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Evans SK, Ober AJ, Korn AR, Peltz A, Friedmann PD, Page K, Murray-Krezan C, Huerta S, Ryzewicz SJ, Tarhuni L, Nuckols TK, E Watkins K, Danovitch I. Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder. Addict Sci Clin Pract 2024; 19:31. [PMID: 38671482 PMCID: PMC11046820 DOI: 10.1186/s13722-024-00461-x] [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: 09/18/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hospitalization presents an opportunity to begin people with opioid use disorder (OUD) on medications for opioid use disorder (MOUD) and link them to care after discharge; regrettably, people admitted to the hospital with an underlying OUD typically do not receive MOUD and are not connected with subsequent treatment for their condition. To address this gap, we launched a multi-site randomized controlled trial to test the effectiveness of a hospital-based addiction consultation team (the Substance Use Treatment and Recovery Team (START)) consisting of an addiction medicine specialist and care manager team that provide collaborative care and a specified intervention to people with OUD during the inpatient stay. Successful implementation of new practices can be impacted by organizational context, though no previous studies have examined context prior to implementation of addiction consultation services (ACS). This study assessed pre-implementation context for implementing a specialized ACS and tailoring it accordingly. METHODS We conducted semi-structured interviews with hospital administrators, physicians, physician assistants, nurses, and social workers at the three study sites between April and August 2021 before the launch of the pragmatic trial. Using an analytical framework based on the Consolidated Framework for Implementation Research, we completed a thematic analysis of interview data to understand potential barriers or enablers and perceptions about acceptability and feasibility. RESULTS We interviewed 28 participants across three sites. The following themes emerged across sites: (1) START is an urgently needed model for people with OUD; (2) Intervention adaptations are recommended to meet local and cultural needs; (3) Linking people with OUD to community clinicians is a highly needed component of START; (4) It is important to engage stakeholders across departments and roles throughout implementation. Across sites, participants generally saw a need for change from usual care to support people with OUD, and thought the START was acceptable and feasible to implement. Differences among sites included tailoring the START to support the needs of varying patient populations and different perceptions of the prevalence of OUD. CONCLUSIONS Hospitals planning to implement an ACS in the inpatient setting may wish to engage in a systematic pre-implementation contextual assessment using a similar framework to understand and address potential barriers and contextual factors that may impact implementation. Pre-implementation work can help ensure the ACS and other new practices fit within each unique hospital context.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Ariella R Korn
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Alex Peltz
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Departement of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 300, 15213, Pittsburgh, PA, USA
| | - Sergio Huerta
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Stephen J Ryzewicz
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Lina Tarhuni
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Teryl K Nuckols
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
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Meredith LS, Wong EC, Marx BP, Han B, Korn AR, Tobin JN, Cassells A, Williamson S, Franco M, Overa CC, Holder T, Lin TJ, Sloan DM. Design of a hybrid implementation effectiveness cluster randomized controlled trial of delivering written exposure therapy for PTSD in underserved primary care settings. Contemp Clin Trials 2024; 138:107435. [PMID: 38211725 DOI: 10.1016/j.cct.2024.107435] [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: 09/21/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) results in substantial costs to society. Prevalence of PTSD among adults is high, especially among those presenting to primary care settings. Evidence-based psychotherapies (EBPs) for PTSD are available but dissemination and implementation within primary care settings is challenging. Building Experience for Treating Trauma and Enhancing Resilience (BETTER) examines the effectiveness of integrating Written Exposure Therapy (WET) within primary care collaborative care management (CoCM). WET is a brief exposure-based treatment that has the potential to address many challenges of delivering PTSD EBPs within primary care settings. METHODS The study is a hybrid implementation effectiveness cluster-randomized controlled trial in which 12 Federally Qualified Health Centers (FQHCs) will be randomized to either CoCM plus WET (CoCM+WET) or CoCM only with 60 patients within each FQHC. The primary aim is to evaluate the effectiveness of CoCM+WET to improve PTSD and depression symptom severity. Secondary treatment outcomes are mental and physical health functioning. The second study aim is to examine implementation of WET within FQHCs using FQHC process data and staff interviews pre- and post-intervention. Exploratory aims are to examine potential moderators and mediators of the intervention. Assessments occur at baseline, and 3- and 12-month follow-up. CONCLUSION The study has the potential to impact practice and improve clinical and public health outcomes. By establishing the effectiveness and feasibility of delivering a brief trauma-focused EBP embedded within CoCM in primary care, the study aims to improve PTSD outcomes for underserved patients. TRIAL REGISTRATION (Clinicaltrials.govNCT05330442).
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Affiliation(s)
- Lisa S Meredith
- RAND Corporation, Santa Monica, CA, United States of America; VA HSR&D Center for Healthcare Innovation, Implementation & Policy, Sepulveda, CA, United States of America.
| | - Eunice C Wong
- RAND Corporation, Santa Monica, CA, United States of America
| | - Brian P Marx
- National Center for PTSD, Behavioral Science Division at VA Boston Healthcare, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Bing Han
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States of America
| | - Ariella R Korn
- RAND Corporation, Boston, MA 02116, United States of America
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, United States of America; The Rockefeller University Center for Clinical and Translational Science, New York, NY, United States of America
| | - Andrea Cassells
- Clinical Directors Network (CDN), New York, NY, United States of America
| | | | - Meghan Franco
- Pardee RAND Graduate School, Santa Monica, CA, United States of America
| | - Cleo Clarize Overa
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - Tameir Holder
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - T J Lin
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - Denise M Sloan
- National Center for PTSD, Behavioral Science Division at VA Boston Healthcare, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
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Vorkoper S, Korn AR, Maruvada P, Nicastro HL, Shi S. NIH-supported implementation science and nutrition research: a portfolio review of the past decade. Front Public Health 2023; 11:1235164. [PMID: 37915813 PMCID: PMC10616832 DOI: 10.3389/fpubh.2023.1235164] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Objective This portfolio analysis aims to describe the scope of NIH-funded extramural research grants at the intersection of nutrition research and implementation science (IS) from 2011 to 2022 and to offer insights into future research opportunities relevant to the Strategic Plan for NIH Nutrition Research 2020-2030. Methods A portfolio analysis of funded grants using NIH reporting systems was conducted to identify nutrition research and IS awarded between fiscal years 2011 and 2022. The authors screened the titles and abstracts for inclusion criteria: research and career development awards involved a nutrition and/or dietary intervention and measured a stated implementation outcome or used an IS theory, model, or framework. Results In total, 33 NIH-funded awards met the inclusion criteria. Almost half of the awards (48.5%) were investigator-initiated research projects compared to research career awards and cooperative agreements. While studies were predominantly conducted in the United States, 15.2% were conducted in low- and middle-income countries in Africa, Latin America, and Asia. Adults aged 19-64 years and children aged 2-11 years represented most of the study populations (45.5 and 15.2%, respectively). Studies provided nutrition/dietary guidelines and created culturally tailored interventions, which were then adapted in collaboration with community partners in schools, hospitals, and religious settings. The most cited IS outcomes were feasibility, costs, adoption, and acceptability. Sixteen awards (48.5%) used an IS theory, model, or framework to guide their work. Discussion The findings show the breadth of NIH-funded nutrition and implementation research and highlight potential research opportunities.
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Affiliation(s)
- Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, MD, United States
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Padma Maruvada
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Holly L. Nicastro
- Office of Nutrition Research, National Institutes of Health, Bethesda, MD, United States
| | - Scarlet Shi
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Korn AR, Walsh-Bailey C, Correa-Mendez M, DelNero P, Pilar M, Sandler B, Brownson RC, Emmons KM, Oh AY. Social determinants of health and US cancer screening interventions: A systematic review. CA Cancer J Clin 2023; 73:461-479. [PMID: 37329257 PMCID: PMC10529377 DOI: 10.3322/caac.21801] [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: 01/04/2023] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.
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Affiliation(s)
- Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Behavioral and Policy Sciences Department, RAND Corporation, Boston, MA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Margarita Correa-Mendez
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - April Y. Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Economos CD, Calancie L, Korn AR, Allender S, Appel JM, Bakun P, Hennessy E, Hovmand PS, Kasman M, Nichols M, Pachucki MC, Swinburn BA, Tovar A, Hammond RA. Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study. BMC Public Health 2023; 23:529. [PMID: 36941543 PMCID: PMC10026415 DOI: 10.1186/s12889-023-15288-5] [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: 08/12/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence about how they affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments. METHODS We studied a community coalition (N = 16, Shape Up Under 5 "SUU5 Committee") focused on early childhood obesity prevention in Somerville, MA from 2015-17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis. RESULTS Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee's social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003). CONCLUSION SUU5 had positive effects on "upstream" drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed "midstream" community policies, systems, and environments.
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Affiliation(s)
- Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Steven Allender
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Julia M Appel
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Peter Bakun
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Peter S Hovmand
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - Matt Kasman
- Economic Studies, Brookings, Washington, D.C., USA
| | - Melanie Nichols
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mark C Pachucki
- Sociology and Computational Social Science Institute, University of Massachusetts, Amherst, MA, USA
| | - Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Alison Tovar
- Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Ross A Hammond
- Economic Studies, Brookings, Washington, D.C., USA
- Brown School, Washington University in St Louis, St Louis, MO, USA
- Santa Fe Institute, Santa Fe, NM, USA
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Kasman M, Hammond RA, Mack-Crane A, Purcell R, Korn AR, Appel JM, Hennessy E, Swinburn B, Allender S, Economos CD. Using Agent-Based Modeling to Extrapolate Community-Wide Impact from a Stakeholder-Driven Childhood Obesity Prevention Intervention: Shape Up Under 5. Child Obes 2023; 19:130-138. [PMID: 35612430 PMCID: PMC9986012 DOI: 10.1089/chi.2021.0264] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Whole-of-community interventions are a promising systems-based approach to childhood obesity prevention. A theorized driver of success is "Stakeholder-Driven Community Diffusion" (SDCD): the spread of knowledge about and engagement with obesity prevention efforts from a committee of stakeholder representatives. We focus on the potential of SDCD to affect the broader community. Methods: We use an agent-based model of SDCD to dynamically represent the interpersonal interactions that drive community diffusion of knowledge and engagement. We test its explanatory power using longitudinal data from a sample of community members and then use simulations to extrapolate from this limited sample to the unobserved community at large. We also consider counterfactual scenarios that show how changes in implementation strategy might have led to different patterns of community change. Results: Our model can reproduce real-world patterns of diffusion. Simulations show a substantial increase in knowledge (an approximate doubling) and a slight increase in engagement throughout the broader community. A relatively small amount of this change in knowledge (∼10%), and all the change in engagement is attributable to direct intervention effects on committee members. Conclusions: SDCD is premised on creating preconditions for sustainable change. Previous work has estimated impact on small samples closely linked to the stakeholder committee, but the degree to which this translates into the much broader diffusion envisioned by SDCD theory is unknown. This analysis demonstrates the potential of interventions to do just that. Additionally, the counterfactual scenarios suggest that simulation can help tailor implementation of SDCD interventions to increase impact.
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Affiliation(s)
- Matt Kasman
- Economics Studies Program, Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC, USA
| | - Ross A Hammond
- Economics Studies Program, Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC, USA
- Public Health, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - Austen Mack-Crane
- Economics Studies Program, Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC, USA
| | - Rob Purcell
- Economics Studies Program, Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC, USA
| | - Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Julia M Appel
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Nicastro HL, Vorkoper S, Sterling R, Korn AR, Brown AGM, Maruvada P, Oh AY. Opportunities to advance implementation science and nutrition research: a commentary on the Strategic Plan for NIH Nutrition Research. Transl Behav Med 2023; 13:1-6. [PMID: 36370119 PMCID: PMC10091491 DOI: 10.1093/tbm/ibac066] [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: 11/13/2022] Open
Abstract
Despite population-wide recommendations by the U.S. Dietary Guidelines for Americans and others to encourage health-promoting dietary patterns, the proportion of Americans following dietary recommendations remains low. The gaps in the adoption and integration of evidence-based dietary interventions, practices, programs, and policies (EBIs) into community and clinical settings signal the need to strengthen efforts in implementation science (IS) in nutrition research to understand and alleviate barriers to adopting and sustaining healthy dietary behaviors and practices. Equally important is the translation of this research into practice in a variety of settings and across the diversity of populations. Recognizing this need, the U.S. National Institutes of Health (NIH) 2020-2030 Strategic Plan for NIH Nutrition Research calls for the expansion of IS as a key opportunity to advancing nutrition research. This commentary highlights three scientific opportunities to stimulate IS in nutrition research and provides examples for each opportunity. These include: (a) Advance consideration of implementation and dissemination early in the design of interventions to facilitate opportunities for equitable scale-up and sustainability of EBIs, (b) Develop and test strategies for equitable implementation of nutrition and diet EBIs in health care and community settings, and (c) Build and strengthen the infrastructure, capacity, and expertise needed to increase use of IS in clinical and community nutrition research to swiftly move the research into practice. By advancing the three opportunities identified in this commentary, the scientific community has the potential to advance the field of nutrition research and IS with the ultimate goal of improving public health.
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Affiliation(s)
- Holly L Nicastro
- Office of Nutrition Research, National Institutes of Health, Bethesda, MD, USA
| | - Susan Vorkoper
- Division of International Science Policy, Planning and Evaluation, Fogarty International Center, Bethesda, MD, USA
| | - Rene Sterling
- Division of Genomics and Society, National Human Genome Research Institute, Bethesda, MD, USA
| | - Ariella R Korn
- Cancer Prevention Fellowship Program, Rockville, MD, USA.,Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Alison G M Brown
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Padma Maruvada
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - April Y Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Korn AR, Reedy J, Brockton NT, Kahle LL, Mitrou P, Shams-White MM. The 2018 World Cancer Research Fund/American Institute for Cancer Research Score and cancer risk: a longitudinal analysis in the NIH-AARP Diet and Health Study. Cancer Epidemiol Biomarkers Prev 2022; 31:1983-1992. [PMID: 35877953 PMCID: PMC9532348 DOI: 10.1158/1055-9965.epi-22-0044] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/12/2022] [Revised: 04/14/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We examined associations between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations using the standardized 2018 WCRF/AICR Score and cancer risk among older U.S. adults. METHODS Participants included 215,102 adults in the NIH-AARP Diet and Health Study followed between 2004-2011 (mean 7.0 person-years). Scores (range: 0-7 points) were calculated from self-reported weight, physical activity, and diet and alcohol intake measures. Outcomes included 17 cancers reviewed by WCRF/AICR (cases: male n=11,066; female n=8,865) and top three U.S. cancers in males (total n=4,658; lung n=2,211; prostate n=920; colorectal n=1,527) and females (total n=5,957; lung n=1,475; post-menopausal breast n=3,546; colorectal n=936). Cox proportional hazard ratios (HRs) were estimated for score and cancer risk associations, stratifying by sex and smoking status. RESULTS Each one-point score increase was associated with 6-13% reduced cancer risk across combined outcomes, except for male never smokers' risk for top three cancers and male current smokers' risk for both combined cancer outcomes. Higher scores were associated with decreased lung cancer risk only among male former smokers (HR=0.84; 95%CI: 0.79-0.89) and female current smokers (HR=0.89; 95%CI: 0.82-0.96). Higher scores were associated with 7-19% decreased breast cancer risk across smoking strata and 10-14% decreased colorectal cancer risk among male and female never and former smokers. CONCLUSIONS Greater Recommendations adherence was associated with reduced cancer risk. IMPACT Findings emphasize the importance of considering combined contributions of multiple lifestyle factors for cancer prevention among older adults and the potential modifying role of smoking history.
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Affiliation(s)
- Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Jill Reedy
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Lisa L Kahle
- Information Management Services, Inc., Rockville, Maryland
| | - Panagiota Mitrou
- World Cancer Research Fund International, London, United Kingdom
| | - Marissa M Shams-White
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Korn AR, Walsh-Bailey C, Pilar M, Sandler B, Bhattacharjee P, Moore WT, Brownson RC, Emmons KM, Oh AY. Social determinants of health and cancer screening implementation and outcomes in the USA: a systematic review protocol. Syst Rev 2022; 11:117. [PMID: 35676720 PMCID: PMC9175338 DOI: 10.1186/s13643-022-01995-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the delivery, uptake, and implementation of cancer screening to meet evidence-based recommendations is needed to reduce persistent cancer health disparities in the USA. Current national public health targets emphasize the role of social determinants of health (SDOH) on cancer screening. However, there remains a need to explicate these linkages, toward the goal of identifying and implementing effective interventions that target and address SDOH to reduce inequities in cancer screening. METHODS We will conduct a systematic review of English language peer-reviewed original research articles published between 2010 and 2021 that describe observational (qualitative and quantitative) and intervention studies conducted in the USA. In alignment with Healthy People 2030, we will include studies of breast, cervical, colorectal, and/or lung cancer screening. Guided by multiple SDOH frameworks, we will broadly define SDOH by five domain areas: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Following systematic literature searches in five databases (Ovid MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library) and piloting of screening procedures, reviewers will independently screen titles/abstracts for potential relevance. Reviewer pairs will then screen full text articles for eligibility criteria. We will extract data items from included articles, including study characteristics, cancer screening intervention information, and coding of SDOH constructs. We will assess study quality using the Mixed Methods Appraisal Tool and synthesize our findings using narrative, descriptive statistics, tables, and figures. Our approach will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. DISCUSSION By completing this systematic review, we will summarize recent literature on SDOH and cancer screening, identify research gaps for inclusion of SDOH, and propose future opportunities for advancing equity in cancer screening by integrating SDOH as part of the implementation context to promote uptake, sustainability, and scale-up in the implementation of screening guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021276582 .
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Affiliation(s)
- Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20850, USA.
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Brittney Sandler
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Prema Bhattacharjee
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - W Todd Moore
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.,University of Kansas Medical Center, Kansas, KS, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, USA.,Department of Surgery, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MT, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - April Y Oh
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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10
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Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons K, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun 2022; 3:56. [PMID: 35659151 PMCID: PMC9164317 DOI: 10.1186/s43058-022-00311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.
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Affiliation(s)
- Prajakta Adsul
- Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Essie Torres
- East Carolina University, 2309 Carol Belk Bldg, Greenville, NC 27858 USA
| | | | - Barbara Baquero
- University of Washington, 3980 15th Ave. NE, Seattle, WA 98195 USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Montserrat Soler
- Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Stephanie Wheeler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC 27599 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
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Slining MM, Fair M, Penkert LP, Wills S, Smyers J, Korn AR, Rusnak S, Knobel S. Development of a Community Coalition to Influence Nutrition and Physical Activity in Early Childhood Education. Prog Community Health Partnersh 2022; 16:37-44. [PMID: 35342109 DOI: 10.1353/cpr.2022.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Recognizing insufficient support for healthy eating and physical activity in early childhood education centers in Greenville, South Carolina, a group of stakeholders formed a workgroup as an organizing structure. Members developed and implemented a 2-year community-based participatory research initiative aimed at nutrition and physical activity policy, systems and environment change in 10 early childhood education centers. OBJECTIVES This article 1) describes engagement efforts and partnerships leading to formation of the workgroup and initiative, 2) presents data on Workgroup members' knowledge and engagement, and 3) shares lessons learned. METHODS Workgroup member knowledge and engagement related to obesity prevention was measured at two time points during the ECE initiative using the "Stakeholder-driven Community Diffusion Survey." LESSONS LEARNED Knowledge and engagement scores increased over the measurement period. Scores for engagement were higher than scores for knowledge at both time points. There was a substantial increase in perceived leadership and stewardship, knowledge of intervention factors and how to intervene sustainably, and understanding of local resources and roles. An important strength was stakeholder buy-in and ownership of planning and implementation processes.
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12
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Jacob RR, Korn AR, Huang GC, Easterling D, Gundersen DA, Ramanadhan S, Vu T, Angier H, Brownson RC, Haire-Joshu D, Oh AY, Schnoll R. Collaboration networks of the implementation science centers for cancer control: a social network analysis. Implement Sci Commun 2022; 3:41. [PMID: 35418309 PMCID: PMC9009020 DOI: 10.1186/s43058-022-00290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Multi-center research initiatives offer opportunities to develop and strengthen connections among researchers. These initiatives often have goals of increased scientific collaboration which can be examined using social network analysis. METHODS The National Cancer Institute (NCI)-funded Implementation Science Centers in Cancer Control (ISC3) initiative conducted an online social network survey in its first year of funding (2020) to (1) establish baseline network measures including the extent of cross-center collaboration and (2) assess factors associated with a network member's access to the network such as one's implementation science (IS) expertise. Members of the seven funded centers and NCI program staff identified collaborations in planning/conducting research, capacity building, product development, scientific dissemination, and practice/policy dissemination. RESULTS Of the 192 invitees, 182 network members completed the survey (95%). The most prevalent roles were faculty (60%) and research staff (24%). Almost one-quarter (23%) of members reported advanced expertise in IS, 42% intermediate, and 35% beginner. Most members were female (69%) and white (79%). One-third (33%) of collaboration ties were among members from different centers. Across all collaboration activities, the network had a density of 14%, suggesting moderate cohesion. Degree centralization (0.33) and betweenness centralization (0.07) measures suggest a fairly dispersed network (no single or few central member(s) holding all connections). The most prevalent and densely connected collaboration was in planning/conducting research (1470 ties; 8% density). Practice/policy dissemination had the fewest collaboration, lowest density (284 ties' 3% density), and the largest number of non-connected members (n=43). Access to the ISC3 network varied significantly depending on members' level of IS expertise, role within the network, and racial/ethnic background. Across all collaboration activities, most connected members included those with advanced IS expertise, faculty and NCI staff, and Hispanic or Latino and white members. CONCLUSIONS Results establish a baseline for assessing the growth of cross-center collaborations, highlighting specific areas in need of particular growth in network collaborations such as increasing engagement of racial and ethnic minorities and trainees or those with less expertise in IS.
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Affiliation(s)
- Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Grace C Huang
- Westat, 1600 Research Blvd., Rockville, MD, 20850, USA
| | - Douglas Easterling
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Division of Population Sciences, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Thuy Vu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, 98195, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, 63130, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63117, USA
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - April Y Oh
- Division of Cancer Control and Population Sciences, Implementation Science Team, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA, 19104, USA
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13
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Calancie L, Nappi D, Appel J, Hennessy E, Korn AR, Mitchell J, Patrick A, Werner K, Economos CD. Implementing and Evaluating a Stakeholder-Driven Community Diffusion-Informed Early Childhood Intervention to Prevent Obesity, Cuyahoga County, Ohio, 2018-2020. Prev Chronic Dis 2022; 19:E03. [PMID: 35050848 PMCID: PMC8794263 DOI: 10.5888/pcd19.210181] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE AND OBJECTIVES The purpose of this article is to demonstrate and evaluate aspects of a Stakeholder-Driven Community Diffusion (SDCD)-informed intervention with a group of stakeholders drawn from a large coalition seeking a novel approach for promoting policy, systems, and environmental-level change. The objectives were to implement an SDCD intervention, assess changes in participants' perspectives, and evaluate where the group's actions fit within the context of a systems map that the group created during the intervention. INTERVENTION APPROACH An SDCD-informed intervention convened 12 multisector stakeholders from the Early Ages Healthy Stages coalition in Cuyahoga County, Ohio. They participated in group model building activities to promote systems thinking related to childhood obesity prevention, reviewed evidence about topics of interest to the group, and were provided with technical assistance and seed funding to guide the selection and implementation of actions prioritized by the group. EVALUATION METHODS Data were collected via meeting notes and group model building outputs to demonstrate implementation and action prioritization; online surveys and qualitative interviews to measure perspective change among stakeholders; and a follow-up survey to the broader coalition assessing actions coalition members were taking. RESULTS An SDCD-informed intervention guided the development of a systems map and the selection of 4 actions: 1) develop a better understanding of the local early childcare environment; 2) assess the effectiveness and impact of Ohio Healthy Programs (OHP); 3) advocate for OHP and improved early childhood education quality; and 4) hold OHP designees accountable to high-quality programming. Data collected from surveys and interviews showed increased awareness of programs, resources, and collaboration opportunities among stakeholders. Follow-up survey results showed ongoing coalition action throughout the systems map. IMPLICATIONS FOR PUBLIC HEALTH Using an SDCD-informed intervention among a coalition of community stakeholders provided a unique approach for implementing, assessing, and analyzing collaborative efforts to prevent childhood obesity in Cuyahoga County. Our approach can be applied to help researchers and stakeholders improve efforts to address childhood obesity in their communities.
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Affiliation(s)
- Larissa Calancie
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Deanna Nappi
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Julia Appel
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Erin Hennessy
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Ariella R Korn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | | | | | - Kelsey Werner
- Boston College School of Social Work, Chestnut Hill, Massachusetts
| | - Christina D Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111.
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Calancie L, Fullerton K, Appel JM, Korn AR, Hennessy E, Hovmand P, Economos CD. Implementing Group Model Building With the Shape Up Under 5 Community Committee Working to Prevent Early Childhood Obesity in Somerville, Massachusetts. J Public Health Manag Pract 2022; 28:E43-E55. [PMID: 32810067 DOI: 10.1097/phh.0000000000001213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe our process of using group model building (GMB) with the Shape Up Under 5 Committee; measure the effects on Committee members; and describe the community-wide health messaging campaign that resulted from the process. DESIGN Pilot study. SETTING Somerville, Massachusetts. PARTICIPANTS Members of the Shape Up Under 5 Committee, a multisector group of professionals. INTERVENTION Research team convened the Committee and facilitated GMB from October 2015 to June 2017. MAIN OUTCOME MEASURES Boundary objects produced during GMB activities; committee members' perspectives on early childhood obesity in their community; and Committee members' knowledge, engagement, and trust at the conclusion of each meeting. RESULTS Working together using GMB activities and with support from the research team, the Committee created a community-wide campaign that provided evidence-based messages to reach an entire city that emphasized diversity and reaching immigrants and community members who spoke languages other than English. More than 80% of Committee members reported changes in their perspectives related to early childhood obesity at the conclusion of the pilot test. Six perspective shift themes emerged from interviews and open-ended survey items: exposure to new perspectives about challenges community members face; increased awareness of others working on similar issues; increased knowledge about early childhood obesity; seeing value in creating a space to work across sectors; appreciating complexity and linkages between early childhood obesity prevention and other community issues; and how participation in committee influences members' priorities in their own work. Knowledge of and engagement with early childhood obesity prevention varied at the conclusion of each meeting, as did increases in trust among Committee members. CONCLUSION Group model building is a promising approach to support multisector groups working to address early childhood obesity in their community. Meeting activities may have had differential impacts on members' knowledge of and engagement with early childhood obesity.
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Affiliation(s)
- Larissa Calancie
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts (Drs Calancie, Korn, Hennessy, and Economos and Mss Fullerton and Appel); and Social System Design Lab, Brown School, Washington University in St Louis, St Louis, Missouri (Dr Hovmand)
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15
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Korn AR, Appel J, Hammond RA, Hennessy E, Mâsse LC, Must A, Economos CD. Validation and refinement of the Stakeholder-driven Community Diffusion Survey for childhood obesity prevention. Implement Sci 2021; 16:91. [PMID: 34627319 PMCID: PMC8501696 DOI: 10.1186/s13012-021-01158-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Whole-of-community interventions hold promise in addressing childhood obesity. The COMPACT Stakeholder-driven Community Diffusion theory posits that stakeholders' knowledge of childhood obesity prevention efforts and engagement with the issue contribute to successful intervention implementation. Building on completed formative research and pilot testing, we describe the validation and refinement of knowledge and engagement measures. METHODS We assessed content validity using a modified Delphi process with science (n=18) and practice-based (n=16) experts. Next, we refined the survey based on input from science- and practice-based experts, cognitive response testing, and item analysis of extant survey data. Field testing of the refined survey involved community stakeholders in Greenville County, South Carolina (n=50), East Boston, Massachusetts (n=30), and Tucson, Arizona (n=84) between 2019 and 2020. Construct validity was assessed with confirmatory factor analysis (CFA). Two-week test-retest reliability was assessed among a subsample of 14 paired respondents in South Carolina. RESULTS Experts rated existing knowledge domains (intervention factors, roles, sustainability, problem, resources) and engagement domains (dialogue/mutual learning, flexibility, influence/power, leadership/stewardship, trust) highly for their importance in addressing childhood obesity. Expert input resulted in 11 new knowledge items and 7 new engagement items that mapped onto existing domains. Correspondingly, two domain names were modified: implementation/sustainability and trust/trustworthiness. We also eliminated 8 extant items (4 knowledge and 4 engagement) and adapted item language for comprehension and consistency. Further modifications based on CFA results and item analyses resulted in 23 knowledge items across four domains (roles and resources merged) and 23 engagement items across five domains. Modified knowledge and engagement scales had adequate fit and strong item factor loadings (most >0.7 and all >0.5). Knowledge (α=0.86-0.87) and engagement (α=0.75-0.90) subscales had high internal scale consistency. Knowledge intraclass correlation coefficients (ICCs) for test-retest agreement of subscale scores ranged from 0.50 for intervention factors to 0.86 for roles/resources. For engagement subscale scores, ICCs ranged from 0.70 for trust/trustworthiness to 0.96 for leadership/stewardship. CONCLUSIONS Findings from this multi-method survey development process increase our confidence of the knowledge and engagement measures' content validity, construct validity, and reliability.
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Affiliation(s)
- Ariella R. Korn
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA ,grid.48336.3a0000 0004 1936 8075Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850 USA
| | - Julia Appel
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Ross A. Hammond
- grid.282940.50000 0001 2149 970XCenter on Social Dynamics and Policy, Brookings Institution, Washington, DC USA ,grid.4367.60000 0001 2355 7002Brown School at Washington University, St. Louis, MO USA
| | - Erin Hennessy
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Louise C. Mâsse
- grid.17091.3e0000 0001 2288 9830BC Children’s Hospital Research Institute, School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Aviva Must
- grid.67033.310000 0000 8934 4045Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Christina D. Economos
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
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16
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Korn AR, Hammond RA, Hennessy E, Must A, Pachucki MC, Economos CD. Evolution of a Coalition Network during a Whole-of-Community Intervention to Prevent Early Childhood Obesity. Child Obes 2021; 17:379-390. [PMID: 33761266 PMCID: PMC8390774 DOI: 10.1089/chi.2020.0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Community coalitions often lead and coordinate "whole-of-community" childhood obesity prevention interventions. A growing body of work suggests that coalition network ties, which facilitate transmission of information and advocacy, may be a key part of how such leadership operates. This study provides an understanding of the structure of coalition networks and how this structure changes over time. Methods: We administered semiannual network surveys during a pilot whole-of-community intervention in Somerville, MA (2015-2017). Participants included 16 multisector coalition members and their nominated discussion partners ("first-degree alters") related to childhood obesity prevention. Coalition and first-degree alter respondents named up to 20 discussion partners and reported ties' interaction frequency and perceived influence. Networks were assessed with visualization, descriptive analysis, and exponential random graph models. Results: Total network included 558 stakeholders representing community-based organizations, parents, health care, childcare, universities, among others. Size and membership varied over time. We observed the largest network (n = 256) during intervention planning, and the largest proportion of stakeholders communicating frequently (daily/weekly) about childhood obesity prevention during the peak intervention period. Networks were sparsely interconnected (1%-3% of possible ties observed) and most and least centralized at baseline and follow-up, respectively. Over time, ties were increasingly perceived as influential and siloed within community groups. Conclusions: The network's extensive evolving membership may indicate access to a wide range of resources, ideas, and an ability to broadly disseminate intervention messages. The attenuating network hierarchy over time may have supported more equal participation and control over intervention efforts. Future research should assess generalizability of network patterns, network influences on implementation processes, and possible network interventions.
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Affiliation(s)
- Ariella R. Korn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Address correspondence to: Ariella R. Korn, PhD, MPH, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA.,Brown School, Washington University, St. Louis, MO, USA
| | - Erin Hennessy
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Aviva Must
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Mark C. Pachucki
- Department of Sociology and Computational Social Science Institute, University of Massachusetts Amherst, Amherst, MA, USA
| | - Christina D. Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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17
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Korn AR, Economos CD, Hammond RA, Hennessy E, Kalkwarf HJ, Must A, Woo JG. Associations of mothers' source of feeding information with longitudinal trajectories of sugar-sweetened beverage intake, 100% juice intake and adiposity in early childhood. Pediatr Obes 2021; 16:e12746. [PMID: 33141511 DOI: 10.1111/ijpo.12746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There remains a need to understand how information sources can promote young children's healthy beverage consumption and prevent obesity. OBJECTIVES To examine associations of mothers' primary feeding information source with children's sugar-sweetened beverage (SSB) intake, 100% juice intake and adiposity between ages 3 and 7 years. METHODS We analyzed data from a prospective cohort study (n = 371 children; 13 visits). Mothers reported their primary feeding information source at baseline and completed child 3-day dietary records each visit. Child adiposity indicators were calculated from repeated height/weight measurements and dual-energy X-ray absorptiometry. Longitudinal models examined beverage intakes and adiposity over time by source. RESULTS Primary feeding information sources included doctors (48.2%), mothers (17.5%), grandmothers (13.5%), other healthcare professionals (11.3%) and other family/friends (9.4%). Children's juice intake with age differed by source (P interaction = 0.03), with steepest and slightest intake decreases in the doctor (-19.7% each year; 95% CI: -23.7%, -15.5%) and grandmother (-5.0%; -14.5%, 5.5%) subgroups, respectively. Children's SSB intake did not differ by source, but increased annually by 7.1% (4.5%, 9.8%) overall. The grandmother subgroup had the greatest child adiposity over time. CONCLUSIONS Mothers' primary feeding information source may have important, yet heterogeneous, influences on young children's beverage intakes and adiposity over time. Consistent evidence-based messages are likely needed.
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Affiliation(s)
- Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Ross A Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia, USA.,Brown School at Washington University, St. Louis, Missouri, USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Heidi J Kalkwarf
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Aviva Must
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jessica G Woo
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Whelan J, Strugnell C, Allender S, Korn AR, Brown AD, Orellana L, Hayward J, Brown V, Bell C, Moodie M, Peeters A, Nichols M. Protocol for the measurement of changes in knowledge and engagement in the stepped wedge cluster randomised trial for childhood obesity prevention in Australia: (Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND)). Trials 2020; 21:763. [PMID: 32887655 PMCID: PMC7650215 DOI: 10.1186/s13063-020-04692-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/25/2019] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Community-based interventions have shown promise in addressing the childhood obesity epidemic. Such efforts rely on the knowledge of key community members and their engagement with the drivers of obesity in their community. This paper presents the protocol for the measurement and evaluation of knowledge and engagement among community leaders within a whole-of-community systems intervention across 10 large intervention communities in Australia. Methods We will investigate the role of stakeholder knowledge and engagement in the implementation and effectiveness of the stepped wedge cluster randomised trial in ten communities in Victoria, Australia. Data will be collected using the Stakeholder-driven Community Diffusion Survey (SDCD) to measure levels of knowledge and engagement prior to commencement (2019), across the three separate levels of governance within the intervention at five time points. Primary outcomes will be baseline overall knowledge and engagement scores across the three levels of governance and change in overall knowledge and engagement over time. Discussion We hypothesise there will be heterogeneity between intervention sites on levels of knowledge and engagement and that these differences will be associated with variability in implementation success. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618001986268. Registered on 11 December 2018
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Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia.
| | - Claudia Strugnell
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Andrew D Brown
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | | | - Josh Hayward
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Vicki Brown
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Colin Bell
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Marj Moodie
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Melanie Nichols
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
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Appel JM, Fullerton K, Hennessy E, Korn AR, Tovar A, Allender S, Hovmand PS, Kasman M, Swinburn BA, Hammond RA, Economos CD. Design and methods of Shape Up Under 5: Integration of systems science and community-engaged research to prevent early childhood obesity. PLoS One 2019; 14:e0220169. [PMID: 31369570 PMCID: PMC6675039 DOI: 10.1371/journal.pone.0220169] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 07/04/2019] [Indexed: 11/21/2022] Open
Abstract
Shape Up Under 5 (SUU5) was a two-year early childhood obesity prevention pilot study in Somerville, Massachusetts (2015-2017) designed to test a novel conceptual framework called Stakeholder-driven Community Diffusion. For whole-of-community interventions, this framework posits that diffusion of stakeholders' knowledge about and engagement with childhood obesity prevention efforts through their social networks will improve the implementation of health-promoting policy and practice changes intended to reduce obesity risk. SUU5 used systems science methods (agent-based modeling, group model building, social network analysis) to design, facilitate, and evaluate the work of 16 multisector stakeholders ('the Committee'). In this paper, we describe the design and methods of SUU5 using the conceptual framework: the approach to data collection, and methods and rationale for study inputs, activities and evaluation, which together may further our understanding of the hypothesized processes within Stakeholder-driven Community Diffusion. We also present a generalizable conceptual framework for addressing childhood obesity and similar complex public health issues through whole-of-community interventions.
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Affiliation(s)
- Julia M. Appel
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Karen Fullerton
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Ariella R. Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, South Kingston, Rhode Island, United States of America
| | - Steven Allender
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Peter S. Hovmand
- Social System Design Lab, George Warren Brown School of Social Work, Washington University, Saint Louis, Missouri, United States of America
| | - Matt Kasman
- Center on Social Dynamics and Policy, The Brookings Institution, Washington D.C, United States of America
| | - Boyd A. Swinburn
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
- School of Population Health, University of Auckland, Aukland, New Zealand
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington D.C, United States of America
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
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Korn AR, Hennessy E, Tovar A, Finn C, Hammond RA, Economos CD. Engaging Coalitions in Community-Based Childhood Obesity Prevention Interventions: A Mixed Methods Assessment. Child Obes 2018; 14:537-552. [PMID: 30188181 PMCID: PMC6249669 DOI: 10.1089/chi.2018.0032] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Childhood obesity prevention interventions have engaged coalitions in study design, implementation, and/or evaluation to improve research outcomes; yet, no systematic reviews have been conducted on this topic. This mixed methods review aims to characterize the processes and dynamics of coalition engagement in community-based childhood obesity prevention interventions. METHODS Data Sources: Studies extracted from Ovid MEDLINE, PubMed, and Web of Science; complementary original survey and interview data among researchers of included studies. Eligible Studies: Multisetting community-based obesity prevention interventions in high-income countries targeting children 0-12 years with anthropometric, behavioral, or environmental/policy outcomes. The Community-Based Participatory Research (CBPR) Conceptual Model was used as an overarching framework. RESULTS Thirteen studies met inclusion criteria. Elements of CBPR were evident across all studies with community engagement in problem identification (n = 7), design/planning (n = 11), implementation (n = 12), evaluation (n = 4), dissemination (n = 2), and sustainability (n = 10) phases. Five studies reported favorable intervention effects on anthropometric (n = 4), behavioral (n = 1), and/or policy (n = 1) outcomes; descriptive associations suggested that these studies tended to engage community members in a greater number of research phases. Researchers involved in 7 of 13 included studies completed a survey and interview. Respondents recalled the importance of group facilitation, leadership, and shared understanding to multisector coalition work. Perceived coalition impacts included community capacity building and intervention sustainability. CONCLUSIONS This review contributes to a deeper understanding of intervention processes and dynamics within communities engaged in childhood obesity prevention. Future research should more rigorously assess and report on coalition involvement to assess the influence of coalitions on multiple outcomes, including child weight status.
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Affiliation(s)
- Ariella R. Korn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Erin Hennessy
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Camille Finn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Christina D. Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,Address correspondence to: Christina D. Economos, PhD, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111
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Mueller MP, Blondin SA, Korn AR, Bakun PJ, Tucker KL, Economos CD. Behavioral Correlates of Empirically-Derived Dietary Patterns among University Students. Nutrients 2018; 10:E716. [PMID: 29865279 PMCID: PMC6024866 DOI: 10.3390/nu10060716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 12/19/2022] Open
Abstract
Given the importance of young adulthood in establishing lifelong dietary habits, it is imperative to better understand potential underlying drivers of dietary behavior in the university-age population. Dietary patterns have been associated with disease risk, but behavioral predictors of dietary pattern adherence are poorly understood, especially among emerging adults. This study aims to evaluate health-related behaviors associated with dietary pattern scores among freshmen participating in the Tufts Longitudinal Health Study (TLHS; n = 630). We previously derived dietary patterns using principal components analysis and orthogonal rotation from dietary intake data. Health-related behavior data were collected via survey. All data were collected during the Spring semesters of 1998⁻2007. Unadjusted linear models were used to determine associations between dietary pattern scores and health-related behaviors. Significant correlates were retained in multivariable regression models, which were adjusted for demographic characteristics. We found that never eating meals away from home was associated with higher adherence to the Prudent and lower adherence to the Western and Alcohol patterns. Intention to lose weight was negatively associated with the Western pattern, while intention to gain weight was positively associated with all dietary patterns. These findings suggest that intervention efforts aimed at improving eating out behaviors and engaging in healthy weight management strategies may promote healthier dietary patterns among university students.
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Affiliation(s)
- Megan P Mueller
- Department of Community Health Sciences, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, CA 90095, USA.
| | - Stacy A Blondin
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Peter J Bakun
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Katherine L Tucker
- Clinical Laboratory and Nutritional Sciences, Center for Population Health & Health Disparities, University of Massachusetts-Lowell, Lowell, MA 01854, USA.
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
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Korn AR, Hennessy E, Hammond RA, Allender S, Gillman MW, Kasman M, McGlashan J, Millar L, Owen B, Pachucki MC, Swinburn B, Tovar A, Economos CD. Development and testing of a novel survey to assess Stakeholder-driven Community Diffusion of childhood obesity prevention efforts. BMC Public Health 2018; 18:681. [PMID: 29855295 PMCID: PMC5984309 DOI: 10.1186/s12889-018-5588-1] [Citation(s) in RCA: 20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/23/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Involving groups of community stakeholders (e.g., steering committees) to lead community-wide health interventions appears to support multiple outcomes ranging from policy and systems change to individual biology. While numerous tools are available to measure stakeholder characteristics, many lack detail on reliability and validity, are not context specific, and may not be sensitive enough to capture change over time. This study describes the development and reliability of a novel survey to measure Stakeholder-driven Community Diffusion via assessment of stakeholders' social networks, knowledge, and engagement about childhood obesity prevention. METHODS This study was completed in three phases. Phase 1 included conceptualization and online survey development through literature reviews and expert input. Phase 2 included a retrospective study with stakeholders from two completed whole-of-community interventions. Between May-October 2015, 21 stakeholders from the Shape Up Somerville and Romp & Chomp interventions recalled their social networks, knowledge, and engagement pre-post intervention. We also assessed one-week test-retest reliability of knowledge and engagement survey modules among Shape Up Somerville respondents. Phase 3 included survey modifications and a second prospective reliability assessment. Test-retest reliability was assessed in May 2016 among 13 stakeholders involved in ongoing interventions in Victoria, Australia. RESULTS In Phase 1, we developed a survey with 7, 20 and 50 items for the social networks, knowledge, and engagement survey modules, respectively. In the Phase 2 retrospective study, Shape Up Somerville and Romp & Chomp networks included 99 and 54 individuals. Pre-post Shape Up Somerville and Romp & Chomp mean knowledge scores increased by 3.5 points (95% CI: 0.35-6.72) and (- 0.42-7.42). Engagement scores did not change significantly (Shape Up Somerville: 1.1 points (- 0.55-2.73); Romp & Chomp: 0.7 points (- 0.43-1.73)). Intraclass correlation coefficients (ICCs) for knowledge and engagement were 0.88 (0.67-0.97) and 0.97 (0.89-0.99). In Phase 3, the modified knowledge and engagement survey modules included 18 and 25 items, respectively. Knowledge and engagement ICCs were 0.84 (0.62-0.95) and 0.58 (0.23-0.86). CONCLUSIONS The survey measures upstream stakeholder properties-social networks, knowledge, and engagement-with good test-retest reliability. Future research related to Stakeholder-driven Community Diffusion should focus on prospective change and survey validation for intervention effectiveness.
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Affiliation(s)
- Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Ross A Hammond
- The Brookings Institution, 1775 Massachusetts Ave., NW, Washington, DC, 20036, USA
| | - Steven Allender
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Matthew W Gillman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Matt Kasman
- The Brookings Institution, 1775 Massachusetts Ave., NW, Washington, DC, 20036, USA
| | - Jaimie McGlashan
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Lynne Millar
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Brynle Owen
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Mark C Pachucki
- Department of Sociology, University of Massachusetts Amherst, 200 Hicks Way, Thompson Hall 532, Amherst, MA, 01003, USA
| | - Boyd Swinburn
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia.,School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, 125 Fogarty Hall, Kingston, RI, 02881, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
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