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Sprague BN, Tu W, Unverzagt FW, Moser LR, Adams M, Carter A, Dawkins E, Keith NR, Reinoso DR, Clark DO. Food resources and kitchen skills plus aerobic training (FoRKS+) for black adults with hypertension: A pilot trial protocol. Contemp Clin Trials 2024; 141:107533. [PMID: 38621517 DOI: 10.1016/j.cct.2024.107533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/21/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Midlife hypertension is associated with cognitive decline and Alzheimer's disease and related dementia (ADRD), suggesting that blood pressure control may be a therapeutic target for dementia prevention. Given excess hypertension in non-Hispanic Black (NHB) adults, blood pressure control may also reduce ADRD disparities. We describe a pilot randomized controlled trial (RCT) to evaluate the feasibility and preliminary efficacy of a multicomponent lifestyle-based intervention versus enhanced usual care on cognition among middle-aged NHB adults. METHODS AND STUDY DESIGN The Food Resources and Kitchen Skills plus Aerobic Training (FoRKS+) study is a 2-arm, single-blinded trial that compares those receiving the FoRKS+ program (target N = 64) versus those receiving enhanced usual care (target N = 64) in local federally-qualified health centers. Key eligibility criteria include self-identified NHB adults between ages 35-75 with a mean systolic blood pressure ≥ 130 mm/Hg obtained from 24-h ambulatory blood pressure monitoring. The FoRKS+ program includes 5 weeks of hypertension self-management courses, 11 weeks of nutrition courses, and 12 weeks of aerobic training in dietitian and health coach-led virtual groups. We will collect data on primary cognitive outcomes, feasibility, hypothesized intervention mediators and moderators, and demographic and health covariates at baseline, near intervention weeks 16-, and 28 (primary outcome assessment), and week 52 follow-up. We will use mixed-effects modeling to examine intervention effects on cognition. DISCUSSION This pilot RCT will examine the feasibility and preliminary effects of a multicomponent lifestyle intervention on cognitive function in NHB adults, which may have implications for reducing health disparities in ADRD.
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Affiliation(s)
- Briana N Sprague
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA.
| | - Wanzhu Tu
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frederick W Unverzagt
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lyndsi R Moser
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mariah Adams
- Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA
| | - Amy Carter
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Dawkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - NiCole R Keith
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Department of Kinesiology, Indiana University Bloomington, Bloomington, IN, USA
| | - Deanna R Reinoso
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel O Clark
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
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Rivera R, Holden R, Adams M, Dawkins E, Tu W, Clark D. DELIVERING FOOD RESOURCES AND KITCHEN SKILLS TO OLDER ADULTS WITH FOOD INSECURITY AND HYPERTENSION. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Non-Hispanic Black adults experience higher rates of food insecurity, poor diet quality, and hypertension compared with their non-Hispanic White counterparts. Delivering Food Resources and Kitchen Skills (FoRKS) is an integrated intervention that concurrently addresses food insecurity, nutrition literacy, and chronic disease self-management among older patients at a Federally Qualified Health Center. Two clinical dietitians led virtual hypertension self-management, cooking skills, and nutrition education classes twice per week for 16 weeks. Participants registered for classes, ordered free meal ingredients, and received encouragement from the dietitians through the FoRKS mobile technology application. This study presents diet quality descriptive results from the FoRKS pilot intervention conducted at Eskenazi Health from September 2021 to January 2022 in Indianapolis, Indiana. Participants (n=13) with hypertension (systolic blood pressure ≥120 mm Hg) and who identified as food insecure per the 18-item US Household Food Security Survey Module completed the 2018-version of the National Cancer Institute’s Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool at baseline and post-intervention assessments. Healthy Eating Index (HEI)-2015 scores range from 0-100 and were calculated from ASA24 data. Participants were non-Hispanic Black (n=12) or non-Hispanic White (n=1) with mean age 58 years (range 53-65 years). Mean±SD HEI-2015 scores improved from 51.5±11.9 at baseline to 55.2±12.5 after the intervention. This preliminary data supports further investigation into the efficacy of integrated lifestyle interventions, i.e., FoRKS, using a randomized controlled study design. Addressing food and culinary skills can lead to improvements in diet quality that may translate to improved disease management among diverse older adults.
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Affiliation(s)
- Rebecca Rivera
- Indiana University School of Medicine , Indianapolis, Indiana , United States
| | - Richard Holden
- Indiana University School of Public Health , Indianapolis, Indiana , United States
| | - Mariah Adams
- Eskenazi Health , Indianapolis, Indiana , United States
| | - Emily Dawkins
- Eskenazi Health , Indianapolis, Indiana , United States
| | - Wanzhu Tu
- Indiana University School of Medicine , Indianapolis, Indiana , United States
| | - Daniel Clark
- Indiana University School of Medicine , Indianapolis, Indiana , United States
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Meredith AH, Schmelz AN, Dawkins E, Carter A. Group education program for hypertension control. J Clin Hypertens (Greenwich) 2020; 22:2146-2151. [PMID: 32882098 DOI: 10.1111/jch.14022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Hypertension continues to be a health crisis, with multiple approaches attempting to define best practices for management. The objective of our hypertension group education program is to improve patient health outcomes through engaging a multidisciplinary health professional team. A 6-hour group curriculum was created with a focus on nutrition, lifestyle, and medication approaches to hypertension management, while incorporating personally identified behavior change goals and barriers. Outcomes were tracked pre-program, at program completion, and 6 and 12 months post-program completion. Program participants demonstrated immediate and sustained improvements in blood pressure readings and attainment of personal behavior change goals. Group hypertension education classes are an effective way to care for patients. Additional healthcare resources should be dedicated to creating and evaluating educational delivery models that are sustainable and provide results over time, including financial implications to the health system.
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Affiliation(s)
- Ashley H Meredith
- Purdue University College of Pharmacy, West Lafayette, IN, USA.,Eskenazi Health, Indianapolis, IN, USA
| | - Andrew N Schmelz
- Eskenazi Health, Indianapolis, IN, USA.,Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA
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Gardner T, Benzie M, Börner J, Dawkins E, Fick S, Garrett R, Godar J, Grimard A, Lake S, Larsen R, Mardas N, McDermott C, Meyfroidt P, Osbeck M, Persson M, Sembres T, Suavet C, Strassburg B, Trevisan A, West C, Wolvekamp P. Transparency and sustainability in global commodity supply chains. World Dev 2019; 121:163-177. [PMID: 31481824 PMCID: PMC6686968 DOI: 10.1016/j.worlddev.2018.05.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Over the last few decades rapid advances in processes to collect, monitor, disclose, and disseminate information have contributed towards the development of entirely new modes of sustainability governance for global commodity supply chains. However, there has been very little critical appraisal of the contribution made by different transparency initiatives to sustainability and the ways in which they can (and cannot) influence new governance arrangements. Here we seek to strengthen the theoretical underpinning of research and action on supply chain transparency by addressing four questions: (1) What is meant by supply chain transparency? (2) What is the relevance of supply chain transparency to supply chain sustainability governance? (3) What is the current status of supply chain transparency, and what are the strengths and weaknesses of existing initiatives? and (4) What propositions can be advanced for how transparency can have a positive transformative effect on the governance interventions that seek to strengthen sustainability outcomes? We use examples from agricultural supply chains and the zero-deforestation agenda as a focus of our analysis but draw insights that are relevant to the transparency and sustainability of supply chains in general. We propose a typology to distinguish among types of supply chain information that are needed to support improvements in sustainability governance, and illustrate a number of major shortfalls and systematic biases in existing information systems. We also propose a set of ten propositions that, taken together, serve to expose some of the potential pitfalls and undesirable outcomes that may result from (inevitably) limited or poorly designed transparency systems, whilst offering guidance on some of the ways in which greater transparency can make a more effective, lasting and positive contribution to sustainability.
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Affiliation(s)
- T.A. Gardner
- Stockholm Environment Institute, Sweden
- Corresponding author at: Stockholm Environment Institute, Linnégatan 87D, Box 24218, Stockholm 104 51, Sweden.
| | - M. Benzie
- Stockholm Environment Institute, Sweden
| | - J. Börner
- Institute for Food and Resource Economics, Center for Development Research, University of Bonn, Germany
| | | | - S. Fick
- Stockholm Environment Institute, Sweden
| | | | - J. Godar
- Stockholm Environment Institute, Sweden
| | | | - S. Lake
- Global Canopy, United Kingdom
| | | | | | | | - P. Meyfroidt
- Earth and Life Institute, Université catholique de Louvain, Belgium
- F.R.S.–FNRS, Belgium
| | - M. Osbeck
- Stockholm Environment Institute, Sweden
| | | | | | - C. Suavet
- Stockholm Environment Institute, Sweden
| | | | | | - C. West
- University of York, United Kingdom
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