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Lalika M, McCoy CR, Jones C, Bancos I, Cooper LA, Hayes SN, Johnson MP, Kullo IJ, Kumbamu A, Noseworthy PA, Patten CA, Singh R, Wi CI, Brewer LC. Rationale, design, and participant characteristics of the FAITH! Heart Health+ study: An exploration of the influence of the social determinants of health, stress, and structural racism on African American cardiovascular health. Contemp Clin Trials 2024; 143:107600. [PMID: 38851481 PMCID: PMC11283952 DOI: 10.1016/j.cct.2024.107600] [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: 10/09/2023] [Revised: 04/16/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND African Americans (AAs) face cardiovascular health (CVH) disparities linked to systemic racism. The 2020 police killing of Mr. George Floyd in Minneapolis, Minnesota, alongside the COVID-19 pandemic, exacerbated adverse psychosocial factors affecting CVH outcomes among AAs. This manuscript describes the study protocol and participant characteristics in an ancillary study exploring the relationship between biopsychosocial factors and CVH among AAs. METHODS Using a community-based participatory approach, a mixed-methods ancillary study of 58 AA participants from an overarching randomized control trial (RCT) was conducted. Baseline RCT health assessments (November 2020) provided sociodemographic, medical, and clinical data. Subsequent health assessments (February-December 2022) measured sleep quality, psychosocial factors (e.g., high-effort coping), biomarkers (e.g., cortisol), and cardiovascular diagnostics (e.g., cardio-ankle vascular index). CVH was assessed using the American Heart Association Life's Simple 7 (LS7) (range 0 to 14, poor to ideal) and Life's Essential 8 (LE8) scores (range 0 to 100, low to high). Correlations between these scores will be examined. Focus group discussions via videoconferencing (March to April 2022) assessed psychosocial and structural barriers, along with the impact of COVID-19 and George Floyd's killing on daily life. RESULTS Participants were predominantly female (67%), with a mean age of 54.6 [11.9] years, high cardiometabolic risk (93% had overweight/obesity and 70% hypertension), and moderate LE8 scores (mean 57.4, SD 11.5). CONCLUSION This study will enhance understanding of the associations between biopsychosocial factors and CVH among AAs in Minnesota. Findings may inform risk estimation, patient care, and healthcare policies to address CVD disparities in marginalized populations.
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Affiliation(s)
- Mathias Lalika
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Carrie R McCoy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Clarence Jones
- Hue-Man Partnership, 2400 Park Ave, Minneapolis, MN 55404, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite#2-500, Baltimore, MD 21205, USA.
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Matthew P Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Ravinder Singh
- Division of Clinical Biochemistry & Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA; Center for Health Equity and Community Engagement Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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ElSayed NA, Bannuru RR, Bakris G, Bardsley J, de Boer IH, Gabbay RA, Gockerman J, McCoy RG, McCracken E, Neumiller JJ, Pilla SJ, Rhee CM. Diabetic Kidney Disease Prevention Care Model Development. Clin Diabetes 2023; 42:274-294. [PMID: 38694240 PMCID: PMC11060626 DOI: 10.2337/cd23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.
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Affiliation(s)
- Nuha A. ElSayed
- American Diabetes Association, Alexandria, VA
- Harvard Medical School, Boston, MA
| | | | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago School of Medicine, Chicago, IL
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar System Nursing, Columbia, MD
| | - Ian H. de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | | | | | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, University of Maryland Institute for Health Computing, Rockville, MD
| | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
- Providence Medical Research Center, Providence Health Care, Spokane, WA
| | - Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie M. Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Irvine, CA
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Brewer LC, Abraham H, Clark D, Echols M, Hall M, Hodgman K, Kaihoi B, Kopecky S, Krogman A, Leth S, Malik S, Marsteller J, Mathews L, Scales R, Schulte P, Shultz A, Taylor B, Thomas R, Wong N, Olson T. Efficacy and Adherence Rates of a Novel Community-Informed Virtual World-Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial. J Am Heart Assoc 2023; 12:e030883. [PMID: 38014699 PMCID: PMC10727355 DOI: 10.1161/jaha.123.030883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology-based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center-based CR. This study aims to evaluate efficacy and adherence of the virtual world-based CR program compared with center-based CR within a community-informed, implementation science framework. METHODS Using a noninferiority, hybrid type 1 effectiveness-implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12-week Destination Cardiac Rehab or the center-based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board-approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. CONCLUSIONS The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05897710.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
- Center for Health Equity and Community Engagement ResearchMayo ClinicRochesterMN
| | - Helayna Abraham
- Department of Internal MedicineMayo Clinic College of MedicineRochesterMN
| | - Donald Clark
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Melvin Echols
- Department of Cardiovascular MedicineMorehouse School of MedicineAtlantaGA
| | - Michael Hall
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Karen Hodgman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Brian Kaihoi
- Global Products and ServicesMayo Clinic Center for InnovationRochesterMN
| | - Stephen Kopecky
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Ashton Krogman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shawn Leth
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shaista Malik
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Jill Marsteller
- Center for Health Services and Outcomes ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Lena Mathews
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Robert Scales
- Department of Cardiovascular MedicineMayo Clinic College of MedicinePhoenixAZ
| | - Phillip Schulte
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Adam Shultz
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Bryan Taylor
- Department of Cardiovascular MedicineMayo Clinic College of MedicineJacksonvilleFL
| | - Randal Thomas
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Nathan Wong
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Thomas Olson
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
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Lalika M, Salinas M, Asiedu GB, Jones C, Richard M, Erickson J, Weis J, Abbenyi A, Brockman TA, Sia IG, Wieland ML, White RO, Doubeni CA, Brewer LC. Perspectives of African American Church Leaders in Response to COVID-19 Emergency Preparedness and Risk Communication Efforts Within a Community Engaged Research Partnership: COVID-19 emergency risk communication. Disaster Med Public Health Prep 2023; 17:e532. [PMID: 37830352 PMCID: PMC11017953 DOI: 10.1017/dmp.2023.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Mathias Lalika
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Manisha Salinas
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Jacksonville, FL, USA
| | - Gladys B. Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jennifer Weis
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Adeline Abbenyi
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Tabetha A. Brockman
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Irene G. Sia
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
- Division of Infectious Diseases, Mayo Clinic Department of Medicine, Rochester, MN, USA
| | - Mark L. Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
- Division of Community Internal Medicine, Mayo Clinic Department of Medicine, Rochester, MN, USA
| | - Richard O. White
- Division of Community Internal Medicine, Mayo Clinic Department of Medicine, Jacksonville, FL, USA
| | - Chyke A. Doubeni
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - LaPrincess C. Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
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Thomas VE, Metlock FE, Hines AL, Commodore-Mensah Y, Brewer LC. Community-Based Interventions to Address Disparities in Cardiometabolic Diseases Among Minoritized Racial and Ethnic Groups. Curr Atheroscler Rep 2023; 25:467-477. [PMID: 37428390 DOI: 10.1007/s11883-023-01119-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE OF REVIEW Cardiometabolic diseases (CMDs) are leading causes of death and disproportionally impact historically marginalized racial/ethnic groups in the United States. The American Heart Association developed the Life's Essential 8 (LE8) to promote optimal cardiovascular health (CVH) through eight health behaviors and health factors. The purpose of this review is to summarize contemporary community-engaged research (CER) studies incorporating the LE8 framework among racial/ethnic groups. REVIEW OF FINDINGS Limited studies focused on the interface of CER and LE8. Based on synthesis of articles in this review, the application of CER to individual/collective LE8 metrics may improve CVH and reduce CMDs at the population level. Effective strategies include integration of technology, group activities, cultural/faith-based practices, social support, and structural/environmental changes. CER studies addressing LE8 factors in racial/ethnic groups play an essential role in improving CVH. Future studies should focus on broader scalability and health policy interventions to advance health equity.
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Affiliation(s)
- Victoria E Thomas
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Faith E Metlock
- John Hopkins University School of Nursing, Baltimore, MD, USA
| | - Anika L Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Yvonne Commodore-Mensah
- John Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - LaPrincess C Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
- Mayo Clinic Center for Health Equity and Community Engagement Research, Rochester, MN, USA.
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6
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Maciejko LA, Fox JM, Steffens MT, Patten CA, Newman HR, Decker PA, Wheeler P, Juhn YJ, Wi CI, Gorfine M, Brewer L, Sinicrope PS. Rural and urban residents' attitudes and preferences toward COVID-19 prevention behaviors in a midwestern community. PLoS One 2023; 18:e0286953. [PMID: 37352298 PMCID: PMC10289401 DOI: 10.1371/journal.pone.0286953] [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: 08/23/2021] [Accepted: 05/30/2023] [Indexed: 06/25/2023] Open
Abstract
Rural populations are more vulnerable to the impacts of COVID-19 compared to their urban counterparts as they are more likely to be older, uninsured, to have more underlying medical conditions, and live further from medical care facilities. We engaged the Southeastern MN (SEMN) community (N = 7,781, 51% rural) to conduct a survey of motivators and barriers to masking to prevent COVID-19. We also assessed preferences for types of and modalities to receive education/intervention, exploring both individual and environmental factors primarily consistent with Social Cognitive Theory. Our results indicated rural compared to urban residents performed fewer COVID-19 prevention behaviors (e.g. 62% rural vs. 77% urban residents reported wearing a mask all of the time in public, p<0.001), had more negative outcome expectations for wearing a mask (e.g. 50% rural vs. 66% urban residents thought wearing a mask would help businesses stay open, p<0.001), more concerns about wearing a mask (e.g. 23% rural vs. 14% urban were very concerned about being 'too hot', p<0.001) and lower levels of self-efficacy for masking (e.g. 13.9±3.4 vs. 14.9±2.8, p<0.001). It appears that masking has not become a social norm in rural SEMN, with almost 50% (vs. 24% in urban residents) disagreeing with the expectation 'others in my community will wear a mask to stop the spread of Coronavirus'. Except for people (both rural and urban) who reported not being at all willing to wear a mask (7%), all others expressed interest in future education/interventions to help reduce masking barriers that utilized email and social media for delivery. Creative public health messaging consistent with SCT tailored to rural culture and norms is needed, using emails and social media with pictures and videos from role models they trust, and emphasizing education about when masks are necessary.
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Affiliation(s)
- Laura A. Maciejko
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States of America
| | - Jean M. Fox
- Department of Gastroenterology, Mayo Clinic, Rochester, MN, United States of America
| | | | - Christi A. Patten
- Community Engagement Program, Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States of America
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Hana R. Newman
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States of America
| | - Paul A. Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Phil Wheeler
- Precision Population Science Lab, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, United States of America
| | - Young J. Juhn
- Precision Population Science Lab, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, United States of America
| | - Chung-Il Wi
- Precision Population Science Lab, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, United States of America
| | - Mary Gorfine
- Community Engagement Program, Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States of America
| | - LaPrincess Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States of America
| | - Pamela S. Sinicrope
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
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Brewer LC, Jones C, Slusser JP, Pasha M, Lalika M, Chacon M, Takawira P, Shanedling S, Erickson P, Woods C, Krogman A, Ferdinand D, Underwood P, Cooper LA, Patten CA, Hayes SN. mHealth Intervention for Promoting Hypertension Self-management Among African American Patients Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App. JMIR Form Res 2023; 7:e45061. [PMID: 37115658 PMCID: PMC10337371 DOI: 10.2196/45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/20/2023] [Accepted: 04/27/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND African American individuals are at a higher risk of premature death from cardiovascular diseases than White American individuals, with disproportionate attributable risk from uncontrolled hypertension. Given their high use among African American individuals, mobile technologies, including smartphones, show promise in increasing reliable health information access. Culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. OBJECTIVE This formative study aimed to assess the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among African American patients. METHODS A mixed methods study of African American patients with uncontrolled hypertension was conducted over 2 consecutive phases. In phase 1, patients and clinicians from 2 federally qualified health centers (FQHCs) in the Minneapolis-St Paul, Minnesota area, provided input through focus groups to refine an existing culturally tailored mHealth app (Fostering African-American Improvement in Total Health! [FAITH!] App) for promoting hypertension self-management among African American patients with uncontrolled hypertension (renamed as FAITH! Hypertension App). Phase 2 was a single-arm pre-post intervention pilot study assessing feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention using the FAITH! Hypertension App synchronized with a wireless BP monitor and community health worker (CHW) support to address social determinants of health-related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication and BP self-monitoring, and social networking. Primary outcomes were feasibility (app engagement and satisfaction) and preliminary efficacy (change in BP) at an immediate postintervention assessment. RESULTS In phase 1, thirteen African American patients (n=9, 69% aged ≥50 years and n=10, 77% women) and 16 clinicians (n=11, 69% aged ≥50 years; n=14, 88% women; and n=10, 63% African American) participated in focus groups. Their feedback informed app modifications, including the addition of BP and medication tracking, BP self-care task reminders, and culturally sensitive contexts. In phase 2, sixteen African American patients were enrolled (mean age 52.6, SD 12.3 years; 12/16, 75% women). Overall, 38% (6/16) completed ≥50% of the 10 education modules, and 44% (7/16) completed the postintervention assessment. These patients rated the intervention a 9 (out of 10) on its helpfulness in hypertension self-management. Qualitative data revealed that they viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. The mean systolic and diastolic BPs of the 7 patients decreased by 6.5 mm Hg (P=.15) and 2.8 mm Hg (P=.78), respectively, at the immediate postintervention assessment. CONCLUSIONS A culturally tailored mHealth app reinforced by CHW support may improve hypertension self-management among underresourced African American individuals receiving care at FQHCs. A future randomized efficacy trial of this intervention is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT04554147; https://clinicaltrials.gov/ct2/show/NCT04554147.
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Affiliation(s)
- LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States
| | | | - Joshua P Slusser
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - Maarya Pasha
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Mathias Lalika
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Megan Chacon
- Cardiovascular Health Unit, Minnesota Department of Health, St. Paul, MN, United States
| | - Patricia Takawira
- Cardiovascular Health Unit, Minnesota Department of Health, St. Paul, MN, United States
| | - Stanton Shanedling
- Cardiovascular Health Unit, Minnesota Department of Health, St. Paul, MN, United States
| | - Paul Erickson
- NorthPoint Health and Wellness Center, Minneapolis, MN, United States
| | - Cynthia Woods
- Open Cities Health Center, St. Paul, MN, United States
| | - Ashton Krogman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Daphne Ferdinand
- Healthy Heart Community Prevention Project, Inc., New Orleans, LA, United States
| | - Paul Underwood
- Interventional Cardiology/Structural Heart, Boston Scientific Corporation, Marlborough, MA, United States
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
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Hamid A, MacLeod J, Erb S, Berman G, Martinez HR, Scherrer-Crosbie M, Cheng RK, Brown SA. Editorial: Leveraging digital and technological innovations in cardio-oncology: building collaborative networks, implementing education and improving the cardiac outcomes of patients. Front Cardiovasc Med 2023; 10:1184988. [PMID: 37180799 PMCID: PMC10169814 DOI: 10.3389/fcvm.2023.1184988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Affiliation(s)
| | - James MacLeod
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Samuel Erb
- Medical College of Wisconsin, Green Bay, WI, United States
| | | | - Hugo R. Martinez
- Department of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN, United States
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Richard K. Cheng
- Cardio-Oncology Program, Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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Khan SS, Brewer LC, Canobbio MM, Cipolla MJ, Grobman WA, Lewey J, Michos ED, Miller EC, Perak AM, Wei GS, Gooding H. Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e76-e91. [PMID: 36780391 PMCID: PMC10080475 DOI: 10.1161/cir.0000000000001124] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.
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10
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Yang J, Park B. A scoping review key elements and effects of cardiovascular disease management programs based on community-based participatory research. PLoS One 2023; 18:e0279563. [PMID: 36662793 PMCID: PMC9858102 DOI: 10.1371/journal.pone.0279563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/09/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This scoping review analyses the literature on community-based participatory research (CBPR)-based cardiovascular disease (CVD) management programmes, examining the key elements of their development and implementation and exploring their effectiveness. METHODS This scoping review's methodology had six stages: 1) identifying the research question; 2) identifying relevant studies-search strategy; 3) study selection; 4) charting the data; 5) collating, summarising, and reporting the results; and 6) consultation exercise. The databases used were PubMed, Cochrane, and CINAHL, for the period from 4 March to 3 April 2022. We selected studies 1) published after 2000; 2) targeting community residents over 18 years old; and 3) proposed a CBPR-based CVD management programme, described its development, and evaluated its effects based on its application. Data were extracted independently by each of the two researchers, using a standardised form. RESULTS Among the key aspects of such programmes were the many cases where community organisations led establishment of partnerships and cases where a decision-making committee was formed. Regarding application of the CBPR principles, community partners participated only in executing the research, not in analysing and interpreting research results. In addition, among the 21 studies selected were 6 randomised controlled trials, all of which showed a significant positive effect in experimental groups compared to control groups. CONCLUSION Improvement strategies are needed to allow implementation of CBPR principles in a CBPR-based CVD management programme. Moreover, further verification of programme evaluation research methods is needed. SCOPING REVIEW REGISTRATION This protocol has been registered to the OSF registries. 0000000204460911. Key Elements and Effects of Cardiovascular Disease Management Programs Based on Community-based Participatory Research: Protocol for a Scoping Review'. OSF, 4 Sept. 2020. Web.
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Affiliation(s)
- Juhyeon Yang
- Department of Nursing, Changwon National University, Changwon, Gyeongnam, Republic of Korea
| | - Bohyun Park
- Department of Nursing, Changwon National University, Changwon, Gyeongnam, Republic of Korea
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Sadler D, Okwuosa T, Teske AJ, Guha A, Collier P, Moudgil R, Sarkar A, Brown SA. Cardio oncology: Digital innovations, precision medicine and health equity. Front Cardiovasc Med 2022; 9:951551. [PMID: 36407451 PMCID: PMC9669068 DOI: 10.3389/fcvm.2022.951551] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
The rapid emergence of cardio-oncology has resulted in a rapid growth of cardio-oncology programs, dedicated professional societies sections and committees, and multiple collaborative networks that emerged to amplify the access to care in this new subspecialty. However, most existing data, position statements and guidelines are limited by the lack of availability of large clinical trials to support these recommendations. Furthermore, there are significant challenges regarding proper access to cardio-oncology care and treatment, particularly in marginalized and minority populations. The emergence and evolution of personalized medicine, artificial intelligence (AI), and machine learning in medicine and in cardio-oncology provides an opportunity for a more targeted, personalized approach to cardiovascular complications of cancer treatment. The proper implementation of these new modalities may facilitate a more equitable approach to adequate and universal access to cardio-oncology care, improve health related outcomes, and enable health care systems to eliminate the digital divide. This article reviews and analyzes the current status on these important issues.
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Affiliation(s)
- Diego Sadler
- Cardio Oncology Section, Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, FL, United States
- *Correspondence: Diego Sadler
| | - Tochukwu Okwuosa
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, United States
| | - A. J. Teske
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Avirup Guha
- Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Patrick Collier
- Cleveland Clinic, Cardio Oncology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Rohit Moudgil
- Cleveland Clinic, Cardio Oncology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Abdullah Sarkar
- Cardio Oncology Section, Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, FL, United States
| | - Sherry-Ann Brown
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Ricks JM, Arthur EK, Stryker SD, Yockey RA, Anderson AM, Allensworth-Davies D. A Systematic Literature Review of Community-Based Participatory Health Research with Sexual and Gender Minority Communities. Health Equity 2022; 6:640-657. [PMID: 36081887 PMCID: PMC9448519 DOI: 10.1089/heq.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose: The objective was to review sexual and gender minority (SGM) health research studies to gain an understanding of how the community-based participatory research (CBPR) framework has been operationalized. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a review of all SGM health research studies published in the past 10 years that cited a CBPR approach (PROSPERO Registration No. CRD42016036608). CINAHL, PubMed, and PsycINFO databases were systematically searched in October 2020. Dimensions of community involvement (e.g., shared decision-making; flexibility to community needs and priorities) and the strength of evidence for each dimension were rated using guidance from the Agency of Healthcare Research and Quality. Results: The 48 eligible articles identified reported a range of 0–11 (out of 13) community elements. Seven studies reported zero elements. Qualitative studies (n=28; 58.3%) had an average quality score of 2.32 (range: 1.43–2.5). The 15 (31.3%) cross-sectional studies had an average quality score of 2.08 (range: 1.64–2.27). Conclusion: Adhering to the CBPR framework is challenging. The benefits of striving toward its principles, however, can move us toward transformative and sustainable social change within SGM communities.
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Affiliation(s)
- JaNelle M. Ricks
- Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
| | - Elizabeth K. Arthur
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- The Ohio State University Comprehensive Cancer, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Shanna D. Stryker
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - R. Andrew Yockey
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- Biostatistics and Epidemiology, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA
| | - Avery M. Anderson
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Donald Allensworth-Davies
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- Cleveland State University College of Sciences and Health Professions, Cleveland, Ohio, USA
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Brewer LC, Jenkins S, Hayes SN, Kumbamu A, Jones C, Burke LE, Cooper LA, Patten CA. Community-Based, Cluster-Randomized Pilot Trial of a Cardiovascular Mobile Health Intervention: Preliminary Findings of the FAITH! Trial. Circulation 2022; 146:175-190. [PMID: 35861762 PMCID: PMC9287100 DOI: 10.1161/circulationaha.122.059046] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND African Americans continue to have suboptimal cardiovascular health (CVH) based on the American Heart Association Life's Simple 7 (LS7), 7 health-promoting behaviors and biological risk factors (eg, physical activity, blood pressure). Innovative, community-level interventions in partnership with trusted institutions such as African American churches are potential means to improve CVH in this population. METHODS Using a community-based participatory research approach, the FAITH! Trial (Fostering African American Improvement in Total Health) rigorously assessed the feasibility and preliminary efficacy of a refined, community-informed, mobile health intervention (FAITH! App) for promoting CVH among African Americans in faith communities using a cluster randomized controlled trial. Participants from 16 churches in Rochester and Minneapolis-St Paul, MN, were randomized to receive the FAITH! App (immediate intervention) or were assigned to a delayed intervention comparator group. The 10-week intervention core features included culturally relevant and LS7-focused education modules, diet/physical activity self-monitoring, and a group sharing board. Data were collected via electronic surveys and health assessments. Primary outcomes were average change in mean LS7 score (continuous measure of CVH ranging from poor to ideal [0-14 points]) from baseline to 6 months post-intervention (using generalized estimating equations) and app engagement/usability (by the Health Information Technology Usability Evaluation Scale; range, 0-5). RESULTS Of 85 enrolled participants (randomized to immediate [N=41] and delayed [control] intervention [N=44] groups), 76 and 68 completed surveys/health assessments at baseline and 6 months post-intervention, respectively (80% retention rate with assessments at both baseline and 6-month time points); immediate intervention [N=30] and control [N=38] groups). At baseline, the majority of participants (mean age [SD], 54.2 [12.3] years, 71% female) had <4-year college education level (39/66, 59%) and poor CVH (44% in poor category; mean LS7 score [SD], 6.8 [1.9]). The mean LS7 score of the intervention group increased by 1.9 (SD 1.9) points compared with 0.7 (SD 1.7) point in the control group (both P<0.0001) at 6 months. The estimated difference of this increase between the groups was 1.1 (95% CI, 0.6-1.7; P<0.0001). App engagement/usability was overall high (100% connection to app; >75% completed weekly diet/physical activity tracking; Health Information Technology Usability Evaluation Scale, mean [SD], 4.2 [0.7]). CONCLUSIONS On the basis of preliminary findings, the refined FAITH! App appears to be an efficacious mobile health tool to promote ideal CVH among African Americans. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03777709.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular Medicine (L.C.B., S.N.H.), Mayo Clinic College of Medicine, Rochester, MN
- Center for Health Equity and Community Engagement Research (L.C.B.), Mayo Clinic, Rochester, MN
| | - Sarah Jenkins
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences (S.J.), Mayo Clinic, Rochester, MN
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (L.C.B., S.N.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (A.K.), Mayo Clinic, Rochester, MN
| | | | - Lora E. Burke
- School of Nursing, Department of Health and Community Systems, University of Pittsburgh, PA (L.E.B.)
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.A.C.)
| | - Christi A. Patten
- Department of Psychiatry and Psychology (C.A.P.), Mayo Clinic College of Medicine, Rochester, MN
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Brown SA, Hudson C, Hamid A, Berman G, Echefu G, Lee K, Lamberg M, Olson J. The pursuit of health equity in digital transformation, health informatics, and the cardiovascular learning healthcare system. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 17:100160. [PMID: 38559893 PMCID: PMC10978355 DOI: 10.1016/j.ahjo.2022.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 04/04/2024]
Abstract
African Americans have a higher rate of cardiovascular morbidity and mortality and a lower rate of specialty consultation and treatment than Caucasians. These disparities also exist in the care and treatment of chemotherapy-related cardiovascular complications. African Americans suffer from cardiotoxicity at a higher rate than Caucasians and are underrepresented in clinical trials aimed at preventing cardiovascular injury associated with cancer therapies. To eliminate racial and ethnic disparities in the prevention of cardiotoxicity, an interdisciplinary and innovative approach will be required. Diverse forms of digital transformation leveraging health informatics have the potential to contribute to health equity if they are implemented carefully and thoughtfully in collaboration with minority communities. A learning healthcare system can serve as a model for developing, deploying, and disseminating interventions to minimize health inequities and maximize beneficial impact.
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Affiliation(s)
- Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Gift Echefu
- Baton Rouge General Medical Center, Department of Internal Medicine, Baton Rouge, LA, USA
| | - Kyla Lee
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Morgan Lamberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jessica Olson
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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Community-based, cluster-randomized pilot trial of a cardiovascular mHealth intervention: Rationale, design, and baseline findings of the FAITH! Trial. Am Heart J 2022; 247:1-14. [PMID: 35065922 PMCID: PMC9037298 DOI: 10.1016/j.ahj.2022.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Compared to whites, African-Americans have lower prevalence of ideal cardiovascular health (CVH) based on the American Heart Association Life's Simple 7 (LS7). These CVH inequities have worsened during the COVID-19 pandemic. Ideal LS7 health-promoting behaviors and biological risk factors (eg, diet, blood pressure) are associated with improved CVH outcomes. The FAITH! (Fostering African-American Improvement in Total Health) App, a community-informed, mobile health (mHealth) intervention, previously demonstrated significant improvements in LS7 components among African-Americans, suggesting that mHealth interventions may be effective in improving CVH. This paper presents the FAITH! Trial design, baseline findings, and pandemic-related lessons learned. METHODS Utilizing a community-based participatory research approach, this study assessed the feasibility/preliminary efficacy of a refined FAITH! App for promoting LS7 among African-Americans in faith communities using a cluster, randomized controlled trial. Participants received the FAITH! App (immediate intervention) or were assigned to a delayed intervention comparator group. Baseline data were collected via electronic surveys and health assessments. Primary outcomes are change in LS7 score from baseline to 6-months post-intervention and app engagement/usability. RESULTS Of 85 enrolled individuals, 76 completed baseline surveys/health assessments, for a participation rate of 89% (N = 34 randomized to the immediate intervention, N = 42 to delayed intervention). At baseline, participants were predominantly female (54/76, 71%), employed (56/76, 78%) and of high cardiometabolic risk (72/76, 95% with hypertension and/or overweight/obesity) with mean LS7 scores in the poor range (6.8, SD = 1.9). CONCLUSIONS The FAITH! Trial recruitment was feasible, and its results may inform the use of mHealth tools to increase ideal CVH among African-Americans.
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Brewer LC, Cyriac J, Kumbamu A, Burke LE, Jenkins S, Hayes SN, Jones C, Cooper LA, Patten CA. Sign of the times: Community engagement to refine a cardiovascular mHealth intervention through a virtual focus group series during the COVID-19 Pandemic. Digit Health 2022; 8:20552076221110537. [PMID: 35874864 PMCID: PMC9297470 DOI: 10.1177/20552076221110537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background African-Americans are underrepresented in mobile health intervention research studies which can perpetuate health inequities and the digital divide. A community-based, user-centered approach to designing mobile health interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the coronavirus disease 2019 pandemic. We aimed to refine an existing mobile health intervention via a virtual focus group series. Methods African-American community members (n = 15) from churches in Minneapolis-St. Paul and Rochester, Minnesota were enrolled in a virtual (via videoconferencing), three-session focus group series over five months to refine a cardiovascular health-focused mobile health application (FAITH! [Fostering African-American Improvement in Total Health!] App). Participants accessed the app via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia cardiovascular health-focused education modules, a sharing board for social networking, and diet/physical activity self-monitoring. Participant feedback on app features prompted iterative revisions to the FAITH! App. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale range: 0–5) and user satisfaction. Results Participants (mean age [SD]: 56.9 [12.3] years, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). The revised FAITH! App exceeded the goal Health Information Technology Usability Evaluation Scale score threshold of ≥4 (mean: 4.39, range: 3.20–4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and refinement of the moderated sharing board were identified as areas for future improvement. Conclusions Community-partnered, virtual focus groups can optimize usability and increase participant satisfaction of mobile health lifestyle interventions that aim to promote cardiovascular health in African-Americans.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
| | - Jissy Cyriac
- Department of Internal Medicine, Mayo Clinic Graduate School of Medical Education, Rochester, MN, USA
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lora E. Burke
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Jenkins
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christi A. Patten
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Community-Based Participatory Research to Improve Cardiovascular Health Among US Racial and Ethnic Minority Groups. CURR EPIDEMIOL REP 2022; 9:212-221. [PMID: 36003088 PMCID: PMC9392701 DOI: 10.1007/s40471-022-00298-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/11/2022]
Abstract
Purpose of Review This review aims to assess the contemporary community-based participatory research (CBPR) literature seeking to improve the cardiovascular health of racial and ethnic minority groups in the USA with a higher burden of cardiovascular risk factors and social determinants of health. It summarizes recent CBPR studies based on the American Heart Association Life's Simple 7 (LS7) framework, delineating seven modifiable health behaviors and clinical factors to promote cardiovascular health. Recent Findings Although limited in quantity, studies demonstrated preliminary effectiveness in improving individual and a composite of LS7 indicators by employing strategies centered around fortifying social networks, integrating group activities, leveraging technology, incorporating faith-based and spiritual practices, and implementing changes to the built environment. Summary Future directions for investigators engaged in CBPR include building on the existing body of evidence through more comprehensive studies, scaling effective interventions, and translating CBPR findings to influence health policy to better address health disparities.
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Yang J, Kim E, Park B. Key elements and effects of cardiovascular disease management programs based on community-based participatory research: protocol for a scoping review. Syst Rev 2021; 10:256. [PMID: 34560897 PMCID: PMC8464120 DOI: 10.1186/s13643-021-01804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are health problems that demonstrate high death and prevalence rates, and exhibit large health inequalities across different socio-economic status. Although interest in community-based participatory research (CBPR) is increasing because of the efforts to improve health equity, not enough literature review has been conducted on CBPR-based CVD management programs. The objective of this scoping review is to identify the key elements that should be considered when developing CBPR-based CVD management programs, and explore the effects of CBPR-based CVD management programs. METHODS This study will use the databases of PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) including grey literature. The criteria for selecting literature will be research that was published in or after 2000, applied CBPR, and either developed or implemented CVD management programs. No limit will be placed on the research design or method. Data extraction will be conducted independently by two researchers, and in the case of data mismatch, a consensus will be reached through discussion. The extracted data will be combined through narrative synthesis. DISCUSSION This scoping review will identify specific methods in the development and implementation process of CBPR-based CVD management programs, as well as the characteristics of the programs that were shown to be effective. Therefore, it will be able to provide specific guidelines to researchers, government agencies, and local organizations to design and implement participatory health promotion programs related to CVDs. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://doi.org/10.17605/OSF.IO/ZW2UY.
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Affiliation(s)
- Juhyeon Yang
- Department of Nursing, Changwon National University, Gyeongnam, 51140 Republic of Korea
| | - Eunsim Kim
- Department of Nursing, Changwon National University, Gyeongnam, 51140 Republic of Korea
| | - Bohyun Park
- Department of Nursing, Changwon National University, Gyeongnam, 51140 Republic of Korea
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Brewer LC, Woods C, Patel A, Weis J, Jones C, Abbenyi A, Brockman TA, Sia IG, Berbari E, Crane S, Doubeni CA. Establishing a SARS-CoV-2 (COVID-19) Drive-Through Collection Site: A Community-Based Participatory Research Partnership With a Federally Qualified Health Center. Am J Public Health 2021; 111:658-662. [PMID: 33600248 DOI: 10.2105/ajph.2020.306097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has disproportionately affected underserved and minority populations in the United States. This is partially attributable to limited access to diagnostic testing from deeply rooted structural inequities precipitating higher infection and mortality rates. We describe the process of establishing a drive-through collection site by leveraging an academic-community partnership between a medical institution and a federally qualified health center in Minnesota. Over 10 weeks, 2006 COVID-19 tests were provided to a socioeconomically disadvantaged population of racial/ethnic minorities and low-income essential workers.
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Affiliation(s)
- LaPrincess C Brewer
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Cynthia Woods
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Aarti Patel
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer Weis
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Clarence Jones
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Adeline Abbenyi
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Tabetha A Brockman
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Irene G Sia
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Elie Berbari
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Sarah Crane
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Chyke A Doubeni
- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
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- LaPrincess C. Brewer is with the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Cynthia Woods and Aarti Patel are with Open Cities Health Center, St Paul, MN. Jennifer Weis, Adeline Abbenyi, and Tabetha A. Brockman are with the Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN. Clarence Jones is with Hue-Man Partnership, Minneapolis, MN. Irene G. Sia and Elie Berbari are with the Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Sarah Crane is with the Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Chyke A. Doubeni is with the Department of Family Medicine, Mayo Clinic, Rochester, MN
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20
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Brewer LC, Asiedu GB, Jones C, Richard M, Erickson J, Weis J, Abbenyi A, Brockman TA, Sia IG, Wieland ML, White RO, Doubeni CA. Emergency Preparedness and Risk Communication Among African American Churches: Leveraging a Community-Based Participatory Research Partnership COVID-19 Initiative. Prev Chronic Dis 2020; 17:E158. [PMID: 33301390 PMCID: PMC7769077 DOI: 10.5888/pcd17.200408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) crisis has disproportionately affected the African American population. To mitigate the disparities, we deployed an emergency preparedness strategy within an existing community-based participatory research (CBPR) partnership among African American churches to disseminate accurate COVID-19 information. We used the Centers for Disease Control and Prevention Crisis and Emergency Risk Communication framework to conduct a needs assessment, distribute emergency preparedness manuals, and deliver COVID-19–related messaging among African American churches via electronic communication platforms. A needs assessment showed that the top 3 church emergency resource needs were financial support, food and utilities, and COVID-19 health information. During an 8-week period (April 3–May 31, 2020), we equipped 120 churches with emergency preparedness manuals and delivered 230 messages via social media (Facebook) and email. For reach, we estimated that 6,539 unique persons viewed content on the Facebook page, and for engagement, we found 1,260 interactions (eg, likes, loves, comments, shares, video views, post clicks). Emails from community communication leaders reached an estimated 12,000 church members. CBPR partnerships can be effectively leveraged to promote emergency preparedness and communicate risk among under-resourced communities during a pandemic.
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Affiliation(s)
- LaPrincess C Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Gladys B Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Jennifer Weis
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota
| | - Adeline Abbenyi
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota
| | - Tabetha A Brockman
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota
| | - Irene G Sia
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota.,Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mark L Wieland
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Richard O White
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota.,Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
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21
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Prasad P, Branch M, Asemota D, Elsayed R, Addison D, Brown SA. Cardio-Oncology Preventive Care: Racial and Ethnic Disparities. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00650-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Stampfer O, Mittelstaedt G, Vásquez VB, Karr CJ. Guidance for Genuine Collaboration: Insights from Academic, Tribal, and Community Partner Interviews on a New Research Partnership. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245132. [PMID: 31888160 PMCID: PMC6950304 DOI: 10.3390/ijerph16245132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022]
Abstract
As community engaged research (CEnR) increases in popularity and recognition, specific guidance on partnership approaches that are more likely to lead to community benefits is needed. Here, we describe a qualitative interview study aimed at better understanding community and academic perspectives on elements of genuine collaboration within a project’s new community–academic partnership. This partnership involved a large, public, urban university, a tribal nation government program, a small, rural, community-based university, and a local high school working together to develop CEnR on air quality. Interview questions were formulated from a literature review examining the relationships between trust, cultural relevance, and community involvement in research with partnership processes, roles, and strengths. Twelve semi-structured interviews were conducted with individuals from the community–academic partnership: six University of Washington research team members and six community partners. Guidance for an authentic collaborative partnership supported by interview analyses includes incorporating elements of partnership and project sustainability from the earliest phases and throughout; promoting funding mechanism responsiveness to relationship building and community partner involvement in budget decision-making; acknowledging community strengths, knowledge, and expertise and applying them; establishing roles that reflect community partner capacity building goals; and recognizing community diversity and dynamics to promote representation.
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Affiliation(s)
- Orly Stampfer
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98105, USA
| | - Gillian Mittelstaedt
- Tribal Healthy Homes Network, Issaquah, WA 98029, USA
- Doctor of Public Health Leadership Student, University of Illinois at Chicago, Chicago, IL 60607, USA
| | | | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98105, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
- Northwest Pediatric Environmental Health Specialty Unit, University of Washington, Seattle, WA 98105, USA
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