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Brown KL, Wang NY, Bennett WL, Gudzune KA, Daumit G, Dalcin A, Jerome GJ, Coughlin JW, Appel LJ, Clark JM. Differences in weight-loss outcomes among race-gender subgroups by behavioural intervention delivery mode: An analysis of the POWER trial. Clin Obes 2024:e12670. [PMID: 38741385 DOI: 10.1111/cob.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/18/2024] [Accepted: 03/30/2024] [Indexed: 05/16/2024]
Abstract
Prior in-person behavioural intervention studies have documented differential weight loss between men and women and by race, with Black women receiving the least benefit. Remotely delivered interventions are now commonplace, but few studies have compared outcomes by race-gender groups and delivery modality. We conducted a secondary analysis of POWER, a randomized trial (NCT00783315) designed to determine the effectiveness of 2 active, lifestyle-based, weight loss interventions (remote vs. in-person) compared to a control group. Participants with obesity and at least one cardiovascular disease risk factor (N = 415) were recruited in the Baltimore, MD area. Data from 233 white and 170 Black individuals were used for this analysis. Following an intention-to-treat approach, we compared the mean percent weight loss at 24 months by race-gender subgroups using repeated-measures, mixed-effects models. Everyone lost weight in the active interventions however, weight loss differed by race and gender. white and Black men had similar results for both interventions (white: in-person (-7.6%) remote (-7.4%); Black: in-person (-4.7%) remote (-4.4%)). In contrast, white women lost more weight with the in-person intervention (in-person (-7.2%) compared to the remote (-4.4%)), whereas Black women lost less weight in the in-person group compared to the remote intervention at 24 months (-2.0% vs. -3.0%, respectively; p for interaction <.001). We found differences between the effectiveness of the 2 weight loss interventions-in-person or remote-in white and Black women at 24 months. Future studies should consider intervention modality when designing weight loss interventions for women.
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Affiliation(s)
- Kristal L Brown
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Department of Creative Arts Therapies, Drexel University, College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Gail Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Arlene Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Gerald J Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Department of Kinesiology, Towson University, Baltimore, Maryland, USA
| | - Janelle W Coughlin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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Yeh HC, Jerome GJ, Wang NY, Dalcin A, Bunyard L, Durkin N, Charleston J, Kanarek N, Carducci M, Appel LJ. Abstract P139: Behavioral Weight Loss Programs for Cancer Survivors: A Non-Randomized Clinical Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background:
Clinical trials for weight loss in cancer survivors have been shown to be safe and effective. Pragmatic approaches are needed to facilitate broader adoption. The ASPIRE study evaluates real-world, lifestyle weight loss programs in Maryland on reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes. Here we report 6-month data on weight change.
Methods:
Participants were adults with overweight or obesity, who had a history of solid malignant tumors and completed curative intent treatment. The exclusion criteria were minimized to increase generalizability. Participants self-selected 1 of 3 programs: the Self-Directed (SD) Program provided evidence-based, written materials; the App-Directed (AD) Program additionally provided a commercially available, free smartphone app and weekly diet and exercise tips; and the Coach-Directed (CD) Program additionally included 1-on-1 telephonic coaching. SD and AD had versions with and without weight tracking; CD required weight tracking. Weights were transmitted to the study team using cellular technology with the scales provided and collected at baseline, 3, 6, and 12 months.
Results:
5,644 cancer survivors were invited, mostly via electronic health records; 9% expressed interest. Of these, 67% enrolled (total n=340; n=240 in weight tracking programs; 54% black, 74% women.) Participants in CD were younger, more likely to be women, less likely to have bachelor’s degree, and weighed more than those in SD. At 6m, weights were obtained from 97.5% of participants. Within-program weight reduction was most significant in CD. In the adjusted mixed-effects models, compared with SD participants, CD participants achieved significant weight reduction (see Table)
Conclusion:
Remotely delivered weight loss programs are desirable and can be broad- reach. Intervention with remote coaching was effective. While selected by many participants, app-directed program with weight tracking but without coaching led to small weight reduction.
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Dickerson F, Goldsholl S, Yuan CT, Dalcin A, Eidman B, Minahan E, Gennusa III JV, Mace E, Cullen B, Evins AE, Cather C, Wang NY, McGinty EM, Daumit GL. Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Pilot Study (Preprint). JMIR Res Protoc 2022; 12:e44787. [PMID: 37171851 DOI: 10.2196/44787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and is the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI, but few receive this treatment. Mental health providers have extensive experience working with clients with SMI and frequent treatment contacts, making them well positioned to deliver smoking cessation treatment. However, few mental health providers feel adequately trained to deliver this treatment, and many providers believe that smokers with SMI are not interested in quitting or have concerns about the safety of smoking cessation pharmacotherapy, despite substantial evidence to the contrary. OBJECTIVE We present the protocol for the pilot "IMPACT" (Implementing Action for Tobacco Smoking Cessation Treatment) study, which aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. METHODS We are using a prepost observational design to examine the effects of an implementation intervention designed to improve mental health providers' delivery of the following four evidence-based practices related to smoking cessation treatment: (1) assessment of smoking status, (2) assessment of willingness to quit, (3) behavioral counseling, and (4) pharmacotherapy prescribing. To overcome key barriers related to providers' knowledge and self-efficacy of smoking cessation treatment, the study will leverage implementation strategies including (1) real-time and web-based training for mental health providers about evidence-based smoking cessation treatment and motivational interviewing, including an avatar practice module; (2) a tobacco smoking treatment protocol; (3) expert consultation; (4) coaching; and (5) organizational strategy meetings. We will use surveys and in-depth interviews to assess the implementation intervention's effects on providers' knowledge and self-efficacy, the mechanisms of change targeted by the intervention, as well as providers' perceptions of the acceptability, appropriateness, and feasibility of both the evidence-based practices and implementation strategies. We will use data on care delivery to assess providers' implementation of evidence-based smoking cessation practices. RESULTS The IMPACT study is being conducted at 5 clinic sites. More than 50 providers have been enrolled, exceeding our recruitment target. The study is ongoing. CONCLUSIONS In order for persons with SMI to realize the benefits of smoking cessation treatment, it is important for clinicians to implement evidence-based practices successfully. This pilot study will result in a set of training modules, implementation tools, and resources for clinicians working in community mental health clinics to address tobacco smoking with their clients. Trial Registration: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. TRIAL REGISTRATION ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44787.
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Yuan CT, McGinty EE, Dalcin A, Goldsholl S, Dickerson F, Gudzune KA, Jerome GJ, Thompson DA, Murphy KA, Minahan E, Daumit GL. Scaling Evidence-Based Interventions to Improve the Cardiovascular Health of People With Serious Mental Illness. Front Psychiatry 2022; 13:793146. [PMID: 35185650 PMCID: PMC8855048 DOI: 10.3389/fpsyt.2022.793146] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical trials; however, the uptake of these interventions into real-life clinical settings remains limited. Implementation strategies, which constitute the "how to" component of changing healthcare practice, are critical to supporting the scale-up of evidence-based interventions that can improve the cardiovascular health of people with SMI. And yet, implementation strategies are often poorly described and rarely justified theoretically in the literature, limiting the ability of researchers and practitioners to tease apart why, what, how, and when implementation strategies lead to improvement. In this Perspective, we describe the implementation strategies that the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness is using to scale-up three evidenced-based interventions related to: (1) weight loss; (2) tobacco smoking cessation treatment; and (3) hypertension, dyslipidemia, and diabetes care for people with SMI. Building on concepts from the literature on complex health interventions, we focus on considerations related to the core function of an intervention (i.e., or basic purposes of the change process that the health intervention seeks to facilitate) vs. the form (i.e., implementation strategies or specific activities taken to carry out core functions that are customized to local contexts). By clearly delineating how implementation strategies are operationalized to support the interventions' core functions across these three studies, we aim to build and improve the future evidence base of how to adapt, implement, and evaluate interventions to improve the cardiovascular health of people with SMI.
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Affiliation(s)
- Christina T. Yuan
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Kimberly A. Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gerald J. Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | - David A. Thompson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Karly A. Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eva Minahan
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gail L. Daumit
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Bennett WL, Coughlin JW, Henderson J, Martin S, Yazdy GM, Drabo EF, Showell NN, McKinney C, Martin L, Dalcin A, Sanders R, Wang NY. Healthy for Two/Healthy for You: Design and methods for a pragmatic randomized clinical trial to limit gestational weight gain and prevent obesity in the prenatal care setting. Contemp Clin Trials 2022; 113:106647. [PMID: 34896296 PMCID: PMC8844210 DOI: 10.1016/j.cct.2021.106647] [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: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effect of Healthy for Two/Healthy for You (H42/H4U), a health coaching program, in prenatal care clinics that serve a racially and economically diverse population, on total gestational weight gain (GWG) (vs. usual care). We hypothesize that compared to usual prenatal care, intervention participants will have lower GWG and lower rates of gestational diabetes mellitus (GDM). METHODS We report the rationale and design of a pragmatic, parallel arm randomized clinical trial with 380 pregnant patients ≤15 weeks gestation with overweight or obesity from one of 6 academic and community-based obstetrics practices, randomized to either H42/H4U or usual prenatal care in a 1:1 ratio. The study duration is early pregnancy to 6 months postpartum. The primary outcome is total GWG, calculated as the difference between first clinic-assessed pregnancy weight and the weight at 37 weeks gestation. Key maternal and infant secondary outcomes include GDM incidence, weight retention at 6 months postpartum, infant weight, maternal health behaviors and wellness. CONCLUSIONS This pragmatic clinical trial embeds a pregnancy health coaching program into prenatal care to allow parallel testing compared to usual prenatal care on the outcome of total GWG. The real-world design provides an approach to enhance its sustainability beyond the trial to ultimately improve maternal/child health outcomes and reduce future obesity. TRIAL REGISTRATION The study was first registered at clinicaltrials.gov on 1/26/21 (NCT04724330).
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Affiliation(s)
- Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA..
| | | | - Janice Henderson
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Stephen Martin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Golsa M Yazdy
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Emmanuel F Drabo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Christine McKinney
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Lindsay Martin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Arlene Dalcin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Rachel Sanders
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Nae-Yuh Wang
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
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6
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McGinty EE, Thompson D, Murphy KA, Stuart EA, Wang NY, Dalcin A, Mace E, Gennusa JV, Daumit GL. Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study. Implement Sci Commun 2021; 2:26. [PMID: 33663620 PMCID: PMC7931551 DOI: 10.1186/s43058-021-00129-6] [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: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated "behavioral health home" models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers. METHODS This pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers' self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI. DISCUSSION While we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery. TRIAL REGISTRATION ClinicalTrials.gov, NCT04696653 . Registered on January 6, 2021.
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Affiliation(s)
- Emma Elizabeth McGinty
- Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205 USA
| | - David Thompson
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Karly A. Murphy
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Elizabeth A. Stuart
- Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205 USA
| | - Nae-Yuh Wang
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Arlene Dalcin
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Elizabeth Mace
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Joseph V. Gennusa
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Gail L. Daumit
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
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Murphy KA, Dalcin A, McGinty EE, Goldsholl S, Heller A, Daumit GL. Applying Care Coordination Principles to Reduce Cardiovascular Disease Risk Factors in People With Serious Mental Illness: A Case Study Approach. Front Psychiatry 2021; 12:742169. [PMID: 35002793 PMCID: PMC8727450 DOI: 10.3389/fpsyt.2021.742169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
People with serious mental illness (SMI) have a 2-3-fold higher mortality than the general population, much of which is driven by largely preventable cardiovascular disease. One contributory factor is the disconnect between the behavioral and physical health care systems. New care models have sought to integrate physical health care into primary mental health care settings. However, few examples of successful care coordination interventions to improve health outcomes with the SMI population exist. In this paper, we examine challenges faced in coordinating care for people with SMI and explore pragmatic, multi-disciplinary strategies for overcoming these challenges used in a cardiovascular risk reduction intervention shown to be effective in a clinical trial.
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Affiliation(s)
- Karly A Murphy
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ann Heller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Daumit G, Evins AE, Cather C, Dalcin A, Dickerson F, Miller ER, Appel LJ, Jerome GJ, McCann U, Charleston J, Young D, Gennusa J, Goldsholl S, COOK COURTNEY, Fink T, Wang NY. Abstract 16363: An 18-month Smoking Cessation Intervention Incorporating Pharmacotherapy and Behavioral Counseling Improves Tobacco Abstinence Rates in Adult Smokers With Serious Mental Illness (smi) in Community Mental Health Settings: Results of a Randomized Clinical Trial. Circulation 2020. [DOI: 10.1161/circ.142.suppl_3.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Tobacco smoking is the largest contributor to markedly elevated CVD and preventable death in persons with SMI. Trials of combined pharmacologic and behavioral treatments improve abstinence rates, but have targeted those ready to quit right away, and evidence-based treatments are rarely used in the community. Weight gain often accompanies abstinence. Our objective was to determine the effectiveness of an 18m smoking cessation pharmacotherapy and behavioral counseling intervention incorporating weight management and physical activity in persons with SMI.
Hypothesis:
The active intervention is more effective than control in achieving biochemically validated, 7-day point prevalence smoking abstinence at 18m.
Methods:
We conducted an RCT in 4 community mental health settings in 192 smokers with SMI, stratified by readiness to quit within 30d or in 1 to 6m. The active intervention group was offered 18m of 1
st
-line cessation pharmacotherapy, smoking cessation and weight management counseling tailored to readiness to quit, and support for physical activity. Controls received a quit line referral.
Results:
Mean(SD) age was 49.6(11.7); cigarettes/day 12.1(9.5); BMI 32.0(7.6) kg/m
2
; 49% were male, 48% African-American, 62% willing to quit in 30d, 95% completed 18m follow-up. At 18m, 27.8% of active group and 6.3% of controls achieved 7d smoking abstinence (p<0.0001); adjusted odds ratio 6.0 (95% CI: 2.3 –15.6; p=0.0002). There was no significant modification of intervention effect on abstinence by readiness to quit. Mean difference in weight change over 18m between active and control was not significant (3.5 lbs, 95% CI: -3.3 –10.3; p=0.32).
Conclusions:
Offering 18m of evidence-based cessation treatment in the community substantially increased smoking abstinence without significant weight gain in SMI. Implementing best practice guidelines to treat all smokers regardless of readiness to quit should improve CVD health in this high-risk population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Deborah Young
- Dept of Rsch and Evaluation, Kaiser Permanente, Pasadena, CA
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Santa-Maria CA, Coughlin JW, Sharma D, Armanios M, Blackford AL, Schreyer C, Dalcin A, Carpenter A, Jerome GJ, Armstrong DK, Chaudhry M, Cohen GI, Connolly RM, Fetting J, Miller RS, Smith KL, Snyder C, Wolfe A, Wolff AC, Huang CY, Appel LJ, Stearns V. The Effects of a Remote-based Weight Loss Program on Adipocytokines, Metabolic Markers, and Telomere Length in Breast Cancer Survivors: the POWER-Remote Trial. Clin Cancer Res 2020; 26:3024-3034. [PMID: 32071117 DOI: 10.1158/1078-0432.ccr-19-2935] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/29/2019] [Accepted: 02/14/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We initiated a clinical trial to determine the proportion of breast cancer survivors achieving ≥5% weight loss using a remotely delivered weight loss intervention (POWER-remote) or a self-directed approach, and to determine the effects of the intervention on biomarkers of cancer risk including metabolism, inflammation, and telomere length. EXPERIMENTAL DESIGN Women with stage 0-III breast cancer, who completed local therapy and chemotherapy, with a body mass index ≥25 kg/m2 were randomized to a 12-month intervention (POWER-remote) versus a self-directed approach. The primary objective was to determine the number of women who achieved at least 5% weight loss at 6 months. We assessed baseline and 6-month change in a panel of adipocytokines (adiponectin, leptin, resistin, HGF, NGF, PAI1, TNFα, MCP1, IL1β, IL6, and IL8), metabolic factors (insulin, glucose, lipids, hs-CRP), and telomere length in peripheral blood mononuclear cells. RESULTS From 2013 to 2015, 96 women were enrolled, and 87 were evaluable for the primary analysis; 45 to POWER-remote and 42 to self-directed. At 6 months, 51% of women randomized to POWER-remote lost ≥5% of their baseline body weight, compared with 12% in the self-directed arm [OR, 7.9; 95% confidence interval (CI), 2.6-23.9; P = 0.0003]; proportion were similar at 12 months (51% vs 17%, respectively, P = 0.003). Weight loss correlated with significant decreases in leptin, and favorable modulation of inflammatory cytokines and lipid profiles. There was no significant change in telomere length at 6 months. CONCLUSIONS A remotely delivered weight loss intervention resulted in significant weight loss in breast cancer survivors, and favorable effects on several biomarkers.
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Affiliation(s)
- Cesar A Santa-Maria
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dipali Sharma
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Armanios
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda L Blackford
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen Schreyer
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene Dalcin
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley Carpenter
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerald J Jerome
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Kinesiology, Towson University, Towson, Maryland
| | - Deborah K Armstrong
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Gary I Cohen
- Greater Baltimore Medical Center, Baltimore, Maryland
| | - Roisin M Connolly
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Fetting
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Miller
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen L Smith
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Claire Snyder
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Wolfe
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antonio C Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chiung-Yu Huang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vered Stearns
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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10
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Gudzune KA, Alexander E, Tseng E, Durkin N, Jerome GJ, Dalcin A, Appel LJ, Clark JM. Influence of subsidies and promotional strategies on outcomes in a beneficiary-based commercial weight-loss programme. Clin Obes 2019; 9:e12307. [PMID: 30957415 DOI: 10.1111/cob.12307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary-based, commercial weight-loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight change. Our independent variables were subsidy strategy (total subsidy (n = 9) vs cost sharing (n = 3)) and combination of promotional-subsidy strategies (mixed campaign + total subsidy (n = 6) vs mass media + total subsidy (n = 3)). We used logistic and linear regression analyses adjusted for beneficiary factors and clustering by organization. From 12 participating organizations, 26 068 beneficiaries registered of which 6215 initially engaged. Cost sharing was associated with significantly greater initial engagement as compared to total subsidy (OR 3.73, P < 0.001); however, no significant between-group differences existed in calls or weight change. Mass media + total subsidy group had significantly greater calls and weight loss at 12 months compared to mixed campaign + total subsidy (-2.6% vs -1.8%, P = 0.04). Cost sharing may promote greater initial engagement, although does not contribute to better participation or weight loss relative to total subsidy. If organizations elect total subsidy, then pairing this strategy with a mass media campaign may promote greater participation and weight loss among beneficiaries.
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Affiliation(s)
- Kimberly A Gudzune
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eleanore Alexander
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Tseng
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nowella Durkin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gerald J Jerome
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Arlene Dalcin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeanne M Clark
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
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11
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Alexander E, McGinty EE, Wang NY, Dalcin A, Jerome GJ, Miller ER, Dickerson F, Charleston J, Young DR, Gennusa JV, Goldsholl S, Cook C, Appel LJ, Daumit GL. Effects of a behavioural weight loss intervention in people with serious mental illness: Subgroup analyses from the ACHIEVE trial. Obes Res Clin Pract 2019; 13:205-210. [PMID: 30852244 PMCID: PMC7255457 DOI: 10.1016/j.orcp.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of obesity and related chronic diseases and die 10-20years earlier than the overall population, primarily due to cardiovascular disease. In the ACHIEVE trial, a behavioural weight loss intervention led to clinically significant weight loss in persons with SMI. As the field turns its attention to intervention scale-up, it is important to understand whether the effectiveness of behavioural weight loss interventions for people with SMI, like ACHIEVE, differ for specific subgroups. METHODS This study examined whether the effectiveness of the ACHIEVE intervention differed by participant characteristics (e.g. age, sex, race, psychiatric diagnosis, body mass index) and/or their weight-related attitudes and behaviours (e.g. eating, food preparation, and shopping habits). We used likelihood-based mixed effects models to examine whether the baseline to 18 month effects of the ACHIEVE intervention differed across subgroups. RESULTS No statistically significant differences were found in the effectiveness of the ACHIEVE intervention across any of the subgroups examined. CONCLUSIONS These findings suggest that the ACHIEVE behavioural weight loss intervention is broadly applicable to the diverse population of individuals with SMI.
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Affiliation(s)
- Eleanore Alexander
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States.
| | - Emma E McGinty
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gerald J Jerome
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Kinesiology, Towson University, Baltimore, MD, 21252, United States
| | - Edgar R Miller
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD 21204, United States
| | - Jeanne Charleston
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Deborah R Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91024, United States
| | - Joseph V Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Courtney Cook
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
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12
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Alexander E, Tseng E, Durkin N, Jerome GJ, Dalcin A, Appel LJ, Clark JM, Gudzune KA. Long-term retention in an employer-based, commercial weight-loss programme. Clin Obes 2019; 9:e12284. [PMID: 30248246 DOI: 10.1111/cob.12284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/05/2018] [Accepted: 08/28/2018] [Indexed: 01/14/2023]
Abstract
The aim of this study is to examine factors associated with long-term retention in a commercial weight-loss programme. We conducted a retrospective analysis of an employer-based, commercial programme from 2013 to 2016. Our dependent variable was 'long-term retention', defined as continuously enrolled participants who actively engaged through coach calls at 6 and 12 months. Independent variables included baseline demographics, programme engagement and weight change. We conducted multivariate logistic regression analyses assessing for differences in long-term retention by several factors, adjusted for employer clustering. Overall, 68.3% were retained at 6% and 45.9% at 12 months. Greater number of coach calls and website logins during the first 3 months significantly increased the odds of long-term retention, while having chronic conditions significantly decreased the odds. Weight-loss success (≥5% loss at 6 months) was significantly associated with increased odds of retention (12-month: odds ratio [OR] 2.80, P < 0.001), while early weight-loss failure (≥0% weight change at 1 month) significantly decreased odds of retention (12-month: OR 0.66, P = 0.008). In an employer-based, commercial weight loss programme, greater early programme engagement was associated with long-term retention. Given these programmes' popularity and potential reach, our results could be used to develop and test strategies designed to improve retention in commercial weight-loss programmes.
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Affiliation(s)
- E Alexander
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - E Tseng
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - N Durkin
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - G J Jerome
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
- Department of Kinesiology, Towson University, Towson, Maryland, USA
| | - A Dalcin
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - L J Appel
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - K A Gudzune
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
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13
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Alexander E, Tseng E, Durkin N, Jerome GJ, Dalcin A, Appel LJ, Clark JM, Gudzune KA. Factors associated with early dropout in an employer-based commercial weight-loss program. Obes Sci Pract 2018; 4:545-553. [PMID: 30574348 PMCID: PMC6298204 DOI: 10.1002/osp4.304] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/25/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Minimizing program dropout is essential for weight-loss success, but factors that influence dropout among commercial programs are unclear. This study's objective was to determine factors associated with early dropout in a commercial weight-loss program. METHODS A retrospective analysis of a remotely delivered, employer-based commercial program from 2013 to 2016 was conducted. The dependent variable was 'early dropout', defined as enrollees who disengaged from telephone coaching by month 2's end. Independent variables included demographics, program website engagement and early weight change. Multivariate logistic regression analyses were used to assess for differences in early dropout by several factors, adjusted for employer clustering. RESULTS Of the 5,274 participants, 26.8% dropped out early. Having ≥1 chronic condition (odds ratio [OR] 1.41, p < 0.001) and 'weight-loss failure' defined as ≥0% weight change at month 1's end (OR 1.86, p < 0.001) had significantly increased odds of early dropout. Increasing age by 10-year intervals (OR 0.90, p = 0.002) and 'meeting the website login goal' defined as ≥90 logins in 3 months (OR 0.13, p < 0.001) significantly decreased the odds of early dropout. CONCLUSIONS Presence of comorbidities, less online engagement and weight-loss failure were associated with early dropout in a commercial program. Strategies to prevent dropout among high-risk participants, such as increased support or program tailoring, should be developed and tested.
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Affiliation(s)
- E. Alexander
- Department of Health Policy and ManagementThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - E. Tseng
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
| | - N. Durkin
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
| | - G. J. Jerome
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
- Department of KinesiologyTowson UniversityTowsonMDUSA
| | - A. Dalcin
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
| | - L. J. Appel
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - J. M. Clark
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - K. A. Gudzune
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins School of MedicineBaltimoreMDUSA
- The Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreMDUSA
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14
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Juraschek SP, Plante TB, Charleston J, Miller ER, Yeh HC, Appel LJ, Jerome GJ, Gayles D, Durkin N, White K, Dalcin A, Hermosilla M. Use of online recruitment strategies in a randomized trial of cancer survivors. Clin Trials 2018; 15:130-138. [PMID: 29361843 PMCID: PMC5891380 DOI: 10.1177/1740774517745829] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Despite widespread Internet adoption, online advertising remains an underutilized tool to recruit participants into clinical trials. Whether online advertising is a cost-effective method to enroll participants compared to other traditional forms of recruitment is not known. METHODS Recruitment for the Survivorship Promotion In Reducing IGF-1 Trial, a community-based study of cancer survivors, was conducted from June 2015 through December 2016 via in-person community fairs, advertisements in periodicals, and direct postal mailings. In addition, "Right Column" banner ads were purchased from Facebook to direct participants to the Survivorship Promotion In Reducing IGF-1 Trial website. Response rates, costs of traditional and online advertisements, and demographic data were determined and compared across different online and traditional recruitment strategies. Micro-trials optimizing features of online advertisements were also explored. RESULTS Of the 406 respondents to our overall outreach efforts, 6% (24 of 406) were referred from online advertising. Facebook advertisements were shown over 3 million times (impressions) to 124,476 people, which resulted in 4401 clicks on our advertisement. Of these, 24 people ultimately contacted study staff, 6 underwent prescreening, and 4 enrolled in the study. The cost of online advertising per enrollee was $794 when targeting a general population versus $1426 when accounting for strategies that specifically targeted African Americans or men. By contrast, community fairs, direct mail, or periodicals cost $917, $799, or $436 per enrollee, respectively. Utilization of micro-trials to assess online ads identified subtleties (e.g. use of an advertisement title) that substantially impacted viewer interest in our trial. CONCLUSION Online advertisements effectively directed a relevant population to our website, which resulted in new enrollees in the Survivorship Promotion In Reducing IGF-1 Trial at a cost comparable to traditional methods. Costs were substantially greater with online recruitment when targeting under-represented populations, however. Additional research using online micro-trial tools is needed to evaluate means of more precise recruitment to improve yields in under-represented groups. Potential gains from faster recruitment speed remain to be determined.
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Affiliation(s)
- Stephen P Juraschek
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| | - Timothy B Plante
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
- University of Vermont, Larner College of Medicine, Burlington VT
| | - Jeanne Charleston
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
| | - Edgar R Miller
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
| | - Hsin-Chieh Yeh
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
| | - Lawrence J Appel
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
| | | | - Debra Gayles
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
| | - Nowella Durkin
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
| | - Karen White
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
| | - Arlene Dalcin
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore MD
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15
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McGinty EE, Gudzune KA, Dalcin A, Jerome GJ, Dickerson F, Gennusa J, Goldsholl S, Young D, Daumit GL. Bringing an Effective Behavioral Weight Loss Intervention for People With Serious Mental Illness to Scale. Front Psychiatry 2018; 9:604. [PMID: 30515109 PMCID: PMC6256009 DOI: 10.3389/fpsyt.2018.00604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022] Open
Abstract
People with serious mental illnesses (SMIs) die 10-20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achieving widespread implementation of these interventions is a public health priority. In this Perspective, we consider strategies for scaling the ACHIEVE behavioral weight loss intervention for people with SMI, shown to be effective in a randomized clinical trial (RCT), to mental health programs in the U.S. and internationally. Given the barriers to high-fidelity implementation of the complex, multi-component ACHIEVE intervention in often under-resourced mental health programs, we posit that substantial additional work is needed to realize the full public health potential of this intervention for people with SMI. We discuss considerations for successful "scale-up," or efforts to expand ACHIEVE to similar settings and populations as those included in the RCT, and "scale-out," or efforts to expand the intervention to different mental health program settings/sub-populations with SMI. For both, we focus on considerations related (1) intervention adaptation and (2) implementation strategy development, highlighting four key domains of implementation strategies that we believe need to be developed and tested: staff capacity building, leadership engagement, organizational change, and policy strategies. We conclude with discussion of the types of future research needed to support ACHIEVE scale-up/out, including hybrid trial designs testing the effectiveness of intervention adaptations and/or implementations strategies.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | | | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deborah Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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16
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Santa-Maria CA, Coughlin J, Blackford A, Carpenter A, Dalcin A, Huang CY, Luber B, Schreyer C, Armanios M, Sharma D, Chaudhry M, Jerome GJ, Snyder C, Appel L, Stearns V. Abstract P4-14-01: POWER-remote: A randomized study evaluating the effect of a remote-based weight loss program in women with early stage breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-14-01] [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: 11/16/2022]
Abstract
Abstract
Background: The majority of women diagnosed with breast cancer are overweight or obese, and gain weight after diagnosis. The Practice-based Opportunities for Weight Reduction (POWER) study reported that, in an obese population with cardiovascular risk factors, a scalable remote weight loss intervention with web support was equally effective to an in-person intervention (Appel NEJM 2011). We adapted the remote intervention for breast cancer survivors.
Methods: We conducted a phase II single-blind trial in which women with stage 0-III breast cancer and a BMI ≥25 were randomized to a remotely-delivered weight loss intervention with a study specific website (POWER-remote) or to self-directed weight loss. Participants were stratified by menopausal status and concomitant hormone therapy use. Weight was assessed at baseline, 6 and 12 months. The primary objective was to compare the proportion of women who lost ≥5% of their baseline body weight after 6 months in the POWER-remote and the self-directed arms. A sample size of 80 patients yielded approximately 93.6% power to detect a difference in weight loss response of 19.0% in the self-directed arm and 38.2% in the POWER-remote arm with a one-sided type I error of 10%. We obtained blood samples for correlative studies including inflammatory biomarkers and assessment of telomere length at baseline and 6 months.
Results: From 2013-2015 we enrolled 96 women; 84 were evaluable for the primary analysis. Both cohorts had similar baseline characteristics including menopausal status, race (77% Caucasian and 20% African American in entire cohort), and BMI (average mean 32 kg/m2). The majority (93%) of patients received endocrine therapy, and 55% had completed chemotherapy. At 6 months 43.1% (95% CI 29.3–57.8) of women randomized to POWER-remote had lost ≥5% of their baseline body weight, compared to 11.1% (95% CI 3.7–24.1) in the self-directed arm, p<0.001. A significant difference continued at 12 months, and was observed in all subgroups (Table 1). Biomarker analysis will be presented at the meeting.
Table 1. Proportion of patients achieving ≥5% weight loss after 6 and 12 months POWER-remotePOWER-remoteSelf-DirectedSelf-Directed n% [95% CI]n% [95% CI]p-valueInteraction p-value for heterogeneity of treatment effectLost >=5% of baseline weight at 6 months All patients4343.1 [29.3, 57.8]4111.1 [3.7, 24.1]<0.001 Endocrine therapy3545 [29.3, 61.5]3211.1 [3.1, 26.1]< 0.0010.96No endocrine therapy836.4 [10.9, 69.2]911.1 [0.3, 48.2]0.11 Chemotherapy2126.9 [11.6, 47.8]253.7 [0.1, 19]0.010.64No chemotherapy2260 [38.7, 78.9]1622.2 [6.4, 47.6]0.01 Lost >=5% of baseline weight at 12 months All patients3031.4 [19.1, 45.9]3113.3 [5.1, 26.8]0.006 Endocrine therapy2632.5 [18.6, 49.1]2616.7 [6.4, 32.8]0.040.99No endocrine therapy427.3 [6, 61]50 [0, 33.6]0.05 Chemotherapy1119.2 [6.6, 39.4]167.4 [0.9, 24.3]0.070.72No chemotherapy1944 [24.4, 65.1]1522.2 [6.4, 47.6]0.07
Conclusions: Sustained weight loss over 1 year is feasible in breast cancer survivors who undergo a remotely delivered weight loss intervention. Weight loss was observed irrespective of endocrine therapy or chemotherapy. These data will be used to design a new trial with a physical activity component.
Citation Format: Santa-Maria CA, Coughlin J, Blackford A, Carpenter A, Dalcin A, Huang C-Y, Luber B, Schreyer C, Armanios M, Sharma D, Chaudhry M, Jerome GJ, Snyder C, Appel L, Stearns V. POWER-remote: A randomized study evaluating the effect of a remote-based weight loss program in women with early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-14-01.
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Affiliation(s)
- CA Santa-Maria
- Northwestern University; Johns Hopkins; Towson University Towson
| | - J Coughlin
- Northwestern University; Johns Hopkins; Towson University Towson
| | - A Blackford
- Northwestern University; Johns Hopkins; Towson University Towson
| | - A Carpenter
- Northwestern University; Johns Hopkins; Towson University Towson
| | - A Dalcin
- Northwestern University; Johns Hopkins; Towson University Towson
| | - C-Y Huang
- Northwestern University; Johns Hopkins; Towson University Towson
| | - B Luber
- Northwestern University; Johns Hopkins; Towson University Towson
| | - C Schreyer
- Northwestern University; Johns Hopkins; Towson University Towson
| | - M Armanios
- Northwestern University; Johns Hopkins; Towson University Towson
| | - D Sharma
- Northwestern University; Johns Hopkins; Towson University Towson
| | - M Chaudhry
- Northwestern University; Johns Hopkins; Towson University Towson
| | - GJ Jerome
- Northwestern University; Johns Hopkins; Towson University Towson
| | - C Snyder
- Northwestern University; Johns Hopkins; Towson University Towson
| | - L Appel
- Northwestern University; Johns Hopkins; Towson University Towson
| | - V Stearns
- Northwestern University; Johns Hopkins; Towson University Towson
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17
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Hussain T, Franz W, Brown E, Kan A, Okoye M, Dietz K, Taylor K, Carson KA, Halbert J, Dalcin A, Anderson CAM, Boonyasai RT, Albert M, Marsteller JA, Cooper LA. The Role of Care Management as a Population Health Intervention to Address Disparities and Control Hypertension: A Quasi-Experimental Observational Study. Ethn Dis 2016; 26:285-94. [PMID: 27440967 DOI: 10.18865/ed.26.3.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. DESIGN Quasi-experimental, observational study. SETTING AND PARTICIPANTS 3,964 uncontrolled hypertensive patients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible. INTERVENTION Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparities-related barriers. MAIN MEASURES We assessed the population impact of care management using the RE-AIM framework. To evaluate effectiveness in improving BP, we used unadjusted, adjusted, and propensity-score matched differences-in-differences models to compare those who completed all sessions with partial completers and non-participants. RESULTS Of all eligible patients, 5% participated in care management. Of 629 patients who entered care management, 245 (39%) completed all three sessions. Those completing all sessions on average reached BP control (mean BP 137/78) and experienced 9 mm Hg systolic blood pressure (P<.001) and 4 mm Hg DBP (P=.004) greater improvement than non-participants; findings did not vary in adjusted or propensity-score matched models. Disparities in systolic and diastolic BP between Blacks and Whites were not detectable at completion. CONCLUSIONS It may be possible to achieve BP control among both Black and White patients who participate in a few sessions of care management. However, the very limited reach and patient challenges with program completion should raise significant caution with relying on care management alone to improve population BP control and eliminate related disparities.
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Affiliation(s)
- Tanvir Hussain
- Department of Medicine, University of Nebraska Medical Center; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities
| | - Whitney Franz
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Johns Hopkins Healthcare
| | - Emily Brown
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Johns Hopkins Healthcare
| | - Athena Kan
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities
| | - Mekam Okoye
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Driscoll Children's Hospital, Texas A & M University
| | - Katherine Dietz
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine
| | - Kara Taylor
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Johns Hopkins Healthcare
| | - Kathryn A Carson
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University School of Medicine
| | - Jennifer Halbert
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine
| | - Arlene Dalcin
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine
| | - Cheryl A M Anderson
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Family Medicine and Public Health, University of California San Diego
| | - Romsai T Boonyasai
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine
| | | | - Jill A Marsteller
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
| | - Lisa A Cooper
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University School of Medicine; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
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Vazin R, McGinty EE, Dickerson F, Dalcin A, Goldsholl S, Oefinger Enriquez M, Jerome GJ, Gennusa JV, Daumit GL. Perceptions of strategies for successful weight loss in persons with serious mental illness participating in a behavioral weight loss intervention: A qualitative study. Psychiatr Rehabil J 2016; 39:137-46. [PMID: 27054900 PMCID: PMC4900940 DOI: 10.1037/prj0000182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to describe perceptions of weight loss strategies, benefits, and barriers among persons with serious mental illness who lost weight in the ACHIEVE behavioral weight loss intervention. METHODS Semistructured interviews with 20 ACHIEVE participants were conducted and analyzed using an inductive coding approach. RESULTS Participants perceived tailored exercise sessions, social support, and dietary strategies taught in ACHIEVE-such as reducing portion sizes and avoiding sugar-sweetened beverages-as useful weight loss strategies. Health benefits, improved physical appearance, self-efficacy, and enhanced ability to perform activities of daily living were commonly cited benefits of intervention participation and weight loss. Some participants reported challenges with giving up snack food and reducing portion sizes, and barriers to exercise related to medical conditions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is emerging evidence that behavioral weight loss interventions can lead to clinically meaningful reductions in body weight among persons with serious mental illness. The perspective of persons with serious mental illness regarding strategies for, benefits of, and barriers to weight loss during participation in behavioral weight loss programs provide insight into which elements of multicomponent interventions such as ACHIEVE are most effective. The results of this study suggest that tailored exercise programs, social support, and emphasis on nonclinical benefits of intervention participation, such as improvements in self-efficacy and the ability to participate more actively in family and community activities, are promising facilitators of engagement and success in behavioral weight loss interventions for the population with serious mental illness. (PsycINFO Database Record
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Affiliation(s)
- Roza Vazin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | | | - Arlene Dalcin
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Stacy Goldsholl
- Department of Medicine, Johns Hopkins University School of Medicine
| | | | - Gerald J Jerome
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Joseph V Gennusa
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Gail L Daumit
- Center for Prevention, Epidemiology, and Clinical Research, Division of General Internal Medicine, Johns Hopkins Medical Institutions
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Fitzpatrick SL, Coughlin JW, Appel LJ, Tyson C, Stevens VJ, Jerome GJ, Dalcin A, Brantley PJ, Hill-Briggs F. Application of Latent Class Analysis to Identify Behavioral Patterns of Response to Behavioral Lifestyle Interventions in Overweight and Obese Adults. Int J Behav Med 2015; 22:471-80. [PMID: 25331853 PMCID: PMC4957646 DOI: 10.1007/s12529-014-9446-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 02/07/2023]
Abstract
BACKGROUND Examining responders and non-responders to behavioral lifestyle interventions among overweight/obese adults with additional comorbidities may aid in refining and tailoring obesity treatment. PURPOSE The purpose of this study is to demonstrate the use of latent class analysis to identify patterns of response to behavioral lifestyle interventions based on adherence to diet and exercise recommendations. METHOD Repeated measures latent class analysis was applied to two clinical trial datasets, combination of two active interventions in the PREMIER Trial (n = 501) and phase 1 of the Weight Loss Maintenance Trial (WLM; n = 1685), to identify patterns of response to behavioral lifestyle interventions. Treatment response was based on adherence to daily recommendations for fruit/vegetable, fat, saturated fat, sodium, and exercise at baseline and 6 months. RESULTS In PREMIER, three distinct latent classes emerged: responders (45.9%), non-responders (23.6%), and early adherers (30.5%). Responders and Early Adherers had greater weight loss at 6 and 18 months and were more likely to meet behavioral recommendations at 18 months than Non-responders. For WLM, there were four latent classes: partial responders (16%), non-responders (40%), early adherers (2%), and fruit/veggie only responders (41%). Non-responders in WLM had significantly less weight loss at 6 months compared to that of the other three latent classes. CONCLUSION Latent class analysis is a useful method to apply to clinical trial data to identify distinct patterns of response to behavioral interventions. Overweight/ obese participants who respond to behavioral lifestyle treatment (i.e., meet behavioral recommendations) have significantly greater weight loss than that of participants who do not make behavioral changes.
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Affiliation(s)
- Stephanie L Fitzpatrick
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Room 478A, Chicago, IL, 60607, USA,
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Jerome GJ, Alavi R, Daumit GL, Wang NY, Durkin N, Yeh HC, Clark JM, Dalcin A, Coughlin JW, Charleston J, Louis TA, Appel LJ. Willingness to pay for continued delivery of a lifestyle-based weight loss program: The Hopkins POWER trial. Obesity (Silver Spring) 2015; 23:282-5. [PMID: 25557807 PMCID: PMC4310798 DOI: 10.1002/oby.20981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/27/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In behavioral studies of weight loss programs, participants typically receive interventions free of charge. Understanding an individual's willingness to pay (WTP) for weight loss programs could be helpful when evaluating potential funding models. This study assessed WTP for the continuation of a weight loss program at the end of a weight loss study. METHODS WTP was assessed with monthly coaching contacts at the end of the two-year Hopkins POWER trial. Interview-administered questionnaires determined the amount participants were willing to pay for continued intervention. Estimated maximum payment was calculated among those willing to pay and was based on quantile regression adjusted for age, body mass index, race, sex, household income, treatment condition, and weight change at 24 months. RESULTS Among the participants (N=234), 95% were willing to pay for continued weight loss intervention; the adjusted median payment was $45 per month. Blacks had a higher adjusted median WTP ($65/month) compared to Non-Blacks ($45/month), P=0.021. CONCLUSIONS A majority of participants were willing to pay for a continued weight loss intervention with a median monthly amount that was similar to the cost of commercial weight loss programs.
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Affiliation(s)
- Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, Maryland, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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21
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Jerome GJ, Dalcin A, Coughlin JW, Fitzpatrick S, Wang NY, Durkin N, Yeh HC, Charleston J, Pozefsky T, Daumit GL, Clark JM, Louis TA, Appel LJ. Longitudinal accuracy of web-based self-reported weights: results from the Hopkins POWER Trial. J Med Internet Res 2014; 16:e173. [PMID: 25042773 PMCID: PMC4129117 DOI: 10.2196/jmir.3332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/05/2014] [Accepted: 06/25/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Websites and phone apps are increasingly used to track weights during weight loss interventions, yet the longitudinal accuracy of these self-reported weights is uncertain. OBJECTIVE Our goal was to compare the longitudinal accuracy of self-reported weights entered online during the course of a randomized weight loss trial to measurements taken in the clinic. We aimed to determine if accuracy of self-reported weight is associated with weight loss and to determine the extent of misclassification in achieving 5% weight loss when using self-reported compared to clinic weights. METHODS This study examined the accuracy of self-reported weights recorded online among intervention participants in the Hopkins Practice-Based Opportunities for Weight Reduction (POWER) trial, a randomized trial examining the effectiveness of two lifestyle-based weight loss interventions compared to a control group among obese adult patients with at least one cardiovascular risk factor. One treatment group was offered telephonic coaching and the other group was offered in-person individual coaching and group sessions. All intervention participants (n=277) received a digital scale and were asked to track their weight weekly on a study website. Research staff used a standard protocol to measure weight in the clinic. Differences (self-reported weight - clinic weight) indicate if self-report under (-) or over (+) estimated clinic weight using the self-reported weight that was closest in time to the clinic weight and was within a window ranging from the day of the clinic visit to 7 days before the 6-month (n=225) and 24-month (n=191) clinic visits. The absolute value of the differences (absolute difference) describes the overall accuracy. RESULTS Underestimation of self-reported weights increased significantly from 6 months (mean -0.5 kg, SD 1.0 kg) to 24 months (mean -1.1 kg, SD 2.0 kg; P=.002). The average absolute difference also increased from 6 months (mean 0.7 kg, SD 0.8 kg) to 24 months (mean 1.3, SD 1.8 kg; P<.001). Participants who achieved the study weight loss goal at 24 months (based on clinic weights) had lower absolute differences (P=.01) compared to those who did not meet this goal. At 24 months, there was 9% misclassification of weight loss goal success when using self-reported weight compared to clinic weight as an outcome. At 24 months, those with self-reported weights (n=191) had three times the weight loss compared to those (n=73) without self-reported weights (P<.001). CONCLUSIONS Underestimation of weight increased over time and was associated with less weight loss. In addition to intervention adherence, weight loss programs should emphasize accuracy in self-reporting. TRIAL REGISTRATION ClinicalTrials.gov: NCT00783315; http://clinicaltrials.gov/show/NCT00783315 (Archived by WebCite at http://www.webcitation.org/6R4gDAK5K).
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Affiliation(s)
- Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States.
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Santa-Maria CA, Blackford A, Jerome GJ, Coughlin J, Snyder CF, Dalcin A, Shehata C, Jeter S, Schreyer C, Luber B, Appel LJ, Stearns V. POWER-remote: A randomized study evaluating the effect of a remote-based weight loss program on biomarkers in women with early-stage breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps9657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cesar Augusto Santa-Maria
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Amanda Blackford
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | - Claire Frances Snyder
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer at Johns Hopkins, Baltimore, MD
| | - Arlene Dalcin
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christina Shehata
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Stacie Jeter
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | - Brandon Luber
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Vered Stearns
- The Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Fitzpatrick SL, Bandeen-Roche K, Stevens VJ, Coughlin JW, Rubin RR, Brantley PJ, Funk KL, Svetkey LP, Jerome GJ, Dalcin A, Charleston J, Appel LJ. Examining behavioral processes through which lifestyle interventions promote weight loss: results from PREMIER. Obesity (Silver Spring) 2014; 22:1002-7. [PMID: 24124061 PMCID: PMC3968223 DOI: 10.1002/oby.20636] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the behavioral processes through which lifestyle interventions impacted weight loss. METHODS The analyses were limited to overweight and obese Black and White adults randomized to a PREMIER lifestyle intervention (N = 501). Structural equation modeling was conducted to test the direct and indirect relationships of session attendance, days of self-monitoring diet and exercise, change in diet composition and exercise, and 6-month weight change. RESULTS Greater session attendance was associated with increased self-monitoring, which was in turn significantly related to reduction in percent energy from total fat consumed. Change in percent energy from fat and self-monitoring was associated with 6-month percent change in weight. Both a decrease in fat intake and increase in self-monitoring are potential mediators of the relationship between attendance and weight change. CONCLUSIONS The findings provide a reasonable model that suggests regular session attendance and use of behavioral strategies like self-monitoring are associated with improved behavioral outcomes that are associated with weight loss.
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Affiliation(s)
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | | | - Janelle W. Coughlin
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine
| | | | | | | | | | | | - Arlene Dalcin
- Department of Medicine, Johns Hopkins School of Medicine
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Rubin RR, Peyrot M, Wang NY, Coughlin JW, Jerome GJ, Fitzpatrick SL, Bennett WL, Dalcin A, Daumit G, Durkin N, Chang YT, Yeh HC, Louis TA, Appel LJ. Patient-reported outcomes in the practice-based opportunities for weight reduction (POWER) trial. Qual Life Res 2013; 22:2389-98. [PMID: 23515902 PMCID: PMC4137865 DOI: 10.1007/s11136-013-0363-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate effects of two behavioral weight-loss interventions (in-person, remote) on health-related quality of life (HRQOL) compared to a control intervention. METHODS Four hundred and fifty-one obese US adults with at least one cardiovascular risk factor completed five measures of HRQOL and depression: MOS SF-12 physical component summary (PCS) and mental component summary; EuroQoL-5 dimensions single index and visual analog scale; PHQ-8 depression symptoms; and PSQI sleep quality scores at baseline and 6 and 24 months after randomization. Change in each outcome was analyzed using outcome-specific mixed-effects models controlling for participant demographic characteristics. RESULTS PCS-12 scores over 24 months improved more among participants in the in-person active intervention arm than among control arm participants (P < 0.05, ES = 0.21); there were no other statistically significant treatment arm differences in HRQOL change. Greater weight loss was associated with improvements in most outcomes (P < 0.05 to < 0.0001). CONCLUSIONS Participants in the in-person active intervention improved more in physical function HRQOL than participants in the control arm did. Greater weight loss during the study was associated with greater improvement in all PRO except for sleep quality, suggesting that weight loss is a key factor in improving HRQOL.
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Affiliation(s)
- R R Rubin
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,
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Daumit GL, Dickerson FB, Wang NY, Dalcin A, Jerome GJ, Anderson CAM, Young DR, Frick KD, Yu A, Gennusa JV, Oefinger M, Crum RM, Charleston J, Casagrande SS, Guallar E, Goldberg RW, Campbell LM, Appel LJ. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med 2013; 368:1594-602. [PMID: 23517118 PMCID: PMC3743095 DOI: 10.1056/nejmoa1214530] [Citation(s) in RCA: 358] [Impact Index Per Article: 32.5] [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] [Indexed: 01/07/2023]
Abstract
BACKGROUND Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness. METHODS We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months. RESULTS Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was -3.2 kg (-7.0 lb, P=0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P=0.009). There were no significant between-group differences in adverse events. CONCLUSIONS A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials.gov number, NCT00902694.).
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Affiliation(s)
- Gail L Daumit
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland 21287, USA.
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Dickerson FB, Yu A, Dalcin A, Jerome GJ, Gennusa JV, Charleston J, Crum RM, Campbell L, Oefinger M, Appel LJ, Daumit GL. Cigarette Smoking and Health Characteristics in Individuals With Serious Mental Illness Enrolled in a Behavioral Weight Loss Trial. J Dual Diagn 2013; 9:39-46. [PMID: 24072987 PMCID: PMC3780421 DOI: 10.1080/15504263.2012.749829] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Cigarette smoking is the most preventable cause of disease and death in the US. We examined the prevalence of smoking and the association between smoking status and health characteristics in persons with serious mental illness. Methods: A total of 291 overweight or obese adults with serious mental illness were enrolled in a behavioral weight loss trial. Cigarette smoking, co-occurring medical diagnoses, dietary intake, blood pressure, cardiovascular fitness, body mass index, quality of life, and psychiatric symptoms were assessed at baseline in 2008-2011. Fasting glucose and lipid markers were measured from blood samples. Cardiovascular risk profile was calculated based on the global Framingham Health Study Risk Equation. Results: A total of 128 (44%) of participants were current smokers or had smoked in the previous one year. The smokers had significantly higher diastolic blood pressure and blood triglyceride levels, and lower HDL cholesterol than the nonsmokers, adjusted for age, sex, education, and diagnosis. They were more likely to have a history of emphysema, and had a 10-year cardiovascular disease risk of 13.2%, significantly higher than the 7.4% in the nonsmokers. The smokers also had elevated ratings of psychopathology on the BASIS-24 scale. Smokers did not differ from nonsmokers in cardiovascular fitness, body mass index, depression, quality of life, or other comorbid medical diagnoses. There was no characteristic in which smokers appeared healthier than nonsmokers. Conclusions: The prevalence of smoking in this contemporary cohort of individuals with serious mental illness who were motivated to lose weight was more than twice that in the overall population. Smokers had more indicators of cardiovascular disease and poorer mental health than did nonsmokers. The high burden of comorbidity in smokers with serious mental illness indicates a need for broad health interventions.
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Jerome GJ, Rubin RR, Clark JM, Dalcin A, Coughlin JW, Yeh HC, Miller ER, Wang NY, Louis TA, Durkin N, Charleston J, Daumit GL, Appel LJ. From efficacy to effectiveness: lessons learned from the Practice-Based Opportunities for Weight Reduction (POWER) trial. J Comp Eff Res 2012; 1:213-6. [PMID: 24237403 PMCID: PMC4764069 DOI: 10.2217/cer.12.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Gerald J Jerome
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Towson University, Department of Kinesiology, Towson, MD, USA
| | - Richard R Rubin
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Departments of Medicine & Pediatrics, Baltimore, MD, USA
| | - Jeanne M Clark
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology & Clinical Research, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Arlene Dalcin
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
| | - Janelle W Coughlin
- Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD, USA
| | - Hsin-Chieh Yeh
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology & Clinical Research, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Edgar R Miller
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology & Clinical Research, MD, USA
| | - Nae-Yuh Wang
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology & Clinical Research, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, USA
| | - Thomas A Louis
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, USA
| | - Nowella Durkin
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
| | - Jeanne Charleston
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
| | - Gail L Daumit
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology & Clinical Research, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Lawrence J Appel
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology & Clinical Research, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
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Casagrande SS, Dalcin A, McCarron P, Appel LJ, Gayles D, Hayes J, Daumit G. A nutritional intervention to reduce the calorie content of meals served at psychiatric rehabilitation programs. Community Ment Health J 2011; 47:711-5. [PMID: 21691819 PMCID: PMC6449692 DOI: 10.1007/s10597-011-9436-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/24/2010] [Accepted: 06/10/2011] [Indexed: 11/29/2022]
Abstract
To assess the effectiveness of an intervention to reduce the calorie content of meals served at two psychiatric rehabilitation programs. Intervention staff assisted kitchen staff with ways to reduce calories and improve the nutritional quality of meals. Breakfast and lunch menus were collected before and after a 6-month intervention period. ESHA software was used to determine total energy and nutrient profiles of meals. Total energy of served meals significantly decreased by 28% at breakfast and 29% at lunch for site 1 (P < 0.05); total energy significantly decreased by 41% at breakfast for site 2 (P = 0.018). Total sugars significantly decreased at breakfast for both sites (P ≤ 0.001). In general, sodium levels were high before and after the intervention period. The nutrition intervention was effective in decreasing the total energy and altering the composition of macro-nutrients of meals. These results highlight an unappreciated opportunity to improve diet quality in patients attending psychiatric rehabilitation programs.
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Champagne CM, Broyles ST, Moran LD, Cash KC, Levy EJ, Lin PH, Batch BC, Lien LF, Funk KL, Dalcin A, Loria C, Myers VH. Dietary intakes associated with successful weight loss and maintenance during the Weight Loss Maintenance trial. J Am Diet Assoc 2011; 111:1826-35. [PMID: 22117658 PMCID: PMC3225890 DOI: 10.1016/j.jada.2011.09.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/05/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dietary components effective in weight maintenance efforts have not been adequately identified. OBJECTIVE To determine the effects of changes in dietary consumption on weight loss and maintenance during the Weight Loss Maintenance clinical trial. DESIGN Weight Loss Maintenance was a randomized controlled trial. Successful weight loss participants who completed Phase I of the trial and lost 4 kg were randomized to one of three maintenance intervention arms in Phase II and followed for an additional 30 months. PARTICIPANTS/SETTING The multicenter trial was conducted from 2003 through 2007. This substudy included 828 successful weight loss participants. METHODS The Block Food Frequency Questionnaire (FFQ) was used to assess nutrient intake levels and food group servings. Carbohydrates, proteins, fats, dietary fiber, fruit/vegetable, and dairy servings were utilized as predictor variables. The FFQ was collected on all participants at study entry (beginning of Phase I). Those randomized to Phase II completed the FFQ at three additional time points: randomization (beginning of Phase II), 12 months, and 30 months. INTERVENTION The main intervention focused on long-term maintenance of weight loss using the Dietary Approaches to Hypertension diet. This substudy examined if changes to specific dietary variables were associated with weight loss and maintenance. STATISTICAL ANALYSES PERFORMED Linear regression models that adjusted for change in total energy examined the relationship between changes in dietary intake and weight for each time period. Site, age, race, sex, and a race-sex interaction were included as covariates. RESULTS Participants who substituted protein for fat lost, on average, 0.33 kg per 6 months during Phase I (P<0.0001) and 0.07 kg per 6 months during Phase II (P<0.0001) per 1% increase in protein. Increased intake of fruits and vegetables was associated with weight loss in Phases I and II: 0.29 kg per 6 months (P<0.0001) and 0.04 kg per 6 months (P=0.0062), respectively, per 1-serving increase. Substitution of carbohydrates for fat and protein for carbohydrates were associated with weight loss during both phases. Increasing dairy intake was associated with significant weight loss during Phase II (-0.17 kg per 6 months per 1-serving increase, P=0.0002), but not during Phase I. Dietary fiber revealed no significant findings. CONCLUSIONS Increasing fruits, vegetables, and low-fat dairy may help achieve weight loss and maintenance.
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Affiliation(s)
- Catherine M. Champagne
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-2553, Fax: 225-763-3045,
| | - Stephanie T Broyles
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-2760, Fax: 225-763-3009,
| | - Laura D. Moran
- Baton Rouge Clinic, 7373 Perkins Road, Baton Rouge, LA 70808, Phone: 225-246-9413, Fax: 225-246-9159,
| | - Katherine C. Cash
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-3110 Fax: 225-763-3045,
| | - Erma J. Levy
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-3167, Fax: 225-763-3045,
| | - Pao-Hwa Lin
- Department of Medicine, Nephrology Division, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, Phone: 919-660-6685, Fax: 919-660-8802,
| | - Bryan C. Batch
- Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center Box 3031, Durham, NC 27710, Phone: 919-681-2168, Fax: 919-681-9846,
| | - Lillian F. Lien
- Division of Endocrinology, Metabolism, and Nutrition, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27710, Phone: 919-684-9036, Fax: 919-681-7796,
| | - Kristine L. Funk
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227-1110, Phone: 503-335-2443, Fax: 503-335-2428,
| | - Arlene Dalcin
- Johns Hopkins ProHealth, 1849 Gwynn Oak Avenue Suite 3, Baltimore, MD 21207, Phone: 410-265-1109, Fax: 410-281-1134,
| | - Catherine Loria
- National Heart, Lung and Blood Institute, National Institutes of Health, Division of Cardiovascular Services, 6701 Rockledge Drive, Ste. 10018, MSC 7936, Bethesda, MD 20892-7936, Phone: 301-435-0702, Fax: 301-480-5158,
| | - Valerie H. Myers
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, Phone: 225-763-3085, Fax: 225-763-3045,
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Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G, Miller ER, Dalcin A, Jerome GJ, Geller S, Noronha G, Pozefsky T, Charleston J, Reynolds JB, Durkin N, Rubin RR, Louis TA, Brancati FL. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2011; 365:1959-68. [PMID: 22085317 PMCID: PMC4074540 DOI: 10.1056/nejmoa1108660] [Citation(s) in RCA: 528] [Impact Index Per Article: 40.6] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity and its cardiovascular complications are extremely common medical problems, but evidence on how to accomplish weight loss in clinical practice is sparse. METHODS We conducted a randomized, controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor. Participants were recruited from six primary care practices; 63.6% were women, 41.0% were black, and the mean age was 54.0 years. One intervention provided patients with weight-loss support remotely--through the telephone, a study-specific Web site, and e-mail. The other intervention provided in-person support during group and individual sessions, along with the three remote means of support. There was also a control group in which weight loss was self-directed. Outcomes were compared between each intervention group and the control group and between the two intervention groups. For both interventions, primary care providers reinforced participation at routinely scheduled visits. The trial duration was 24 months. RESULTS At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was -0.8 kg in the control group, -4.6 kg in the group receiving remote support only (P<0.001 for the comparison with the control group), and -5.1 kg in the group receiving in-person support (P<0.001 for the comparison with the control group). The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. The change in weight from baseline did not differ significantly between the two intervention groups. CONCLUSIONS In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00783315.).
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Affiliation(s)
- Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
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Jerome GJ, Yeh HC, Dalcin A, Reynolds J, Gauvey-Kern ME, Charleston J, Durkin N, Appel LJ. Treatment of Obesity in Primary Care Practice: The Practice Based Opportunities for Weight Reduction (POWER) Trial at Johns Hopkins. ACTA ACUST UNITED AC 2009; 5:216-221. [DOI: 10.1089/obe.2009.0506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jerome GJ, Young DR, Dalcin A, Charleston J, Anthony C, Hayes J, Daumit GL. Physical activity levels of persons with mental illness attending psychiatric rehabilitation programs. Schizophr Res 2009; 108:252-7. [PMID: 19157787 PMCID: PMC2679956 DOI: 10.1016/j.schres.2008.12.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 12/03/2008] [Accepted: 12/08/2008] [Indexed: 11/29/2022]
Abstract
This study objectively measured physical activity levels in overweight and obese adults with severe mental illness and examined relationships among psychiatric symptoms, cognitive functioning and physical activity. A diverse sample (50% female, 50% African American) of overweight and obese adults (n=55) with mental illness were asked to wear accelerometers for 4 days. Study participants averaged 120 min/week of moderate to vigorous physical activity (MVPA); 35% had >or=150 min/week of MVPA. Only 4% accumulated >or=150 min/week of MVPA in bouts >or=10 min as per public health recommendations. Depressive symptoms, psychological distress and cognitive functioning were not associated with physical activity (p>.05). Although participants appeared to have substantial minutes of MVPA, increased physical activity bouts, or sessions, may be necessary for increased health and weight management benefits for persons with severe mental illness. Efforts are needed to increase physical activity sessions in this vulnerable population.
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Affiliation(s)
- Gerald J. Jerome
- Department of Kinesiology, Towson University, Towson, Maryland, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah Rohm Young
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
| | - Arlene Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeanne Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher Anthony
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Hayes
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Gail L Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland, Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Hollis JF, Gullion CM, Stevens VJ, Brantley PJ, Appel LJ, Ard JD, Champagne CM, Dalcin A, Erlinger TP, Funk K, Laferriere D, Lin PH, Loria CM, Samuel-Hodge C, Vollmer WM, Svetkey LP. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med 2008; 35:118-26. [PMID: 18617080 PMCID: PMC2515566 DOI: 10.1016/j.amepre.2008.04.013] [Citation(s) in RCA: 245] [Impact Index Per Article: 15.3] [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: 11/09/2007] [Revised: 02/25/2008] [Accepted: 04/03/2008] [Indexed: 12/24/2022]
Abstract
BACKGROUND To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I). METHODS Eligible adults were aged > or =25, overweight or obese (BMI=25-45 kg/m2), and on medications for hypertension and/or dyslipidemia. Anthropomorphic, demographic, and psychosocial measures were collected at baseline and 6 months. Participants (n=1685) attended 20 weekly group sessions to encourage calorie restriction, moderate-intensity physical activity, and the DASH (dietary approaches to stop hypertension) dietary pattern. Weight-loss predictors with missing data were replaced by multiple imputation. RESULTS Participants were 44% African American and 67% women; 79% were obese (BMI> or =30), 87% were taking anti-hypertensive medications, and 38% were taking antidyslipidemia medications. Participants attended an average of 72% of 20 group sessions. They self-reported 117 minutes of moderate-intensity physical activity per week, kept 3.7 daily food records per week, and consumed 2.9 servings of fruits and vegetables per day. The Phase-I follow-up rate was 92%. Mean (SD) weight change was -5.8 kg (4.4), and 69% lost at least 4 kg. All race-gender subgroups lost substantial weight: African-American men (-5.4 kg +/- 7.7); African-American women (-4.1 kg +/- 2.9); non-African-American men (-8.5 kg +/- 12.9); and non-African-American women (-5.8 kg +/- 6.1). Behavioral measures (e.g., diet records and physical activity) accounted for most of the weight-loss variation, although the association between behavioral measures and weight loss differed by race and gender groups. CONCLUSIONS The WLM behavioral intervention successfully achieved clinically significant short-term weight loss in a diverse population of high-risk patients.
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Affiliation(s)
- Jack F Hollis
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA.
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Lasser VI, Raczynski JM, Stevens VJ, Mattfeldt-Beman MK, Kumanyika S, Evans M, Danielson E, Dalcin A, Batey DM, Belden LK. Trials of Hypertension Prevention, phase II. Structure and content of the weight loss and dietary sodium reduction interventions. Trials of Hypertension Prevention (TOHP) Collaborative Research Group. Ann Epidemiol 1995; 5:156-64. [PMID: 7795834 DOI: 10.1016/1047-2797(94)00060-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Identifying effective, nonpharmacologic means of preventing or significantly delaying the onset of hypertension would be a major advance in the primary prevention of cardiovascular disease. In the first phase of the Trials of Hypertension Prevention (TOHP I), adults with high-normal diastolic blood pressure were randomly assigned to one of seven nonpharmacologic interventions. Only weight loss and reduction of dietary sodium proved to be effective strategies for reducing blood pressure. The second phase of TOHP (TOHP II) will test the effectiveness of weight loss, reduction of dietary sodium, and their combination of lowering blood pressure and preventing the onset of hypertension over a 3- to 4-year follow-up period. This article describes the three interventions used in TOHP II, methods used to maintain continued participation in this long-term trial, and protocol enhancements designed to maximize intervention effectiveness.
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Sproat JE, Dalcin A, Weitauer N, Roberts RS. Hypertrophic sternal scars: silicone gel sheet versus Kenalog injection treatment. Plast Reconstr Surg 1992; 90:988-92. [PMID: 1448534] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A prospective, randomized trial was designed to compare the standard Kenalog injection of established hypertrophic sternal scars with topical silicone gel sheets (Spenco). Fourteen poststernotomy cardiac patients with symptomatic scars were randomized to treatment in one-half of the scar with Kenalog injection. Simultaneously, the other half of the scar received the silicone gel sheet. The standard Kenalog injection used was 40 mg/ml x 1 cc, mixed with 1 cc of 1% Xylocaine with epinephrine. The gel sheets were worn continuously for 12 hours for 12 weeks. Pretreatment and posttreatment photographs were compared for color and appearance by blindfolded observers. Scar measurements (length, width, and height) were taken weekly in each area, and the patients were asked to rank their symptoms within each half as worse, the same, or better. The primary outcome of patient preference was analyzed sequentially, and the recruitment was terminated after 11 patients had completed the study, 10 of whom favored the silicone gel treatment (p < 0.05). Three patients remained in the treatment phase at the time of termination and completed the study subsequently. For the total sample of 14 subjects, 11 preferred the silicone gel, 1 expressed no preference, and 2 preferred the injection. The average time to improvement was 3.9 +/- 0.62 days (gel) versus 6.8 +/- 1.86 days (Kenalog). This study demonstrates that silicone gel sheets provide earlier symptomatic relief and a more aesthetic scar and are the preferred treatment of patients with symptomatic hypertrophic sternal scars.
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Affiliation(s)
- J E Sproat
- Department of Surgery, Hamilton General Hospital, Ont., Canada
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