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Konuthula D, Tan MM, Burnet DL. Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents. Curr Diab Rep 2023; 23:185-193. [PMID: 37273161 PMCID: PMC10240116 DOI: 10.1007/s11892-023-01513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. RECENT FINDINGS There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.
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Affiliation(s)
| | - Marcia M Tan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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Examining current physical activity interventions in Black school-age children and parents: A systematic review. Prev Med 2021; 153:106814. [PMID: 34597612 DOI: 10.1016/j.ypmed.2021.106814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 09/10/2021] [Accepted: 09/26/2021] [Indexed: 11/21/2022]
Abstract
Obesity is prevalent in Black children and adults; increasing physical activity (PA) can aid in reducing childhood obesity in both age groups. The purpose of this systematic review is to examine current research on PA interventions in school-age Black children. Adhering to PRISMA guidelines, a systematic search was conducted in six databases for PA interventions in Black children. A total of 13 articles met inclusion criteria (n = 7 randomized controlled trial, n = 5 quasi-experimental, n = 1 cross-sectional). The majority of the articles were on a combination of diet and PA programs (n = 9). Four articles targeted PA and parental role modeling of PA as the outcome showing positive intervention effects. Nine additional studies included PA as an outcome variable along with at least one additional obesity-related predictor. PA interventions for Black school-age children typically use a parent-child dyadic approach (n = 13), are guided by theory (n = 11) and are high quality. However, continued investigation is warranted to draw definitive conclusions and determine how to best involve parents within the PA interventions. Theory-driven higher quality trials that clearly describe the structured PA component and outcomes among Black parent-child dyads are needed.
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Guerra PH, Silvestre R, Mello THTD, Carvalho ALBS, Costa FFD, Florindo AA. Effects of community health worker-based interventions on physical activity levels in children: a systematic review. ACTA ACUST UNITED AC 2021; 40:e2020232. [PMID: 34706032 PMCID: PMC8547134 DOI: 10.1590/1984-0462/2022/40/2020232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
Abstract
Objective: To identify the strategies and effects of interventions carried out by community health workers (CHW) on physical activity (PA) levels in children and adolescents. Data source: In August 2020, a systematic review, designed according to the PRISMA checklist items, was conducted by searches in seven electronic databases and in reference lists. Original studies were searched without restriction with regard to year of publication; they were written in Spanish, English or Portuguese and examined interventions implemented by CHW, involving theoretical and/or practical contents of PA, with a focus on children and/or adolescents between three and 19 years of age. Data synthesis: Of the 2,321 studies initially retrieved, eight were included, targeting samples with more specific characteristics (e.g., clinical, ethnic and/or socioeconomic). In all studies, CHW were trained to lead educational activities. In three non-controlled trials, positive results were observed, involving indicators such as moderate and vigorous PA and physical inactivity reduction. Also, two positive results were found in reducing sedentary behavior. Conclusions: Even though most of the interventions included did not have a significant effect on increasing PA levels, the available findings reinforce the role of CHW as an important strategy for dialogue between health services and the most vulnerable communities, and they suggest a greater articulation of these professionals in the actions developed in the school context.
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Gamble A, Beech BM, Wade BC, Sutton VD, Lim C, Sandridge S, Welsch MA. Telehealth Diabetes Prevention Intervention for the Next Generation of African American Youth: Protocol for a Pilot Trial. JMIR Res Protoc 2021; 10:e25699. [PMID: 33787504 PMCID: PMC8047807 DOI: 10.2196/25699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background In 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population. Objective This study tests the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children with risk for T2DM. Concurrently, investigators aim to evaluate an implementation strategy for the uptake of the intervention by the University of Mississippi Medical Center’s (UMMC) pediatric weight management clinic. Methods This single-arm trial will enroll 20 parents with overweight or obesity of children (8-11 years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11 weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi–enabled iPads with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant lifestyle coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the UMMC’s pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies facilitated using problem-solving and goal-setting skills. The implementation strategy has 2 targets: the pediatric weight management clinic site and clinical team and parents of children at risk for T2DM engaged in intensive obesity treatment to prevent T2DM. The multifaceted implementation protocol includes 4 discrete strategies: creating a new clinical team, changing the service site, intervening with families, and promoting organizational readiness for change. Results Recruitment and enrollment began in December 2020, and the intervention is scheduled to be delivered to the first cohort of parents in March 2021. The results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include changes from baseline to 12 and 30 weeks in the child BMI z score and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol was approved by the UMMC’s Institutional Review Board (#2020V0249). Conclusions The proposed intervention approach is supported by the scientific literature and is scalable given the current and future health care subsidies for telehealth. Findings from this pilot trial will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk AA pediatric populations. International Registered Report Identifier (IRRID) PRR1-10.2196/25699
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Affiliation(s)
- Abigail Gamble
- Department of Preventive Medicine, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States.,Department of Pediatrics, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States.,Myrlie Evers-Williams Institute for the Elimination of Health Disparities, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Bettina M Beech
- Department of Health Systems and Population Health Science, College of Medicine, University of Houston, Houston, TX, United States
| | - Breanna C Wade
- Department of Preventive Medicine, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Victor D Sutton
- Department of Preventive Medicine, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States.,Office of Preventive Health and Health Equity, Mississippi State Department of Health, Ridgeland, MS, United States
| | - Crystal Lim
- Division of Psychology, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Shanda Sandridge
- Pediatric Gastroenterology, Children's Healthcare of Mississippi, Jackson, MS, United States
| | - Michael A Welsch
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
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Palmer KNB, Garr Barry VE, Marrero DG, McKinney BM, Graves AN, Winters CK, Hannon TS. Intervention Delivery Matters: What Mothers at High Risk for Type 2 Diabetes Want in a Diabetes Prevention Program-Results from a Comparative Effectiveness Trial. Diabetes Ther 2020; 11:2411-2418. [PMID: 32770443 PMCID: PMC7414259 DOI: 10.1007/s13300-020-00891-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 02/04/2023] Open
Abstract
Participants in the ENCOURAGE Healthy Families Study, a family-focused, modified Diabetes Prevention Program, reported challenges to and preferences for engaging in a diabetes prevention program. Challenges with flexible intervention delivery, accessibility, the traditional group-based format, and Coronavirus Disease 2019 (COVID-19) exposure risk can be mitigated by participant preferences for one-on-one, virtual/online intervention delivery.Trial Registration: ClinicalTrials.gov identifier, NCT01823367.
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Affiliation(s)
- Kelly N B Palmer
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
| | - Valene E Garr Barry
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL, USA
| | - David G Marrero
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Brett M McKinney
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | | | | | - Tamara S Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
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Vitolins MZ, Blackwell CS, Katula JA, Isom SP, Case LD. Long-term Weight Loss Maintenance in the Continuation of a Randomized Diabetes Prevention Translational Study: The Healthy Living Partnerships to Prevent Diabetes (HELP PD) Continuation Trial. Diabetes Care 2019; 42:1653-1660. [PMID: 31296648 PMCID: PMC6702609 DOI: 10.2337/dc19-0295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE HELP PD was a clinical trial of 301 adults with prediabetes. Participants were randomized to enhanced usual care (EUC) or to a lifestyle weight loss (LWL) intervention led by community health workers that consisted of a 6-month intensive phase (phase 1) and 18 months of maintenance (phase 2). At 24 months, participants were asked to enroll in phase 3 to assess whether continued group maintenance (GM) sessions would maintain improvements realized in phases 1 and 2 compared with self-directed maintenance (SM) or EUC. RESEARCH DESIGN AND METHODS In phase 3, LWL participants were randomly assigned to GM or SM. EUC participants remained in the EUC arm and, along with participants in SM, received monthly newsletters. All participants received semiannual dietitian sessions. Anthropometrics and biomarkers were assessed every 6 months. Mixed-effects models were used to assess changes in outcomes over time. RESULTS Eighty-two of the 151 intervention participants (54%) agreed to participate in phase 3; 41 were randomized to GM and 41 to SM. Of the 150 EUC participants, 107 (71%) continued. Ninety percent of clinic visits were completed. Over 48 months of additional follow-up, outcomes remained relatively stable in the EUC participants; the GM group was able to maintain body weight, BMI, and waist circumference; and these measures all increased significantly (P < 0.001) in the SM group. CONCLUSIONS Participants in the GM arm maintained weight loss achieved in phases 1 and 2, while those in the SM arm regained weight. Because group session attendance by the participants in the GM arm was low, it is unclear what intervention components led to successful weight maintenance.
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Affiliation(s)
- Mara Z Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Caroline S Blackwell
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Scott P Isom
- Department of Biostatistics and Data Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - L Douglas Case
- Department of Biostatistics and Data Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Hingle MD, Turner T, Going S, Ussery C, Roe DJ, Saboda K, Kutob R, Stump C. Feasibility of a family-focused YMCA-based diabetes prevention program in youth: The E.P.I.C. Kids (Encourage, Practice, and Inspire Change) Study. Prev Med Rep 2019; 14:100840. [PMID: 30911460 PMCID: PMC6416652 DOI: 10.1016/j.pmedr.2019.100840] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 01/08/2023] Open
Abstract
Efficacious lifestyle modification programs for children at risk of type 2 diabetes (T2D) have not been well established outside of clinical settings. In this study, the feasibility of a family-focused, YMCA-based prevention program for children at risk of T2D was evaluated between September 2015 and July 2016 in Tucson, Arizona. A 12-week YMCA-led lifestyle intervention was adapted for 9–12-year-old children and their families to encourage healthy eating, physical activity, and supportive home environments. Two YMCA locations were randomized to offer either a face-to-face lifestyle coach-led intervention or an alternating face-to-face and digitally-delivered intervention. Program feasibility and preliminary effects on child anthropometric and behavioral outcomes were assessed at baseline and post-intervention. Changes were assessed using linear regression combining delivery formats, with adjustment for clustering of participants within site/format. Forty-eight children (10.9 ± 1.2 years old; 45% female; 40% Hispanic; 43% White; 87% obese) and their parents enrolled, and 36 (75%) completed 12-week measures. Weekly program attendance averaged 61%. Participants and coaches highly rated program content and engagement strategies. Statistically significant changes in child BMI-z score (−0.05, p = 0.03) and family food and physical activity environment (+5.5% family nutrition and physical activity score, p = 0.01) were observed. A YMCA-led family-focused T2D intervention was feasible for the YMCA and participants and effects on child weight, behavior, and the home environment warranted further investigation. Efficacious youth diabetes prevention is not widely available in community settings The YMCA offers scalable, sustainable delivery of a family-focused T2D prevention E.P.I.C. Kids was feasible and preliminary effects warrant further investigation
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Affiliation(s)
- Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA.,The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Tami Turner
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA.,The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Scott Going
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA.,The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Chris Ussery
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA.,The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Denise J Roe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Randa Kutob
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.,The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Craig Stump
- Diabetes Program, College of Medicine, University of Arizona, Tucson, AZ, USA.,The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA.,Southern Arizona VA Health Care System, Tucson, AZ, USA
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Hannon TS, Saha CK, Carroll AE, Palmer KN, O'Kelly Phillips E, Marrero DG. The ENCOURAGE healthy families study: A comparative effectiveness trial to reduce risk for type 2 diabetes in mothers and children. Pediatr Diabetes 2018; 19:1041-1049. [PMID: 29781140 DOI: 10.1111/pedi.12692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/12/2018] [Accepted: 05/13/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Trials in adults have demonstrated that interventions targeting lifestyle are effective in preventing or delaying type 2 diabetes (T2D). To address this need in youth, we developed ENCOURAGE Healthy Families (ENCOURAGE), based on the US Diabetes Prevention Program (DPP). STUDY DESIGN Here, we present results of the ENCOURAGE randomized, comparative effectiveness trial in which we evaluated ENCOURAGE delivered to (1) mothers only, and (2) mothers with added content delivered to their children. PARTICIPANTS The study was performed in Indianapolis, IN, at an academic medical center and the YMCA; December 2012 to April 2016. Women with a history of gestational diabetes mellitus (GDM) or prediabetes with children aged 8 to 15 years enrolled (n = 128). OUTCOME MEASURES Outcomes were collected at baseline, postintervention (3 months), 6 and 12 months. The primary outcome was weight change at 3 months in adults; secondary outcomes included glycosylated hemoglobin (HbA1c), lipids, and blood pressure. RESULTS In neither program did mothers' weight change. HbA1c decreased at 3 months in both groups (mothers only=-0.09%, P = .019; mothers and children=-0.11%, P = .003). Participating children had a reduction in body mass index (BMI) percentile at 3 (-1.77, P = .014), 6 (-3.0, P = .002), and 12 months (-2.91, P = .004). HbA1c decreased in children in both groups (mothers only = -0.12% at 3 months [P < .0001], -0.13% at 6 months [P < .001], and -0.07% at 12 months [P = .001]; mothers and children = -0.08% at 3 months (P < .0001), -0.07% at 6 months (P = .0004), and -0.04% at 12 months (P = .03). CONCLUSION ENCOURAGE was beneficial for reducing BMI percentile in participating children.
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Affiliation(s)
- Tamara S Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chandan K Saha
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron E Carroll
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kelly Nb Palmer
- University of Arizona Health Sciences, College of Public Health, Tucson, Arizona
| | - Erin O'Kelly Phillips
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - David G Marrero
- University of Arizona Health Sciences, College of Public Health, Tucson, Arizona
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Alhassan S, Nwaokelemeh O, Greever CJ, Burkart S, Ahmadi M, St. Laurent CW, Barr-Anderson DJ. Effect of a culturally-tailored mother-daughter physical activity intervention on pre-adolescent African-American girls' physical activity levels. Prev Med Rep 2018; 11:7-14. [PMID: 30065909 PMCID: PMC6066471 DOI: 10.1016/j.pmedr.2018.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/24/2018] [Accepted: 05/05/2018] [Indexed: 01/11/2023] Open
Abstract
Positive parent-child attachment can be determined by opportunities for the child to interact with his/her parent and can influence a child's physical activity (PA) behavior. Therefore, an intervention that provides children and their parent more time to interact positively could impact children's PA. We examined the efficacy of a 12-week mother-daughter intervention on African-American girls' PA levels. In Spring of 2013 and 2014, mother-daughter dyads (n = 76) from Springfield, MA, were randomly assigned to one of three groups [child-mother (CH-M, n = 28), child alone (CH, n = 25), or control (CON, n = 23)] that participated in an afterschool culturally-tailored dance intervention (60 min/day, 3 days/week, 12 weeks). Girls in the CH-M group participated in the intervention with their maternal figure, while girls in the CH group participated in the intervention alone. CON group participants received weekly health-related newsletters. PA was assessed with accelerometers for seven days at baseline, 6-weeks, and 12-weeks. Hierarchical linear modeling was used to examine rates of change in PA. During the afterschool intervention time, girls in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in vigorous PA compared to both the CON (γ = 0.80, p < 0.001) and the CH group (χ2 (1)=13.01, p < 0.001). Mothers in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in total daily moderate-to-vigorous PA compared to CH group's mothers (γ = 0.07, p = 0.01). This culturally-tailored mother-daughter afterschool intervention influenced African-American girls' afterschool hour PA levels, but not total daily PA. Trial Registration: Study is registered at www.clinicaltrials.govNCT01588379. A joint mother-daughter dance intervention can improve mothers' activity level. An afterschool dance intervention can improve girls afterschool activity level. A joint afterschool dance intervention can improve mother and daughter relationship. Mothers and daughters enjoy participating in culturally-tailored dance intervention.
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Affiliation(s)
- Sofiya Alhassan
- University of Massachusetts Amherst, Department of Kinesiology, Amherst, MA, United States
- Corresponding author at: University of Massachusetts, Department of Kinesiology, 110 Totman Building, 30 Eastman Lane, Amherst, MA 01003-9258, United States.
| | - Ogechi Nwaokelemeh
- University of Massachusetts Amherst, Department of Kinesiology, Amherst, MA, United States
| | - Cory J. Greever
- University of Massachusetts Amherst, Department of Kinesiology, Amherst, MA, United States
| | - Sarah Burkart
- University of Massachusetts Amherst, Department of Kinesiology, Amherst, MA, United States
| | - Matthew Ahmadi
- University of Massachusetts Amherst, Department of Kinesiology, Amherst, MA, United States
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11
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Addressing Disparities in Physical Activity Participation Among African American and Latino Youth. ACTA ACUST UNITED AC 2018. [DOI: 10.1123/kr.2018-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Barlow SE, Butte NF, Hoelscher DM, Salahuddin M, Pont SJ. Strategies to Recruit a Diverse Low-Income Population to Child Weight Management Programs From Primary Care Practices. Prev Chronic Dis 2017; 14:E138. [PMID: 29267156 PMCID: PMC5743022 DOI: 10.5888/pcd14.170301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose and Objectives Primary care practices can be used to engage children and families in weight management programs. The Texas Childhood Obesity Research Demonstration (TX CORD) study targeted patients at 12 primary care practices in diverse and low-income areas of Houston, Texas, and Austin, Texas for recruitment to a trial of weight management programs. This article describes recruitment strategies developed to benefit both families and health care practices and the modification of electronic health records (EHRs) to reflect recruitment outcomes. Intervention Approach To facilitate family participation, materials and programs were provided in English and Spanish, and programs were conducted in convenient locations. To support health care practices, EHRs and print materials were provided to facilitate obesity recognition, screening, and study referral. We provided brief training for providers and their office staffs that covered screening patients for obesity, empathetic communication, obesity billing coding, and use of counseling materials. Evaluation Methods We collected EHR data from 2012 through 2014, including demographics, weight, and height, for all patients aged 2 to 12 years who were seen in the 12 provider practices during the study’s recruitment phase. The data of patients with a body mass index (BMI) at or above the 85th percentile were compared with the same data for patients who were referred to the study and patients who enrolled in the study. We also examined reasons that patients referred to the study declined to participate. Results Overall, 26% of 7,845 patients with a BMI at or above the 85th percentile were referred to the study, and 27% of referred patients enrolled. Enrollment among patients with a BMI at or above the 85th percentile was associated with being Hispanic and with more severe obesity than with patients of other races/ethnicities or less severe obesity, respectively. Among families of children aged 2 to 5 years who were referred, 20% enrolled, compared with 30% of families of older children (>5 y to 12 y). Referral rates varied widely among the 12 primary care practices, and referral rates were not associated with EHR modifications. Implications for Public Health Engagement and recruitment strategies for enrolling families in primary care practice in weight management programs should be strengthened. Further study of factors associated with referral and enrollment, better systems for EHR tools, and data on provider and office adherence to study protocols should be examined. EHRs can track referral and enrollment to capture outcomes of recruitment efforts.
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Affiliation(s)
- Sarah E Barlow
- Texas Children's Hospital, Baylor College of Medicine, Houston Texas.,Children's Health, GI Practice, 1935 Medical District Dr, Dallas, TX 75235, Mail Code F4.06.
| | - Nancy F Butte
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth)-School of Public Health, Austin, Texas
| | - Meliha Salahuddin
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth)-School of Public Health, Austin, Texas
| | - Stephen J Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, Texas
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Spears EC, Foster MJ, Bonner TJ. Diabetes Prevention for African-Americans: a Scoping Review. J Racial Ethn Health Disparities 2017; 5:947-965. [PMID: 29218497 DOI: 10.1007/s40615-017-0443-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and is preventable in many instances. African-Americans are disproportionately represented in T2DM statistics. The strategies in place to prevent disease development in this population warrant critical examination. METHODS A scoping review of literature was conducted to provide an overview of the largely inconsistent approach to African-American T2DM prevention research. Specific research questions included: (1) How are African-Americans treated in the existing T2DM literature? (1a) Are African-Americans primarily treated as a homogenous group in the literature? (1b) Has the literature addressed middle-class African-Americans? (2) Is the T2DM prevention literature focused on primary or secondary prevention? The review included articles published from 1985 to 2016, examining the methodology and approach toward African-Americans in each article. RESULTS The review yielded 653 unduplicated articles. Through title, abstract, and full-text screenings, 381 articles were excluded. Of the remaining articles only 37% were focused on the prevention of T2DM development, and only 22.7% described a participant education component. The majority of the studies were observational (n = 19). Only 53.5% included majority African-American participants. Samples ranged from 2 to 27,899 individuals, which were often treated as homogeneous groups in terms of income and/or education (62.3%). CONCLUSION The approach to T2DM prevention in African-Americans is largely inconsistent, which may be contributing to stagnation in this area of research.
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Affiliation(s)
- Erica C Spears
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA.
| | - Margaret J Foster
- Health Sciences Center, Texas A&M University, College Station, TX, USA
| | - Timethia J Bonner
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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14
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Bertran EA, Pinelli NR, Sills SJ, Jaber LA. The Arab American experience with diabetes: Perceptions, myths and implications for culturally-specific interventions. Prim Care Diabetes 2017; 11:13-19. [PMID: 27460886 PMCID: PMC5201435 DOI: 10.1016/j.pcd.2016.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/20/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
AIMS Culturally-specific lifestyle diabetes prevention programs require an assessment of population disease perceptions and cultural influences on health beliefs and behaviors. The primary objectives were to assess Arab Americans' knowledge and perceptions of diabetes and their preferences for a lifestyle intervention. METHODS Sixty-nine self-identified Arab or Arab Americans ≥30 years of age and without diabetes participated in 8 focus groups. RESULTS Emerging themes from the data included myths about diabetes etiology, folk remedies, and social stigma. The main barrier to healthcare was lack of health insurance and/or cost of care. Intervention preferences included gender-specific exercise, group-delivered education featuring religious ideology, inclusion of the family, and utilization of community facilities. CONCLUSION Lifestyle interventions for Arab Americans need to address cultural preferences, diabetes myths, and folk remedies. Interventions should incorporate Arabic cultural content and gender-specific group education and exercise. Utilization of family support and religious centers will enable culturally-acceptable and cost-effective interventions.
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Affiliation(s)
- Elizabeth A Bertran
- Eugene Applebaum School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2134, Detroit, MI 48201, USA(2).
| | - Nicole R Pinelli
- Eugene Applebaum School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2134, Detroit, MI 48201, USA(2).
| | - Stephen J Sills
- The University of North Carolina at Greensboro, 320 Graham Building UNCG, Greensboro, NC 27402-6170, USA.
| | - Linda A Jaber
- Eugene Applebaum School of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2134, Detroit, MI 48201, USA(2).
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15
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Huang TTK, Ferris E, Tripathi D. An Integrative Analysis of the Effect of Lifestyle and Pharmacological Interventions on Glucose Metabolism in the Prevention and Treatment of Youth-Onset Type 2 Diabetes. Curr Diab Rep 2016; 16:78. [PMID: 27380713 DOI: 10.1007/s11892-016-0767-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preventing and managing youth-onset type 2 diabetes are a major challenge. This paper reviews the evidence of lifestyle and drug therapies in improving glucose, insulin, and insulin sensitivity. Forty-four interventions were analyzed, of which 11 were drug (mainly metformin) interventions combined with lifestyle while the remainder used lifestyle strategies only. Fewer than a dozen out of 44 interventions reported significant improvements in glucose-related outcomes. Metformin in addition to lifestyle therapy did not necessarily enhance intervention effects. The overall lack of findings can be partially attributed to the heterogeneity of study populations, the lack of intervention intensity, under-powered study design, and the challenging lives of at-risk populations. New treatment options in both drugs and lifestyle strategies are direly needed.
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Affiliation(s)
- Terry T-K Huang
- Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, #803, New York, NY, 10027, USA.
| | - Emily Ferris
- Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, #803, New York, NY, 10027, USA
| | - Devanshi Tripathi
- Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, #803, New York, NY, 10027, USA
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16
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Gefter L, Morioka-Douglas N, Srivastava A, Rodriguez E. Supporting At-Risk Youth and Their Families to Manage and Prevent Diabetes: Developing a National Partnership of Medical Residency Programs and High Schools. PLoS One 2016; 11:e0158477. [PMID: 27383902 PMCID: PMC4934855 DOI: 10.1371/journal.pone.0158477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 06/16/2016] [Indexed: 12/01/2022] Open
Abstract
Background The Stanford Youth Diabetes Coaches Program (SYDCP) is a school based health program in which Family Medicine residents train healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. This study evaluates the impact of the SYDCP when disseminated to remote sites. Additionally, this study aims to assess perceived benefit of enhanced curriculum. Methods From 2012–2015, 10 high schools and one summer camp in the US and Canada and five residency programs were selected to participate. Physicians and other health providers implemented the SYDCP with racial/ethnic-minority students from low-income communities. Student coaches completed pre- and posttest surveys which included knowledge, health behavior, and psychosocial asset questions (i.e., worth and resilience), as well as open-ended feedback questions. T-test pre-post comparisons were used to determine differences in knowledge and psychosocial assets, and open and axial coding methods were used to analyze qualitative data. Results A total of 216 participating high school students completed both pre-and posttests, and 96 nonparticipating students also completed pre- and posttests. Student coaches improved from pre- to posttest significantly on knowledge (p<0.005 in 2012–13, 2014 camp, and 2014–15); worth (p<0.1 in 2014–15); problem solving (p<0.005 in 2014 camp and p<0.1 in 2014–15); and self-efficacy (p<0.05 in 2014 camp). Eighty-two percent of student coaches reported that they considered making a behavior change to improve their own health as a result of program participation. Qualitative feedback themes included acknowledgment of usefulness and relevance of the program, appreciation for physician instructors, knowledge gain, pride in helping family members, improved relationships and connectedness with family members, and lifestyle improvements. Conclusion Overall, when disseminated, this program can increase health knowledge and some psychosocial assets of at-risk youth and holds promise to empower these youth with health literacy and encourage them to adopt healthy behaviors.
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Affiliation(s)
- Liana Gefter
- Center for Primary Care Research, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- * E-mail:
| | - Nancy Morioka-Douglas
- Center for Primary Care Research, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Ashini Srivastava
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Eunice Rodriguez
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
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17
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Kitzman-Ulrich HE, Wilson DK, Lyerly JE. Qualitative Perspectives from African American Youth and Caregivers for Developing the Families Improving Together (FIT) for Weight Loss Intervention. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2016; 4:263-274. [PMID: 27800292 DOI: 10.1037/cpp0000147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study obtained qualitative data from African American (AA) youth and caregiver dyads to inform the Families Improving Together (FIT) for Weight Loss Trial. Focus groups were conducted with 55 AA parent and caregiver dyads to gather perspectives on facilitators and barriers, motivators, and program preferences for health and weight loss using a socio-ecological framework. Four main themes emerged: using a positive health promotion framework for weight loss programs, social support and the role of parents in providing positive support, using a socio-ecological approach to examine factors that contribute to weight, and creating programs that are convenient, fun, and reduce barriers to participation. The findings from this study were used to develop the FIT intervention and indicate important individual, interpersonal, and environmental factors to consider when developing weight management and healthy lifestyle programs for AA families.
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Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJM, van Sluijs EMF. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obes Rev 2016; 17:345-60. [PMID: 26756281 PMCID: PMC4819691 DOI: 10.1111/obr.12362] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Family-based interventions represent a potentially valuable route to increasing child physical activity (PA) in children. A dual meta-analysis and realist synthesis approach examined existing interventions to assist those developing programmes to encourage uptake and maintenance of PA in children. DESIGN Studies were screened for inclusion based on including participants aged 5-12 years, having a substantive aim of increasing PA by engaging the family and reporting on PA outcome. Duplicate data extraction and quality assessment were conducted. Meta-analysis was conducted in STATA. Realist synthesis included theory development and evidence mapping. RESULTS Forty-seven studies were included, of which three received a 'strong' quality rating, 21 'moderate' and 23 'weak'. The meta-analysis (19 studies) demonstrated a significant small effect in favour of the experimental group (standardized mean difference: 0.41; 95%CI 0.15-0.67). Sensitivity analysis, removing one outlier, reduced this to 0.29 (95%CI 0.14-0.45). Realist synthesis (28 studies) provided insight into intervention context (particularly, family constraints, ethnicity and parental motivation), and strategies to change PA (notably, goal-setting and reinforcement combined). CONCLUSION This review provides key recommendations to inform policy makers and other practitioners in developing evidence-based interventions aimed at engaging the family to increase PA in children, and identifies avenues for future research.
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Affiliation(s)
- H E Brown
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - A J Atkin
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - J Panter
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - G Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - M J M Chinapaw
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - E M F van Sluijs
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Cui Z, Seburg EM, Sherwood NE, Faith MS, Ward DS. Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: a review of the clinical trials registration database. Trials 2015; 16:564. [PMID: 26651822 PMCID: PMC4674912 DOI: 10.1186/s13063-015-1089-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 11/27/2015] [Indexed: 12/27/2022] Open
Abstract
Background Efforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component. Methods First, completed home-, community-, and school-based trials involving minority or low-income children aged 2–17 years were identified in a search of the ClinicalTrials.gov registry. Second, a PubMed search of identified trials was conducted to locate publications pertinent to identified trials. Recruitment and retention rates were calculated for studies that included relevant information. Results Our final analytic sample included 43 studies. Of these, 25 studies reported recruitment or retention strategies, with the amount of information varying from a single comment to several pages; 4 published no specific information on recruitment or retention; and 14 had no publications listed in PubMed. The vast majority (92 %) of the 25 studies reported retention rates of, on average, 86 %. Retention rates were lower in studies that: targeted solely Hispanics or African Americans (vs. mixed races of African Americans, whites, and others); involved children and parents (vs. children only); focused on overweight or obese children (vs. general children), lasted ≥1 year (vs. <1 year), were home or community-based (vs. school-based), included nutrition and physical activity intervention (vs. either intervention alone), had body mass index or other anthropometrics as primary outcome measures (vs. obesity-related behavior, insulin sensitivity, etc.). Retention rates did not vary based on child age, number of intervention sessions, or sample size. Conclusions Variable amounts of information were provided on recruitment and retention strategies in obesity-related trials involving minority or low-income children. Although reported retention rates were fairly high, a lack of reporting limited the available information. More and consistent reporting and systematic cataloging of recruitment and retention methods are needed. In addition, qualitative and quantitative studies to inform evidence-based decisions in the selection of effective recruitment and retention strategies for trials including minority or low-income children are warranted.
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Affiliation(s)
- Zhaohui Cui
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
| | - Elisabeth M Seburg
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Myles S Faith
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
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20
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Chin MH, Goddu AP, Ferguson MJ, Peek ME. Expanding and sustaining integrated health care-community efforts to reduce diabetes disparities. Health Promot Pract 2015; 15:29S-39S. [PMID: 25359247 DOI: 10.1177/1524839914532649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To reduce racial and ethnic disparities in diabetes care and outcomes, it is critical to integrate health care and community approaches. However, little work describes how to expand and sustain such partnerships and initiatives. We outline our experience creating and growing an initiative to improve diabetes care and outcomes in the predominantly African American South Side of Chicago. Our project involves patient education and activation, a quality improvement collaborative with six clinics, provider education, and community partnerships. We aligned our project with the needs and goals of community residents and organizations, the mission and strategic plan of our academic medical center, various strengths and resources in Chicago, and the changing health care marketplace. We use the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change conceptual model and the Consolidated Framework for Implementation Research to elucidate how we expanded and sustained our project within a shifting environment. We recommend taking action to integrate health care with community projects, being inclusive, building partnerships, working with the media, and understanding vital historical, political, and economic contexts.
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21
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Sanders Thompson VL, Johnson-Jennings M, Bauman AA, Proctor E. Use of culturally focused theoretical frameworks for adapting diabetes prevention programs: a qualitative review. Prev Chronic Dis 2015; 12:E60. [PMID: 25950567 PMCID: PMC4436044 DOI: 10.5888/pcd12.140421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Diabetes disproportionately affects underserved racial/ethnic groups in the United States. Diabetes prevention interventions positively influence health; however, further evaluation is necessary to determine what role culture plays in effective programming. We report on the status of research that examines cultural adaptations of diabetes prevention programs. Methods We conducted database searches in March and April 2014. We included studies that were conducted in the United States and that focused on diabetes prevention among African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Latinos. Results A total of 58 studies were identified for review; 29 were excluded from evaluation. Few adaptations referenced or followed recommendations for cultural adaptation nor did they justify the content modifications by providing a rationale or evidence. Cultural elements unique to racial/ethnic populations were not assessed. Conclusion Future cultural adaptations should use recommended processes to ensure that culture’s role in diabetes prevention–related behavioral changes contributes to research.
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Affiliation(s)
- Vetta L Sanders Thompson
- Washington University in St. Louis, Brown School, One Brookings Dr, CB 1196, St. Louis, MO, 63130.
| | | | - Ana A Bauman
- Washington University in St. Louis, Brown School, St. Louis, Missouri
| | - Enola Proctor
- Washington University in St. Louis, Brown School, St. Louis, Missouri
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22
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Barr-Anderson DJ, Singleton C, Cotwright CJ, Floyd MF, Affuso O. Outside-of-school time obesity prevention and treatment interventions in African American youth. Obes Rev 2014; 15 Suppl 4:26-45. [PMID: 25196405 DOI: 10.1111/obr.12204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/12/2023]
Abstract
Outside-of-school time (OST; i.e. before/after-school hours, summer time), theory-based interventions are potential strategies for addressing increased obesity among African American youth. This review assessed interventions across multiple settings that took place during OST among African American youth aged 5-18 years old. Seven databases were searched for studies published prior to October 2013; 28 prevention and treatment interventions that assessed weight or related behaviours as a primary or secondary outcome were identified. Overall, these studies reported heterogeneous intervention length, theoretical frameworks, methodological quality, outcomes, cultural adaption and community engagement; the latter two attributes have been identified as potentially important intervention strategies when working with African Americans. Although not always significant, generally, outcomes were in the desired direction. When examining programmes by time of intervention (i.e. after-school, summer time, time not specified or multiple time periods), much of the variability remained, but some similarities emerged. After-school studies generally had a positive impact on physical activity, fruit/vegetable consumption and caloric intake, or body composition. The single summer time intervention showed a trend towards reduced body mass index. Overall findings suggest that after-school and summer programmes, alone or perhaps in combination, offer potential benefits for African American youth and could favourably influence diet and physical activity behaviour.
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Affiliation(s)
- D J Barr-Anderson
- Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
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23
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Brackney DE, Cutshall M. Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse. J Sch Nurs 2014; 31:6-21. [PMID: 24862181 DOI: 10.1177/1059840514535445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Childhood obesity and the early development of type 2 diabetes (T2 DM) place students at risk for chronic health problems. The school nurse is uniquely situated to promote school health initiatives that influence health behavior. The purpose of this review was to determine effective nonpharmacological interventions for prevention of T2 DM in youth. Researchers from 35 reports modified T2 DM risk factors. These nonpharmacological interventions often include increasing daily activity, decreasing caloric intake, and increasing muscle mass. Some researchers also included psychological and social support interventions intended to strengthen initiating and/or maintaining health behavior. Characteristics of effective nonpharmacological T2 DM prevention interventions are discussed. Findings from this review are a useful guide for the implementation of T2 DM prevention strategies in the school setting. Few school-based studies included high school students; therefore, further research is needed among older adolescents on the efficacy of nonpharmacological interventions in the high school.
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Affiliation(s)
- Dana E Brackney
- Department of Nursing, College of Health Sciences, Appalachian State University, Boone, NC, USA
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24
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Vivian EM, Colbert LH, Remington PL. Lessons Learned from a Community Based Lifestyle Intervention for Youth at Risk for Type 2 Diabetes. ACTA ACUST UNITED AC 2013; 1. [PMID: 24353925 DOI: 10.4172/2165-7904.1000191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This pilot study examined the feasibility and acceptability of a peer led diabetes prevention intervention for youth in an underserved community. METHODS Children and adolescents randomized to the intervention group participated in a one year program which included peer support, physical activity, and family nutrition, and behavior modification sessions. Participants were asked about their satisfaction with the study and possible benefits, what they learned, and whether they would recommend participation to a friend. Youth randomized to the control group received monthly healthy lifestyle educational materials through the mail. RESULTS Children and adolescents (n=67) with an average age of 12.5 years and BMI greater than or equal to 85 percentile for age and sex were enrolled in the study. The average monthly participation rate varied between 90 and 50 percent with a mean rate of 82 percent. Ninety four percent of parents reported being very satisfied with the program and all (100%) reported they would recommend the program to a friend. All the children and adolescents (100%) reported that they enjoyed working with the youth peer coaches and 94% felt their assigned coach was a good role model. The observed changes in BMI z-score trended towards improvement in the intervention group, but this study was underpowered to detect differences between groups. CONCLUSION The peer led diabetes prevention program was feasible and acceptable and demonstrated potential for improving health behaviors.
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Affiliation(s)
- Eva M Vivian
- University of Wisconsin-Madison, School of Pharmacy, Madison, USA
| | - Lisa H Colbert
- Departments of Kinesiology and Population Health Sciences, 2035 Gymnasium-Natatorium, 2000 Observatory Drive, Madison, USA
| | - Patrick L Remington
- UW School of Medicine and Public Health, Health Sciences Learning Center, Room 4263, 750 Highland Avenue Madison, USA
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Barr-Anderson DJ, Adams-Wynn AW, DiSantis KI, Kumanyika S. Family-focused physical activity, diet and obesity interventions in African-American girls: a systematic review. Obes Rev 2013; 14:29-51. [PMID: 23057473 PMCID: PMC3524349 DOI: 10.1111/j.1467-789x.2012.01043.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/28/2012] [Accepted: 08/30/2012] [Indexed: 11/30/2022]
Abstract
Obesity interventions that involve family members may be effective with racial/ethnic minority youth. This review assessed the nature and effectiveness of family involvement in obesity interventions among African-American girls aged 5-18 years, a population group with high rates of obesity. Twenty-six databases were searched between January 2011 and March 2012, yielding 27 obesity pilot or full-length prevention or treatment studies with some degree of family involvement and data specific to African-American girls. Interventions varied in type and level of family involvement, cultural adaptation, delivery format and behaviour change intervention strategies; most targeted parent-child dyads. Some similarities in approach based on family involvement were identified. The use of theoretical perspectives specific to African-American family dynamics was absent. Across all studies, effects on weight-related behaviours were generally promising but often non-significant. Similar conclusions were drawn for weight-related outcomes among the full-length randomized controlled trials. Many strategies appeared promising on face value, but available data did not permit inferences about whether or how best to involve family members in obesity prevention and treatment interventions with African-American girls. Study designs that directly compare different types and levels of family involvement and incorporate relevant theoretical elements may be an important next step.
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Affiliation(s)
- D J Barr-Anderson
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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