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Yaseen A, DeSantis SM, Sabharwal R, Talebi Y, Swartz MD, Zhang S, Leon Novelo L, Pinzon-Gomez CL, Messiah SE, Valerio-Shewmaker M, Kohl HW, Ross J, Lakey D, Shuford JA, Pont SJ, Boerwinkle E. Baseline characteristics of SARS-CoV-2 vaccine non-responders in a large population-based sample. PLoS One 2024; 19:e0303420. [PMID: 38739625 PMCID: PMC11090326 DOI: 10.1371/journal.pone.0303420] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Studies indicate that individuals with chronic conditions and specific baseline characteristics may not mount a robust humoral antibody response to SARS-CoV-2 vaccines. In this paper, we used data from the Texas Coronavirus Antibody REsponse Survey (Texas CARES), a longitudinal state-wide seroprevalence program that has enrolled more than 90,000 participants, to evaluate the role of chronic diseases as the potential risk factors of non-response to SARS-CoV-2 vaccines in a large epidemiologic cohort. METHODS A participant needed to complete an online survey and a blood draw to test for SARS-CoV-2 circulating plasma antibodies at four-time points spaced at least three months apart. Chronic disease predictors of vaccine non-response are evaluated using logistic regression with non-response as the outcome and each chronic disease + age as the predictors. RESULTS As of April 24, 2023, 18,240 participants met the inclusion criteria; 0.58% (N = 105) of these are non-responders. Adjusting for age, our results show that participants with self-reported immunocompromised status, kidney disease, cancer, and "other" non-specified comorbidity were 15.43, 5.11, 2.59, and 3.13 times more likely to fail to mount a complete response to a vaccine, respectively. Furthermore, having two or more chronic diseases doubled the prevalence of non-response. CONCLUSION Consistent with smaller targeted studies, a large epidemiologic cohort bears the same conclusion and demonstrates immunocompromised, cancer, kidney disease, and the number of diseases are associated with vaccine non-response. This study suggests that those individuals, with chronic diseases with the potential to affect their immune system response, may need increased doses or repeated doses of COVID-19 vaccines to develop a protective antibody level.
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Affiliation(s)
- Ashraf Yaseen
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Stacia M. DeSantis
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Rachit Sabharwal
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Yashar Talebi
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Michael D. Swartz
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Shiming Zhang
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Luis Leon Novelo
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Cesar L. Pinzon-Gomez
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston, School of Public Health in Dallas, Dallas, TX, United States of America
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas, United States of America
| | - Melissa Valerio-Shewmaker
- The University of Texas Health Science Center at Houston, School of Public Health in Brownville, Brownsville, TX, United States of America
| | - Harold W. Kohl
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, United States of America
- University of Texas at Austin, Austin, TX, United States of America
| | - Jessica Ross
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
| | - David Lakey
- University of Texas System, Austin, TX, United States of America
- The University of Texas Health Science Center Tyler, Tyler, TX, United States of America
| | - Jennifer A. Shuford
- Texas Department of State Health Services, Austin, TX, United States of America
| | - Stephen J. Pont
- Texas Department of State Health Services, Austin, TX, United States of America
| | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, United States of America
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2
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Sandoval MN, McClellan SP, Pont SJ, Ross JA, Swartz MD, Silberman MA, Boerwinkle E. Prozone masks elevated SARS-CoV-2 antibody level measurements. PLoS One 2024; 19:e0301232. [PMID: 38547209 PMCID: PMC10977713 DOI: 10.1371/journal.pone.0301232] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
We report a prozone effect in measurement of SARS-CoV-2 spike protein antibody levels from an antibody surveillance program. Briefly, the prozone effect occurs in immunoassays when excessively high antibody concentration disrupts the immune complex formation, resulting in a spuriously low reported result. Following participant inquiries, we observed anomalously low measurement of SARS-CoV-2 spike protein antibody levels using the Roche Elecsys® Anti-SARS-CoV-2 S immunoassay from participants in the Texas Coronavirus Antibody Research survey (Texas CARES), an ongoing prospective, longitudinal antibody surveillance program. In July, 2022, samples were collected from ten participants with anomalously low results for serial dilution studies, and a prozone effect was confirmed. From October, 2022 to March, 2023, serial dilution of samples detected 74 additional cases of prozone out of 1,720 participants' samples. Prozone effect may affect clinical management of at-risk populations repeatedly exposed to SARS-CoV-2 spike protein through multiple immunizations or serial infections, making awareness and mitigation of this issue paramount.
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Affiliation(s)
- Micaela N. Sandoval
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | | | - Stephen J. Pont
- Center for Public Health Policy and Practice at Texas Department of State Health Services, Austin, Texas, United States of America
| | - Jessica A. Ross
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Mark A. Silberman
- Clinical Pathology Laboratories, Austin, Texas, United States of America
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
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3
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DeSantis SM, Yaseen A, Hao T, León-Novelo L, Talebi Y, Valerio-Shewmaker MA, Pinzon Gomez CL, Messiah SE, Kohl HW, Kelder SH, Ross JA, Padilla LN, Silberman M, Wylie S, Lakey D, Shuford JA, Pont SJ, Boerwinkle E, Swartz MD. RE: Incidence of SARS-CoV-2 Breakthrough Infections After Vaccination in Adults: A Population-Based Survey Through 1 March 2023. Open Forum Infect Dis 2023; 10:ofad564. [PMID: 38099238 PMCID: PMC10720767 DOI: 10.1093/ofid/ofad564] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- Stacia M DeSantis
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ashraf Yaseen
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tianyao Hao
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Luis León-Novelo
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yashar Talebi
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Melissa A Valerio-Shewmaker
- School of Public Health in Brownsville, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Cesar L Pinzon Gomez
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sarah E Messiah
- School of Public Health in Dallas, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas, USA
| | - Harold W Kohl
- School of Public Health in Austin, The University of Texas Health Science Center at Houston, Austin, Texas, USA
- The University of Texas at Austin, Austin, Texas, USA
| | - Steven H Kelder
- School of Public Health in Austin, The University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Jessica A Ross
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lindsay N Padilla
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | | | - David Lakey
- The University of Texas System, Austin, Texas, USA
- The University of Texas at Tyler Health Science Center, Tyler, Texas, USA
| | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, Texas, USA
| | - Eric Boerwinkle
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael D Swartz
- School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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4
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Messiah SE, Talebi Y, Swartz MD, Sabharwal R, Han H, Bergqvist E, Kohl HW, Valerio-Shewmaker M, DeSantis SM, Yaseen A, Kelder SH, Ross J, Padilla LN, Gonzalez MO, Wu L, Lakey D, Shuford JA, Pont SJ, Boerwinkle E. Long-term immune response to SARS-CoV-2 infection and vaccination in children and adolescents. Pediatr Res 2023:10.1038/s41390-023-02857-y. [PMID: 37875728 DOI: 10.1038/s41390-023-02857-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND This analysis examined the durability of antibodies present after SARS-CoV-2 infection and vaccination in children and adolescents. METHODS Data were collected over 4 time points between October 2020-November 2022 as part of a prospective population-based cohort aged 5-to-19 years (N = 810). Results of the (1) Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test); and (2) qualitative and semi-quantitative detection of antibodies to the SARS CoV-2 spike protein receptor binding domain (Roche S-test); and (3) self-reported antigen/PCR COVID-19 test results, vaccination and symptom status were analyzed. RESULTS N antibody levels reached a median of 84.10 U/ml (IQR: 20.2, 157.7) cutoff index (COI) ~ 6 months post-infection and increased slightly to a median of 85.25 (IQR: 28.0, 143.0) COI at 12 months post-infection. Peak S antibody levels were reached at a median of 2500 U/mL ~6 months post-vaccination and remained for ~12 months (mean 11.6 months, SD 1.20). CONCLUSIONS This analysis provides evidence of robust durability of nucleocapsid and spike antibodies in a large pediatric sample up to 12 months post-infection/vaccination. This information can inform pediatric SARS-CoV-2 vaccination schedules. IMPACT This study provided evidence of robust durability of both nucleocapsid and spike antibodies in a large pediatric sample up to 12 months after infection. Little is known about the long-term durability of natural and vaccine-induced SARS-CoV-2 antibodies in the pediatric population. Here, we determined the durability of anti-SARS-CoV-2 spike (S-test) and nucleocapsid protein (N-test) in children/adolescents after SARS-CoV-2 infection and/or vaccination lasts at least up to 12 months. This information can inform future SARS-CoV-2 vaccination schedules in this age group.
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Affiliation(s)
- Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA.
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA.
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA.
| | - Yashar Talebi
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Rachit Sabharwal
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Haoting Han
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Emma Bergqvist
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA
| | - Harold W Kohl
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Science Center at Houston, School of Public Health in Austin, Austin, TX, USA
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Melissa Valerio-Shewmaker
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health in Brownville, Brownsville, TX, USA
| | - Stacia M DeSantis
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Ashraf Yaseen
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Steven H Kelder
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Science Center at Houston, School of Public Health in Austin, Austin, TX, USA
| | - Jessica Ross
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Lindsay N Padilla
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Leqing Wu
- Department of Biostatistics and Data Science, UTHealth Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - David Lakey
- University of Texas System, Austin, TX, USA
- The University of Texas Health Science Center Tyler, Tyler, TX, USA
| | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, TX, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health (UTHealth) Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
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5
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Messiah SE, Swartz MD, Abbas RA, Talebi Y, Kohl HW, Valerio-Shewmaker M, DeSantis SM, Yaseen A, Kelder SH, Ross JA, Padilla LN, Gonzalez MO, Wu L, Lakey D, Shuford JA, Pont SJ, Boerwinkle E. SARS-CoV-2 Serostatus and COVID-19 Illness Characteristics by Variant Time Period in Non-Hospitalized Children and Adolescents. Children (Basel) 2023; 10:children10050818. [PMID: 37238366 DOI: 10.3390/children10050818] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe COVID-19 illness characteristics, risk factors, and SARS-CoV-2 serostatus by variant time period in a large community-based pediatric sample. DESIGN Data were collected prospectively over four timepoints between October 2020 and November 2022 from a population-based cohort ages 5 to 19 years old. SETTING State of Texas, USA. PARTICIPANTS Participants ages 5 to 19 years were recruited from large pediatric healthcare systems, Federally Qualified Healthcare Centers, urban and rural clinical practices, health insurance providers, and a social media campaign. EXPOSURE SARS-CoV-2 infection. MAIN OUTCOME(S) AND MEASURE(S) SARS-CoV-2 antibody status was assessed by the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test). Self-reported antigen or PCR COVID-19 test results and symptom status were also collected. RESULTS Over half (57.2%) of the sample (N = 3911) was antibody positive. Symptomatic infection increased over time from 47.09% during the pre-Delta variant time period, to 76.95% during Delta, to 84.73% during Omicron, and to 94.79% during the Omicron BA.2. Those who were not vaccinated were more likely (OR 1.71, 95% CI 1.47, 2.00) to be infected versus those fully vaccinated. CONCLUSIONS Results show an increase in symptomatic COVID-19 infection among non-hospitalized children with each progressive variant over the past two years. Findings here support the public health guidance that eligible children should remain up to date with COVID-19 vaccinations.
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Affiliation(s)
- Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in Dallas, The University of Texas (UT) Health Science Center at Houston, Dallas, TX 77030, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX 75207, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX 77030, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Rhiana A Abbas
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yashar Talebi
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Harold W Kohl
- School of Public Health in Austin, The University of Texas Health Science Center at Houston, Austin, TX 78701, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas at Austin, Austin, TX 78705, USA
| | - Melissa Valerio-Shewmaker
- School of Public Health in Brownville, The University of Texas Health Science Center at Houston, Brownsville, TX 78520, USA
| | - Stacia M DeSantis
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Ashraf Yaseen
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Steven H Kelder
- School of Public Health in Austin, The University of Texas Health Science Center at Houston, Austin, TX 78701, USA
| | - Jessica A Ross
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Lindsay N Padilla
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michael O Gonzalez
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Leqing Wu
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - David Lakey
- Administration Division, University of Texas System, Austin, TX 78701, USA
- Department of Medicine, The University of Texas Health Science Center Tyler, Tyler, TX 75708, USA
| | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, TX 78711, USA
| | - Eric Boerwinkle
- Department of Biostatistics and Data Sciences, School of Public Health in Houston, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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6
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DeSantis SM, Yaseen A, Hao T, León-Novelo L, Talebi Y, Valerio-Shewmaker MA, Pinzon Gomez CL, Messiah SE, Kohl HW, Kelder SH, Ross JA, Padilla LN, Silberman M, Tuzo S, Lakey D, Shuford JA, Pont SJ, Boerwinkle E, Swartz MD. Incidence and predictors of breakthrough and severe breakthrough infections of SARS-CoV-2 after primary series vaccination in adults: A population-based survey of 22,575 participants. J Infect Dis 2023; 227:1164-1172. [PMID: 36729177 DOI: 10.1093/infdis/jiad020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/20/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Breakthrough infections of SARS-CoV-2 are well-documented. The current study estimates breakthrough incidence across pandemic waves, and evaluates predictors of breakthrough and severe breakthrough infections (defined as those requiring hospitalization). METHODS 89,762 participants underwent longitudinal antibody surveillance. Incidence rates were calculated using total person-days contributed. Bias-corrected and age-adjusted logistic regression determined multivariable predictors of breakthrough and severe breakthrough infection, respectively. RESULTS The incidence was 0.45 (0.38, 0.50) during pre-Delta, 2.80 (2.25, 3.14) during Delta, and 11.2 (8.80, 12.95) during Omicron, per 10,000 person-days. Factors associated with elevated odds of breakthrough included Hispanic ethnicity (vs non-Hispanic White, OR=1.243[1.073, 1.441]), larger household size (OR=1.251 [1.048, 1.494] for 3-5 vs. 1 and OR=1.726 [1.317, 2.262] for more than 5 vs. 1 person), rural vs urban living (OR=1.383 [1.122, 1.704]), receiving Pfizer or Johnson&Johnson vs. Moderna, and multiple comorbidities. Of the 1,700 breakthrough infections, 1,665 reported on severity; 112 (6.73%) were severe. Higher BMI, Hispanic ethnicity, vaccine type, asthma, and hypertension predicted severe breakthroughs. CONCLUSION Breakthrough infection was 4-25 times more common during the Omicron-dominant wave versus earlier waves. Higher burden of severe breakthrough infections was identified in subgroups.
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Affiliation(s)
- Stacia M DeSantis
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Ashraf Yaseen
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Tianyao Hao
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Luis León-Novelo
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Yashar Talebi
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Melissa A Valerio-Shewmaker
- The University of Texas Health Science Center at Houston, School of Public Health in Brownsville, Brownsville, TX, USA
| | - Cesar L Pinzon Gomez
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston, School of Public Health in Dallas, Dallas, TX, USA.,Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX, USA
| | - Harold W Kohl
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, USA.,The University of Texas at Austin, Austin, TX, USA
| | - Steven H Kelder
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, USA
| | - Jessica A Ross
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Lindsay N Padilla
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | | | | | - David Lakey
- The University of Texas System, Austin, TX, USA.,The University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, TX, USA
| | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
| | - Michael D Swartz
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, US
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7
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Messiah SE, DeSantis SM, Leon-Novelo LG, Talebi Y, Brito FA, Kohl HW, Valerio-Shewmaker MA, Ross JA, Swartz MD, Yaseen A, Kelder SH, Zhang S, Omega-Njemnobi OS, Gonzalez MO, Wu L, Boerwinkle E, Lakey DL, Shuford JA, Pont SJ. Durability of SARS-CoV-2 Antibodies From Natural Infection in Children and Adolescents. Pediatrics 2022; 149:185412. [PMID: 35301530 DOI: 10.1542/peds.2021-055505] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sarah E Messiah
- Center for Pediatric Population Health.,The University of Texas Health Science Center at Houston, School of Public Health in Dallas, Dallas,Texas.,Children's Health System of Texas, Dallas, Texas
| | - Stacia M DeSantis
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Luis G Leon-Novelo
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Yashar Talebi
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Frances A Brito
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Harold W Kohl
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas.,The University of Texas System, Austin, Texas
| | - Melissa A Valerio-Shewmaker
- The University of Texas Health Science Center at Houston, School of Public Health in Brownsville, Brownsville, Texas
| | - Jessica A Ross
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Michael D Swartz
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Ashraf Yaseen
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Steven H Kelder
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas
| | - Shiming Zhang
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Onyinye S Omega-Njemnobi
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas
| | - Michael O Gonzalez
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Leqing Wu
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, Texas
| | | | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, Texas
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8
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Swartz MD, DeSantis SM, Yaseen A, Brito FA, Valerio-Shewmaker MA, Messiah SE, Leon-Novelo LG, Kohl HW, Pinzon-Gomez CL, Hao T, Zhang S, Talebi Y, Yoo J, Ross JR, Gonzalez MO, Wu L, Kelder SH, Silberman M, Tuzo S, Pont SJ, Shuford JA, Lakey D, Boerwinkle E. Antibody Duration After Infection From SARS-CoV-2 in the Texas Coronavirus Antibody Response Survey. J Infect Dis 2022; 227:193-201. [PMID: 35514141 PMCID: PMC9833436 DOI: 10.1093/infdis/jiac167] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 12/23/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 01/20/2023] Open
Abstract
Understanding the duration of antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 is important to controlling the current pandemic. Participants from the Texas Coronavirus Antibody Response Survey (Texas CARES) with at least 1 nucleocapsid protein antibody test were selected for a longitudinal analysis of antibody duration. A linear mixed model was fit to data from participants (n = 4553) with 1 to 3 antibody tests over 11 months (1 October 2020 to 16 September 2021), and models fit showed that expected antibody response after COVID-19 infection robustly increases for 100 days postinfection, and predicts individuals may remain antibody positive from natural infection beyond 500 days depending on age, body mass index, smoking or vaping use, and disease severity (hospitalized or not; symptomatic or not).
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Affiliation(s)
- Michael D Swartz
- Correspondence: Michael D. Swartz, PhD, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030 ()
| | - Stacia M DeSantis
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Ashraf Yaseen
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Frances A Brito
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Melissa A Valerio-Shewmaker
- The University of Texas Health Science Center in Houston, School of Public Health in Brownsville, Brownsville, Texas, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center in Houston, School of Public Health in Dallas, Dallas, Texas, USA
| | - Luis G Leon-Novelo
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Harold W Kohl
- The University of Texas Health Science Center in Houston, School of Public Health in Austin, Austin, Texas, USA,The University of Texas at Austin, College of Education, Department of Kinesiology and Health Education, Austin, Texas, USA
| | - Cesar L Pinzon-Gomez
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Tianyao Hao
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Shiming Zhang
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Yashar Talebi
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Joy Yoo
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Jessica R Ross
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Michael O Gonzalez
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Leqing Wu
- The University of Texas Health Science Center in Houston, School of Public Health in Houston, Houston, Texas, USA
| | - Steven H Kelder
- The University of Texas Health Science Center in Houston, School of Public Health in Austin, Austin, Texas, USA
| | | | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, Texas, USA
| | | | - David Lakey
- University of Texas System, Office of Health Affairs, Austin, Texas, USA
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McCormick DW, Richardson LC, Young PR, Viens LJ, Gould CV, Kimball A, Pindyck T, Rosenblum HG, Siegel DA, Vu QM, Komatsu K, Venkat H, Openshaw JJ, Kawasaki B, Siniscalchi AJ, Gumke M, Leapley A, Tobin-D’Angelo M, Kauerauf J, Reid H, White K, Ahmed FS, Richardson G, Hand J, Kirkey K, Larson L, Byers P, Garcia A, Ojo M, Zamcheck A, Lash MK, Lee EH, Reilly KH, Wilson E, de Fijter S, Naqvi OH, Harduar-Morano L, Burch AK, Lewis A, Kolsin J, Pont SJ, Barbeau B, Bixler D, Reagan-Steiner S, Koumans EH. Deaths in Children and Adolescents Associated With COVID-19 and MIS-C in the United States. Pediatrics 2021; 148:peds.2021-052273. [PMID: 34385349 PMCID: PMC9837742 DOI: 10.1542/peds.2021-052273] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.
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Affiliation(s)
| | | | | | | | | | - Anne Kimball
- CDC COVID-19 Response Team,Epidemic Intelligence Service, CDC
| | | | | | | | | | | | - Heather Venkat
- Arizona Department of Health Services,CDC Career Epidemiology Field Officer Program
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kim Kirkey
- Michigan Department of Health and Human Services
| | | | | | - Ali Garcia
- Nevada Department of Health and Human Services
| | | | | | - Maura K. Lash
- New York City Department of Health and Mental Hygiene
| | - Ellen H. Lee
- New York City Department of Health and Mental Hygiene
| | | | - Erica Wilson
- North Carolina Department of Health and Human Services
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10
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Davis JN, Pérez A, Asigbee FM, Landry MJ, Vandyousefi S, Ghaddar R, Hoover A, Jeans M, Nikah K, Fischer B, Pont SJ, Richards D, Hoelscher DM, Van Den Berg AE. School-based gardening, cooking and nutrition intervention increased vegetable intake but did not reduce BMI: Texas sprouts - a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2021; 18:18. [PMID: 33485354 PMCID: PMC7825209 DOI: 10.1186/s12966-021-01087-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 04/02/2020] [Accepted: 01/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although school garden programs have been shown to improve dietary behaviors, there has not been a cluster-randomized controlled trial (RCT) conducted to examine the effects of school garden programs on obesity or other health outcomes. The goal of this study was to evaluate the effects of a one-year school-based gardening, nutrition, and cooking intervention (called Texas Sprouts) on dietary intake, obesity outcomes, and blood pressure in elementary school children. METHODS This study was a school-based cluster RCT with 16 elementary schools that were randomly assigned to either the Texas Sprouts intervention (n = 8 schools) or to control (delayed intervention, n = 8 schools). The intervention was one school year long (9 months) and consisted of: a) Garden Leadership Committee formation; b) a 0.25-acre outdoor teaching garden; c) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school-year; and d) nine monthly parent lessons. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Child outcomes measured were anthropometrics (i.e., BMI parameters, waist circumference, and body fat percentage via bioelectrical impedance), blood pressure, and dietary intake (i.e., vegetable, fruit, and sugar sweetened beverages) via survey. Data were analyzed with complete cases and with imputations at random. Generalized weighted linear mixed models were used to test the intervention effects and to account for clustering effect of sampling by school. RESULTS A total of 3135 children were enrolled in the study (intervention n = 1412, 45%). Average age was 9.2 years, 64% Hispanic, 47% male, and 69% eligible for free and reduced lunch. The intervention compared to control resulted in increased vegetable intake (+ 0.48 vs. + 0.04 frequency/day, p = 0.02). There were no effects of the intervention compared to control on fruit intake, sugar sweetened beverages, any of the obesity measures or blood pressure. CONCLUSION While this school-based gardening, nutrition, and cooking program did not reduce obesity markers or blood pressure, it did result in increased vegetable intake. It is possible that a longer and more sustained effect of increased vegetable intake is needed to lead to reductions in obesity markers and blood pressure. CLINICAL TRIALS NUMBER NCT02668744 .
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Affiliation(s)
- Jaimie N Davis
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA.
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living - Department of Biostatistics and Data Science - The University of Texas Health (UTHealth) Science Center at Houston, Austin Campus, Austin, USA
| | - Fiona M Asigbee
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Matthew J Landry
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Sarvenaz Vandyousefi
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Reem Ghaddar
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Amy Hoover
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Matthew Jeans
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Katie Nikah
- Department of Nutritional Sciences, University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Brian Fischer
- Michael & Susan Dell Center for Healthy Living - Department of Biostatistics and Data Science - The University of Texas Health (UTHealth) Science Center at Houston, Austin Campus, Austin, USA
| | - Stephen J Pont
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Daphne Richards
- Texas A&M AgriLife Extension Service, Travis County, Austin, USA
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living - Department of Health Promotion and Behavioral Sciences - UTHealth Science Center at Houston, Austin Campus, Austin, USA
| | - Alexandra E Van Den Berg
- Michael & Susan Dell Center for Healthy Living - Department of Health Promotion and Behavioral Sciences - UTHealth Science Center at Houston, Austin Campus, Austin, USA
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11
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Barlow SE, Salahuddin M, Durand C, Pont SJ, Hoelscher DM, Butte NF. Evaluation of BMI Metrics to Assess Change in Adiposity in Children with Overweight and Moderate and Severe Obesity. Obesity (Silver Spring) 2020; 28:1512-1518. [PMID: 32935936 DOI: 10.1002/oby.22858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to examine the relation between change in different BMI metrics and change in adiposity over a 12-month weight management intervention. METHODS Baseline and 12-month weights and heights from 399 children aged 2 to 12 years with BMI ≥ 85th percentile were used to calculate BMI, %BMIp95, %BMIp50, BMI z-score (BMIz), and modified BMI z-score (BMImz). Changes (Δ) in these measures were compared with changes in body fat percent (Δfat%) from bioelectrical impedance assessment. Correlation and regression models predicting associations between ΔBMI metrics and Δfat% were examined. RESULTS A total of 89% of the cohort was Hispanic, and 34% had class 2 or 3 obesity. In models predicting Δfat% adjusting for age, sex, and weight category, R2 for ΔBMI, ΔBMIz, BMImz, Δ%BMIp95, and Δ%BMIp50 were 0.53, 0.38, 0.45, 0.53, and 0.54, respectively (all P < 0.001). Only the ΔBMIz model had an interaction with weight status. Among the models with the highest R2, age group and sex interacted with the Δ%BMIp95 model but not ΔBMI or ΔBMIp50 models. CONCLUSIONS Longitudinal analyses demonstrate the utility of several BMI metrics other than z-score in capturing adiposity change consistently across a range of obesity severity. Characteristics of studied groups and interpretability could influence metric choice.
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Affiliation(s)
- Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Dallas, Texas, USA
| | - Meliha Salahuddin
- Department of Community Health, University of Texas Health Science Center at Tyler, Austin, Texas, USA
- Population Health, Office of Health Affairs, University of Texas System, Austin, Texas, USA
| | - Casey Durand
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin, Texas, USA
| | - Stephen J Pont
- Department of Pediatrics, Department of Population Health, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin, Texas, USA
| | - Nancy F Butte
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
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12
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Barlow SE, Durand C, Salahuddin M, Pont SJ, Butte NF, Hoelscher DM. Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX-CORD). Pediatr Obes 2020; 15:e12609. [PMID: 31944617 DOI: 10.1111/ijpo.12609] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Many childhood obesity intervention studies report mean outcomes but do not explore the variation in responses and the characteristics of those who respond well. OBJECTIVE To identify child and family characteristics associated with improvement in the primary outcome, %BMIp95 , of the Texas Childhood Obesity Research Demonstration project (TX-CORD). METHODS The 12-month TX-CORD secondary prevention study randomized 549 children, ages 2 to 12 years, with BMI ≥85th percentile to the intensive intervention vs. the comparison program, with measurements at baseline, 3-, and 12-months. A growth mixture model was used to identify mutually exclusive latent %BMIp95 trajectories. Latent class regression tested associations between baseline characteristics and latent class membership. RESULTS A 2-class solution emerged after accounting for the effect of intervention randomization. Latent Class 1 participants (86% of sample) were characterized by mild-to-moderate obesity and demonstrated a significantly greater response to the intensive intervention between 0 and 3 months (slope-on-group = -0.931, p = 0.03). A rebound between 3 and 12 months was not significantly different between arms. Latent Class 2 participants (14%), who had severe obesity, demonstrated no difference in response between intervention groups. Characteristics associated with Class 1 membership included younger age (2-5 years vs. 6-12 years: OR 3.70, p = .035) and lower maternal BMI category (< 35 kg/m2 vs. ≥ 35 kg/m2 : OR 7.14, p < .0001). CONCLUSIONS The optimal target population for the intensive intervention are children who have milder obesity, are younger, and do not have a mother with severe obesity. Children with severe obesity may require different approaches.
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Affiliation(s)
- Sarah E Barlow
- Baylor College of Medicine, Houston, Texas.,Texas Children's Hospital, Houston, Texas.,current affiliation University of Texas Southwestern Medical Center, Dallas, Texas.,current affiliation Children Health, Dallas, Texas
| | - Casey Durand
- University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas
| | - Meliha Salahuddin
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin Regional Campus, Austin, Texas.,current affiliation Population Health, University of Texas Health Science Center at Tyler, Tyler, Texas.,current affiliation Office of Health Affairs, University of Texas System, Austin, Texas
| | - Stephen J Pont
- University of Texas at Austin Dell Medical School, Austin, Texas
| | - Nancy F Butte
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Deanna M Hoelscher
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin Regional Campus, Austin, Texas
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13
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Davis JN, Nikah K, Asigbee FM, Landry MJ, Vandyousefi S, Ghaddar R, Hoover A, Jeans M, Pont SJ, Richards D, Hoelscher DM, Van Den Berg AE, Bluestein M, Pérez A. Corrigendum to "Design and participant characteristics of TX sprouts: A school-based cluster randomized gardening, nutrition, and cooking intervention" [Contemp Clin Trials 85 (2019) 105834]. Contemp Clin Trials 2019; 88:105906. [PMID: 31791858 DOI: 10.1016/j.cct.2019.105906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jaimie N Davis
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA.
| | - Katie Nikah
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Fiona M Asigbee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew J Landry
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Sarvenaz Vandyousefi
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Reem Ghaddar
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Amy Hoover
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew Jeans
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Stephen J Pont
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin Campus, Austin, USA
| | - Alexandra E Van Den Berg
- Michael & Susan Dell Center for Healthy Living, Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin Campus, Austin, USA
| | - Meagan Bluestein
- Michael & Susan Dell Center for Healthy Living, Department of Biostatistics and Data Science, University of Texas Health (UTHealth) Science Center, Austin Regional Campus, Austin, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, Department of Biostatistics and Data Science, University of Texas Health (UTHealth) Science Center, Austin Regional Campus, Austin, USA
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Barlow SE, Salahuddin M, Butte NF, Hoelscher DM, Pont SJ. Improvement in Primary Care Provider Self-Efficacy and Use of Patient-Centered Counseling To Address Child Overweight and Obesity after Practice-Based Changes: Texas Childhood Obesity Research Demonstration Study. Child Obes 2019; 14:518-527. [PMID: 30153036 DOI: 10.1089/chi.2018.0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/13/2022]
Abstract
BACKGROUND The Texas Childhood Obesity Research Demonstration project, a multicenter, multisystem approach to childhood overweight and obesity (OW/OB), included training and materials to support primary care clinics (PCCs) in addressing child OW/OB in the office. This study evaluated the impact over 24 months of brief training and practice-based support on primary care providers' (PCPs) perceived self-efficacy and practice behaviors. METHODS The PCPs at five Houston and seven Austin PCCs completed questionnaires at baseline (2012, n = 36), 12 months (2013, n = 30), and 24 months (2014, n = 34) follow-up. Mixed-effects linear regression models were used to compare changes in self-efficacy (15 items, responses 1-4: not at all confident to very confident) and practice behaviors (30 items, responses 0-4: never to always) in obesity-related screening and counseling, and to assess association between prior training and these outcomes. RESULTS Self-efficacy items for identification of (2.9 [0.1] vs. 3.3 [0.1]) and counseling about (2.8 [0.1] vs. 3.4 [0.1]) OW/OB-related parenting practices, and setting behavioral goals (2.9 [0.2] vs. 3.3 [0.2]) improved significantly (p < 0.05) between baseline and 24-month follow-up. Self-efficacy items with "confident" mean baseline scores that further improved included determining child OW/OB (3.6 [0.1] vs. 3.9 [0.1]) and interpreting BMI (3.6 [0.1] vs. 3.9 [0.1]). At all measurements, PCPs reported frequently addressing medical problems and lifestyle behaviors. Use of patient-centered counseling techniques, which was low at baseline, increased significantly, including asking permission before discussing lifestyle (1.5 [0.3] vs. 2.4 [0.3]). Prior training was associated with improved self-efficacy. CONCLUSIONS The improvement in PCPs' self-efficacy and patient-centered counseling to address childhood OW/OB supports implementation of brief training and practice support in clinics that serve Medicaid-eligible children.
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Affiliation(s)
- Sarah E Barlow
- 1 Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, TX
| | - Meliha Salahuddin
- 2 Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston (UTHealth) , Austin, TX.,3 Population Health , Office of Health Affairs, UT System, Austin, TX
| | - Nancy F Butte
- 4 Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center , Houston, TX
| | - Deanna M Hoelscher
- 2 Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston (UTHealth) , Austin, TX
| | - Stephen J Pont
- 5 Department of Pediatrics, Dell Medical School, Moody College of Communication, Stan Richards School of Advertising and Public Relations, University of Texas at Austin , Austin, TX
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15
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Davis J, Nikah K, Asigbee FM, Landry MJ, Vandyousefi S, Ghaddar R, Hoover A, Jeans M, Pont SJ, Richards D, Hoelscher DM, Van Den Berg AE, Bluestein M, Pérez A. Design and participant characteristics of TX sprouts: A school-based cluster randomized gardening, nutrition, and cooking intervention. Contemp Clin Trials 2019; 85:105834. [PMID: 31449880 DOI: 10.1016/j.cct.2019.105834] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 04/02/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
AIMS To outline the study design, outcome measures, protocol and baseline characteristics of enrolled participants of Texas (TX) Sprouts, a one-year school-based gardening, nutrition, and cooking cluster randomized trial. METHODS Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to the delayed intervention over three years (2016-2019). The intervention arm received: formation/training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly during school hours by hired educators throughout one school year; and nine parent lessons taught monthly to families. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Primary outcomes included: dietary intake, dietary-related behaviors, obesity, and metabolic parameters. Child measures included: height, weight, waist circumference, body composition, blood pressure, and dietary psychosocial variables. A subsample of children were measured for glucose, hemoglobin-A1C, and 24-hour dietary recalls. Parent measures included: height and weight, dietary intake, and related dietary psychosocial variables. RESULTS Of the 4239 eligible students, 3137 students consented and provided baseline clinical measures; 3132 students completed child surveys, with 92% of their parents completing parent surveys. The subsamples of blood draws and dietary recalls were 34% and 24%, respectively. Intervention arm baseline descriptives, clinical and dietary data for children and parents are reported. CONCLUSION The TX Sprouts intervention targeted primarily low-income Hispanic children and their parents; utilized an interactive gardening, nutrition, and cooking program; and measured a battery of dietary behaviors, obesity and metabolic outcomes.
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Affiliation(s)
- JaimieN Davis
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA.
| | - Katie Nikah
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Fiona M Asigbee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew J Landry
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Sarvenaz Vandyousefi
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Reem Ghaddar
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Amy Hoover
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew Jeans
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Stephen J Pont
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin Campus, Austin, USA
| | - Alexandra E Van Den Berg
- Michael & Susan Dell Center for Healthy Living, Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin Campus, Austin, USA
| | - Meagan Bluestein
- Michael & Susan Dell Center for Healthy Living, Department of Biostatistics and Data Science, University of Texas Health (UTHealth) Science Center, Austin Regional Campus, Austin, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, Department of Biostatistics and Data Science, University of Texas Health (UTHealth) Science Center, Austin Regional Campus, Austin, USA
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16
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Salahuddin M, Barlow SE, Pont SJ, Butte NF, Hoelscher DM. Development and use of an index for measuring implementation of a weight management program in children in primary care clinics in Texas. BMC Fam Pract 2018; 19:191. [PMID: 30518321 PMCID: PMC6280362 DOI: 10.1186/s12875-018-0882-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/23/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The primary care clinic component included the American Academy of Pediatrics' Next Steps weight management counseling materials that support brief healthy lifestyle-focused visits. The current study describes the methodology and assesses the implementation of the Next Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention. METHODS The study used a serial cross-sectional study design to collect data from 11 primary care clinics in Houston (n = 5) and Austin (n = 6), Texas, in 2013-2014. Responses of primary care providers on 42 self-reported survey questions assessing acceptability, adoption, appropriateness, and feasibility of the program were utilized to create a mean standardized clinic implementation index score. Provider scores were aggregated to represent Next Steps implementation scores at the clinic level. A mixed effects logistic regression test was conducted to determine the association between program implementation and the enrollment of children in the secondary prevention. RESULTS Mean implementation index score was lower at Year 2 of implementation (2014) than Year 1 (2013) although the decrease was not significant [63.2% (12.2%) in 2013 vs. 55.3% (16.5%) in 2014]. There were no significant associations between levels of implementation of Next Steps and enrollment into TX CORD secondary prevention study. CONCLUSIONS The development of an index using process evaluation measures can be used to assess the implementation and evaluation of provider-based obesity prevention tools in primary care clinics.
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Affiliation(s)
- Meliha Salahuddin
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX USA
- University of Texas Health Science Center at Tyler, Tyler, TX USA
- Population Health, Office of Health Affairs, University of Texas System, Austin, TX USA
| | - Sarah E. Barlow
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
- UT Southwestern Medical Center, Dallas, TX USA
| | - Stephen J. Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children’s Medical Center, University of Texas at Austin Dell Medical School, Houston, TX USA
| | - Nancy F. Butte
- USDA/ARS Children’s Nutrition Research Center; Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Deanna M. Hoelscher
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX USA
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Siegel RM, Haemer M, Kharofa RY, Christison AL, Hampl SE, Tinajero-Deck L, Lockhart MK, Reich S, Pont SJ, Stratbucker W, Robinson TN, Shaffer LA, Woolford SJ. Community Healthcare and Technology to Enhance Communication in Pediatric Obesity Care. Child Obes 2018; 14:453-460. [PMID: 29878851 PMCID: PMC6422001 DOI: 10.1089/chi.2017.0339] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Childhood obesity continues to be a critical healthcare issue and a paradigm of a pervasive chronic disease affecting even our youngest children. When considered within the context of the socioecological model, the factors that influence weight status, including the social determinants of health, limit the impact of multidisciplinary care that occurs solely within the medical setting. Coordinated care that incorporates communication between the healthcare and community sectors is necessary to more effectively prevent and treat obesity. In this article, the Expert Exchange authors, with input from providers convened at an international pediatric meeting, provide recommendations to address this critical issue. These recommendations draw upon examples from the management of other chronic conditions that might be applied to the treatment of obesity, such as the use of care plans and health assessment forms to allow weight management specialists and community personnel (e.g., school counselors) to communicate about treatment recommendations and responses. To facilitate communication across the healthcare and community sectors, practical considerations regarding the development and/or evaluation of communication tools are presented. In addition, the use of technology to enhance healthcare-community communication is explored as a means to decrease the barriers to collaboration and to create a web of connection between the community and healthcare providers that promote wellness and a healthy weight status.
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Affiliation(s)
- Robert M. Siegel
- Cincinnati Children's Hospital and Department of Pediatrics, Center for Better Health and Nutrition, University of Cincinnati College of Medicine, Cincinnati, OH.,Address correspondence to:Robert M. Siegel, MDCincinnati Children's Hospital and Department of PediatricsCenter for Better Health and NutritionUniversity of CincinnatiCollege of Medicine3333 Burnet AvenueCincinnati, OH 45229
| | - Matthew Haemer
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.,Obesity Treatment Program, Children's Hospital Colorado, Aurora, CO
| | - Roohi Y. Kharofa
- Division of General and Community Pediatrics, Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amy L. Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Sarah E. Hampl
- General Pediatrics and Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO
| | | | - Mary Kate Lockhart
- Department of Pediatrics, School of Medicine at SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO
| | - Sarah Reich
- Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Stephen J. Pont
- Texas Department of State Health Services, Office of Science and Population Health, Austin, TX
| | - William Stratbucker
- Helen DeVos Children's Hospital, Michigan State University, Grand Rapids, MI
| | - Thomas N. Robinson
- Division of General Pediatrics, Department of Pediatrics, Stanford University and Lucile Packard Children's Hospital Stanford, Stanford, CA
| | - Laura A. Shaffer
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
| | - Susan J. Woolford
- Department of Pediatrics, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI
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18
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Borner KB, Mitchell TB, Gray JS, Davis AM, Pont SJ, Sweeney BR, Hampl S, Dreyer Gillette ML. Factor Structure of a Spanish Translation of an Obesity-Specific Parent-Report Measure of Health-Related Quality of Life. J Pediatr Psychol 2018; 43:1028-1037. [PMID: 29771361 DOI: 10.1093/jpepsy/jsy030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/17/2018] [Indexed: 11/12/2022] Open
Abstract
Objective Latino youth are disproportionately affected by pediatric obesity and consequently experience impaired health-related quality of life (HRQOL). Although many caregivers of Latino youth do not speak English fluently, no validated Spanish translations of obesity-specific HRQOL measures exist for this population. Therefore, non-English-speaking Latino parents have typically been excluded from analyses related to HRQOL. This study assesses the factor structure of a Spanish translation of a parent-report measure of obesity-specific HRQOL, Sizing Them Up, in a treatment-seeking sample of children with obesity. Methods Structural equation modeling was used to assess the factor structure of the 6-subscale, 22-item Sizing Them Up measure in 154 parents of treatment-seeking Latino youth (5-18 years of age). Analyses exploring internal consistency and convergent validity were also conducted. Results Acceptable measurement fit was achieved for the six-factor solution. However, the higher-order model assessing Total HRQOL did not reach acceptable levels, as results found that the Positive Social Attributes (PSA) subscale was not representative of Total HRQOL; internal consistency and convergent validity results also supported this finding. Conclusions The current study provides support for the utility of a modified version of Sizing Them Up, excluding the PSA Scale, as a parent-report measure of obesity-specific HRQOL in treatment-seeking Latino youth with obesity.
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Affiliation(s)
- Kelsey B Borner
- Division of Pain Medicine, Children's National Medical Center
| | | | - Jane S Gray
- Texas Child Study Center, Dell Children's Medical Center, University of Texas at Austin
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition.,University of Kansas Medical Center
| | - Stephen J Pont
- Texas Department of State Health Services, Office of Science and Population Health.,University of Texas at Austin, Dell Medical School & College of Communications
| | - Brooke R Sweeney
- Center for Children's Healthy Lifestyles & Nutrition.,Department of Pediatrics, Division of General Academic Pediatrics, Children's Mercy Kansas City.,University of Missouri Kansas City School of Medicine
| | - Sarah Hampl
- Center for Children's Healthy Lifestyles & Nutrition.,Department of Pediatrics, Division of General Academic Pediatrics, Children's Mercy Kansas City
| | - Meredith L Dreyer Gillette
- Center for Children's Healthy Lifestyles & Nutrition.,Department of Pediatrics, Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City
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19
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Salahuddin M, Pérez A, Ranjit N, Kelder SH, Barlow SE, Pont SJ, Butte NF, Hoelscher DM. Predictors of Severe Obesity in Low-Income, Predominantly Hispanic/Latino Children: The Texas Childhood Obesity Research Demonstration Study. Prev Chronic Dis 2017; 14:E141. [PMID: 29283881 PMCID: PMC5757383 DOI: 10.5888/pcd14.170129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The objective of this study was to identify predictors of severe obesity in a low-income, predominantly Hispanic/Latino sample of children in Texas. METHODS This cross-sectional analysis examined baseline data on 517 children from the secondary prevention component of the Texas Childhood Obesity Research Demonstration (TX CORD) study; data were collected from September 2012 through February 2014. Self-administered surveys were used to collect data from parents of children who were aged 2 to 12 years, had a body mass index (BMI) in the 85th percentile or higher, and resided in Austin, Texas, or Houston, Texas. Multivariable logistic regression models adjusted for sociodemographic covariates were used to examine associations of children's early-life and maternal factors (large-for-gestational-age, exclusive breastfeeding for ≥4 months, maternal severe obesity [BMI ≥35.0 kg/m2]) and children's behavioral factors (fruit and vegetable consumption, physical activity, screen time) with severe obesity (BMI ≥120% of 95th percentile), by age group (2-5 y, 6-8 y, and 9-12 y). RESULTS Across all ages, 184 (35.6%) children had severe obesity. Among children aged 9 to 12 years, large-for-gestational-age at birth (odds ratio [OR] = 2.31; 95% confidence interval [CI], 1.13-4.73) was significantly associated with severe obesity. Maternal severe obesity was significantly associated with severe obesity among children aged 2 to 5 years (OR = 2.67; 95% CI, 1.10-6.47) and 9 to 12 years (OR = 4.12; 95% CI, 1.84-9.23). No significant association was observed between behavioral factors and severe obesity in any age group. CONCLUSION In this low-income, predominantly Hispanic/Latino sample of children, large-for-gestational-age and maternal severe obesity were risk factors for severe obesity among children in certain age groups. Promoting healthy lifestyle practices during preconception and prenatal periods could be an important intervention strategy for addressing childhood obesity.
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Affiliation(s)
- Meliha Salahuddin
- Michael & Susan Dell Center for Healthy Living, Austin, Texas
- The University of Texas Health Science Center at Houston School of Public Health in Austin,1616 Guadalupe St, Suite 6.300, Austin, TX 78701. ;
- Population Health, Office of Health Affairs, University of Texas System, Austin, Texas
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, Austin, Texas
- The University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, Texas
| | - Nalini Ranjit
- Michael & Susan Dell Center for Healthy Living, Austin, Texas
- The University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, Texas
| | - Steven H Kelder
- Michael & Susan Dell Center for Healthy Living, Austin, Texas
- The University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, Texas
| | - Sarah E Barlow
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Stephen J Pont
- Texas Department of State Health Services, Office of Science and Population Health, Austin, Texas
- University of Texas at Austin Dell Medical School, Austin, Texas
| | - Nancy F Butte
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, Austin, Texas
- The University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, Texas
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20
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Barlow SE, Butte NF, Hoelscher DM, Salahuddin M, Pont SJ. Strategies to Recruit a Diverse Low-Income Population to Child Weight Management Programs From Primary Care Practices. Prev Chronic Dis 2017; 14:E138. [PMID: 29267156 PMCID: PMC5743022 DOI: 10.5888/pcd14.170301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/18/2022] Open
Abstract
Purpose and Objectives Primary care practices can be used to engage children and families in weight management programs. The Texas Childhood Obesity Research Demonstration (TX CORD) study targeted patients at 12 primary care practices in diverse and low-income areas of Houston, Texas, and Austin, Texas for recruitment to a trial of weight management programs. This article describes recruitment strategies developed to benefit both families and health care practices and the modification of electronic health records (EHRs) to reflect recruitment outcomes. Intervention Approach To facilitate family participation, materials and programs were provided in English and Spanish, and programs were conducted in convenient locations. To support health care practices, EHRs and print materials were provided to facilitate obesity recognition, screening, and study referral. We provided brief training for providers and their office staffs that covered screening patients for obesity, empathetic communication, obesity billing coding, and use of counseling materials. Evaluation Methods We collected EHR data from 2012 through 2014, including demographics, weight, and height, for all patients aged 2 to 12 years who were seen in the 12 provider practices during the study’s recruitment phase. The data of patients with a body mass index (BMI) at or above the 85th percentile were compared with the same data for patients who were referred to the study and patients who enrolled in the study. We also examined reasons that patients referred to the study declined to participate. Results Overall, 26% of 7,845 patients with a BMI at or above the 85th percentile were referred to the study, and 27% of referred patients enrolled. Enrollment among patients with a BMI at or above the 85th percentile was associated with being Hispanic and with more severe obesity than with patients of other races/ethnicities or less severe obesity, respectively. Among families of children aged 2 to 5 years who were referred, 20% enrolled, compared with 30% of families of older children (>5 y to 12 y). Referral rates varied widely among the 12 primary care practices, and referral rates were not associated with EHR modifications. Implications for Public Health Engagement and recruitment strategies for enrolling families in primary care practice in weight management programs should be strengthened. Further study of factors associated with referral and enrollment, better systems for EHR tools, and data on provider and office adherence to study protocols should be examined. EHRs can track referral and enrollment to capture outcomes of recruitment efforts.
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Affiliation(s)
- Sarah E Barlow
- Texas Children's Hospital, Baylor College of Medicine, Houston Texas.,Children's Health, GI Practice, 1935 Medical District Dr, Dallas, TX 75235, Mail Code F4.06.
| | - Nancy F Butte
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth)-School of Public Health, Austin, Texas
| | - Meliha Salahuddin
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth)-School of Public Health, Austin, Texas
| | - Stephen J Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, Texas
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21
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Abstract
The stigmatization of people with obesity is widespread and causes harm. Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth. Health care professionals continue to seek effective strategies and resources to address the obesity epidemic; however, they also frequently exhibit weight bias and stigmatizing behaviors. This policy statement seeks to raise awareness regarding the prevalence and negative effects of weight stigma on pediatric patients and their families and provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. In summary, these recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting.
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Affiliation(s)
- Stephen J Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center of Central Texas, Ascension, Austin, Texas; .,Department of Pediatrics, Dell Medical School; Center for Health Communication, Moody College of Communication; Department of Nutritional Sciences; University of Texas at Austin, Austin Texas
| | - Rebecca Puhl
- Rudd Center for Food Policy and Obesity and Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
| | - Stephen R Cook
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York; and
| | - Wendelin Slusser
- Jane and Terry Semel Healthy Campus Initiative, David Geffen School of Medicine and Jonathan and Karin Fielding School of Public Health, University of Los Angeles, Los Angeles, California
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22
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Miller SJ, Batra AK, Shearrer GE, House BT, Cook LT, Pont SJ, Goran MI, Davis JN. Dietary fibre linked to decreased inflammation in overweight minority youth. Pediatr Obes 2016; 11:33-9. [PMID: 25728000 DOI: 10.1111/ijpo.12017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/31/2014] [Revised: 12/11/2014] [Accepted: 12/17/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to examine the relationship between diet and inflammation, and adiposity in minority youth. DESIGN AND METHODS The study was designed as a cross-sectional analysis of 142 overweight (≥85th body mass index percentile) Hispanic and African-American adolescents (14-18 years) with the following measures: anthropometrics, adiposity via magnetic resonance imaging, dietary intake via 24-h dietary recalls, and inflammation markers from fasting blood draws utilizing a multiplex panel. Partial correlations were estimated and analysis of covariance (ancova) models fit to examine the relationship among dietary variables, inflammation markers and adiposity measures with the following a priori covariates: Tanner stage, ethnicity, sex, total energy intake, total body fat and total lean mass. RESULTS Inference based on ancova models showed that the highest tertile of fibre intake (mean intake of 21.3 ± 6.1 g d(-1) ) vs. the lowest tertile of fibre intake (mean intake of 7.4 ± 1.8 g d(-1) ) was associated with 36% lower plasminogen activator inhibitor-1 (P = 0.02) and 43% lower resistin (P = 0.02), independent of covariates. Similar results were seen for insoluble fibre. No other dietary variables included in this study were associated with inflammation markers. CONCLUSIONS These results suggest that increases in dietary fibre could play an important role in lowering inflammation and therefore metabolic disease risk in high-risk minority youth.
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Affiliation(s)
- S J Miller
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - A K Batra
- Drug Dynamics Institute, College of Pharmacy, The University of Texas at Austin, Austin, USA
| | - G E Shearrer
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - B T House
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - L T Cook
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - S J Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Austin, USA
| | - M I Goran
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - J N Davis
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, USA
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23
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Estrada E, Eneli I, Hampl S, Mietus-Snyder M, Mirza N, Rhodes E, Sweeney B, Tinajero-Deck L, Woolford SJ, Pont SJ. Children's Hospital Association consensus statements for comorbidities of childhood obesity. Child Obes 2014; 10:304-17. [PMID: 25019404 PMCID: PMC4120655 DOI: 10.1089/chi.2013.0120] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this article is to provide accessible, user-friendly clinical consensus statements to facilitate the screening, interpretation of results, and early treatment for some of the most common childhood obesity comorbidities. METHODS Members of the Children's Hospital Association (formerly NACHRI) FOCUS on a Fitter Future II (FFFII), a collaboration of 25 US pediatric obesity centers, used a combination of the best available evidence and collective clinical experience to develop consensus statements for pediatric obesity-related comorbidities. FFFII also surveyed the participating pediatric obesity centers regarding their current practices. RESULTS The work group developed consensus statements for use in the evaluation and treatment of lipids, liver enzymes, and blood pressure abnormalities and PCOS in the child with overweight and obesity. The results of the FFFII survey illustrated the variability in the approach for initial evaluation and treatment as well as pattern of referrals to subspecialists among programs. CONCLUSIONS The consensus statements presented in this article can be a useful tool for PCPs in the management and overall care of children with overweight and obesity.
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Affiliation(s)
- Elizabeth Estrada
- Division of Endocrinology, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Sarah Hampl
- Weight Management, Children's Mercy Hospital, University of Missouri–Kansas City, Kansas City, MO
| | - Michele Mietus-Snyder
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Nazrat Mirza
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Erinn Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | - Brooke Sweeney
- Department of Pediatrics, Kosair Children's Hospital, University of Louisville, Louisville, KY
| | | | - Susan J. Woolford
- Department of Pediatrics, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI
| | - Stephen J. Pont
- Dell Children's Medical Center, University of Texas Southwestern, Austin, TX
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Donovan-Kicken E, Mackert M, Guinn TD, Tollison AC, Breckinridge B, Pont SJ. Health literacy, self-efficacy, and patients' assessment of medical disclosure and consent documentation. Health Commun 2011; 27:581-590. [PMID: 22107084 DOI: 10.1080/10410236.2011.618434] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Informed consent documents are designed to convey the risks of medical procedures to patients, yet they are often difficult to understand; this is especially true for individuals with limited health literacy. An important opportunity for advancing knowledge about health literacy and informed consent involves examining the theoretical pathways that help to explain how health literacy relates to information processing when patients read consent forms. In this study, we proposed and tested a model that positioned self-efficacy as a mediator of the association between health literacy and patients' comprehension and assessment of informed consent documentation. Findings from structured interviews with patients (n = 254) indicated that lower health literacy predicted lower self-efficacy, which predicted feeling less well informed and less prepared, being more confused about the procedure and its hazards, and wanting more information about risks. Incorporating awareness of self-efficacy into disclosure documents and consent conversations may be a useful means of prompting patients to ask questions that can help them make informed decisions about care.
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Affiliation(s)
- Erin Donovan-Kicken
- Department of Communication Studies, College of Communication, The University of Texas at Austin, 1 University Station A1105, Austin, TX 78712, USA.
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Pont SJ, Grijalva CG, Griffin MR, Scott TA, Cooper WO. National rates of diarrhea-associated ambulatory visits in children. J Pediatr 2009; 155:56-61. [PMID: 19394047 DOI: 10.1016/j.jpeds.2009.01.075] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 01/07/2009] [Accepted: 01/30/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate national rates of ambulatory healthcare visits due to diarrhea- and rotavirus-associated illness before the introduction of rotavirus vaccine. STUDY DESIGN Annual rates for diarrhea-associated visits in children age < 5 years were calculated for 1995-2004 using National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and US Census Bureau data. Rates by age, race, and time period were compared using Poisson regression. RESULTS Annual rates of outpatient and emergency department (ED) visits for 1995-2004 were 955 (95% confidence interval [CI] = 803 to 1107) and 314 (95% CI = 278 to 350)/10,000 person-years, respectively. Annual outpatient (P = .470) and ED (P = .734) visit rates remained stable from 1995 to 2004. Outpatient visits were less frequent in African Americans than Caucasians (716/10,000 person-years vs 1012/10,000 person-years; P < .05; incidence rate ratio [IRR] = 0.71; 95% CI = 0.51 to 0.99), whereas ED visits were more frequent in African Americans than Caucasians (520/10,000 person-years vs 286/10,000 person-years; P < .05; IRR = 1.83; 95% CI = 1.58 to 2.11). Approximately 29% of outpatient diarrhea-associated outpatient visits (273/10,000 person-years; 95% CI = 145 to 401) and 25% of diarrhea-associated ED visits (78/10,000 person-years; 95% CI = 64 to 83) were due to rotavirus. CONCLUSIONS Diarrhea- and rotavirus-associated illness is associated with significant healthcare utilization. Future studies are needed to investigate factors causing differences in healthcare use by race and to explore the impact of the rotavirus vaccine.
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Affiliation(s)
- Stephen J Pont
- Department of Pediatrics, University of Texas Medical Branch-Austin Programs, Austin, TX, USA
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26
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Pont SJ, Carpenter LR, Griffin MR, Jones TF, Schaffner W, Dudley JA, Arbogast PG, Cooper WO. Trends in healthcare usage attributable to diarrhea, 1995-2004. J Pediatr 2008; 153:777-82. [PMID: 18692199 DOI: 10.1016/j.jpeds.2008.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Revised: 04/29/2008] [Accepted: 06/23/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine current diarrhea-associated healthcare usage rates and associated sociodemographic factors. These data can be used to determine the impact of the rotavirus vaccine. STUDY DESIGN Using discharge diagnosis codes, we determined diarrhea-associated visit rates for children aged 0 to 18 years enrolled in Tennessee Medicaid, 1995-2004. Poisson regression compared data across time and within strata. The winter residual excess method estimated the rotavirus burden. RESULTS Analyzing approximately 500 000 person-years annually, outpatient and hospitalization rates remained stable from 1995 to 2004; emergency department (ED) rates approximately doubled, incidence rate ratio (IRR): 1.92 (1.81-2.04). White children used healthcare at greater rates than black children: outpatient IRR 1.90: (1.85-1.95), ED IRR: 1.69 (1.64-1.74), and inpatient IRR: 1.82 (1.73-1.92); and rural children greater than urban: outpatient IRR 1.66 (1.62-1.70), ED IRR 1.14 (1.11-1.17), inpatient IRR 1.88 (1.80-1.97). Children aged 0 to 35 months experienced 1627 outpatient and 792 ED visits, and 148 hospitalizations per 10 000 child-years; rotavirus may have affected up to 40% of these hospitalizations. CONCLUSIONS Diarrhea-associated ED visit rates nearly doubled from 1995 to 2004. Future studies could explore factors resulting in increased healthcare usage by white children and those living in rural areas and document the rotavirus vaccine's impact after its release.
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Affiliation(s)
- Stephen J Pont
- Department of Pediatrics, Vanderbilt University, Nashville, TN
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Gesell SB, Reynolds EB, Ip EH, Fenlason LC, Pont SJ, Poe EK, Barkin SL. Social influences on self-reported physical activity in overweight Latino children. Clin Pediatr (Phila) 2008; 47:797-802. [PMID: 18539872 PMCID: PMC4486014 DOI: 10.1177/0009922808318340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/17/2022]
Abstract
Psychosocial variables influence physical activity for different age groups, sex, and ethnic groups. However, little is known about their influence on physical activity in preadolescent Latino children. The authors examined how a) confidence in one's ability to be physically active (self-efficacy); b) ideas about the consequences of being physically active (beliefs), and c) the influences of family and friends on physical activity (social influences) effect physical activity levels in overweight (body mass index >or=85%) Latino preadolescent children. One hundred and fourteen preadolescents participated in a larger intervention designed to improve healthy lifestyles for Latino families. The authors report baseline data collected at a community-based primary care clinic. Multivariate regression analyses showed that only social influences significantly predicted (P < .01) the metabolic equivalent adjusted self-reported baseline physical activity. Prevention and intervention strategies that augment social influences on physical activity are likely to result in more physical activity and improved health in these children.
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Affiliation(s)
- Sabina B. Gesell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Edward H. Ip
- Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lindy C. Fenlason
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen J. Pont
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eli K. Poe
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shari L. Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Carpenter LR, Pont SJ, Cooper WO, Griffin MR, Dudley JA, Arbogast P, Schaffner W, Jones TF. Stool cultures and antimicrobial prescriptions related to infectious diarrhea. J Infect Dis 2008; 197:1709-12. [PMID: 18426365 DOI: 10.1086/588142] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Stool cultures can be important in guiding antimicrobial therapy for diarrhea. From among 11.64 million person-years of Tennessee Medicaid enrollment data collected from 1995 through 2004, 315,828 diarrheal episodes were identified. Stool cultures were performed for only 15,820 episodes (5.0%). Antimicrobials were prescribed for 32,949 episodes (10.4%), 89.4% of which were not accompanied by a stool culture. White race and urban residence were associated with higher rates of stool culture. Frequent use of antimicrobials for diarrhea without stool culture may indicate inappropriate antimicrobial use and has critical implications for public health.
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Affiliation(s)
- L Rand Carpenter
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Cooper WO, Willy ME, Pont SJ, Ray WA. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol 2007; 196:544.e1-5. [PMID: 17547888 DOI: 10.1016/j.ajog.2007.01.033] [Citation(s) in RCA: 308] [Impact Index Per Article: 18.1] [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] [Received: 08/15/2006] [Revised: 11/28/2006] [Accepted: 01/24/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify the rate of exposures to antidepressants during pregnancy in a large cohort of women. STUDY DESIGN This was a retrospective cohort study of 105,335 pregnancies among women enrolled in Tennessee Medicaid from 1999-2003. Pregnancies were classified according to antidepressant exposures during pregnancy using previously validated computerized pharmacy records linked with birth certificates. RESULTS During the study period, 8.7% of women giving birth had exposure to any antidepressant; 6.2% had exposure to a selective serotonin reuptake inhibitor. Maternal age > 25 years (P < .0001), white race (P < .0001), and education > 12 years (P = .008) were significant predictors of antidepressant exposure. The proportion of pregnancies with antidepressant use increased from 5.7% of pregnancies in 1999 to 13.4% of pregnancies in 2003 (p < .0001). The increase was mostly accounted for by increases in selective serotonin reuptake inhibitor exposures. CONCLUSION There is an urgent need for further studies that better quantify the fetal consequences of exposure to antidepressants.
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Affiliation(s)
- William O Cooper
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232-2504, USA.
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Pont SJ, Robbins JM, Bird TM, Gibson JB, Cleves MA, Tilford JM, Aitken ME. Congenital malformations among liveborn infants with trisomies 18 and 13. Am J Med Genet A 2006; 140:1749-56. [PMID: 16835915 DOI: 10.1002/ajmg.a.31382] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [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: 11/06/2022]
Abstract
Trisomy 18 and trisomy 13 are associated with serious and/or fatal birth defects, with death frequently occurring in the first month of life. Previous studies are limited by small samples and are dated. This study characterized the comorbid birth defects associated with trisomy 18 and trisomy 13 among US liveborn infants using the Healthcare Cost and Utilization Project's Kids' Inpatient Database and Nationwide Inpatient Sample, two large, current and nationally representative databases. The occurrence of 39 commonly reported comorbid birth defects among infants with trisomies 18 and 13 was compared to the occurrence of malformations among newborns without trisomies. The prevalences of trisomy 18 and 13 were 1.29/10,000 and 0.85/10,000 live births, respectively. Among infants with trisomy 18, 61% were female, 45.4% with heart defects. Among those with trisomy 13, 53% were female, 38.4% had heart defects, 24.5% had orofacial anomalies, and 11.2% had central nervous system abnormalities. More than half of the newborns with both conditions died prior to discharge. This updated information can be used to inform clinical decision-making and may help providers better prepare families for infants with trisomies.
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Affiliation(s)
- Stephen J Pont
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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