1
|
Spierling Bagsic SR, Fortmann AL, San Diego ERN, Soriano EC, Belasco R, Sandoval H, Bastian A, Padilla Neely OM, Talavera L, Leven E, Evancha N, Philis-Tsimikas A. Outcomes of the Dulce Digital-COVID Aware (DD-CA) discharge texting platform for US/Mexico border Hispanic individuals with diabetes. Diabetes Res Clin Pract 2024; 210:111614. [PMID: 38484985 PMCID: PMC11062488 DOI: 10.1016/j.diabres.2024.111614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Hispanic individuals have higher type 2 diabetes (T2D) prevalence, poorer outcomes, and are disproportionately affected by COVID-19. Culturally-tailored, diabetes educational text messaging has previously improved HbA1c in this population. METHODS During the pandemic, hospitalized Hispanic adults with T2D (N = 172) were randomized to receive Dulce Digital-COVID Aware ("DD-CA") texting platform upon discharge plus diabetes transition service (DTS) or DTS alone. DD-CA includes diabetes educational messaging with additional COVID-safe messaging (e.g., promoting masking; social distancing; vaccination). FINDINGS Among adults with poorly-controlled diabetes (Mean HbA1c = 9.6 ± 2.2 %), DD-CA did not reduce 30- or 90-day readmissions compared to standard care (28 % vs 15 %, p = .06; 37 % vs 35 %, p = .9, respectively). However, the improvement in HbA1c was larger among those in the DD-CA compared to DTS at 3 months (n = 56; -2.69 % vs. -1.45 %, p = .0496) with reduced effect at 6 months (n = 64; -2.03 % vs -0.91 %, p = .07). Low follow-up completion rates and the addition of covariates (to control for baseline group differences that existed despite randomization) impacted statistical power. INTERPRETATION During the pandemic, DD-CA offered an alternative digital approach to diabetes and COVID education and support for a high-risk Hispanic population and achieved trends toward improvement in glycemic control despite relatively low engagement and not reducing hospital readmissions.
Collapse
Affiliation(s)
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Emily Rose N San Diego
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Rebekah Belasco
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Alessandra Bastian
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Olivia M Padilla Neely
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Laura Talavera
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Eric Leven
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Nicole Evancha
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| |
Collapse
|
2
|
Spierling Bagsic SR, Savin KL, Soriano EC, San Diego ERN, Orendain N, Clark T, Sandoval H, Chichmarenko M, Perez-Ramirez P, Farcas E, Godino J, Gallo LC, Philis-Tsimikas A, Fortmann AL. Process evaluation of Dulce Digital-Me: an adaptive mobile health (mHealth) intervention for underserved Hispanics with diabetes. Transl Behav Med 2023; 13:635-644. [PMID: 37011033 PMCID: PMC10496430 DOI: 10.1093/tbm/ibad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Type 2 diabetes disproportionately impacts ethnic minorities and individuals from low socioeconomic status. Diabetes self-management education and support has been shown to improve clinical outcomes in these populations, and mobile health (mHealth) interventions can reduce barriers to access. Dulce Digital-Me (DD-Me) was developed to integrate adaptive mHealth technologies to enhance self-management and reduce disparities in the high-risk, underserved Hispanic population. The objective of the present study was to evaluate reach, adoption, and implementation of an mHealth diabetes self-management education and support intervention in this underrepresented population. The present analysis is a multimethod process evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The study was effective in reaching a sample that was representative of the intended population; only modest but significant differences were observed in sex and age. The DD-Me health coach (HC) cited several important facilitators of intervention adoption, including outreach frequency and personalization, and the automated HC report. Implementation fidelity was high, with participants receiving >90% of intended interventions. Participants who received DD-Me with support from a HC were most engaged, suggesting utility and acceptability of integrating HCs with mHealth interventions. Perceptions of implementation among study participants were positive and consistent across study arms. This evaluation revealed the target population was successfully reached and engaged in the digital health interventions, which was implemented with high fidelity. Further studies should evaluate the efficacy and maintenance of the study following the RE-AIM model to determine whether this intervention warrants expansion to additional settings and populations.
Collapse
Affiliation(s)
| | - Kimberly L Savin
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | | | - Natalia Orendain
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Taylor Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | | | - Perla Perez-Ramirez
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emilia Farcas
- Qualcomm Institute, University of California San Diego, La Jolla, CA, USA
| | - Job Godino
- Qualcomm Institute, University of California San Diego, La Jolla, CA, USA
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| |
Collapse
|
3
|
Gallo LC, Fortmann AL, Clark TL, Roesch SC, Bravin JI, Spierling Bagsic SR, Sandoval H, Savin KL, Gilmer T, Talavera GA, Philis-Tsimikas A. Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial. J Gen Intern Med 2023; 38:2098-2106. [PMID: 36697929 PMCID: PMC9876654 DOI: 10.1007/s11606-022-08006-1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary driver of high healthcare costs. OBJECTIVE We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes. DESIGN Randomized, controlled, single-blind parallel-groups. PARTICIPANTS Hispanic/Latino adults (N=536; 75% of those screened and eligible; M=62.3 years (SD=13.9); 48% women; 73% born in Mexico) with multiple chronic cardiometabolic conditions and at least one behavioral health concern (e.g., depression symptoms, alcohol misuse) hospitalized at a hospital that serves a large, mostly Hispanic/Latino, low-income population. INTERVENTIONS Usual care (UC) involved best-practice discharge processes (e.g., discharge instructions, assistance with appointments). Mi Puente ("My Bridge"; MP) was a culturally appropriate program of UC plus inpatient and telephone encounters with a behavioral health nurse and community mentor team who addressed participants' social, medical, and behavioral health needs. MAIN MEASURES The primary outcome was 30- and 180-day readmissions (inpatient, emergency, and observation visits). Patient-reported outcomes (quality of life, patient activation) and healthcare use were also examined. KEY RESULTS In intention-to-treat models, the MP group evidenced a higher rate of recurrent hospitalization (15.9%) versus UC (9.4%) (OR=1.91 (95% CI 1.09, 3.33)), and a greater number of recurrent hospitalizations (M=0.20 (SD=0.49) MP versus 0.12 (SD=0.45) UC; P=0.02) at 30 days. Similar trends were observed at 180 days. Both groups showed improved patient-reported outcomes, with no advantage in the Mi Puente group. Results were similar in per protocol analyses. CONCLUSIONS In this at-risk population, the MP group experienced increased hospital utilization and did not demonstrate an advantage in improved patient-reported outcomes, relative to UC. Possible reasons for these unexpected findings are discussed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02723019. Registered on 30 March 2016.
Collapse
Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- South Bay Latino Research Center, San Diego State University, 780 Bay Blvd. Suite 200, Chula Vista, CA, 91910, USA.
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Taylor L Clark
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Julia I Bravin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Kimberly L Savin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Todd Gilmer
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | | |
Collapse
|
4
|
Spierling Bagsic SR, Fortmann AL, Belasco R, Bastian A, Lohnes S, Ritko A, Sandoval H, Chichmarenko M, Soriano EC, Talavera L, Philis-Tsimikas A. Real-Time Continuous Glucose Monitoring in the Hospital: A Real-World Experience. J Diabetes Sci Technol 2023; 17:656-666. [PMID: 37056168 PMCID: PMC10210125 DOI: 10.1177/19322968231165982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Glycemic control in the hospital setting is imperative for improving outcomes among patients with diabetes. Bedside point-of-care (POC) glucose monitoring has remained the gold standard for decades, while only providing momentary glimpses into a patient's glycemic control. Continuous glucose monitoring (CGM) has been shown to improve glycemic control in the ambulatory setting. However, a paucity of inpatient experience and data remains a barrier to US Food and Drug Administration (FDA) approval and expanded/non-research use in the hospital setting. METHOD Amid the COVID-19 pandemic, the FDA exercised its enforcement discretion to not object to the use of CGM systems for the treatment of patients in hospital settings to support COVID-19 health care-related efforts to reduce viral exposure of health care workers. Following this announcement, Scripps Health, a large not-for-profit health care system in San Diego, California, implemented CGM as the new "standard of care" (CGM as SOC) for glucose monitoring and management in the hospital. RESULTS The present report serves to (1) detail the implementation procedures for employing this new SOC; (2) describe the patients receiving CGM as SOC, their glycemic control, and hospital outcomes; and (3) share lessons learned over two years and nearly 900 hospital encounters involving CGM. CONCLUSIONS Here, we conclude that CGM is feasible in the hospital setting by using a dedicated diabetes care team and the CGM technology with remote monitoring.
Collapse
Affiliation(s)
| | - Addie L. Fortmann
- Scripps Whittier Diabetes Institute,
Scripps Health, San Diego, CA, USA
| | - Rebekah Belasco
- Scripps Whittier Diabetes Institute,
Scripps Health, San Diego, CA, USA
| | | | - Suzanne Lohnes
- Scripps Whittier Diabetes Institute,
Scripps Health, San Diego, CA, USA
| | | | - Haley Sandoval
- Scripps Whittier Diabetes Institute,
Scripps Health, San Diego, CA, USA
| | | | - Emily C. Soriano
- Scripps Whittier Diabetes Institute,
Scripps Health, San Diego, CA, USA
| | - Laura Talavera
- Scripps Whittier Diabetes Institute,
Scripps Health, San Diego, CA, USA
| | | |
Collapse
|
5
|
Fisher L, Fortmann AL, Florissi C, Stoner K, Knaebel J, Stuhr A. How Frequently and for How Long Do Adults With Type 2 Diabetes Use Management Apps? The REALL Study. J Diabetes Sci Technol 2023; 17:345-352. [PMID: 34802281 PMCID: PMC10012363 DOI: 10.1177/19322968211058766] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study is to identify predictors of utilization of a type 2 diabetes (T2D) management App over time for insulin users (IUs) and noninsulin users (NIUs). RESEARCH DESIGN AND METHODS We followed over 16 weeks a national sample of unselected T2D adults who independently elected to download and pair a CONTOUR DIABETES App with their CONTOUR NEXT ONE glucose meter. App use and frequency of glucose testing were recorded. Baseline surveys recorded participant demographic, disease status, distress, medication taking, and views of technology to predict utilization. RESULTS Mean age was 51.6 years (108 IUs; 353 NIUs), 48% were female, time with diabetes was 6.9 years, and self-reported HbA1c was 8.1% (36.3 mmol/mol). Mean duration of App use was 85.4 days and 40% stopped using the App before 16 weeks. Continuous users were older and reported higher distress, better medication taking, and more positive attitudes toward technology (all P < .01). IUs tested more frequently than NIUs, but frequency and intensity of testing decreased markedly for both groups over time. More predictors of App use frequency and testing occurred for NIUs than IUs: older age, higher HbA1c, lower distress, more medication taking (all P < .05). CONCLUSIONS App use and testing decreased markedly over time. Variations in the predictors of frequency of App use suggest that the utilization of mobile technologies requires a tailored approach that addresses the specific needs of individual users, compared with adopting a one-size-fits-all strategy, and that IUs and NIUs may require very different strategies of customization.
Collapse
Affiliation(s)
- Lawrence Fisher
- Department of Family and Community
Medicine, University of California, San Francisco, San Francisco, CA, USA
- Lawrence Fisher, Department of Family and
Community Medicine, University of California, San Francisco, Box 0900, San
Francisco, CA 94143, USA.
| | - Addie L. Fortmann
- Scripps Whittier Diabetes Institute,
Scripps Health, San Diego, CA, USA
| | | | - Keaton Stoner
- dQ&A—The Diabetes Research Company,
San Francisco, CA, USA
| | | | | |
Collapse
|
6
|
Polonsky WH, Fortmann AL, Soriano EC, Guzman SJ, Funnell MM. The AH-HA! Project: Transforming Group Diabetes Self-Management Education Through the Addition of Flash Glucose Monitoring. Diabetes Technol Ther 2023; 25:194-200. [PMID: 36409486 DOI: 10.1089/dia.2022.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven "discovery learning" approach to education.
Collapse
Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Susan J Guzman
- Behavioral Diabetes Institute, San Diego, California, USA
| | - Martha M Funnell
- Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
7
|
Polonsky WH, Soriano EC, Fortmann AL. The Role of Retrospective Data Review in the Personal Use of Real-Time Continuous Glucose Monitoring: Perceived Impact on Quality of Life and Health Outcomes. Diabetes Technol Ther 2022; 24:492-501. [PMID: 35255224 DOI: 10.1089/dia.2021.0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: To explore whether regularly reviewing one's own retrospective continuous glucose monitoring (CGM) data might be linked with perceived quality of life (QoL) and glycemic benefits. Methods: Adults with type 1 diabetes (N = 300) or insulin-using type 2 diabetes (N = 198) using the Dexcom G5 Mobile or G6 Real-Time CGM (RT-CGM) system and receiving the weekly CLARITY summary report of their glucose data completed a survey exploring their use of the report and its perceived value and impact on QoL and glycemic outcomes. Regression analyses examined whether personal use of the report was associated with QoL, perceived glycemic outcomes, and RT-CGM metrics. Results: The majority reported that receiving and viewing the report contributed to improved hypoglycemic confidence (75.9%) and overall well-being (50.0%), reduced diabetes distress (59.3%-74.1%), and helped to improve A1C (73.1%) and reduce problems with hypoglycemia (61.8%) and chronic hyperglycemia (73.1%). Regularly reviewing the report with family or friends (positive predictor) and doing nothing with the report's information (negative predictor) were independently associated with QoL and perceived glycemic outcomes. Surprisingly, both predictors were also associated with poorer glycemic control (e.g., greater % time above range >180). Conclusions: These findings suggest that receiving a weekly RT-CGM summary report may contribute to QoL and health benefits, especially if the individual chooses to actively review and make use of the report's findings and openly reviews the findings with family or friends. Prospective studies are needed to more precisely determine how retrospective RT-CGM data summaries can best be presented and utilized effectively by adults with diabetes to enhance health outcomes.
Collapse
Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, California
- Department of Medicine, University of California, San Diego, California
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| |
Collapse
|
8
|
Clark TL, Fortmann AL, Philis-Tsimikas A, Bodenheimer T, Savin KL, Sandoval H, Bravin JI, Gallo LC. Process evaluation of a medical assistant health coaching intervention for type 2 diabetes in diverse primary care settings. Transl Behav Med 2022; 12:350-361. [PMID: 34791499 PMCID: PMC8849003 DOI: 10.1093/tbm/ibab144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Team-based models that use medical assistants (MAs) to provide self-management support for adults with type 2 diabetes (T2D) have not been pragmatically tested in diverse samples. This cluster-randomized controlled trial compares MA health coaching with usual care in adults with T2D and poor clinical control ("MAC Trial"). The purpose was to conduct a multi-method process evaluation of the MAC Trial using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Reach was assessed by calculating the proportion of enrolled participants out of the eligible pool and examining representativeness of those enrolled. Key informant interviews documented adoption by MA Health Coaches. We examined implementation from the research and patient perspectives by evaluating protocol adherence and the Patient Perceptions of Chronic Illness Care (PACIC-SF) measure, respectively. Findings indicate that the MAC Trial was efficient and effective in reaching patients who were representative of the target population. The acceptance rate among those approached for health coaching was high (87%). Both MA Health Coaches reported high satisfaction with the program and high levels of confidence in their role. The intervention was well-implemented, as evidenced by the protocol adherence rate of 79%; however, statistically significant changes in PACIC-SF scores were not observed. Overall, if found to be effective in improving clinical and patient-reported outcomes, the MAC model holds potential for wider-scale implementation given its successful adoption and implementation and demonstrated ability to reach patients with poorly controlled T2D who are at-risk for diabetes complications in diverse primary care settings.
Collapse
Affiliation(s)
- Taylor L Clark
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | | | - Thomas Bodenheimer
- Department of Family and Community Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Kimberly L Savin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Julia I Bravin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| |
Collapse
|
9
|
Philis-Tsimikas A, Fortmann AL, Godino JG, Schultz J, Roesch SC, Gilmer TP, Farcas E, Sandoval H, Savin KL, Clark T, Chichmarenko M, Jones JA, Gallo LC. Dulce Digital-Me: protocol for a randomized controlled trial of an adaptive mHealth intervention for underserved Hispanics with diabetes. Trials 2022; 23:80. [PMID: 35090520 PMCID: PMC8796443 DOI: 10.1186/s13063-021-05899-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND By 2034, the number of US individuals with diabetes is predicted to increase from 23.7 to 44.1 million, and annual diabetes-related spending is expected to grow from $113 to $336 billion. Up to 55% of US Hispanics born in the year 2000 are expected to develop diabetes during their lifetime. Poor healthcare access and cultural barriers prevent optimal care, adherence, and clinical benefit, placing Hispanics at disproportionate risk for costly diabetes complications. Mobile technology is increasingly prevalent in all populations and can circumvent such barriers. Our group developed Dulce Digital, an educational text messaging program that improved glycemic control relative to usual care. Dulce Digital-Me (DD-Me) has been tailored to a participant's individual needs with a greater focus on health behavior change. METHODS This is a three-arm, parallel group, randomized trial with equal allocation ratio enrolling Hispanic adults with low income and poorly managed type 2 diabetes (N = 414) from a San Diego County Federally Qualified Health Center. Participants are randomized to receive Dulce Digital, Dulce Digital-Me-Automated, or Dulce Digital-Me-Telephonic. The DD-Me groups include Dulce Digital components plus personalized goal-setting and feedback delivered via algorithm-driven automated text messaging (DD-Me-Automated) or by the care team health coach (DD-Me-Telephonic) over a 12-month follow-up period. The study will examine the comparative effectiveness of the three groups in improving diabetes clinical control [HbA1c, primary outcome; low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP)] and patient-provider communication and patient adherence (i.e., medication, self-management tasks) over 12 months and will examine cost-effectiveness of the three interventions. DISCUSSION Our comparative evaluation of three mHealth approaches will elucidate how technology can be integrated most effectively and efficiently within primary care-based chronic care model approaches to reduce diabetes disparities in Hispanics and will assess two modes of personalized messaging delivery (i.e., automated messaging vs. telephonic by health coach) to inform cost and acceptability. TRIAL REGISTRATION NCT03130699-All items from the WHO Trial Registration data set are available in https://clinicaltrials.gov/ct2/show/study/NCT03130699 .
Collapse
Affiliation(s)
- Athena Philis-Tsimikas
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Addie L. Fortmann
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Job G. Godino
- grid.421317.20000 0004 0497 8794Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, USA ,grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, USA
| | | | - Scott C. Roesch
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA ,grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, San Diego, USA
| | - Todd P. Gilmer
- grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, USA
| | - Emilia Farcas
- grid.266100.30000 0001 2107 4242Qualcomm Institute, University of California, San Diego, USA
| | - Haley Sandoval
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Kimberly L. Savin
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Taylor Clark
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Mariya Chichmarenko
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Jennifer A. Jones
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Linda C. Gallo
- grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, San Diego, USA
| |
Collapse
|
10
|
Abstract
BACKGROUND To examine caregivers' experiences with real-time continuous glucose monitoring (RT-CGM) data sharing and its impact on quality of life (QoL) and health outcomes. METHODS Parents of children with type 1 diabetes (T1D) (N = 303) and spouses/partners of T1D adults (N = 212) using the Dexcom G5 Mobile or G6 RT-CGM system and who were actively following their T1Ds' RT-CGM data completed a survey examining their perceived value of data sharing, the impact of sharing on their own QoL and their child/partner's health, and how they used RT-CGM data to support their T1Ds' diabetes management. Regression analyses examined whether their actions were linked to reported changes in QoL and health outcomes. RESULTS Respondents were predominantly non-Hispanic White (91.1% parents; 88.7% partners), female (78.2% parents; 54.7% partners), and college-educated (65.3% parents; 61.8% partners). The majority reported that data sharing had enhanced hypoglycemic confidence (97.7% parents; 98.1% partners), overall well-being (60.4% parents; 63.2% partners), and sleep quality (78.0% parents; 61.3% partners). Of note, three positive caregiver actions were broadly consistent and significant predictors of QoL and health benefits for both parents and partners: celebrating success related to glycemic control, providing encouragement when glycemic control is challenging, and teamwork discussions about how the caregiver should respond to out-of-range values. CONCLUSIONS RT-CGM data sharing was associated with a range of QoL and health benefits for caregivers. Degree of benefits was influenced by the collaborative actions taken by caregivers to support their child's or partner's diabetes management. To determine the most effective strategies for collaborative data sharing, longitudinal trials are needed.
Collapse
Affiliation(s)
- William H. Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA
- Department of Medicine, University of California, San Diego, CA, USA
- William H. Polonsky, Behavioral Diabetes Institute, 5230 Carroll Canyon Road, Suite 208, San Diego, CA 92121, USA.
| | | |
Collapse
|
11
|
Polonsky WH, Fortmann AL, Price D, Fisher L. "Hyperglycemia aversiveness": Investigating an overlooked problem among adults with type 1 diabetes. J Diabetes Complications 2021; 35:107925. [PMID: 33836966 DOI: 10.1016/j.jdiacomp.2021.107925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the problem of adults with type 1 diabetes (T1D) who purposefully keep their glucose levels low, and to explore contributors to, and possible impact of, this potentially dangerous phenomenon. METHODS We developed three self-report items as a means to identify individuals who endorse a consistent preference for hypoglycemia over hyperglycemia ("Hyperglycemia Aversives"). In a large T1D survey (n = 219), validated measures of well-being, emotional distress and hypoglycemic awareness, and glycemic metrics derived from the past 14-day period, were used to examine whether Hyperglycemia Aversives could be characterized as a distinct group. RESULTS Hyperglycemia Aversives comprised 16.4% of the sample. This unique group demonstrated significantly higher mean %TIR (71.6% vs. 63.6%) and %TBR (5.1% vs. 2.2%), lower mean %TAR > 250 mg/dL (6.0% vs. 10.1%), and higher rates of impaired hypoglycemic awareness and recurrent severe hypoglycemia episodes than the remaining study sample ("Non-Aversives") (all ps < 0.01). The two groups did not demonstrate significant differences on psychosocial outcomes. CONCLUSIONS We identified a group of T1D adults reporting a consistent preference for hypoglycemia over hyperglycemia. These individuals achieve significantly greater %TIR and less %TAR, but at the cost of greater %TBR and more frequent severe hypoglycemia episodes.
Collapse
Affiliation(s)
- W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, United States of America; Department of Medicine, University of California, San Diego, CA, United States of America.
| | - A L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA, United States of America
| | - D Price
- Dexcom, Inc., San Diego, CA, United States of America
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
| |
Collapse
|
12
|
Abstract
Background: To examine experiences with real-time continuous glucose monitoring (RT-CGM) data sharing and its impact on health-related outcomes. Methods: Adults with type 1 diabetes (T1D) (N = 302) using the Dexcom G5 Mobile or G6 RT-CGM system and sharing data with ≥1 family/friend follower completed a survey exploring their perceived value of data sharing, the impact of sharing on health and quality of life (QoL) outcomes, and how their chief follower (CF) used shared data to support their diabetes management. Regression analyses examined whether CF actions were linked to reported changes in health and QoL outcomes for the T1D adult. Results: The majority had lived with T1D >10 years, (76.5%), used RT-CGM >1 year (58.0%), and identified their spouse/partner as CF (51.9%). Data sharing reportedly contributed to improved hypoglycemic confidence (for 89.4% of respondents), improved overall well-being (54.3%), and reduced diabetes distress (36.1%). Benefits related to data sharing included fewer episodes of severe hypoglycemia (62.2%), better sleep (52.4%), and A1C improvement (47.3%). In particular, three positive CF actions were independent predictors of health and QoL benefits: celebrating success related to glycemic control, providing encouragement when glycemic control is challenging, and teamwork discussions about how CF should respond to out-of-range values. Conclusions: RT-CGM data sharing was associated with a range of health and QoL-related benefits. The occurrence of benefits was influenced by the collaborative management approaches taken by RT-CGM users and their data-sharing followers. Longitudinal trials are needed to determine the most effective patterns of collaborative data sharing, leading to their implementation into routine diabetes management.
Collapse
Affiliation(s)
- William H. Polonsky
- Behavioral Diabetes Institute, San Diego, California
- Department of Medicine, University of California, San Diego, California
- Address correspondence to: William H. Polonsky, PhD, Behavioral Diabetes Institute, 5230 Carroll Canyon Rd., Suite #208, San Diego, CA 92121, USA
| | - Addie L. Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| |
Collapse
|
13
|
Polonsky WH, Fortmann AL. The influence of time in range on daily mood in adults with type 1 diabetes. J Diabetes Complications 2020; 34:107746. [PMID: 33077350 DOI: 10.1016/j.jdiacomp.2020.107746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/30/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the impact of time in range (TIR) on mood in adults with type 1 diabetes (T1D). METHODS We followed a cohort of 219 T1D adults, all currently employing a real-time continuous glucose monitoring system (RT-CGM), to investigate how daily changes in CGM metrics were associated with nightly reports of positive and negative mood over a two-week period. RESULTS Greater daily %TIR (70-180 mg/dL) and less time in "severe" hyperglycemia (% time above range (TAR) > 300 mg/dL) were both significantly associated with higher ratings on all positive mood elements and lower ratings on most negative mood elements (all ps < 0.05). When entered together as predictors, %TIR but not %TAR >300 emerged as an independent predictor of many of the positive and negative mood variables. Neither daily changes in time spent in hypoglycemia (< 70 mg/dL) nor glycemic variability (represented by the coefficient of variation) were significantly related to reported mood. CONCLUSIONS This study provides the first evidence that time in range (%TIR) is associated with, and likely enhances, daily mood. Consistent with previous studies, we also found that more time spent in "severe" hyperglycemia is linked to more negative mood.
Collapse
Affiliation(s)
- W H Polonsky
- Department of Medicine, University of California, San Diego, USA; Behavioral Diabetes Institute, San Diego, CA, USA.
| | - A L Fortmann
- Scripps Whittier Diabetes Institute, La Jolla, CA, USA
| |
Collapse
|
14
|
Fortmann AL, Spierling Bagsic SR, Talavera L, Garcia IM, Sandoval H, Hottinger A, Philis-Tsimikas A. Glucose as the Fifth Vital Sign: A Randomized Controlled Trial of Continuous Glucose Monitoring in a Non-ICU Hospital Setting. Diabetes Care 2020; 43:2873-2877. [PMID: 32855160 PMCID: PMC7576427 DOI: 10.2337/dc20-1016] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The current standard for hospital glucose management is point-of-care (POC) testing. We conducted a randomized controlled trial of real-time continuous glucose monitoring (RT-CGM) compared with POC in a non-intensive care unit (ICU) hospital setting. RESEARCH DESIGN AND METHODS A total of 110 adults with type 2 diabetes on a non-ICU floor received RT-CGM with Dexcom G6 versus usual care (UC). RT-CGM data were wirelessly transmitted from the bedside. Hospital telemetry monitored RT-CGM data and notified bedside nursing of glucose alerts and trends. Standardized protocols were used for interventions. RESULTS The RT-CGM group demonstrated significantly lower mean glucose (M∆ = -18.5 mg/dL) and percentage of time in hyperglycemia >250 mg/dL (-11.41%) and higher time in range 70-250 mg/dL (+11.26%) compared with UC (P values <0.05). Percentage of time in hypoglycemia was very low. CONCLUSIONS RT-CGM can be used successfully in community-based hospital non-ICU settings to improve glucose management. Continuously streaming glucose readings may truly be the fifth vital sign.
Collapse
|
15
|
Fortmann AL, Philis-Tsimikas A, Euyoque JA, Clark TL, Vital DG, Sandoval H, Bravin JI, Savin KL, Jones JA, Roesch S, Gilmer T, Bodenheimer T, Schultz J, Gallo LC. Medical assistant health coaching ("MAC") for type 2 diabetes in diverse primary care settings: A pragmatic, cluster-randomized controlled trial protocol. Contemp Clin Trials 2020; 100:106164. [PMID: 33053431 DOI: 10.1016/j.cct.2020.106164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 01/30/2023]
Abstract
In the US, nearly 11% of adults were living with diagnosed diabetes in 2017, and significant type 2 diabetes (T2D) disparities are experienced by socioeconomically disadvantaged, racial/ethnic minority populations, including Hispanics. The standard 15-min primary care visit does not allow for the ongoing self-management support that is needed to meet the complex needs of individuals with diabetes. "Team-based" chronic care delivery is an alternative approach that supplements physician care with contact from allied health personnel in the primary care setting (e.g., medical assistants; MAs) who are specially trained to provide ongoing self-management support or "health coaching." While rigorous trials have shown MA health coaching to improve diabetes outcomes, less is known about if and how such a model can be integrated within real world, primary care clinic workflows. Medical Assistant Health Coaching for Type 2 Diabetes in Diverse Primary Care Settings - A Pragmatic, Cluster-Randomized Controlled Trial will address this gap. Specifically, this study compares MA health coaching versus usual care in improving diabetes clinical control among N = 600 at-risk adults with T2D, and is being conducted at four primary care clinics that are part of two health systems that serve large, ethnically/racially, and socioeconomically diverse populations in Southern California. Electronic medical records are used to identify eligible patients at both health systems, and to examine change in clinical control over one year in the overall sample. Changes in behavioral and psychosocial outcomes are being evaluated by telephone assessment in a subset (n = 300) of participants, and rigorous process and cost evaluations will assess potential for sustainability and scalability.
Collapse
Affiliation(s)
- Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Johanna A Euyoque
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Taylor L Clark
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr, San Diego, CA 92182 / 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Daniela G Vital
- San Diego State University Research Foundation, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Julia I Bravin
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr, San Diego, CA 92182 / 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Kimberly L Savin
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr, San Diego, CA 92182 / 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Jennifer A Jones
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive, Suite 200, San Diego, CA 92121, USA.
| | - Scott Roesch
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Thomas Bodenheimer
- Department of Family and Community Medicine, University of California at San Francisco School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, USA
| | - James Schultz
- Neighborhood Healthcare, 460 N Elm St, Escondido, CA 92025, USA.
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
| |
Collapse
|
16
|
Abstract
Background: Hypoglycemic confidence (HC) represents the degree to which an individual feels secure regarding his or her ability to stay safe from hypoglycemia-related problems. Self-report scales assessing HC in adults with type 1 diabetes (T1D) have found that greater HC is associated with better glycemic control and that HC rises significantly after real-time continuous glucose monitoring is introduced. To determine whether HC might be similarly meaningful in the partners of T1D adults, we developed the Hypoglycemic Confidence Scale for Partners (Partner-HCS). This article describes the construction and validation of the Partner-HCS and examines how HC in T1D partners is related to hypoglycemia-related experience and key psychosocial constructs. Methods: Items were developed from interviews with seven T1D partners, resulting in 12 self-report items. Exploratory factor analysis (EFA) was then conducted on data collected from T1D partners (n = 218). Variables to establish construct validity for the Partner-HCS included partner-reported diabetes distress, hypoglycemic fear, generalized anxiety, and confidence regarding glucagon use, as well as frequency of recent severe hypoglycemia in the T1D adult. Hierarchical regression analyses examined the unique contribution of Partner-HCS scores, independent of hypoglycemic fear, to key psychosocial constructs and hypoglycemia-related factors. Results: EFA of the 12 items yielded a single-factor solution, accounting for 51.2% of the variance. Construct validity was demonstrated by significant univariate associations with key psychosocial constructs. Importantly, Partner-HCS total score was, independent of hypoglycemic fear, significantly associated with diabetes distress (P < 0.05), overall relationship satisfaction (P = 0.004), number of severe hypoglycemic episodes in the last 6 months (P < 0.05), and confidence using glucagon (P = 0.007). In total, 38.5% of T1D partners indicated relatively low HC. Conclusions: HC is an important facet of the experiences of T1D partners. It is related to, yet distinct from, hypoglycemic fear. The Partner-HCS is a reliable, valid method for assessing HC in partners of T1D adults.
Collapse
Affiliation(s)
- William H Polonsky
- Department of Medicine, University of California, San Diego, California
- Behavioral Diabetes Institute, San Diego, California
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California
| | | | - Anh Nguyen
- Xeris Pharmaceuticals, Chicago, Illinois
| | | |
Collapse
|
17
|
Gallo LC, Fortmann AL, Bravin JI, Clark TL, Savin KL, Ledesma DL, Euyoque J, Sandoval H, Roesch SC, Gilmer T, Talavera GA, Philis-Tsimikas A. My Bridge (Mi Puente), a care transitions intervention for Hispanics/Latinos with multimorbidity and behavioral health concerns: protocol for a randomized controlled trial. Trials 2020; 21:174. [PMID: 32051005 PMCID: PMC7014646 DOI: 10.1186/s13063-019-3722-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/06/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Multimorbidity affects four of ten US adults and eight of ten adults ages 65 years and older, and frequently includes both cardiometabolic conditions and behavioral health concerns. Hispanics/Latinos (hereafter, Latinos) and other ethnic minorities are more vulnerable to these conditions, and face structural, social, and cultural barriers to obtaining quality physical and behavioral healthcare. We report the protocol for a randomized controlled trial that will compare Mi Puente (My Bridge), a cost-efficient care transitions intervention conducted by a specially trained Behavioral Health Nurse and Volunteer Community Mentor team, to usual care or best-practice discharge approaches, in reducing hospital utilization and improving patient reported outcomes in Latino adults with multiple cardiometabolic conditions and behavioral health concerns. The study will examine the degree to which Mi Puente produces superior reductions in hospital utilization at 30 and 180 days (primary aim) and better patient-reported outcomes (quality of life/physical health; barriers to healthcare; engagement with outpatient care; patient activation; resources for chronic disease management), and will examine the cost effectiveness of the Mi Puente intervention relative to usual care. Methods Participants are enrolled as inpatients at a South San Diego safety net hospital, using information from electronic medical records and in-person screenings. After providing written informed consent and completing self-report assessments, participants randomized to usual care receive best-practice discharge processes, which include educational materials, assistance with outpatient appointments, referrals to community-based providers, and other assistance (e.g., with billing, insurance) as required. Those randomized to Mi Puente receive usual-care materials and processes, along with inpatient visits and up to 4 weeks of follow-up phone calls from the intervention team to address their integrated physical-behavioral health needs and support the transition to outpatient care. Discussion The Mi Puente Behavioral Health Nurse and Volunteer Community Mentor team intervention is proposed as a cost-effective and culturally appropriate care transitions intervention for Latinos with multimorbidity and behavioral health concerns. If shown to be effective, close linkages with outpatient healthcare and community organizations will help maximize uptake, dissemination, and scaling of the Mi Puente intervention. Trial registration ClinicalTrials.gov: NCT02723019. Registered on 30 March 2016.
Collapse
Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, San Diego CA, USA.
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Julia I Bravin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Taylor L Clark
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Kimberly L Savin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | | | - Johanna Euyoque
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego CA, USA
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | | | | |
Collapse
|
18
|
Fortmann AL, Walker C, Barger K, Robacker M, Morrisey R, Ortwine K, Loupasi I, Lee I, Hogrefe L, Strohmeyer C, Philis-Tsimikas A. Care Team Integration in Primary Care Improves One-Year Clinical and Financial Outcomes in Diabetes: A Case for Value-Based Care. Popul Health Manag 2020; 23:467-475. [PMID: 31944895 DOI: 10.1089/pop.2019.0103] [Citation(s) in RCA: 6] [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: 01/22/2023] Open
Abstract
Despite significant treatment advances, diabetes outcomes remain suboptimal and health care costs continue to rise. There are limited data on the feasibility and financial implications of integrating a diabetes-specific care team in the primary care setting (ie, where the majority of diabetes is treated). This pragmatic quality improvement project investigated whether a cardiometabolic care team intervention (CMC-TI) could achieve greater improvements in clinical, behavioral, and cost outcomes compared to usual diabetes care in a large primary care group in Southern California. Over 12 months, n = 236 CMC-TI and n = 239 usual care patients with type 1 or 2 diabetes were identified using the electronic medical record. In the CMC-TI group, a registered nurse (RN)/certified diabetes educator care manager, medical assistant health coach, and RN depression care manager utilized electronic medical record-based risk stratification reports, standardized decision-support tools, live and remote tailored treatments, and coaching to manage care. Results indicated that the CMC-TI group achieved greater improvements in glycemic and lipid control, diabetes self-management behaviors, and emotional distress over 1 year compared with the usual care group (all P < .05). The CMC-TI group also had a significant 12.6% reduction in total health care costs compared to a 51.7% increase in the usual care group during the same period and inclusive of CMC-TI program costs. Patients and providers reported high satisfaction with CMC-TI. These findings highlight that team-based care management interventions that utilize nurses, medical assistant health coaches, and behavioral specialists to support diabetes patients can help primary care practices achieve value-based targets of improved health, cost, and patient experience.
Collapse
Affiliation(s)
| | - Chris Walker
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Kelly Barger
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Maire Robacker
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Robin Morrisey
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | | | - Ioanna Loupasi
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Ina Lee
- Scripps Health, San Diego, California, USA
| | - Lou Hogrefe
- Scripps Coastal Medical Group, San Diego, California, USA.,Regional Health, Rapid City, South Dakota, USA
| | | | | |
Collapse
|
19
|
Abstract
IN BRIEF In the United States, Hispanics have a 66% greater risk of developing type 2 diabetes and, once diagnosed, exhibit worse outcomes than non-Hispanic whites. It is therefore imperative to ensure that interventions meet the specific needs of this at-risk group. This article provides a selective review of the evidence on innovative, real-world approaches (both live and technology-based) to improving behavioral, psychosocial, and clinical outcomes in underserved Hispanics with type 2 diabetes. Key aspects of successful live interventions have included multimodal delivery, greater dosage/attendance, and at least some in-person delivery; effective technology-based approaches involved frequent but intermittent communication, bi-directional messaging, tailored feedback, multimodal delivery, and some human interaction. Across modalities, cultural tailoring also improved outcomes. Additional research is needed to address methodological limitations of studies to date and pinpoint the most efficacious components and optimal duration of interventions. Future efforts should also attend to variability within the U.S. Hispanic population to ensure acceptability and sustainability of interventions in this diverse group.
Collapse
Affiliation(s)
| | - Kimberly L. Savin
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Taylor L. Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| |
Collapse
|
20
|
Meneghini LF, Fortmann AL, Clark TL, Rodriguez K. Making Inroads in Addressing Population Health in Underserved Communities With Type 2 Diabetes. Diabetes Spectr 2019; 32:303-311. [PMID: 31798287 PMCID: PMC6858077 DOI: 10.2337/ds19-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/27/2022]
Abstract
IN BRIEF Diabetes continues to represent a substantial individual and societal burden for those affected by the disease and its complications in the United States, and especially for racial/ethnic minorities, the socioeconomically disadvantaged, and the underinsured. Although tools and strategies are now available to manage the condition and its associated comorbidities at the patient level, we continue to struggle to gain control of this health burden at the population health level. Most patients are not achieving desired clinical goals and thus continue to be exposed to preventable risks and complications. As the U.S. health system moves toward a more value-based system of reimbursement, there are opportunities to rethink our approaches to patient and population health management and to harness the available tools and technologies to better understand the disease burden, stratify our patient populations by risk, redirect finite resources to high-impact initiatives, and facilitate better diabetes care management for patients and providers alike.
Collapse
Affiliation(s)
- Luigi F. Meneghini
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health & Hospital System, Dallas, TX
| | | | - Taylor L. Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | |
Collapse
|
21
|
Gutierrez AP, Fortmann AL, Savin K, Clark TL, Gallo LC. Effectiveness of Diabetes Self-Management Education Programs for US Latinos at Improving Emotional Distress: A Systematic Review. Diabetes Educ 2018; 45:13-33. [PMID: 30569831 DOI: 10.1177/0145721718819451] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE This systematic review examined whether diabetes self-management education (DSME) interventions for US Latino adults improve general emotional distress (eg, depression symptoms) and/or health-specific emotional distress (eg, diabetes distress). The topic is important given the high prevalence of type 2 diabetes (T2DM), concomitant distress, and worse health outcomes among Latinos and considering the barriers that distress poses for effective diabetes self-management. METHODS Following PRISMA guidelines, a search of the online databases PsycINFO, CINAHL, PubMed, and CENTRAL was conducted from database inception through April 2018. A comprehensive search strategy identified trials testing DSME interventions for US Latinos with T2DM that reported on changes in general or health-specific emotional distress. Risk of bias was assessed using the EPHPP Quality Assessment Tool. Raw mean differences ( D) and effect sizes ( d) were computed where possible. RESULTS Fifteen studies were included in the review. Six of 8 studies that examined depression symptoms reported significant symptom reduction. Of 10 studies that examined health-specific emotional distress, 6 reported significant symptom reduction. Effect sizes ranged from -0.20 to -3.85. Null findings were more readily found among studies with very small sample sizes (n < 30) and studies testing interventions without specific psychosocial content, with little cultural tailoring, with less frequent intervention sessions, and with support sessions lacking concurrent diabetes education. Most studies (11) received a weak rating of evidence quality. CONCLUSIONS There is an absence of strong evidence to support that DSME programs tailored for Latino adults with T2DM are beneficial for improving emotional distress. Methodologically robust studies are needed.
Collapse
Affiliation(s)
- Angela P Gutierrez
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Kimberly Savin
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Taylor L Clark
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| |
Collapse
|
22
|
McCurley JL, Fortmann AL, Gutierrez AP, Gonzalez P, Euyoque J, Clark T, Preciado J, Ahmad A, Philis-Tsimikas A, Gallo LC. Pilot Test of a Culturally Appropriate Diabetes Prevention Intervention for At-Risk Latina Women. Diabetes Educ 2017; 43:631-640. [PMID: 29059040 PMCID: PMC5849058 DOI: 10.1177/0145721717738020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of the study was to test the preliminary effectiveness, feasibility, and acceptability of a peer-led, culturally appropriate, Diabetes Prevention Program (DPP)-based lifestyle intervention for Latina women at high-risk for type 2 diabetes (T2DM). Methods Participants (N = 61) were overweight/obese (body mass index [BMI] ≥25) Latina women with no diabetes, at elevated risk either due to midlife age (45-65 years; n = 37) or history of gestational diabetes mellitus (n = 24). The study used a 1-group pretest-posttest design and offered 12 weeks of peer-led education sessions in a community setting. The intervention targeted physical activity and dietary behaviors to facilitate weight reduction and included culturally appropriate content, age-specific health information, and stress/emotion management strategies. Clinical and self-report assessments were conducted at baseline, month 3, and month 6. Results Mean participant age was 47.8 years (SD = 10.8). Most (91.2%) were born in Mexico, and 43.3% had a ninth-grade education or less. At month 6, participants achieved a mean reduction of 4.1% body weight (7 lb [3.2 kg]). Statistically significant improvements were observed for dietary behaviors, stress, and depression symptoms. Attrition was low, 5% (3 women). Focus groups indicated that intervention content increased knowledge, was applicable, highly valued, culturally relevant, and would be recommended to others. Conclusions This culturally tailored DPP adaptation was feasible and acceptable for 2 groups of Latina women at high-risk for T2DM and showed preliminary effectiveness in reducing weight and modifying self-reported dietary behaviors, stress, and depression symptoms. Further research is needed to identify ways to enhance weight loss and diabetes prevention in this at-risk, underserved population.
Collapse
Affiliation(s)
- Jessica L McCurley
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California (Ms McCurley, Ms Gutierrez)
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California (Dr Fortmann, Ms Euyoque, Ms Clark, Ms Preciado, Dr Ahmad, Dr Philis-Tsimikas)
| | - Angela P Gutierrez
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California (Ms McCurley, Ms Gutierrez)
| | - Patricia Gonzalez
- Ventura County Health Care Agency, Ventura, California (Dr Gonzalez)
| | - Johanna Euyoque
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California (Dr Fortmann, Ms Euyoque, Ms Clark, Ms Preciado, Dr Ahmad, Dr Philis-Tsimikas)
| | - Taylor Clark
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California (Dr Fortmann, Ms Euyoque, Ms Clark, Ms Preciado, Dr Ahmad, Dr Philis-Tsimikas)
| | - Jessica Preciado
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California (Dr Fortmann, Ms Euyoque, Ms Clark, Ms Preciado, Dr Ahmad, Dr Philis-Tsimikas)
| | - Aakif Ahmad
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California (Dr Fortmann, Ms Euyoque, Ms Clark, Ms Preciado, Dr Ahmad, Dr Philis-Tsimikas)
| | - Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California (Dr Fortmann, Ms Euyoque, Ms Clark, Ms Preciado, Dr Ahmad, Dr Philis-Tsimikas)
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California (Dr Gallo)
| |
Collapse
|
23
|
Fortmann AL, Gallo LC, Garcia MI, Taleb M, Euyoque JA, Clark T, Skidmore J, Ruiz M, Dharkar-Surber S, Schultz J, Philis-Tsimikas A. Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes. Diabetes Care 2017; 40:1349-1355. [PMID: 28600309 PMCID: PMC5606313 DOI: 10.2337/dc17-0230] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/11/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes is growing in epidemic proportions and disproportionately affects lower-income, diverse communities. Text messaging may provide one of the most rapid methods to overcome the "digital divide" to improve care. RESEARCH DESIGN AND METHODS A randomized, nonblinded, parallel-groups clinical trial design allocated N = 126 low-income, Hispanic participants with poorly controlled type 2 diabetes to receive the Dulce Digital intervention or usual care (UC). Dulce Digital participants received up to three motivational, educational, and/or call-to-action text messages per day over 6 months. The primary outcome was HbA1c; lipids, blood pressure, and BMI were secondary outcomes. Satisfaction and acceptability were evaluated via focus groups and self-report survey items. RESULTS The majority of patients were middle-aged (mean age 48.43 years, SD 9.80), female (75%), born in Mexico (91%), and uninsured (75%) and reported less than a ninth-grade education level (73%) and mean baseline HbA1c 9.5% (80 mmol/mol), SD 1.3, and fasting plasma glucose 187.17 mg/dL, SD 64.75. A statistically significant time-by-group interaction effect indicated that the Dulce Digital group achieved a significantly greater reduction in HbA1c over time compared with UC (P = 0.03). No statistically significant effects were observed for secondary clinical indicators. The number of blood glucose values texted in by participants was a statistically significant predictor of month 6 HbA1c (P < 0.05). Satisfaction and acceptability ratings for the Dulce Digital intervention were high. CONCLUSIONS Use of a simple, low-cost text messaging program was found to be highly acceptable in this sample of high-risk, Hispanic individuals with type 2 diabetes and resulted in greater improvement in glycemic control compared with UC.
Collapse
Affiliation(s)
- Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | | | - Mariam Taleb
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | | | - Taylor Clark
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Jessica Skidmore
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Monica Ruiz
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | | | | | | |
Collapse
|
24
|
Boeldt DL, Cheung C, Ariniello L, Darst BF, Topol S, Schork NJ, Philis-Tsimikas A, Torkamani A, Fortmann AL, Bloss CS. Patient perspectives on whole-genome sequencing for undiagnosed diseases. Per Med 2016; 14:17-25. [PMID: 29749824 DOI: 10.2217/pme-2016-0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/05/2023]
Abstract
This study assessed perspectives on whole-genome sequencing (WGS) for rare disease diagnosis and the process of receiving genetic results. Semistructured interviews were conducted with adult patients and parents of minor patients affected by idiopathic diseases (n = 10 cases). Three main themes were identified through qualitative data analysis and interpretation: perceived benefits of WGS; perceived drawbacks of WGS; and perceptions of the return of results from WGS. Findings suggest that patients and their families have important perspectives on the use of WGS in diagnostic odyssey cases. These perspectives could inform clinical sequencing research study designs as well as the appropriate deployment of patient and family support services in the context of clinical genome sequencing.
Collapse
Affiliation(s)
- Debra L Boeldt
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA
| | - Cynthia Cheung
- The Qualcomm Institute of Calit2, University of California, San Diego, CA, USA
| | - Lauren Ariniello
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA
| | - Burcu F Darst
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA
| | - Sarah Topol
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA
| | - Nicholas J Schork
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA.,Department of Molecular & Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Ali Torkamani
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA.,Department of Integrative Structural & Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Cinnamon S Bloss
- Scripps Translational Science Institute, Scripps Genomic Medicine, Scripps Health, La Jolla, CA, USA
| |
Collapse
|
25
|
Castañeda SF, Buelna C, Giacinto RE, Gallo LC, Sotres-Alvarez D, Gonzalez P, Fortmann AL, Wassertheil-Smoller S, Gellman MD, Giachello AL, Talavera GA. Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med 2016; 87:144-150. [PMID: 26921653 PMCID: PMC4884536 DOI: 10.1016/j.ypmed.2016.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/15/2015] [Revised: 01/25/2016] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
Abstract
Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/Study of Latinos enrolled a cohort of Hispanic/Latino adults (N=16,415) 18-74years of age at the time of recruitment, from four US metropolitan areas, between March 2008 and June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking were associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention.
Collapse
Affiliation(s)
- Sheila F Castañeda
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Christina Buelna
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Rebeca Espinoza Giacinto
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, 137 E. Franklin Street, Suite 203, CB#8030, Chapel Hill, NC 27514, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, 10140 Campus Point Drive, San Diego, CA 92121, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1312, Bronx, NY 10461, USA
| | - Marc D Gellman
- Behavioral Medicine Research Center, University of Miami, 1251 Stanford Dr, Coral Gables, FL 33146, USA
| | - Aida L Giachello
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Suite 1400, Chicago, IL 60611, USA
| | - Gregory A Talavera
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| |
Collapse
|
26
|
Fortmann AL, Roesch SC, Penedo FJ, Isasi CR, Carnethon MR, Corsino L, Schneiderman N, Daviglus ML, Teng Y, Giachello A, Gonzalez F, Gallo LC. Glycemic control among U.S. Hispanics/Latinos with diabetes from the HCHS/SOL Sociocultural Ancillary Study: do structural and functional social support play a role? J Behav Med 2014; 38:153-9. [PMID: 25107503 DOI: 10.1007/s10865-014-9587-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/14/2014] [Indexed: 12/25/2022]
Abstract
Social support is one potential source of health-related resiliency in Hispanics with diabetes. This study examined relationships of structural (i.e., social integration) and functional (i.e., perceived) social support with glycemic control (glycosylated hemoglobin; HbA1c) in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. This study included 766 men and women representing multiple Hispanic ethnic backgrounds, aged 18-74 years, with diagnosed diabetes who completed fasting blood draw, medication review, and measures of sociodemographic factors, medical history, structural support (Cohen Social Network Index), and functional support (Interpersonal Support Evaluation List-12). After adjusting for sociodemographic covariates and medication, a one standard deviation increase in functional support was related to an 0.18% higher HbA1c (p = 0.04). A similar trend was observed for structural support; however, this effect was non-significant in adjusted models. Greater functional support was associated with poorer glycemic control in Hispanics.
Collapse
Affiliation(s)
- Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gallo LC, Roesch SC, Fortmann AL, Carnethon MR, Penedo FJ, Perreira K, Birnbaum-Weitzman O, Wassertheil-Smoller S, Castañeda SF, Talavera GA, Sotres-Alvarez D, Daviglus ML, Schneiderman N, Isasi CR. Associations of chronic stress burden, perceived stress, and traumatic stress with cardiovascular disease prevalence and risk factors in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Psychosom Med 2014; 76:468-75. [PMID: 24979579 PMCID: PMC4349387 DOI: 10.1097/psy.0000000000000069] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The current study examined multiple stress indicators (chronic, perceived, traumatic) in relation to prevalent coronary heart disease, stroke, and major cardiovascular disease (CVD) risk factors (i.e., diabetes, dyslipidemia, hypertension, and current smoking) in the multisite Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (2010-2011). METHODS Participants were 5313 men and women 18 to 74 years old, representing diverse Hispanic/Latino ethnic backgrounds, who underwent a comprehensive baseline clinical examination and sociocultural examination with measures of stress. RESULTS Chronic stress burden was related to a higher prevalence of coronary heart disease after adjusting for sociodemographic, behavioral, and biological risk factors (odds ratio [OR; 95% confidence interval], 1.22 [1.10-1.36]) and related to stroke prevalence in the model adjusted for demographic and behavioral factors (OR [95% confidence interval], 1.26 [1.03-1.55]). Chronic stress was also related to a higher prevalence of diabetes (OR = 1.20 [1.11-1.31]) and hypertension (OR = 1.10 [1.02-1.19]) in individuals free from CVD (n = 4926). Perceived stress (OR = 1.03 [1.01-1.05]) and traumatic stress (OR = 1.15 [1.05-1.26]) were associated with a higher prevalence of smoking. Participants who reported a greater number of lifetime traumatic events also unexpectedly showed a lower prevalence of diabetes (OR = 0.89 [0.83-0.97]) and hypertension (OR = 0.88 [0.82-0.93]). Effects were largely consistent across age and sex groups. CONCLUSIONS The study underscores the advantages of examining multiple indicators of stress in relation to health because the direction and consistency of associations may vary across distinct stress conceptualizations. In addition, the study suggests that chronic stress is related to higher CVD risk and prevalence in Hispanics/Latinos, the largest US ethnic minority group.
Collapse
Affiliation(s)
| | | | | | - Mercedes R. Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Frank J. Penedo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Krista Perreira
- Department of Public Policy, College of Arts & Sciences, University of North Carolina at Chapel Hill
| | | | | | | | | | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Martha L. Daviglus
- Institute for Minority Health Research, Department of Medicine, University of Illinois at Chicago
| | | | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| |
Collapse
|
28
|
Philis-Tsimikas A, Fortmann AL, Dharkar-Surber S, Euyoque JA, Ruiz M, Schultz J, Gallo LC. Dulce Mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes. Transl Behav Med 2014; 4:18-25. [PMID: 24653773 DOI: 10.1007/s13142-014-0253-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Latina women with prior gestational diabetes mellitus (GDM) are at elevated risk for type 2 diabetes mellitus and cardiovascular disease. Few primary prevention programs are designed for low socioeconomic status, Spanish-speaking populations. We examined the effectiveness of a Diabetes Prevention Program (DPP) translation in low-income Latinas with a history of GDM. Eighty-four Latinas, 18-45 years old with GDM in the past 3 years, underwent an 8-week peer-educator-led group intervention, with tailoring for Latino culture and recent motherhood. Lifestyle changes and diabetes and cardiovascular risk factors were assessed at study baseline, month 3 and month 6. Participants showed significant improvements in lipids, blood pressure, physical activity, dietary fat intake, and fatalistic and cultural diabetes beliefs (p < 0.05). Formative evaluation provides preliminary evidence of program acceptability. A peer-led, culturally appropriate DPP translation was effective in improving lifestyle changes and some indicators of cardiovascular and diabetes risk in Latinas with GDM.
Collapse
Affiliation(s)
- Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | - Sapna Dharkar-Surber
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | - Johanna A Euyoque
- Department of Psychology, San Diego State University, San Diego, CA USA
| | - Monica Ruiz
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | | | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA USA
| |
Collapse
|
29
|
Matt GE, Quintana PJE, Fortmann AL, Zakarian JM, Galaviz VE, Chatfield DA, Hoh E, Hovell MF, Winston C. Thirdhand smoke and exposure in California hotels: non-smoking rooms fail to protect non-smoking hotel guests from tobacco smoke exposure. Tob Control 2013; 23:264-72. [PMID: 23669058 DOI: 10.1136/tobaccocontrol-2012-050824] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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: 11/04/2022]
Abstract
INTRODUCTION This study examined tobacco smoke pollution (also known as thirdhand smoke, THS) in hotels with and without complete smoking bans and investigated whether non-smoking guests staying overnight in these hotels were exposed to tobacco smoke pollutants. METHODS A stratified random sample of hotels with (n=10) and without (n=30) complete smoking bans was examined. Surfaces and air were analysed for tobacco smoke pollutants (ie, nicotine and 3-ethynylpyridine, 3EP). Non-smoking confederates who stayed overnight in guestrooms provided urine and finger wipe samples to determine exposure to nicotine and the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone as measured by their metabolites cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), respectively. FINDINGS Compared with hotels with complete smoking bans, surface nicotine and air 3EP were elevated in non-smoking and smoking rooms of hotels that allowed smoking. Air nicotine levels in smoking rooms were significantly higher than those in non-smoking rooms of hotels with and without complete smoking bans. Hallway surfaces outside of smoking rooms also showed higher levels of nicotine than those outside of non-smoking rooms. Non-smoking confederates staying in hotels without complete smoking bans showed higher levels of finger nicotine and urine cotinine than those staying in hotels with complete smoking bans. Confederates showed significant elevations in urinary NNAL after staying in the 10 most polluted rooms. CONCLUSIONS Partial smoking bans in hotels do not protect non-smoking guests from exposure to tobacco smoke and tobacco-specific carcinogens. Non-smokers are advised to stay in hotels with complete smoking bans. Existing policies exempting hotels from complete smoking bans are ineffective.
Collapse
Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, , San Diego, California, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Quintana PJE, Matt GE, Chatfield D, Zakarian JM, Fortmann AL, Hoh E. Wipe sampling for nicotine as a marker of thirdhand tobacco smoke contamination on surfaces in homes, cars, and hotels. Nicotine Tob Res 2013; 15:1555-63. [PMID: 23460657 DOI: 10.1093/ntr/ntt014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Secondhand smoke contains a mixture of pollutants that can persist in air, dust, and on surfaces for months or longer. This persistent residue is known as thirdhand smoke (THS). Here, we detail a simple method of wipe sampling for nicotine as a marker of accumulated THS on surfaces. METHODS We analyzed findings from 5 real-world studies to investigate the performance of wipe sampling for nicotine on surfaces in homes, cars, and hotels in relation to smoking behavior and smoking restrictions. RESULTS The intraclass correlation coefficient for side-by-side samples was 0.91 (95% CI: 0.87-0.94). Wipe sampling for nicotine reliably distinguished between private homes, private cars, rental cars, and hotels with and without smoking bans and was significantly positively correlated with other measures of tobacco smoke contamination such as air and dust nicotine. The sensitivity and specificity of possible threshold values (0.1, 1, and 10 μg/m(2)) were evaluated for distinguishing between nonsmoking and smoking environments. Sensitivity was highest at a threshold of 0.1 μg/m(2), with 74%-100% of smoker environments showing nicotine levels above threshold. Specificity was highest at a threshold of 10 μg/m(2), with 81%-100% of nonsmoker environments showing nicotine levels below threshold. The optimal threshold will depend on the desired balance of sensitivity and specificity and on the types of smoking and nonsmoking environments. CONCLUSIONS Surface wipe sampling for nicotine is a reliable, valid, and relatively simple collection method to quantify THS contamination on surfaces across a wide range of field settings and to distinguish between nonsmoking and smoking environments.
Collapse
Affiliation(s)
- Penelope J E Quintana
- Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 4162, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Fortmann AL, Gallo LC. Social support and nocturnal blood pressure dipping: a systematic review. Am J Hypertens 2013; 26:302-10. [PMID: 23382479 PMCID: PMC3888008 DOI: 10.1093/ajh/hps041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 03/07/2012] [Revised: 09/22/2012] [Accepted: 10/06/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Attenuated nocturnal blood pressure (BP) dipping is a better predictor of cardiovascular disease (CVD) morbidity and mortality than resting BP measurements. Studies have reported associations between social support, variously defined, and BP dipping. METHODS A systematic review of the literature was conducted to investigate associations of functional and structural social support with nocturnal BP dipping assessed over a minimum of 24 hours. RESULTS A total of 297 articles were identified. Of these, 11 met criteria for inclusion; all studies were cross-sectional in design and included adult participants only (mean age = 19 to 72 years). Evidence was most consistent for an association between functional support and BP dipping, such that 5 of 7 studies reported statistically (or marginally) significant positive associations with BP dipping. Statistically significant functional support-BP dipping associations were moderate (standardized effect size (d) = 0.41) to large (d = 2.01) in magnitude. Studies examining structural support were fewer and relatively less consistent; however, preliminary evidence was observed for associations of marital status and social contact frequency with BP dipping. Statistically significant structural support findings were medium (d = 0.53) to large (d = 1.13) in magnitude. CONCLUSIONS Overall, findings suggest a link between higher levels of functional support and greater nocturnal BP dipping; preliminary evidence was also observed for the protective effects of marriage and social contact frequency. Nonetheless, the relatively small number of studies conducted to date and the heterogeneity of findings across meaningful subgroups suggest that additional research is needed to substantiate these conclusions.
Collapse
Affiliation(s)
- Addie L Fortmann
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.
| | | |
Collapse
|
32
|
Fortmann AL, Rutledge T, Corey McCulloch R, Shivpuri S, Nisenzon AN, Muse J. Satisfaction with life among veterans with spinal cord injuries completing multidisciplinary rehabilitation. Spinal Cord 2013; 51:482-6. [DOI: 10.1038/sc.2012.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
33
|
Fortmann AL, Gallo LC, Roesch SC, Mills PJ, Barrett-Connor E, Talavera GA, Elder JP, Matthews KA. Socioeconomic status, nocturnal blood pressure dipping, and psychosocial factors: a cross-sectional investigation in Mexican-American women. Ann Behav Med 2012; 44:389-98. [PMID: 22777880 PMCID: PMC3767761 DOI: 10.1007/s12160-012-9387-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite established links between reduced nocturnal blood pressure (BP) dipping and cardiovascular disease, BP dipping research in Hispanics is limited. PURPOSE This study investigated socioeconomic status (SES) as a predictor of BP dipping and the contributions of psychosocial factors to this relationship. Analyses were conducted for the overall sample and separately for higher and lower acculturated women. METHODS Mexican-American women (N = 291; 40-65 years) reported demographics and completed psychosocial assessments and 36-h ambulatory BP monitoring. RESULTS Lower SES related to reduced BP dipping in the overall sample and in more US-acculturated women (r's = .17-.30, p's < .05), but not in less-acculturated women (r's = .07, p's > .10). An indirect effect model from SES to BP dipping via psychosocial resources/risk fits well across samples. CONCLUSIONS In Mexican-American women, the nature of SES gradients in BP dipping and the roles of psychosocial resources/risk differ by acculturation level.
Collapse
Affiliation(s)
- Addie L. Fortmann
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA. SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 9245 Sky Park Court Suite 105, San Diego, CA 92123, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Scott C. Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Paul J. Mills
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Elizabeth Barrett-Connor
- Department of Family and Preventive Medicine, University of California, San Diego, San Diego, CA, USA
| | - Greg A. Talavera
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - John P. Elder
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Karen A. Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
34
|
Gallo LC, Fortmann AL, de Los Monteros KE, Mills PJ, Barrett-Connor E, Roesch SC, Matthews KA. Individual and neighborhood socioeconomic status and inflammation in Mexican American women: what is the role of obesity? Psychosom Med 2012; 74:535-42. [PMID: 22582313 PMCID: PMC3372661 DOI: 10.1097/psy.0b013e31824f5f6d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Inflammation may represent a biological mechanism underlying associations of socioeconomic status (SES) with cardiovascular disease. We examined relationships of individual and neighborhood SES with inflammatory markers in Mexican American women and evaluated contributions of obesity and related heath behaviors to these associations. METHODS Two hundred eighty-four Mexican American women (mean age = 49.74 years) were recruited from socioeconomically diverse South San Diego communities. Women completed measures of sociodemographic characteristics and health behaviors, and underwent a physical examination with fasting blood draw for assay of plasma C-reactive protein (CRP), interleukin 6 (IL-6), and soluble intercellular adhesion molecule 1 (sICAM-1). Neighborhood SES was extracted from the US Census Bureau 2000 database. RESULTS In multilevel models, a 1-standard deviation higher individual or neighborhood SES related to a 27.35% and 23.56% lower CRP level (p values < .01), a 7.04% and 5.32% lower sICAM-1 level (p values < .05), and a 10.46% (p < .05) and 2.40% lower IL-6 level (not significant), respectively. Controlling for individual SES, a 1-standard deviation higher neighborhood SES related to a 18.05% lower CRP level (p = .07). Differences in body mass index, waist circumference, and dietary fat consumption contributed significantly to SES-inflammation associations. CONCLUSIONS The findings support a link between SES and inflammatory markers in Mexican American women and implicate obesity and dietary fat in these associations. Additional effects of neighborhood SES were not statistically significant; however, these findings should be viewed tentatively due to the small sample size to evaluate contextual effects. Trial Registration ClinicalTrials.gov identifier: NCT00387166.
Collapse
Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego StateUniversity, San Diego, CA, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Matt GE, Fortmann AL, Quintana PJE, Zakarian JM, Romero RA, Chatfield DA, Hoh E, Hovell MF. Towards smoke-free rental cars: an evaluation of voluntary smoking restrictions in California. Tob Control 2012; 22:201-7. [PMID: 22337558 DOI: 10.1136/tobaccocontrol-2011-050231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Some car rental companies in California and other states in the USA have established non-smoking policies for their vehicles. This study examined the effectiveness of these policies in maintaining smoke-free rental cars. METHODS A stratified random sample of 250 cars (non-smoker, smoker and unknown designation) was examined in San Diego County, California, USA. Dust, surfaces and the air of each vehicle cabin were sampled and analysed for residual tobacco smoke pollutants (also known as thirdhand smoke (THS)), and each car was inspected for visual and olfactory signs of tobacco use. Customer service representatives were informally interviewed about smoking policies. FINDINGS A majority of putative non-smoker cars had nicotine in dust, on surfaces, in air and other signs of tobacco use. Independent of a car's smoking status, older and higher mileage cars had higher levels of THS pollution in dust and on surfaces (p<0.05), indicating that pollutants accumulated over time. Compared with smoker cars, non-smoker cars had lower levels of nicotine on surfaces (p<0.01) and in dust (p<0.05) and lower levels of nicotine (p<0.05) and 3-ethynylpyridine (p<0.05) in the air. Non-smoking signage in cars was associated with lower levels of THS pollutants in dust and air (p<0.05). CONCLUSIONS Existing policies and practices were successful in lowering THS pollution levels in non-smoker cars compared with smoker cars. However, policies failed in providing smoke-free rental cars; THS levels were not as low as those found in private cars of non-smokers with in-car smoking bans. Major obstacles include inconsistent communication with customers and the lack of routine monitoring and enforcement strategies. Strengthening policies and their implementation would allow car rental companies to reduce costs, better serve their customers and make a constructive contribution to tobacco control efforts.
Collapse
Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA 92182-4611, USA.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Gallo LC, Fortmann AL, Roesch SC, Barrett-Connor E, Elder JP, de los Monteros KE, Shivpuri S, Mills PJ, Talavera GA, Matthews KA. "Socioeconomic status, psychosocial resources and risk, and cardiometabolic risk in Mexican-American women": Correction. Psychol Health 2012. [DOI: 10.1037/a0026670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
37
|
Gallo LC, Fortmann AL, Roesch SC, Barrett-Connor E, Elder JP, de los Monteros KE, Shivpuri S, Mills PJ, Talavera GA, Matthews KA. Socioeconomic status, psychosocial resources and risk, and cardiometabolic risk in Mexican-American women. Health Psychol 2011; 31:334-42. [PMID: 22059620 DOI: 10.1037/a0025689] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The current study examined the contributions of psychosocial factors to the association between socioeconomic status (SES) and metabolic syndrome (MetSyn) risk, in a randomly selected community cohort of 304 middle-aged (40-65 years old) Mexican-American women, a population at elevated cardiometabolic risk. METHODS Participants underwent a clinical exam and measures of demographic factors and psychosocial resource (i.e., personal and social resources) and risk (i.e., negative emotions and cognitions) variables. Confirmatory factor analysis (CFA) and structural equation models (SEMs) were performed in the total sample and in more- and less-U.S.-acculturated women (defined by language preference) separately. RESULTS CFAs revealed single latent constructs for SES (i.e., income, education) and psychosocial resources/risk. Three-factor solution was identified, with blood pressure (systolic diastolic), lipids (high-density lipoprotein cholesterol triglycerides), and metabolic variables (glucose waist circumference) forming separate factors. SEMs showed that an indirect effects model with SES relating to MetSyn factors through psychosocial resources/risk provided a reasonable descriptive and statistical fit in the full and more-acculturated sample (root mean square error of approximation [RMSEA] and standardized root-mean-square residual < .08); fit in the less-acculturated sample was marginal according to RMSEA = .09. A significant mediated path from low SES to higher waist circumference/fasting glucose via lower psychosocial resources/higher psychosocial risk was identified in the overall and more-acculturated samples (p < .05). CONCLUSIONS In this cohort of healthy, middle-aged Mexican-American women, contributions of psychosocial factors to SES-MetSyn associations were limited to the core underlying metabolic mechanisms, and to more-U.S.-acculturated women.
Collapse
Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, CA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Fortmann AL, Gallo LC, Philis-Tsimikas A. Glycemic control among Latinos with type 2 diabetes: the role of social-environmental support resources. Health Psychol 2011; 30:251-8. [PMID: 21553968 DOI: 10.1037/a0022850] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources. METHODS Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support resources for disease management influence hemoglobin A1c (HbA1c) levels in a sample of 208 Latinos with Type 2 diabetes recruited from low-income serving community clinics in San Diego County. We hypothesized that the relationship between support resources for disease-management and HbA1c would be mediated by diabetes self-management and/or depression. RESULTS Participants who perceived greater support resources for disease-management reported better diabetes self-management (β = .40, p < .001) and less depression (β = -.19, p < .01). In turn, better diabetes self-management and less depression were associated with tighter glycemic control (HbA1c; β = -.17, p < .05 and β = .15, p < .05, respectively). Once the indirect effects via diabetes self-management (95% CI [-.25; -.03]) and depression (95% CI [-.14; -.01]) were statistically controlled, the direct pathway from support resources to HbA1c was markedly reduced (p = .57). CONCLUSIONS These findings demonstrate the important connection that support resources for disease management can have with diabetes self-management, emotional well-being, and glycemic control among Latinos. Thus, programs targeting diabetes self-management and glycemic control in this population should consider culturally relevant, multilevel influences on health outcomes.
Collapse
Affiliation(s)
- Addie L Fortmann
- San Diego State University/University of California, San Diego, CA 92123, USA.
| | | | | |
Collapse
|
39
|
Fortmann AL, Gallo LC, Walker C, Philis-Tsimikas A. Support for disease management, depression, self-care, and clinical indicators among Hispanics with type 2 diabetes in San Diego County, United States of America. Rev Panam Salud Publica 2011; 28:230-4. [PMID: 20963271 DOI: 10.1590/s1020-49892010000900014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/17/2010] [Indexed: 11/22/2022] Open
Abstract
This study used a social-ecological framework to examine predictors of depression, diabetes self-management, and clinical indicators of health risk among Hispanics with type 2 diabetes residing in the United States (U.S.)-Mexico border region in San Diego County, California, United States of America. Important links were observed between greater social-environmental support for disease management and less depression, better diabetes self-management, and lower body mass index and serum triglyceride concentrations. Less depressive symptomatology was also related to lower hemoglobin A1c levels. Findings suggest that programs aiming to improve diabetes self-management and health outcomes in Hispanics with type 2 diabetes should consider multilevel, social, and environmental influences on health, behavior, and emotional well-being.
Collapse
Affiliation(s)
- Addie L Fortmann
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.
| | | | | | | |
Collapse
|
40
|
Matt GE, Quintana PJE, Zakarian JM, Fortmann AL, Chatfield DA, Hoh E, Uribe AM, Hovell MF. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tob Control 2011; 20:e1. [PMID: 21037269 PMCID: PMC3666918 DOI: 10.1136/tc.2010.037382] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [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: 11/03/2022]
Abstract
BACKGROUND This study examined whether thirdhand smoke (THS) persists in smokers' homes after they move out and non-smokers move in, and whether new non-smoking residents are exposed to THS in these homes. METHODS The homes of 100 smokers and 50 non-smokers were visited before the residents moved out. Dust, surfaces, air and participants' fingers were measured for nicotine and children's urine samples were analysed for cotinine. The new residents who moved into these homes were recruited if they were non-smokers. Dust, surfaces, air and new residents' fingers were examined for nicotine in 25 former smoker and 16 former non-smoker homes. A urine sample was collected from the youngest resident. RESULTS Smoker homes' dust, surface and air nicotine levels decreased after the change of occupancy (p<0.001); however dust and surfaces showed higher contamination levels in former smoker homes than former non-smoker homes (p<0.05). Non-smoking participants' finger nicotine was higher in former smoker homes compared to former non-smoker homes (p<0.05). Finger nicotine levels among non-smokers living in former smoker homes were significantly correlated with dust and surface nicotine and urine cotinine. CONCLUSIONS These findings indicate that THS accumulates in smokers' homes and persists when smokers move out even after homes remain vacant for 2 months and are cleaned and prepared for new residents. When non-smokers move into homes formerly occupied by smokers, they encounter indoor environments with THS polluted surfaces and dust. Results suggest that non-smokers living in former smoker homes are exposed to THS in dust and on surfaces.
Collapse
Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, San Diego, California 92182-4611, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Fortmann AL, Romero RA, Sklar M, Pham V, Zakarian J, Quintana PJE, Chatfield D, Matt GE. Residual tobacco smoke in used cars: futile efforts and persistent pollutants. Nicotine Tob Res 2010; 12:1029-36. [PMID: 20805293 DOI: 10.1093/ntr/ntq144] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smoking cigarettes in the enclosed environment of a car leads to the contamination of a car's microenvironment with residual tobacco smoke pollution (TSP). METHODS Surface wipe, air, and dust samples were collected in used cars sold by nonsmokers (n = 40) and smokers (n = 87) and analyzed for nicotine. Primary drivers were interviewed about smoking behavior and restrictions, and car interiors were inspected to investigate (a) differences in car dustiness, signs of past smoking, ventilation use, mileage, and passenger cabin volume among nonsmokers and smokers with and without in-car smoking bans and (b) factors that contribute to the contamination of cars with residual TSP, such as ventilation use, cleaning behaviors, signs of past smoking, and holding the cigarette near/outside the car window while smoking. RESULTS Smokers reported using air conditioning less (p < .05) and driving with windows down more often than nonsmokers (p = .05); their cars were also dustier (p < .01) and exhibited more ash and burn marks than nonsmokers' cars (p < .001). Number of cigarettes smoked by the primary driver was the strongest predictor of residual TSP indicators (R(2) = .10 - .16, p = .001). This relationship was neither mediated by ash or burn marks nor moderated by efforts to remove residual TSP from the vehicle (i.e., cleaning, ventilation) or attempts to prevent tobacco smoke pollutants from adsorbing while smoking (e.g., holding the cigarette near/outside window). DISCUSSION Findings suggest that smokers can prevent their cars from becoming contaminated with residual TSP by reducing or ceasing smoking; however, commonly used cleaning and ventilation methods did not successfully decrease contamination levels. Disclosure requirements and smoke-free certifications could help protect buyers of used cars and empower them to request nonsmoking environments or a discount on cars that have been smoked in previously.
Collapse
Affiliation(s)
- Addie L Fortmann
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92123, USA
| | | | | | | | | | | | | | | |
Collapse
|