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Browne J, Wu WC, Jiang L, Singh M, Bozzay ML, Kunicki ZJ, Bayer TA, De Vito AN, Primack JM, McGeary JE, Kelso CM, Rudolph JL. Lower odds of successful community discharge after medical hospitalization for Veterans with schizophrenia: A retrospective cohort study of national data. J Psychiatr Res 2024; 173:58-63. [PMID: 38489871 DOI: 10.1016/j.jpsychires.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Jennifer M Primack
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
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Abrantes AM, Browne J, Uebelacker LA, Anderson BJ, Barter S, Shah Z, Kunicki ZJ, Caviness C, Price LH, Desaulniers J, Brown RA. Randomized Controlled Trial of Aerobic Exercise for Smoking Cessation Among Individuals With Elevated Depressive Symptoms. Nicotine Tob Res 2024; 26:634-638. [PMID: 37819741 PMCID: PMC11033564 DOI: 10.1093/ntr/ntad201] [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: 02/19/2023] [Revised: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Adults with depression have higher rates of cigarette smoking and are more likely to relapse than those without depression. Pharmacological, psychological, and combined interventions have largely yielded small improvements in smoking outcomes for adults with depression. Aerobic exercise (AE) may facilitate smoking cessation in this subpopulation. METHODS This study was a 12-week two-arm randomized controlled trial that evaluated the effect of a moderate-intensity AE program compared to a health education contact (HEC) control on smoking cessation in adults with elevated depressive symptoms (mild to severe). Participants (n = 231) were randomized to AE or HEC and received smoking cessation treatment (telephone counseling and nicotine replacement therapy). Primary (biologically confirmed 7-day point prevalence abstinence) and secondary (depressive symptoms, objective and self-reported physical activity, and cardiorespiratory fitness) outcomes were assessed at baseline, 3, 6, and 12 months. Data were analyzed with mixed-effects generalized linear models controlling for age, gender, nicotine dependence, history of major depression disorder, and month of follow-up assessment. RESULTS There were no significant differences in primary or secondary outcomes between the AE and HEC groups. CONCLUSIONS The AE program was not superior to HEC in facilitating smoking cessation, increases in physical activity, or improved depressive symptoms. Given evidence for the positive acute effects of exercise on mood and smoking urges, future research should consider testing alternative exercise approaches for aiding smoking cessation beyond structured, AE programs. IMPLICATIONS This study found that an adjunctive aerobic exercise (AE) program was not superior to a health education contact control for adults with elevated depressive symptoms, all of whom also received standard smoking cessation treatment. This finding adds to the growing body of literature that structured AE programs for smoking cessation may have limited efficacy for cessation outcomes. Future research is needed to test alternative methods of integrating AE into smoking cessation treatment, such as strategically using exercise to manage cravings and low mood in the moment.
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Affiliation(s)
- Ana M Abrantes
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Julia Browne
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychology and School of Nursing, Research Service, VA Providence Healthcare System, Providence, RI, USA
| | - Lisa A Uebelacker
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Sarah Barter
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Zainab Shah
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Celeste Caviness
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Lawrence H Price
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Julie Desaulniers
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
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Moitra E, Amaral TM, Benz MB, Cambow S, Elwy AR, Kunicki ZJ, Lu Z, Rafferty NS, Rabasco A, Rossi R, Schatten HT, Gaudiano BA. A Hybrid Type 1 trial of a multi-component mHealth intervention to improve post-hospital transitions of care for patients with serious mental illness: Study protocol. Contemp Clin Trials 2024; 139:107481. [PMID: 38431134 PMCID: PMC10960682 DOI: 10.1016/j.cct.2024.107481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The transition from acute (e.g., psychiatric hospitalization) to outpatient care is associated with increased risk for rehospitalization, treatment disengagement, and suicide among people with serious mental illness (SMI). Mobile interventions (i.e., mHealth) have the potential to increase monitoring and improve coping post-acute care for this population. This protocol paper describes a Hybrid Type 1 effectiveness-implementation study, in which a randomized controlled trial will be conducted to determine the effectiveness of a multi-component mHealth intervention (tFOCUS) for improving outcomes for adults with SMI transitioning from acute to outpatient care. METHODS Adults meeting criteria for schizophrenia-spectrum or major mood disorders (n = 180) will be recruited from a psychiatric hospital and randomized to treatment-as-usual (TAU) plus standard discharge planning and aftercare (CHECK-IN) or TAU plus tFOCUS. tFOCUS is a 12-week intervention, consisting of: (a) a patient-facing mHealth smartphone app with daily self-assessment prompts and targeted coping strategies; (b) a clinician-facing web dashboard; and, (c) mHealth aftercare advisors, who will conduct brief post-hospital clinical calls with patients (e.g., safety concerns, treatment engagement) and encourage app use. Follow-ups will be conducted at 6-, 12-, and 24-weeks post-discharge to assess primary and secondary outcomes, as well as target mechanisms. We also will assess barriers and facilitators to future implementation of tFOCUS via qualitative interviews of stakeholders and input from a Community Advisory Board throughout the project. CONCLUSIONS Information gathered during this project, in combination with successful study outcomes, will inform a potential tFOCUS intervention scale-up across a range of psychiatric hospitals and healthcare systems. CLINICALTRIALS govregistration: NCT05703412.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Toni M Amaral
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Madeline B Benz
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Simranjeet Cambow
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Zhengduo Lu
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Neil S Rafferty
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Ana Rabasco
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Rita Rossi
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Brandon A Gaudiano
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Browne J, Rudolph JL, Jiang L, Bayer TA, Kunicki ZJ, De Vito AN, Bozzay ML, McGeary JE, Kelso CM, Wu WC. Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure. J Psychosom Res 2024; 178:111604. [PMID: 38309130 DOI: 10.1016/j.jpsychores.2024.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure. METHODS This study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics. RESULTS The sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07). CONCLUSIONS Veterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
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Bayer TA, Jiang L, Kunicki ZJ, Quinn M, De Vito AN, Kelso CM, Rudolph JL, Sullivan JL. Identifying Alzheimer's disease and related disorders via diagnostic codes in Veterans with heart failure. J Am Geriatr Soc 2024; 72:949-952. [PMID: 38059373 DOI: 10.1111/jgs.18701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Thomas A Bayer
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, Rhode Island, USA
- Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lan Jiang
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, Rhode Island, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - McKenzie Quinn
- Providence VA Medical Center, Providence, Rhode Island, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington, DC, USA
| | - James L Rudolph
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, Rhode Island, USA
- Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Health Services Policy, and Practice, Brown School of Public Health, Providence, Rhode Island, USA
| | - Jennifer L Sullivan
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, Rhode Island, USA
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Ahmad N, Kunicki ZJ, Tambor E, Epstein-Lubow G, Tremont G. Burden and Depression among Empirically-Derived Subgroups of Family Caregivers for Individuals With Dementia. J Geriatr Psychiatry Neurol 2024; 37:163-172. [PMID: 37551824 PMCID: PMC10840657 DOI: 10.1177/08919887231195217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Dementia caregiving experiences are not universal and different factors may influence the risk for burden and depression. This study examined factors such as the relationship with the care recipient, severity of dementia, and relationship satisfaction to uncover different types of caregiver burden profiles using baseline assessment for a telephone-based intervention study for dementia caregivers. Participants (n = 233) completed a battery of psychological and caregiving related surveys. The sample was predominantly White and female. Latent class analysis suggested four class models in subsamples of spousal caregivers and adult children caregivers. The results suggested four distinct classes among samples of spousal and adult child caregivers. Differences in burden emerged across both spouses and adult children, and differences in depression also emerged in the spousal sample. Our findings demonstrate the diversity of the caregiving experience and suggest that future psychosocial interventions may benefit from being tailored to the needs of caregiver subgroups.
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Affiliation(s)
- Nina Ahmad
- Department of Biology, Tufts University, Medford, MA, USA
| | - Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Gary Epstein-Lubow
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Education Development Center, Waltham, MA, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Neuropsychology Program, Rhode Island Hospital, Providence, RI, USA
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Rabasco A, Arias S, Benz MB, Weinstock LM, Miller I, Boudreaux ED, Camargo CA, Kunicki ZJ, Gaudiano BA. Longitudinal risk of suicide outcomes in people with severe mental illness following an emergency department visit and the effects of suicide prevention treatment. J Affect Disord 2024; 347:477-485. [PMID: 38065475 PMCID: PMC10872614 DOI: 10.1016/j.jad.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/29/2023] [Accepted: 12/02/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Individuals with severe mental illness (SMI), including bipolar disorder (BD) and schizophrenia-spectrum disorders (SSD), are at high risk for suicide. However, suicide research often excludes individuals with SMI. The current research examined differences in suicide outcomes (i.e., suicide attempt or death) for adults with and without BD and SSD diagnoses following an emergency department (ED) visit and investigated the efficacy of the Coping Long Term with Active Suicide Program (CLASP) intervention in reducing suicide outcomes among people with SMI. METHODS 1235 adults presenting with recent suicidality were recruited from 8 different EDs across the United States. Using a quasi-experimental, stepped wedge series design, participants were followed for 52-weeks with or without subsequent provision of CLASP. RESULTS Participants in the SSD group and the BD group had significantly shorter time to and higher rate of suicide outcomes than participants with other psychiatric diagnoses in all study phases and in non-CLASP phases, respectively. Participants with BD receiving the CLASP intervention had significantly longer time to suicide outcomes than those not receiving CLASP; these differences were not observed among those with SSD. LIMITATIONS Study limitations include self-reported psychiatric diagnosis, exclusion of homeless participants, and small sample size of participants with SSD. CONCLUSIONS Participants with SMI were at higher risk for suicide outcomes than participants with other psychiatric diagnoses. CLASP was efficacious among those participants with BD. Psychiatric diagnosis may be a key indicator of prospective suicide risk. More intensive and specialized follow-up mental health treatment may be necessary for those with SSD.
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Affiliation(s)
- Ana Rabasco
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
| | - Sarah Arias
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Madeline B Benz
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | | | - Ivan Miller
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | | | - Carlos A Camargo
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zachary J Kunicki
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brandon A Gaudiano
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
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Daniels TE, Zitkovsky EK, Laumann LE, Kunicki ZJ, Price DJ, Peterson AL, Dennery PA, Kao HT, Parade SH, Price LH, Abrantes AM, Tyrka AR. Circulating Cell-Free Mitochondrial DNA and Depressive Symptoms Among Low-Active Adults Who Smoke. Psychosom Med 2024; 86:37-43. [PMID: 37769227 PMCID: PMC10843087 DOI: 10.1097/psy.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Mitochondrial dysfunction is implicated in the pathophysiology of psychiatric disorders. Levels of circulating cell-free mitochondrial DNA (cf-mtDNA) are observed to be altered in depression. However, the few studies that have measured cf-mtDNA in depression have reported conflicting findings. This study examined cf-mtDNA and depressive symptoms in low-active adults who smoke. METHODS Participants were adults 18 to 65 years old ( N = 109; 76% female) with low baseline physical activity and depressive symptoms recruited for a smoking cessation study. Self-report measures assessed depression severity, positive and negative affect, and behavioral activation. Blood was collected and analyzed for cf-mtDNA. Relationships between depressive symptoms and cf-mtDNA were examined with correlations and linear regression. RESULTS Levels of cf-mtDNA were associated with categorically defined depression (Center for Epidemiologic Studies Depression Scale score >15), lower positive affect, and decreased behavioral activation ( p < .05). Relationships remained significant after adjustment for age, sex, and nicotine dependence. In a linear regression model including all depressive symptom measures as predictors, Center for Epidemiologic Studies Depression Scale group and lower positive affect remained significant. CONCLUSIONS This work suggests that mitochondrial changes are associated with depressive symptoms in low-active adults who smoke. Higher levels of cf-mtDNA in association with depression and with lower positive affect and decreased behavioral activation are consistent with a possible role for mitochondrial function in depressive symptoms.
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Affiliation(s)
- Teresa E. Daniels
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Emily K. Zitkovsky
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA
| | - Laura E. Laumann
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Destiny J. Price
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
| | - Abigail L. Peterson
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, Rhode Island, USA
| | - Phyllis A. Dennery
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, Rhode Island, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Hung-Teh Kao
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children’s Research Center, E.P. Bradley Hospital, East Providence, RI, USA
| | - Lawrence H. Price
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Behavioral Medicine and Addictions Research Department, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Audrey R. Tyrka
- Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ho ZV, Arias SA, Kunicki ZJ, Sarkar IN, Chen ES. Characterizing suicidal ideation, suicidal behaviors, and service utilization among unhoused individuals using a health information exchange. J Clin Psychol 2023; 79:2542-2555. [PMID: 37433045 PMCID: PMC10592413 DOI: 10.1002/jclp.23566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/25/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Unhoused individuals have high rates of suicidal ideation (SI) and suicidal behaviors (SB), but few have studied the relative timing of homelessness and SI/SB. Our study examines the potential to use state-wide electronic health record data from Rhode Island's health information exchange (HIE) to identify temporal relationships, service utilization, and associations of SI/SB among unhoused individuals. METHODS We use timestamped HIE data for 5368 unhoused patients to analyze service utilization and the relative timing of homelessness versus SI/SB onset. Multivariable models identified associations of SI/SB, hospitalization, and repeat acute care utilization within 30 days from clinical features representing 10,000+ diagnoses captured within the HIE. RESULTS The onset of SI typically precedes homelessness onset, while the onset of SB typically follows. Weekly rates of suicide-related service utilization increased over 25 times the baseline rate during the week before and after homelessness onset. Over 50% of encounters involving SI/SB result in hospitalization. Of those engaging in acute care for suicide-related reasons, we found high rates of repeat acute care encounters. CONCLUSION HIEs are a particularly valuable resource for understudied populations. Our study demonstrates how longitudinal, multi-institutional data from an HIE can be used to characterize temporal associations, service utilization, and clinical associations of SI and behaviors among a vulnerable population at scale. Increasing access to services that address co-occurring SI/SB, mental health, and substance use is needed.
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Affiliation(s)
- Zandra V Ho
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
| | - Sarah A Arias
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA
| | - Zachary J Kunicki
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA
| | - Indra Neil Sarkar
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
- Rhode Island Quality Institute, Providence, Rhode Island, USA
| | - Elizabeth S Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
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10
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Allen JD, Kunicki ZJ, Greaney ML. Mental Health of Brazilian Immigrant Women: The Role of Discrimination, Social Support, and Community Strengths. J Immigr Minor Health 2023; 25:1016-1024. [PMID: 37191876 PMCID: PMC10185951 DOI: 10.1007/s10903-023-01485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women.
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Affiliation(s)
- Jennifer D Allen
- Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Avenue, Medford, MA, 02155, USA.
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard Box G-BH, Providence, RI, USA
| | - Mary L Greaney
- Department of Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI, USA
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11
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Thompson LI, Kunicki ZJ, Emrani S, Strenger J, De Vito AN, Britton KJ, Dion C, Harrington KD, Roque N, Salloway S, Sliwinski MJ, Correia S, Jones RN. Remote and in-clinic digital cognitive screening tools outperform the MoCA to distinguish cerebral amyloid status among cognitively healthy older adults. Alzheimers Dement (Amst) 2023; 15:e12500. [PMID: 38026761 PMCID: PMC10680059 DOI: 10.1002/dad2.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/15/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION We evaluated the accuracy of remote and in-person digital tests to distinguish between older adults with and without AD pathological change and used the Montreal Cognitive Assessment (MoCA) as a comparison test. METHODS Participants were 69 cognitively normal older adults with known beta-amyloid (Aβ) PET status. Participants completed smartphone-based assessments 3×/day for 8 days, followed by TabCAT tasks, DCTclock™, and MoCA at an in-person study visit. We calculated the area under the curve (AUC) to compare task accuracies to distinguish Aβ status. RESULTS Average performance on the episodic memory (Prices) smartphone task showed the highest accuracy (AUC = 0.77) to distinguish Aβ status. On in-person measures, accuracy to distinguish Aβ status was greatest for the TabCAT Favorites task (AUC = 0.76), relative to the DCTclockTM (AUC = 0.73) and MoCA (AUC = 0.74). DISCUSSION Although further validation is needed, our results suggest that several digital assessments may be suitable for more widespread cognitive screening application.
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Affiliation(s)
- Louisa I. Thompson
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Zachary J. Kunicki
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Sheina Emrani
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Jennifer Strenger
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Alyssa N. De Vito
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | | | - Catherine Dion
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Karra D. Harrington
- Department of Human Development & Family StudiesThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Nelson Roque
- Department of PsychologyUniversity of Central FloridaOrlandoFloridaUSA
| | - Stephen Salloway
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Martin J. Sliwinski
- Department of Human Development & Family StudiesThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Stephen Correia
- Department of Health Promotion and BehaviorSchool of Public HealthUniversity of GeorgiaFloridaUSA
| | - Richard N. Jones
- Department of Psychiatry & Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
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12
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Kunicki ZJ, Ngo LH, Marcantonio ER, Tommet D, Feng Y, Fong TG, Schmitt EM, Travison TG, Jones RN, Inouye SK. Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium. JAMA Intern Med 2023; 183:442-450. [PMID: 36939716 PMCID: PMC10028541 DOI: 10.1001/jamainternmed.2023.0144] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/19/2023] [Indexed: 03/21/2023]
Abstract
Importance The study results suggest that delirium is the most common postoperative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia. Objective To examine the patterns and pace of cognitive decline up to 72 months (6 years) in a cohort of older adults following delirium. Design, Setting, and Participants This was a prospective, observational cohort study with long-term follow-up including 560 community-dwelling older adults (older than 70 years) in the ongoing Successful Aging after Elective Surgery study that began in 2010. The data were analyzed from 2021 to 2022. Exposure Development of incident delirium following major elective surgery. Main Outcomes and Measures Delirium was assessed daily during hospitalization using the Confusion Assessment Method, which was supplemented with medical record review. Cognitive performance using a comprehensive battery of neuropsychological tests was assessed preoperatively and across multiple points postoperatively to 72 months of follow-up. We evaluated longitudinal cognitive change using a composite measure of neuropsychological performance called the general cognitive performance (GCP), which is scaled so that 10 points on the GCP is equivalent to 1 population SD. Retest effects were adjusted using cognitive test results in a nonsurgical comparison group. Results The 560 participants (326 women [58%]; mean [SD] age, 76.7 [5.2] years) provided a total of 2637 person-years of follow-up. One hundred thirty-four participants (24%) developed postoperative delirium. Cognitive change following surgery was complex: we found evidence for differences in acute, post-short-term, intermediate, and longer-term change from the time of surgery that were associated with the development of postoperative delirium. Long-term cognitive change, which was adjusted for practice and recovery effects, occurred at a pace of about -1.0 GCP units (95% CI, -1.1 to -0.9) per year (about 0.10 population SD units per year). Participants with delirium showed significantly faster long-term cognitive change with an additional -0.4 GCP units (95% CI, -0.1 to -0.7) or -1.4 units per year (about 0.14 population SD units per year). Conclusions and Relevance This cohort study found that delirium was associated with a 40% acceleration in the slope of cognitive decline out to 72 months following elective surgery. Because this is an observational study, we cannot be sure whether delirium directly causes subsequent cognitive decline, or whether patients with preclinical brain disease are more likely to develop delirium. Future research is needed to understand the causal pathway between delirium and cognitive decline.
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Affiliation(s)
- Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Long H. Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward R. Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Douglas Tommet
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Yi Feng
- Department of Measurement, Statistics, and Evaluation, University of Maryland, College Park
| | - Tamara G. Fong
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Eva M. Schmitt
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Thomas G. Travison
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sharon K. Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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13
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Daniels TE, Zitkovsky EK, Kunicki ZJ, Price DJ, Peterson AL, Dennery PA, Kao HT, Price LH, Tyrka AR, Abrantes AM. Corrigendum to "Associations of circulating cell-free DNA, C-reactive protein, and cardiometabolic risk among low-active smokers with elevated depressive symptoms" [Brain Behav. Immun. - Health 25 (2022) 100519]. Brain Behav Immun Health 2023; 27:100583. [PMID: 36714822 PMCID: PMC9874069 DOI: 10.1016/j.bbih.2022.100583] [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] [Indexed: 01/06/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.bbih.2022.100519.].
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Affiliation(s)
- Teresa E. Daniels
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA,Corresponding author. 1011 Veterans Memorial Parkway, Riverside, RI, 02915, USA.
| | - Emily K. Zitkovsky
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Destiny J. Price
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Abigail L. Peterson
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, RI, USA
| | - Phyllis A. Dennery
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, RI, USA,Department of Pediatrics, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Hung-Teh Kao
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Lawrence H. Price
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Audrey R. Tyrka
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Behavioral Medicine and Addictions Research Department, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA
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14
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Bayer TA, Jiang L, Erqou S, Kunicki ZJ, Singh M, Duprey M, Bozzay M, McGeary JE, Zullo AR, Wu WC, Gravenstein S, Rudolph JL. Incidence of New Dementia Diagnosis in Veterans Admitted to Nursing Homes After Heart Failure Hospitalization. J Alzheimers Dis 2023; 94:1397-1404. [PMID: 37424463 PMCID: PMC11016306 DOI: 10.3233/jad-221300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Hospitalization with heart failure (HF) may signal an increased risk of Alzheimer's disease and related dementias (ADRD). Nursing homes routinely assess cognition but the association of these results with new ADRD diagnosis in a population at high risk of ADRD is not known. OBJECTIVE To determine the association between nursing home cognitive assessment results and new diagnosis of dementia after heart failure hospitalization. METHODS This retrospective cohort study included Veterans hospitalized for HF and discharged to nursing homes, from 2010 to 2015, without a prior diagnosis of ADRD. We determined mild, moderate, or severe cognitive impairment using multiple items of the nursing home admission assessment. We used Cox regression to determine the association of cognitive impairment with new ADRD diagnosis during 365 days of follow-up. RESULTS The cohort included 7,472 residents, new diagnosis of ADRD occurred in 4,182 (56%). The adjusted hazard ratio of ADRD diagnosis was 4.5 (95% CI 4.2, 4.8) for the mild impairment group, 5.4 (95% CI 4.8, 5.9) for moderate impairment, and 4.0 (95% CI 3.2, 5.0) for severe impairment compared to the cognitively intact group. CONCLUSION New ADRD diagnoses occurred in more than half of Veterans with HF admitted to nursing homes for post-acute care.
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Affiliation(s)
- Thomas A. Bayer
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA
| | - Lan Jiang
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
| | - Sebhat Erqou
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
| | - Zachary J. Kunicki
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Mriganka Singh
- Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA
| | - Matthew Duprey
- Brown University School of Public Health, Department of Health Services Policy and Practice, Providence, RI, USA
| | - Melanie Bozzay
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Providence VA Medical Center, Center for Neurorestoration and Neurotechnology, Providence, RI, USA
| | - John E. McGeary
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Andrew R. Zullo
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
- Brown University School of Public Health, Department of Health Services Policy and Practice, Providence, RI, USA
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
| | - Wen-Chih Wu
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
- Providence VA Medical Center, Department of Medicine, Providence, RI, USA
| | - Stefan Gravenstein
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA
- Brown University School of Public Health, Department of Health Services Policy and Practice, Providence, RI, USA
| | - James L. Rudolph
- Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA
- Brown University School of Public Health, Department of Health Services Policy and Practice, Providence, RI, USA
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15
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Kunicki ZJ, Madrigal C, Quach LT, Riester MR, Jiang L, Duprey MS, Bozzay M, Zullo AR, Singh M, McGeary J, Wu WC, Rudolph JL. Comparing Resident, Proxy, and Staff Respondents for Nursing Home Residents' Preferences for Everyday Living. J Appl Gerontol 2023; 42:28-36. [PMID: 36029016 DOI: 10.1177/07334648221123059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To encourage person-centered care, the Centers for Medicare and Medicaid require nursing homes to measure resident preferences using the Preferences Assessment Tool (PAT). No known research has examined the implications of respondent type (i.e., resident, proxy, staff) on preference importance; therefore, the purpose of this study was to compare the importance of preferences depending on which respondent completed the PAT. Participants included 16,111 Veterans discharged to community-based skilled nursing facilities after hospitalization for heart failure. A majority (95%) of residents completed the PAT compared to proxy (3%) and staff (2%). Proxy responders were both more and less likely to indicate individual preferences as important compared to residents. Staff members were consistently less likely to indicate all preferences as important compared to residents. Findings from this study emphasize the need for proxy and staff to find methods to better understand residents' preferences when residents are not able to participate in assessments.
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Affiliation(s)
- Zachary J Kunicki
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Caroline Madrigal
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Health Services, Policy, and Practice, 174610Brown University School of Public Health, Providence, RI, USA
| | - Lien T Quach
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Gerontology, The University of Massachusetts Boston, Boston, MA, USA.,Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa R Riester
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA
| | - Matthew S Duprey
- Department of Health Services, Policy, and Practice, 174610Brown University School of Public Health, Providence, RI, USA
| | - Melanie Bozzay
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA.,VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA
| | - Andrew R Zullo
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Health Services, Policy, and Practice, 174610Brown University School of Public Health, Providence, RI, USA
| | - Mriganka Singh
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Medicine, 12321Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - John McGeary
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Wen-Chih Wu
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Medicine, 12321Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - James L Rudolph
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
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16
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Kunicki ZJ, Bayer T, Jiang L, Bozzay ML, Quinn MJ, De Vito AN, Emrani S, Erqou S, McGeary JE, Zullo AR, Duprey MS, Singh M, Primack JM, Kelso CM, Wu WC, Rudolph JL. Comparing Lookback Periods to Ascertain Alzheimer's Disease and Related Dementias. Am J Alzheimers Dis Other Demen 2023; 38:15333175231199566. [PMID: 37650437 PMCID: PMC10623942 DOI: 10.1177/15333175231199566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Claims data are a valuable resource for studying Alzheimer's disease and related dementias (ADRD). Alzheimer's disease and related dementias is often identified using a list of claims codes and a fixed lookback period of 3 years of data. However, a 1-year lookback or an approach using all-available lookback data could be beneficial based on different research questions. Thus, the purpose of this study was to compare 1-year and all-available lookback approaches to ascertaining ADRD compared to the standard 3-year approach. Using a cohort of Veterans hospitalized for heart failure (N = 373, 897), our results suggested high agreement (93% or greater) between the lookback periods. The 1-year lookback period had lower sensitivity (60%) and underestimated the prevalence of ADRD. These results suggest that 1-year and all-available lookback periods are viable approaches when using claims data.
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Affiliation(s)
- Zachary J. Kunicki
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - Thomas Bayer
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | | | - McKenzie J. Quinn
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
| | - Alyssa N. De Vito
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sheina Emrani
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sebhat Erqou
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
| | - John E. McGeary
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - Andrew R. Zullo
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Mriganka Singh
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer M. Primack
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - Catherine M. Kelso
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
- Office of Patient Care Services, Geriatrics and Extended Care, Veterans Health Administration, Washington, DC, USA
| | - Wen-Chih Wu
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - James L. Rudolph
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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17
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Stevenson BL, Kunicki ZJ, Brick L, Blevins CE, Stein M, Abrantes AM. Using Ecological Momentary Assessments and Fitbit Data to Examine Daily Associations Between Physical Activity, Affect and Alcohol Cravings in Patients with Alcohol Use Disorder. Int J Behav Med 2022; 29:543-552. [PMID: 34750719 PMCID: PMC9079186 DOI: 10.1007/s12529-021-10039-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preliminary studies show that structured physical activity (PA) interventions can reduce negative affect and alcohol use in patients recovering from alcohol use disorder (AUD). The current study tested whether the association between PA, affect, and alcohol cravings can be observed in patients' natural environments (i.e., without a structured intervention) as well. METHOD Twenty-five participants with AUD completed 3 weeks of ecological momentary assessment (EMA) monitoring and wore Fitbit devices to measure physical activity directly after discharge from partial hospitalization treatment for AUD. PA was operationalized as total steps and consecutive 10-min bouts of moderate-intensity exercise (100 steps/minute). RESULTS Only 56% of participants engaged in any bouts of moderate-intensity physical activity throughout the 3-week study period (mode = 1 bout), and participants logged an average of 8183 steps/day (SD = 5560). Daily steps were associated with a higher positive affect and lower alcohol cravings, and with higher positive affect the next day, but the effects were very small. No relationships were observed between PA and affect or alcohol cravings at the hourly level except a random effect signifying that bouts of PA were either positively associated or not associated with negative affect in the next hour for different participants. CONCLUSIONS Overall, results suggest that naturalistic PA may be beneficial for a small subset of patients in recovery from AUD, but the majority did not engage in regular exercise or experience improvements in affect and cravings as a result of PA.
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Affiliation(s)
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Leslie Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Claire E Blevins
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA.
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18
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Daniels TE, Zitkovsky EK, Kunicki ZJ, Price DJ, Peterson AL, Dennery PA, Kao HT, Price LH, Tyrka AR, Abrantes AM. Associations of circulating cell-free DNA, C-reactive protein, and cardiometabolic risk among low-active smokers with elevated depressive symptoms. Brain Behav Immun Health 2022; 25:100519. [PMID: 36164463 PMCID: PMC9508337 DOI: 10.1016/j.bbih.2022.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 01/31/2023] Open
Abstract
Background and aims Cell-free DNA (cfDNA) is elevated in several disease states. Metabolic syndrome is a constellation of factors associated with poor cardiometabolic outcomes. This study examined associations of cfDNA from the nucleus (cf-nDNA) and mitochondria (cf-mtDNA), C-reactive protein (CRP), and metabolic syndrome risk, in low-active smokers with depressive symptoms. Methods Participants (N = 109; mean age 47) self-reported medical history. Physical activity was determined by accelerometry and anthropometrics were measured. Blood was collected and analyzed for cf-nDNA, cf-mtDNA, CRP, triglycerides, high-density lipoprotein, hemoglobin A1c. A continuous metabolic syndrome composite risk score was calculated. Relationships of cf-nDNA, cf-mtDNA, CRP, and cardiometabolic risk were examined with correlations and linear regression. Results CRP and cf-nDNA were significantly associated with metabolic syndrome risk (r = .39 and r = .31, respectively), cf-mtDNA was not (r = .01). In a linear regression, CRP and cf-nDNA significantly predicted the metabolic syndrome risk score, findings that remained significant controlling for age, gender, nicotine dependence, and physical activity. Conclusions Associations of cf-nDNA with both CRP and metabolic risk suggest a role for cf-nDNA in inflammatory processes associated with metabolic syndrome. The negative findings for cf-mtDNA suggest distinct roles for cf-nDNA and cf-mtDNA in these processes.
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Affiliation(s)
- Teresa E. Daniels
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA,Corresponding author. 1011 Veterans Memorial Parkway, Riverside, RI, 02915, USA.
| | - Emily K. Zitkovsky
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Destiny J. Price
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Abigail L. Peterson
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, RI, USA
| | - Phyllis A. Dennery
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, RI, USA,Department of Pediatrics, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Hung-Teh Kao
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Lawrence H. Price
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Audrey R. Tyrka
- Mood Disorders Research Program and Laboratory for Clinical and Translational, Neuroscience, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA,Behavioral Medicine and Addictions Research Department, Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA
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19
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McNamara J, Kunicki ZJ, Neptune L, Parsons K, Byrd-Bredbenner C. Development and Validation of the Young Adult Nutrition Literacy Tool. J Nutr Educ Behav 2022; 54:691-701. [PMID: 35469757 DOI: 10.1016/j.jneb.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 01/19/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To create a tool to measure college students' functional, interactive, and critical nutrition literacy. DESIGN (1) Focus group: item generation, (2) expert review, (3) exploratory factor structure analysis, (4) item refinement and modification, (5) factor structure validation, and (6) criterion validation. SETTING Two land-grant college campuses. PARTICIPANTS College students aged between 18 and 24 years. MAIN OUTCOME MEASURES Survey data was used to assess nutrition literacy. ANALYSIS Exploratory factor analysis, confirmatory factor analysis (CFA), item response theory (IRT) analyses, and correlations. RESULTS One-hundred and twenty-three items were generated and tested in an online survey format. Items were eliminated on the basis of face validity, expert feedback, exploratory factor analysis, and CFA/IRT. The 3 measures (functional, interactive, and critical) were analyzed separately. All 3 measures showed reasonable model fit in the CFA/IRT models. Criterion validity showed small to medium effect sizes between measures and fruit/vegetable intake. Reliability estimates met reasonable standards for each measure. CONCLUSIONS AND IMPLICATIONS The Young Adult Nutrition Literacy Tool is a novel instrument that measures all 3 domains of nutrition literacy. Strengths include a rigorous 6-step development process, reasonable psychometric properties, and a large breadth of items.
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Affiliation(s)
- Jade McNamara
- School of Food and Agriculture, University of Maine, Orono, ME.
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Leigh Neptune
- School of Food and Agriculture, University of Maine, Orono, ME
| | - Kayla Parsons
- School of Food and Agriculture, University of Maine, Orono, ME
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ
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20
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Shiff HM, Arias F, Dufour AB, Carr D, Chen F, Gou Y, Jones R, Schmitt E, Travison TG, Kunicki ZJ, Okereke OI, Inouye SK. Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures. Innov Aging 2022; 6:igac050. [PMID: 36128514 PMCID: PMC9478553 DOI: 10.1093/geroni/igac050] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later-life delirium. In this study, we explored the association between paternal occupation and delirium risk.
Research Design and Methods
A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM-Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay.
Results
Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR (95% confidence interval [CI]) = 1.6 (1.1, 2.3). All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index. Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared with white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 (95% CI = 0.4, 1.4) additional severity units.
Discussion and Implications
Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life-course framework to evaluate the risk of later-life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.
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Affiliation(s)
- Haley M Shiff
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
| | - Alyssa B Dufour
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Deborah Carr
- Department of Sociology, Boston University , Boston, Massachusetts , USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Yun Gou
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Richard Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Eva Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Thomas G Travison
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Olivia I Okereke
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts , USA
| | - Sharon K Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
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21
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Kunicki ZJ, Kattelmann KK, Olfert MD, Franzen-Castle L, Colby SE, Mathews DR, White AA. Dyadic Analysis of a Self-report Physical Activity Measure for Adult-Youth Dyads. Child Psychiatry Hum Dev 2022; 53:440-447. [PMID: 33611737 DOI: 10.1007/s10578-021-01144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
Adult physical activity levels influence youth physical activity levels, but the nature of this relationship is still unknown. Most research focusing on this topic has been conducted with accelerometers, which are ideal since self-report physical activity measures can be biased. However, self-report measures for physical activity are useful to include in studies to gather information at low-cost. The purpose of this study was to further develop a self-report adult-youth dyad measure of physical activity. This study was conducted using secondary data analysis of the physical activity measures used in an intervention on behavioral nutrition (iCook 4-H). Participants were a sample of 214 adults (M = 39.0, SD = 8.0 years) and youth (M = 9.4, SD = 0.7 years) pairs. Accelerometer data was collected for a subset of youth (n = 122). There was dependency between the adult-youth physical activity data, and a dyadic confirmatory factor analysis model showed good fit to the data and achieved metric invariance, a measure to determine if the same construct was being measured in both youth and adults. Invariance was confirmed across matched versus unmatched sex pairs and some evidence of invariance with youth accelerometer data. Based on study findings, when using self-report measures of physical activity, researchers should measure both members of the adult-youth dyad to get more accurate measurements. Further validation of these findings is needed using an objective physical activity measure, like accelerometers, with all participants and more diverse samples.
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Affiliation(s)
- Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Brown University, 345 Blackstone Boulevard, Box G-BH, Providence, RI, 02096, USA.
| | - Kendra K Kattelmann
- Department of Health and Nutritional Sciences, South Dakota State University, Box 2203, Brookings, SD, SWG 443, USA
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, G016 Agricultural Science Building, Morgantown, WV, USA
| | - Lisa Franzen-Castle
- Nutrition and Health Sciences Department, University of Nebraska-Lincoln, 110 Ruth Leverton Hall, Lincoln, NE, USA
| | - Sarah E Colby
- Department of Nutrition, University of Tennessee, Knoxville, TN, USA
| | - Douglas R Mathews
- School of Food and Agriculture, University of Maine, 5735 Hitchner Hall, Orono, ME, USA
| | - Adrienne A White
- School of Food and Agriculture, University of Maine, 5735 Hitchner Hall, Orono, ME, USA
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22
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Kunicki ZJ, Hallgren M, Uebelacker LA, Brown RA, Price LH, Abrantes AM. Examining the effect of exercise on the relationship between affect and cravings among smokers engaged in cessation treatment. Addict Behav 2022; 125:107156. [PMID: 34710842 PMCID: PMC8629942 DOI: 10.1016/j.addbeh.2021.107156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
Cigarette smoking is associated with multiple adverse health outcomes. When smokers attempt to quit smoking, one of the leading predictors of relapse are cravings. Recent research shows a relationship between positive and negative affect, exercise, and cravings, but the exact nature of this relationship has yet to be understood. This study explored the relationships between positive and negative affect and cravings in a sample of participants with elevated levels of depressive symptoms (N = 202; 68.8% female; mean age = 46.1 years) who were enrolled in a smoking cessation trial to test the efficacy of a 12-week exercise intervention relative to a health education control on smoking outcomes. Data on affect and craving were gathered before weekly study intervention sessions, and data on cravings were gathered again after each session. The results showed that negative affect had a significant and positive association with cravings before an exercise or health education session. After the session, positive and negative affect were not significant predictors of changes in cravings from pre-session. However, regardless of level of positive or negative affect participants in the exercise condition showed greater reductions in craving pre- to post-class than those in the control condition. These findings suggest that negative affect is associated with cravings, but cravings can be mitigated by exercise.
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Affiliation(s)
- Zachary J Kunicki
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States.
| | - Mats Hallgren
- Karolinska Institute, Department of Global Public Health, Sweden
| | - Lisa A Uebelacker
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States; Butler Hospital, Behavioral Medicine and Addictions Research, United States
| | - Richard A Brown
- The University of Texas at Austin, School of Nursing, United States
| | - Lawrence H Price
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States
| | - Ana M Abrantes
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States; Butler Hospital, Behavioral Medicine and Addictions Research, United States
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23
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Greaney ML, Kunicki ZJ, Drohan MM, Nash CC, Cohen SA. Sleep Quality Among Informal Caregivers During the COVID-19 Pandemic: A Cross-Sectional Study. Gerontol Geriatr Med 2022; 8:23337214211057387. [PMID: 35024381 PMCID: PMC8744195 DOI: 10.1177/23337214211057387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/12/2021] [Indexed: 12/25/2022] Open
Abstract
Sleep is an integral component of health. The impact of the COVID-19 pandemic on sleep quality among informal caregivers, individuals who provide unpaid care or assistance to family members or friends, assisting older adults is not well understood. Therefore, informal caregivers in the United States providing care for individuals aged 50+ were recruited via Amazon's Mechanical Turk, an online platform for enrolling study participants into social and behavioral science research, to complete an online survey. The sample of informal caregivers (n = 835) was 69% male and 55% non-Hispanic. Multivariable linear regression models were constructed to assess the associations between sleep disturbance scores (SDS) and sleep-related impairment scores (SIS) and caregiving-related measures (hours caregiving/week, length of time spent caregiving, and caregiver burden), demographics, and region of the United States. The analysis determined that Black (β = 2.6, 95% CI [-4.3, -0.9]) and Asian informal caregivers (β = -1.8, 95% CI [-3.4, -0.3]) had lower mean SIS than White caregivers, the referent group. In addition, increasing caregiver burden was associated with increased SDS (β = 0.8, 95% CI [0.6, 1.0]) and SIS (β = 1.3, 95% CI [0.7, 1.6]). In conclusion, higher caregiver burden was associated with higher SIS and SDS, suggesting that informal caregivers' sleep should be assessed, and when needed interventions should be offered.
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Affiliation(s)
- Mary L. Greaney
- Department of Health Studies, University of Rhode Island, Kingston, RI, USA
| | - Zachary J. Kunicki
- Department of Psychiatry and Human
Behavior, Warren Alpert Medical School of Brown
University, Providence, RI, USA
| | - Meghan M. Drohan
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Caitlin C. Nash
- Department of Health Studies, University of Rhode Island, Kingston, RI, USA
| | - Steven A. Cohen
- Department of Health Studies, University of Rhode Island, Kingston, RI, USA
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24
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Braun TD, Riley KE, Kunicki ZJ, Finkelstein-Fox L, Conboy LA, Park CL, Schifano E, Abrantes AM, Lazar SW. Internalized weight stigma and intuitive eating among stressed adults during a mindful yoga intervention: associations with changes in mindfulness and self-compassion. Health Psychol Behav Med 2021; 9:933-950. [PMID: 34868736 PMCID: PMC8635578 DOI: 10.1080/21642850.2021.1992282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/24/2022] Open
Abstract
Purpose Internalized weight stigma (IWS) is common in the United States of America across body weight categories, and is implicated in the development of distress and unhealthy eating behaviors (e.g. overeating, disordered eating) that can foster poor cardiometabolic health. While emerging intervention research shows early promise in reducing IWS, long-term efficacy is unclear and novel strategies remain needed. This analysis examined whether participation in a mindful yoga intervention was associated with reduced IWS and increased intuitive eating, an adaptive eating behavior, and whether these changes correlated with each other or with changes in mindfulness and self-compassion. Methods Participants were stressed adults with low fruit and vegetable intake (N = 78, 64.1% White, M. Body Mass Index 25.59 ± 4.45) enrolled in a parent clinical trial of a 12-week mindful yoga intervention. Validated self-report measures of IWS, intuitive eating, mindfulness, and self-compassion were administered at pre-treatment, mid-treatment (8 weeks), post-treatment (12 weeks), and 4-month follow-up (24 weeks). Results Linear mixed modeling revealed significant improvements in IWS and intuitive eating across the four timepoints (p < .001). Reduced IWS correlated with increased intuitive eating pre- to post-treatment (p = .01). Improved self-compassion and mindfulness correlated with intuitive eating (both p = . 04), but not IWS (p = .74 and p = .56, respectively). Conclusion This study offers preliminary support for the hypothesis that mindful yoga may promote intuitive eating and reduce IWS among stressed adults with poor diet, and suggests that changes in these factors may co-occur over time. Further investigation with controlled designs is necessary to better understand the temporality and causality of these relationships.Trial registration: ClinicalTrials.gov identifier: NCT02098018.
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Affiliation(s)
- Tosca D Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine, Brown University, Providence, RI, USA.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Kristen E Riley
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Zachary J Kunicki
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Lucy Finkelstein-Fox
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, USA
| | - Lisa A Conboy
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Crystal L Park
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, USA
| | | | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine, Brown University, Providence, RI, USA.,Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychology, Harvard Medical School, Boston, MA, USA
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25
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Braun TD, Kunicki ZJ, Blevins CE, Stein MD, Marsh E, Feltus S, Miranda R, Thomas JG, Abrantes AM. Prospective Associations between Attitudes toward Sweet Foods, Sugar Consumption, and Cravings for Alcohol and Sweets in Early Recovery from Alcohol Use Disorders. Alcohol Treat Q 2021; 39:269-281. [PMID: 34566252 DOI: 10.1080/07347324.2020.1868958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sweet liking (heightened preference for highly-sweet solutions) is linked to Alcohol Use Disorder (AUD) and relapse, as well as attitudes towards sweet foods - use of sugar to cope with negative affect (sweet-cope), and impaired control over sweets consumption (sweet-control). This prospective analysis of individuals with AUD (N=26) participating in an Alcohol and Drug partial hospitalization program observed increases in self-reported sugar consumption and sweet craving from Time 1 (T1) to Time 2 (T2; 4 weeks later). Sweet-cope (T1) predicted T2 sweet craving. In an exploratory cross-lagged panel model, sweet-cope predicted sugar consumption and sweet craving at T1 and T2, and alcohol craving at T2. This pattern of results suggests the hypothesis that use of sugar to regulate negative affect may prove a novel, modifiable risk mechanism of the association between sweet liking and relapse. Sweet-cope may also prove an intervention target for improving nutrition and weight-related factors in early recovery. Future research in larger sample sizes is needed.
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Affiliation(s)
- Tosca D Braun
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Behavioral Medicine and Addictions Research, Butler Hospital
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Claire E Blevins
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Behavioral Medicine and Addictions Research, Butler Hospital
| | - Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital.,Department of Health Law, Policy & Management, Boston University School of Public Health
| | - Eliza Marsh
- Behavioral Medicine and Addictions Research, Butler Hospital
| | - Sage Feltus
- Behavioral Medicine and Addictions Research, Butler Hospital.,Department of Psychology, Binghamton University
| | - Robert Miranda
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Center for Alcohol and Addiction Studies, Brown University
| | - John G Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Weight Control and Diabetes Research Center, The Miriam Hospital
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Behavioral Medicine and Addictions Research, Butler Hospital
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26
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Kim DS, Kunicki ZJ, Philips OW, Jones RN, Friedman JH, Kluger B, Akbar U. Racial and geographic disparities with gastrostomy tube placement in dementia and parkinsonian disorders. Parkinsonism Relat Disord 2021; 91:28-31. [PMID: 34479055 DOI: 10.1016/j.parkreldis.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many patients with advanced dementia and Parkinson's disease and related disorders (PDRD) are receiving gastrostomy tube (GT) placement annually, despite its lack of proven benefit for preventing aspiration, enhancing nutrition, or prolonging survival. Given clinical practice variability in the care of people with neurodegenerative disorders, we sought to examine racial and geographic disparities in GT placement for these populations in the United States. METHOD Data were extracted from a publicly-available national database using diagnostic and procedural codes from 2006 to 2010. GT placement rates and odds ratios were calculated for two groups: PDRD and non-parkinsonian dementia (NPD). RESULTS In the PDRD group, odds of GT placement were higher among patients coded as Black (OR 1.69, CI 0.80-3.56, p = 0.17) and Asian (OR 2.17, CI 0.70-6.78, p = 0.18) than Whites; although these tendencies did not reach statistical significance. In the NPD group, GT placement among Black patients was significantly more likely (OR 2.88, CI 1.90-4.36, p < 0.001) than their white counterparts, while Asian patients were significantly less likely (OR 0.12, CI 0.02-0.91, p = 0.04). Compared to the Northeast region, there were significantly lower odds of GT placement in the Midwest region (OR 0.37, CI 0.24-0.58, p < 0.001) in the NPD group only. No difference in odds was observed between the sexes in both groups. CONCLUSION This study showed geographic and racial disparities in GT placement among PDRD and NPD patients. Further studies should aim to clarify best practices for GT placement in PDRD and causes of practice differences within and between PDRD and NPD groups.
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Affiliation(s)
- Duk Soo Kim
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Oliver W Philips
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | - Richard N Jones
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph H Friedman
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Benzi Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Umer Akbar
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
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Greaney ML, Kunicki ZJ, Drohan MM, Ward-Ritacco CL, Riebe D, Cohen SA. Self-reported changes in physical activity, sedentary behavior, and screen time among informal caregivers during the COVID-19 pandemic. BMC Public Health 2021; 21:1292. [PMID: 34215246 PMCID: PMC8252978 DOI: 10.1186/s12889-021-11294-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Informal caregivers providing unpaid assistance may be vulnerable to changes in health behaviors due to modifications in caregiving during the COVID-19 pandemic. Therefore, this cross-sectional study explored self-reported changes in physical activity (PA), sedentary behavior, and screen time among informal caregivers providing care for older adults aged 50+ during the pandemic. METHODS Study participants were recruited via Amazon's Mechanical Turk and reported their perceived changes (increased a lot, increased a little, remained the same, decreased a little, decreased a lot) in moderate-intensity PA (MPA), vigorous-intensity PA (VPA), sedentary behavior, and screen time (weekday and weekend) during the pandemic. For analytic purposes, response categories were categorized into three-level ordinal variables-increased (increased a lot, increased a little), no change (remained the same), decreased (decreased a little, decreased a lot). Multinomial logistic regression models assessed the likelihood of changes (vs. no change) in MPA, VPA, sedentary behavior, and screen time (weekday, weekend) based on caregiving and demographic characteristics. RESULTS In total, 2574 individuals accessed the study link, 464 of whom did not meet eligibility requirements. In addition, people who completed 80% or less of the survey (n = 1171) and/or duplicate IP addresse (n = 104) were excluded, resulting in an analytic sample of n = 835. The sample was 69% male, had a mean age of 34 (SD = 9.7), and 48% reported increased VPA, while 55% reported increased MPA. The majority also reported increased sedentary behavior, as well as increased screen time. Respondents living with their care recipient were more likely to report increased weekday screen time (Odds Ratio [OR] = 1.55, 95% CI 1.11-2.16) and sedentary behavior (OR = 1.80, 95% CI 1.28-2.53) than respondents not living with the care recipient. Those living with their care recipient were also more likely to reported increased MPA (OR = 1.64, 95% CI 1.16-2.32), and VPA (OR = 1.53, 95% CI 1.09-2.15), but also more likely to report a decrease in VPA (OR = 1.75, 95% CI 1.14-2.70). CONCLUSION The majority of respondents reported that their MPA, VPA PA, sedentary behavior, and screen time had changed during the pandemic. Living with the care recipient was associated with both positive and negative changes in behavior. Future research can explore factors associated with these reported changes in behavior.
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Affiliation(s)
- Mary L Greaney
- Department of Health Studies, University of Rhode Island, 25 West Independent Way, Kingston, Rhode Island, 02881, USA.
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Megan M Drohan
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Deborah Riebe
- Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Steven A Cohen
- Department of Health Studies, University of Rhode Island, 25 West Independent Way, Kingston, Rhode Island, 02881, USA
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Kunicki ZJ, Gaudiano BA, Miller IW, Tremont G, Salloway S, Darling E, Broughton MK, Kraines MA, Hoopes R, Epstein-Lubow G. Differences in Burden Severity in Adult-Child Family Caregivers and Spousal Caregivers of Persons with Dementia. J Gerontol Soc Work 2021; 64:518-532. [PMID: 33820479 DOI: 10.1080/01634372.2021.1912242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
Researchers are continuing to focus on the nature and sources of burden of family caregivers of persons living with dementia. Caregiving stress and burden are assessed and addressed by social workers, including at high-risk times such as hospitalization. This study tested whether adult-child family caregivers experience greater perceived burden than spousal caregivers, accounting for risks of acute stress which can accompany hospitalization for their care recipient, where social workers may be meeting with family caregivers for the first time. Family caregivers (N = 76; n = 42 adult-child; n = 34 spouse) were recruited during care-recipient clinical treatment. The settings of care included an outpatient memory care program and an inpatient geriatric psychiatry service. Results showed that adult-child caregivers reported greater burden as compared with spousal caregivers, but no differences regarding depressive symptoms, perceived stress, or grief. After controlling for demographics and location of care, being an adult-child caregiver remained a predictor of greater burden severity. Being an adult-child family caregiver may place an individual at increased risk for experiencing high burden. These findings suggest socials workers should consider how adult-child caregivers may benefit from strategies to address and reduce burden, beyond those typically offered to spousal caregivers.
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Affiliation(s)
- Zachary J Kunicki
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Brandon A Gaudiano
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Ivan W Miller
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Geoffrey Tremont
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Stephen Salloway
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- Brown University, The Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Ellen Darling
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | | | - Morganne A Kraines
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Ryan Hoopes
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Gary Epstein-Lubow
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Cohen SA, Kunicki ZJ, Drohan MM, Greaney ML. Exploring Changes in Caregiver Burden and Caregiving Intensity due to COVID-19. Gerontol Geriatr Med 2021; 7:2333721421999279. [PMID: 33718523 PMCID: PMC7919204 DOI: 10.1177/2333721421999279] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
This study explored self-reported changes in caregiving intensity (CI) and
caregiver burden (CB) among informal caregivers due to the COVID-19 pandemic
overall and by gender. Informal caregivers for someone age 50+ completed a
survey via Amazon’s MTurk in June 2020. Participants reported changes in CI and
CB due to COVID-19 and provided demographic information. Multinomial logistic
regression models assessed changes in CI and CB attributed to the COVID-19
pandemic overall and by gender. The sample (n = 835) was 68.5%
male and had an average age of 34 years (SD 9.8); 55.7% had
increased CI, and 53.1% had increased CB attributed to the pandemic. Increased
CB due to COVID-19 was associated with increased CI (OR 5.67, 95% CI 3.92–8.00).
Male caregivers with decreased CI due to COVID-19 were nearly seven times as
likely as those with no change in CI to have reduced CB due to COVID-19 (OR
6.91, 95% CI 3.29–14.52). Women with decreased CI due to COVID-19 were over
eight times as likely to have reduced CB due to COVID (OR 8.30, 95% CI
2.66–25.91). Results indicate that many caregivers experienced increases in CI
and CB since the start of the COVID-19 pandemic, and that these changes are
complex and vary by gender.
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Affiliation(s)
| | - Zachary J Kunicki
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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30
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Cohen SA, Kunicki ZJ, Nash CC, Drohan MM, Greaney ML. Rural-Urban Differences in Caregiver Burden Due to the COVID-19 Pandemic among a National Sample of Informal Caregivers. Gerontol Geriatr Med 2021; 7:23337214211025124. [PMID: 34212069 PMCID: PMC8216387 DOI: 10.1177/23337214211025124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/19/2021] [Revised: 05/15/2021] [Accepted: 05/26/2021] [Indexed: 12/23/2022] Open
Abstract
The objective of this exploratory study was to explore potential associations between changes to caregiver burden (CB) due to the COVID-19 pandemic and rural-urban status using a nationally representative sample of 761 informal caregivers. Tertiles of two measures of rural-urban status were used: Rural-Urban Commuting Areas (RUCAs) and population density. Bivariate and multivariable binary and ordinal logistic regression were used to asses study objectives. Using RUCAs, rural informal caregivers were more than twice as likely as urban informal caregivers to report a substantial increase in CB due to COVID-19 (OR 2.27, 95% CI [1.28-4.02]). Similar results were observed for population density tertiles (OR 2.20, 95% CI [1.22-3.96]). Having a COVID-19 diagnosis was also significantly associated with increased CB. Understanding and addressing the root causes of rural-urban disparities in CB among informal caregivers is critical to improving caregiver health and maintaining this critical component of the healthcare system.
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Arnold T, Kunicki ZJ, Rogers BG, Haubrick KK, Klasko-Foster L, Norris AL, Drohan MM, Greaney ML, Cohen SA. Validating the Psychosocial Functioning during COVID-19 Questionnaire among a Sample of Informal Caregivers. Gerontol Geriatr Med 2021; 7:2333721421997200. [PMID: 33748339 PMCID: PMC7903817 DOI: 10.1177/2333721421997200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic has had a dramatic impact on global economies and societies. Although social distancing policies are needed to contain the spread and impact of COVID-19, they also impose a psychological and economic burden on people who are already experiencing increased distress such as caregivers. Yet, few measures have been developed and validated to measure the psychosocial impact of COVID-19. Utilizing item response theory (IRT), the purpose of this study was to develop and psychometrically validate a measure of psychosocial functioning-the Psychosocial Functioning during COVID-19 (PFC-19) Questionnaire-to assess changes in social interaction, mental health, health behavior, and global functioning among a sample of informal caregivers during the COVID-19 pandemic. The analytic sample (n = 733) was recruited from Amazon Mechanic Turk (MTurk) (69% male, 55% white). Results suggest a two-factor measure, assessing global functioning (14 items) and affective response (8 items), with strong evidence for reliability, validity, and dimensionality. Future research should replicate this factor structure in other samples.
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Affiliation(s)
- Trisha Arnold
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, USA
| | | | - Brooke G. Rogers
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Miriam Hospital, Providence, RI, USA
| | | | | | - Alyssa L. Norris
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, USA
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McNamara J, Kunicki ZJ, Olfert MD, Byrd-Bredbenner C, Greene G. Revision and Psychometric Validation of a Survey Tool to Measure Critical Nutrition Literacy in Young Adults. J Nutr Educ Behav 2020; 52:726-731. [PMID: 32151440 DOI: 10.1016/j.jneb.2020.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To refine and psychometrically validate the Revised Critical Nutrition Literacy Tool in a young adult sample. METHODS Young adults recruited from 3 universities completed the 11-item Critical Nutrition Literacy Tool claims scale. Exploratory factor analysis, confirmatory factor analysis (CFA), and item response theory were used to validate the Critical Nutrition Literacy Tool. Omega and Cronbach α assessed reliability. RESULTS A total of 1,718 participants completed the survey. Results from exploratory factor analysis and CFA analyses suggested that a 2-factor, 7-item instrument showed a reasonable fit to the data based on the comparative fit index and standardized root mean residual values, χ2(13) =161.64, P < .001, comparative fit index = 0.90, root mean square error of approximation = 0.11, standardized root mean residual = 0.07. All items loaded well onto the factors from the CFA and item response theory perspectives. The full measure and both factors showed questionable (>0.60) or acceptable (>0.70) internal consistency. CONCLUSIONS AND IMPLICATIONS A revised 2-factor instrument capturing (factor 1) critical appraisal of media and (factor 2) evidence-based sources of nutrition information demonstrated sound psychometric characteristics. Further item testing is necessary for different populations, and item development is warranted to capture Internet/social media sources and the relationship among critical nutrition literacy, dietary behaviors, and health outcomes.
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Affiliation(s)
- Jade McNamara
- School of Food and Agriculture, University of Maine, Orono, ME.
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Melissa D Olfert
- Department of Human Nutrition and Food, West Virginia University, Morgantown, WV
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Geoffrey Greene
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
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Kunicki ZJ, Zambrotta NS, Tate MC, Surrusco AR, Risi MM, Harlow LL. Keep Your Stats in the Cloud! Evaluating the Use of Google Sheets to Teach Quantitative Methods. J Stat Educ 2019; 27:188-197. [PMID: 33013153 PMCID: PMC7531441 DOI: 10.1080/10691898.2019.1665485] [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] [Indexed: 06/11/2023]
Abstract
Teaching quantitative methods at the undergraduate level is a difficult yet rewarding endeavor due to the challenges instructors face in presenting the material. One way to bolster student learning is through the use of statistical software packages. Google Sheets is a cloud-based spreadsheet program capable of many basic statistical procedures, which has yet to be evaluated for use in quantitative methods courses. This article contains pros and cons to using Google Sheets in the classroom, and provides an evaluation of student attitudes towards using Google Sheets in an introductory quantitative methods class. The results suggest favorable student attitudes towards Google Sheets and, that attitudes towards Google Sheets show a positive relationship with quantitative self-efficacy. Thus, based on the positive student attitudes and the unique features of Google Sheets, it is a viable program to use in introductory methods classes. However, due to limited functionality, Google Sheets may not be useful for more advanced courses. Future research may want to evaluate the use of third-party Google Sheets applications, which can increase functionality, and the use of Google Sheets in online classes.
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Affiliation(s)
- Zachary J Kunicki
- University of Rhode Island Psychology Department, 45 Upper College Road, Kingston, RI 02881
| | - Nicholas S Zambrotta
- University of Rhode Island Psychology Department, 45 Upper College Road, Kingston, RI 02881
| | - Marie C Tate
- University of Rhode Island Psychology Department, 45 Upper College Road, Kingston, RI 02881
| | - Angela R Surrusco
- University of Rhode Island Psychology Department, 45 Upper College Road, Kingston, RI 02881
| | - Megan M Risi
- University of Rhode Island Psychology Department, 45 Upper College Road, Kingston, RI 02881
| | - Lisa L Harlow
- University of Rhode Island Psychology Department, 45 Upper College Road, Kingston, RI 02881
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Mathews DR, Kunicki ZJ, Colby SE, Franzen-Castle L, Kattelmann KK, Olfert MD, White AA. Development and Testing of Program Evaluation Instruments for the iCook 4-H Curriculum. J Nutr Educ Behav 2019; 51:S21-S29. [PMID: 30472311 DOI: 10.1016/j.jneb.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop and test the validity of program outcome evaluation instruments for cooking, eating, and playing together for obesity prevention during iCook 4-H. DESIGN Instrument development for both youth and adults through pre-post testing of items newly constructed and compiled to address key curriculum constructs. Testing occurred throughout program intervention and dissemination to determine dimensionality, internal consistency and test-retest reliability, and validity. SETTING A 5-state out-of-school program in cooperative extension and other community sites. PARTICIPANTS Youths aged 9-10 years; adults were main food preparers; the first phase involved 214 dyads and the second phase, 74 dyads. MAIN OUTCOME MEASURE(S) Youth measures were cooking skills, culinary self-efficacy, physical activity, and openness to new foods. Adult measures were cooking together, physical activity, and eating together. ANALYSIS Exploratory factor analysis to determine initial scale structure and confirmatory factor analysis to confirm factor structures. Longitudinal invariance tests to see whether the factor structure held over time. Test-retest reliability was determined by Pearson r and internal consistency was determined by coefficient Ω and Cronbach α. Validity testing was determined by Pearson r correlations. RESULTS Youth cooking skills, openness to new foods, and adult eating together and cooking together showed strong evidence for dimensionality, reliability, and validity. Youth physical activity and adult physical activity measures showed strong evidence for dimensionality and validity but not reliability. The youth culinary self-efficacy measure showed strong evidence for reliability and validity but weaker evidence for dimensionality. CONCLUSIONS AND IMPLICATIONS Program outcome evaluation instruments for youths and adults were developed and tested to accompany the iCook 4-H curriculum. Program leaders, stakeholders, and administrators may monitor outcomes within and across programs and generate consistent reporting.
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Affiliation(s)
| | | | - Sarah E Colby
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Lisa Franzen-Castle
- Nutrition and Health Sciences Department, University of Nebraska-Lincoln, Lincoln, NE
| | - Kendra K Kattelmann
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, WV
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