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Orfin RH, Ramos Santiago JW, Decena Soriano R, Romero Acosta E, Bermudez D, Rodriguez YL, Li D, Rahman I, McIntosh S, Ossip DJ, Cupertino AP, Cartujano-Barrera F. Kick Vaping: Feasibility, acceptability, and preliminary impact of a vaping cessation text messaging intervention for Latino young adults. J Ethn Subst Abuse 2024:1-13. [PMID: 39196764 DOI: 10.1080/15332640.2024.2397422] [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: 08/30/2024]
Abstract
OBJECTIVE To assess the feasibility, acceptability, and preliminary impact of Kick Vaping among Latino young adults. METHODS Forty Latino young adults (ages 18 to 25) who were currently vaping received Kick Vaping, a vaping cessation text messaging intervention available in English and Spanish. Feasibility was measured by the eligibility, enrollment, and follow-up rates. Acceptability was measured by overall satisfaction with the intervention. Preliminary impact was measured by self-reported 7-day point prevalence abstinence and changes in self-efficacy. RESULTS Two hundred three individuals were identified, 61 were assessed for eligibility, and 55 were eligible. Forty individuals consented to participate and were enrolled in Kick Vaping. At baseline, most participants used disposable devices (70%), vaped daily (97.5%), had low (37.5%) or medium (35.0%) e-cigarette dependence, and had attempted to quit in the past year (72.5%). At Month 3, the follow-up rate was 90% (36/40). Treating those lost to follow-up as participants who continued vaping, 75% (30/40) of participants self-reported 7-day point prevalence abstinence. Self-efficacy mean scores significantly increased from 30.65 (SD 8.07) at baseline to 50.11 (SD 10.57) at follow-up (p < 0.01). Most participants (88.9%, 32/36) reported being satisfied/extremely satisfied with Kick Vaping. CONCLUSION It is feasible to recruit and retain Latino young adults in a vaping cessation text messaging intervention. Kick Vaping generated high satisfaction among Latino young adults, significantly increased self-efficacy, and resulted in a notable vaping cessation rate at Month 3. Additional testing in a randomized controlled trial is warranted to assess the efficacy of the intervention.
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Affiliation(s)
- Rafael H Orfin
- University of Rochester Medical Center, Rochester, New York
| | | | | | | | | | | | - Dongmei Li
- University of Rochester Medical Center, Rochester, New York
| | - Irfan Rahman
- University of Rochester Medical Center, Rochester, New York
| | - Scott McIntosh
- University of Rochester Medical Center, Rochester, New York
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Cartujano-Barrera F, Cox LS, Catley D, Cai X, Diaz FJ, Arana-Chicas E, Chávez-Iñiguez A, Ogedegbe C, Graves KD, Rivera MP, Ponce A, Ellerbeck EF, Cupertino AP. Decídetexto: Mobile Cessation Support for Latino Adults Who Smoke: A Randomized Clinical Trial. Chest 2024:S0012-3692(24)04904-3. [PMID: 39134144 DOI: 10.1016/j.chest.2024.07.160] [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: 02/04/2024] [Revised: 07/01/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Latino adults experience multiple barriers to health care access and treatment that result in tobacco-related disparities. Mobile interventions have the potential to deliver smoking cessation treatment among Latino adults, the highest users of mobile technologies. RESEARCH QUESTION Is Decídetexto, a culturally accommodated mobile health intervention, more effective for smoking cessation compared with standard care among Latinx adults who smoke? STUDY DESIGN AND METHODS A two-arm parallel group randomized clinical trial (RCT) was conducted in Kansas, New Jersey, and New York between October 2018 and September 2021. Eligible Latino adults who smoke (n = 457) were randomly assigned to Decídetexto or a standard care group. The primary outcome was biochemically verified 7-day smoking abstinence at week 24. Secondary outcomes included self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake and adherence of nicotine replacement therapy (NRT). RESULTS Participants' mean age was 48.7 (SD, 11.1) years, 45.2% were female, and 50.3% smoked ≥10 cigarettes per day. Two hundred twenty-nine participants were assigned to Decídetexto and 228 to standard care. Treating those lost to follow-up as participants who continued smoking, 14.4% of participants in the Decídetexto group were biochemically verified abstinent at week 24 compared with 9.2% in the standard care group (OR, 1.66; 95% CI, 0.93-2.97; P = .09). Treating those lost to follow-up as participants who continued smoking, 34.1% of the participants in the Decídetexto group self-reported smoking abstinence at week 24 compared with 20.6% of participants in the standard care group (OR, 1.99; 95% CI, 1.31-3.03; P < .001). Analyzing only participants who completed the assessment at week 24, 90.6% (174/192) of participants in the Decídetexto group self-reported using NRT for at least 1 day compared with 70.2% (139/198) of participants in standard care (OR, 4.10; 95% CI, 2.31-7.28; P < .01). INTERPRETATION Among Latino adults who smoke, the Decídetexto intervention was not associated with a statistically significant increase in biochemically verified abstinence at week 24. However, the Decídetexto intervention was associated with a statistically significant increase in self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake of NRT. This RCT provides encouragement for the use of Decídetexto for smoking cessation among Latino adults. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03586596.
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Affiliation(s)
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Francisco J Diaz
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO
| | - Evelyn Arana-Chicas
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Arlette Chávez-Iñiguez
- Emergency and Trauma Center, Hackensack University Medical Center (C. O.), Hackensack, NJ
| | - Chinwe Ogedegbe
- Department of Oncology, Georgetown University, Washington, DC
| | - Kristi D Graves
- Department of Oncology, Georgetown University, Washington, DC
| | - M Patricia Rivera
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | | | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY; Department of Surgery, University of Rochester Medical Center, Rochester, NY
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Lara D, Alaniz-Cantú EI, Siddalingaiaha S, Oliveira I, Chávez-Iñiguez A, DeJesus E, Fuller D, Marquez DX, Vásquez E, Li D, McIntosh S, Ossip DJ, Cupertino AP, Cartujano-Barrera F. Actívatexto: Feasibility and Acceptability of a Mobile Intervention That Promotes Smoking Cessation and Physical Activity among Latinos. CANCER RESEARCH COMMUNICATIONS 2024; 4:1016-1023. [PMID: 38592449 PMCID: PMC11000686 DOI: 10.1158/2767-9764.crc-23-0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/16/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
The purpose of this study was to assess the feasibility and acceptability of a mobile intervention that promotes smoking cessation and physical activity among Latinos living in the United States. Twenty Latino adults who smoked and did not meet recommended levels of physical activity were recruited using community-based recruitment strategies. Participants received Actívatexto, a theory-based, culturally accommodated, 12-week text messaging intervention (available in English and Spanish) that promotes smoking cessation and physical activity. Actívatexto integrates four components: (i) a text messaging program, (ii) a wearable device, (iii) an online dashboard where the research team manages participants' incoming and outgoing data from both the text messaging program and wearable device, and (iv) nicotine replacement therapies (NRT). We assessed self-reported 7-day point prevalence smoking abstinence at month 3, weekly minutes of moderate to vigorous physical activity (MVPA), pharmacotherapy adherence, and satisfaction. At baseline, participants' mean age was 47.3 years old (SD 16.0), 55% of participants were female, and 60% indicated that Spanish was their language of preference. Seventy-five percent of participants smoked 1-10 cigarettes daily and 35% smoked their first cigarette within 5 minutes after waking up. At month 3, 14 participants (70%) self-reported 7-day point prevalence smoking abstinence (90% follow-up rate). Fitbit-assessed mean minutes of MVPA per week increased from 113 (SD 127; range: 0-399) at week 1 to 177 (SD 163; range: 0-513) at month 3 (P = 0.15). Sixteen participants (88.9%, 16/18) reported NRT use in the past 90 days. Most participants reported being extremely satisfied or satisfied with the intervention (88.9%, 16/18). SIGNIFICANCE Actívatexto resulted in a noteworthy cessation rate at month 3 (70%), increased mean weekly minutes of MVPA, produced high use of NRT, and was well received by participants. Additional testing in a randomized clinical trial is warranted to assess the efficacy of the intervention.
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Affiliation(s)
- Daimarelys Lara
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Edgar I. Alaniz-Cantú
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Simran Siddalingaiaha
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Igor Oliveira
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Arlette Chávez-Iñiguez
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Elisa DeJesus
- Language Services, Ibero American Action League, Rochester, New York
| | - Daniel Fuller
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - David X. Marquez
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, SUNY University at Albany, Albany, New York
| | - Dongmei Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Deborah J. Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
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Hernández-Torres R, Alaniz-Cantu E, Bautista Rojas MV, Lara D, Merritt S, DeJesus E, D’Abundo ML, McIntosh S, Ossip DJ, Fuller D, Rivera MP, Cupertino AP, Cartujano-Barrera F. Understanding the Perspectives of Latino Adults Who Smoke on Physical Activity: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3128. [PMID: 36833833 PMCID: PMC9964119 DOI: 10.3390/ijerph20043128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/09/2023]
Abstract
Smoking and sedentary lifestyle frequently co-occur among Latinos. Evidence suggests that moderate to vigorous physical activity (MVPA) may enhance smoking cessation rates. However, this synergistic phenomenon has not been studied among Latinos, the largest minority group in the United States. This qualitative study consisted of semi-structured interviews in English or Spanish with Latino adults who smoke (n = 20) to understand their perspectives on physical activity. Participants were recruited using community-based recruitment strategies. The Health Belief Model was used as a framework for qualitative theoretical analysis. Multiple perceived benefits (e.g., mood management, strategy to quit smoking), susceptibility (e.g., risk of cardiovascular diseases, physical impairment), and barriers (e.g., lack of social support, low financial resources) of being physically active were identified. Moreover, multiple cues to action to do physical activity (e.g., being a role model, spending time with family and friends) were identified. These factors provide concrete operational strategies to address smoking cessation and physical activity among Latinos. Further research is needed on how best to integrate these perspectives into smoking cessation interventions.
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Affiliation(s)
| | - Edgar Alaniz-Cantu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | | | - Daimarelys Lara
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Sarah Merritt
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Elisa DeJesus
- Health Literacy & Language Services, Ibero-American Action League, Inc., Rochester, NY 14605, USA
| | - Michelle Lee D’Abundo
- Department of Interprofessional Health Sciences and Health Administration, Seton Hall University, Nutley, NJ 07110, USA
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Deborah J. Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Daniel Fuller
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
| | - M. Patricia Rivera
- Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
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Cartujano-Barrera F, Hernández-Torres R, Orfin RH, Chávez-Iñiguez A, Alvarez Lopez O, Azogini C, Bermudez D, Arana-Chicas E, Cai X, McIntosh S, Ossip DJ, Cupertino AP. Proactive and Reactive Recruitment of Black and Latino Adolescents in a Vaping Prevention Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:937. [PMID: 35883921 PMCID: PMC9321256 DOI: 10.3390/children9070937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to assesses the effectiveness of proactive and reactive methods in the recruitment of Black and Latino adolescents into a vaping-prevention randomized controlled trial (RCT). This study also assessed the characteristics of study participants by recruitment method. Proactive recruitment strategies included study presentations at community-based events (e.g., festivals, health fairs), school-based events (e.g., back-to-school events, after-school programs), and recreational centers (e.g., fitness centers, malls). Reactive recruitment strategies included study advertisements via social media (e.g., Facebook posts shared by local community-based organizations), word of mouth, and an academic-based research hub. Using proactive and reactive methods, in a 4-month period, 362 Black and Latino adolescents were successfully enrolled into the RCT. Compared to the proactive method, adolescents screened reactively were equally likely to be eligible but significantly more likely to enroll in the study. However, both proactive and reactive strategies made notable contributions to the overall recruitment effort. Moreover, proactive and reactive methods attracted adolescents with different characteristics (e.g., age, gender, sexual orientation, etc.). These findings suggest that both proactive and reactive recruitment strategies should be implemented for studies interested in recruiting a diverse sample of Black and Latino adolescents.
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Affiliation(s)
- Francisco Cartujano-Barrera
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Ruthmarie Hernández-Torres
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Rafael H. Orfin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Arlette Chávez-Iñiguez
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Olga Alvarez Lopez
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Chiamaka Azogini
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Diana Bermudez
- Hackensack High School, Hackensack Public Schools, Hackensack, NJ 07601, USA;
| | - Evelyn Arana-Chicas
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Deborah J. Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; (R.H.-T.); (R.H.O.); (A.C.-I.); (O.A.L.); (C.A.); (E.A.-C.); (S.M.); (D.J.O.); (A.P.C.)
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Arana-Chicas E, Cartujano-Barrera F, Rieth KK, Richter KK, Ellerbeck EF, Cox LS, Graves KD, Diaz FJ, Catley D, Cupertino AP. Effectiveness of Recruitment Strategies of Latino Smokers: Secondary Analysis of an mHealth Smoking Cessation Randomized Clinical Trial (Preprint). J Med Internet Res 2021; 24:e34863. [PMID: 35759320 PMCID: PMC9274407 DOI: 10.2196/34863] [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: 11/12/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background Latinos remain disproportionately underrepresented in clinical trials, comprising only 2%-3% of research participants. In order to address health disparities, it is critically important to increase enrollment of Latino smokers in smoking cessation trials. There is limited research examining effective recruitment strategies for this population. Objective The purpose of this study was to compare the effectiveness of direct versus mass and high- versus low-effort recruitment strategies on recruitment and retention of Latino smokers to a randomized smoking cessation trial. We also examine how the type of recruitment might have influenced the characteristics of enrolled participants. Methods Latino smokers were enrolled into Decídetexto from 4 states—New Jersey, Kansas, Missouri, and New York. Participants were recruited from August 2018 until March 2021. Mass recruitment strategies included English and Spanish advertisements to the Latino community via flyers, Facebook ads, newspapers, television, radio, church bulletins, and our Decídetexto website. Direct, high-effort strategies included referrals from clinics or community-based organizations with whom we partnered, in-person community outreach, and patient registry calls. Direct, low-effort strategies included texting or emailing pre-existing lists of patients who smoked. A team of trained bilingual (English and Spanish) recruiters from 9 different Spanish-speaking countries of origin conducted recruitment, assessed eligibility, and enrolled participants into the trial. Results Of 1112 individuals who were screened, 895 (80.5%) met eligibility criteria, and 457 (457/895, 51.1%) enrolled in the trial. Within the pool of screened individuals, those recruited by low-effort recruitment strategies (both mass and direct) were significantly more likely to be eligible (odds ratio [OR] 1.67, 95% CI 1.01-2.76 and OR 1.70, 95% CI 0.98-2.96, respectively) and enrolled in the trial (OR 2.60, 95% CI 1.81-3.73 and OR 3.02, 95% CI 2.03-4.51, respectively) compared with those enrolled by direct, high-effort strategies. Among participants enrolled, the retention rates at 3 months and 6 months among participants recruited via low-effort strategies (both mass and direct) were similar to participants recruited via direct, high-effort methods. Compared with enrolled participants recruited via direct (high- and low-effort) strategies, participants recruited via mass strategies were less likely to have health insurance (44.0% vs 71.2% and 71.7%, respectively; P<.001), lived fewer years in the United States (22.4 years vs 32.4 years and 30.3 years, respectively; P<.001), more likely to be 1st generation (92.7% vs 76.5% and 77.5%, respectively; P=.007), more likely to primarily speak Spanish (89.3% vs 65.8% and 66.3%, respectively), and more likely to be at high risk for alcohol abuse (5.8 mean score vs 3.8 mean score and 3.9 mean score, respectively; P<.001). Conclusions Although most participants were recruited via direct, high-effort strategies, direct low-effort recruitment strategies yielded a screening pool more likely to be eligible for the trial. Mass recruitment strategies were associated with fewer acculturated enrollees with lower access to health services—groups who might benefit a great deal from the intervention. Trial Registration ClinicalTrials.gov identifier: NCT03586596; https://clinicaltrials.gov/ct2/show/NCT03586596 International Registered Report Identifier (IRRID) RR2-DOI: 10.1016/j.cct.2020.106188
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Affiliation(s)
- Evelyn Arana-Chicas
- Department of Surgery, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Francisco Cartujano-Barrera
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Katherine K Rieth
- Department of Otolaryngology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Kimber K Richter
- Department of Population Health, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Edward F Ellerbeck
- Department of Population Health, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Lisa Sanderson Cox
- Department of Population Health, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Kristi D Graves
- Department of Oncology, Georgetown University Medical Center, Washington DC, DC, United States
| | - Francisco J Diaz
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Delwyn Catley
- Center for Children's Healthy Lifestyle and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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