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Cheng TYD, Chaudhari PV, Bitsie KR, Striley CW, Varma DS, Cottler LB. The HealthStreet Cancer Survivor Cohort: a Community Registry for Cancer Research. J Cancer Surviv 2024; 18:366-374. [PMID: 35089522 PMCID: PMC9329490 DOI: 10.1007/s11764-022-01173-4] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This report describes a cancer survivor cohort from a community engagement program and compares characteristics and willingness to participate in health research between the cancer survivors and non-cancer community members. METHODS Among 11,857 members enrolled in HealthStreet at the University of Florida (10/2011-03/2020), 991 cancer survivors were identified and 1:1 matched to control members without cancer on sex, age, and zip code. Demographics, body weight, height, social determinants of health, history of cancer, and willingness to participate in research were recorded by Community Health Workers as a part of the baseline Health Needs Assessment. RESULTS Among the cancer survivors, 71.6% were female and 19.2% lived in rural areas with a mean age of 56.7 years in females and 60.8 years in males. At baseline, 44.7% received a cancer diagnosis within 5 years, while 15.8%, more than 20 years. Cancer survivors (vs. matched non-cancer controls) were less likely to be Black (31.1% vs. 63.6%) but more likely to be divorced, separated, or widowed (49.5% vs. 41.2%), be normal/underweight (34.0% vs. 25.6%) and have health insurance (80.0% vs. 68.6%; all p < 0.05). Cancer survivors versus matched controls reported higher rates of ever being in a health research study (32.4% vs. 24.9%) and interest in participating in studies ranging from minimal risk to greater-than-minimal risk. CONCLUSIONS Cancer survivors from this community engagement program agnostic to cancer types and treatment are diverse in geography, race, and social determinants of health and can be a valuable resource for observational, interventional, and biospecimen research in cancer survivorship.
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Affiliation(s)
- Ting-Yuan David Cheng
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA.
| | - Piyush V Chaudhari
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Kevin R Bitsie
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, 4th Floor, P.O. Box 100231, Gainesville, FL, 32610, USA
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McMahon AN, Varma DS, Fechtel H, Sibille K, Li Z, Cook RL, Wang Y. Perceived Effectiveness of Medical Cannabis Among Adults with Chronic Pain: Findings from Interview Data in a Three-Month Pilot Study. Cannabis 2023; 6:62-75. [PMID: 37484052 PMCID: PMC10361798 DOI: 10.26828/cannabis/2023/000149] [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] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objectives Patient-reported outcomes are critical to evaluate the effectiveness of medical cannabis as an alternative treatment for chronic pain. This study examined the perceived effectiveness of medical cannabis for chronic pain management among middle-aged and older adults newly initiating medical cannabis. Methods Interview data from participants in a three-month pilot study were analyzed to assess the perceived effectiveness of medical cannabis on chronic pain and related outcomes. The interview was conducted after approximately one month of usage and responses were analyzed using the RADaR (Rigorous and Accelerated Data Reduction) technique. Results 51 adults initiating medical cannabis for chronic pain were interviewed (24 women, 27 men, mean age 54.4, SD = 12.0), with the majority (n=41) identifying as Non-Hispanic White followed by Non-Hispanic Black (n=7), Multi-racial (2), Hispanic White (1). Most study participants (62.7%) reported MC being overall effective. Common benefits included reduced pain intensity, anxiety, and dependency on pain and psychiatric medications. Improvements in physical functioning, sleep quality, and mood were reported. Common challenges included difficulty finding a suitable product or dose, experiencing side effects such as 'undesired high', 'stomach issues', and a limited 'threshold of pain' treatable by the product. Discussion Findings suggest most participants perceived medical cannabis to be overall effective for chronic pain management. Participants reported improved physical and mental functioning and reduced use of pain and psychiatric medications. Future research systematically assessing side effects, dosage and mode of consumption is needed to further evaluate the outcomes among adults initiating medical cannabis.
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Affiliation(s)
| | | | | | | | - Zhigang Li
- Department of Biostatistics, University of Florida
| | | | - Yan Wang
- Department of Epidemiology, University of Florida
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3
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Parisi CE, Wang Y, Varma DS, Vaddiparti K, Ibañez GE, Carrillo LC, Cook RL. Changes in frequency of cannabis use among people with HIV during the COVID-19 pandemic: a multi-methods study to explore the underlying reasons for change. Am J Drug Alcohol Abuse 2023; 49:470-480. [PMID: 36898081 PMCID: PMC10695005 DOI: 10.1080/00952990.2023.2176234] [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] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 03/12/2023]
Abstract
Background: People with HIV (PWH) report higher rates of cannabis use than the general population. It is unclear how cannabis use among PWH has been impacted by the COVID-19 pandemic and the implications for the health and wellbeing of PWH.Objectives: To describe changes in frequency of cannabis use among a sample of PWH during the pandemic, reasons for those changes, and implications of the findings.Methods: The data are cross-sectional and come from questions asked in a follow-up phone survey administered to a prospective cohort of PWH in Florida between May 2020 and March 2021. Participants who used cannabis were asked about changes in their frequency of cannabis use in a quantitative survey and reasons for changes in a qualitative open-ended question. Qualitative data were analyzed using thematic analysis.Results: Among 227 PWH (mean age 50, 50% men, 69% Black/African American, 14% Hispanic/Latino), 13% decreased frequency of cannabis, 11% increased frequency, and 76% reported no change. The most common reasons for increasing frequency of cannabis use were reducing anxiety/stress, trying to relax, coping with grief or reducing symptoms of depression, and reducing boredom during the pandemic. Supply or access issues, health concerns, and having already wanted to reduce cannabis use were common reasons for decreased frequency.Conclusion: Nearly 25% of the sample changed their cannabis use frequency during the pandemic. These findings shed light on the behaviors and motivations of PWH who use cannabis and can inform clinical practice and interventions during public health emergencies and beyond.
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Affiliation(s)
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | - Deepthi S. Varma
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | | | - Gladys E. Ibañez
- Department of Epidemiology, Florida International University, Miami, FL USA
| | | | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL USA
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Varma DS, Mualem M, Goodin A, Gurka KK, Wen TST, Gurka MJ, Roussos-Ross K. Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers. JMIR Form Res 2023; 7:e44500. [PMID: 37285185 DOI: 10.2196/44500] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/14/2023] [Accepted: 04/07/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. OBJECTIVE This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. METHODS Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. RESULTS Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. CONCLUSIONS The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population.
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Affiliation(s)
- Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Maya Mualem
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety Consortium for Medical Marijuana Clinical Outcomes Research, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Kelly K Gurka
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Tony Soo-Tung Wen
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Matthew J Gurka
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Kay Roussos-Ross
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, United States
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Deaterly CD, Varma DS, Li Y, Manavalan P, Cook RL. Mental health, substance use, and risky sexual behaviors among women living with HIV. J Nurs Scholarsh 2023; 55:751-760. [PMID: 37132071 PMCID: PMC10626942 DOI: 10.1111/jnu.12900] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Risky sexual behavior has been explored in women living with HIV (WLHIV) internationally but is not well studied in WLHIV in the United States (U.S.). This merits further investigation due to the negative reproductive and HIV health outcomes associated with risky sexual behavior, such as the increased risk for HIV transmission and infertility from sexually transmitted infections (STIs). The aims of this study are to (1) describe sexual behaviors in a cohort of WLHIV in Florida, (2) determine whether demographic characteristics, substance use, and mental health symptoms are associated with risky sexual behavior in a cohort of WLHIV in Florida, and (3) explore whether the relationship between substance use and mental health symptoms and risky sexual behavior differs in reproductive-age (age 18-49), compared to non-reproductive-age WLHIV (age 50+). DESIGN This was a cross-sectional analysis of data from a multisite cohort study done in Florida. METHODS Data were collected from a sample of 304 participants who were recruited into the Florida Cohort Study from 9 clinical and community sites in Florida between 2014 to 2017. The predictor variables of interest were mental health symptoms, substance use, and demographic variables. The outcome variable of interest was risky sexual behavior which was defined as reporting ≥1 of the following: (1) at least one STI diagnosis in the past 12 months, (2) two or more sexual partners in the past 12 months, or (3) any inconsistent condom use in the past 12 months. Descriptive statistics, bivariate analysis, and logistic regression (p < 0.1) were conducted on the variables of interest. RESULTS The mean age of the sample was 47.8 years, and approximately half (51.6%) of the sample was of reproductive-age. Reporting ≥1 risky sexual behavior was reported in over half (51.6%) of the reproductive-age WLHIV in the sample and 32% of the non-reproductive-age WLHIV in the sample. Binge drinking, alcohol-related problems, marijuana use, and age were all significantly associated with self-reporting ≥1 risky sexual behaviors in all WLHIV. Self-reporting binge drinking, marijuana use, and a high alcohol-related problems score respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior in all WLHIV. Neither mental health symptoms nor race/ethnicity or education were significantly associated with self-reporting ≥1 risky sexual behavior in all WLHIV. Self-reporting severe anxiety symptoms and high alcohol-related problems scores respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior only in reproductive-age WLHIV from the sample. CONCLUSION Marijuana use, binge drinking, and alcohol-related problems appear to have a relationship with risky sexual behavior in WLHIV regardless of age. Reproductive-age also appears to influence risky sexual behavior in WLHIV, and specific reporting severe anxiety symptoms and high alcohol-related problems in reproductive-age WLHIV increases the odds of engaging in risky sexual behavior. CLINICAL SIGNIFICANCE This study holds clinical significance for nurses and other clinicians working in reproductive health settings and clinics with WLHIV. Results indicate that it could be beneficial to do more screening for mental health symptoms (particularly anxiety) and alcohol use in younger reproductive-age WLHIV.
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Affiliation(s)
| | - Deepthi S. Varma
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yancheng Li
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Preeti Manavalan
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
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LeBeau K, Varma DS, Kreider CM, Castañeda G, Knecht C, Cowper Ripley D, Jia H, Hale-Gallardo J. Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities. Front Public Health 2023; 11:1057586. [PMID: 37050942 PMCID: PMC10083506 DOI: 10.3389/fpubh.2023.1057586] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundThe Veterans Health Administration (VHA) is one of the largest providers of telehealth in the United States and continues to lead the way in transforming healthcare services. VHA has been implementing its Whole Health (WH) initiative since 2018, a proactive practice empowering patients to take charge of their health and well-being. A key facilitator of the WH initiative is the WH coach who partners with Veterans to achieve their health-related goals. A gap exists in the literature regarding the understanding of WH coaches’ use of telehealth to engage rural-residing Veterans. COVID-19 unexpectedly interrupted in-person VHA delivery of care, including WH coaching which primarily relied on in-person delivery and focused less on telehealth. During the pandemic, WH coaches had to adapt and integrate different modalities to engage their Veteran patients. We examined WH coaches’ approaches to extending coaching to rural Veterans via technology, emphasizing the advantages of telehealth, existing gaps in telehealth delivery, and opportunities for telehealth as a coaching modality.MethodsThis project was implemented as part of a larger mixed methods evaluation regarding WH coaching for rural Veterans; this manuscript presents the findings from the qualitative data from the larger study. The qualitative dataset is comprised of data collected using three different qualitative methods: four focus groups (n = 11; 3–4 participants per group), in-depth individual interviews (n = 9), and open-ended responses from a national web-based survey (n = 140). Focus group, in-depth interview, and open-ended survey data were collected sequentially and separately analyzed following each wave of data collection. Findings from the three analyses were then collaboratively merged, compared, reorganized, and refined by the evaluation team to create final themes.ResultsThree final themes that emerged from the merged data were: (1) Advantages of Telehealth; (2) Telehealth Gaps for Rural Veterans, and (3) Strategies for Bridging Telehealth Gaps. Themes explicate telehealth advantages, gaps, and opportunities for rural Veteran WH coaching.ConclusionFindings highlight that video telehealth alone is not sufficient for meeting the needs of rural Veterans. Digital technologies hold promise for equalizing health access gaps; however, both human factors and broadband infrastructure constraints continue to require WH coaches to use a mix of modalities in working with rural Veterans. To overcome challenges and bridge gaps, WH coaches should be ready to adopt a blended approach that integrates virtual, in-person, and lower-tech options.
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Affiliation(s)
- Kelsea LeBeau
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
- *Correspondence: Kelsea LeBeau,
| | - Deepthi S. Varma
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Consuelo M. Kreider
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Gail Castañeda
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
| | - Cheri Knecht
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
| | - Diane Cowper Ripley
- Director Emeritus, GeoSpatial Outcomes Division, Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
| | - Huanguang Jia
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - J. Hale-Gallardo
- Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Office of Rural Health, Veterans Health Administration, Salt Lake City, UT, United States
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Magalhães M, Havelaar AH, Varma DS, Cacho N, Sullivan S, Parker LA. Leveraging mHealth and a milk expression frequency biomarker during postpartum to prolong lactation among parents of critically ill infants: a pilot study. J Perinatol 2023; 43:616-623. [PMID: 36882532 PMCID: PMC9991875 DOI: 10.1038/s41372-023-01639-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To assess the feasibility and potential benefits of personalized biomarker-based text messages in prolonging lactation among parents of critically ill infants. STUDY DESIGN Thirty-six participants were randomized to receive either daily texts with Mother's Own Milk (MOM) sodium levels or standard care. Surveys at months 1 and 3 assessed whether infants were receiving exclusive MOM feeding, any MOM feeding, and whether the parent was still lactating. Kaplan-Meier and log-rank tests were used for time-to-event analysis within and between intervention and control groups. RESULTS Participants were predominantly on Medicaid (72%), delivered infants <1500 g, and by c-section (56%). Kaplan-Meier probabilities at month 3 suggest prolonged MOM feeding (63% [0.95CI, 0.43-0.91] vs. 41% [0.95CI, 0.21-0.67]) and lactation (63% [0.95CI, 0.42-0.95] vs. 37% [0.95CI, 0.18-0.76]) in the enhanced group compared to the control group. CONCLUSION Personalized biomarker-based text messages are feasible and may prolong lactation and MOM feeding among parents of critically ill infants.
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Affiliation(s)
- Marina Magalhães
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA. .,Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Arie H Havelaar
- Department of Animal Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.,Food Systems Institute, University of Florida, Gainesville, FL, USA
| | - Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole Cacho
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra Sullivan
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Leslie A Parker
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Hale-Gallardo J, Kreider CM, Castañeda G, LeBeau K, Varma DS, Knecht C, Cowper Ripley D, Jia H. Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches' Expanded Services and Support during COVID-19. Int J Environ Res Public Health 2022; 19:13447. [PMID: 36294023 PMCID: PMC9602744 DOI: 10.3390/ijerph192013447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this qualitative study was to explore perspectives of Whole Health (WH) coaches at the Veterans Health Administration (VHA) on meeting the needs of rural Veterans during the COVID-19 pandemic. The evaluation design employed a qualitative description approach, employing focus groups and in-depth interviews with a convenience sample of WH coaches across the VHA system. Fourteen coaches who work with rural Veterans participated in either one of three focus groups, individual interviews, or both. The focus group data and in-depth interviews were analyzed separately using thematic analysis, and findings were then merged to compare themes across both datasets. Four primary themes were identified: bridging social risk factors for rural Veterans, leveraging technology to stay connected with Veterans at-a-distance, redirecting Veterans to alternate modes of self-care, and maintaining flexibility in coaching role during COVID-19. One overarching theme was also identified following a post-hoc analysis driven by interdisciplinary team discussion: increased concerns for Veteran mental health during COVID-19. Coaches reported using a variety of strategies to respond to the wide-ranging needs of rural Veterans during the pandemic. Implications of findings for future research and practice are discussed.
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Affiliation(s)
- J Hale-Gallardo
- Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Office of Rural Health, Veterans Health Administration, Salt Lake City, UT 84148, USA
| | - Consuelo M Kreider
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32611, USA
| | - Gail Castañeda
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Kelsea LeBeau
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Deepthi S Varma
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
- Department of Epidemiology, University of Florida, Gainesville, FL 32611, USA
| | - Cheri Knecht
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Diane Cowper Ripley
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Huanguang Jia
- Department of Biostatistics, University of Florida, Gainesville, FL 32611, USA
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Parisi CE, Varma DS, Wang Y, Vaddiparti K, Ibañez GE, Cruz L, Cook RL. Changes in Mental Health Among People with HIV During the COVID-19 Pandemic: Qualitative and Quantitative Perspectives. AIDS Behav 2022; 26:1980-1991. [PMID: 34993668 PMCID: PMC8736305 DOI: 10.1007/s10461-021-03547-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
People with HIV (PWH) are at risk for adverse mental health outcomes, which could be elevated during the COVID-19 pandemic. This study describes reasons for changes in mental health among PWH during the pandemic. Data come from closed- and open-ended questions about mental health changes from a follow-up to a cohort study on PWH in Florida during part of the COVID-19 pandemic (May 2020-March 2021). Qualitative data were analyzed using thematic analysis. Among the total sample of 227 PWH (mean age 50.0, 49.7% men, 69.2% Black/African American, 14.1% Hispanic/Latino), 30.4% reported worsened mental health, 8.4% reported improved mental health, and 61.2% reported no change. The primary reasons for worsened mental health were concerns about COVID-19, social isolation, and anxiety/stress; reasons for improved mental health included increased focus on individual wellness. Nearly one-third of the sample experienced worsened mental health. These results provide support for increased mental health assessments in HIV treatment settings.
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Affiliation(s)
- Christina E Parisi
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Deepthi S Varma
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Yan Wang
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Krishna Vaddiparti
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Liset Cruz
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
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Angell AM, Varma DS, Deavenport-Saman A, Yin L, Solomon O, Bai C, Zou B. Effects of Sex, Race, and Ethnicity on Primary and Subspecialty Healthcare Use by Autistic Children in Florida: A Longitudinal Retrospective Cohort Study (2012-2018). Res Autism Spectr Disord 2022; 94:101951. [PMID: 35498508 PMCID: PMC9053730 DOI: 10.1016/j.rasd.2022.101951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Amber M. Angell
- Department of Occupational Therapy at University of Florida, PO Box 100165, Gainesville, FL 32610
| | - Deepthi S. Varma
- Department of Epidemiology at University of Florida, 2004 Mowry Road, Gainesville, FL, 32610
| | - Alexis Deavenport-Saman
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
| | - Larry Yin
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy at University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089
| | - Olga Solomon
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
| | - Chen Bai
- Department of Biostatistics at University of Florida, 2004 Mowry Road, Gainesville, FL, 32610
| | - Baiming Zou
- Department of Biostatistics at University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599
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Boullosa CC, Vaddiparti K, Lopez-Quintero C, Varma DS, L Cook R. Clinical Decision Making by Medical Marijuana Physicians in Florida: A Qualitative Assessment. Subst Use Misuse 2022; 57:2042-2052. [PMID: 36305815 DOI: 10.1080/10826084.2022.2129995] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Medical marijuana (MMJ) was legalized in November 2016 with the passing of Amendment 2 in the state of Florida. Since the legalization, many studies have been conducted to understand the direct effect medical marijuana has on specific medical conditions. Unlike most allopathic drugs, medical marijuana does not target single ailments or specific conditions and does not follow precise recommending guidelines. There is scarce knowledge on how patient characteristics, including medical conditions, affect a physician's direct recommendations and registry limits. To obtain insight on the effect patient characteristics have on the clinical decision-making process, we conducted ten qualitative interviews of medical marijuana physicians who are certified to order medical marijuana for patients in Florida. Interview topics ranged from typical daily practice to specific recommendations for patient histories. Each interview was transcribed and thematically analyzed. Five major patient characteristics that influence a physician's recommendation emerged from the interviews: patient medical history, co-medications, lifestyle, marijuana experience level and counter-indications. Each category was analyzed further to understand how the characteristics influenced the practice of recommending and ordering product. Physicians emphasized the equivalent importance of reviewing a patient's medical history, lifestyle, and past marijuana experiences while also expressing the need to look holistically at the individual patient. Instead of the characteristics determining what the physician recommends for the patient and orders through the registry, the characteristics dictate the education given to the patient so that the patient may lead and determine their own individual care.
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Affiliation(s)
| | - Krishna Vaddiparti
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | | | - Deepthi S Varma
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
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12
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Varma DS, Young ME, Kreider CM, Williams K, Vaddiparti K, Parisi C, Semeah LM. Practical Considerations in Qualitative Health Research During the COVID-19 Pandemic. Int J Qual Methods 2021; 20:16094069211043755. [PMID: 34602922 PMCID: PMC8473965 DOI: 10.1177/16094069211043755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic has forced both quantitative and qualitative health researchers to adapt and strategize data collection strategies without causing any harm to the participants or researchers. This has resulted in utilizing various types of strategies such as online surveys and synchronous virtual platforms such as Zoom and Webex. This transition from face-to-face to synchronous online platforms has helped in increasing coverage as well as reaching participants who are otherwise unreachable. While quantitative health researchers seem to have made a seamless transition to synchronous online platforms, qualitative health researchers who rely on studying participants in their "real-world-settings" are facing unique challenges with online data collection strategies. This article critically examines the benefits and challenges of implementing qualitative health research studies via synchronous online platforms and provides several practical considerations that can inform qualitative health researchers. It can also assist Institutional Review Board members in reviewing and implementing qualitative health research study protocols in a manner that preserves the integrity, richness, and iterative nature of qualitative research methodology.
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Affiliation(s)
- Deepthi S. Varma
- Department of Epidemiology, College
of Public Health and Health Professions and College of Medicine,
University
of Florida, Gainesville, FL, USA
| | - Mary E. Young
- Department of Occupational Therapy,
College of Public Health and Health Professions and College of Medicine,
University
of Florida, Gainesville, FL, USA
| | - Consuelo M. Kreider
- Department of Occupational Therapy,
College of Public Health and Health Professions and College of Medicine,
University
of Florida, Gainesville, FL, USA
| | - Katherine Williams
- Department of Counselor Education,
College of Education, University of
Florida, Gainesville, FL, USA
| | - Krishna Vaddiparti
- Department of Epidemiology, College
of Public Health and Health Professions and College of Medicine,
University
of Florida, Gainesville, FL, USA
| | - Christina Parisi
- Department of Epidemiology, College
of Public Health and Health Professions and College of Medicine,
University
of Florida, Gainesville, FL, USA
| | - Luz M. Semeah
- Veterans Rural Health Resource Center-
Gainesville (VRHRC) within the North Florida/South Georgia Veterans
Health System, Gainesville, FL,
USA
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Grumbach K, Cottler LB, Brown J, LeSarre M, Gonzalez-Fisher RF, Williams CD, Michener JL, Nease DE, Tandon D, Varma DS, Eder M. It should not require a pandemic to make community engagement in research leadership essential, not optional. J Clin Transl Sci 2021; 5:e95. [PMID: 34192052 PMCID: PMC8134899 DOI: 10.1017/cts.2021.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/03/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022] Open
Abstract
Efforts to move community engagement in research from marginalized to mainstream include the NIH requiring community engagement programs in all Clinical and Translational Science Awards (CTSAs). However, the COVID-19 pandemic has exposed how little these efforts have changed the dominant culture of clinical research. When faced with the urgent need to generate knowledge about prevention and treatment of the novel coronavirus, researchers largely neglected to involve community stakeholders early in the research process. This failure cannot be divorced from the broader context of systemic racism in the US that has contributed to Black, Indigenous, and People of Color (BIPOC) communities bearing a disproportionate toll from COVID-19, being underrepresented in COVID-19 clinical trials, and expressing greater hesitancy about COVID-19 vaccination. We call on research funders and research institutions to take decisive action to make community engagement obligatory, not optional, in all clinical and translational research and to center BIPOC communities in this process. Recommended actions include funding agencies requiring all research proposals involving human participants to include a community engagement plan, providing adequate funding to support ongoing community engagement, including community stakeholders in agency governance and proposal reviews, promoting racial and ethnic diversity in the research workforce, and making a course in community engaged research a requirement for Masters of Clinical Research curricula.
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Affiliation(s)
- Kevin Grumbach
- Department of Family and Community Medicine and Clinical and Translational Science Institute, University of California, San Francisco, CA, USA
| | - Linda B. Cottler
- Department of Epidemiology and Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Jen Brown
- Alliance for Research in Chicagoland Communities and Clinical and Translational Sciences Institute, Northwestern University, Evanston, IL, USA
| | - Monique LeSarre
- Rafiki Coalition and African American Community Health Equity Council, San Francisco, CA, USA
| | | | - Carla D. Williams
- Georgetown-Howard University Center for Clinical and Translational Science, Washington, DC, USA
| | - J. Lloyd Michener
- Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, USA
| | - Donald E. Nease
- Department of Family Medicine and the Colorado Clinical and Translational Sciences Institute, University of Colorado – Anschutz Medical Campus, Aurora, CO, USA
| | - Darius Tandon
- Department of Medical Social Sciences and Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Deepthi S. Varma
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Milton Eder
- Department of Family Medicine and Community Health, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
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14
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Otufowora A, Liu Y, Varma DS, Striley CW, Cottler LB. Correlates related to follow-up in a community engagement program in North Central Florida. J Community Psychol 2020; 48:2723-2739. [PMID: 32949042 PMCID: PMC7719614 DOI: 10.1002/jcop.22450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/09/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 05/04/2023]
Abstract
AIMS This analysis identifies the correlates of 60- and 120-day telephone-based study follow-ups among community-dwelling adults in North Central Florida. METHODS Six thousand three hundred and forty participants were recruited by Community Health Workers from the University of Florida's community engagement program with a face-to-face baseline and two phone follow-ups assessing indicators of health. RESULTS Physical disability versus none (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.2─1.9), high trust in research versus none (aOR, 1.5; 95% CI, 1.1─2.1), history of research participation versus none (aOR, 1.6; 95% CI, 1.3─2.0), having health insurance versus none (aOR, 1.4; 95% CI, 1.1─1.7), interest in research participation versus none (aOR, 1.8; 95% CI, 1.3─2.7), and no drug use versus drug use (aOR, 0.5; 95% CI, 0.3─0.9) significantly predicted completion of follow-up. CONCLUSIONS Health and social factors such as disability, insurance, history of and interest in research, trust and no drug use significantly predicted completing two follow-ups. These findings can facilitate efforts to minimize attrition in the research enterprise.
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Affiliation(s)
- Ayodeji Otufowora
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
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Otufowora A, Liu Y, Young H, Egan KL, Varma DS, Striley CW, Cottler LB. Sex Differences in Willingness to Participate in Research Based on Study Risk Level Among a Community Sample of African Americans in North Central Florida. J Immigr Minor Health 2020; 23:19-25. [PMID: 32328873 DOI: 10.1007/s10903-020-01015-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/01/2022]
Abstract
This study examined the association between sex, study risks and willingness to participate in research among a community sample of African Americans. We hypothesized that African American males would be more willing to participate in studies involving both minimal and greater-than-minimal risk. The study sample was recruited through a community engagement program (HealthStreet). Interviewers obtained information on socio-demographic variables and willingness to participate in various research types. We categorized research types into minimal risk and greater- than- minimal risk based on the IRB classification. The study sample comprised 6544 African-Americans; 58.4% were females. About 92.6% of the participants were willing to participate in surveys and 58.1% in research requiring medication use. More males would participate in minimal risk studies requiring review of medical records (males 87.0% vs. females 84.2%, p = 0.0021) and studies involving giving a blood sample (males 84.2% vs. females 81.7%, p = 0.0083). Also, more males would participate in greater than minimal risk studies involving the use of medication (60.5% v. 56.3% p = 0.0007). More males were willing to participate in minimal risk studies (studies involving the review of medical records and giving blood samples) and greater-than-minimal risk study involving the use of medication.
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Affiliation(s)
- Ayodeji Otufowora
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA.
| | - Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Henry Young
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kathleen L Egan
- Department of Health Education and Promotion, College of Health and Human Sciences, East Carolina University, Greenville, NC, USA
| | - Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
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16
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Varma DS, Strelnick AH, Bennett N, Piechowski P, Aguilar-Gaxiola S, Cottler LB. Improving community participation in clinical and translational research: CTSA Sentinel Network proof of concept study. J Clin Transl Sci 2020; 4:323-330. [PMID: 33244413 PMCID: PMC7681133 DOI: 10.1017/cts.2020.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/20/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Research participation by members of racial or ethnic minority groups continues to be less than optimum resulting in difficulties to generalization of research findings. Community-engaged research that relies on a community health worker (CHW) model has been found effective in building trust in the community, thereby motivating people to participate in health research. The Sentinel Network study aimed at testing the feasibility of utilizing the CHW model to link community members to appropriate health research studies at each of the research sites. METHODS The study was conducted at six Clinical and Translational Science Award institutions (N = 2371) across the country; 733 (30.9%) of the participants were from the University of Florida, 525 (22.0%) were from Washington University in St. Louis, 421 (17.8%) were from the University of California, Davis, 288 (12.1%) were from the University of Michigan, Ann Arbor, 250 (10.5%) were from Rochester, and 154 (6.5%) from Albert Einstein College of Medicine. Trained CHWs from each of these sites conducted regular community outreach where they administered a Health Needs Assessment, provided medical and social referrals, and linked to eligible research studies at each of those sites. A 30-day follow-up assessment was developed to track utilization of services satisfaction with the services and research study participation. RESULTS A large majority of people, especially African Americans, expressed willingness to participate in research studies. The top two health concerns reported by participants were hypertension and diabetes. CONCLUSION Findings on the rate of navigation and enrollment in research from this study indicate the effectiveness of a hybrid CHW service and research model of directly engaging community members to encourage people to participate in research.
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Affiliation(s)
- Deepthi S. Varma
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Alvin H. Strelnick
- Division of Community Health, Department of Family and Social Medicine, College of Medicine, Albert Einstein, Montefiore Medical Center, Bronx, NY, USA
| | - Nancy Bennett
- Department of Medicine, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Patricia Piechowski
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities (CRHD), Clinical Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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17
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Wang K, Varma DS, Prosperi M. Response to letter. J Psychiatr Res 2019; 116:195. [PMID: 30558836 DOI: 10.1016/j.jpsychires.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Kai Wang
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Deepthi S Varma
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Mattia Prosperi
- Department of Epidemiology, University of Florida, Gainesville, FL, USA.
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Abstract
Objective The association between early age at menarche and depression among adolescent girls and adult women has been examined in many studies. However, inconsistent results and limitations such as small sample size, low generalizability, and measurement error exist. We aimed to address these issues to assess the association between age at menarche and depressive symptoms in a nationally representative sample of US women aged 18 years and older. Methods We used the 2005–2016 National Health and Nutrition Examination Survey (NHANES) data with a total of 15,674 women aged 18 years and older included in our study. Logistic regression models were used after adjusting for sociodemographic and health-related factors. Results The crude-adjusted model suggests that women with early age of menarche had 1.36 (95% CI [1.16–1.61]) times the odds of current depressive symptoms compared with the normal menarche group, after controlling for age, race/ethnicity, education, poverty income ratio (PIR) and marital status. In the fully-adjusted model, women with early menarche had 1.25 (95% CI [1.05–1.48]) times the odds of current depressive symptoms, after additionally adjusting for smoking status and body mass index (BMI). However, no significant difference was observed between the normal and late menarche groups. Conclusion Further studies are warranted to determine the causal relationship and mechanisms between early menarche and increased risk of depression.
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Affiliation(s)
- Yun Shen
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, United States of America
| | - Deepthi S Varma
- Department of Epidemiology, University of Florida, Gainesville, FL, United States of America
| | - Yi Zheng
- Department of Epidemiology, University of Florida, Gainesville, FL, United States of America
| | - Jenny Boc
- College of Nursing, University of Florida, Gainesville, FL, United States of America
| | - Hui Hu
- Department of Epidemiology, University of Florida, Gainesville, FL, United States of America
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Wang K, Varma DS, Prosperi M. A systematic review of the effectiveness of mobile apps for monitoring and management of mental health symptoms or disorders. J Psychiatr Res 2018; 107:73-78. [PMID: 30347316 DOI: 10.1016/j.jpsychires.2018.10.006] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [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: 07/06/2018] [Revised: 09/01/2018] [Accepted: 10/04/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are a growing number of mobile apps available for monitoring and management of mental health symptoms or disorders. However, clinically validated evidence for most of them is unclear; their benefits to patients on long term use are thus debatable. OBJECTIVE This updated review aimed to systematically appraise the available research evidence of the efficacy and acceptability of mobile apps for mental health in all ages. METHODS A comprehensive literature search (May 2013 to December 2017) in PubMed, Cochrane Library, EMBASE, Web of Science, and Google Scholar was conducted. Abstracts were included if they described mental health apps (targeting depression, anxiety, bipolar disorder, psychosis, post-traumatic stress disorders (PTSD), substance use disorders, sleep disorders, and suicidal behaviors) delivered on mobile devices for all ages. RESULTS In total, 1501 abstracts were identified. Of these, 17 publications describing 16 apps targeting anxiety/stress, alcohol disorder, sleep disorder, depression, suicidal behaviors, and PTSD met the inclusion criteria. Five studies randomized individuals to trial conditions, and 14 apps were proven to have clinically validated evidence in reducing mental health symptoms or disorder. CONCLUSIONS Mental health apps have potentials in improving the monitoring and management of mental health symptoms or disorders. However, majority of the apps that are currently available lack clinically validated evidence of their efficacy. Given the number and pace at which mobile Health (mHealth) apps are being released, further robust research is warranted to develop and test evidence-based programs.
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Affiliation(s)
- Kai Wang
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Deepthi S Varma
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Mattia Prosperi
- Department of Epidemiology, University of Florida, Gainesville, FL, USA.
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20
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Zhang Q, Yu B, Chen X, Varma DS, Li J, Zhao J, Ruan Y, Han X, Min X, Liu Z. Patterns of smoking initiation during adolescence and young adulthood in South-West China: findings of the National Nutrition and Health Survey (2010-2012). BMJ Open 2018; 8:e019424. [PMID: 29858407 PMCID: PMC5988072 DOI: 10.1136/bmjopen-2017-019424] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aims to understand the age patterns of smoking initiation during adolescence and young adulthood in South-West China, where the prevalence of tobacco use is reported as the highest in the country. DESIGN A cross-sectional study. SETTING The data were derived from the China National Nutrition and Health Survey in Yunnan Province, South-West China (2010-2012). PARTICIPANTS A total of 4801 participants aged 15-65 years were included. PRIMARY OUTCOME MEASURES A survival model was used to estimate the hazard of smoking initiation by age and log-rank test was used to compare the hazard curves across subgroups (men/women, urban/rural, Han Chinese/ethnic minority). RESULTS The prevalence of current smoking among men and women were 60.4% (95% CI 58.2% to 62.6%) and 5.1% (95% CI 4.3% to 5.9%), respectively. Smoking was more prevalent among men and women of lower education and less income, as well as rural and ethnic minority women. Among the current smokers, cigarette (80.7%) was the most commonly used tobacco product, followed by waterpipe (10.8%) and pipe tobacco (8.5%). The hazards of smoking initiation were low for both men and women before the age of 15 years (1% for men and 0.05% for women); and the hazards increased quickly from age 15 years and peaked at 19years (21.5% for men and 1.0% for women). Rural and ethnic minority women were at higher risk of smoking initiation than their counterparts between 15 years and 19 years of age (χ2=44.8, p<0.01; χ2=165.2, p<0.01) and no such difference was found in men. CONCLUSIONS Findings of this study underscore the importance to implement tobacco prevention interventions among older teens and young adults in South-West China, especially for rural and ethnic minority women.
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Affiliation(s)
- Qiang Zhang
- Department of Nutrition and Food Hygiene, Yunnan center for disease control and prevention, Kunming, China
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Deepthi S Varma
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Juanjuan Li
- Department of Nutrition and Food Hygiene, Yunnan center for disease control and prevention, Kunming, China
| | - Jiang Zhao
- Department of Nutrition and Food Hygiene, Yunnan center for disease control and prevention, Kunming, China
| | - Yuan Ruan
- Department of Nutrition and Food Hygiene, Yunnan center for disease control and prevention, Kunming, China
| | - Xingmeng Han
- School of Public Health, Kunming Medical University, Kunming, China
| | - Xiangdong Min
- Department of Nutrition and Food Hygiene, Yunnan center for disease control and prevention, Kunming, China
| | - Zhitao Liu
- Department of Nutrition and Food Hygiene, Yunnan center for disease control and prevention, Kunming, China
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21
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Zhang Q, Qin G, Liu Z, Li Z, Li J, Varma DS, Wan Q, Zhao J, Min X, Han X, Liu M. Dietary Balance Index-07 and the Risk of Anemia in Middle Aged and Elderly People in Southwest China: A Cross Sectional Study. Nutrients 2018; 10:nu10020162. [PMID: 29385057 PMCID: PMC5852738 DOI: 10.3390/nu10020162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/10/2018] [Accepted: 01/26/2018] [Indexed: 12/22/2022] Open
Abstract
A balanced diet is essential to achieve and maintain good health. In this study, we assessed diet quality of middle aged and elderly people based on Chinese Diet Balance Index-07 (DBI-07) and explored the associations between DBI-07 and anemia. Data analyzed for this study was from the 2010–2012 National Nutrition and Health Survey in Yunnan province, southwest China (n = 738, aged 50–77 years). Dietary recalls over there consecutive days were done in a face-to-face interview. The scores of DBI-07 for each component and three DBI-07 indicators ((Lower Bound Score (LBS), Higher Bound Score (HBS), Diet Quality Distance (DQD)) were calculated according to compliance with the Dietary Guidelines for Chinese residents. Hemoglobin (Hb) concentration was determined using the cyanmethemoglobin method. Univariate and multivariate linear regression models were used to explore the associations between DBI-07 indicators and anemia, as well as scores of DBI-07 components and Hb level. The sample included 336 men and 402 women. Inadequate intakes of vegetables, fruits, dairy, soybean, eggs, fish and excessive intakes of cereals, meat, cooking oil, salt were both common. 91.3% of the participants had moderate or high levels of inadequate food intake, while 37.7% had moderate or high levels of excessive food intake. The mean Hb was 14.2 ± 1.7 g/dL, with a prevalence of anemia of 13.0%. Subjects with high LBS and DQD were more likely to be anemic (all p < 0.05). After adjustment for potential confounders, there were positive correlations between Hb level and the intakes of vegetables and soybean (βvegetables = 1.04, p < 0.01; βsoybean = 0.82, p = 0.04). In conclusion, dietary imbalance and anemia are common in middle aged and elderly population in southwest China and inadequate intakes of vegetables and soybean may increase the risk of anemia.
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Affiliation(s)
- Qiang Zhang
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Guanghe Qin
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Zhitao Liu
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Zi Li
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Juanjuan Li
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Deepthi S Varma
- Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA.
| | - Qingqing Wan
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Jiang Zhao
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Xiangdong Min
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
| | - Xingmeng Han
- School of Public Health, Kunming Medical University, Kunming 650500, China.
| | - Min Liu
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming 650022, China.
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Abstract
BACKGROUND With rapid urbanization in the past decades, diet diversity continues to increase in China. The present cross-sectional study aims to explore the association between dietary diversity and nutritional status among adults in southwest China. METHODS This study used data from 2011-2012 National Nutritional Survey in Yunnan Province, southwest China (N = 1105).Data of three consecutive 24-hour dietary recalls were used to calculate dietary diversity scores (DDS) and nutrient adequacy ratio (NAR). Body mass index and waist circumference were used to determine nutritional status. Surveylogistic procedure of SAS 9.2 software was used to examine the association between DDS and obesity by estimating odds ratio (OR) and 95% confidence intervals (CI). RESULTS The mean DDS was 5.2 (SD 1.1) out of nine points. Being female, younger age, belonging to Han ethnicity, having higher educational level and household income were positively associated with DDS (all P<0.05). As DDS increased, consumption also increased in most food groups except grains and vegetables. People with medium and high DDS (DDS = 5 and DDS ≥6, respectively) ingested more energy than the recommended quantity(NAR = 1.1 and 1.2, respectively). However, the intakes of Calcium and Vitamin A were seriously inadequate even for people with high DDS (NAR≤0.5). With potential confounders adjusted, people with medium and high DDS were at higher risk of general and central obesity than people with DDS ≤4 (OR = 1.4-1.9, P<0.01). CONCLUSIONS Our data indicated that high DDS was associated with excessive energy intake and obesity among adults in southwest China. Although dietary diversity is widely recommended, public health messages should give less emphasis on dietary diversity.
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Affiliation(s)
- Qiang Zhang
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming, China
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
| | - Zhitao Liu
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Deepthi S. Varma
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
| | - Rong Wan
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Shiwen Zhao
- Department of Nutrition and Food Hygiene, Yunnan Center for Disease Control and Prevention, Kunming, China
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Ahmad J, Khan ME, Mozumdar A, Varma DS. Gender-Based Violence in Rural Uttar Pradesh, India: Prevalence and Association With Reproductive Health Behaviors. J Interpers Violence 2016; 31:3111-3128. [PMID: 25948646 DOI: 10.1177/0886260515584341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study explores the prevalence of different forms of domestic violence and their impact on women's reproductive health behavior in rural Uttar Pradesh (UP), India. Data were collected as a part of a large household survey carried out in 2009-2010. A multistage stratified systematic sampling design was used. A total of 4,223 married women aged 15 to 49 years and 2,274 husbands of these women were interviewed. Data were analyzed using bivariate and multivariate analyses. More than one third of married women in rural UP had experienced one or more forms of violence, such as verbal abuse, physical manhandling, and sexual abuse by their spouse. Nearly 47% of the women had experienced some form of violence during their last pregnancy. Significant associations were found between violence and incorrect reproductive health behaviors, pregnancy complications, poor birth preparedness, poor likelihood of institutional delivery, limited postnatal care, and limited spousal communication for family planning. After controlling for socio-economic variables in multivariate analysis, only pregnancy complications (odds ratio [OR] = 1.62, 95% confidence interval [CI] = [1.40, 1.85]) and lack of delivery preparedness (OR = 0.79, 95% CI = [0.68, 0.93]) were found to be significantly associated with violence. Husband's attitude and reporting of violence by their wives in different situations were not significantly associated. This study provides evidence of the association of violence on the reproductive health behavior of married women in rural India. The results argue for frontline health workers to identify and counsel pregnant women experiencing violence during antenatal check-up to reduce maternal morbidity and mortality.
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Affiliation(s)
| | - M E Khan
- 1 Population Council, New Delhi, India
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24
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Frerichs L, Kim M, Dave G, Cheney A, Hassmiller Lich K, Jones J, Young TL, Cene CW, Varma DS, Schaal J, Black A, Striley CW, Vassar S, Sullivan G, Cottler LB, Brown A, Burke JG, Corbie-Smith G. Stakeholder Perspectives on Creating and Maintaining Trust in Community-Academic Research Partnerships. Health Educ Behav 2016; 44:182-191. [PMID: 27230272 DOI: 10.1177/1090198116648291] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community-academic research partnerships aim to build stakeholder trust in order to improve the reach and translation of health research, but there is limited empirical research regarding effective ways to build trust. This multisite study was launched to identify similarities and differences among stakeholders' perspectives of antecedents to trust in research partnerships. In 2013-2014, we conducted a mixed-methods concept mapping study with participants from three major stakeholder groups who identified and rated the importance of different antecedents of trust on a 5-point Likert-type scale. Study participants were community members ( n = 66), health care providers ( n = 38), and academic researchers ( n = 44). All stakeholder groups rated "authentic communication" and "reciprocal relationships" the highest in importance. Community members rated "communication/methodology to resolve problems" ( M = 4.23, SD = 0.58) significantly higher than academic researchers ( M = 3.87, SD = 0.67) and health care providers ( M = 3.89, SD = 0.62; p < .01) and had different perspectives regarding the importance of issues related to "sustainability." The importance of communication and relationships across stakeholders indicates the importance of colearning processes that involve the exchange of knowledge and skills. The differences uncovered suggest specific areas where attention and skill building may be needed to improve trust within partnerships. More research on how partnerships can improve communication specific to problem solving and sustainability is merited.
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Affiliation(s)
- Leah Frerichs
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mimi Kim
- 2 Duke University, Durham, NC, USA
| | - Gaurav Dave
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ann Cheney
- 3 University of California, Riverside, CA, USA
| | | | | | - Tiffany L Young
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Crystal W Cene
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jennifer Schaal
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adina Black
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | - Arleen Brown
- 5 University of California, Los Angeles, CA, USA
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Varma DS. Sustainability: The Critical Piece in a Successful Intervention. Am J Public Health 2015; 105:e1. [DOI: 10.2105/ajph.2015.302702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Deepthi S. Varma
- Deepthi S. Varma is with the Department of Epidemiology, University of Florida, Gainesville
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Varma DS, Chandra PS, Callahan C, Reich W, Cottler LB. Perceptions of HIV risk among monogamous wives of alcoholic men in South India: a qualitative study. J Womens Health (Larchmt) 2012; 19:815-21. [PMID: 20201705 DOI: 10.1089/jwh.2008.0884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To understand women's perceptions of their own HIV risk and to determine the feasibility of conducting an HIV prevention study. METHODS Two focus groups were conducted in November 2004 with wives of heavy drinkers admitted to the Deaddiction Unit at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India. Data were analyzed using content analysis. RESULTS Results focused on (1) awareness of the women regarding HIV/AIDS and condom use, (2) perception of personal risk for HIV/AIDS and the risk of their spouses, and (3) the feasibility of a future community-based HIV prevention study. Focus group findings indicated that although the majority of the women were aware of HIV/AIDS, there were important misconceptions about the mode of transmission. Women acknowledged the potential risk for HIV associated with their spouse's drinking, as well as their extramarital sexual activities, but expressed an inability to negotiate safer sex behaviors, such as condom use, within the context of marriage. This was often expressed as fear of being physically abused for attempting such negotiations. All women agreed that the HIV prevention study we proposed, originally developed in the West, would be acceptable if tailored to specific local needs. The women provided valuable suggestions for the effective implementation of the study. CONCLUSIONS The findings of this study indicate a critical need to develop culturally relevant HIV prevention programs directly targeted to wives that equip them with effective skills to negotiate safer sex behaviors with their spouses.
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Affiliation(s)
- Deepthi S Varma
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 63108, USA
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Varma DS. ASSESSMENT OF THE EFFECTS OF SOCIAL SUPPORT ON ADOLESCENTS WITH PARENTS WITH HIV/AIDS. Am J Public Health 2008; 98:966; author reply 967. [DOI: 10.2105/ajph.2007.133140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Deepthi S. Varma
- The author is with the Department of Psychiatry, School of Medicine, Washington University, St Louis, MO
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