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Farabi SS, Schwarz C, Persaud A, Gilbert A, Haire-Joshu D, Tabak RG. Sleep, Stress, and Cardiometabolic Health in Women of Childbearing Age with Overweight and Obesity. Womens Health Rep (New Rochelle) 2024; 5:143-151. [PMID: 38414886 PMCID: PMC10898232 DOI: 10.1089/whr.2023.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 02/29/2024]
Abstract
Background Sleep is important for health, but its relationship to cardiometabolic health in women of childbearing age remains unclear. Furthermore, stress, unmet basic needs, and lack of physical activity may be related to disrupted sleep and poor cardiometabolic health in women of childbearing age and these relationships may differ by ethnicity. The purposes of this study were to investigate the relationship between sleep, markers of cardiometabolic health, stress, unmet basic needs, and physical activity in women of childbearing age with overweight or obesity and identify if these relationships differed between women that identified as Latino/Hispanic and non-Latino/Hispanic ethnicity. Methods A secondary cross-sectional analysis was conducted using baseline data from a trial that embeds healthy eating and activity into a national home visiting program, Parents as Teachers. The sample was stratified based on self-reported ethnicity (Hispanic/Latino or non-Hispanic/Latino). Pearson's and Spearman's correlations were used to determine bivariate relationships among sleep, cardiometabolic variables, stress, unmet basic needs, and physical activity. Results Two hundred seventy-six women, 46% of whom identified as Hispanic/Latino, were included in the analysis. Body mass index (BMI) was significantly correlated with sleep disturbance (ρ = 0.23, p = 0.01) in women who identify as Hispanic/Latino. Stress was positively related to sleep disturbance, sleep duration, and unmet needs for both groups of women. BMI was correlated with unmet basic needs in women who identified as non-Hispanic/Latino (ρ = 0.25, p = 0.01). Conclusions Our results suggest that sleep, stress, and basic needs are important in understanding cardiometabolic health in women of childbearing age and these relationships differ depending on ethnicity. Clinical Trial Registration Number: NCT03758638.
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Affiliation(s)
- Sarah S Farabi
- Office of Nursing Research, Goldfarb School of Nursing, St. Louis, Missouri, USA
- Division of Nutritional Science & Obesity Medicine, Center of Human Nutrition, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Cindy Schwarz
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alicia Persaud
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amanda Gilbert
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Haire-Joshu
- Public Health at the Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel G Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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Mittendorfer B, Patterson BW, Haire-Joshu D, Cahill AG, Cade WT, Stein RI, Klein S. Insulin Sensitivity and β-Cell Function During Early and Late Pregnancy in Women With and Without Gestational Diabetes Mellitus. Diabetes Care 2023; 46:2147-2154. [PMID: 37262059 DOI: 10.2337/dc22-1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the metabolic alterations associated with gestational diabetes mellitus (GDM) in women with overweight or obesity. RESEARCH DESIGN AND METHODS We compared fasting and postprandial plasma glucose and free fatty acid (FFA) concentrations, insulin sensitivity (IS; Matsuda index), and β-cell function (i.e., β-cell responsiveness to glucose) by using a frequently sampled oral glucose tolerance test (OGTT) at 15 and 35 weeks' gestation in women with overweight or obesity who had GDM (n = 29) or did not have GDM (No-GDM; n = 164) at 35 weeks. RESULTS At 15 weeks, IS and β-cell function were lower, and fasting, 1-h, and total area-under-the-curve plasma glucose concentrations during the OGTT were higher (all P < 0.05) in the GDM than in the No-GDM group. At 35 weeks compared with 15 weeks, IS decreased, β-cell function increased, and postprandial suppression of plasma FFA was blunted in both the GDM and No-GDM groups, but the decrease in IS and the increase in postprandial FFA concentration were greater and the increase in β-cell function was less (all P ≤ 0.05) in the GDM than in the No-GDM group. A receiver operating characteristic curve analysis showed that both fasting plasma glucose and 1-h OGTT glucose concentration at 15 weeks are predictors of GDM, but the predictive power was <30%. CONCLUSIONS Women with overweight or obesity and GDM, compared with those without GDM, have worse IS and β-cell function early during pregnancy and a greater subsequent decline in IS and blunted increase in β-cell function. Increased fasting and 1-h OGTT plasma glucose concentration early during pregnancy are markers of increased GDM risk, albeit with weak predictive power.
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Affiliation(s)
| | | | | | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University, St. Louis, MO
- Department of Women's Health, The University of Texas at Austin, Dell Medical School, Austin, TX
| | - W Todd Cade
- Program in Physical Therapy, Washington University, St. Louis, MO
| | - Richard I Stein
- Center for Human Nutrition, Washington University, St. Louis, MO
| | - Samuel Klein
- Center for Human Nutrition, Washington University, St. Louis, MO
- Sansum Diabetes Research Institute, Santa Barbara, CA
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Asada Y, Kroll-Desrosiers A, Chriqui JF, Curran GM, Emmons KM, Haire-Joshu D, Brownson RC. Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science. Front Health Serv 2023; 3:1220629. [PMID: 37771411 PMCID: PMC10524255 DOI: 10.3389/frhs.2023.1220629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
Policy implementation science (IS) is complex, dynamic, and fraught with unique study challenges that set it apart from biomedical or clinical research. One important consideration is the ways in which policy interacts with local contexts, such as power and social disadvantage (e.g., based on ability, race, class, sexual identity, geography). The complex nature of policy IS and the need for more intentional integration of equity principles into study approaches calls for creative adaptations to existing implementation science knowledge and guidance. Effectiveness-implementation hybrid studies were developed to enhance translation of clinical research by addressing research questions around the effectiveness of an intervention and its implementation in the same study. The original work on hybrid designs mainly focused on clinical experimental trials; however, over the last decade, researchers have applied it to a wide range of initiatives and contexts, including more widespread application in community-based studies. This perspectives article demonstrates how effectiveness-implementation hybrid studies can be adapted for and applied to equity-centered policy IS research. We draw upon principles of targeted universalism and Equity in Implementation Research frameworks to guide adaptations to hybrid study typologies, and suggest research and engagement activities to enhance equity considerations; for example, in the design and testing of implementing strategies. We also provide examples of equity-centered policy IS studies. As the field of policy IS rapidly evolves, these adapted hybrid type studies are offered to researchers as a starting guide.
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Affiliation(s)
- Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago (UIC), Chicago, IL, United States
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Health Care System, Leeds, MA, United States
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, UMass Amherst, Amherst, MA, United States
| | - Jamie F. Chriqui
- Health Policy Research, Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
- Department of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Debra Haire-Joshu
- Department is Public Health, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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4
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Easterling DV, Jacob RR, Brownson RC, Haire-Joshu D, Gundersen DA, Angier H, DeVoe JE, Likumahuwa-Ackman S, Vu T, Glasgow RE, Schnoll R. Participatory logic modeling in a multi-site initiative to advance implementation science. Implement Sci Commun 2023; 4:106. [PMID: 37644495 PMCID: PMC10466752 DOI: 10.1186/s43058-023-00468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Logic models map the short-term and long-term outcomes that are expected to occur with a program, and thus are an essential tool for evaluation. Funding agencies, especially in the United States (US), have encouraged the use of logic models among their grantees. They also use logic models to clarify expectations for their own funding initiatives. It is increasingly recognized that logic models should be developed through a participatory approach which allows input from those who carry out the program being evaluated. While there are many positive examples of participatory logic modeling, funders have generally not engaged grantees in developing the logic model associated with their own initiatives. This article describes an instance where a US funder of a multi-site initiative fully engaged the funded organizations in developing the initiative logic model. The focus of the case study is Implementation Science Centers in Cancer Control (ISC3), a multi-year initiative funded by the National Cancer Institute. METHODS The reflective case study was collectively constructed by representatives of the seven centers funded under ISC3. Members of the Cross-Center Evaluation (CCE) Work Group jointly articulated the process through which the logic model was developed and refined. Individual Work Group members contributed descriptions of how their respective centers reviewed and used the logic model. Cross-cutting themes and lessons emerged through CCE Work Group meetings and the writing process. RESULTS The initial logic model for ISC3 changed in significant ways as a result of the input of the funded groups. Authentic participation in the development of the logic model led to strong buy-in among the centers, as evidenced by their utilization. The centers shifted both their evaluation design and their programmatic strategy to better accommodate the expectations reflected in the initiative logic model. CONCLUSIONS The ISC3 case study demonstrates how participatory logic modeling can be mutually beneficial to funders, grantees and evaluators of multi-site initiatives. Funded groups have important insights about what is feasible and what will be required to achieve the initiative's stated objectives. They can also help identify the contextual factors that either inhibit or facilitate success, which can then be incorporated into both the logic model and the evaluation design. In addition, when grantees co-develop the logic model, they have a better understanding and appreciation of the funder's expectations and thus are better positioned to meet those expectations.
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Affiliation(s)
- Douglas V Easterling
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Rebekah R Jacob
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63117, USA
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Daniel A Gundersen
- Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Heather Angier
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Sonja Likumahuwa-Ackman
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Thuy Vu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, 98195, USA
| | - Russell E Glasgow
- Department of Family Medicine, University of Colorado, 1890 N Revere Ct, 3Rd Floor, Aurora, CO, 80045, USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4Th Floor, Philadelphia, PA, 19104, USA
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5
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Easterling D, Jacob RR, Brownson RC, Haire-Joshu D, Gundersen DA, Angier H, DeVoe JE, Likumahuwa-Ackman S, Vu T, Glasgow RE, Schnoll R. Participatory Logic Modeling in a Multi-Site Initiative to Advance Implementation Science. RESEARCH SQUARE 2023:rs.3.rs-2846665. [PMID: 37292912 PMCID: PMC10246100 DOI: 10.21203/rs.3.rs-2846665/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: It is increasingly being recognized that logic models should be developed through a participatory approach which allows input from those who carry out the program being evaluated. While there are many positive examples of participatory logic modeling, funders have generally not used this approach in the context of multi-site initiatives. This article describes an instance where the funder and evaluator of a multi-site initiative fully engaged the funded organizations in developing the initiative logic model. The focus of the case study is Implementation Science Centers in Cancer Control (ISC 3 ), a multi-year initiative funded by the National Cancer Institute (NCI). Methods: The case study was collectively constructed by representatives of the seven centers funded under ISC 3 . Members of the Cross-Center Evaluation (CCE) Work Group jointly articulated the process through which the logic model was developed and refined. Individual Work Group members contributed descriptions of how their respective centers reviewed and used the logic model. Cross-cutting themes and lessons emerged through CCE Work Group meetings and the writing process. Results: The initial logic model for ISC 3 changed in significant ways as a result of the input of the funded groups. Authentic participation in the development of the logic model led to strong buy-in among the centers, as evidenced by their utilization. The centers shifted both their evaluation design and their programmatic strategy to better accommodate the expectations reflected in the initiative logic model. Conclusions: The ISC 3 case study provides a positive example of how participatory logic modeling can be mutually beneficial to funders, grantees and evaluators of multi-site initiatives. Funded groups have important insights about what is feasible and what will be required to achieve the initiative's stated objectives. They can also help identify the contextual factors that either inhibit or facilitate success, which can then be incorporated into both the logic model and the evaluation design. In addition, when grantees co-develop the logic model, they have a better understanding and appreciation of the funder's expectations, and thus are better positioned to meet those expectations.
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Affiliation(s)
| | - Rebekah R Jacob
- Washington University In St Louis: Washington University in St Louis
| | - Ross C Brownson
- Washington University In St Louis: Washington University in St Louis
| | - Debra Haire-Joshu
- Washington University In St Louis: Washington University in St Louis
| | | | | | | | | | - Thuy Vu
- University of Washington Seattle Campus: University of Washington
| | - Russell E Glasgow
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
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Garbutt J, Wang R, Graham S, McKay V, Haire-Joshu D, Barker A, Liu L. Provider and Practice Factors Associated With On-Time HPV Vaccination in Primary Care. Acad Pediatr 2022; 23:800-807. [PMID: 36592791 DOI: 10.1016/j.acap.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND In 2018, only one third of girls and boys completed the 2-dose series of the human papillomavirus vaccine by their 13th birthday, the target for on-time vaccination. The study objective was to identify key patient, provider and practice-level factors associated with on-time vaccination in the primary care setting. METHODS We examined data from 20 primary care pediatric practices (89 providers) in St. Louis including: the percentage of eligible patients with on-time vaccination assessed from medical records; providers' knowledge, attitudes and behaviors regarding on-time vaccination assessed with a survey; and practice-level strategies used to optimize vaccine delivery assessed with a 19-item vaccine delivery system score (VDSS). Factors that increased on-time vaccination were identified using logistic regression, controlling for clustering within providers. RESULTS Completion of on-time vaccination occurred in 1347/3125 (43.10%) of patients (95% confidence interval [CI], 41.36%-44.86%) and varied among practices (7.39%-64.24%) and among providers (2.63%-82.50%). Independent predictors for higher completion of on-time vaccination included more frequent use by providers of the announcement style for vaccine recommendation (odds ratio [OR] 1.18, 95% CI, 1.04, 1.35), higher provider self-efficacy to deliver the vaccine according to guideline recommendations if parents were hesitant (OR 1.21, 95% CI, 1.05, 1.40), and higher VDSS (OR 1.20, 95% CI, 1.10, 1.31). CONCLUSIONS Provider and practice-level factors were identified that may represent modifiable targets for improvement in on-time vaccine uptake. Future research is needed to test interventions built on these findings.
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Affiliation(s)
- Jane Garbutt
- Department of Medicine and Department of Pediatrics, Washington University School of Medicine (J Garbutt), St. Louis, Mo.
| | - Ruoyun Wang
- Department of Pediatrics, Washington University School of Medicine (R Wang and S Graham), St. Louis, Mo
| | - Sharon Graham
- Department of Pediatrics, Washington University School of Medicine (R Wang and S Graham), St. Louis, Mo
| | - Virginia McKay
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Debra Haire-Joshu
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Abigail Barker
- Brown School, Washington University (V McKay, D Haire-Joshu, and A Barker), St. Louis, Mo
| | - Lei Liu
- Division of Biostatistics, Washington University School of Medicine (L Liu), St. Louis, Mo
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7
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Cade WT, Mittendorfer B, Patterson BW, Haire-Joshu D, Cahill AG, Stein RI, Schechtman KB, Tinius RA, Brown K, Klein S. Effect of excessive gestational weight gain on insulin sensitivity and insulin kinetics in women with overweight/obesity. Obesity (Silver Spring) 2022; 30:2014-2022. [PMID: 36150208 PMCID: PMC9512396 DOI: 10.1002/oby.23533] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Obesity increases the risk for pregnancy complications and maternal hyperglycemia. The Institute of Medicine developed guidelines for gestational weight gain (GWG) targets for women with overweight/obesity, but it is unclear whether exceeding these targets has adverse effects on maternal glucose metabolism. METHODS Insulin sensitivity (assessed using the Matsuda Insulin Sensitivity Index), β-cell function (assessed as insulin secretion rate in relation to plasma glucose), and plasma insulin clearance rate were evaluated using a frequently sampled oral glucose tolerance test at 15 and 35 weeks of gestation in 184 socioeconomically disadvantaged African American women with overweight/obesity. RESULTS Insulin sensitivity decreased, whereas β-cell function and insulin clearance increased from 15 to 35 weeks of gestation in the entire group. Compared with women who achieved the recommended GWG, excessive GWG was associated with a greater decrease in insulin sensitivity between 15 and 35 weeks. β-cell function and plasma insulin clearance were not affected by excessive GWG. CONCLUSIONS These data demonstrate that gaining more weight during pregnancy than recommended by the Institute of Medicine is associated with functional effects on glucose metabolism.
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Affiliation(s)
- W. Todd Cade
- Program in Physical Therapy, Washington University, St. Louis, Missouri, USA
| | | | - Bruce W. Patterson
- Center for Human Nutrition, Washington University, St. Louis, Missouri, USA
| | | | - Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, USA
- Department of Women’s Health, The University of Texas at Austin, Dell Medical School, Austin TX USA
| | - Richard I. Stein
- Center for Human Nutrition, Washington University, St. Louis, Missouri, USA
| | | | - Rachel A. Tinius
- Program in Physical Therapy, Washington University, St. Louis, Missouri, USA
| | - Katherine Brown
- Program in Physical Therapy, Washington University, St. Louis, Missouri, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University, St. Louis, Missouri, USA
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Gilbert AS, Salvo D, Tabak RG, Haire-Joshu D. Does the neighborhood built environment moderate the effectiveness of a weight-loss intervention for mothers with overweight or obesity? Findings from the Healthy Eating and Active Living Taught at Home (HEALTH) study. Int J Behav Nutr Phys Act 2022; 19:130. [PMID: 36182908 PMCID: PMC9526987 DOI: 10.1186/s12966-022-01368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women of childbearing age are vulnerable to weight gain and experience a high prevalence of obesity due to pregnancy and stressors of parenthood. Lifestyle interventions such as the Healthy Eating and Active Living Taught at Home (HEALTH) study have been effective for weight loss; however, little is known about how the built environment (parks, transit, grocery stores, fast food, walkability etc.), where participants live might modify intervention effectiveness. This study examined whether characteristics of the neighborhood built environment modified effectiveness of the HEALTH study on weight loss. METHODS: Secondary data analysis was conducted using data from HEALTH. Using GIS, buffers were built around participant addresses to capture distance to and availability of food (grocery store, convenience store, fast food) and urban design and transit (parks, street connectivity, transit) built environment characteristics. Built environment characteristics were dichotomized into low and high density and distance. Likelihood ratio tests for interaction were conducted to determine if built environment characteristics modified intervention effectiveness on Body mass index (BMI) and waist circumference (WC). Mixed effects linear regression models were then run to estimate the effect of the HEALTH intervention on weight outcomes at 24-months across both strata of built environment characteristics. RESULTS: The analytic sample (n = 151) had baseline mean BMI 34.9 (SD = 5.8) and mean WC 46.0 cm (SD4.9). All urban design and transit and all food environment characteristics modified HEALTH effectiveness on one or both weight outcomes. The built environment modified the HEALTH intervention such that it was mostly effective for mothers residing in neighborhoods with low transit access, low street connectivity, high park access, and low access to grocery stores, convenience stores, and fast food. CONCLUSIONS Result show the HEALTH was most effective for women residing neighborhoods with built environment characteristics suggestive of suburban neighborhood typology. To maximize impact for mothers residing in all types of neighborhoods, future research should explore scaling up HEALTH in suburban settings, while adapting HEALTH to maximize effectiveness in compact neighborhoods most likely, urban core neighborhoods.
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Affiliation(s)
- Amanda S Gilbert
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Deborah Salvo
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA.
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA.
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Bellmont Hall (BEL) at 2109 San Jacinto Blvd., Austin, TX, 78712, USA.
| | - Rachel G Tabak
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Debra Haire-Joshu
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
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Patil SJ, Golzy M, Johnson A, Wang Y, Parker JC, Saper RB, Haire-Joshu D, Mehr DR, Foraker RE, Kruse RL. Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Clinic-Based Care Coordination Program: A Secondary Data Analysis. J Clin Med 2022; 11:2897. [PMID: 35629024 PMCID: PMC9145991 DOI: 10.3390/jcm11102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Identifying individual and neighborhood-level factors associated with worsening cardiometabolic risks despite clinic-based care coordination may help identify candidates for supplementary team-based care. Methods: Secondary data analysis of data from a two-year nurse-led care coordination program cohort of Medicare, Medicaid, dual-eligible adults, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2), from ten Midwestern primary care clinics in the U.S. Outcome Measures: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed individual and neighborhood-level factors associated with changes in outcome measures from before to after completion of the LIGHT2 program. Results: 6378 participants had pre-and post-intervention levels reported for at least one outcome measure. In adjusted models, higher pre-intervention cardiometabolic measures were associated with worsening of all cardiometabolic measures. Women had worsening LDL-cholesterol compared with men. Women with pre-intervention HbA1c > 6.8% and systolic blood pressure > 131 mm of Hg had worse post-intervention HbA1c and systolic blood pressure compared with men. Adding individual’s neighborhood-level risks did not change effect sizes significantly. Conclusions: Increased cardiometabolic risks and gender were associated with worsening cardiometabolic outcomes. Understanding unresolved gender-specific needs and preferences of patients with increased cardiometabolic risks may aid in tailoring clinic-community-linked care planning.
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Affiliation(s)
- Sonal J Patil
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Mojgan Golzy
- Biostatistics and Research Design Unit, School of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Angela Johnson
- Center for Applied Research and Engagement Systems (CARES), University of Missouri, Columbia, MO 65211, USA
| | - Yan Wang
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Jerry C Parker
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO 65211, USA
| | - Robert B Saper
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Randi E Foraker
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
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McQueen A, Kreuter MW, Herrick CJ, Li L, Brown DS, Haire-Joshu D. Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes. Health Soc Care Community 2022; 30:1035-1044. [PMID: 33704849 PMCID: PMC8433262 DOI: 10.1111/hsc.13296] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/14/2020] [Accepted: 01/07/2021] [Indexed: 05/03/2023]
Abstract
The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.g., food insecurity) or one health outcome. The hypothesis was that among individuals with type 2 diabetes, those with a greater number of social needs would report more health-related problems and be more interested in receiving social needs navigation services. Participants completed a cross-sectional survey by phone (n = 95) or online (n = 14). Most (85%) reported having at least one social need (M = 2.5, SD = 2.2), most commonly not having enough money for unexpected expenses (68%) or necessities like food, shelter and clothing (31%), medical costs (24%), and utilities (23%). Results supported our comprehensive conceptual model. Having more social needs was associated with greater perceived stress, diabetes distress, problems with sleep and executive and cognitive functioning, less frequent diabetes self-care activities, more days of poor mental health and activity limitations, worse self-reported health and more hospitalisations. Number of social needs also was positively associated with interest in having a social needs navigator. Social needs were not associated with days of poor physical health, BMI, self-reported A1C or smoking status. Social needs were associated with a wide range of indicators of poor health and well-being. Participants with the greatest social need burden were most open to intervention.
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Affiliation(s)
- Amy McQueen
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Brown School of Social Work, Washington University in St. Louis, MO
| | | | - Cynthia J. Herrick
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, MO
| | - Linda Li
- Brown School of Social Work, Washington University in St. Louis, MO
| | - Derek S. Brown
- Brown School of Social Work, Washington University in St. Louis, MO
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Schmittdiel JA, Adams AS, Haire-Joshu D, Heisler M, Piatt GA, Ackermann R, Chin MH, Gonzalez JS, Manson SM, Narayan KV, Schillinger D, Brega AG. Comment on Dunne et al. The Women's Leadership Gap in Diabetes: A Call for Equity and Excellence. Diabetes Care 2021;44:1734-1743. Diabetes Care 2022; 45:e97-e98. [PMID: 35561138 PMCID: PMC9174952 DOI: 10.2337/dc21-2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Julie A. Schmittdiel
- Diabetes Research for Equity through Advanced Multilevel Science (DREAMS) Center for Diabetes Translation Research, Palo Alto, Oakland, San Francisco, Merced, and Davis, CA
- Kaiser Permanente Division of Research, Oakland, CA
| | - Alyce S. Adams
- Diabetes Research for Equity through Advanced Multilevel Science (DREAMS) Center for Diabetes Translation Research, Palo Alto, Oakland, San Francisco, Merced, and Davis, CA
- Stanford University School of Medicine, Palo Alto, CA
| | - Debra Haire-Joshu
- Washington Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO
| | - Michele Heisler
- Michigan Center for Diabetes Translation Research, University of Michigan
| | - Gretchen A. Piatt
- Michigan Center for Diabetes Translation Research, University of Michigan
| | - Ron Ackermann
- Chicago Center for Diabetes Translation Research, Chicago, IL
- Northwestern University, Evanston
| | - Marshall H. Chin
- Chicago Center for Diabetes Translation Research, Chicago, IL
- The University of Chicago, Chicago
| | - Jeffrey S. Gonzalez
- New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine
| | - Spero M. Manson
- Center for American Indian and Alaska Native Diabetes Translation Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Dean Schillinger
- Diabetes Research for Equity through Advanced Multilevel Science (DREAMS) Center for Diabetes Translation Research, Palo Alto, Oakland, San Francisco, Merced, and Davis, CA
- University of California, San Francisco
| | - Angela G. Brega
- Center for American Indian and Alaska Native Diabetes Translation Research, University of Colorado Anschutz Medical Campus, Aurora, CO
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Jacob RR, Korn AR, Huang GC, Easterling D, Gundersen DA, Ramanadhan S, Vu T, Angier H, Brownson RC, Haire-Joshu D, Oh AY, Schnoll R. Collaboration networks of the implementation science centers for cancer control: a social network analysis. Implement Sci Commun 2022; 3:41. [PMID: 35418309 PMCID: PMC9009020 DOI: 10.1186/s43058-022-00290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Multi-center research initiatives offer opportunities to develop and strengthen connections among researchers. These initiatives often have goals of increased scientific collaboration which can be examined using social network analysis. METHODS The National Cancer Institute (NCI)-funded Implementation Science Centers in Cancer Control (ISC3) initiative conducted an online social network survey in its first year of funding (2020) to (1) establish baseline network measures including the extent of cross-center collaboration and (2) assess factors associated with a network member's access to the network such as one's implementation science (IS) expertise. Members of the seven funded centers and NCI program staff identified collaborations in planning/conducting research, capacity building, product development, scientific dissemination, and practice/policy dissemination. RESULTS Of the 192 invitees, 182 network members completed the survey (95%). The most prevalent roles were faculty (60%) and research staff (24%). Almost one-quarter (23%) of members reported advanced expertise in IS, 42% intermediate, and 35% beginner. Most members were female (69%) and white (79%). One-third (33%) of collaboration ties were among members from different centers. Across all collaboration activities, the network had a density of 14%, suggesting moderate cohesion. Degree centralization (0.33) and betweenness centralization (0.07) measures suggest a fairly dispersed network (no single or few central member(s) holding all connections). The most prevalent and densely connected collaboration was in planning/conducting research (1470 ties; 8% density). Practice/policy dissemination had the fewest collaboration, lowest density (284 ties' 3% density), and the largest number of non-connected members (n=43). Access to the ISC3 network varied significantly depending on members' level of IS expertise, role within the network, and racial/ethnic background. Across all collaboration activities, most connected members included those with advanced IS expertise, faculty and NCI staff, and Hispanic or Latino and white members. CONCLUSIONS Results establish a baseline for assessing the growth of cross-center collaborations, highlighting specific areas in need of particular growth in network collaborations such as increasing engagement of racial and ethnic minorities and trainees or those with less expertise in IS.
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Affiliation(s)
- Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Grace C Huang
- Westat, 1600 Research Blvd., Rockville, MD, 20850, USA
| | - Douglas Easterling
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Division of Population Sciences, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Thuy Vu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, 98195, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, 63130, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63117, USA
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - April Y Oh
- Division of Cancer Control and Population Sciences, Implementation Science Team, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA, 19104, USA
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Huebschmann AG, Johnston S, Davis R, Kwan BM, Geng E, Haire-Joshu D, Sandler B, McNeal DM, Brownson RC, Rabin BA. Promoting rigor and sustainment in implementation science capacity building programs: A multi-method study. Implementation Research and Practice 2022; 3:26334895221146261. [PMID: 37091073 PMCID: PMC9924281 DOI: 10.1177/26334895221146261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The field of Implementation science (IS) continues to evolve, and the number and type of IS capacity building Programs (ISCBPs) are in flux. These changes push the field to revisit the accepted IS competencies and to guide sustainment of ISCBPs. Our objectives were: (1) compare characteristics of current ISCBPs; (2) identify recommendations to support ISCBP sustainment; (3) measure how often ISCBPs address IS competencies; (4) identify novel and important IS competencies for the field. Method This multi-method study included ISCBPs delivering structured, longitudinal IS training, excluding single courses and brief workshops. We used three complementary methods to meet our objectives. First, we identified ISCBPs via an internet search and snowball sampling methods. Second, we surveyed these ISCBPs to identify areas of program focus, types of trainees, IS competencies addressed, and recommendations to sustain ISCBPs. Third, we conducted a modified Delphi process with IS researchers/leaders to reach consensus on the IS competencies that were both important and novel as compared to the IS competencies published to date. Results Among 74 eligible ISCBPs identified, 46 responded (62% response rate). Respondent ISCBPs represented diverse areas of focus (e.g., global health, cardiopulmonary disease) and trainee stages (e.g., graduate students, mid-career faculty). While most respondent ISCBPs addressed core IS methods, targeting IS competencies was less consistent (33% for nongraduate/non-fellowship ISCBPs; >90% for graduate/national ISCBPs). Our modified Delphi process identified eight novel and important IS competencies related to increasing health equity or the speed of translation. Recommendations to sustain ISCBPs included securing financial administrative support. Conclusions Current ISCBPs train learners across varying career stages in diverse focus areas. To promote rigor, we recommend ISCBPs address specific IS competencies, with consideration of these eight novel/emerging competencies. We also recommend ISCBPs report on their IS competencies, focus area(s), and trainee characteristics. ISCBP programs need administrative financial support. Plain Language Summary There is a limited workforce capacity to conduct implementation science (IS) research. To address this gap, the number and type of IS capacity building Programs (ISCBPs) focusing on training researchers and practitioners in IS methods continue to increase. Our efforts to comprehensively identify and describe ISCBPs for researchers and practitioners highlighted four implications for leaders of ISCBPs related to program sustainment and rigor. First, we identified a range of contextual characteristics of ISCBPs, including the research topics, methods, and IS competencies addressed, and the types of trainees accepted. Second, given the variability of trainee types and research, rigorous ISCBP programs should tailor the IS competencies and methods addressed to the skills needed by the types of trainees in their program. Third, the field of IS needs to periodically revisit the competencies needed with attention to the skills needed in the field. We used a consensus-building process with ISCBP leaders and other IS experts to expand existing IS competencies and identified eight important, novel IS competencies that broadly relate to promoting health equity and speeding the translation of research to practice. Finally, as more institutions consider developing ISCBPs, we identified factors needed to support ISCBP sustainment, including ongoing financial support. In addition to these implications for ISCBP leaders, there are also policy implications. For example, IS journals may enact policies to require manuscripts evaluating ISCBP performance to report on certain contextual characteristics, such as the IS competencies addressed and types of trainees accepted. The field may also consider developing an accreditation body to evaluate the rigor of ISCBP curricula.
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Affiliation(s)
- Amy G Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- Division of General Internal Medicine, CU-Anschutz, Aurora, CO, USA
- Ludeman Family Center for Women's Health Research, CU-Anschutz, Aurora, CO, USA
| | - Shelly Johnston
- Washington University Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Davis
- Health Service and Population Research Department, Centre for Implementation Science, King's College London, London, UK
| | - Bethany M Kwan
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- Department of Emergency Medicine, CU-Anschutz, Aurora, CO, USA
- Colorado Clinical & Translational Sciences Institute, CU-Anschutz, Aurora, CO, USA
| | - Elvin Geng
- Department of Medicine (Division of Infectious Diseases), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Debra Haire-Joshu
- Washington University Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
- Department of Medicine (Division of Geriatrics and Nutritional Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brittney Sandler
- Department of Medicine (Division of Infectious Diseases), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Demetria M McNeal
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- Division of General Internal Medicine, CU-Anschutz, Aurora, CO, USA
- Colorado Clinical & Translational Sciences Institute, CU-Anschutz, Aurora, CO, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Borsika A Rabin
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus (CU-Anschutz), Aurora, CO, USA
- ACTRI Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Tabak RG, Schwarz CD, Kemner A, Johnston S, Aramburu A, Haire-Joshu D. Social Determinants of Health Discussed with Mothers During Personal Visits Before and During the COVID-19 Pandemic. Health Equity 2021; 5:536-544. [PMID: 34909520 PMCID: PMC8665790 DOI: 10.1089/heq.2020.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: This report describes the social determinants of health (SDOH) discussed during personal visits at the time leading up to and during the first 4 months of the pandemic from families across the United States. Methods: This is a secondary analysis from a cluster randomized trial that embeds Healthy Eating and Active Living Taught at Home within Parents as Teachers (PAT). PAT is a national organization serving families prenatal through kindergarten, delivered by parent educators. After parent educators complete visits with mothers in the trial, they complete brief surveys including the question "Did issues with any of these come up during the visit?" with yes/no options for "Transportation," "Housing," "Food insecurity," "Childcare," "Financial constraint," or "Other." Results: Among the 60 mothers with visit records in the months before and during (March-July 2020) COVID-19, 55% identified as Hispanic or Latino and 52% reported food insecurity at baseline. During COVID-19, financial constraints and other SDOH were as common as they were before COVID-19; childcare issues were discussed less frequently and food security was discussed more frequently. When comparing the number of SDOH parent educators reported discussing with mothers in visits that took place before COVID-19 with the number of SDOH discussed in visits during COVID-19, the number of SDOH increased for 41% for mothers identifying as Hispanic or Latino and only 8% for non-Hispanic or Latino mothers. Conclusions: This study can help build an understanding of how COVID-19 is impacting families, and how these impacts may be inequitable. Clinical Trial Registration Number: NCT03758638.
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Affiliation(s)
- Rachel G. Tabak
- Center for Diabetes Translation Research, Washington University in St. Louis Brown School, St. Louis, Missouri, USA
| | - Cynthia D. Schwarz
- Center for Diabetes Translation Research, Washington University in St. Louis Brown School, St. Louis, Missouri, USA
| | - Allison Kemner
- Parents as Teachers National Center, St. Louis, Missouri, USA
| | - Shelly Johnston
- Center for Diabetes Translation Research, Washington University in St. Louis Brown School, St. Louis, Missouri, USA
| | - Adriana Aramburu
- Center for Diabetes Translation Research, Washington University in St. Louis Brown School, St. Louis, Missouri, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis Brown School, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Phelan S, Marquez F, Redman LM, Arteaga S, Clifton R, Grice BA, Haire-Joshu D, Martin CK, Myers CA, Pomeroy J, Vincent E, Van Horn L, Peaceman A, Ashby-Thompson M, Gallagher D, Pi-Sunyer X, Boekhoudt T, Drews K, Brown G. The moderating role of the built environment in prenatal lifestyle interventions. Int J Obes (Lond) 2021; 45:1357-1361. [PMID: 33637948 PMCID: PMC8164971 DOI: 10.1038/s41366-021-00782-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
This study examined whether the neighborhood built environment moderated gestational weight gain (GWG) in LIFE-Moms clinical trials. Participants were 790 pregnant women (13.9 weeks' gestation) with overweight or obesity randomized within four clinical centers to standard care or lifestyle intervention to reduce GWG. Geographic information system (GIS) was used to map the neighborhood built environment. The intervention relative to standard care significantly reduced GWG (coefficient = 0.05; p = 0.005) and this effect remained significant (p < 0.03) after adjusting for built environment variables. An interaction was observed for presence of fast food restaurants (coefficient = -0.007; p = 0.003). Post hoc tests based on a median split showed that the intervention relative to standard care reduced GWG in participants living in neighborhoods with lower fast food density 0.08 [95% CI, 0.03,0.12] kg/week (p = 0.001) but not in those living in areas with higher fast food density (0.02 [-0.04, 0.08] kg/week; p = 0.55). Interaction effects suggested less intervention efficacy among women living in neighborhoods with more grocery/convenience stores (coefficient = -0.005; p = 0.0001), more walkability (coefficient -0.012; p = 0.007) and less crime (coefficient = 0.001; p = 0.007), but post-hoc tests were not significant. No intervention x environment interaction effects were observed for total number of eating establishments or tree canopy. Lifestyle interventions during pregnancy were effective across diverse physical environments. Living in environments with easy access to fast food restaurants may limit efficacy of prenatal lifestyle interventions, but future research is needed to replicate these findings.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health and Center for Health Research, Cal Poly, San Luis Obispo, CA, USA.
| | - Fred Marquez
- Department of Anthropology & Geography and Center for Health Research, Cal Poly, San Luis Obispo, CA, USA
| | | | - Sonia Arteaga
- The Environmental influences on Child Health Outcomes (ECHO) Program, The National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Clifton
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Brian A Grice
- Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Jeremy Pomeroy
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Eileen Vincent
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Alan Peaceman
- Department of Obstetrics & Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Maxine Ashby-Thompson
- New York Nutrition Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dympna Gallagher
- New York Nutrition Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Xavier Pi-Sunyer
- New York Nutrition Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Trisha Boekhoudt
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Kimberly Drews
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Greg Brown
- Department of Natural Resources Management and Environmental Sciences, Cal Poly, San Luis Obispo, CA, USA
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Brownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implement Sci 2021; 16:28. [PMID: 33740999 PMCID: PMC7977499 DOI: 10.1186/s13012-021-01097-0] [Citation(s) in RCA: 199] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA. .,Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA.
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research and Center for Obesity Prevention and Policy Research, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
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Haire-Joshu D, Morshed AB, Phad A, Johnston S, Tabak RG. Applying RE-AIM to Evaluate the External Validity of Weight Gain Prevention Interventions in Young Adults: A Systematic Review. J Public Health Manag Pract 2021; 27:154-165. [PMID: 32332487 PMCID: PMC7837750 DOI: 10.1097/phh.0000000000001159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of this review was to use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to assess the extent to which weight gain prevention studies targeting young adults reported on elements of external validity. DESIGN Systematic review. ELIGIBILITY CRITERIA Articles of interest included a lifestyle/behavioral intervention targeting weight gain prevention. Eligibility criteria included the following: study design of randomized controlled trials, quasi-randomized control trials, or natural experiments; average participant age between 18 and 35 years; study duration of at least 12 months; and published in English between January 2008 and May 2018. Studies had to report weight or body mass index as a measured outcome and were excluded if they were paired with smoking cessation programs, were conducted in specific groups (ie, pregnant women, breast cancer survivors), or were follow-ups to weight loss studies. STUDY SELECTION After removing duplicates, the search yielded 11426 articles. Titles and abstracts were screened by 1 reviewer; 144 articles were assessed in a full-text review by 2 reviewers. Discrepancies were resolved by consensus. Nine studies (13 articles) were included in the review. MAIN OUTCOMES MEASURES Reported elements of the RE-AIM framework. RESULTS A total of 9 studies met the selection criteria. All studies lacked full reporting on external validity elements. Of the total of 60 RE-AIM reporting criteria, 8 were reported by all 9 studies, 26 criteria were reported by fewer than 4 studies, and 22 criteria were not reported by any of the studies. DISCUSSION There remains inadequate reporting of elements of external validity and generalizability in weight gain prevention studies. This is a significant scientific constraint that limits the information required to disseminate and implement prevention of weight gain interventions for population impact. Standardized reporting may be needed to ensure results that demonstrate not only internal validity but also external validity and generalizability are needed to promote public health impact.
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Affiliation(s)
- Debra Haire-Joshu
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Alexandra B. Morshed
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Allison Phad
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Shelly Johnston
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Rachel G. Tabak
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
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Mazzucca S, Arredondo EM, Hoelscher DM, Haire-Joshu D, Tabak RG, Kumanyika SK, Brownson RC. Expanding Implementation Research to Prevent Chronic Diseases in Community Settings. Annu Rev Public Health 2021; 42:135-158. [PMID: 33467924 DOI: 10.1146/annurev-publhealth-090419-102547] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.
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Affiliation(s)
- Stephanie Mazzucca
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Elva M Arredondo
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, California 92123-4311, USA;
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, University of Texas, Austin, Texas 78701, USA;
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Rachel G Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , , .,Department of Surgery, Division of Public Health Sciences; and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
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Redman LM, Drews KL, Klein S, Horn LV, Wing RR, Pi-Sunyer X, Evans M, Joshipura K, Arteaga SS, Cahill AG, Clifton RG, Couch KA, Franks PW, Gallagher D, Haire-Joshu D, Martin CK, Peaceman AM, Phelan S, Thom EA, Yanovski SZ, Knowler WC. Attenuated early pregnancy weight gain by prenatal lifestyle interventions does not prevent gestational diabetes in the LIFE-Moms consortium. Diabetes Res Clin Pract 2021; 171:108549. [PMID: 33238176 PMCID: PMC9041868 DOI: 10.1016/j.diabres.2020.108549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/29/2020] [Accepted: 11/06/2020] [Indexed: 12/30/2022]
Abstract
AIMS To examine the effect of lifestyle (diet and physical activity) interventions on the prevalence of GDM, considering the method of GDM ascertainment and its association with early pregnancy characteristics and maternal and neonatal outcomes in the LIFE-Moms consortium. METHODS LIFE-Moms evaluated the effects of lifestyle interventions to optimize gestational weight gain in 1148 pregnant women with BMI ≥ 25 kg/m2 and without known diabetes at enrollment, compared with standard care. GDM was assessed between 24 and 31-weeks gestation by a 2-hour, 75-gram OGTT or by local clinical practice standards. RESULTS Lifestyle interventions initiated prior to 16 weeks reduced early excess GWG compared with standard care (0.35 ± 0.24 vs 0.43 ± 0.26 kg per week, p=<0.0001) but did not affect GDM diagnosis (11.1% vs 11.6%, p = 0.91). Using the 75-gram, 2-hour OGTT, 13. 0% of standard care and 11.0% of the intervention group had GDM by the IADPSG criteria (p = 0.45). The 'type of diagnostic test' did not change the result (p = 0.86). Women who developed GDM were significantly heavier, more likely to have obesity, and more likely to have dysglycemia at baseline. CONCLUSION Moderate-to-high intensity lifestyle interventions grounded in behavior change theory initiated between 9 and 16-weeks gestation did not affect the prevalence of GDM despite reducing early GWG. CLINICALTRIALS.GOV: NCT01545934, NCT01616147, NCT01771133, NCT01631747, NCT01768793, NCT01610752, NCT01812694.
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Affiliation(s)
- Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Kimberly L Drews
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Xavier Pi-Sunyer
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, USA
| | - Kaumudi Joshipura
- Center for Clinical Research and Health Promotion, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; Department of Epidemiology, Harvard T.H. Chan Public Health School, Harvard University, Boston, MA, USA
| | - S Sonia Arteaga
- Division of Cardiovascular Diseases, The National Heart, Lung, and Blood Institute, Bethesda, MD, USA; The Environmental Influences on Child Health Outcomes (ECHO) Program Office, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, TX, USA
| | - Rebecca G Clifton
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Kimberly A Couch
- Phoenix Indian Medical Center, Indian Health Service, Phoenix, AZ, USA
| | - Paul W Franks
- Department of Nutrition, Harvard T.H. Chan Public Health School, Harvard University, Boston, MA, USA; Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | - Dympna Gallagher
- New York Obesity Research Center, Dept. of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Alan M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Elizabeth A Thom
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
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Brownson RC, Jacob RR, Carothers BJ, Chambers DA, Colditz GA, Emmons KM, Haire-Joshu D, Kerner JF, Padek M, Pfund C, Sales A. Building the Next Generation of Researchers: Mentored Training in Dissemination and Implementation Science. Acad Med 2021; 96:86-92. [PMID: 32941251 PMCID: PMC7769184 DOI: 10.1097/acm.0000000000003750] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PROBLEM Dissemination and implementation (D&I) science provides the tools needed to close the gap between known intervention strategies and their effective application. The authors report on the Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) program-a D&I training program for postdoctoral or early-career cancer prevention and control scholars. APPROACH MT-DIRC was a 2-year training institute in which fellows attended 2 annual Summer Institutes and other conferences and received didactic, group, and individual instruction; individualized mentoring; and other supports (e.g., pilot funding). A quasi-experimental design compared changes in 3 areas: mentoring, skills, and network composition. To evaluate mentoring and D&I skills, data from fellows on their mentors' mentoring competencies, their perspectives on the importance of and satisfaction with mentoring priority areas, and their self-rated skills in D&I competency domains were collected. Network composition data were collected from faculty and fellows for 3 core social network domains: contact, mentoring, and collaboration. Paired t tests (mentoring), linear mixed models (skills), and descriptive analyses (network composition) were performed. OUTCOMES Mentors were rated as highly competent across all mentoring competencies, and each mentoring priority area showed reductions in gaps between satisfaction and importance between the 6 and 18 months post-first Summer Institute. Fellows' self-rated skills in D&I competencies improved significantly in all domains over time (range: 42.5%-52.9% increase from baseline to 18 months post-first Summer Institute). Mentorship and collaboration networks grew over time, with the highest number of collaboration network ties for scholarly manuscripts (n = 199) in 2018 and for research projects (n = 160) in 2019. NEXT STEPS Building on study findings and existing literature, mentored training of scholars is an important approach for building D&I skills and networks, and thus to better applying the vast amount of available intervention evidence to benefit cancer control.
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Affiliation(s)
- Ross C. Brownson
- R.C. Brownson is Steven H. and Susan U. Lipstein Distinguished Professor of Public Health, Prevention Research Center, Brown School at Washington University in St. Louis, and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Rebekah R. Jacob
- R.R. Jacob is research manager, Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Bobbi J. Carothers
- B.J. Carothers is senior data analyst, Center for Public Health Systems Science, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - David A. Chambers
- D.A. Chambers is deputy director for implementation science, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Graham A. Colditz
- G.A. Colditz is Niess-Gain Professor of Surgery, Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Karen M. Emmons
- K.M. Emmons is professor of social and behavioral sciences, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Debra Haire-Joshu
- D. Haire-Joshu is Joyce Wood Professor, Center for Diabetes Translation Research and Center for Obesity Prevention and Policy Research, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Jon F. Kerner
- J.F. Kerner was senior scientific advisor, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Margaret Padek
- M. Padek is research manager, Implementation Science Center for Cancer Control, Brown School at Washington University in St. Louis, and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Christine Pfund
- C. Pfund is senior scientist, Center for the Improvement of Mentored Experiences in Research, and Wisconsin Center for Education Research and Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Anne Sales
- A. Sales is professor, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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21
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Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, Thornton PL, Haire-Joshu D. Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care 2020; 44:dci200053. [PMID: 33139407 PMCID: PMC7783927 DOI: 10.2337/dci20-0053] [Citation(s) in RCA: 532] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Nancy E Adler
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Tiffany L Gary-Webb
- Departments of Epidemiology and Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Pamela L Thornton
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, St. Louis, MO
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22
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Haire-Joshu D, Schwarz C, Jacob R, Kristen P, Johnston S, Quinn K, Tabak R. Raising Well at Home: a pre-post feasibility study of a lifestyle intervention for caregivers and their child with obesity. Pilot Feasibility Stud 2020; 6:149. [PMID: 33042569 PMCID: PMC7541221 DOI: 10.1186/s40814-020-00692-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/21/2020] [Indexed: 01/15/2023] Open
Abstract
Background Few efficacious pediatric obesity interventions have been successfully translated and sustained in real-world practice, often due to inadequate fit with the priorities of under-resourced populations. Lifestyle interventions, which incorporate tailoring of essential weight loss ingredients and adaptation of mode and intensity to the living circumstances of children with obesity, are needed. The purpose of this pilot study was to test the feasibility and efficacy of a tailored lifestyle intervention for caregivers and their children with obesity, conducted in partnership with Envolve, Inc., a family of comprehensive health solutions and wholly owned subsidiary of Centene Corporation. Methods This 6-month pilot study employed a pretest-posttest design to assess the impact of a tailored lifestyle intervention delivered by peer coaches on (a) caregiver and child weight impacted by changes in dietary intake, walking, and screen time; (b) changes in the home environment; and (c) caregiver engagement and satisfaction. The intervention was delivered via 3 core home visits every 4-6 weeks, with additional support via text. Results The majority of caregivers were female (95.2%) and Black (73.7%). Children had median age of 11.1 years and majority were female (57.6%), with a median BMI near the 99th percentile (Mdn 98.8, IQR 3.5) or 118.3% (IQR 35.8) of the 95th percentile for their sex and age. Participants expressed high satisfaction with the program (mean range 96.7-100.0% agreement on satisfaction items). From baseline to post, caregivers' BMI decreased by 1.8% (p = 0.016, r = 0.22), while children's BMI percentile z-score decreased significantly (p = 0.023, r = 0.18) and BMI percent of the 95th percentile remained constant (p = 0.05, r = 0.15). Caregivers and children decreased sugar-sweetened beverage intake (p = 0.026, r = 0.22; p = 0.006, r = 0.23, respectively), reduced presence of soda in the home (p = 0.002, g = 0.43), and decreased screen time (p = 0.046, g = 0.22). Other eating and walking behaviors remained stable for caregivers and child. Conclusion The Raising Well at Home pilot demonstrated that tailored lifestyle interventions, delivered by peer coaches in the home and via text, are feasible and can improve weight, eating, and environmental measures of caregivers and children with obesity. Future work should determine the effectiveness, sustainability, and scalability of this intervention in sites located across the country. Trial registration ClinicalTrials.gov (NCT04224623). Registered 9 January 2020-retrospectively registered.
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Affiliation(s)
- Debra Haire-Joshu
- Center for Obesity Prevention and Policy Research, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA.,Center for Diabetes Translation Research, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA
| | - Cindy Schwarz
- Center for Obesity Prevention and Policy Research, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA
| | - Rebekah Jacob
- Prevention Research Center in St. Louis, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA
| | - Pat Kristen
- Centene Center for Health Transformation, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA
| | - Shelly Johnston
- Center for Diabetes Translation Research, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA
| | - Karyn Quinn
- Centene Center for Health Transformation, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA
| | - Rachel Tabak
- Center for Diabetes Translation Research, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA.,Prevention Research Center in St. Louis, the Brown School, Washington University in St. Louis, One Brookings Drive, CB 1196, Saint Louis, MO 63130 USA
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23
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Affiliation(s)
- Christina D Economos
- ChildObesity180, Boston, MA, USA.,Division of Nutrition Interventions, Communication, and Behavior Change, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Center for Obesity Prevention and Policy Research, Brown School at Washington University, St. Louis, MO, USA
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24
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Scott-Sheldon LAJ, Hedges LV, Cyr C, Young-Hyman D, Khan LK, Magnus M, King H, Arteaga S, Cawley J, Economos CD, Haire-Joshu D, Hunter CM, Lee BY, Kumanyika SK, Ritchie LD, Robinson TN, Schwartz MB. Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019. Child Obes 2020; 16:S221-S248. [PMID: 32936038 PMCID: PMC7482126 DOI: 10.1089/chi.2020.0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Larry V Hedges
- Department of Statistics, Northwestern University, Evanston, IL, USA
| | - Chris Cyr
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Laura Kettel Khan
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather King
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Sonia Arteaga
- Office of the Director, National Institutes of Health, National Institutes of Health, Bethesda, MD, USA
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
- Department of Economics, Cornell University, Ithaca, NY, USA
| | - Christina D Economos
- Division of Nutrition Interventions, Communication, and Behavior Change, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Debra Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University, Saint Louis, MO, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Bruce Y Lee
- CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Berkeley, CA, USA
| | - Thomas N Robinson
- Departments of Pediatrics and Medicine, Stanford Solutions Science Lab, Stanford University, Stanford, CA, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
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25
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King H, Magnus M, Hedges LV, Cyr C, Young-Hyman D, Kettel Khan L, Scott-Sheldon LAJ, Saul JA, Arteaga S, Cawley J, Economos CD, Haire-Joshu D, Hunter CM, Lee BY, Kumanyika SK, Ritchie LD, Robinson TN, Schwartz MB. Childhood Obesity Evidence Base Project: Methods for Taxonomy Development for Application in Taxonomic Meta-Analysis. Child Obes 2020; 16:S27-S220. [PMID: 32936039 PMCID: PMC7482109 DOI: 10.1089/chi.2020.0138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Meta-analysis has been used to examine the effectiveness of childhood obesity prevention efforts, yet traditional conventional meta-analytic methods restrict the kinds of studies included, and either narrowly define mechanisms and agents of change, or examine the effectiveness of whole interventions as opposed to the specific actions that comprise interventions. Taxonomic meta-analytic methods widen the aperture of what can be included in a meta-analysis data set, allowing for inclusion of many types of interventions and study designs. The National Collaborative on Childhood Obesity Research Childhood Obesity Evidence Base (COEB) project focuses on interventions intended to prevent childhood obesity in children 2-5 years old who have an outcome measure of BMI. The COEB created taxonomies, anchored in the Social Ecological Model, which catalog specific outcomes, intervention components, intended recipients, and contexts of policies, initiatives, and interventions conducted at the individual, interpersonal, organizational, community, and societal level. Taxonomies were created by discovery from the literature itself using grounded theory. This article describes the process used for a novel taxonomic meta-analysis of childhood obesity prevention studies between the years 2010 and 2019. This method can be applied to other areas of research, including obesity prevention in additional populations.
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Affiliation(s)
- Heather King
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | | | - Larry V Hedges
- Department of Statistics, Northwestern University, Evanston, IL, USA
| | - Chris Cyr
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Laura Kettel Khan
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jason A Saul
- Center for Impact Sciences, Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Sonia Arteaga
- Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - John Cawley
- Department of Policy Analysis and Management and Cornell University, Ithaca, NY, USA
- Department of Economics, Cornell University, Ithaca, NY, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Debra Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School Washington University, Saint Louis, MO, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Bruce Y Lee
- CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California Agriculture and Natural Resources, Berkeley, CA, USA
| | - Thomas N Robinson
- Stanford Solutions Science Lab, Stanford University, Stanford, CA, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
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26
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Tabak RG, Furtado K, Schwarz CD, Haire-Joshu D. Neighborhood Perceptions Among Pregnant African American Women in St. Louis, Missouri, Before and After the Shooting of Michael Brown. Health Equity 2020; 4:353-361. [PMID: 32908956 PMCID: PMC7473163 DOI: 10.1089/heq.2019.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aims to examine perceptions of neighborhood quality and safety before and after the death of Michael Brown and the unrest that followed. Methods: In this secondary analysis of baseline data from one site in The Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium, pregnant African American women in the St. Louis region completed a survey of neighborhood perceptions. Logistic regression was used to explore associations between perceptions among those completing baseline surveys and entering the study before and after August 9, 2014 (range: 2012-2015), adjusted for demographic characteristics. Results: Of 267 participants, half (n=134) completed the survey after August 9, 2014. Thirty-four percent of participants completing the survey after this date felt "The crime rate in my neighborhood makes it unsafe to go on walks during the day" compared with 21% of those completing the survey before (adjusted odds ratio=2.0, 95% confidence interval: 1.1-3.7). There were no consistently significant differences in demographic characteristics or in the remaining 16 neighborhood items. Conclusions: This study is an example of how an unexpected shift in the community context in the wake of a profound event may impact health behaviors and outcomes in a measurable way. Clinical Trials Registration: NCT01768793.
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Affiliation(s)
- Rachel G. Tabak
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Diabetes Translation Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Karishma Furtado
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cynthia D. Schwarz
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Anthony H, Tabak R, Morshed AB, Schwarz C, Phad A, Haire-Joshu D. Awareness and accuracy of height and weight among mothers and their preschool-aged children. Public Health 2020; 182:151-154. [PMID: 32320905 PMCID: PMC7265393 DOI: 10.1016/j.puhe.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/18/2019] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A constant challenge in addressing the issue of obesity is the validity and reliability of self-reported measurements to calculate body mass index, that assesses the prevalence of obesity in a population. The objective of this study is to analyze both awareness and accuracy of mothers who are overweight or obese, in reporting their own and their child's height and weight measurements. STUDY DESIGN cross-sectional study. METHODS In this study, mothers were asked over phone to self-report height and weight for them and their child. This was followed by objective measurement of maternal and child height and weight by study staff in a clinical setting. The descriptive and statistical analysis of the data obtained were carried out using SAS software. RESULTS 1) The mean weight of mothers who inaccurately self-reported their weight was 9.5 kg greater than the mean weight of those who reported accurately (P < 0.001). (2) Despite being aware of, and reporting their own measurements, 50% (n = 116) of mothers reported not knowing their child's height and 23% (n = 54) of them reported not knowing their child's weight. CONCLUSION Strategies to tackle both maternal awareness and accuracy of child's measurements can help with early identification of child's obesity risk and prevention of long-term consequences.
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Affiliation(s)
- H Anthony
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA; Department of Gastroenterology, Internal Medicine, Washington University in St. Louis, USA.
| | - R Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - A B Morshed
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - C Schwarz
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - A Phad
- Center for Diabetes Translation and Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63110, USA
| | - D Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA; Department of Internal Medicine, Washington University School of Medicine, Washington University in St. Louis, USA
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Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
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Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
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Abstract
Background. Upper limb (UL) performance, or use, in daily life is complex and likely influenced by many factors. While the recovery trajectory of UL impairment poststroke is well documented, little is known about the recovery trajectory of sensor-measured UL performance in daily life early after stroke and the potential moderating role of psychosocial factors. Objective. To examine the recovery trajectory of UL performance within the first 12 weeks poststroke and characterize the potential moderating role of belief, confidence, and motivation on UL performance. Methods. This was a longitudinal, prospective cohort study quantifying UL performance and related psychosocial factors early after stroke. UL performance was quantified via bilateral, wrist-worn accelerometers over 5 assessment sessions for 24 hours. Belief, confidence, and motivation to use the paretic UL, and self-perceived barriers to UL recovery were quantified via survey. Change in 4 accelerometer variables and the moderating role of psychosocial factors was tested using hierarchical linear modeling. The relationship between self-perceived barriers and UL performance was tested via Spearman rank-order correlation analysis. Results. UL performance improved over the first 12 weeks after stroke. Belief, confidence, and motivation did not moderate UL performance over time. There was a negative relationship between UL performance and self-perceived barriers to UL recovery at week 2, which declined over time. Conclusions. Sensor-measured UL performance can improve early after stroke. Early after stroke, rehabilitation interventions may not need to directly target belief, confidence, and motivation but may instead focus on reducing self-perceived barriers to UL recovery.
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Affiliation(s)
| | - Michael J Strube
- Psychological and Brain Sciences, Washington University, St. Louis, MO
| | | | | | - Catherine E. Lang
- Program in Physical Therapy, Washington University, St. Louis, MO
- Program in Occupational Therapy, Washington University, St. Louis, MO
- Department of Neurology, Washington University, St. Louis, MO
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Waddell KJ, Tabak RG, Strube MJ, Haire-Joshu D, Lang CE. Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke. J Neurol Phys Ther 2019; 43:197-203. [PMID: 31436612 PMCID: PMC6744298 DOI: 10.1097/npt.0000000000000287] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE The recovery patterns of upper limb (UL) impairment after stroke are established. Psychosocial factors such as belief that paretic UL recovery is possible, confidence, and motivation to use the paretic UL in everyday tasks are unexplored early after stroke. The purpose of this exploratory study was to characterize belief, confidence, and motivation to use the paretic UL in daily life, and self-perceived barriers to UL recovery over the first 24 weeks after stroke. METHODS This was a longitudinal cohort study (N = 30) with 8 assessment sessions over the first 24 weeks after stroke. Belief, confidence, and motivation to use the paretic UL and self-perceived barriers were quantified via survey and analyzed using descriptive statistics. Change in the number of self-perceived barriers between weeks 2 and 24 was tested using a paired-samples t test. The relationship between UL capacity, depressive symptomatology, cognition, and each psychosocial factor was examined using Spearman rank-order correlation analyses. RESULTS Twenty-two participants completed all study assessments. Belief, confidence, and motivation were high across the 24 weeks, with little variation. There was no difference between the average number of barriers from weeks 2 to 24. There was no relationship between the clinical measures and psychosocial factors at week 2, 12, or 24. DISCUSSION AND CONCLUSIONS High levels of belief, confidence, and motivation appear consistent over the first 6 months after stroke. The lack of correlations between psychosocial factors and clinical measures suggests belief, confidence, and motivation may not be vulnerable to functional status early after stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A283).
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Affiliation(s)
| | | | - Michael J Strube
- Psychological and Brain Sciences, Washington University, St. Louis, MO
| | | | - Catherine E. Lang
- Program in Physical Therapy, Washington University, St. Louis, MO
- Program in Occupational Therapy, Washington University, St. Louis, MO
- Department of Neurology, Washington University, St. Louis, MO
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Abstract
OBJECTIVE History of stroke and diabetes increases risk for cardiometabolic disease, which can be mitigated through lifestyle management. To evaluate lifestyle risk behaviors among stroke survivors, we compared the prevalence of three lifestyle risk behaviors-physical inactivity, consuming one or less fruit and one or less vegetable daily, and overweight/obesity-between stroke survivors with and without diabetes. DESIGN Data from the 2013 and 2015 Behavioral Risk Factor Surveillance System were examined. Weighted and age-adjusted prevalence estimates as well as crude and adjusted odds ratios (adjusted for sociodemographic characteristics) were calculated to compare lifestyle risk behaviors between US stroke survivors with and without diabetes. RESULTS Prevalence and adjusted odds ratios for lifestyle risk behaviors were higher in respondents with diabetes compared with those without diabetes for consuming one or less fruit and one or less vegetable daily (58.8% vs. 53.7%, adjusted odds ratio = 1.14), physical inactivity (65.7% vs. 54.6%, adjusted odds ratio = 1.41), and overweight/obesity (87.2% vs. 63.1%, adjusted odds ratio = 2.42). CONCLUSIONS Prevalence of select lifestyle risk behaviors exceeds 50% in adults with stroke but is higher in adults with diabetes compared with adults without diabetes. Effective interventions, community programs, and healthcare policy are needed to promote lifestyle management in adults with stroke, particularly among those with diabetes.
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Affiliation(s)
- Ryan R Bailey
- From the Brown School, Washington University in St. Louis, St. Louis, Missouri (RRB, AP, RT, DH-J); Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota (RM); and Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri (ALF)
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Parra DC, Van Zandt A, Wang P, Goodman M, Abhishek J, Haire-Joshu D, Brownson RC. Evaluating Park Use and Satisfaction: The Case of Trojan Park in St. Louis Missouri. Int J Environ Res Public Health 2019; 16:ijerph16152798. [PMID: 31390742 PMCID: PMC6696297 DOI: 10.3390/ijerph16152798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022]
Abstract
Background: Providing public access to exercise and play is vital for health promotion across populations. We evaluated the use of and satisfaction at Trojan Park, a multigenerational playground with multiple activity areas and fitness zones in the city of Wellston in St. Louis County, MO. Methods: We used video footage and the System for Observing Play and Recreation in Communities (SOPARC), which is a valid and reliable system for collecting data on physical activity in parks. We then performed intercept interviews to gather user information and measure overall satisfaction with the park. Results: The park received a variety of attendees across age groups, with children and middle-aged adults representing 41.1% and 50.3% of total park users, respectively. During the time observed, 47% of attendees were engaged in moderate to vigorous physical activity (MVPA), 22% were engaged in light physical activity (walking), and 30% were sedentary. We also observed participants spending the most time on the basketball court (38%), playground (28%), and picnic (17%) areas. Park users traveled a wide range of distances to access the park and the overwhelming majority reported a high level of satisfaction. Conclusions: Our findings demonstrate that multigenerational playgrounds with access to various activities and fitness zones may provide social and physical health benefits.
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Affiliation(s)
- Diana C Parra
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, 4444 Forest Park Ave, Campus Box 8502, St. Louis, MO 63108, USA.
| | - Alexandria Van Zandt
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, 4444 Forest Park Ave, Campus Box 8502, St. Louis, MO 63108, USA
| | - Peter Wang
- Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Micah Goodman
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Janardan Abhishek
- Department of Biology, School of Medicine, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
- Center for Diabetes Translation Research, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA
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Tabak RG, Schwarz CD, Kemner A, Schechtman KB, Steger-May K, Byrth V, Haire-Joshu D. Disseminating and implementing a lifestyle-based healthy weight program for mothers in a national organization: a study protocol for a cluster randomized trial. Implement Sci 2019; 14:68. [PMID: 31238955 PMCID: PMC6593605 DOI: 10.1186/s13012-019-0916-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Excessive weight gain among young adult women age 18–45 years is an alarming and overlooked trend that must be addressed to reverse the epidemics of obesity and chronic disease. During this vulnerable period, women tend to gain disproportionally large amounts of weight compared to men and to other life periods. Healthy Eating and Active Living Taught at Home (HEALTH) is a lifestyle modification intervention developed in partnership with Parents as Teachers (PAT), a national home visiting, community-based organization with significant reach in this population. HEALTH prevented weight gain, promoted sustained weight loss, and reduced waist circumference. PAT provides parent–child education and services free of charge to nearly 170,000 families through up to 25 free home visits per year until the child enters kindergarten. Methods This study extends effectiveness findings with a pragmatic cluster randomized controlled trial to evaluate dissemination and implementation (D&I) of HEALTH across three levels (mother, parent educator, PAT site). The trial will evaluate the effect of HEALTH and the HEALTH training curriculum (implementation strategy) on weight among mothers with overweight and obesity across the USA (N = 252 HEALTH; N = 252 usual care). Parent educators from 28 existing PAT sites (14 HEALTH, 14 usual care) will receive the HEALTH training curriculum through PAT National Center, using PAT’s existing training infrastructure, as a continuing education opportunity. An extensive evaluation, guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), will determine implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and adaptation) at the parent educator level. The Conceptual Framework for Implementation Research will characterize determinants that influence HEALTH D&I at three levels: mother, parent educator, and PAT site to enhance external validity (reach and maintenance). Discussion Embedding intervention content within existing delivery channels can help expand the reach of evidence-based interventions. Interventions, which have been adapted, can still be effective even if the effect is reduced and can still achieve population impact by reaching a broader set of the population. The current study will build on this to test not only the effectiveness of HEALTH in real-world PAT implementation nationwide, but also elements critical to D&I, implementation outcomes, and the context for implementation. Trial registration https://ClinicalTrials.gov, NCT03758638. Registered 29 November 2018 Electronic supplementary material The online version of this article (10.1186/s13012-019-0916-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Allison Kemner
- Research and Quality, Parents as Teachers, 2228 Ball Drive, St. Louis, MO, 63146, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Veronda Byrth
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
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Tinius RA, López JD, Cade WT, Stein RI, Haire-Joshu D, Cahill AG. Patient and obstetric provider communication regarding weight gain management among socioeconomically disadvantaged African American women who are overweight/obese. Women Health 2019; 60:156-167. [PMID: 31096872 DOI: 10.1080/03630242.2019.1616044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To examine the communication between obstetric providers and their socioeconomically disadvantaged, African American patients who are overweight and obese during pregnancy, and whether this communication relates to outcomes. Pregnant patients and their obstetric providers were surveyed between October 2012 and March 2016 at Washington University School of Medicine in St. Louis, MO. Percent agreement between patients' and obstetric providers' survey responses was analyzed and measured (κ coefficient). Descriptive and multilevel logistic regression analyses aimed at identifying the relation of perceived communication between providers and patients to gestational weight gain, diet, and exercise during pregnancy. A total of 99 pregnant women and 18 obstetric providers participated in the study. Significant lack of agreement was observed between patients and obstetric providers regarding communication about weight gain recommendations, risk factors associated with excessive weight gain, what constitutes adequate exercise per week, exercise recommendations, dietary recommendations, and risk factors associated with a poor diet. Our findings suggest patients were not receiving intended messages from their obstetric providers. Thus, more effective patient-obstetric provider communication is needed regarding gestational weight gain, exercise and dietary recommendations among overweight/obese, socioeconomically disadvantaged, African American women.
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Affiliation(s)
- Rachel A Tinius
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY, USA.,Program in Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Julia D López
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - W Todd Cade
- Program in Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Debra Haire-Joshu
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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Haire-Joshu D, Cahill AG, Stein RI, Cade WT, Woolfolk CL, Moley K, Mathur A, Schwarz CD, Schechtman KB, Klein S. Randomized Controlled Trial of Home-Based Lifestyle Therapy on Postpartum Weight in Underserved Women with Overweight or Obesity. Obesity (Silver Spring) 2019; 27:535-541. [PMID: 30900408 PMCID: PMC6526535 DOI: 10.1002/oby.22413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to assess the efficacy of a home-based lifestyle intervention delivered through Parents as Teachers (PAT), a national home-visiting organization, designed to minimize excessive weight gain through 12 months post partum in socioeconomically disadvantaged (SED) African American women with overweight or obesity. METHODS This randomized controlled trial was conducted at a single center as part of the Lifestyle Interventions for Expectant Moms (LIFE-Moms) consortium. Analysis was conducted with 185 SED African American women (BMI 25.0-45.0 kg/m2 at pregnancy onset) retained from an original sample of 267 randomized to standard PAT or PAT+Lifestyle, which embedded lifestyle therapy within standard PAT delivered prenatally and for 12 months post partum. RESULTS Compared with standard PAT, the PAT+Lifestyle group gained less weight (2.5 kg vs. 5.7 kg; P = 0.01) and were more likely to return to their baseline weight (38.0% vs. 21.5%; P = 0.01) from baseline to 12 months post partum. There were no differences between groups in cardiometabolic outcomes, indices of glycemic control and insulin sensitivity, and plasma lipid profile. The estimated cost of PAT+Lifestyle was $81 more to deliver per family than standard PAT. CONCLUSIONS PAT+Lifestyle decreases weight gain during pregnancy through 12 months post partum in SED African American women with overweight or obesity at the start of pregnancy with minimal additional cost.
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Affiliation(s)
- Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Richard I Stein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri, USA
| | - W Todd Cade
- Program in Physical Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Candice L Woolfolk
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelle Moley
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amit Mathur
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cynthia D Schwarz
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri, USA
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Bailey RR, Phad A, McGrath R, Tabak R, Haire-Joshu D. Prevalence of 3 Healthy Lifestyle Behaviors Among US Adults With and Without History of Stroke. Prev Chronic Dis 2019; 16:E23. [PMID: 30789819 PMCID: PMC6395084 DOI: 10.5888/pcd16.180409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Engaging in healthy lifestyle behaviors decreases risk for cardiometabolic complications, which is of particular concern for stroke survivors whose history of stroke (HOS) increases cardiometabolic risk. Population-based estimates of healthy behaviors in adults with HOS are lacking but could be used to inform research, policy, and health care practice. The objective of this study was to calculate and compare population-based estimates of the prevalence of consuming 1 or more fruit and 1 or more vegetable daily, meeting weekly aerobic physical activity recommendations, having a body mass index (BMI) of less than 25 kg/m2, and the number of healthy behaviors among US adults with and without HOS. METHODS We used data from the 2015 Behavioral Risk Factor Surveillance System. Weighted and age-adjusted (to the 2000 US standard population) prevalence estimates and adjusted odds ratios (AORs, adjusted for demographic variables) were computed for study variables. RESULTS Adults with HOS were less likely than adults without HOS to consume 1 or more fruit and 1 or more vegetable daily (AOR = 0.85; 95% confidence interval [CI], 0.79-0.91), meet weekly aerobic physical activity recommendations (AOR = 0.72; 95% CI, 0.67-0.78), and engage in 2 (AOR = 0.86; 95% CI, 0.79-0.94) or 3 (AOR = 0.73; 95% CI, 0.64-0.82) healthy behaviors. Adults with HOS were more likely to engage in 0 healthy behaviors (AOR = 1.26; 95% CI, 1.16-1.37). Having a BMI of less than 25 kg/m2 and engaging in 1 healthy behavior were similar between groups. CONCLUSION Prevalence of individual and total number of healthy behaviors was lower in adults with HOS for several healthy behaviors. Future research, policy, and health care practice is needed to promote healthy behaviors in adults with HOS.
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Affiliation(s)
- Ryan R Bailey
- Ryan R. Bailey, PhD, OTR/L, Washington University in St Louis, Brown School, Campus Box 1196, One Brookings Dr, St Louis, MO 63110.
| | - Allison Phad
- Washington University in St Louis, St Louis, Missouri
| | - Ryan McGrath
- North Dakota State University, Fargo, North Dakota
| | - Rachel Tabak
- Washington University in St Louis, St Louis, Missouri
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Morshed AB, Tabak RG, Schwarz CD, Haire-Joshu D. The Impact of a Healthy Weight Intervention Embedded in a Home-Visiting Program on Children's Weight and Mothers' Feeding Practices. J Nutr Educ Behav 2019; 51:237-244. [PMID: 30385250 PMCID: PMC6392451 DOI: 10.1016/j.jneb.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/24/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine whether a healthy weight intervention embedded in the Parents as Teachers (PAT) home visiting program, which was previously found to improve mothers' body mass index (BMI) and obesity-related behaviors, changed the BMI of preschool children or maternal feeding practices. METHODS This stratified randomized trial included preschool-aged children at risk for overweight whose mothers were overweight or had obesity (n = 179). The Healthy Eating and Active Living Taught at Home (HEALTH) intervention was based on the Diabetes Prevention Program. Differences were examined using repeated-measures mixed-ANOVA models. RESULTS Compared with PAT usual care, the HEALTH intervention had no effect on children's BMI or maternal feeding practices. However, combined analyses showed that children's BMI percentile decreased (P = .007), BMI z-scores were maintained (P = .19), and 3 of 8 feeding practices improved over time (P < .05). CONCLUSIONS AND IMPLICATIONS Additional research is needed to assess the effectiveness of PAT to prevent preschool-age obesity using rigorous designs (eg, group-randomized trials) and to identify its active components. HEALTH is ready to be scaled up to prevent maternal weight gain through embedding within the national PAT program.
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Affiliation(s)
| | - Rachel G Tabak
- Brown School, Washington University in St Louis, St Louis, MO
| | | | - Debra Haire-Joshu
- Brown School, Washington University in St Louis, St Louis, MO; Department of Medicine, Washington University School of Medicine, Washington University in St Louis, St Louis, MO
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Abstract
Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation.
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Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Felicia Hill-Briggs
- Departments of Medicine; Health, Behavior and Society; and Acute and Chronic Care; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
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Zwald ML, Eyler AA, Haire-Joshu D, Handy SL, Harris JK, Moreland-Russell S, Brownson RC. Network influences on the development and implementation of active transportation policies in six U.S. cities. Prev Med 2019; 118:176-183. [PMID: 30385154 DOI: 10.1016/j.ypmed.2018.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
Abstract
Many communities have prioritized policy and built environment changes to promote active transportation (AT). However, limited information exists on the partnerships and processes necessary to develop and implement such policy and environmental changes, particularly among organizations in non-health sectors. Within the transportation sector, metropolitan planning organizations (MPOs) are increasingly recognized as organizations that can support AT policies. This study examined inter-organizational relationships among MPOs and their partners working to advance AT policies in six U.S. cities. In fall 2015, an average of 22 organizations in each city participated in an online survey about partnerships with MPOs and other organizations developing and implementing AT policies. Measures included organizational characteristics and relational attributes including: level of AT policy collaboration, information transmission, resource sharing, and perceived decisional power. Descriptive network analysis and exponential random graph modeling were used to examine organizational attributes and relational predictors associated with inter-organizational collaboration in each network. MPOs served as collaborative intermediaries, connecting other organizations around AT policies, in half of the cities examined. Organizations in each city were more likely to collaborate around AT policies when partners communicated at least quarterly. In half of the cities, the probability of AT policy collaboration was higher when two agencies exchanged resources and when organizations had perceived decisional authority. Network analysis helped identify factors likely to improve partnerships around AT policies. Results may contribute to best practices for collaboration among researchers, practitioners, policymakers, and advocates across diverse sectors seeking to promote population-level physical activity.
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Affiliation(s)
- Marissa L Zwald
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Amy A Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Susan L Handy
- Department of Environmental Science and Policy, University of California at Davis, USA
| | - Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Sarah Moreland-Russell
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Brown School, Washington University in St. Louis, St. Louis, MO, USA; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Phad A, Johnston S, Tabak RG, Mazzucca S, Haire-Joshu D. Developing priorities to achieve health equity through diabetes translation research: a concept mapping study. BMJ Open Diabetes Res Care 2019; 7:e000851. [PMID: 31908801 PMCID: PMC6936412 DOI: 10.1136/bmjdrc-2019-000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/17/2019] [Accepted: 11/03/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The goal of diabetes translation research is to advance research into practice and ensure equitable benefit from scientific evidence. This study uses concept mapping to inform and refine future directions of diabetes translation research with the goal of achieving health equity in diabetes prevention and control. RESEARCH DESIGN AND METHODS This study used concept mapping and input from a national network of diabetes researchers and public health practitioners. Concept mapping is a mixed-method, participant-based process. First, participants generated statements by responding to a focus prompt ("To eliminate disparities and achieve health equity in the prevention and treatment of diabetes, research should…"). Participants then sorted statements by conceptual similarity and rated each statement on importance and feasibility (Likert scale of 1-5). A cluster map was created using multidimensional scaling and hierarchical cluster analysis; statements were plotted by average importance and feasibility. RESULTS Ten clusters were identified containing between 6 and 12 statements from 95 total generated statements. The ranges of average importance and feasibility ratings for clusters were fairly high and narrow (3.62-4.09; 3.10-3.93, respectively). Clusters with the most statements in the "go-zone" quadrant (above average importance/feasibility) were community and partner engagement (n=7), dissemination and implementation principles (n=4), and enrichment and capacity building (n=4). Clusters with the most statements in the "innovative-targets" quadrant (above average importance, below average feasibility) included next generation interventions (n=6), policy approaches (n=4), and interventions for specific populations (n=4). CONCLUSIONS This study created a framework of 10 priority areas to guide current and future efforts in diabetes translation research to achieve health equity. Themes rated as highly important and feasible provide the basis to evaluate current research support. Future efforts should explore how to best support innovative-targets, those rated highly important but less feasible.
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Affiliation(s)
- Allison Phad
- Washington University Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Shelly Johnston
- Washington University Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel G Tabak
- Prevention Research Center in St. Louis, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Haire-Joshu
- The Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Affiliation(s)
- Debra Haire-Joshu
- The Brown School, Center for Obesity Prevention and Policy Research, Washington University in St Louis, St Louis, Missouri.,Department of Medicine, The School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Felicia Hill-Briggs
- Department of Medicine, Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Health, Behavior, and Society, Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Acute and Chronic Care, Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Peaceman AM, Clifton RG, Phelan S, Gallagher D, Evans M, Redman LM, Knowler WC, Joshipura K, Haire-Joshu D, Yanovski SZ, Couch KA, Drews KL, Franks PW, Klein S, Martin CK, Pi-Sunyer X, Thom EA, Van Horn L, Wing RR, Cahill AG. Lifestyle Interventions Limit Gestational Weight Gain in Women with Overweight or Obesity: LIFE-Moms Prospective Meta-Analysis. Obesity (Silver Spring) 2018; 26:1396-1404. [PMID: 30230252 PMCID: PMC6148360 DOI: 10.1002/oby.22250] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effects of varied lifestyle intervention programs designed to ameliorate excess gestational weight gain (GWG) in pregnant women with overweight or obesity compared with standard care, including effects on pregnancy outcomes. METHODS Seven clinical centers conducted separate randomized clinical trials to test different lifestyle intervention strategies to modify GWG in diverse populations. Eligibility criteria, specific outcome measures, and assessment procedures were standardized across trials. The results of the separate trials were combined using an individual-participant data meta-analysis. RESULTS For the 1,150 women randomized, the percent with excess GWG per week was significantly lower in the intervention group compared with the standard care group (61.8% vs. 75.0%; odds ratio [95% CI]: 0.52 [0.40 to 0.67]). Total GWG from enrollment to 36 weeks' gestation was also lower in the intervention group (8.1 ± 5.2 vs. 9.7 ± 5.4 kg; mean difference: -1.59 kg [95% CI:-2.18 to -0.99 kg]). The results from the individual trials were similar. The intervention and standard care groups did not differ in preeclampsia, gestational diabetes, cesarean delivery, or birth weight. CONCLUSIONS Behavioral lifestyle interventions focusing primarily on diet and physical activity among women with overweight and obesity resulted in a significantly lower proportion of women with excess GWG. This modest beneficial effect was consistent across diverse intervention modalities in a large, racially and socioeconomically diverse US population of pregnant women.
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Affiliation(s)
- Alan M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebecca G Clifton
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, California, USA
| | - Dympna Gallagher
- New York Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Kaumudi Joshipura
- Center for Clinical Research and Health Promotion, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Kimberly A Couch
- Phoenix Indian Medical Center, Indian Health Service, Phoenix, Arizona, USA
| | - Kimberly L Drews
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Xavier Pi-Sunyer
- New York Obesity Research Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Elizabeth A Thom
- The Biostatistics Center, George Washington University, Washington, DC, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
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Tabak RG, Morshed AB, Schwarz CD, Haire-Joshu D. Impact of a Healthy Weight Intervention Embedded Within a National Home Visiting Program on the Home Food Environment. Front Public Health 2018; 6:178. [PMID: 29998092 PMCID: PMC6028746 DOI: 10.3389/fpubh.2018.00178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/31/2018] [Indexed: 01/16/2023] Open
Abstract
Purpose: To determine whether a lifestyle intervention embedded within Parents as Teachers (PAT), a national child development and parenting home visiting program, helped families make food-related home environment changes. Design: Secondary data analysis of a stratified randomized pragmatic trial. (Trial Registration: This study is registered at www.clinicaltrials.gov NCT01567033). Setting: Participant homes in St. Louis, Missouri. Subjects: Women (n = 179 with pre-post data, of 230 with baseline) participating in standard PAT, with overweight or obesity, and at least one preschool child with BMI percentile ≥60%. Intervention: PAT + Healthy Eating and Active Living Taught at Home (HEALTH), embedded elements of the Diabetes Prevention Program within the standard PAT curriculum. PAT + HEALTH addressed specific behaviors that impact caloric intake (e.g., sugar-sweetened beverages), focusing on behavioral and environmental strategies. Consistent with PAT practice, the frequency, number, and focus (i.e., time spent on intervention components) of home visits were determined by the family's needs; dose structure was flexible [on average intervention: 23 (SD = 9), usual care: 13 (SD = 6) visits]. Measures: Food availability/accessibility and distractions in the home were assessed with items drawn largely from the HomeSTEAD Survey. Analysis: Generalized estimating equations (GEEs) were used to test equality of changes between baseline and 24 months in the intervention and usual care groups. Results: The only significant difference in the pattern of change between usual care and intervention was soda availability/accessibility (p = 0.013). Conclusion: This embedded intervention successfully reduced availability/accessibility of sugar-sweetened beverages in the home. However, given the limited impact on other food-related home environment factors, future interventions could seek to more effectively intervene on all aspects of the home environment.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States.,The Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States
| | - Alexandra B Morshed
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States.,The Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Debra Haire-Joshu
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Lewkowitz AK, López JD, Stein RI, Rhoades JS, Schulz RC, Woolfolk CL, Macones GA, Haire-Joshu D, Cahill AG. Effect of a Home-Based Lifestyle Intervention on Breastfeeding Initiation Among Socioeconomically Disadvantaged African American Women with Overweight or Obesity. Breastfeed Med 2018; 13:418-425. [PMID: 29912571 PMCID: PMC6065521 DOI: 10.1089/bfm.2018.0006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Socioeconomically disadvantaged (SED) African American women with overweight or obesity are less likely to breastfeed. OBJECTIVE To test whether a home-based lifestyle intervention impacts breastfeeding initiation rates in SED African American women with overweight or obesity. STUDY DESIGN This was a secondary analysis of a randomized controlled trial from October 2012 to March 2016 at a university-based hospital within the LIFE-Moms consortium. SED African American women with overweight or obesity and singleton gestations were randomized by 16 weeks to Parents as Teachers (PAT)-a home-based parenting support and child development educational intervention-or PAT+, PAT with additional content on breastfeeding. Participants completed a breastfeeding survey. Outcomes included breastfeeding initiation and reasons for not initiating or not continuing breastfeeding. RESULTS One hundred eighteen women were included: 59 in PAT+; 59 in PAT. Breastfeeding initiation rates were similar in each group (78.00% in PAT+; 74.58% in PAT). On a one to four scale, with four denoting "very important," women in PAT+ and PAT were equally likely to rate their beliefs that formula was better than breast milk or breastfeeding would be too inconvenient as the most important reasons to not initiate breastfeeding. On the same scale, women similarly rated their difficulty latching or concern for low milk supply as the most important reasons for breastfeeding cessation. CONCLUSION SED African American women with overweight or obesity who received a home-based educational intervention had higher breastfeeding rates than is reported nationally for black women (59%). However, the intervention with more breastfeeding content did not further increase breastfeeding rates or impact reasons for breastfeeding cessation. TRIAL REGISTRATION ClinicalTrials.gov : NCT01768793.
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Affiliation(s)
- Adam K. Lewkowitz
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Julia D. López
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Richard I. Stein
- Center for Human Nutrition, Washington University in St. Louis, St. Louis, Missouri
| | - Janine S. Rhoades
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Rosa C. Schulz
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Candice L. Woolfolk
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - George A. Macones
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Debra Haire-Joshu
- School of Public Health and Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
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Budd EL, McQueen A, Eyler AA, Haire-Joshu D, Auslander WF, Brownson RC. The role of physical activity enjoyment in the pathways from the social and physical environments to physical activity of early adolescent girls. Prev Med 2018; 111:6-13. [PMID: 29447926 PMCID: PMC5985153 DOI: 10.1016/j.ypmed.2018.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 11/25/2022]
Abstract
Most girls experience a notable decline in physical activity (PA) in early adolescence, increasing their risk for harmful health outcomes. Enjoyment for PA (i.e., positive feelings toward PA) is a determinant of PA among girls during adolescence and sustained PA throughout adulthood. Previous studies recommended increasing girls' PA enjoyment in order to increase their PA, but did not include environmental-level strategies for how families, schools, or communities do this. To gain insight on such strategies, this study examines the role of PA enjoyment as a mediator of social and physical environments to moderate-to-vigorous intensity PA of early adolescent girls. Cross-sectional, secondary analyses, using structural equation modeling, were conducted on a U.S. national dataset of 1721 sixth grade girls from the Trial of Activity for Adolescent Girls in 2003. Mediation model fit parameters included χ2 (292, N = 1721) = 947.73 p < 0.001, CFI = 0.95, RMSEA = 0.04 (90% CI = 0.03, 0.04), and SRMR = 0.037 suggesting overall good fit. There were no indirect effects on PA through PA enjoyment from the social or physical environmental factors. To PA, there were significant direct effects only from social support from friends (β = 0.15, CI = 0.09, 0.22). To PA enjoyment, there were significant direct effects from social support from family (β = 0.15, CI = 0.08, 0.23), school climate (teachers β = 0.15, CI = 0.10, 0.21 and boys β = 0.15, CI = 0.09, 0.20), and neighborhood environment (β = 0.10, CI = 0.04, 0.17). The findings of this study identified several direct effects of the social and physical environment on PA enjoyment that can begin to inform environmental-level strategies for increasing PA enjoyment among early adolescent girls.
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Affiliation(s)
- Elizabeth L Budd
- College of Education, University of Oregon, 5251 University of Oregon, HEDCO Building, Eugene, OR 97403, USA.
| | - Amy McQueen
- Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130, USA.
| | - Amy A Eyler
- Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130, USA.
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130, USA.
| | - Wendy F Auslander
- Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130, USA.
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130, USA; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63130, USA.
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46
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Tabak RG, Dsouza N, Schwarz CD, Quinn K, Kristen P, Haire-Joshu D. A formative study to understand perspectives of families eligible for a pediatric obesity program: a qualitative study. BMC Public Health 2018; 18:586. [PMID: 29720138 PMCID: PMC5932800 DOI: 10.1186/s12889-018-5466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Raising Well® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation. Methods Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data. Results From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches’ flexibility and willingness to work with the family’s schedule. Acceptability themes suggest providing actionable strategies tailored to the family’s context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended. Conclusions RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Nishita Dsouza
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Karyn Quinn
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Patricia Kristen
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
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Cahill AG, Haire-Joshu D, Cade WT, Stein RI, Woolfolk CL, Moley K, Mathur A, Schechtman K, Klein S. Weight Control Program and Gestational Weight Gain in Disadvantaged Women with Overweight or Obesity: A Randomized Clinical Trial. Obesity (Silver Spring) 2018; 26:485-491. [PMID: 29464907 PMCID: PMC5826625 DOI: 10.1002/oby.22070] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of a home-based lifestyle intervention delivered through Parents as Teachers (PAT) to reduce excessive gestational weight gain (GWG). METHODS This was a single-blinded randomized controlled trial conducted as part of the LIFE-Moms consortium at a single university-based tertiary care institution from October 2012 to March 2016. There were 267 socioeconomically disadvantaged (SED) African American women with overweight or obesity (BMI 25.0-45.0 kg/m2 before pregnancy. Participants were randomized to therapy with standard PAT alone (n = 134) or PAT plus a lifestyle intervention program embedded within the standard PAT program (PAT+) (n = 133). Both interventions were delivered in 10 biweekly home visits during pregnancy. The primary outcome was the percentage of women whose GWG exceeded the Institute of Medicine guidelines, and secondary outcomes included both weekly and total GWG. RESULTS Compared with the standard PAT group in the intent-to-treat analysis, the PAT + group gained less weekly (0.4 kg vs. 0.5 kg/wk; P = 0.04) and total (8.0 kg vs. 9.6 kg; P = 0.02) weight during gestation. Fewer participants in the PAT + group had excessive total GWG (36.1% vs. 45.9%), but the difference between groups was not statistically significant (P = 0.11). CONCLUSIONS PAT + reduced the weekly and total GWG in SED African American women with overweight or obesity at the start of pregnancy.
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Affiliation(s)
- Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Debra Haire-Joshu
- School of Public Health and Medicine, Washington University in St. Louis, One Bookings Drive, Campus Box 1196, St. Louis, Missouri, 63130
| | - W. Todd Cade
- Program in Physical Therapy, Washington University in St. Louis, 4444 Forest Park Avenue, Suite 1101, St. Louis, Missouri 63108
| | - Richard I. Stein
- Center for Human Nutrition, Washington University in St. Louis, 507 South Euclid Avenue, St. Louis, Missouri 63110
| | - Candice L. Woolfolk
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Kelle Moley
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Amit Mathur
- Department of Pediatrics, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8116, St. Louis, Missouri 63110
| | - Kenneth Schechtman
- Department of Biostatistics, Washington University in St. Louis, 4523 Clayton Road, St. Louis, Missouri 63110
| | - Samuel Klein
- Program in Physical Therapy, Washington University in St. Louis, 4444 Forest Park Avenue, Suite 1101, St. Louis, Missouri 63108
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Morshed AB, Ballew P, Elliott MB, Haire-Joshu D, Kreuter MW, Brownson RC. Evaluation of an online training for improving self-reported evidence-based decision-making skills in cancer control among public health professionals. Public Health 2017; 152:28-35. [PMID: 28732323 PMCID: PMC5966825 DOI: 10.1016/j.puhe.2017.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this evaluation was to assess the effect of the online evidence-based cancer control (EBCC) training on improving the self-reported evidence-based decision-making (EBDM) skills in cancer control among Nebraska public health professionals. STUDY DESIGN Cross-sectional group comparison. METHODS Previously developed EBDM measures were administered via online surveys to 201 public health professionals at baseline (comparison group) and 123 professionals who took part in the training. Respondents rated the importance of and their skill level in 18 EBCC skills. Differences were examined using analysis of variance models adjusted for gender, age, years at agency, and years in position, and stratified by respondent educational attainment. RESULTS Among professionals without an advanced degree, training participants reported higher overall skill scores (P = .016) than the baseline non-participant group, primarily driven by differences in the partnerships and collaboration and evaluation domains. No differences in importance ratings were observed. Among professionals with advanced degrees, there were no differences in skill scores and small differences in importance scores in the expected direction (P < .05). Respondents at baseline rated the following facilitators for EBDM as important: expectations from agency leaders and community partners, high priority placed on EBDM by leadership, trainings, and positive feedback. They also reported using a variety of materials for making decisions about programs and policies, though few used individual scientific studies. CONCLUSIONS EBCC led to improved self-reported EBDM skills among public health professionals without an advanced degree, though a gap remained between the self-reported skills and the perceived importance of the skills. Further research on training content and modalities for professionals with higher educational attainment and baseline skill scores is needed.
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Affiliation(s)
- A B Morshed
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - P Ballew
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - M B Elliott
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - D Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - M W Kreuter
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - R C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
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Cahill AG, Haire-Joshu D, Cade WT, Stein RI, Woolfolk CL, Klein S. 79: Randomized controlled trial of home-based weight management therapy in pregnant socioeconomically disadvantaged (SED) women with overweight/obesity. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE To identify perceived indicators of the physical environment associated with obesity in rural communities. DESIGN Cross-sectional telephone survey. SETTING Thirteen communities in rural Missouri, Tennessee, and Arkansas, 2003. SUBJECTS A total of 2510 adults completed the survey and 2210 respondents were included in the analysis (74% female, 93% white, and 27% obese). MEASURES The 106-item survey measured perceptions of the neighborhood environment (recreational facilities, land use, transportation/safety, aesthetics, and food environment) and health-related behaviors. The primary outcome was obese (body mass index [BMI] > or = 30 kg/mn2) vs. normal weight (BMI = 18.5-24.9 kg/m2). ANALYSIS Logistic regression was used to control for age, gender and education. RESULTS Several indicators of the perceived neighborhood environment were associated with being obese (adjusted odds ratio [95% confidence interval]), including furthest distance to the nearest recreational facility (1.8 [1.3-2.4]), unpleasant community for physical activity (1.8 [1.3-2.6]), feeling unsafe from crime (2.1 [1.5-2.9]) or traffic (1.7 [1.2-2.3]), and few nonresidential destinations (1.4 [1.0-1.9]). Distance to recreational facilities and crime safety remained significant in the multivariate model, along with dietary-fat intake, sedentary behavior, and moderate/vigorous physical activity. CONCLUSION This study adds to a growing evidence base of environmental correlates of obesity and makes a unique contribution regarding rural communities. If causality is established, environmental interventions that target obesogenic neighborhood features may reduce the prevalence of obesity on a population level.
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Affiliation(s)
- Tegan K Boehmer
- Department of Community Health, School of Public Health, Saint Louis University, St. Louis, Missouri, USA
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