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Zheng T, Kelsey K, Zhu C, Pennell KD, Yao Q, Manz KE, Zheng YF, Braun JM, Liu Y, Papandonatos G, Liu Q, Shi K, Brochman S, Buka SL. Adverse birth outcomes related to concentrations of per- and polyfluoroalkyl substances (PFAS) in maternal blood collected from pregnant women in 1960-1966. Environ Res 2024; 241:117010. [PMID: 37696323 DOI: 10.1016/j.envres.2023.117010] [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] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/12/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Prior animal and epidemiological studies suggest that per- and polyfluoroalkyl substances (PFAS) exposure may be associated with reduced birth weight. However, results from prior studies evaluated a relatively small set of PFAS. OBJECTIVES Determine associations of gestational PFAS concentrations in maternal serum samples banked for 60 years with birth outcomes. METHODS We used data from 97 pregnant women from Boston and Providence that enrolled in the Collaborative Perinatal Project (CPP) study (1960-1966). We quantified concentrations of 27 PFAS in maternal serum in pregnancy and measured infant weight, height and ponderal index at birth. Covariate-adjusted associations between 11 PFAS concentrations (>75% detection limits) and birth outcomes were estimated using linear regression methods. RESULTS Median concentrations of PFOA, PFNA, PFHxS, and PFOS were 6.189, 0.330, 14.432, and 38.170 ng/mL, respectively. We found that elevated PFAS concentrations during pregnancy were significantly associated with lower birth weight and ponderal index at birth, but no significant associations were found with birth length. Specifically, infants born to women with PFAS concentrations ≥ median levels had significantly lower birth weight (PFOS: β = -0.323, P = 0.006; PFHxS: β = -0.292, P = 0.015; PFOA: β = -0.233, P = 0.03; PFHpS: β = -0.239, P = 0.023; PFNA: β = -0.239, P = 0.017). Similarly, women with PFAS concentrations ≥ median levels had significantly lower ponderal index (PFHxS: β = -0.168, P = 0.020; PFHxA: β = -0.148, P = 0.018). CONCLUSIONS Using data from this US-based cohort study, we found that 1) maternal PFAS levels from the 1960s exceeded values in contemporaneous populations and 2) that gestational concentrations of certain PFAS were associated with lower birth weight and infant ponderal index. Additional studies with larger sample size are needed to further examine the associations of gestational exposure to individual PFAS and their mixtures with adverse birth outcomes.
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Affiliation(s)
- T Zheng
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
| | - K Kelsey
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - C Zhu
- West China School of Public Health, Sichuan University, Sichuan, 610044, China
| | - K D Pennell
- School of Engineering, Brown University, 184 Hope Street, Providence, RI, 02912, USA
| | - Q Yao
- West China School of Public Health, Sichuan University, Sichuan, 610044, China
| | - K E Manz
- School of Engineering, Brown University, 184 Hope Street, Providence, RI, 02912, USA
| | - Y F Zheng
- Department of Gynecology, Hubei Provincial Women and Children Hospital, Wuhan, 430070, China; Wuhan Science and Technology University, Wuhan, 430062, China
| | - J M Braun
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Y Liu
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - G Papandonatos
- Department of Biostatistics, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Q Liu
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - K Shi
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - S Brochman
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - S L Buka
- Department of Epidemiology, Brown School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
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Gans KM, Risica PM, Keita AD, Dionne L, Mello J, Stowers KC, Papandonatos G, Whittaker S, Gorham G. Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. Int J Behav Nutr Phys Act 2018; 15:80. [PMID: 30126463 PMCID: PMC6102886 DOI: 10.1186/s12966-018-0704-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fruit and vegetable (F&V) intake can reduce risks for chronic disease, but is much lower than recommended amounts in most Western populations, especially for those with low income levels. Rigorous research is needed on practical, cost-effective interventions that address environmental as well as personal determinants of F&V intake. This paper presents the results of a cluster randomized controlled trial evaluating the efficacy of 'Live Well, Viva Bien' (LWVB), a multicomponent intervention that included discount, mobile fresh F&V markets in conjunction with nutrition education. METHODS Fifteen subsidized housing sites in Providence County, Rhode Island (8 intervention and 7 control sites) were randomized using a random number generator. Of these, nine housed elderly and/or disabled residents and six housed families. A total of 1597 adult housing site residents (treatment n = 837; control n = 760) were enrolled (73% women, 54% Hispanic, 17% black, Mean age 54 years). A year-long multicomponent intervention including mobile F&V markets plus nutrition education (e.g. campaigns, DVDs, newsletters, recipes, and chef demonstrations) was implemented at intervention sites. Physical activity and stress interventions were implemented at control sites. Follow-up occurred at 6 and 12 months. The main outcome measure was F&V consumption measured by National Cancer Institute's 'Eating at America's Table All Day Screener'. RESULTS From baseline to 12 months, the intervention group increased total F&V intake by 0.44 cups with the control group decreasing intake by 0.08 cups (p < .02). Results also showed an increased frequency of F&V eating behaviors compared to the control group (p < .01). There was a clear dose response effect of the F&V markets with participants who reported attending all or most of the markets increasing F&V intake by 2.1 cups and 0.86 cups, respectively compared with less than half cup increases for lower levels of market attendance (p < .05). Use of the DVDs, recipes and taste-testings was also associated with greater increases in F&V intake; however, use of other educational components was not. CONCLUSIONS LWVB is the first cluster, randomized controlled trial to demonstrate the efficacy of year-round F&V markets on improving F&V intake for low-income adults, which provides an evidence-base to bolster the mission of mobile produce markets. Further, the results more broadly support investment in environmental changes to alleviate disparities in F&V consumption and diet-related health inequities. TRIAL REGISTRATION NUMBER Clinicatrials.gov registration number: NCT02669472.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Akilah Dulin Keita
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Kristen Cooksey Stowers
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, USA
| | - George Papandonatos
- Department of Statistical Scieces, Brown University School of Public Health, Providence, USA
| | | | - Gemma Gorham
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
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Stacy SL, Eliot M, Etzel T, Papandonatos G, Calafat AM, Chen A, Hauser R, Lanphear BP, Sathyanarayana S, Ye X, Yolton K, Braun JM. Patterns, Variability, and Predictors of Urinary Triclosan Concentrations during Pregnancy and Childhood. Environ Sci Technol 2017; 51:6404-6413. [PMID: 28516781 PMCID: PMC5576563 DOI: 10.1021/acs.est.7b00325] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Exposure to triclosan, an antimicrobial used in many consumer products, is ubiquitous in the United States, yet only limited data are available on the predictors and variability of exposure, particularly in children. We examined the patterns, variability, and predictors of urinary triclosan concentrations in 389 mother-child pairs enrolled in the Health Outcomes and Measures of the Environment Study from 2003 to 2006. We quantified triclosan in 3 urine samples collected from women between 16 weeks of pregnancy and birth and 6 urine samples collected from children between the ages of 1-8 years. For maternal and child samples, we calculated intraclass correlation coefficients (ICCs) to assess triclosan reproducibility and identified sociodemographic predictors of triclosan. Among 8 year old children, we examined associations between triclosan and personal-care product use. We detected triclosan in >70% of urine samples. Median maternal triclosan varied across pregnancy from 17 to 11 ng/mL, while in children, median concentrations increased from 3.6 to 17 ng/mL over the first 4 years of life, declining slightly at later ages. Triclosan reproducibility was fair to good during pregnancy and for child samples taken weeks apart (ICCs = 0.4-0.6) but poor for annual child samples (ICCs = 0.2-0.4). Triclosan was 66% (95% CI: 29-113) higher in 8 year olds using hand soap compared to nonusers and increased monotonically with hand-washing frequency. Toothpaste use in children was also positively associated with triclosan. Our results suggest that urinary triclosan concentrations have modest stability over weeks to months; children are exposed to triclosan through the use of some personal-care products.
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Affiliation(s)
- Shaina L. Stacy
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, United States
| | - Melissa Eliot
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, United States
| | - Taylor Etzel
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, United States
| | - George Papandonatos
- Department of Biostatistics, Brown University, Providence, Rhode Island 02912, United States
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Aimin Chen
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, United States
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Bruce P. Lanphear
- Child and Family Research Institute, BC Children's Hospital and the Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia V5A 1S6, Canada
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington Seattle Children's Research Institute, Seattle, Washington 98105, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington 98195, United States
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Kimberly Yolton
- Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, United States
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island 02912, United States
- Corresponding Author: Phone: 401-863-5397;
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Gorham G, Dulin-Keita A, Risica PM, Mello J, Papandonatos G, Nunn A, Gorham S, Roberson M, Gans KM. Effectiveness of Fresh to You, a Discount Fresh Fruit and Vegetable Market in Low-Income Neighborhoods, on Children's Fruit and Vegetable Consumption, Rhode Island, 2010-2011. Prev Chronic Dis 2015; 12:E176. [PMID: 26469949 PMCID: PMC4611858 DOI: 10.5888/pcd12.140583] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction Eating fruits and vegetables is associated with lowered risk for many chronic diseases. However, most Americans, especially members of low-income and minority populations, do not eat adequate amounts. Fresh to You is a public–private partnership program that brings discount fresh produce markets into low-income neighborhoods. We conducted a mixed-methods evaluation of Fresh to You to assess the effect of the program on children’s consumption of fruits and vegetables. Methods A local produce distributor brought the Fresh to You markets to 6 community organizations serving low-income families in Rhode Island. The markets, held weekly for 5 months at each site, sold fresh produce at below-retail prices. Parents (N = 480) of children aged 3 to 13 years were recruited at the markets to participate in a 5-month cohort study. The primary outcome was change in children’s fruit and vegetable intake, measured by a validated screener. We also conducted postintervention focus groups at each site with parents and qualitative interviews with site contacts to collect feedback about Fresh to You. Results From baseline to 5 months, there was a significant increase in children’s daily fruit and vegetable consumption of 0.48 cups (t = 4.16, P < .001). Data from follow-up parent surveys, focus groups, and site contact interviews provided positive feedback about Fresh to You and recommendations for improvement. Conclusion Fresh to You was effective at increasing consumption of fruits and vegetables among racially and ethnically diverse low-income children aged 3 to 13 years whose parents shopped at the markets. The intervention could serve as a model program for replication in other cities. Refinements and a more rigorous evaluation are needed.
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Affiliation(s)
- Gemma Gorham
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island
| | - Akilah Dulin-Keita
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Patricia Markham Risica
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Jennifer Mello
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - George Papandonatos
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Amy Nunn
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island
| | - Sara Gorham
- Institute for Community Health Promotion, Brown University School of Public Health and Rhode Island Public Health Institute, Providence, Rhode Island
| | - Mya Roberson
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island
| | - Kim M Gans
- Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, 8th Floor, Box G-S121-8, Providence, RI 02912. . Dr Gans is also affiliated with the Rhode Island Public Health Institute, Providence, Rhode Island, and the University of Connecticut, Department of Human Development and Family Studies, and the Center for Health Interventions and Prevention, Storrs, Connecticut
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Tremont G, Davis J, Bryant K, Ott BR, Papandonatos G, Fortinsky R, Gozalo P, Bishop D. O3‐09‐03: EFFECT OF A TELEPHONE‐BASED DEMENTIA CAREGIVER INTERVENTION ON USE OF COMMUNITY SUPPORT SERVICES AND HEALTH CARE RESOURCES. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.04.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Geoffrey Tremont
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUnited States
| | - Jennifer Davis
- Alpert Medical School of Brown University/Rhode Island HospitalProvidenceRhode IslandUnited States
| | | | - Brian R. Ott
- Brown UniversityProvidenceRhode IslandUnited States
| | | | - Richard Fortinsky
- University of Connecticut Center on AgingFarmingtonConnecticutUnited States
| | - Pedro Gozalo
- Brown UniversityProvidenceRhode IslandUnited States
| | - Duane Bishop
- Rhode Island HospitalProvidenceRhode IslandUnited States
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Springate BA, Tremont G, Papandonatos G, Ott BR. Screening for Mild Cognitive Impairment Using the Dementia Rating Scale-2. J Geriatr Psychiatry Neurol 2014; 27:139-44. [PMID: 24578462 DOI: 10.1177/0891988714522700] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/13/2013] [Indexed: 11/15/2022]
Abstract
This study examined the sensitivity and specificity of the Dementia Rating Scale-2 (DRS-2) to distinguish individuals with mild cognitive impairment (MCI) from both patients with Alzheimer's disease (AD) and healthy controls (HCs). A total of 50 HCs, 98 patients with MCI, and 49 patients with AD completed a neurological examination and battery of neuropsychological tests that included the DRS-2. Across almost all subscales of the DRS-2, patients with AD scored significantly worse than patients with MCI who in turn performed more poorly than the HCs. The only exception was the construction subscale where no significant difference was found between patients with MCI and the HCs. At a cutoff of 136, the sensitivity was 71% and specificity was 86% for distinguishing between patients with MCI and the HCs. Sensitivity was 82% and specificity was 78% for distinguishing between patients with MCI and patients with AD (cutoff score <124). For distinguishing between patients (with MCI and AD) and the HCs, sensitivity was 81% and specificity was 86% at a cutoff of 136. Our findings suggest the DRS-2 is a brief, easily administered cognitive test that appears to be useful in assisting with the detection of MCI.
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Affiliation(s)
- Beth A Springate
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | | | - Brian R Ott
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA Department of Neurology, Rhode Island Hospital, Providence, RI, USA
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Stroud LR, Papandonatos G, Shenassa E, Rodriguez D, Niaura R, LeWinn K, Lipsitt LP, Buka SL. Prenatal glucocorticoids and maternal smoking during pregnancy independently program adult nicotine dependence in daughters: a 40-year prospective study. Biol Psychiatry 2014; 75:47-55. [PMID: 24034414 PMCID: PMC3858529 DOI: 10.1016/j.biopsych.2013.07.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/25/2013] [Accepted: 07/12/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maternal smoking during pregnancy (MSDP) is an independent risk factor for offspring nicotine dependence (ND), but mechanisms remain unknown. We investigated prenatal glucocorticoid (cortisol) and androgen (testosterone) associations with offspring ND over 40 years and the possibility that prenatal glucocorticoids and androgens would mediate links between MSDP and offspring ND. METHODS Participants were 1086 mother-adult offspring pairs (59% female) from the New England Family Study, a 40-year longitudinal follow-up of the Collaborative Perinatal Project. MSDP was assessed prospectively at each prenatal visit. Maternal cortisol, testosterone, and cotinine (nicotine metabolite) were assayed from third trimester maternal sera. Offspring lifetime ND was assessed via structured interview. RESULTS Significant bivariate associations emerged for: 1) MSDP/cotinine and lifetime ND; and 2) maternal cortisol and lifetime ND, for daughters only. In multivariate models, maternal cortisol and MSDP/cotinine remained significantly and independently associated with increased odds of lifetime ND of daughters. However, cortisol did not mediate the MSDP-lifetime ND relation. No associations emerged between maternal testosterone and offspring ND. CONCLUSIONS Results provide the first evidence in support of prenatal glucocorticoid programming of adult ND over 40 years in daughters only. Our study highlights two independent prenatal pathways leading to increased risk for ND in daughters: elevated prenatal glucocorticoids and MSDP/nicotine exposure. Daughter-specific effects of glucocorticoid and MSDP programming over 40 years highlight the breadth and persistence of sexually dimorphic programming effects in humans. Results do not support androgen programming of offspring ND.
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Affiliation(s)
- Laura R. Stroud
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | | | - Edmond Shenassa
- Program in Maternal-Child Health, School of Public Health, University of Maryland
| | - Daniel Rodriguez
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation
| | - Kaja LeWinn
- Department of Psychiatry, University of California, San Francisco
| | | | - Stephen L. Buka
- Department of Epidemiology, School of Public Health, Brown University
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Manning K, Davis J, Papandonatos G, Ott B. P2–318: Clock drawing as a screen for impaired driving in aging and dementia: Is it worth the time? Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kevin Manning
- New York Presbyterian Hospital ‐ Westchester Division White Plains New York United States
| | | | | | - Brian Ott
- Brown University Providence Rhode Island United States
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9
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Tremont G, Davis J, Grover C, Bryant K, Ott B, Papandonatos G, Fortinsky R, Gozalo P, Bishop D. O2–05–04: Randomized controlled trial of a telephone‐delivered intervention (FITT‐Caregiver) for dementia caregivers. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.04.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Geoffrey Tremont
- Alpert Medical School of Brown University Providence Rhode Island United States
| | - Jennifer Davis
- Alpert Medical School of Brown University Providence Rhode Island United States
| | | | | | - Brian Ott
- Brown University Providence Rhode Island United States
| | | | - Richard Fortinsky
- University of Connecticut Health Center Farmington Connecticut United States
| | - Pedro Gozalo
- Brown University Providence Rhode Island United States
| | - Duane Bishop
- Rhode Island Hospital Providence Rhode Island United States
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Tremont G, Davis J, O'Connor K, Grover C, Bishop D, Ott B, Papandonatos G, Fortinsky R. P2‐382: Relationship between expectancy/credibility and early response to telephone‐based dementia caregiver interventions. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Geoffrey Tremont
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUnited States
| | - Jennifer Davis
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUnited States
| | | | | | - Duane Bishop
- Rhode Island HospitalProvidenceRhode IslandUnited States
| | - Brian Ott
- Brown UniversityProvidenceRhode IslandUnited States
| | | | - Richard Fortinsky
- University of Connecticut Health CenterFarmingtonConnecticutUnited States
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Wing RR, Papandonatos G, Fava JL, Gorin AA, Phelan S, McCaffery J, Tate DF. Maintaining large weight losses: the role of behavioral and psychological factors. J Consult Clin Psychol 2009; 76:1015-21. [PMID: 19045969 DOI: 10.1037/a0014159] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [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
Few studies have examined predictors of weight regain after significant weight losses. This prospective study examined behavioral and psychological predictors of weight regain in 261 successful weight losers who completed an 18-month trial of weight regain prevention that compared a control condition with self-regulation interventions delivered face-to-face or via the Internet. Linear mixed effect models were used to examine behavioral and psychological predictors of weight regain, both as main effects and as interactions with treatment group. Decreases in physical activity were related to weight regain across all 3 groups, and increased frequency of self-weighing was equally protective in the 2 intervention groups but not in the control group. Increases in depressive symptoms, disinhibition, and hunger were also related to weight regain in all groups. Although the impact of changes in restraint was greatest in the Internet group and weakest in the face-to-face group, the latter was the only group with increases in restraint over time and consequent decreases in magnitude of weight regain. Future programs should focus on maintaining physical activity, dietary restraints, and frequent self-weighing and should include stronger components to modify psychological parameters.
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Affiliation(s)
- Rena R Wing
- Department of Psychiatry and Human Behavior, Miriam Hospital and Brown Medical School, Providence, RI 02903, USA.
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Stanton CA, Papandonatos G, Lloyd-Richardson EE, Kazura A, Shiu SY, Niaura R. How do Mothers, Fathers, and Friends Influence Stages of Adolescent Smoking? Adolesc Fam Health 2009; 4:95-111. [PMID: 23226718 PMCID: PMC3514408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Parent and friend influences may differentially promote or deter adolescent smoking at discrete stages. Drawing from national (Add Health) data, a partial proportional odds ordinal regression model was utilized to examine the multivariate influence of parent and friend variables and their interactions on transitions across smoking stages (Never Smokers, Experimenters, Intermittent, Regular/Established) separately for mother-child pairs (N = 15,983) and father-child pairs (N = 1,142). Friend smoking status was by far the strongest predictor across smoking stages. Gender differences indicated males with one or more daily smoking friends are at higher risk for regular smoking relative to females. Fathers' smoking status had a direct effect on teen smoking across all stages, whereas mothers' smoking was significant in influencing which stage of smoking teens exhibited. Moreover, maternal smoking status had an indirect effect by moderating the association between teen smoking and the closeness of the mother-teen relationship. Mothers who smoke were found to have a stronger impact on the transition to regular smoking compared to mothers who do not smoke regardless of the number of smoking friends the teen reports. Results have implications for stage-matched and family-based prevention and intervention programs.
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Affiliation(s)
- Cassandra A Stanton
- Cassandra Stanton, Elizabeth Lloyd-Richardson, Alessandra Kazura, and Raymond Niaura, Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Brown Medical School; George Papandonatos and Shang-Ying Shiu, Center for Statistical Sciences, Brown Medical School
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Abstract
AIMS To examine the reliability of self-report cigarette smoking questions by describing recanting (denial of previous smoking reports) in a nationally representative sample of US adolescents followed throughout young adulthood. Predictors of recanting across stages of smoking uptake/progression are examined. DESIGN A total of 12 985 respondents to cigarette smoking questions during in-home interviews at waves I and III (6 years apart) of the National Longitudinal Study of Adolescent Health (Add Health). The sample survey procedures of Stata 9.0 were used to produce nationally representative estimates, with standard errors adjusted for both clustering at the school level and stratification by geographical region. MEASUREMENTS Recanting probabilities determined by reports of stages of smoking uptake/progression at each time-point were predicted by race/ethnicity, parental education, household income, poverty level, depression and peer daily smoking. FINDINGS Stage-specific results indicated that recanting is higher when the earlier smoking was less frequent/intense. Recanters were older, from lower-income households and had higher baseline depression levels. Non-Hispanic black youth were significantly more likely to recant previous smoking compared to non-Hispanic white youth, even in multivariate models controlling for socio-demographic variables. Predictors of recanting differed by level of tobacco involvement. The greater likelihood of non-Hispanic black respondents to deny previous smoking may be a reflection of less intense or more intermittent use of tobacco that leads to recall differences over time. CONCLUSIONS Racial/ethnic subgroups and/or respondents endorsing depressive symptoms may be more vulnerable to misclassification during interpretation of national survey data and subsequently not identified properly for prevention/intervention programs.
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Stroud LR, Solomon C, Shenassa E, Papandonatos G, Niaura R, Lipsitt LP, Lewinn K, Buka SL. Long-term stability of maternal prenatal steroid hormones from the National Collaborative Perinatal Project: still valid after all these years. Psychoneuroendocrinology 2007; 32:140-50. [PMID: 17270355 PMCID: PMC2693201 DOI: 10.1016/j.psyneuen.2006.11.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 11/18/2006] [Accepted: 11/19/2006] [Indexed: 10/23/2022]
Abstract
Large epidemiological samples, including the National Collaborative Perinatal Project (NCPP), in which blood/serum was collected during pregnancy and offspring followed longitudinally, offer the unique opportunity to examine neuroendocrine mechanisms underlying prenatal "programming" of adult health and disease. However, in order to conduct longitudinal analyses, it is critical to determine the validity of maternal prenatal samples stored over long periods. We investigated the validity of cortisol, testosterone, and their binding globulins (corticosteroid-binding globulin (CBG) and sex hormone-binding globulin (SHBG)) in maternal prenatal serum from the NCPP after over 40 years of storage. Study 1 included 64 maternal serum samples collected on the day of delivery; study 2 involved 1099 third trimester serum samples collected between gestational weeks 31 and 36. Across both studies, cortisol and testosterone concentrations were consistent with values from published studies of fresh samples collected at similar points in gestation. CBG and SHBG were present, but showed some differences from published studies. Results support the validity of cortisol and testosterone values following 40+ years of storage. Results also provide validation for future longitudinal tests of prenatal "programming" hypotheses within the NCPP. Stability of steroid hormones over decades suggests that stored samples from other longitudinal studies may also allow opportunities to investigate links between prenatal steroids and long-term offspring outcomes.
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Affiliation(s)
- Laura R Stroud
- Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Coro West, Suite 500, 1 Hoppin Street, Providence, RI 02903, USA.
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15
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Napolitano MA, Whiteley JA, Papandonatos G, Dutton G, Farrell NC, Albrecht A, Bock B, Bazzarre T, Sciamanna C, Dunn AL, Marcus BH. Outcomes from the women's wellness project: a community-focused physical activity trial for women. Prev Med 2006; 43:447-53. [PMID: 16919322 DOI: 10.1016/j.ypmed.2006.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 06/19/2006] [Accepted: 06/22/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Given the low rates of physical activity participation, innovative intervention approaches are needed to make a public health impact. METHODS The study was conducted at the Miriam Hospital/Brown Medical School in Providence, RI, and in communities of Southeastern Massachusetts from 2002 to 2005. Previously sedentary women (n = 280; mean age = 47.1; 94.6% Caucasian) were randomly assigned to one of three conditions: (1) Choose to Move, a self-help printed booklet (n = 93), (2) Jumpstart, a motivationally tailored, print based intervention (n = 95); or (3) Wellness, women's health materials (n = 92). Face-to-face contact at months 3 (M3) and 12 (M12) occurred within participants' communities in local libraries. RESULTS At M3, participants in the Jumpstart condition reported significantly more minutes of physical activity per week (M = 140.4, SE = 14.82) than participants in the Wellness condition (M = 98.1, SE = 15.09), (t(275) = 2.00, p < 0.05). The Jumpstart arm showed a trend towards significance (t(275) = 1.93, p = 0.054) when compared with the CTM arm (M = 99.5, SE = 15.11); there was no significant difference between the CTM and Wellness arms (t(275) = 0.07, p = NS). At M12, there were no significant differences (F(2,275) = 0.147, p = NS) between any of the treatment arms. CONCLUSIONS Results suggest that print-based programs for physical activity may be efficacious short-term, but more research is needed to find approaches that are effective long-term. It is possible to deliver print-based programs through existing community infrastructures, however these approaches need further evaluation to examine maintenance effects apart from the demand characteristics of a research study.
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Affiliation(s)
- Melissa A Napolitano
- The Miriam Hospital and Brown Medical School, Centers for Behavioral and Preventive Medicine, Providence, RI 02903, USA.
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16
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Abstract
Current research has shown relationships between the environment (eg, parks and trails) and levels of physical activity participation. This study was designed to implement and evaluate a communications based worksite campaign to promote awareness of an existing local walking path and to increase walking. Promotional materials were distributed for 1 month via flyers, email, website postings, and during bi-weekly information booths. Evaluations were conducted at baseline, during, and following the promotional campaign. Borderline statistically significant increases in walking activity from baseline were observed midway through the campaign (p = 0.069) and following the campaign (p = 0.075). Counts observed during the intervention were almost triple those at baseline and increased in the post-campaign phase to approximately three and a half times those at baseline. Sign recognition surveys revealed at baseline, 51% of the participants correctly identified the walking path signs, which increased to 65% during the campaign (p = .0674). Familiarity with physical activity messages around the workplace increased from 64.6% at baseline to 75.5% during the campaign (p = .097). This study shows initial promise of a theoretically based communications intervention to increase knowledge of physical activity and to promote walking.
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Affiliation(s)
- Melissa A Napolitano
- Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, Rhode Island, USA.
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17
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Borrelli B, Novak S, Hecht J, Emmons K, Papandonatos G, Abrams D. Home health care nurses as a new channel for smoking cessation treatment: outcomes from project CARES (Community-nurse Assisted Research and Education on Smoking). Prev Med 2005; 41:815-21. [PMID: 16182355 DOI: 10.1016/j.ypmed.2005.08.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 08/02/2005] [Accepted: 08/09/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clinical guidelines for smoking cessation may not be sufficient for helping some subgroups of smokers quit. Incorporating smoking cessation into home-based medical care can proactively reach high-risk smokers who may not have access to (or spontaneously seek) smoking cessation. METHOD Home health care nurses (N = 98) were randomly assigned to deliver either Motivational Enhancement (ME; Motivational Interviewing + Carbon Monoxide Feedback) or Standard Care (AHCPR Guidelines for smoking cessation) to their patients. Seventy percent of patients were eligible and willing to participate (N = 273; 54% female, mean age = 57 years, 83% Caucasian, 41% < high school education). The study was conducted in Providence, RI, USA from 1998 to 2003. RESULTS Biochemically verified continuous abstinence rates at the 12-month follow-up were 4.2% (SC) and 8.7% (ME) for intent to treat analyses, and 5.2% (SC) and 11.8% (ME) using all available cases (P > 0.05). ME reported more quit attempts and significantly greater reductions in the number of cigarettes smoked per day at all follow-ups through 12 months of post-treatment (all P values < 0.05). CONCLUSIONS Use of an existing public health channel such as home health care to reach smokers who vary in their motivation to quit could have the potential for large public health impact.
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Affiliation(s)
- Belinda Borrelli
- The Centers for Behavioral and Preventive Medicine, Brown Medical School/The Miriam Hospital, Coro West Building, Suite 500, One Hoppin Street, Providence, RI 02903, USA.
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Abstract
BACKGROUND Research has shown that older women with breast cancer are less likely than younger women to receive treatment in accordance with accepted guidelines. Cancer-related research networks (eg, Comprehensive Cancer Centers) have been funded by the National Cancer Institute to increase the dissemination of new treatment strategies, but little is known about their relationship to cancer treatment patterns. OBJECTIVES We used a 3-level hierarchical regression model to examine the relationship of treating facilities' memberships in cancer research networks to compliance with guidelines for primary treatment of early stage breast cancer, controlling for patient and facility factors. RESEARCH DESIGN We analyzed data from a database linking SEER registry data and Medicare claims in patients aged 65 years of age or older with early-stage breast cancer to data on the treating facility, including variables that indicate membership(s) in cancer research networks. SUBJECTS A total of 16,600 women with stage I or stage II breast cancer, diagnosed between 1990 and 1994, and who received treatment in one of 423 facilities were studied. MEASURES The key independent variable in this analysis was membership in NCI-funded cancer research networks. The outcome measure is a 3-category variable defined as (1) mastectomy (MAST), (2) breast-conserving surgery plus radiation therapy (BCS+RT), or (3) BCS alone. RESULTS Patients treated at facilities that were members of 2 or more cancer research networks were more likely to receive guideline-concordant treatment (ie, MAST or BCS+RT) than similar patients treated at non-member facilities. CONCLUSIONS Organizational factors may influence compliance with treatment guidelines and be useful in improving the quality of care.
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Affiliation(s)
- Linda Laliberte
- Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island 02912, USA.
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19
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Abstract
To significantly reduce smoking prevalence, treatments must balance reach, efficacy, and cost. The Internet can reach millions of smokers cost-effectively. Many cessation Web sites exist, but few have been evaluated. As a result, the potential impact of the Internet on smoking prevalence remains unknown. The present study reports the results, challenges, and limitations of a preliminary, large-scale evaluation of a broadly disseminated smoking cessation Web site used worldwide (QuitNet). Consecutive registrants (N=1,501) were surveyed 3 months after they registered on the Web site to assess 7-day point prevalence abstinence. Results must be interpreted cautiously because this is an uncontrolled study with a 25.6% response rate. Approximately 30% of those surveyed indicated they had already quit smoking at registration. Excluding these participants, an intention-to-treat analysis yielded 7% point prevalence abstinence (for the responders only, abstinence was 30%). A range of plausible cessation outcomes (9.8%-13.1%) among various subgroups is presented to illustrate the strengths and limitations of conducting Web-based evaluations, and the tensions between clinical and dissemination research methods. Process-to-outcome analyses indicated that sustained use of QuitNet, especially the use of social support, was associated with more than three times greater point prevalence abstinence and more than four times greater continuous abstinence. Despite its limitations, the present study provides useful information about the potential efficacy, challenging design and methodological issues, process-to-outcome mechanisms of action, and potential public health impact of Internet-based behavior change programs for smoking cessation.
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Affiliation(s)
- Nathan K Cobb
- Beth Israel Deaconess Medical Center/Harvard University School of Medicine, Boston, MA, USA
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20
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Mor V, Papandonatos G, Miller SC. End-of-Life Hospitalization for African American and Non-Latino White Nursing Home Residents: Variation by Race and a Facility's Racial Composition. J Palliat Med 2005; 8:58-68. [PMID: 15662174 DOI: 10.1089/jpm.2005.8.58] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hospitalization of nursing home residents at the end of life is common, more so among African Americans. Whether a nursing home's racial mix is associated with hospitalization is unknown. OBJECTIVE This study examined the association between race, a nursing home's racial mix, and end-of-life hospitalization. DESIGN This was a retrospective cohort study. SETTING/SUBJECTS Studied were nursing home residents in New York (n = 14,159) and Mississippi (n = 1481) who died in 1995-1996 and had a minimum data set (MDS) assessment within 120 days of death. MEASUREMENTS The outcome measure was the odds of hospitalization in the last 90 days of life. A variable reflecting a nursing home's proportion of African American residents (in 1995-1996) represented a nursing home's racial mix. RESULTS Forty-six percent of African Americans and 32% of whites were hospitalized in the last 90 days of life. After controlling for demographics, diagnoses, function, patient preferences (do-not-resuscitate [DNR]), and facility resources, nursing home residents in facilities having higher proportions of African American residents had greater odds of hospitalization (adjusted odds ratio [AOR] 1.14; 95% confidence interval [CI] 1.10, 1.18 in New York and AOR 1.35; 95% CI 1.24, 1.46 in Mississippi). Age and frailty interacted with race; older African Americans had a 16% greater likelihood (95% CI 1.08, 1.24) of hospitalization, and African Americans with more functional limitations had a 37% (95% CI 1.24, 1.51) greater likelihood of hospitalization than did comparable whites. CONCLUSIONS It appears higher end-of-life hospitalization rates for African American residents are attributable to the facilities where most reside, and to differential hospitalization of older or more functional limited residents.
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Affiliation(s)
- Vincent Mor
- Department of Community Health, Center for Gerontology and Health Care Research, Brown University Medical School, Providence, Rhode Island 02912, USA.
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21
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Abstract
AIMS Smoking cessation treatment trials often require that smokers quit on or before a protocol-defined date. The goals of this paper were to: (1) identify factors associated with adherence to a protocol-defined quit date and (2) determine whether such adherence predicts cessation outcome (relapse). DESIGN A quasi-experimental secondary analysis of data collected from a randomized placebo-controlled trial of fluoxetine (60 mg or 30 mg) versus placebo for smoking cessation. SETTING AND PARTICIPANTS Clinic-based smoking cessation treatment program comprising 989 non-depressed smokers. INTERVENTION Participants received cognitive behavioral therapy for smoking cessation and either study medication or placebo for 10 weeks. They were required to set a quit date within 2 weeks of their second study visit (by visit 4). FINDINGS Significant predictors of quit date adherence were low nicotine dependence and active drug treatment. High-dose fluoxetine (60 mg) and male gender were protective against relapse. Adherence to quit date was not an independent predictor of relapse; instead there was a significant interaction between quit date adherence and gender. Among non-adherers to the quit date, women were more than 2.5 times as likely as men to relapse; among adherers to the quit date, women were only 1.3 times as likely as men to relapse. CONCLUSIONS Although women were more likely than men to relapse regardless of quit date adherence, adherence was strongly protective against relapse for women.
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Affiliation(s)
- Belinda Borrelli
- Center for Behavioral and Preventive Medicine, Brown Medical School, Providence, RI, USA.
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Affiliation(s)
- Robert L Stout
- Decision Sciences Institute, Providence, Rhode Island 02096, USA
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23
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DePue JD, Goldstein MG, Schilling A, Reiss P, Papandonatos G, Sciamanna C, Kazura A. Dissemination of the AHCPR clinical practice guideline in community health centres. Tob Control 2002; 11:329-35. [PMID: 12432158 PMCID: PMC1747684 DOI: 10.1136/tc.11.4.329] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate dissemination of the Agency for Health Care Policy and Research (AHCPR) Smoking cessation clinical practice guideline in community health centres. DESIGN Pre- and post-trial. SETTING Fourteen community health centres in Rhode Island. SUBJECTS Provider performance was assessed with 1798 and 1591 patient contacts, in pre-post cross sectional consecutive samples, respectively, and 891 contacts at one year follow up. INTERVENTIONS Three, one hour on-site provider training sessions, on review of effective tobacco interventions, use of office systems, and tobacco counselling skill building. OUTCOME MEASURES Chart documentation of four A's (Ask, Advise, Assist, and Arrange follow up) at most recent primary care visit. RESULTS While average performance rates increased for Ask and Advise (from 30% to 44%, and 19% to 26%, pre-post, respectively), significant increases were found only for some visit types, with further differences by patient sex. There were significant increases for Ask for all except obstetric/gynaecological (ob/gyn) visit types. Patients at yearly physicals and first visits were more likely to be asked at all time points, while males were more likely to be asked at acute visits than were females. There were no significant increases for Advise, Assist, and Arrange across time, although female patients showed a differential increase in Advise post-training. Advise was significantly more likely in yearly physicals and first visits, and less likely in ob/gyn visits, at all time points. CONCLUSIONS This guideline dissemination effort resulted in quite different provider counselling rates across patient sexes, and visit types. Guideline implementation may require more sustained efforts, with multiple strategies, which are reinforced at higher policy levels, to more fully integrate tobacco interventions into routine primary care practice with all patients who smoke.
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Affiliation(s)
- J D DePue
- The Centers for Behavioral and Preventive Medicine, the Miriam Hospital/Brown Medical School, Providence, Rhode Island 02903, USA.
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24
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Borrelli B, McQuaid EL, Becker B, Hammond K, Papandonatos G, Fritz G, Abrams D. Motivating parents of kids with asthma to quit smoking: the PAQS project. Health Educ Res 2002; 17:659-669. [PMID: 12408210 DOI: 10.1093/her/17.5.659] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The Parents of Asthmatics Quit Smoking (PAQS) project contrasts two theory-based smoking cessation interventions for parents of children with asthma, and compares mechanisms of behavior change within and across theoretical perspectives. We hypothesize that enhancing the perception of risk to self and child will motivate smoking cessation more than standard approaches that emphasize building self-efficacy and coping skills for quitting in a population that is largely not motivated to quit smoking. Smokers (n = 288) and their asthmatic children who receive nurse-delivered in-home asthma education (as part of the insurance carrier's standard of care) are randomized into one of two treatment conditions: (1) the Behavioral Action Model (BAM), in which nurses emphasize goal setting and skill building to enhance self-efficacy to quit smoking, or 2) the Precaution Adoption Model (PAM), in which nurses tailor the intervention to the smoker's readiness to quit and incorporate biomarker feedback [i.e. level of carbon monoxide exposure to the smoker and level of environmental tobacco smoke (ETS) exposure to the child] in order to increase risk perception in smokers. In both conditions, smokers who are ready to quit receive the nicotine patch. Analyses will examine (1) quit rates, ETS level and motivation to quit as the primary dependent variables, (2) mediators of behavior change between and within conditions, and (3) relations between parent smoking outcomes and child asthma morbidity (i.e. ER visits and asthma symptoms) post-treatment. Results will help tailor interventions to this population, and identify mechanisms of behavior change that result in adaptive health outcomes for smokers and their children who have asthma.
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Affiliation(s)
- Belinda Borrelli
- Center for Behavioral and Preventive Medicine, Brown University, Providence, RI 02903, USA.
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25
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Lloyd-Richardson EE, Papandonatos G, Kazura A, Stanton C, Niaura R. Differentiating stages of smoking intensity among adolescents: stage-specific psychological and social influences. J Consult Clin Psychol 2002. [PMID: 12182283 DOI: 10.1037//0022-006x.70.4.998] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers' understanding of the impact of sociocultural and psychological factors on the various stages of adolescent smoking uptake is limited. Using national data, the authors examined transitions across smoking stages among adolescents (N = 20,747) as a function of interpersonal, familial, and peer domains. Peer smoking was particularly influential on differentiating regular smoking, whereas alcohol use was most influential on earlier smoking. Although significant, depression and delinquency were attenuated in the context of other variables. Higher school grade was more likely to differentiate regular smoking from earlier smoking stages, whereas African American ethnicity and connectedness to school and family were protective of smoking initiation. Results lend support for an interactional approach to adolescent smoking, with implications for stage-matched prevention and intervention applications.
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Affiliation(s)
- Elizabeth E Lloyd-Richardson
- Centers for Behavioral and Preventive Medicine, Brown Medical School/The Miriam Hospital, Providence, Rhode Island 02903, USA.
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26
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Lloyd-Richardson EE, Papandonatos G, Kazura A, Stanton C, Niaura R. Differentiating stages of smoking intensity among adolescents: stage-specific psychological and social influences. J Consult Clin Psychol 2002; 70:998-1009. [PMID: 12182283 DOI: 10.1037/0022-006x.70.4.998] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers' understanding of the impact of sociocultural and psychological factors on the various stages of adolescent smoking uptake is limited. Using national data, the authors examined transitions across smoking stages among adolescents (N = 20,747) as a function of interpersonal, familial, and peer domains. Peer smoking was particularly influential on differentiating regular smoking, whereas alcohol use was most influential on earlier smoking. Although significant, depression and delinquency were attenuated in the context of other variables. Higher school grade was more likely to differentiate regular smoking from earlier smoking stages, whereas African American ethnicity and connectedness to school and family were protective of smoking initiation. Results lend support for an interactional approach to adolescent smoking, with implications for stage-matched prevention and intervention applications.
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Affiliation(s)
- Elizabeth E Lloyd-Richardson
- Centers for Behavioral and Preventive Medicine, Brown Medical School/The Miriam Hospital, Providence, Rhode Island 02903, USA.
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27
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Borrelli B, Spring B, Niaura R, Hitsman B, Papandonatos G. Influences of gender and weight gain on short-term relapse to smoking in a cessation trial. J Consult Clin Psychol 2001. [PMID: 11495180 DOI: 10.1037//0022-006x.69.3.511] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few researchers have studied whether weight gain has an impact on short-term relapse to smoking. The authors of this study investigated predictors of relapse among 989 participants (60% women) in a randomized, double-blind, 10-week multicenter trial to determine the effect of fluoxetine (30 or 60 mg) versus placebo in combination with behavioral counseling for smoking cessation. Medication compliance and smoking status were biochemically verified. At Visit 2, participants were asked to set a quit date within the subsequent 2 visits. A proportional hazards regression model was used to predict risk of relapse within the first 3 months of quitting. Weight gain predicted relapse, but for men only. Female gender also predicted relapse. The results led the authors to question whether postcessation weight gain interventions should be restricted to women smokers.
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Affiliation(s)
- B Borrelli
- Center for Behavioral and Preventive Medicine, Brown University School of Medicine, Miriam Hospital, Providence, Rhode Island 02903, USA.
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28
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Borrelli B, Spring B, Niaura R, Hitsman B, Papandonatos G. Influences of gender and weight gain on short-term relapse to smoking in a cessation trial. J Consult Clin Psychol 2001; 69:511-5. [PMID: 11495180 DOI: 10.1037/0022-006x.69.3.511] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few researchers have studied whether weight gain has an impact on short-term relapse to smoking. The authors of this study investigated predictors of relapse among 989 participants (60% women) in a randomized, double-blind, 10-week multicenter trial to determine the effect of fluoxetine (30 or 60 mg) versus placebo in combination with behavioral counseling for smoking cessation. Medication compliance and smoking status were biochemically verified. At Visit 2, participants were asked to set a quit date within the subsequent 2 visits. A proportional hazards regression model was used to predict risk of relapse within the first 3 months of quitting. Weight gain predicted relapse, but for men only. Female gender also predicted relapse. The results led the authors to question whether postcessation weight gain interventions should be restricted to women smokers.
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Affiliation(s)
- B Borrelli
- Center for Behavioral and Preventive Medicine, Brown University School of Medicine, Miriam Hospital, Providence, Rhode Island 02903, USA.
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29
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Sucato DJ, Rougraff B, McGrath BE, Sizinski J, Davis M, Papandonatos G, Green D, Szarzanowicz T, Mindell ER. Ewing's sarcoma of the pelvis. Long-term survival and functional outcome. Clin Orthop Relat Res 2000:193-201. [PMID: 10810477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fifty patients with Ewing's sarcoma of the pelvis were treated using a multidisciplinary approach; followup of surviving patients averaged 137 months (range, 40-276 months). The addition of surgical resection to the multidisciplinary treatment for all patients was associated with improved survival compared with survival of patients treated with chemotherapy and radiation therapy alone; the addition of surgery to the treatment regimen of 37 patients without metastases also was associated with improved survival. There were no significant differences between the surgical and nonsurgical groups in terms of tumor size, stage of disease, patient age, duration of symptoms before diagnosis, or anatomic site. Surgery was used more often in recently treated patients, but the year of diagnosis and treatment did not significantly affect overall survival, secondary to large confidence intervals. The Short Form-36 and the Musculoskeletal Tumor Society functional evaluation instruments showed a superior level of function in the nonsurgical group, but this difference was not statistically significant. There have been many advances in the treatment of patients with Ewing's sarcoma during the past 3 decades, resulting in improved survival for patients with Ewing's sarcoma of the pelvis. The addition of surgery significantly improved survival and did not show a significant difference in functional outcome.
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Affiliation(s)
- D J Sucato
- Department of Orthopedic Surgery, State University of New York at Buffalo, USA
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Abstract
To test the hypothesis that fetal pancreatic exocrine and endocrine function are stimulated in parallel in the diabetic pregnancy, 68 mothers with gestational and pregestational diabetes who underwent amniocenteses after 34 weeks' for the evaluation of fetal lung maturity were enrolled. Amniotic fluid specimens were analyzed for C-peptide and trypsin content. Amniotic fluid specimens were obtained from 92 non-diabetic women undergoing amniocenteses for lung maturity, preterm labor, or premature rupture of membranes. Groups were compared using the Wilcoxon rank-sum test, Kruskal Wallis rank sum test, and Spearman's rank correlation test. C-peptide amniotic fluid concentrations were significantly greater in diabetics (median 0.6 ng/ml) than non-diabetics (median 0.4 ng/ml, P= 0.0001), in pregestational (median 0.6 ng/ml) vs. gestational diabetics (median 0.4 ng/ml, P = 0.006), and greater in proportion to severity of disease according to diabetic class (A1 = 0.4 ng/ml, A2 = 0.55 ng/ml, B = 0.6 ng/ml, C = 0.7 ng/ml, D = 0.85 ng/ml, P = 0.04). No significant differences were detected in amniotic fluid trypsin between the diabetic and non-diabetic or the gestational and non-gestational diabetic groups. There was no correlation between C-peptide and trypsin within the diabetic groups. Stimulation of the exocrine and endocrine pancreas does not occur in parallel in the fetus of the diabetic mother. Although originating as a single organ, pancreatic exocrine and endocrine functions are distinct in both physiologic and pathologic conditions.
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Affiliation(s)
- Y G Gollin
- The Children's Hospital of Buffalo, Department of Obstetrics and Gynecology, State University of New York at Buffalo, USA
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