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Bernhart JA, Fellers AW, Wilson MJ, Hutto B, Bailey S, Turner-McGrievy GM. COVID-19 Pandemic Associations on Mental and Physical Health in African Americans Participating in a Behavioral Intervention. J Racial Ethn Health Disparities 2023; 10:3070-3076. [PMID: 36469289 PMCID: PMC9734885 DOI: 10.1007/s40615-022-01481-6] [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: 07/07/2022] [Revised: 11/01/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has had disproportionate effects on communities of color, with higher death rates among African Americans (AA). The purpose of this study was to assess associations in African Americans' mental and physical health with the COVID-19 pandemic. Data for this study came from a larger nutrition intervention of AAs in the Southeastern United States, the Nutritious Eating with Soul study. Data collected before and after March 15, 2020 (the day when local South Carolina schools and businesses closed), were analyzed to assess the association of the pandemic on participants' stress, control of healthy eating, physical activity, and body mass index. Repeated measures analysis of covariance using full maximum likelihood estimation to handle missing data was used. At the onset of the COVID-19 pandemic, 150 participants were enrolled in the study (48.2 ± 10.6 years old, 79% female, 75% with college degree or higher). Participants' reporting of stress did not show statistically significant change over time. Cognitive control increased 1.43 points (F = 20.60, p < 0.0001) and body mass index increased 0.72 kg/m2 (F = 10.68, p = 0.001). Future longitudinal studies should investigate how the COVID-19 pandemic continues to present challenges to understanding and improving health among African Americans. The study is registered at www.clinicaltrials.gov NCT03354377.
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Affiliation(s)
- J A Bernhart
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Room 536, 915 Greene Street, SC, 29208, Columbia, USA.
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA.
| | - A W Fellers
- University of South Carolina School of Medicine, 6439 Garners Ferry Road, Columbia, SC, 29209, USA
| | - M J Wilson
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - B Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA
| | - S Bailey
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - G M Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Room 536, 915 Greene Street, SC, 29208, Columbia, USA
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Kracht CL, St Romain J, Hardee JC, Santoro N, Redman LM, Marlatt KL. "Weight loss is my goal and being healthy is my goal… I can get over the hot flashes": a qualitative exploration of menopausal transition experiences and preferences for weight management among White women. Menopause 2023; 30:1022-1032. [PMID: 37699233 PMCID: PMC10528173 DOI: 10.1097/gme.0000000000002248] [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] [Indexed: 09/14/2023]
Abstract
OBJECTIVES A qualitative research study design was used to (1) describe experiences of White women during the menopausal transition, and (2) identify barriers and facilitators for participating in a lifestyle program targeting weight management. METHODS Perimenopausal and postmenopausal White women who self-reported a desire to lose or maintain weight participated in focus groups. Women were queried about their past diet, exercise, and weight management practices; menopausal transition; and specific components and considerations for developing a lifestyle program for weight management. Thematic analysis was conducted on coded transcripts and four main themes emerged, each containing three to six subthemes. RESULTS Twenty-eight White women (age 54 ± 3 y, body mass index 31.4 ± 9.5 kg/m 2 ) were enrolled. Overall, women felt menopause was a major life event that coincided with weight gain and frustrating body changes. Women already engaged in many different types of exercises and diets to lose weight. Women also talked to healthcare professionals about menopause but were disappointed in the support they received. Women were interested in a lifestyle program that included menopause-specific education, which focused on results beyond weight, which was flexible to their busy lifestyle, and which provided opportunities to build camaraderie among other women experiencing menopause. CONCLUSIONS This cohort of White women were interested in receiving menopause information and improving their overall health as part of a lifestyle program targeting weight management during this transition. Building camaraderie with other women affected by menopause is important to women, as is creating a lifestyle program that is flexible with daily life.
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Affiliation(s)
| | | | - Julie C Hardee
- From the Pennington Biomedical Research Center, Baton Rouge, LA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Leanne M Redman
- From the Pennington Biomedical Research Center, Baton Rouge, LA
| | - Kara L Marlatt
- From the Pennington Biomedical Research Center, Baton Rouge, LA
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Turner-McGrievy GM, Wilcox S, Frongillo EA, Murphy EA, Hutto B, Wilson M, Davey M, Bernhart JA, Okpara N, Bailey S, Hu E. Effect of a Plant-Based vs Omnivorous Soul Food Diet on Weight and Lipid Levels Among African American Adults: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2250626. [PMID: 36633848 PMCID: PMC9857469 DOI: 10.1001/jamanetworkopen.2022.50626] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE More African American individuals die from cardiovascular disease (CVD) than any other chronic disease condition. Despite this disparity, African American individuals are underrepresented in nutrition and CVD interventions. OBJECTIVE To compare the effects of an entirely plant-based (vegan) or low-fat omnivorous (omni) diet on change in body weight and lipids during a 2-year intervention. DESIGN, SETTING, AND PARTICIPANTS The Nutritious Eating With Soul (NEW Soul) study was a 2-year, randomized clinical trial conducted in 2 cohorts (2018-2020 and 2019-2021) that took place in a university teaching kitchen in Columbia, South Carolina (before March 2020), and via online videoconference sessions (after March 2020). Participants included African American adults aged 18 to 65 years with overweight or obesity (body mass index of 25.0-49.9) and without type 2 diabetes, uncontrolled thyroid disease, recent weight loss, or pregnancy. Data assessors and statisticians were blinded to study condition. Data analysis was performed from March to June 2022. INTERVENTIONS The intervention included weekly nutrition classes for 6 months biweekly classes for 6 months, and monthly classes for 12 months. Dietary interventions either emphasized no animal product intake (vegan) or a low-fat omnivorous diet (omni). Both dietary patterns emphasized soul food cuisine (traditional African American southern foodways). MAIN OUTCOMES AND MEASURES Primary outcomes included change in body weight and lipid measures at 12 months. RESULTS There were 568 participants who completed an online screening questionnaire; 409 were excluded and 159 were randomized (77 to the vegan group and 82 to the omni group). Of the 159 participants (mean [SD] age, 48.4 [10.6] years; 126 female [79%]) who began the study, the main outcome of body weight was obtained for 121 participants (76%) at 12 months. There were no differences in outcomes between groups, including 12-month changes in weight (mean, -2.39 kg [95% CI, -3.48 to -1.30 kg] for the vegan group vs -2.03 kg [95% CI, -3.07 to -1.00 kg] for the omni group; P = .64), total cholesterol (-1.05 mg/dL [95% CI, -9.60 to 7.50 mg/dL] for the vegan group vs 1.66 mg/dL [95% CI, -7.20 to 10.50 mg/dL] for the omni group; P = .67), or low-density lipoprotein cholesterol (mean, -2.56 mg/dL [95% CI, -9.52 to 4.40 mg/dL] for the vegan group vs -0.79 mg/dL [95% CI, -7.98 to 6.40 mg/dL] for the omni group; P = .73). Weight loss at 12 months among cohort 1, whose weight was assessed in 2019 before the COVID-19 pandemic, was significantly greater than that for cohort 2, whose weight was assessed summer 2020 during COVID-19 (-3.45 kg [95% CI, -4.67 to -2.22 kg] vs -1.24 kg [95% CI, -2.24 to -0.25 kg]; P = .01). CONCLUSIONS AND RELEVANCE In this randomized clinical trial examining weight loss and CVD risk factor reduction among African American adults, there were no differences between the groups, and the magnitude of changes overall was small. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03354377.
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Affiliation(s)
- Gabrielle M. Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Edward A. Frongillo
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | | | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Mary Wilson
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Marty Davey
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - John A. Bernhart
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia
| | - Nkechi Okpara
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | - Shiba Bailey
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, Columbia
| | - Emily Hu
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
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Parker H, Burkart S, Reesor-Oyer L, Smith MT, Dugger R, von Klinggraeff L, Weaver RG, Beets MW, Armstrong B. Feasibility of Measuring Screen Time, Activity, and Context Among Families With Preschoolers: Intensive Longitudinal Pilot Study. JMIR Form Res 2022; 6:e40572. [PMID: 36173677 PMCID: PMC9562053 DOI: 10.2196/40572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Digital media has made screen time more available across multiple contexts, but our understanding of the ways children and families use digital media has lagged behind the rapid adoption of this technology. Objective This study evaluated the feasibility of an intensive longitudinal data collection protocol to objectively measure digital media use, physical activity, sleep, sedentary behavior, and socioemotional context among caregiver-child dyads. This paper also describes preliminary convergent validity of ecological momentary assessment (EMA) measures and preliminary agreement between caregiver self-reported phone use and phone use collected from passive mobile sensing. Methods Caregivers and their preschool-aged child (3-5 years) were recruited to complete a 30-day assessment protocol. Within 30-days, caregivers completed 7 days of EMA to measure child behavior problems and caregiver stress. Caregivers and children wore an Axivity AX3 (Newcastle Upon Tyne) accelerometer to assess physical activity, sedentary behavior, and sleep. Phone use was assessed via passive mobile sensing; we used Chronicle for Android users and screenshots of iOS screen time metrics for iOS users. Participants were invited to complete a second 14-day protocol approximately 3-12 months after their first assessment. We used Pearson correlations to examine preliminary convergent validity between validated questionnaire measures of caregiver psychological functioning, child behavior, and EMA items. Root mean square errors were computed to examine the preliminary agreement between caregiver self-reported phone use and objective phone use. Results Of 110 consenting participants, 105 completed all protocols (105/110, 95.5% retention rate). Compliance was defined a priori as completing ≥70%-75% of each protocol task. There were high compliance rates for passive mobile sensing for both Android (38/40, 95%) and iOS (64/65, 98%). EMA compliance was high (105/105, 100%), but fewer caregivers and children were compliant with accelerometry (62/99, 63% and 40/100, 40%, respectively). Average daily phone use was 383.4 (SD 157.0) minutes for Android users and 354.7 (SD 137.6) minutes for iOS users. There was poor agreement between objective and caregiver self-reported phone use; root mean square errors were 157.1 and 81.4 for Android and iOS users, respectively. Among families who completed the first assessment, 91 re-enrolled to complete the protocol a second time, approximately 7 months later (91/105, 86.7% retention rate). Conclusions It is feasible to collect intensive longitudinal data on objective digital media use simultaneously with accelerometry and EMA from an economically and racially diverse sample of families with preschool-aged children. The high compliance and retention of the study sample are encouraging signs that these methods of intensive longitudinal data collection can be completed in a longitudinal cohort study. The lack of agreement between self-reported and objectively measured mobile phone use highlights the need for additional research using objective methods to measure digital media use. International Registered Report Identifier (IRRID) RR2-36240
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Affiliation(s)
- Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sarah Burkart
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Layton Reesor-Oyer
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Michal T Smith
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Roddrick Dugger
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Pfammatter AF, Battalio SL, Olvera C, DeZelar M, Moore D, Scanlan L, Siddique J, Spring B, Chang SH. The EVO study protocol for a randomized controlled evaluation trial of an optimized weight management intervention. Contemp Clin Trials 2022; 116:106750. [PMID: 35378301 PMCID: PMC9133162 DOI: 10.1016/j.cct.2022.106750] [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: 10/21/2021] [Revised: 02/26/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is a substantial public health concern; however, gold-standard behavioral treatments for obesity are costly and burdensome. Existing adaptations to the efficacious Diabetes Prevention Program (DPP) demonstrate mixed results. Our prior research applying the Multiphase Optimization Strategy (MOST) to DPP identifies a more parsimonious, less costly intervention (EVO) resulting in significant weight loss. OBJECTIVE The aim of the remotely conducted EVO trial is to test the non-inferiority of EVO against DPP. We will conduct economic evaluations alongside the trial to estimate delivery and patient costs, cost-effectiveness, and lifetime healthcare costs of EVO as compared to DPP. Exploratory analyses will examine maintenance, moderators, and mediators of the treatment effect. STUDY DESIGN The EVO trial will recruit nationally to randomize 524 participants with obesity. Participants will receive either EVO or DPP over a 6 month period. EVO participants will be provided online lessons, a smartphone application to self-monitor diet, physical activity, and weight, and attend 12 brief calls with a Health Promotionist. DPP participants will receive the first 6 months of the Center for Disease Control's T2D materials and attend 16 one-hour video call sessions with staff certified in DPP delivery. Weight will be measured at baseline, 3-, 6-, and 12-months. Itemized delivery cost will be collected. Staff and participants will also provide information to estimate costs for intervention-related activities. SIGNIFICANCE The EVO trial could establish evidence supporting dissemination of a scalable, cost-effective behavioral treatment with potential to shift clinical practice guidelines, inform policy, and reduce the prevalence of obesity.
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Affiliation(s)
- Angela Fidler Pfammatter
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Samuel L Battalio
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Charlie Olvera
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Margaret DeZelar
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Dominique Moore
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Laura Scanlan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Reesor-Oyer L, Parker H, Burkart S, Smith MT, Dugger R, von Klinggraeff L, Weaver RG, Beets MW, Armstrong B. Measuring Micro Temporal Processes Underlying Preschoolers Screen Use and Behavioral Health: Protocol for the Tots & Tech Study (Preprint). JMIR Res Protoc 2022; 11:e36240. [PMID: 36169993 PMCID: PMC9557980 DOI: 10.2196/36240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 12/19/2022] Open
Abstract
Background Excessive screen time is associated with poor health and behavioral outcomes in children. However, research on screen time use has been hindered by methodological limitations, including retrospective reports of usual screen time and lack of momentary etiologic processes occurring within each day. Objective This study is designed to assess the feasibility and utility of a comprehensive multibehavior protocol to measure the digital media use and screen time context among a racially and economically diverse sample of preschoolers and their families. This paper describes the recruitment, data collection, and analytical protocols for the Tots and Tech study. Methods The Tots and Tech study is a longitudinal, observational study of 100 dyads: caregivers and their preschool-age children (aged 3-5 years). Both caregivers and children will wear an Axivity AX3 accelerometer (Axivity Ltd) for 30 days to assess their physical activity, sedentary behavior, and sleep. Caregivers will complete ecological momentary assessments (EMAs) for 1 week to measure child behavioral problems, caregiver stress, and child screen time. Results The Tots and Tech study was funded in March 2020. This study maintains rolling recruitment, with each dyad on their own assessment schedule, depending on the time of enrollment. Enrollment was scheduled to take place between September 2020 and May 2022. We aim to enroll 100 caregiver-child dyads. The Tots and Tech outcome paper is expected to be published in 2022. Conclusions The Tots and Tech study attempts to overcome previous methodological limitations by using objective measures of screen time, physical activity, sedentary behavior, and sleep behaviors with contextual factors measured by EMA. The results will be used to evaluate the feasibility and utility of a comprehensive multibehavior protocol using objective measures of mobile screen time and accelerometry in conjunction with EMA among caregiver-child dyads. Future observational and intervention studies will be able to use this study protocol to better measure screen time and its context. International Registered Report Identifier (IRRID) DERR1-10.2196/36240
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Affiliation(s)
- Layton Reesor-Oyer
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Hannah Parker
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Sarah Burkart
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michal T Smith
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Roddrick Dugger
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Lauren von Klinggraeff
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - R Glenn Weaver
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michael W Beets
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
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