1
|
Niranjan SJ, Brown G, Bailey J, Geurs R, Robinson KJ, Schechter MS, Powers KE, Clemm C, Reno K, Oates GR. "I eat chocolate milk for dinner because we just have nothing in our fridge": The invisible burden and dire consequences of food insecurity for people with cystic fibrosis in the United States. Pediatr Pulmonol 2024. [PMID: 39041893 DOI: 10.1002/ppul.27179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND One-third of people with cystic fibrosis (pwCF) are food insecure, with profound negative implications for their health. This qualitative study explored lived experiences with food insecurity among pwCF or their caregivers and summarized their perspectives on food insecurity screening in the cystic fibrosis (CF) programs where they receive care. METHODS Semi-structured qualitative interviews were conducted with two groups: (1) adults with CF and (2) parents or caregivers of children with CF. PwCF or their caregivers with previously documented food insecurity were referred for participation by pediatric and adult CF programs across the United States. Interviews were recorded and transcribed, and data were coded and analyzed by two independent coders using a content-analysis approach with a constant comparative method to generate themes. RESULTS A total of 26 participants from 22 CF programs were interviewed. The sample included 17 adults with CF and nine parents of children with CF. Participants were predominantly White (88%) and female (92%). Five overarching themes emerged: (1) food insecurity among CF patients and their families is onerous, (2) financial constraints imposed by the CF disease contribute to food insecurity, (3) federal and state programs provide limited food assistance, and other support is minimal, (4) shame and stigma engulf conversations around food insecurity with CF care teams, and (5) food insecurity screening in clinical settings is critical. CONCLUSIONS Food insecurity among pwCF is invisible, but its consequences are dire. Assistance is limited, screening is inconsistent, and stigma is widespread. There is an urgent need to normalize food insecurity screening, standardize the screening process, and expand food assistance programs for pwCF.
Collapse
Affiliation(s)
| | - Georgia Brown
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Julianna Bailey
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robin Geurs
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Keith J Robinson
- University of Vermont Children's Hospital, Burlington, Vermont, USA
| | - Michael S Schechter
- Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | | | | | - Kim Reno
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Gabriela R Oates
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
2
|
Alkhateeb AA, Mancl LA, Ramos KJ, Rothen ML, Kotsakis GA, Trence DL, Chi DL. The association between cystic fibrosis-related diabetes and periodontitis in adults: A pilot cross-sectional study. PLoS One 2024; 19:e0305975. [PMID: 38917148 PMCID: PMC11198763 DOI: 10.1371/journal.pone.0305975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES Periodontitis is a highly prevalent complication of diabetes. However, the association between cystic fibrosis-related diabetes (CFRD) and periodontitis has not yet been evaluated. The objective of this study was to assess if: 1) CFRD is associated with periodontitis among adults with CF, and 2) periodontitis prevalence differs by CF and diabetes status. METHODS This was a pilot cross-sectional study of the association between CFRD and periodontitis in adults with cystic fibrosis (CF) (N = 32). Historical non-CF controls (N = 57) from the U.S. National Health and Nutrition Examination Survey (NHANES) dataset were frequency matched to participants with CF on age, sex, diabetes status, and insulin use. We defined periodontitis using the U.S. Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) case definition, as the presence of two or more interproximal sites with CAL ≥3 mm and two or more interproximal sites with PD ≥4 mm (not on the same tooth) or one site with PD ≥5 mm. Because NHANES periodontal data were only available for adults ages ≥30 years, our analysis that included non-CF controls focused on this age group (CF N = 19, non-CF N = 57). Based on CF and diabetes status, we formed four groups: CFRD, CF and no diabetes, non-CF with diabetes, and non-CF and no diabetes (healthy). We used the Fisher's exact test for hypotheses testing. RESULTS There was no association between CFRD and periodontitis for participants with CF ages 22-63 years (CFRD 67% vs. CF no diabetes 53%, P = 0.49), this was also true for those ages ≥30 years (CFRD 78% vs. CF no diabetes 60%, P = 0.63). For the two CF groups, the prevalence of periodontitis was significantly higher than for healthy controls (CFRD 78% vs. healthy 7%, P<0.001; CF no diabetes 60% vs. healthy 7%, P = 0.001) and not significantly different than the prevalence for non-CF controls with diabetes (CFRD 78% vs. non-CF with diabetes 56%, P = 0.43; CF no diabetes 60% vs. non-CF with diabetes 56%, P = 0.99). CONCLUSION Among participants with CF, CFRD was not associated with periodontitis. However, regardless of diabetes status, participants with CF had increased prevalence of periodontitis compared to healthy controls.
Collapse
Affiliation(s)
- Alaa A. Alkhateeb
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States of America
- Department of Dental Health Sciences, School of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States of America
| | - Kathleen J. Ramos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Marilynn L. Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States of America
| | - Georgios A. Kotsakis
- Department of Periodontics, Dental School, University of Texas Health at San Antonio, San Antonio, TX, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Dace L. Trence
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Donald L. Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
3
|
Bailey J, Baker E, Schechter MS, Robinson KJ, Powers KE, Dasenbrook E, Hossain M, Durham D, Brown G, Clemm C, Reno K, Oates GR. Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States. J Cyst Fibros 2024; 23:524-531. [PMID: 37666711 PMCID: PMC10907545 DOI: 10.1016/j.jcf.2023.08.006] [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: 04/30/2023] [Revised: 07/18/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF. METHODS We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics. RESULTS The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025). CONCLUSIONS Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF.
Collapse
Affiliation(s)
- Julianna Bailey
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Elizabeth Baker
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Michael S Schechter
- Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, United States
| | - Keith J Robinson
- University of Vermont Children's Hospital, Burlington, VT, United States
| | | | - Elliot Dasenbrook
- Cleveland Clinic Respiratory Institute, Cleveland, OH, United States
| | - Monir Hossain
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Dixie Durham
- St. Luke's Cystic Fibrosis Center of Idaho, United States
| | - Georgia Brown
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Cristen Clemm
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Kim Reno
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Gabriela R Oates
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States.
| |
Collapse
|
4
|
Canter KS, Weaver L, Reed M, Chidekel A. Screening for food insecurity and mental health needs during the early days of the COVID-19 pandemic: A patient experience project to meet an urgent clinical need. Pediatr Pulmonol 2024. [PMID: 38174835 DOI: 10.1002/ppul.26853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Kimberly S Canter
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
| | - Lauren Weaver
- Division of Social Services, Nemours Children's Health, Wilmington, Delaware, USA
| | - Michelle Reed
- Division of Clinical Nutrition Services, Nemours Children's Health, Wilmington, Delaware, USA
| | - Aaron Chidekel
- Division of Pulmonary Medicine, Nemours Children's Health, Wilmington, Delaware, USA
| |
Collapse
|
5
|
Oates GR, Schechter MS. Aiming to Improve Equity in Pulmonary Health: Cystic Fibrosis. Clin Chest Med 2023; 44:555-573. [PMID: 37517835 PMCID: PMC10458995 DOI: 10.1016/j.ccm.2023.03.011] [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: 08/01/2023]
Abstract
This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, geographic location, gender identity, or sexual orientation documented in the literature. We outline the mechanisms that generate and perpetuate such disparities across levels and domains of influence and assess the implications of this evidence. We then recommend strategies for improving equity in CF outcomes, drawing on recommendations for the general population and considering approaches specific to people living with CF.
Collapse
Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, USA
| |
Collapse
|
6
|
Seyoum S, Regenstein M, Benoit M, Dieni O, Willis A, Reno K, Clemm C. Cost burden among the CF population in the United States: A focus on debt, food insecurity, housing and health services. J Cyst Fibros 2023; 22:471-477. [PMID: 36710098 DOI: 10.1016/j.jcf.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/09/2022] [Accepted: 01/06/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Advancements in the cystic fibrosis (CF) field have resulted in longer lifespans for individuals with CF. This has led to more responsibility for complex care regimens, frequent health care, and prescription medication utilization that are costly and may not be fully covered by health insurance. There are outstanding questions about unmet medical needs among the U.S. population with CF and how the financial burden of CF is associated with debt, housing instability, and food insecurity. METHODS Researchers developed the CF Health Insurance Survey (CF HIS) to survey a convenience sample of people living with CF in the U.S. The sample was weighted to reflect the parameters of the 2019 Cystic Fibrosis Foundation Patient Registry Annual Data Report, and chi-square tests and multiple logistic regression models were conducted. RESULTS A total of 1,856 CF patients in the U.S. were included in the study. Of these, 64% faced a financial burden: 55% of respondents faced debt issues, 26% housing issues, and 33% food insecurity issues. A third reported at least one unmet medical need: 24% faced unmet prescription needs, 12% delayed or shortened a hospitalization, and 10% delayed or skipped a care center visit as a result of the cost of care. CONCLUSIONS People with CF in the U.S. experience high financial burden, which is associated with unmet medical needs. Income is the biggest risk factor for financial burden for people with CF, with people dually covered by Medicare and Medicaid particularly at risk.
Collapse
Affiliation(s)
- Semret Seyoum
- Department of Health Policy and Management, the George Washington University, 950 New Hampshire Ave NW #2, Washington, D.C. 20052, USA
| | - Marsha Regenstein
- Department of Health Policy and Management, the George Washington University, 950 New Hampshire Ave NW #2, Washington, D.C. 20052, USA
| | - Marie Benoit
- Department of Health Policy and Management, the George Washington University, 950 New Hampshire Ave NW #2, Washington, D.C. 20052, USA.
| | - Olivia Dieni
- Cystic Fibrosis Foundation, 4550 Montgomery Ave suite 1100 n, Bethesda, MD 20814, USA
| | - Anne Willis
- Cystic Fibrosis Foundation, 4550 Montgomery Ave suite 1100 n, Bethesda, MD 20814, USA
| | - Kim Reno
- Cystic Fibrosis Foundation, 4550 Montgomery Ave suite 1100 n, Bethesda, MD 20814, USA
| | - Cristen Clemm
- Cystic Fibrosis Foundation, 4550 Montgomery Ave suite 1100 n, Bethesda, MD 20814, USA
| |
Collapse
|
7
|
Jennings D, List R, Bruschwein H, Compton M, Somerville L, Williamson L, Murray R, Evangelista B, Albon D. Social determinants of health screening and intervention: A cystic fibrosis quality improvement process. Pediatr Pulmonol 2022; 57:3035-3043. [PMID: 36039394 PMCID: PMC9826285 DOI: 10.1002/ppul.26131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Lower socioeconomic status is associated with significantly poorer outcomes in weight, lung function, and pulmonary exacerbation rates in people with cystic fibrosis (PwCF). GLOBAL AIM We aim to reduce health disparities and inequities faced by PwCF by screening for and addressing unmet social needs. SPECIFIC AIMS We aimed to increase routine social determinants of health (SDoH) screening of eligible PwCF from 0% to 95% and follow-up within 2 weeks for those PwCF who screened positive and requested assistance from 0% to 95% by December 31, 2021. METHODS The Model for Improvement methodology was used. A process map and a simplified failure mode effects analysis chart were created for the screening and SDoH follow-up process. For those who screened positive for SDoH and requested assistance, follow-up contact was made to offer intervention. INTERVENTION Adult PwCF who had at least one UVA Clinic encounter in 2021 were screened for SDoH. The SDoH screening tool included eight domains: housing, food, transportation, utilities, health-care access, medication access, income/employment, and education. Follow-up was completed with all PwCF who screened positive for SDoH. RESULTS A total of 132 of 142 (93.0%) PwCF eligible for screening completed the SDoH screening. Of the PwCF who completed screening, 56 (42.4%) screened positive for SDoH. A follow-up rate of 100% was achieved in June 2021 and maintained through December 2021. CONCLUSION Implementing screening for SDOH and follow-up to mitigate social difficulties in adult PwCF at UVA was successful and could be reproduced at other CF care centers.
Collapse
Affiliation(s)
- Deirdre Jennings
- Department of Social Work, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rhonda List
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Heather Bruschwein
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Martina Compton
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Lindsay Somerville
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Lauren Williamson
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rachel Murray
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Brielle Evangelista
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dana Albon
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| |
Collapse
|
8
|
Oates GR, Schechter MS. Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies. Expert Rev Respir Med 2022; 16:637-650. [PMID: 35705523 DOI: 10.1080/17476348.2022.2090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions. AREAS COVERED This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice. EXPERT OPINION Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.
Collapse
Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, USA
| |
Collapse
|
9
|
Corbera-Hincapie MA, Atteih SE, Stransky OM, Weiner DJ, Yann IM, Kazmerski TM. Experiences and Perspectives of Individuals with Cystic Fibrosis and Their Families Related to Food Insecurity. Nutrients 2022; 14:nu14132573. [PMID: 35807754 PMCID: PMC9268710 DOI: 10.3390/nu14132573] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022] Open
Abstract
Food insecurity (FI) rates among people with cystic fibrosis (CF) are significantly higher than in the general US population. This study explored the experiences and perceptions of adults and parents of children with CF surrounding FI. We recruited parents of children with CF ages 0–18 years and adults with CF ages 18 years and older from a large, accredited U.S. CF care center and the Cystic Fibrosis Foundation Community Voice to participate in a qualitative study using semi-structured telephone interviews to explore experiences and preferences related to food insecurity. Two coders independently reviewed each transcript to apply the codebook and identify any emerging codes using an ongoing, iterative process to identify central themes. We interviewed 20 participants (six adults with CF and 14 parents of children with CF) and identified five major themes: (1) FI in CF is influenced by a variety of factors, ranging from nutritional demands to competing financial barriers; (2) FI impacts CF health outcomes; (3) Open patient-provider communication around FI is vital; (4) FI screening and discussions should be normalized in CF care; (5) Comprehensive FI resources are vital. FI is an important topic that should routinely be addressed with the CF care team to destigmatize and encourage individuals to be more forthcoming about their FI status. Results from this study will inform future larger investigations on the impact of FI on CF health and aid in the design and planning of targeted interventions and advocacy efforts.
Collapse
Affiliation(s)
- Montserrat A. Corbera-Hincapie
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.E.A.); (D.J.W.); (I.M.Y.); (T.M.K.)
- Correspondence: ; Tel.: +1-786-412-1300
| | - Samar E. Atteih
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.E.A.); (D.J.W.); (I.M.Y.); (T.M.K.)
| | - Olivia M. Stransky
- Center for Innovative Research on Gender Health Equity (CONVERGE), Pittsburgh, PA 15224, USA;
| | - Daniel J. Weiner
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.E.A.); (D.J.W.); (I.M.Y.); (T.M.K.)
| | - Iris M. Yann
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.E.A.); (D.J.W.); (I.M.Y.); (T.M.K.)
| | - Traci M. Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.E.A.); (D.J.W.); (I.M.Y.); (T.M.K.)
- Center for Innovative Research on Gender Health Equity (CONVERGE), Pittsburgh, PA 15224, USA;
| |
Collapse
|
10
|
Greaney C, Bohan K, Tecklenborg S, Casserly B, Green J, Van de Ven P, Robinson K, Tierney A. Diet quality in cystic fibrosis – associations with patient reported outcome measures and enablers and barriers to eating a healthy diet: A protocol paper for a mixed methods study. HRB Open Res 2022; 5:33. [PMID: 36091185 PMCID: PMC9428499 DOI: 10.12688/hrbopenres.13533.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background: People with cystic fibrosis (PWCF) have increased energy requirements. However, in recent years concerns have emerged regarding the ‘cystic fibrosis (CF) diet’ in terms of reliance on energy-dense, nutrient poor foods, which tend to be higher in saturated fat, sugar, and salt. These foods lack essential nutrients and are aetiologically linked with diet-related chronic diseases. The aim is to explore habitual dietary intakes in PWCF and (i) assess adherence to CF dietary guidelines and population specific healthy eating guidelines; (ii) derive a diet quality score and the inflammatory potential for the average diet consumed by PWCF and assess associations with patient reported outcome measures; (iii) assess drivers for current consumption patterns and enablers and barriers to eating a healthy diet. Methods: The aim is to recruit between 100-180 PWCF. A mixed methods study will be performed. Using three-day food diaries and food frequency questionnaires, aims (i) and (ii) will be addressed. The Dietary Approaches to Stop Hypertension (DASH) score and Healthy Eating Index-International (HEI-I) will derive diet quality scores. The Dietary Inflammatory Index (DII®) will ascertain inflammatory potential of the diet. Validated questionnaires will be used to report health related quality of life measures. Online focus groups and semi-structured interview with PWCF will address aim (iii). Conclusions: It is timely to revise dietary priorities and targets for CF. However, a greater understanding of what adults with CF currently consume and what they require in terms of nutrition and dietary guidance into the future is needed. In doing so, this research will help to clarify nutrition priorities and simplify the dietary aspects of CF treatment, thereby supporting adherence.
Collapse
Affiliation(s)
- Cian Greaney
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Bohan
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Sarah Tecklenborg
- Cystic Fibrosis Ireland, 24 Lower Rathmines Rd, Rathmines, Dublin, Ireland
| | - Brian Casserly
- Department of Respiratory Medicine, University Hospital Limerick, Dooradoyle, Limerick, V94 F858, Ireland
| | - James Green
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Pepijn Van de Ven
- Department of Electronic and Computer Engineering, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Audrey Tierney
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| |
Collapse
|
11
|
Lim JT, Ly NP, Willen SM, Iwanaga K, Gibb ER, Chan M, Church GD, Neemuchwala F, McGarry ME. Food insecurity and mental health during the COVID-19 pandemic in cystic fibrosis households. Pediatr Pulmonol 2022; 57:1238-1244. [PMID: 35112507 DOI: 10.1002/ppul.25850] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The COVID-19 pandemic impacted many households due to shelter-in-place orders and economic hardship. People with cystic fibrosis (CF) experienced increased food insecurity compared to the general population before the pandemic, even though adequate food access is needed to maintain nutrition goals associated with improved health-related outcomes. Little is known about the impact the pandemic had on the food insecurity of people with CF and their families. OBJECTIVE To investigate how the COVID-19 pandemic impacted food insecurity, mental health, and self-care in people with CF. METHODS Adults with CF and parents/guardians of children with CF were recruited via social media to complete online questionnaires from May 2020 to February 2021. Questionnaires in English and Spanish included USDA 2-question food insecurity screening, Patient Health Questionnaire-4 for mental health screening, and directed questions on the impact of the pandemic. RESULTS Of 372 respondents, 21.8% of the households experienced food insecurity during the pandemic compared to 18.8% prepandemic (p < .001). More food insecure patients with CF reported weight loss (32.1% vs. 13.1%, p < .001), worse airway clearance adherence (13.6% vs. 5.8%, p < .01), and worse medication adherence (12.4% vs. 1.7%, p < .01) compared to food secure patients. Food insecure subjects were more likely to have an abnormal mental health screen compared to food secure subjects (53.1% vs. 16.2%, p < .001). CONCLUSION Food insecurity increased in the CF population during the COVID-19 pandemic. Food insecure subjects reported worse mental health and self-care during the pandemic compared to food secure subjects.
Collapse
Affiliation(s)
- Janet T Lim
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Ngoc P Ly
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Shaina M Willen
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Kensho Iwanaga
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Elizabeth R Gibb
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Marilynn Chan
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Gwynne D Church
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Fatima Neemuchwala
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Meghan E McGarry
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| |
Collapse
|
12
|
Gabel ME, Fox CK, Grimes RA, Lowman JD, McDonald CM, Stallings VA, Michel SH. Overweight and cystic fibrosis: An unexpected challenge. Pediatr Pulmonol 2022; 57 Suppl 1:S40-S49. [PMID: 34738328 DOI: 10.1002/ppul.25748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/06/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023]
Abstract
Achieving a healthy weight balance has been a central focus of care for people who have cystic fibrosis (CF). Over the years, the emphasis has primarily been on promoting weight gain to optimize pulmonary outcomes. With continued improvements in CF care, including highly effective CF modulators available for many people, the CF community is now experiencing a new challenge: addressing the concern that some people are gaining weight excessively. While at this time, we do not know to what extent overweight and obesity will affect health outcomes for people with CF, it is likely that excessive weight gain may have negative health impacts similar to those seen in the general population. In this paper, we review the history of nutritional guidelines for people with CF, as well as more recent trends toward overweight and obesity for some. A multidisciplinary approach is needed to collaboratively start the oftentimes difficult conversation regarding excessive weight gain, and to identify resources to help people achieve and maintain a healthy weight through diet, exercise, and behavioral modification.
Collapse
Affiliation(s)
- Megan E Gabel
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Claudia K Fox
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rachel A Grimes
- Department of Psychiatry, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - John D Lowman
- Department of Physical Therapy, Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine M McDonald
- Department of Clinical Nutrition, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Virginia A Stallings
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Suzanne H Michel
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
13
|
Corbera-Hincapie MA, Kurland KS, Hincapie MR, Fabio A, Weiner DJ, Kim SC, Kazmerski TM. Geospatial Analysis of Food Deserts and Their Impact on Health Outcomes in Children with Cystic Fibrosis. Nutrients 2021; 13:3996. [PMID: 34836250 PMCID: PMC8621515 DOI: 10.3390/nu13113996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/20/2022] Open
Abstract
Food insecurity (FI) is defined as "the limited or uncertain access to adequate food." One root cause of FI is living in a food desert. FI rates among people with cystic fibrosis (CF) are higher than the general United States (US) population. There is limited data on the association between food deserts and CF health outcomes. We conducted a retrospective review of people with CF under 18 years of age at a single pediatric CF center from January to December 2019 using demographic information and CF health parameters. Using a Geographic Information System, we conducted a spatial overlay analysis at the census tract level using the 2015 Food Access Research Atlas to assess the association between food deserts and CF health outcomes. We used multivariate logistic regression analysis and adjusted for clinical covariates and demographic covariates, using the Child Opportunity Index (COI) to calculate odds ratios (OR) with confidence intervals (CI) for each health outcome. People with CF living in food deserts and the surrounding regions had lower body mass index/weight-for-length (OR 3.18, 95% CI: 1.01, 9.40, p ≤ 0.05 (food desert); OR 4.41, 95% CI: 1.60, 12.14, p ≤ 0.05 (600 ft buffer zone); OR 2.83, 95% CI: 1.18, 6.76, p ≤ 0.05 (1200 ft buffer zone)). Food deserts and their surrounding regions impact pediatric CF outcomes independent of COI. Providers should routinely screen for FI and proximity to food deserts. Interventions are essential to increase access to healthy and affordable food.
Collapse
Affiliation(s)
- Montserrat A. Corbera-Hincapie
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Kristen S. Kurland
- School of Architecture, Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA 15213, USA;
| | - Mark R. Hincapie
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh Epidemiology Data Center, Pittsburgh, PA 15260, USA;
| | - Daniel J. Weiner
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Sandra C. Kim
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| | - Traci M. Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.R.H.); (D.J.W.); (S.C.K.); (T.M.K.)
| |
Collapse
|
14
|
Prieur MG, Christon LM, Mueller A, Smith BA, Georgiopoulos AM, Boat TF, Filigno SS. Promoting emotional wellness in children with cystic fibrosis, Part I: Child and family resilience. Pediatr Pulmonol 2021; 56 Suppl 1:S97-S106. [PMID: 32658376 DOI: 10.1002/ppul.24958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/06/2023]
Abstract
Attention should be given to individual and family well-being from a child's first interaction with the medical team and continuing throughout development, especially for families who experience chronic illnesses, such as cystic fibrosis (CF). While much attention has been given to the mental health of people with CF 12 years and older, this paper explores various areas for CF teams to assess and provide additional resources during the first 12 years of a child's life to promote child and family wellness. In this paper, we discuss parental mental health, social determinants of health, adherence/self-care, nutrition, attention to family lifestyle factors, engagement with school and peers, and modulator therapy for this age group of people with CF. This is the first of two companion papers which examines emotional wellness of children during the early years. The second paper examines mental health assessment and intervention for children under 12. Both encourage teams to strive to promote optimal child and family emotional health and wellness, emphasizing holistic health promotion and prevention, early identification, and intervention.
Collapse
Affiliation(s)
- Mary G Prieur
- Departments of Psychiatry and Pediatricsm School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lillian M Christon
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina
| | | | - Beth A Smith
- Division of Child & Adolescent Psychiatry, University at Buffalo-The State University of New York, Buffalo, New York
| | | | - Thomas F Boat
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|