michael Duncan
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK
| | - David Broom
- Institute of Health and Wellbeing, Coventry University, Coventry CV1 2DS, UK,Corresponding author
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7
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillian B, Bower P, Panagioti M. Interventions Using Wearable Physical Activity Trackers Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2116382. [PMID: 34283229 PMCID: PMC9387744 DOI: 10.1001/jamanetworkopen.2021.16382] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Importance Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic conditions, such as diabetes, prediabetes, obesity, and cardiovascular disease, is unknown. Objective To assess the association of interventions using wearable PA trackers (accelerometers, fitness trackers, and pedometers) with PA levels and other health outcomes in adults with cardiometabolic conditions. Data Sources For this systematic review and meta-analysis, searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO were performed from January 1, 2000, until December 31, 2020, with no language restriction. A combination of Medical Subject Heading terms and text words of diabetes, obesity, cardiovascular disease, pedometers, accelerometers, and Fitbits were used. Study Selection Randomized clinical trials or cluster randomized clinical trials that evaluated the use of wearable PA trackers, such as pedometers, accelerometers, or fitness trackers, were included. Trials were excluded if they assessed the trackers only as measuring tools of PA before and after another intervention, they required participants to be hospitalized, assessors were not blinded to the trackers, or they used a tracker to measure the effect of a pharmacological treatment on PA among individuals. Data Extraction and Synthesis The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A random-effects model was used for the meta-analysis. Main Outcomes and Measures The primary outcome was mean difference in PA levels. When the scale was different across studies, standardized mean differences were calculated. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. Results A total of 38 randomized clinical trials with 4203 participants were eligible in the systematic review; 29 trials evaluated pedometers, and 9 evaluated accelerometers or fitness trackers. Four studies did not provide amenable outcome data, leaving 34 trials (3793 participants) for the meta-analysis. Intervention vs comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I2 = 88%; 95% CI, 84.3%-90.8%; P < .001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks. Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; β = -0.04; 95% CI, -0.11 to -0.01), included men (23 studies; β = 0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; β = 0.20; 95% CI, 0.02-0.32). Conclusions and Relevance In this systematic review and meta-analysis, interventions that combined wearable activity trackers with health professional consultations were associated with significant improvements in PA levels among people with cardiometabolic conditions.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health,
Brighton and Sussex Medical School, University of Brighton, Brighton, United
Kingdom
| | - Brian McMillian
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
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Kariuki JK, Gibbs BB, Erickson KI, Kriska A, Sereika S, Ogutu D, Milton H, Wagner L, Rao N, Peralta R, Bobb J, Bermudez A, Hirshfield S, Goetze T, Burke LE. The feasibility and acceptability of a web-based physical activity for the heart (PATH) intervention designed to reduce the risk of heart disease among inactive African Americans: Protocol for a pilot randomized controlled trial. Contemp Clin Trials 2021; 104:106380. [PMID: 33798731 PMCID: PMC8180502 DOI: 10.1016/j.cct.2021.106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many studies have used the internet to promote physical activity (PA) in several settings, including the home environment, but few have been tailored for African Americans (AAs). To address this research gap, we conducted focus groups with AAs to inform the development of a web-based intervention, Physical Activity for The Heart (PATH), that leverages openly accessible platforms, such as YouTube, to promote PA in any setting. PURPOSE To describe the rationale and design of a pilot randomized clinical trial (RCT), that examines the feasibility and acceptability of the PATH intervention among 30 AA adults aged 40--70 years without history of cardiovascular disease. METHODS A 12-week, single-site, wait-listed RCT with subjects randomized 1:1 to either: 1) treatment group - participants receive the PATH intervention, including the online portal and twice a month phone calls from a PA coach, or 2) attention control group - participants receive a self-help PA handout and twice a month general health newsletter. All participants self-monitor step count using actigraphy. The primary outcomes of this 12-week, pilot RCT are recruitment, retention, and adherence to self-monitoring (Actigraph wear time) and the intervention protocol (PATH utilization). The secondary outcomes include changes in PA (step count, moderate-to-vigorous PA, exercise self-efficacy), and cardiometabolic risk (HbA1C, HDL, LDL, total cholesterol, type 2 diabetes risk score, percent body fat, weight, and waist circumference) from baseline to 12 weeks. CONCLUSIONS This study will provide PATH intervention feasibility and acceptability data among inactive AA adults and will inform a future, full-scale RCT testing efficacy.
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Affiliation(s)
| | | | | | | | | | - David Ogutu
- Ritiko Cloud-based Home-care Software, MA, USA
| | | | | | - Neel Rao
- University of Pittsburgh, PA, USA
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9
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Mönninghoff A, Kramer JN, Hess AJ, Ismailova K, Teepe GW, Tudor Car L, Müller-Riemenschneider F, Kowatsch T. Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2021; 23:e26699. [PMID: 33811021 PMCID: PMC8122296 DOI: 10.2196/26699] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. OBJECTIVE The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. METHODS We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. RESULTS Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence. CONCLUSIONS mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.
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Affiliation(s)
- Annette Mönninghoff
- Institute for Customer Insight, University of St. Gallen, St. Gallen, Switzerland
- Institute for Mobility, University of St. Gallen, St. Gallen, Switzerland
| | - Jan Niklas Kramer
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- CSS Insurance, Lucerne, Switzerland
| | - Alexander Jan Hess
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Kamila Ismailova
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Gisbert W Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Public Health, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | | | - Tobias Kowatsch
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore-ETH Centre, Singapore, Singapore
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillan B, Bower P, Panagioti M. Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1912895. [PMID: 31596494 PMCID: PMC6802237 DOI: 10.1001/jamanetworkopen.2019.12895] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 01/15/2023] Open
Abstract
Importance Accelerometers and pedometers are accessible technologies that could have a role in encouraging physical activity (PA) in line with current recommendations. However, there is no solid evidence of their association with PA in participants with 1 or more cardiometabolic conditions such as diabetes, prediabetes, obesity, and cardiovascular disease. Objectives To assess the association of accelerometer- and pedometer-based interventions with increased activity and other improved health outcomes in adults with cardiometabolic conditions and to examine characteristics of the studies that could influence the association of both interventions in improving PA. Data Sources Records from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and PsycINFO were searched from inception until August 2018 with no language restriction. Study Selection Randomized clinical trials or cluster randomized clinical trials evaluating the use of wearable technology devices such as pedometers and accelerometers as motivating and monitoring tools for increasing PA were included. After removing duplicates, the searches retrieved 5762 references. Following abstract and title screening of 1439 references and full-text screening of 107 studies, 36 studies met inclusion criteria. Data Extraction and Synthesis Mean difference in PA was assessed by random-effects meta-analysis. Where the scale was different across studies, the standardized mean difference was used instead. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. This study was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The primary outcome was objectively measured PA in the short to medium term (postintervention to 8 months' follow-up). Results Thirty-six randomized clinical trials (20 using accelerometers and 16 using pedometers) involving 5208 participants were eligible for review. Meta-analysis involving 32 of these trials (4856 participants) showed medium improvements in PA: accelerometers and pedometers combined vs comparator showed a small significant increase in PA overall (standardized mean difference, 0.39 [95% CI, 0.28-0.51]; I2 = 60% [95% CI, 41%-73%]) in studies of short to medium follow-up over a mean (SD) of 32 (28.6) weeks. Multivariable metaregression showed improved association with PA for complex interventions that involved face-to-face consultation sessions with facilitators (β = 0.36; 95% CI, 0.17-0.55; P < .001) and pedometer-based interventions (β = 0.30; 95% CI, 0.08-0.52; P = .002). Conclusions and Relevance In this study, complex accelerometer- and pedometer-based interventions led to significant small to medium improvements in PA levels of people with cardiometabolic conditions. However, longer-term trials are needed to assess their performance over time. This study found no evidence that simple self-monitored interventions using either pedometers or accelerometers are associated with improvements in PA.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, United Kingdom
| | - Brian McMillan
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
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11
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Pekmezi D, Ainsworth C, Desmond R, Pisu M, Williams V, Wang K, Holly T, Meneses K, Marcus B, Demark-Wahnefried W. Physical Activity Maintenance Following Home-Based, Individually Tailored Print Interventions for African American Women. Health Promot Pract 2018; 21:268-276. [PMID: 30203677 PMCID: PMC8258802 DOI: 10.1177/1524839918798819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African American women report low participation in physical activity and are disproportionately burdened by related conditions (obesity, breast, and colon cancer). Physical activity interventions have shown promising results among African American women, but most studies in this area have focused on short-term increases. More enduring changes in health behavior will be needed to eliminate existing health disparities. Thus, the current study examined 12-month physical activity and psychosocial outcomes from a pilot randomized controlled trial (N = 84) of a Home-based Individually tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. Retention was 77.4% at 12 months. HIPP participants increased self-reported moderate-to-vigorous physical activity from 35.1 minutes/week (standard deviation [SD] = 47.8) at baseline to 124 minutes/week (SD = 95.5) at 12 months, compared with the wellness contact control participants who reported increases from 48.2 minutes/week (SD = 51.3) to 102.5 minutes/week (SD = 94.5) over 12 months (between-group p > .05). Results indicate that modest improvements in moderate-to-vigorous physical activity and related psychosocial variables occurred during the active intervention phase (months 0-6) and were sustained during the tapered maintenance period (months 6-12). Low-cost, high-reach, home-based strategies have great potential for supporting sustained participation in physical activity and achieving long-term health benefits among African American women in the Deep South.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cole Ainsworth
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Renee Desmond
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kaiying Wang
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Taylor Holly
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Pekmezi D, Ainsworth C, Holly T, Williams V, Joseph R, Wang K, Rogers LQ, Marcus B, Desmond R, Demark-Wahnefried W. Physical Activity and Related Psychosocial Outcomes From a Pilot Randomized Trial of an Interactive Voice Response System-Supported Intervention in the Deep South. HEALTH EDUCATION & BEHAVIOR 2018; 45:957-966. [PMID: 29884069 PMCID: PMC7457542 DOI: 10.1177/1090198118775492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical activity exerts cancer-protective effects, yet most Americans are inactive, especially in the South, where cancer incidence rates are generally higher. Telephone-based approaches can help overcome physical activity intervention barriers in this region (literacy, costs, lack of transportation/technology, distance from facilities) and can be automated via interactive voice response (IVR) systems for improved reach and cost-effectiveness. AIMS To evaluate the Deep South IVR-supported Active Lifestyle (DIAL) intervention. METHOD A pilot randomized controlled trial was conducted among 63 underactive adults in Birmingham, Alabama, from 2015 to 2017. RESULTS Retention was 88.9% at 12 weeks, and ≥75% adherence (IVR contact on at least 63 out of 84 days) was noted among 62.5% of intervention participants. Intervention participants reported larger increases in self-reported minutes of moderate-to-vigorous intensity physical activity from baseline to 12 weeks than the wait-list control arm (median change = 47.5 vs. 5.0 minutes, respectively, p = .09). Moreover, the intervention produced significantly greater increases in physical activity self-regulation ( p < .001) and social support from family ( p = .001) and friends ( p = .009) from baseline to 12 weeks, compared with the wait-list control. Significant decreases in self-reported sleep disturbance also were found in the intervention arm but not among the controls, p < .05. Overall, intervention participants reported being satisfied with the DIAL program (71.4%) and would recommend it to friends (92.9%). DISCUSSION Findings support the feasibility, acceptability, and preliminary efficacy of the DIAL intervention. CONCLUSION Next steps include intervention refinement in preparation for a fully powered efficacy trial and eventual dissemination to rural counties.
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13
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Bevel M, Babatunde OA, Heiney SP, Brandt HM, Wirth MD, Hurley TG, Khan S, Johnson H, Wineglass CM, Warren TY, Murphy EA, Sercy E, Thomas AS, Hébert JR, Adams SA. Sistas Inspiring Sistas Through Activity and Support (SISTAS): Study Design and Demographics of Participants. Ethn Dis 2018; 28:75-84. [PMID: 29725191 DOI: 10.18865/ed.28.2.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Recruiting racial, ethnic, and other underserved minorities into conventional clinic-based and other trials is known to be challenging. The Sistas Inspiring Sistas Through Activity and Support (SISTAS) Program was a one-year randomized controlled trial (RCT) to promote physical activity and healthy eating among AA women in SC to reduce inflammatory biomarkers, which are linked to increased breast cancer (BrCa) risk and mortality. This study describes the development, recruitment, and implementation of the SISTAS clinical trial and provides baseline characteristics of the study participants. Methods SISTAS was developed using community-based participatory research (CBPR) approaches. At baseline, study participants completed assessments and underwent clinical measurements and blood draws to measure C-reactive protein (CRP) and interleukin-6 (IL-6). Participants randomized to the intervention received 12 weekly classes followed by nine monthly booster sessions. Post-intervention measurements were assessed at 12-week and 12-month follow-ups. Results We recruited a total of 337 women who tended to: be middle-aged (mean age 48.2 years); have some college education; be employed full-time; have Medicare as their primary insurance; be non-smokers; and perceive their personal health as good. On average, the women were pre-hypertensive at baseline (mean systolic blood pressure = 133.9 mm Hg; mean diastolic blood pressure = 84.0 mm Hg) and morbidly obese (mean BMI >40.0 kg/m2); the mean fat mass and fat-free mass among participants were 106.4 lb and 121.0 lb, respectively. Conclusion The SISTAS RCT addresses some of the gaps in the literature with respect to CBPR interventions targeting AA women, such as implementing diet and physical activity in CBPR-based studies to decrease BrCa risk.
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Affiliation(s)
- Malcolm Bevel
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Oluwole A Babatunde
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Sue P Heiney
- College of Nursing, University of South Carolina
| | - Heather M Brandt
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Michael D Wirth
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Thomas G Hurley
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Samira Khan
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Hiluv Johnson
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Cassandra M Wineglass
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Tatiana Y Warren
- Community Works, Bon Secours Baltimore Health Systems; Baltimore, Maryland
| | - E Angela Murphy
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina
| | - Erica Sercy
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Amanda S Thomas
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - James R Hébert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
| | - Swann Arp Adams
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina.,College of Nursing, University of South Carolina
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14
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Pekmezi D, Ainsworth C, Holly T, Williams V, Benitez T, Wang K, Rogers LQ, Marcus B, Demark-Wahnefried W. Rationale, design, and baseline findings from a pilot randomized trial of an IVR-Supported physical activity intervention for cancer prevention in the Deep South: the DIAL study. Contemp Clin Trials Commun 2018; 8:218-226. [PMID: 29503878 PMCID: PMC5830176 DOI: 10.1016/j.conctc.2017.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Telephone-delivered interventions do not require frequent clinic visits, literacy, or costly technology and thus may represent promising approaches to promoting physical activity in the Deep South, a largely rural U.S. region, with generally lower physical activity, income, and education levels. Building on past Interactive Voice Response (IVR) system-based HIV studies and extensive formative research (11 focus groups on physical activity intervention needs/preferences in the Deep South), the resulting IVR-supported physical activity intervention is now being tested in a randomized controlled trial with a waitlist control. The sample (n=63) includes mostly obese (Mean BMI=30.1) adults (Mean age=43 years) in Birmingham, AL. Both genders (55.6% male) and African Americans (58.7%) are well-represented. Most participants reported at least some college (92%), full time employment (63.5%), and household income <$50,000 per year (61.9%). Baseline physical activity (Mean=39.6 minutes/week, SD=56.4), self-efficacy, self-regulation, and social support were low. However, high physical activity enjoyment and outcome expectations bode well. Self-report physical activity was associated with physical activity enjoyment (r=.36) and social support (friends r=.25, p's<.05) at baseline. Consequently, these may be important variables to emphasize in our program. Depression and anxiety were negatively correlated with some early indicators of behavior change (e.g., physical activity self-regulation; r's =-.43 and -.46, respectively, p's<.01) and thus may require additional attention. Such technology-supported strategies have great potential to reach underserved populations and address physical activity-related health disparities in this region.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Cole Ainsworth
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Taylor Holly
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Victoria Williams
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Tanya Benitez
- University of California, San Diego, 9500 Gilman Drive, 0628, La Jolla, CA. 92093-0628
| | - Kaiying Wang
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Laura Q Rogers
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Bess Marcus
- Brown University, 121 S Main St, Providence, RI 02903
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