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Richardson TN, Ventura AK, Brewer A, Shirwani A, de la Barrera B, Kay MC. Awareness and Support of Responsive Bottle Feeding Among WIC Counselors and Caregivers: A Formative Qualitative Study. J Nutr Educ Behav 2024; 56:342-350. [PMID: 38466247 PMCID: PMC11081858 DOI: 10.1016/j.jneb.2024.01.009] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To understand the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counselor experiences discussing responsive bottle feeding during counseling and WIC participants' knowledge, understanding, and use of responsive bottle feeding. METHODS Qualitative descriptive, semistructured interviews with 23 participants (8 WIC counselors and 15 WIC participants) were conducted online via Zoom. The WIC counselors and mothers of WIC-enrolled bottle-fed infants were recruited through a network of WIC clinics in North Carolina. Interviews were recorded, transcribed, and collaboratively analyzed using content analysis. RESULTS The WIC participants received responsive infant feeding support from WIC counselors but often in the context of breastfeeding. WIC counselors provided valuable support for families but were challenged by limited training on responsive bottle feeding, balancing promoting breastfeeding with supporting mothers' feeding decisions, and time constraints. CONCLUSIONS AND IMPLICATIONS Findings provide preliminary support for the need to develop and pilot an intervention focused on promoting responsive feeding for parents of bottle-fed infants.
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Affiliation(s)
- Taylor N Richardson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Alison K Ventura
- Department of Kinesiology and Public Health and Center for Health Research, California Polytechnic State University, San Luis Obispo, CA
| | | | - Avan Shirwani
- School of Osteopathic Medicine, Campbell University, Lillington, NC
| | | | - Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC
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Abstract
This JAMA Pediatrics Patient Page describes the benefits of eating family meals together at home.
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Affiliation(s)
- Callie L Brown
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Melissa C Kay
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Lindsay A Thompson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Miller HN, Gallis JA, Berger MB, Askew S, Egger JR, Kay MC, Finkelstein EA, de Leon M, DeVries A, Brewer A, Holder MG, Bennett GG. Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial. J Med Internet Res 2024; 26:e50330. [PMID: 38416574 PMCID: PMC11009856 DOI: 10.2196/50330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The prevalence of obesity and its associated comorbidities continue to rise in the United States. Populations who are uninsured and from racial and ethnic minority groups continue to be disproportionately affected. These populations also experience fewer clinically meaningful outcomes in most weight loss trials. Weight gain prevention presents a useful strategy for individuals who experience barriers to weight loss. Given the often-limited weight management resources available to patients in primary care settings serving vulnerable patients, evaluating interventions with pragmatic designs may help inform the design of comprehensive obesity care delivered in primary care. OBJECTIVE This study aims to evaluate the effectiveness of Balance, a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention, delivered to patients receiving primary care within federally qualified community health centers. METHODS Balance was a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention delivered to individuals who had a BMI of 25-40 kg/m2, spoke English or Spanish, and were receiving primary care within a network of federally qualified community health centers in North Carolina. The Balance intervention was designed to encourage behavioral changes that result in a slight energy deficit. Intervention participants received tailored goal setting and tracking, skills training, self-monitoring, and responsive health coaching from registered dietitians. Weight was measured at regular primary care visits and documented in the electronic health record. We compared the percentage of ≤3% weight gain in each arm at 24 months after randomization-our primary outcome-using individual empirical best linear unbiased predictors from the linear mixed-effects model. We used individual empirical best linear unbiased predictors from participants with at least 1 electronic health record weight documented within a 6-month window centered on the 24-month time point. RESULTS We randomized 443 participants, of which 223 (50.3%) participants were allocated to the intervention arm. At baseline, participants had a mean BMI of 32.6 kg/m2. Most participants were Latino or Hispanic (n=200, 45.1%) or non-Latino or Hispanic White (n=115, 26%). In total, 53% (n=235) of participants had at least 1 visit with weight measured in the primary time window. The intervention group had a higher proportion with ≤3% weight gain at 6 months (risk ratio=1.12, 95% CI 0.94-1.28; risk difference=9.5, 95% CI -4.5 to 16.4 percentage points). This difference attenuated to the null by 24 months (risk ratio=1.00, 95% CI 0.82-1.20; risk difference=0.2, 95% CI -12.1 to 11.0 percentage points). CONCLUSIONS In adults with overweight or obesity receiving primary care at a community health center, we did not find long-term evidence to support the dissemination of a digital health intervention for weight gain prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT03003403; https://clinicaltrials.gov/study/NCT03003403. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-019-6926-7.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Miriam B Berger
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC, United States
| | - Eric Andrew Finkelstein
- Duke-NUS Medical School Singapore, Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | | | - Ashley Brewer
- Piedmont Health Services, Inc, Chapel Hill, NC, United States
| | - Marni Gwyther Holder
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gary G Bennett
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
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Bernate Angulo SV, Nezami BT, Martin SL, Kay MC, Richardson TN, Wasser HM. Concordance in dietary intake among caregivers and infants during the period of complementary feeding: A scoping review. Appetite 2024; 194:107178. [PMID: 38141877 PMCID: PMC11027945 DOI: 10.1016/j.appet.2023.107178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
Dietary intake during infancy shapes later food preferences and is important for short- and long-term health and wellbeing. Although caregivers are thought to influence the developing food preferences of infants, children less than two years have been notably absent in existing meta-analyses on the topic. This scoping review seeks to fill this gap by using a systematic process to identify and summarize the published literature on the resemblance of caregiver and infant diet during the period of complementary feeding (6-23 months). Articles were included if they assessed intake of foods or beverages other than human milk or commercial milk formula and reported a test of association between the intake of caregivers and infants. Four electronic databases (PubMed, EMBASE, Scopus, and Global Health) were systematically searched for articles published since 2000. Thirty-three articles, representing 32 studies, were identified. The majority of studies examined infant intake of food groups/items (n = 20), seven studies examined infant dietary patterns, and six studies examined dietary diversity. Studies predominantly reported associations between diets of mothers and infants (n = 31); three studies reported associations for fathers. Most studies assessed infant diet at one timepoint (n = 26), with 12 studies combining the intakes of younger (0-11 months) and older infants (12-23 months). Food groups examined, in order of frequency, included 'non-core' foods and beverages (n = 14), vegetables (n = 13), fruits (n = 12), protein foods (n = 6), grains (n = 5), and dairy foods (n = 4). Definitions of variables for food groups and dietary patterns were highly heterogeneous, but consistent for dietary diversity. Nearly all studies (n = 31) reported significant associations between dietary intakes of caregivers and infants. Findings suggest caregiver diet may be a promising focus for interventions aiming to shape the food preferences and dietary intakes of infants.
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Affiliation(s)
- Sara V Bernate Angulo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Brooke T Nezami
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC, 27708, USA
| | - Taylor N Richardson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Heather M Wasser
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Hammad NM, Kay MC. Perspectives on healthy eating practices and acceptance of WIC-approved foods among parents of young children enrolled in WIC. PLoS One 2023; 18:e0295902. [PMID: 38127887 PMCID: PMC10734995 DOI: 10.1371/journal.pone.0295902] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The prevalence of childhood obesity remains high in the United States, particularly among children living in low-income households. Diet quality plays an important role in obesity prevention, particularly among mothers as they serve as role models. Those served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receive nutrient-rich foods aimed at increasing diet quality, yet redemption is low. Digital interventions targeting WIC parents show potential for behavior change and could be used for childhood obesity prevention. METHODS This study describes the formative research conducted to understand perspectives on healthy eating practices, acceptance of WIC-approved foods, and preferences for the use of digital tools to improve the purchasing and consumption of WIC-approved foods to improve diet quality. In-depth interviews were conducted with 13 WIC parents and caregivers. RESULTS A variety of definitions for and misconceptions about healthy eating exist among WIC caregivers. Most purchased foods were fruits, vegetables, milk, cheese, and eggs and the least purchased foods were yogurt and peanut butter. The biggest facilitator for purchasing WIC-approved foods was the preference of children and caregivers, whereas the biggest barrier was children's picky eating behaviors. Most caregivers reported using their phone to get nutrition information. Most caregivers reported their interest in receiving weekly text messages and indicated preferences about receiving recipes. CONCLUSION A text messaging program that includes sending weekly messages, recipes, and nutrition tips is hypothesized to improve diet quality and increase redemption of WIC-approved foods.
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Affiliation(s)
- Nour M. Hammad
- Department of Nutrition, Harvard University, Boston, Massachusetts, United States of America
| | - Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, North Carolina, United States of America
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Lutz MR, Orr CJ, Shonna Yin H, Heerman WJ, Flower KB, Sanders LM, Rothman RL, Schildcrout JS, Bian A, Kay MC, Wood CT, Delamater AM, Perrin EM. TV Time, Especially During Meals, is Associated with Less Healthy Dietary Practices in Toddlers. Acad Pediatr 2023:S1876-2859(23)00370-4. [PMID: 37802249 DOI: 10.1016/j.acap.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/23/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND While several studies examine the relationship between screen time and dietary practices in children and teenagers, there is limited research in toddlers. This study evaluates the association between television (TV) exposure and dietary practices in two-year-old children. METHODS We conducted a cross-sectional, secondary data analysis from the Greenlight Intervention Study. Toddlers' daily TV watching time, mealtime TV, and dietary practices were assessed by caregiver report at the 24-month well child visit. Separate regression models were used and adjusted for sociodemographic/household characteristics and clinic site. RESULTS 532 toddlers were included (51% Latino; 30% non-Latino Black; 59% ≤$20,000 annual household income). Median daily TV watching time was 42 minutes [IQR: 25, 60]; 25% reported the TV was "usually on" during mealtimes. After adjustment, toddlers who watched more TV daily had higher odds of consuming sugar-sweetened beverages (SSB), fast food, and more junk food; those watching less TV had higher odds of consuming more fruits/vegetables. Those with the TV "usually on" during mealtimes were more likely to consume SSB [aOR 3.72 (95%CI 2.16-6.43)], fast food [aOR 2.83 (95%CI 1.54-5.20)], and more junk food [aOR 4.25 (95%CI 2.71-6.65)]. CONCLUSIONS Among toddlers from primarily minoritized populations and of lower socioeconomic status, those who watched more TV daily and usually had the TV on during meals had significantly less healthy dietary practices, even after adjusting for known covariates. This study supports the current American Academy of Pediatrics screen time guidelines and underscores the importance of early counseling on general and mealtime TV.
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Affiliation(s)
- Melissa R Lutz
- Department of Pediatrics, Johns Hopkins University School of Medicine.
| | - Colin J Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill.
| | - H Shonna Yin
- Department of Pediatrics and Population Health, New York University Grossman School of Medicine.
| | | | - Kori B Flower
- Department of Pediatrics, University of North Carolina at Chapel Hill.
| | - Lee M Sanders
- Departments of Pediatrics and Health Policy, Stanford University.
| | - Russell L Rothman
- Department of Pediatrics, Vanderbilt University Medical Center; Department of Internal Medicine, Vanderbilt University Medical Center.
| | | | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center.
| | - Melissa C Kay
- Duke Center for Childhood Obesity Research and Duke Global Digital Health Science Center, Duke University School of Medicine, and Duke Global Health Institute.
| | - Charles T Wood
- Department of Pediatrics, Duke University School of Medicine.
| | - Alan M Delamater
- Mailman Center for Child Development, University of Miami Miller School of Medicine.
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins University School of Medicine; Johns Hopkins School of Nursing.
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Kay MC, Pankiewicz AR, Schildcrout JS, Wallace S, Wood CT, Shonna Yin H, Rothman RL, Sanders LM, Orr C, Delamater AM, Flower KB, Perrin EM. Early Sweet Tooth: Juice Introduction During Early Infancy is Related to Toddler Juice Intake. Acad Pediatr 2023; 23:1343-1350. [PMID: 37150479 PMCID: PMC10592660 DOI: 10.1016/j.acap.2023.04.009] [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: 08/15/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess if 100% fruit juice intake prior to 6 months is associated with juice and sugar-sweetened beverage (SSB) intake at 24 months and whether this differs by sociodemographic factors. METHODS We used longitudinal data from infants enrolled in the control (no obesity intervention) arm of Greenlight, a cluster randomized trial to prevent childhood obesity which included parent-reported child 100% fruit juice intake at all well child checks between 2 and 24 months. We studied the relationship between the age of juice introduction (before vs after 6 months) and juice and SSB intake at 24 months using negative binomial regression while controlling for baseline sociodemographic factors. RESULTS We report results for 187 participants (43% Hispanic, 39% non-Hispanic Black), more than half (54%) of whom had reported 100% fruit juice intake before 6 months. Average 100% fruit juice intake at 24 months was greater than the recommended amount (of 4 oz) and was 8.2 oz and 5.3 oz for those who had and had not, respectively, been introduced to juice before 6 months. In adjusted models, early introduction of juice was associated with a 43% (95% confidence interval: 5%-96%) increase in juice intake at 24 months. CONCLUSIONS 100% fruit juice intake exceeding recommended levels at 6 and 24 months in this diverse cohort was prevalent. Introducing 100% fruit juice prior to 6 months may put children at greater risk for more juice intake as they age. Further research is necessary to determine if early guidance can reduce juice intake.
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Affiliation(s)
- Melissa C Kay
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Aaron R Pankiewicz
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Jonathan S Schildcrout
- Department of Biostatistics (JS Schildcrout), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Shelby Wallace
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Charles T Wood
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - H Shonna Yin
- Departments of Pediatrics and Population Health (H Shonna Yin), New York University Grossman School of Medicine.
| | - Russell L Rothman
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Lee M Sanders
- Department of Pediatrics (LM Sanders), Stanford University, Calif.
| | - Colin Orr
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Alan M Delamater
- Department of Pediatrics (AM Delamater), University of Miami, Coral Gables, Fla.
| | - Kori B Flower
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Md.
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Kay MC, Hennink-Kaminski H, Kerr ZY, Gildner P, Ingram BM, Cameron KL, Houston MN, Linnan LA, Marshall SW, Peck KY, Register-Mihalik JK. Factors and expectations influencing concussion disclosure within NCAA Division I athletes: A mixed methodological approach. J Sport Health Sci 2023; 12:388-397. [PMID: 34547482 DOI: 10.1016/j.jshs.2021.09.006] [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] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Participation in sports is associated with many benefits to all aspects of health; however, it also comes with the risk of injury, particularly concussions. Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms. Although recent research has explored factors affecting concussion disclosure, use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. METHODS This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions about disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research tradition. RESULTS Participants had good concussion knowledge (median = 46.0), positive attitudes (median = 38.0), strong beliefs (median = 13.0), and strong intentions to disclose concussion symptoms (median = 7.0). None of the constructs differed by participants' gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. CONCLUSION The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions. Interventions must prioritize stakeholder- and team-based perspectives on concussion to establish a network supportive to disclosure.
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Affiliation(s)
- Melissa C Kay
- School of Health Professions, College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Zachary Y Kerr
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brittany M Ingram
- Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA; Departments of Physical Medicine and Rehabilitation and Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Megan N Houston
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Laura A Linnan
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen Y Peck
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Johna K Register-Mihalik
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Berger MB, Chisholm M, Miller HN, Askew S, Kay MC, Bennett GG. "We bleed for our community:" A qualitative exploration of the implementation of a pragmatic weight gain prevention trial from the perspectives of community health center professionals. BMC Public Health 2023; 23:695. [PMID: 37060053 PMCID: PMC10103522 DOI: 10.1186/s12889-023-15574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Clinical trial implementation continues to shift toward pragmatic design, with the goal of increasing future adoption in clinical practice. Yet, few pragmatic trials within clinical settings have qualitatively assessed stakeholder input, especially from those most impacted by research implementation and outcomes, i.e., providers and staff. Within this context, we conducted a qualitative study of the implementation of a pragmatic digital health obesity trial with employees at a Federally qualified health center (FQHC) network in central North Carolina. METHODS Participant recruitment was conducted through purposive sampling of FQHC employees from a variety of backgrounds. Two researchers conducted semi-structured qualitative interviews and collected demographic data. Interviews were digitally recorded, professionally transcribed and double-coded by two independent researchers using NVivo 12. Coding discrepancies were reviewed by a third researcher until intercoder consensus was reached. Responses were compared within and across participants to elucidate emergent themes. RESULTS Eighteen qualitative interviews were conducted, of whom 39% provided direct medical care to patients and 44% worked at the FQHC for at least seven years. Results illuminated the challenges and successes of a pragmatically designed obesity treatment intervention within the community that serves medically vulnerable patients. Although limited time and staffing shortages may have challenged recruitment processes, respondents described early buy-in from leadership; an alignment of organizational and research goals; and consideration of patient needs as facilitators to implementation. Respondents also described the need for personnel power to sustain novel research interventions and considerations of health center resource constraints. CONCLUSIONS Results from this study contribute to the limited literature on pragmatic trials utilizing qualitative methods, particularly in community-based obesity treatment. To continue to merge the gaps between research implementation and clinical care, qualitative assessments that solicit stakeholder input are needed within pragmatic trial design. For maximum impact, researchers may wish to solicit input from a variety of professionals at trial onset and ensure that shared common goals and open collaboration between all partners is maintained throughout the trial. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (NCT03003403) on December 28, 2016.
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Affiliation(s)
- Miriam B Berger
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA.
| | - Miriam Chisholm
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Hailey N Miller
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, USA
| | - Sandy Askew
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Melissa C Kay
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
- Department of Pediatrics, Duke University, 3116 N. Duke Street, Room 1029, 27704, Durham, NC, USA
| | - Gary G Bennett
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
- Department of Psychology and Neuroscience, Duke University, 222 Reuben-Cooke, Durham, NC, 27708, USA
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Lyons GC, Kay MC, Duke NN, Bian A, Schildcrout JS, Perrin EM, Rothman RL, Yin HS, Sanders LM, Flower KB, Delamater AM, Heerman WJ. Social Support and Breastfeeding Outcomes Among a Racially and Ethnically Diverse Population. Am J Prev Med 2023; 64:352-360. [PMID: 36460526 PMCID: PMC9974778 DOI: 10.1016/j.amepre.2022.10.002] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Social support is a modifiable social determinant of health that shapes breastfeeding outcomes and may contribute to racial and ethnic breastfeeding disparities. This study characterizes the relationship between social support and early breastfeeding. METHODS This is a cross-sectional analysis of baseline data collected in 2019-2021 for an RCT. Social support was measured using the Enhancing Recovery in Coronary Heart Disease Social Support Instrument. Outcomes, collected by self-report, included (1) early breastfeeding within the first 21 days of life, (2) planned breastfeeding duration, and (3) confidence in meeting breastfeeding goals. Each outcome was modeled using proportional odds regression, adjusting for covariates. Analysis was conducted in 2021-2022. RESULTS Self-reported race and ethnicity among 883 mothers were 50% Hispanic, 17% Black, 23% White, and 10% other. A large proportion (88%) of mothers were breastfeeding. Most breastfeeding mothers (82%) planned to breastfeed for at least 6 months, with more than half (58%) planning to continue for 12 months or more. Most women (65%) were confident or very confident in meeting their breastfeeding duration goal. In adjusted models, perceived social support was associated with planned breastfeeding duration (p=0.042) but not with early breastfeeding (p=0.873) or confidence in meeting breastfeeding goals (p=0.427). Among the covariates, maternal depressive symptoms were associated with lower breastfeeding confidence (p<0.001). CONCLUSIONS The associations between perceived social support and breastfeeding outcomes are nuanced. In this sample of racially and ethnically diverse mothers, social support was associated with longer planned breastfeeding duration but not with early breastfeeding or breastfeeding confidence.
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Affiliation(s)
| | - Melissa C Kay
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Naomi N Duke
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Eliana M Perrin
- Department of Pediatrics, Schools of Medicine and Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Russell L Rothman
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - H Shonna Yin
- Department of Pediatrics, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | - Lee M Sanders
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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11
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Kay MC, Hammad NM, Truong T, Herring SJ, Bennett GG. Feasibility, Acceptability, and Initial Efficacy of a Digital Intervention to Improve Consumption of Foods Received within a National Nutrition Assistance Program. Nutrients 2023; 15:nu15020438. [PMID: 36678309 PMCID: PMC9861113 DOI: 10.3390/nu15020438] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Many mothers are vulnerable to poor diet quality, particularly those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrient-rich foods through its benefits packages, but many WIC participants are not redeeming them. We assessed the feasibility and acceptability of a digital intervention to support redemption and consumption of WIC-approved foods to ultimately improve diet quality. We enrolled 54 maternal-child dyads receiving WIC benefits to receive three to four weekly text messages for 12 weeks focused on behavioral goals to improve consumption of WIC-approved foods. We assessed engagement with weekly tracking messages and satisfaction and collected 24 h dietary recalls to assess preliminary efficacy on dietary intake. Participants were mostly non-Hispanic white (63%) and working (63%), and responded to 7.4 (standard deviation: 4.6) of the 12 weekly messages. Half (n = 27) were high engagers (responded to 80% or more of weekly messages), with 28% (n = 15) responding to all messages. Most felt the feedback (94%) and tips (87%) were helpful and would recommend the program (91%). More were consuming leafy green vegetables compared to baseline (p = 0.01). Mothers of children enrolled in WIC found a text messaging intervention focused on consumption of WIC-approved foods enjoyable and helpful.
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Affiliation(s)
- Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, NC 27708, USA
- Correspondence:
| | - Nour M. Hammad
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27708, USA
| | - Sharon J. Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Temple University, Philadelphia, PA 19140, USA
| | - Gary G. Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
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12
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Kay MC, Duffy EW, Sun B, Borger C. Comparing Diet Quality Indices for Low-Income 24-Month-Old Toddlers: Exploring Changes Driven by 2020-2025 Dietary Guidelines for Americans. J Nutr 2023; 153:215-224. [PMID: 36913456 PMCID: PMC10196569 DOI: 10.1016/j.tjnut.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Accurate assessment of toddler diet quality is essential for understanding current intakes and evaluating the effect of interventions and programs to promote healthy eating and prevent chronic disease. OBJECTIVES The goal of this article was to assess the diet quality among toddlers using two different indices appropriate for 24-mo-old toddlers and compare differences in scoring between the measures by race and Hispanic origin. METHODS We used cross-sectional data from 24-mo-old toddlers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a national study that includes 24-hour dietary recall information from children enrolled in WIC at birth. The main outcome measure was diet quality using both the toddler diet quality index (TDQI) and the healthy eating index (HEI)-2015. We derived mean scores for overall diet quality and for each component. We examined associations between the distribution of diet quality scores across terciles and by race and Hispanic origin using Rao-Scott chi-square tests of association. RESULTS Nearly half of the mothers and caregivers self-identified as Hispanic (49%). Diet quality scores were higher when using the HEI-2015 compared with the TDQI (56.4 vs. 49.9, respectively). The difference in component scores was largest for refined grains, followed by sodium, added sugars, and dairy. Toddlers from Hispanic mothers and caregivers had significantly higher component scores for greens and beans and dairy but had lower scores for whole grains (P < 0.05) than those for the other racial and ethnic subgroups assessed. CONCLUSIONS We found noteworthy differences in toddler diet quality depending on whether the HEI-2015 or TDQI is used, and children of different racial and ethnic subgroups may be differentially classified as having high or low diet quality depending on which index is used. This may have important implications for understanding which populations are at risk of future diet-related diseases.
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Affiliation(s)
- Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC, USA.
| | - Emily W Duffy
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
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Heerman WJ, Perrin EM, Yin HS, Schildcrout JS, Delamater AM, Flower KB, Sanders L, Wood C, Kay MC, Adams LE, Rothman RL. The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity. Contemp Clin Trials 2022; 123:106987. [PMID: 36323344 DOI: 10.1016/j.cct.2022.106987] [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: 04/01/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. METHODS This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. CONCLUSIONS By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.
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Affiliation(s)
- William J Heerman
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Eliana M Perrin
- Johns Hopkins University, Department of Pediatrics, Schools of Medicine and Nursing, 200 N. Wolfe St, Rubenstein Building-2071, Baltimore, MD 21287, United States of America.
| | - H Shonna Yin
- New York University School of Medicine, Departments of Pediatrics and Population Health, 550 First Avenue, New York, NY 10016, United States of America.
| | - Jonathan S Schildcrout
- Vanderbilt University Medical Center, Department of Biostatistics, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave., Miami, FL 33136, United States of America.
| | - Kori B Flower
- University of North Carolina at Chapel Hill, Division of General Pediatrics and Adolescent Medicine, 231 MacNider Building, CB# 7225, 321 S. Columbia Street, UNC School of Medicine, Chapel Hill, NC 27599-7225, United States of America.
| | - Lee Sanders
- Stanford University School of Medicine, United States of America.
| | - Charles Wood
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Melissa C Kay
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Russell L Rothman
- Vanderbilt University Medical Center, Institute of Medicine and Public Health, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
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14
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Kay MC, Miller HN, Askew S, Spaulding EM, Chisholm M, Christy J, Yang Q, Steinberg DM. Patterns of Engagement With an Application-Based Dietary Self-Monitoring Tool Within a Randomized Controlled Feasibility Trial. AJPM Focus 2022; 1:100037. [PMID: 37791242 PMCID: PMC10546506 DOI: 10.1016/j.focus.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The Dietary Approaches to Stop Hypertension dietary pattern is a proven way to manage hypertension, but adherence remains low. Dietary tracking applications offer a highly disseminable way to self-monitor intake on the pathway to reaching dietary goals but require consistent engagement to support behavior change. Few studies use longitudinal dietary self-monitoring data to assess trajectories and predictors of engagement. We used dietary self-monitoring data from participants in Dietary Approaches to Stop Hypertension Cloud (N=59), a feasibility trial to improve diet quality among women with hypertension, to identify trajectories of engagement and explore associations between participant characteristics. Methods We used latent class growth modeling to identify trajectories of engagement with a publicly available diet tracking application and used bivariate and regression analyses to assess the associations of classifications of engagement with participant characteristics. Results We identified 2 latent classes of engagement: consistent engagers and disengagers. Consistent engagers were more likely to be older, more educated, and married or living with a partner. Although consistent engagers exhibited slightly greater changes in Dietary Approaches to Stop Hypertension score, the difference was not significant. Conclusions This study highlights an important yet underutilized methodologic approach for uncovering dietary self-monitoring engagement patterns. Understanding how certain individuals engage with digital technologies is an important step toward designing cost-effective behavior change interventions. Trial registration This study is registered at www.clinicaltrials.gov NCT03215472.
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Affiliation(s)
- Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Hailey N. Miller
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- School of Nursing, Duke University, Durham, North Carolina
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Erin M. Spaulding
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miriam Chisholm
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Jacob Christy
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- Medable, Inc., Palo Alto, California
| | - Qing Yang
- School of Nursing, Duke University, Durham, North Carolina
| | - Dori M. Steinberg
- School of Nursing, Duke University, Durham, North Carolina
- Equip Health, Inc., Carlsbad, California
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15
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Maradiaga Panayotti GM, Miner DS, Hannon EA, Kay MC, Shaikh SK, Jooste KR, Erickson E, Kovarik T, Wood CT. Implementation of a Novel Tool to Collect Milk Feeding Data on Infants in Primary Care Clinics. Clin Pediatr (Phila) 2022; 61:768-775. [PMID: 35658591 DOI: 10.1177/00099228221101002] [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: 11/17/2022]
Abstract
We aimed to capture milk feeding type in real time in a racially and socioeconomically diverse population. An electronic tool to assess milk feeding type at every medical visit for children aged 0 to 2 years was designed and incorporated into nursing workflows. The Milk Box tool was successfully added to the electronic clinical workspace of a large health system. There were eight clinics, with diverse characteristics, which incorporated the use of the Milk Box tool over 12 months. Time to 50% uptake of Milk Box varied from 3 to 5 months. Time to >80% uptake varied from 6 to 8 months. Our results show that Milk Box can be quickly incorporated into a clinical workflow when the team is given appropriate training and support. The tool also allows a primary care practice to study local breast milk consumption trends and to provide both individualized and system-level lactation support.
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Affiliation(s)
- Gabriela M Maradiaga Panayotti
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Dean S Miner
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Health Technology Solutions, Durham, NC, USA
| | - Emily A Hannon
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Melissa C Kay
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Sophie K Shaikh
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Karen R Jooste
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth Erickson
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Charles T Wood
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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16
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Kerr ZY, Chandran A, Nedimyer AK, Rothschild AE, Kay MC, Gildner P, Byrd KH, Haarbauer-Krupa JK, Register-Mihalik JK. Use of sport-related concussion information sources among parents of United States middle school children. J Sport Health Sci 2022; 11:716-724. [PMID: 32417468 PMCID: PMC9729916 DOI: 10.1016/j.jshs.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/14/2020] [Accepted: 03/16/2020] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Parents may use various information sources to obtain information about sport-related concussions (SRC). This study examined SRC-related information sources used by parents of United States middle school children (age: 10-15 years). METHODS A panel of 1083 randomly selected U.S. residents, aged ≥18 years and identifying as parents of middle school children, completed an online questionnaire capturing parental and child characteristics, and utilization and perceived trustworthiness of various sources of SRC-related information. Multivariable logistic regression models identified factors associated with utilizing each source. Adjusted odds ratios (OR) with 95% confidence intervals (95%CIs) excluding 1.00 were deemed significant. RESULTS Doctors/healthcare providers (49.9%) and other healthcare-related resources (e.g., Centers for Disease Control and Prevention, WebMD) (37.8%) were common SRC-related information sources; 64.0% of parents utilized ≥1 of these sources. Both sources were considered "very" or "extremely" trustworthy for SRC-related information among parents using these sources (doctors/healthcare providers: 89.8%; other healthcare-related resources: 70.9%). A 10-year increase in parental age was associated with higher odds of utilizing doctors/healthcare providers (adjusted odd ratio (ORadjusted) = 1.09, 95%CI: 1.02-1.16) and other healthcare-related resources (ORadjusted = 1.11, 95%CI: 1.03-1.19). The odds of utilizing doctors/healthcare providers (ORadjusted = 0.58, 95%CI: 0.40-0.84) and other healthcare-related resources (ORadjusted = 0.64, 95%CI: 0.44-0.93) were lower among parents whose middle school children had concussion histories versus the parents of children who did not have concussion histories. CONCLUSION One-third of parents did not report using doctors/healthcare providers or other healthcare-related resources for SRC-related information. Factors associated with underutilization of these sources may be targets for future intervention. Continuing education for healthcare providers and educational opportunities for parents should highlight accurate and up-to-date SRC-related information.
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Affiliation(s)
- Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA.
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Aliza K Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC 27599-8700, USA
| | - Allison E Rothschild
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 27599-7400, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - K Hunter Byrd
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Juliet K Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
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White MJ, Kay MC, Truong T, Green CL, Yin HS, Flower KB, Rothman RL, Sanders LM, Delamater AM, Duke NN, Perrin EM. Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors. Acad Pediatr 2022; 22:1429-1436. [PMID: 35227910 PMCID: PMC10078964 DOI: 10.1016/j.acap.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors. METHODS Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their 2-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics. RESULTS Eight hundred and twenty-six mother-infant dyads (27.3% non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the United States; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. US-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the United States. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support. CONCLUSIONS Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC.
| | - Melissa C Kay
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC; Duke Global Digital Health Science Center (MC Kay), Duke University, Durham, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Hsiang Shonna Yin
- Departments of Pediatrics and Population Health (HS Yin), New York University Grossman School of Medicine, New York, NY
| | - Kori B Flower
- University of North Carolina at Chapel Hill School of Medicine (KB Flower), Chapel Hill, NC
| | - Russell L Rothman
- Department of Pediatrics (RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn
| | - Lee M Sanders
- Departments of Pediatrics and Health Policy (LM Sanders), Stanford University, Stanford, Calif
| | - Alan M Delamater
- Mailman Center for Child Development (AM Delamater), University of Miami Miller School of Medicine, Miami, Fla
| | - Naomi N Duke
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins Schools of Medicine and Nursing, Baltimore, Md
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Kay MC, Hammad NM, Herring SJ, Bennett GG. Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study. JMIR Res Protoc 2021; 10:e32441. [PMID: 34914616 PMCID: PMC8717134 DOI: 10.2196/32441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. OBJECTIVE This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. METHODS We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants' diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. RESULTS Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. CONCLUSIONS The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32441.
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Miller HN, Berger MB, Askew S, Kay MC, Hopkins CM, Iragavarapu MS, de Leon M, Freed M, Barnes CN, Yang Q, Tyson CC, Svetkey LP, Bennett GG, Steinberg DM. The Nourish Protocol: A digital health randomized controlled trial to promote the DASH eating pattern among adults with hypertension. Contemp Clin Trials 2021; 109:106539. [PMID: 34400362 PMCID: PMC8556291 DOI: 10.1016/j.cct.2021.106539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over 100 million adults in the United States have hypertension. The DASH (Dietary Approaches to Stop Hypertension) eating pattern is an evidence-based first-line treatment option for hypertension; however, adherence to the DASH eating pattern at a population level remains low. To address this gap, we will implement Nourish, a randomized controlled efficacy trial that will leverage a commercially-available smartphone application and evidence-based behavior change principles to improve adherence to the DASH eating pattern among adults with hypertension. METHODS The Nourish trial is a two-arm, 12-month randomized control trial that will enroll adults (N = 300) with hypertension, defined as a systolic blood pressure of 120-159 mmHg; a diastolic blood pressure of 80-99 mmHg; and/or adults on blood pressure-lowering medication. Nourish will test the efficacy of a digital health intervention, as compared to the attention control arm, on DASH eating pattern adherence and blood pressure. Intervention components will include skills training, self-monitoring, personalized feedback, and responsive coaching. The primary outcome of the trial is 6-month changes in adherence to the DASH eating pattern, as measured by 24-h dietary recalls. DISCUSSION Millions of Americans remain in need of effective behavioral interventions to manage and improve their hypertension and its adverse consequences. The ubiquity of smartphones offers a promising approach to disseminate the DASH eating pattern. By leveraging these widely used smartphone applications, combined with evidence-based behavior change principles and the DASH eating plan, Nourish will demonstrate the effectiveness of a digital health intervention to improve DASH adherence, and ultimately, to reduce blood pressure. Trial Number: NCT03875.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America.
| | - Miriam B Berger
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Christina M Hopkins
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America; Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America
| | - Meghana Sai Iragavarapu
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Mia de Leon
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Megan Freed
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Cherie N Barnes
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Qing Yang
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Crystal C Tyson
- School of Medicine, Duke University, Durham, NC, United States of America
| | - Laura P Svetkey
- School of Medicine, Duke University, Durham, NC, United States of America
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America; Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America
| | - Dori M Steinberg
- School of Nursing, Duke University, Durham, NC, United States of America; Equip Health, LLC, San Diego, CA, United States of America
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20
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Haarbauer-Krupa JK, Register-Mihalik JK, Nedimyer AK, Chandran A, Kay MC, Gildner P, Kerr ZY. Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5-10 years. J Safety Res 2021; 78:203-209. [PMID: 34399916 PMCID: PMC9139453 DOI: 10.1016/j.jsr.2021.05.003] [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] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding parents' concussion-related knowledge and attitudes will contribute to the development of strategies that aim to improve concussion prevention and sport safety for elementary school children. This study investigated the association between parent- and child-related factors and concussion symptom knowledge and care-seeking attitudes among parents of elementary school children (aged 5-10 years). METHODS Four hundred parents of elementary school children completed an online questionnaire capturing parental and child characteristics; concussion symptom knowledge (25 items, range = 0-50; higher = better knowledge); and concussion care-seeking attitudes (five 7-point scale items, range = 5-35; higher = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher score levels. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) excluding 1.00 were deemed statistically significant. RESULTS Select parent and child characteristics were associated with higher score levels for both outcomes. For example, odds of better knowledge level in parents were higher with increased age (10-year increase aOR = 1.59; 95% CI = 1.10-2.28), among females (aOR = 3.90; 95% CI = 2.27-6.70), and among white/non-Hispanics (aOR = 1.79; 95%CI = 1.07-2.99). Odds of more positive concussion care-seeking attitude levels were higher among parents with a college degree (aOR = 1.98; 95%CI = 1.09-3.60). Child sports participation was not associated with higher score levels for either outcome. CONCLUSIONS Certain elementary school parent characteristics were associated with parents' concussion symptom knowledge and care-seeking attitudes. While the findings suggest providing parents with culturally and demographically relevant concussion education might be helpful, they also emphasize the importance of ensuring education/prevention regardless of their children's sports participation. Practical Applications: Pediatric healthcare providers and elementary schools offer an optimal community-centered location to reach parents with this information within various communities.
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Affiliation(s)
- Juliet K Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aliza K Nedimyer
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Kay MC, Parr JJ, Oglesby LW. Presence Of Obesity And Relationship To Injury Within Mississippi High School Football Players. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761328.91534.00] [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: 11/21/2022]
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22
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Ingram BM, Kay MC, Callahan CE, Gildner P, Kerr ZY, Register-Mihalik JK. Effects Of An Interactive Concussion Education Platform On Concussion-related Knowledge, Attitudes, Perceived Norms, And Intention To Disclose In Collegiate Club Sport Athletes. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763792.67503.4d] [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: 11/21/2022]
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23
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Callahan CE, Kay MC, Mihalik JP, Marshall SW, Gildner P, Kerr Z, Cameron KL, Houston MN, Mrazik M, Register-Mihalik JK. The Association Between Sensation-seeking Behaviors And Concussion Care-seeking Intentions And Disclosure Behaviors Among Collegiate Student-athletes. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763036.68193.e6] [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: 11/21/2022]
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Kay MC, Duffy EW, Harnack LJ, Anater AS, Hampton JC, Eldridge AL, Story M. Development and Application of a Total Diet Quality Index for Toddlers. Nutrients 2021; 13:1943. [PMID: 34198828 PMCID: PMC8229507 DOI: 10.3390/nu13061943] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022] Open
Abstract
For the first time, the 2020-2025 Dietary Guidelines for Americans include recommendations for infants and toddlers under 2 years old. We aimed to create a diet quality index based on a scoring system for ages 12 to 23.9 months, the Toddler Diet Quality Index (DQI), and evaluate its construct validity using 24 h dietary recall data collected from a national sample of children from the Feeding Infants and Toddlers Study (FITS) 2016. The mean (standard error) Toddler DQI was 49 (0.6) out of 100 possible points, indicating room for improvement. Toddlers under-consumed seafood, greens and beans, and plant proteins and over-consumed refined grains and added sugars. Toddler DQI scores were higher among children who were ever breastfed, lived in households with higher incomes, and who were Hispanic. The Toddler DQI performed as expected and offers a measurement tool to assess the dietary quality of young children in accordance with federal nutrition guidelines. This is important for providing guidance that can be used to inform public health nutrition policies, programs, and practices to improve diets of young children.
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Affiliation(s)
- Melissa C. Kay
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
| | - Emily W. Duffy
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Lisa J. Harnack
- School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA;
| | - Andrea S. Anater
- Research Triangle Institute International, Research Triangle Park, NC 27709, USA; (A.S.A.); (J.C.H.)
| | - Joel C. Hampton
- Research Triangle Institute International, Research Triangle Park, NC 27709, USA; (A.S.A.); (J.C.H.)
| | - Alison L. Eldridge
- Nestlé Research, Nestlé Institute of Health Sciences, Route du Jorat 57, 1000 Lausanne, Switzerland;
| | - Mary Story
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
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25
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Kerr ZY, Nedimyer AK, Kay MC, Chandran A, Gildner P, Byrd KH, Haarbauer-Krupa JK, Register-Mihalik JK. Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US. J Sport Health Sci 2021; 10:113-121. [PMID: 32919064 PMCID: PMC7987565 DOI: 10.1016/j.jshs.2020.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 08/04/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Developing appropriate concussion prevention and management paradigms in middle school (MS) settings requires understanding parents' general levels of concussion-related knowledge and attitudes. This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children (aged 10-15 years). METHODS A panel of 1224 randomly selected U.S. residents, aged ≥ 18 years and identifying as parents of MS children, completed an online questionnaire capturing parental and child characteristics. The parents' concussion-symptom knowledge was measured using 25 questions, with possible answers being "yes", "maybe", and "no". Correct answers earned 2 points, "maybe" answers earned 1 point, and incorrect answers earned 0 point (range: 0-50; higher scores = better knowledge). Concussion care-seeking attitudes were also collected using five 7-point scale items (range: 5-35; higher scores = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher scores. Models met proportional odds assumptions. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) (excluding 1.00) were deemed statistically significant. RESULTS Median scores were 39 (interquartile range: 32-44) for symptom knowledge and 32 (interquartile range: 28-35) for care-seeking attitude. In multivariable models, odds of better symptom knowledge were higher in women vs. men (aOR = 2.28; 95%CI: 1.71-3.05), white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.88; 95%CI: 1.42-2.49), higher parental age (10-year-increase aOR = 1.47; 95%CI: 1.26-1.71), and greater competitiveness (10%-scale-increase aOR = 1.24; 95%CI: 1.13-1.36). Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.45; 95%CI: 1.06-1.99) and in older parental age (10-year-increase aOR = 1.24; 95%CI: 1.05-1.47). CONCLUSION Characteristics of middle school children's parents (e.g., sex, race or ethnicity, age) are associated with their concussion-symptom knowledge and care-seeking attitudes. Parents' variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA.
| | - Aliza K Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC 27599-8700, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN 46202, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - K Hunter Byrd
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Juliet K Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
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26
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Wood CT, Witt WP, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater AM, Flower KB, Kay MC, Perrin EM. Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life. Acad Pediatr 2021; 21:288-296. [PMID: 32961335 PMCID: PMC10910619 DOI: 10.1016/j.acap.2020.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether proportion of breast versus formula feeding and timing of complementary food introduction affect the odds of rapid gain in weight status in a diverse sample of infants. METHODS Using data from Greenlight Intervention Study, we analyzed the effects of type of milk feeding (breastfeeding, formula, or mixed feeding) from the 2- to 6-month well visits, and the introduction of complementary foods before 4 months on rapid increase in weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) before 12 months using multivariable logistic regression models. RESULTS Of the 865 infants enrolled, 469 had complete data on all variables of interest, and 41% and 33% of those infants had rapid increases in WAZ and WLZ, respectively. Odds of rapid increase in WAZ remained lowest for infants breastfeeding from 2 to 6 months (adjusted odds ratio [aOR] 0.34; 95% confidence interval [CI]: 0.17, 0.69) when compared to infants who were formula-fed. Adjusted for feeding, introduction of complementary foods after 4 months was associated with decreased odds of rapid increase in WLZ (aOR 0.64; 95% CI: 0.42, 0.96). CONCLUSIONS Feeding typified by predominant breastfeeding and delaying introduction of complementary foods after 4 months reduces the odds of rapid increases in WAZ and WLZ in the first year of life.
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Affiliation(s)
- Charles T Wood
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine (CT Wood and EM Perrin), Durham, NC.
| | - Whitney P Witt
- College of Health, Lehigh University, (WP Witt), Bethlehem, PA
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Duke Clinical Research Institute (AC Skinner), Durham, NC
| | - Hsiang S Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine/Bellevue Hospital Center (HS Yin), New York, NY
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center (RL Rothman), Nashville, Tenn
| | - Lee M Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University (LM Sanders), Stanford, Calif
| | - Alan M Delamater
- Department of Pediatrics, University of Miami School of Medicine (AM Delamater), Miami, Fla
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine (KB Flower), Chapel Hill, NC
| | - Melissa C Kay
- Duke Center for Childhood Obesity Research and Duke Global Digital Health Science Center, Duke University School of Medicine and Duke Global Health Institute (MC Kay), Durham, NC
| | - Eliana M Perrin
- Division of Primary Care Pediatrics and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine (CT Wood and EM Perrin), Durham, NC
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Callahan CE, Kay MC, Kerr ZY, Hinson MT, Linnan LA, Hennink-Kaminski H, Gildner P, Marshall SW, Houston MN, Cameron KL, Register-Mihalik J. Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes Among National Collegiate Athletic Association Division I Student-Athletes. J Athl Train 2021; 56:461578. [PMID: 33618368 PMCID: PMC8010936 DOI: 10.4085/1062-6050-0211.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/09/2022]
Abstract
CONTEXT Limited data exist concerning differences in concussion-education exposure and how education exposures relate to care seeking and symptom disclosure, specifically by National Collegiate Athletic Association Division I student-athletes. OBJECTIVE To investigate demographic characteristics associated with concussion-education exposure and examine whether overall education exposure (yes versus no) and education-source exposure number (multiple sources versus a single source) affect concussion care-seeking and disclosure factors in Division I student-athletes. DESIGN Cross-sectional study. SETTING Classroom or online survey. PATIENTS OR OTHER PARTICIPANTS Division I student-athletes (n = 341). MAIN OUTCOME MEASURE(S) Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion-education groups. Prevalence ratios (PRs) and 95% CIs were calculated to quantify the associations between student-athlete characteristics and (1) overall concussion-education exposure and (2) source-exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MDs) and 95% CIs, which allowed us to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion-education exposure and exposure to multiple sources. Separate multivariable binomial regression models were performed to estimate adjusted PRs and 95% CIs in order to evaluate associations of intention, perceived control, and care-seeking or disclosure behaviors and overall concussion-education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history. RESULTS Overall, 276 (80.9%) participants reported previous concussion education, with 179 (64.9%) being exposed to multiple sources. Student-athletes who participated in a contact sport (adjusted PR = 1.24; 95% CI = 1.06, 1.44) and those who had a concussion history (adjusted PR = 1.19; 95% CI = 1.09, 1.31) had higher prevalences of concussion-education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR = 0.82; 95% CI = 0.68, 0.99). Overall concussion-education exposure was significantly associated with more favorable perceived social norms surrounding concussion care seeking (adjusted MD = 1.37; 95% CI = 0.13, 2.61). CONCLUSIONS These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.
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Affiliation(s)
- Christine E. Callahan
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Melissa C. Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg
| | - Zachary Y. Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Madison T. Hinson
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Laura A. Linnan
- Department of Health Behavior, Gillings School of Global Public Health
| | | | - Paula Gildner
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | - Stephen W. Marshall
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | | | | | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
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Bennett GG, Steinberg D, Bolton J, Gallis JA, Treadway C, Askew S, Kay MC, Pollak KI, Turner EL. Optimizing an Obesity Treatment Using the Multiphase Optimization Strategy Framework: Protocol for a Randomized Factorial Trial. JMIR Res Protoc 2021; 10:e19506. [PMID: 33459600 PMCID: PMC7850907 DOI: 10.2196/19506] [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: 04/22/2020] [Revised: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Effective weight loss interventions exist, yet few can be scaled up for wide dissemination. Further, none has been fully delivered via text message. We used the multiphase optimization strategy (MOST) to develop multicomponent interventions that consist only of active components, those that have been experimentally determined to impact the chosen outcome. Objective The goal of this study is to optimize a standalone text messaging obesity intervention, Charge, using the MOST framework to experimentally determine which text messaging components produce a meaningful contribution to weight change at 6 months. Methods We designed a 6-month, weight loss texting intervention based on our interactive obesity treatment approach (iOTA). Participants are randomized to one of 32 experimental conditions to test which standalone text messaging intervention components produce a meaningful contribution to weight change at 6 months. Results The project was funded in February 2017; enrollment began in January 2018 and data collection was completed in June 2019. Data analysis is in progress and first results are expected to be submitted for publication in 2021. Conclusions Full factorial trials are particularly efficient in terms of cost and logistics when leveraged for standalone digital treatments. Accordingly, MOST has the potential to promote the rapid advancement of digital health treatments. Subject to positive findings, the intervention will be low cost, immediately scalable, and ready for dissemination. This will be of great potential use to the millions of Americans with obesity and the providers who treat them. Trial Registration ClinicalTrials.gov NCT03254940; https://clinicaltrials.gov/ct2/show/NCT03254940 International Registered Report Identifier (IRRID) RR1-10.2196/19506
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Affiliation(s)
- Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Jamiyla Bolton
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - John A Gallis
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Cayla Treadway
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, United States.,Department of Populations Health Sciences, Duke University, Durham, NC, United States
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
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29
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Steinberg DM, Kay MC, Svetkey LP, Askew S, Christy J, Burroughs J, Ahmed H, Bennett GG. Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial. JMIR Mhealth Uhealth 2020; 8:e17536. [PMID: 33284116 PMCID: PMC7752529 DOI: 10.2196/17536] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/03/2020] [Accepted: 09/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. OBJECTIVE This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. METHODS We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. RESULTS The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: -2.8 mmHg, 95% CI -1.8 to 7.4; P=.23) and diastolic (mean difference: -3.6 mmHg, 95% CI -0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. CONCLUSIONS A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. TRIAL REGISTRATION ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472.
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Affiliation(s)
- Dori M Steinberg
- Duke University School of Nursing, Durham, NC, United States.,Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States.,Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Laura P Svetkey
- Sarah W Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, United States.,Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Jacob Christy
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
| | - Jasmine Burroughs
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Hira Ahmed
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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Callahan CE, Kay MC, Kerr ZY, Hinson MT, Linnan LA, Hennink-Kaminski H, Gildner P, Marshall SW, Houston MN, Cameron KL, Register-Mihalik JK. Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes among NCAA Division I Student-Athletes. J Athl Train 2020:446979. [PMID: 33150430 DOI: 10.4085/211-20] [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] [Indexed: 11/09/2022]
Abstract
CONTEXT There are limited data concerning differences in concussion education exposure and how education exposures relates to care-seeking and symptom disclosure, specifically in Division I student-athletes. OBJECTIVE Investigate demographic characteristics associated with concussion education exposure and examine whether overall education exposure (yes vs. no) and education source exposure number (multiple sources vs. single source) affects concussion care-seeking and disclosure factors in Division I student-athletes. DESIGN Cross-sectional survey. SETTING Classroom or online. PARTICIPANTS NCAA Division I student-athletes (n=341). MAIN OUTCOME MEASURE(S) Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion education groups. Prevalence ratios (PR) and 95% confidence intervals (CI) quantified the association between student-athlete characteristics and 1) overall concussion education exposure and 2) source exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MD) and 95%CI to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion education exposure and exposure to multiple sources. Separate multivariable binomial regression models estimated adjusted PRs and 95%CI to assess associations of intention, perceived control, and care-seeking/disclosure behaviors and overall concussion education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history. RESULTS Overall, n=276 (80.9%) reported previous concussion education, with 179 (64.9%) exposed to multiple sources. Student-athletes that participated in a contact sport (adjusted PR=1.24, 95%CI=1.06,1.44) and those who had a concussion history (adjusted PR=1.19, 95%CI=1.09,1.31) had higher prevalence of previous concussion education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR=0.82, 95%CI=0.68, 0.99). Overall concussion education exposure was significantly associated with more favorable perceived social norms surrounding concussion care-seeking (adjusted MD=1.37, 95%CI=0.13,2.61). CONCLUSIONS Findings highlight potential differences in overall concussion education exposure and provide clinicians with information on groups who may benefit from targeted additional education.
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Affiliation(s)
- Christine E Callahan
- 1. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 2. Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 3. Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa C Kay
- 4. School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Zachary Y Kerr
- 1. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 2. Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 3. Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 5. Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Madison T Hinson
- 1. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 2. Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura A Linnan
- 6. Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heidi Hennink-Kaminski
- 7. Hussman School of Media and Journalism, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paula Gildner
- 5. Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen W Marshall
- 5. Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 8. Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Johna K Register-Mihalik
- 1. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 2. Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 3. Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 5. Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kerr ZY, Gildner P, Nedimyer AK, Chandran A, Kay MC, Byrd KH, Register-Mihalik JK. Approaching community priorities in youth sports injury prevention research. Inj Epidemiol 2020; 7:35. [PMID: 32624001 PMCID: PMC7335636 DOI: 10.1186/s40621-020-00261-2] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in youth sports is often complex. As interest in youth sports injury prevention grows, scientists should consider community priorities beyond a specific research study. MAIN TEXT This commentary discusses the authors' personal experiences researching concussion prevention in middle school sports, as the overarching community faced multiple challenges. These challenges included a series of weather-related emergencies that resulted in a shift in the community's priorities, multi-day school closures, and cancellations of sports activities and meetings. We discuss the importance of considering community priorities and providing support as scientists, colleagues, and members of the communities in which we conduct research. CONCLUSION Scientists should consider the changing circumstances and dynamics surrounding community priorities in order to help drive their research-based decisions and ensure successful and respectful applications of research based on community values and priorities.
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Affiliation(s)
- Zachary Y. Kerr
- Department of Exercise and Sport Science, Injury Prevention Research Center, University of North Carolina at Chapel Hill, 313 Woollen Gym CB#8700, Chapel Hill, NC 27599-8700 USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Sheryl-Mar South Building, 521 S Greensboro St, Carrboro, NC 27510 USA
| | - Aliza K. Nedimyer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB#8700, Chapel Hill, NC 27599-8700 USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, 401 West Michigan Street, Suite 500, Indianapolis, IN 46202 USA
| | - Melissa C. Kay
- School of Health Professions, University of Southern Mississippi, Harkins Hall (EHH), Hattiesburg, MS 224 USA
| | - K. Hunter Byrd
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Sheryl-Mar South Building, 521 S Greensboro St, Carrboro, NC 27510 USA
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, Injury Prevention Research Center, University of North Carolina, 125 Fetzer Hall CB#8700, Chapel Hill, NC 27599-8700 USA
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Kay MC, Cholera R, Flower KB, Yin HS, Rothman RL, Sanders LM, Delamater AM, Perrin EM. Are Low-Income, Diverse Mothers Able to Meet Breastfeeding Intentions After 2 Months of Breastfeeding? Breastfeed Med 2020; 15:435-442. [PMID: 32357088 PMCID: PMC7374637 DOI: 10.1089/bfm.2020.0025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Little is known about intended breastfeeding duration of women who initiate breastfeeding. We describe the association between intended and actual breastfeeding duration among low-income, diverse mothers who report maintaining breastfeeding for the first 2 months postpartum. Materials and Methods: We included mothers (64% Hispanic, 17% non-Hispanic black) participating in Greenlight, a cluster randomized childhood obesity prevention trial, who were providing breast milk at the 2-month preventive service visit and reported intended breastfeeding duration at this visit. Breastfeeding status was assessed at subsequent visits, up to 24 months. Poisson regression with a robust variance estimator was used to estimate risk ratios and 95% confidence intervals for meeting breastfeeding intentions. Covariates included race/ethnicity, income, receiving benefits from the Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC), education, age, employment, depression, maternal obesity, U.S. born, whether infant was first born, and study site. Results: Median intended breastfeeding duration was 11.5 months (interquartile range [IQR]: 6-12) and median actual breastfeeding duration was 8.6 months (IQR: 4-14) (n = 349). Approximately half (49%) met intended breastfeeding duration. Breastfeeding duration differed based on milk type provided at the 2-month visit in that mothers providing mostly or only breast milk had increased likelihood of meeting breastfeeding intentions. Regardless of milk type provided at 2 months, the longer a mother intended to breastfeed, the less likely she was to meet her breastfeeding intentions. Conclusions: In this diverse sample of women less than half met breastfeeding intentions despite maintaining breastfeeding for 2 months. Understanding factors that prevent mothers from attaining intended breastfeeding duration is critical to improving breastfeeding outcomes, especially in low income and ethnic minority populations.
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Affiliation(s)
| | | | - Kori B Flower
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - H Shonna Yin
- New York University School of Medicine, New York, New York, USA
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Kay MC, Kerr ZY, Kucera KL, DeFreese J, Petschauer MA, Register-Mihalik JK. Influence Of Demographic Factors On Concussion-related Decision-making By Certified Athletic Trainers. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676956.06407.62] [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: 11/21/2022]
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Nedimyer AK, Chandran A, Kay MC, Gildner P, Byrd KH, Register-Mihalik JK, Kerr ZY. Factors Associated With Perceived Safety Norms Within Children’s Sports Environments. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000671464.15754.62] [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: 11/21/2022]
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White MJ, Armstrong SC, Kay MC, Perrin EM, Skinner A. Associations between milk fat content and obesity, 1999 to 2016. Pediatr Obes 2020; 15:e12612. [PMID: 31905266 DOI: 10.1111/ijpo.12612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The relationship between milk fat content and body mass index (BMI) remains unclear. The objective of this study was to determine if milk fat content is associated with obesity in children, adolescents and young adults. METHODS We used repeated cross sections of National Health and Nutrition Examination Survey (NHANES), 1999 to 2016. Using logistic regression, we measured associations between first milk consumed after formula/breast milk (whole, 2%, 1%, or fat-free) and weight status (≥85th to <95th BMI percentile, overweight; ≥95th BMI percentile, obesity) among children 2 to 6 years (n = 8367). We also assessed associations between current milk type and weight status among those 2 to 20 years of age (n = 26 750). RESULTS Children 2 to 6 years with obesity were less likely to have been weaned to whole milk versus healthy weight children (adjusted odds ratio [aOR], 0.77; 95% CI, 0.60-0.98; P = .031). Individuals 2 to 20 years with overweight or obesity were less likely to drink whole milk as their current milk and more likely to drink fat-free or 1% milk compared with healthy weight children. CONCLUSIONS Whole milk consumers are less likely to have obesity. It is unclear whether this relationship is causal or a reflection of United States Department of Agriculture recommendations. Further examination of the factors that influence milk choice among diverse cohorts would lend clarity to this important issue.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
| | - Sarah C Armstrong
- Department of Pediatrics, Community and Family Medicine, Duke Clinical Research Institute, Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
| | - Melissa C Kay
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina.,Duke Global Health Institute, Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Eliana M Perrin
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
| | - Asheley Skinner
- Department of Population Health Sciences, Duke Clinical Research Institute, Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
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Weber Rawlins ML, Snedden TR, Kay MC, Valovich Mcleod T, Welch Bacon CE. School nurses' perceptions of concussion management for secondary school student-athletes. Brain Inj 2020; 34:665-672. [PMID: 32183537 DOI: 10.1080/02699052.2020.1739334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: School nurses play a vital role in concussion management at the secondary school level, often being the only on-site healthcare provider during school hours. However, little is known regarding how they perceive their role in the concussion management process. The purpose of this study was to explore school nurses' perceptions and satisfaction with concussion management in the secondary school setting using a qualitative approach.Methods: Twenty-two school nurses employed within a United States secondary school setting completed individual, semi-structured phone interviews. Data were analyzed using a consensual qualitative research approach.Results: Four overall themes emerged. This manuscript focuses on one specific theme: school nurse perceptions and satisfaction regarding concussion management. Subthemes included: school nurses' overall perception and satisfaction with current concussion management procedures, interactions with other involved personnel, concussion assessment tools, school nurses' perceived role, current concussion management policies, concussion education, and school nurse continuing education specific to concussion.Conclusions: School nurses were generally positive regarding concussion management within their setting and were satisfied with their roles overall. However, participants identified a number of areas that require further attention to ensure an evidence-based, consistent team approach to concussion management to support best student outcomes and continuity of care.
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Affiliation(s)
| | - Traci R Snedden
- School of Nursing, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Tamara Valovich Mcleod
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, Arizona, USA.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Cailee E Welch Bacon
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, Arizona, USA.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
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Register-Mihalik JK, Marshall SW, Kay MC, Kerr ZY, Peck KY, Houston MN, Linnan LA, Hennink-Kaminski H, Gildner P, Svoboda SJ, Cameron KL. Perceived social norms and concussion-disclosure behaviours among first-year NCAA student-athletes: implications for concussion prevention and education. Res Sports Med 2020; 29:1-11. [PMID: 31984812 DOI: 10.1080/15438627.2020.1719493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/28/2023]
Abstract
Timely disclosure and identification of concussion symptoms are essential to proper care. Perceived social norms are a potential driving factor in many health-related decisions. The study purpose was to describe concussion disclosure behaviours and identify the association between perceived social norms and these disclosure behaviours. First-year student-athletes (n = 391) at two NCAA institutions completed a cross-sectional survey about concussion disclosure and disclosure determinants. Log-binomial regression models identified factors associated with concussion disclosure behaviour prevalence for: higher intention to disclose symptoms, disclosed all at time of injury, eventually disclosed all, and never participated with concussion symptoms. More favourable perceived social norms were associated with higher prevalence of intention to disclose (PR = 1.34; 95%CI: 1.18, 1.53) and higher prevalence of never participating in sports with concussion symptoms (PR = 1.50; 95%CI: 1.07, 2.10). Clinicians, coaches, sports administrators, and healthcare practitioners should be mindful of the need to create supportive social environments to improve concussion symptom disclosure.
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Affiliation(s)
- Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,School of Health Professions, University of Southern Mississippi , Hattiesburg, MS, USA
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
| | - Laura A Linnan
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital , West Point, NY, USA
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Register-Mihalik JK, Kay MC, Kerr ZY, Peck KY, Houston MN, Gildner P, Svoboda SJ, Marshall SW, Cameron KL. Influence of Concussion Education Exposure on Concussion-Related Educational Targets and Self-Reported Concussion Disclosure among First-Year Service Academy Cadets. Mil Med 2019; 185:e403-e409. [PMID: 31789379 DOI: 10.1093/milmed/usz414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Concussion disclosure is often essential for military personnel to receive appropriate care following concussive injury. Concussion-related education and training may play a role in improving disclosure and recognition among peers, allowing for more timely concussion identification and treatment. The objectives of this study were to: (1) describe concussion education exposure among first-year service academy cadets and (2) examine the association between exposure to concussion education sources (multiple vs. only one) and concussion-related knowledge, attitudes, perceived social norms, intention to disclose symptoms, and disclosure behaviors.
Materials and Methods
First-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure during preseason concussion baseline testing sessions. Associations between key cadet characteristics and exposure to multiple concussion education sources were examined using odds ratios and 95% confidence intervals. Linear regression was used to model the continuous measures of concussion-related knowledge, attitudes, and perceived social norms. Log-binomial regression was used to model the categorical outcomes of high perceived control over concussion disclosure (higher vs. lower), intention to disclose (higher vs. lower), and disclosure of all possible concussive events at the time of injury (yes vs. no). The primary predictor for all models was exposure to multiple sources of concussion education (video, coach, medical professional, or other) vs. exposure to only one educational source. All models were adjusted for gender, high school contact sport participation, and previous concussion history.
Results
Of the 972 first-year cadets (85% response; age = 18.4 ± 0.9 years; 21.7% female, 29.0% NCAA student-athlete), 695 (71.5%) reported receiving some type of previous concussion education and 229 (23.6%) reported a previous concussion history (206/229 reported the actual number they experienced). Of those reporting previous concussion-related education (n = 695), 542 (78.0%) watched a video, 514 (74.0%) talked with a coach about concussion, 433 (62.3%) talked with a medical professional, and 61 (8.8%) reported other sources of education ranging from anatomy teachers to brochures. Overall, 527 (75.8%) reported receiving more than one source of concussion education. Having played a contact sport in high school and having a history of concussion were associated with having multiple concussion education exposures. Being female was associated with lower odds of multiple exposures. Exposure to multiple sources of concussion education was not associated with knowledge, attitudes, perceived norms, or higher intention to disclose concussion symptoms. However, among those with a concussion history, exposure to multiple sources of concussion education was associated with a nearly 40% higher prevalence of disclosing all concussions at the time of injury compared to only one source of educational exposure (67.1% vs. 48.3%; prevalence ratio = 1.4; 95% confidence interval: 0.9, 2.1). Thus, although multiple sources of education may not influence intermediate variables of knowledge, attitudes, perceived norms and intentions, exposure to multiple sources of concussion education may influence actual decision-making around concussion disclosure among first-year service academy cadets.
Conclusion
These data suggest disparities in concussion education exposure that can be addressed in first-year cadets. Additionally, findings support the importance and use of multiple sources of concussion education in improving cadet’s concussion-related decision-making.
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Affiliation(s)
- Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, CB# 8700, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, CB# 8700, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- School of Health Professions, University of Southern Mississippi, 118 college Dr. #5122, Hattiesburg, MS, 39406
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, CB# 8700, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
| | - Paula Gildner
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
| | - Stephen W Marshall
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- Department of Epidemiology, CB#7400, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Duffy EW, Kay MC, Jacquier EF, Catellier D, Hampton J, Anater AS, Story M. Trends in Food Consumption Patterns of US Infants and Toddlers from Feeding Infants and Toddlers Studies (FITS) in 2002, 2008, 2016. Nutrients 2019; 11:nu11112807. [PMID: 31744210 PMCID: PMC6893614 DOI: 10.3390/nu11112807] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022] Open
Abstract
The Feeding Infants and Toddlers Study (FITS) is the largest survey of dietary intake among infants and young children in the United States. Dietary patterns in early childhood are a key component of prevention of diet-related chronic diseases, yet little is known about how food consumption patterns of infants and young children have changed over time. The objective of this study is to examine trends in food and beverage consumption among children ages 6–23.9 months using data from the FITS conducted in 2002, 2008, and 2016. A total of 5963 infants and young children ages 6–23.9 months were included in these analyses. Food consumption data were collected using a multiple-pass 24-h recall by telephone using the Nutrition Data System for Research. Linear trends were assessed using the Wald’s test in a multivariable linear regression model. Positive significant findings include increases in breast milk consumption and decreases in the consumption of sweets, sugar-sweetened beverages, and 100% fruit juice. More troubling findings include decreasing infant cereal consumption, stagnant or decreasing whole grain consumption, and stagnant consumption of vegetables. Our findings suggest some promising improvements in dietary intake among infants and toddlers in the United States over the past 15 years, but further policy, programmatic, and industry efforts are still needed.
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Affiliation(s)
- Emily W. Duffy
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +1-336-341-9149
| | - Melissa C. Kay
- Duke Global Health Institute, Duke University, Durham, NC 27110, USA; (M.C.K.); (M.S.)
| | | | - Diane Catellier
- RTI International, Research Triangle Park, NC 27709, USA; (D.C.); (J.H.); (A.S.A.)
| | - Joel Hampton
- RTI International, Research Triangle Park, NC 27709, USA; (D.C.); (J.H.); (A.S.A.)
| | - Andrea S. Anater
- RTI International, Research Triangle Park, NC 27709, USA; (D.C.); (J.H.); (A.S.A.)
| | - Mary Story
- Duke Global Health Institute, Duke University, Durham, NC 27110, USA; (M.C.K.); (M.S.)
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Lee KM, Kay MC, Kucera KL, Prentice WE, Kerr ZY. Epidemiology of Cervical Muscle Strains in Collegiate and High School Football Athletes, 2011-2012 Through 2013-2014 Academic Years. J Athl Train 2019; 54:780-786. [PMID: 31335177 DOI: 10.4085/1062-6050-229-18] [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] [Indexed: 11/09/2022]
Abstract
CONTEXT Cervical muscle strains are an often-overlooked injury, with neck- and spine-related research typically focusing on spinal cord and vertebral injuries. OBJECTIVE To examine the rates and distributions of cervical muscle strains in collegiate and high school football athletes. DESIGN Descriptive epidemiology study. SETTING Collegiate and high school football teams. PATIENTS OR OTHER PARTICIPANTS The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) collected data from collegiate football athletes. The High School National Athletic Treatment, Injury and Outcomes Network (HS NATION) and High School Reporting Information Online (HS RIO) collected data from high school football athletes. Data from the 2011-2012 through 2013-2014 academic years were used. MAIN OUTCOME MEASURE(S) Athletic trainers collected injury and exposure data for football players. Injury counts, injury rates per 10 000 athlete-exposures (AEs), and injury rate ratios with 95% confidence intervals (CIs) were calculated. RESULTS The NCAA-ISP reported 49 cervical muscle strains (rate = 0.96/10 000 AEs), of which 28 (57.1%) were TL (time loss; rate = 0.55/10 000 AEs). High School NATION reported 184 cervical muscle strains (rate = 1.66/10 000 AEs), of which 33 (17.9%) were TL injuries (rate = 0.30/10 000 AEs). The HS RIO, which collects only TL injuries, reported 120 TL cervical muscle strains (rate = 0.51/10 000 AEs). The overall injury rate was lower in the NCAA-ISP than in HS NATION (injury rate ratio = 0.58; 95% CI = 0.42, 0.79); when restricted to TL injuries, the overall injury rate was higher in the NCAA-ISP (injury rate ratio = 1.83; 95% CI = 1.11, 3.03). No differences were found when comparing TL injuries in HS RIO and the NCAA-ISP. Cervical muscle-strain rates were higher during competitions than during practices across all 3 surveillance systems for all injuries. Most cervical muscle strains were due to player contact (NCAA-ISP = 85.7%, HS NATION = 78.8%, HS RIO = 85.8%). CONCLUSIONS The incidence of cervical muscle strains in football players was low compared with other injuries. Nonetheless, identifying and implementing interventions, particularly those aimed at reducing unsafe player contact, are essential to further decrease the risk of injury and associated adverse outcomes.
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Affiliation(s)
- Katherine M Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg
| | - Kristen L Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - William E Prentice
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Kay MC, Sturch BM, Register-Mihalik JK. Athletic Training Educator Concussion Symptomology Prioritization for Clinical Decision-Making Compared to Typical Symptom Presentation. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562234.19224.b3] [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: 11/21/2022]
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Berger MB, Steinberg DM, Askew S, Gallis JA, Treadway CC, Egger JR, Kay MC, Batch BC, Finkelstein EA, DeVries A, Brewer A, Bennett GG. The Balance protocol: a pragmatic weight gain prevention randomized controlled trial for medically vulnerable patients within primary care. BMC Public Health 2019; 19:596. [PMID: 31101037 PMCID: PMC6525404 DOI: 10.1186/s12889-019-6926-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/30/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND For patients with obesity who are not ready for or experience barriers to weight loss, clinical practice guidelines recommend provider counseling on preventing further weight gain as a first-line treatment approach. Unfortunately, evidence-based weight gain prevention interventions are not routinely available within primary care. To address this gap, we will implement a pragmatic 12-month randomized controlled trial of a digital weight gain prevention intervention delivered to patients receiving primary care within a network of Federally Qualified Community Health Centers in central North Carolina. METHODS Balance (Equilibrio in Spanish) is a pragmatic effectiveness trial that will randomize adult patients who have overweight or obesity (BMI of 25-40 kg/m2) to either: 1) a weight gain prevention intervention with tailored behavior change goals and tracking, daily weighing on a network-connected electronic scale, and responsive weight and goal coaching delivered remotely by health center registered dietitians; or 2) a usual care program with automated healthy living text messages and print materials and routine primary care. The primary outcome will be weight gain prevention at 24-months, defined as ≤3% change in baseline weight. To align with its pragmatic design, trial outcome data will be pulled from the electronic health record of the community health center network. DISCUSSION For underserved, often rurally-located patients with obesity, digital approaches to promote a healthy lifestyle can curb further weight gain. Yet enrolling medically vulnerable patients into a weight gain prevention trial, many of whom are from racial/ethnic minorities, can be difficult. Despite these potential challenges, we plan to recruit a large, diverse sample from rural areas, and will implement a remotely-delivered weight gain prevention intervention to medically vulnerable patients. Upcoming trial results will demonstrate the effectiveness of this pragmatic approach to implement and evaluate a digital weight gain prevention intervention within primary care. TRIALS REGISTRATION NCT03003403 . Registered December 28, 2016.
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Affiliation(s)
- Miriam B Berger
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA.
| | - Dori M Steinberg
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA.,Duke University School of Nursing, 307 Trent Drive, Pearson Room 2055, DUMC 3322, Durham, NC, 27708, USA
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - John A Gallis
- Duke Global Health Institute, Duke University, Trent Drive, Room 236, Durham, NC, 27708, USA
| | - Cayla C Treadway
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Trent Drive, Room 236, Durham, NC, 27708, USA
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Bryan C Batch
- Duke University Medical Center, DUMC 3031, Durham, NC, 27710, USA
| | - Eric A Finkelstein
- National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Abigail DeVries
- Piedmont Health Services, Inc., 127 Kingston Drive, Chapel Hill, NC, 27514, USA
| | - Ashley Brewer
- Piedmont Health Services, Inc., 127 Kingston Drive, Chapel Hill, NC, 27514, USA
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA.,Duke University, Department of Psychology and Neuroscience, Campus Box 90086, Durham, NC, 27708, USA
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Kay MC, Burroughs J, Askew S, Bennett GG, Armstrong S, Steinberg DM. Digital Weight Loss Intervention for Parents of Children Being Treated for Obesity: A Prospective Cohort Feasibility Trial. J Med Internet Res 2018; 20:e11093. [PMID: 30573449 PMCID: PMC6320402 DOI: 10.2196/11093] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity continues to increase, and clinic-based treatment options have failed to demonstrate effectiveness. One of the strongest predictors of child weight is parent weight. Parental treatment for weight loss may indirectly reduce obesity in the child. We have previously demonstrated the effectiveness among adults of a fully automated, evidence-based digital weight loss intervention (Track). However, it is unknown if it is feasible to deliver such a treatment directly to parents with obesity who bring their child with obesity to a weight management clinic for treatment. OBJECTIVE The objective of our study was to evaluate the feasibility of and engagement with a digital weight loss intervention among parents of children receiving treatment for obesity. METHODS We conducted a 6-month pre-post feasibility trial among parents or guardians and their children aged 4-16 years presenting for tertiary care obesity treatment. Along with the standard family-based treatment protocol, parents received a 6-month digital weight loss intervention, which included weekly monitoring of personalized behavior change goals via mobile technologies. We examined levels of engagement by tracking completed weeks of self-monitoring and feasibility by assessing change in weight. RESULTS Participants (N=48) were on average 39 years old, mostly female (35/42, 82% ), non-Hispanic Black individuals (21/41, 51%) with obesity (36/48, 75%). Over a quarter had a yearly household income of <US $25,000, and about a third had the equivalent of a high school education. Children were on average 10 years old and had a body mass index of 29.8 kg/m2. The median percentage of weeks participants tracked their behaviors was 77% (18.5/24 total weeks; interquartile range [IQR] 6.3 to 100). The median number of attempts via phone or text message (short message service) required to complete one tracking week was 3.3 (IQR 2.6 to 4.9). Nearly half (23/48, 48%) had high levels of engagement, completing 80% (19/24) or more weeks of tracking. Of the 26 participants with weight measurements reported at 6 months, of which 81% (21/26) were self-reported, there was a median 2.44 kg (IQR -6.5 to 1.0) decrease in weight. CONCLUSIONS It is feasible to deliver an evidence-based digital weight loss intervention to parents or guardians whose children are enrolled in a weight management program. Given the feasibility of this approach, future studies should investigate the effectiveness of digital weight loss interventions for parents on child weight and health outcomes.
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Affiliation(s)
- Melissa C Kay
- Duke Global Digital Health Science Center, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, United States
| | - Jasmine Burroughs
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Sarah Armstrong
- Duke Center for Childhood Obesity Research, Duke Department of Pediatrics, Duke University, Durham, NC, United States
| | - Dori M Steinberg
- Duke Global Digital Health Science Center, Duke School of Nursing, Duke University, Durham, NC, United States
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Register-Mihalik JK, Cameron KL, Kay MC, Kerr ZY, Peck KY, Houston MN, Linnan LA, Hennink-Kaminski H, Gildner P, Svoboda SJ, Marshall SW. Determinants of intention to disclose concussion symptoms in a population of U.S. military cadets. J Sci Med Sport 2018; 22:509-515. [PMID: 30551922 DOI: 10.1016/j.jsams.2018.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 05/04/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Non-disclosure of concussion complicates concussion management, but almost nothing is known about non-disclosure in military settings. This study describes concussion disclosure-related knowledge, attitudes, perceived social norms, perceived control, and intention. Additionally, the study identifies determinants of high intention to disclose concussion symptoms. DESIGN Cross sectional survey. METHODS First-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure. Independent variables included: gender, race, ethnicity, high school athlete status, NCAA athlete status, previous concussion history, previous concussion education, socioeconomic proxy, concussion-related knowledge, attitudes about concussion, perceived social norms (perceived peer/organizational support and actions), and perceived control over disclosure. Log-binomial regression was used to identify determinants of high intention to disclose concussion symptoms. RESULTS A total of 972 first-year military service academy cadets completed the survey [85% response; age=18.4±0.9y]. In the simple models, previous concussion history was associated with lower intention to disclose concussion symptoms. High perceived control over disclosure, higher concussion knowledge, more favorable attitudes and social norms about concussion were associated with high intention to disclose. In the multivariable model, a 10% shift towards more favorable perceived social norms (PR=1.28; p<0.001) and attitudes (PR=1.07; p=0.05) about concussion were associated with high intention to disclose concussion symptoms. High perceived control over disclosure was associated with high intention to disclose concussion symptoms (PR=1.39; p=0.08). CONCLUSIONS Concussion-related perceived social norms, attitudes, and perceived control are associated with intention to disclose. Organizationally appropriate intervention strategies can be developed from these data.
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Affiliation(s)
- Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA.
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Laura A Linnan
- Department of Health Behavior, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA
| | - Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
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Hirschhorn RM, Kerr ZY, Wasserman EB, Kay MC, Clifton DR, Dompier TP, Yeargin SW. Epidemiology of Injuries Requiring Emergency Transport Among Collegiate and High School Student-Athletes. J Athl Train 2018; 53:906-914. [PMID: 30284458 DOI: 10.4085/1062-6050-340-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/24/2023]
Abstract
CONTEXT: Data regarding the epidemiology of emergency-transport incidents (ETIs) of patients with sport-related injuries are lacking. Understanding the use of emergency services by athletic trainers can help improve emergency preparedness and prehospital care for injured student-athletes. OBJECTIVE: To determine the frequencies and types of ETIs resulting from athletic participation. DESIGN: Descriptive epidemiology study. SETTING: Participating colleges and high schools during 2009-2010 to 2014-2015 and 2011-2012 to 2013-2014, respectively. PATIENTS OR OTHER PARTICIPANTS: Student-athletes in 23 high school and 25 intercollegiate sports. MAIN OUTCOME MEASURE(S): Data on injuries requiring emergency transport were collected by each team's athletic trainer via their respective online injury-tracking software. Athletic trainers also collected data on athlete-exposures (AEs). Emergency-transport incident frequencies and injury rates per 10 000 AEs with 95% confidence intervals (CIs) were reported. For each ETI, the sport, body part, injury mechanism, and final diagnosis were recorded. RESULTS: A total of 339 and 146 ETIs were reported in collegiate and high school players, respectively. Collegiate women's ice hockey had the highest ETI rate (1.28/10 000 AEs; 95% CI = 0.71, 1.86). In high school, football had the highest rate at 0.80 per 10 000 AEs (95% CI = 0.64, 0.97). Athletes with head or face injuries required the most transports in college (n = 71, 20.9%) and high school (n = 33, 22.6%) across all sports. Strains (n = 50, 14.7%) and fractures (n = 35, 24.0%) were the leading diagnoses for patients undergoing transport in college and high school, respectively. CONCLUSIONS: Athletic trainers should maintain a high level of emergency preparedness when working with sports that have high rates and numbers of ETIs. Athletes with injuries to the head/face required the most frequent transport across competition levels. Athletic trainers should have the appropriate equipment and protocols in place to handle these patients. Future researchers should examine the differences between field and hospital diagnoses to help improve prehospital care and decrease the likelihood of unnecessary emergency transports.
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Affiliation(s)
| | - Zachary Y Kerr
- Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Erin B Wasserman
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill
| | - Daniel R Clifton
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | | | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia
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Kay MC, Welker EB, Jacquier EF, Story MT. Beverage Consumption Patterns among Infants and Young Children (0⁻47.9 Months): Data from the Feeding Infants and Toddlers Study, 2016. Nutrients 2018; 10:E825. [PMID: 29949886 PMCID: PMC6073729 DOI: 10.3390/nu10070825] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Data about early life beverage intake patterns is sparse. We describe beverage patterns among infants and young children from the Feeding Infants and Toddlers Study (FITS) 2016. (2) Methods: FITS 2016 is a cross-sectional survey of U.S. parents/caregivers of children 0⁻47.9 months (n = 3235). Food and beverage intakes were collected by 24-h dietary recalls to describe beverage consumption patterns including: a) prevalence of consumption, per capita and per consumer intake, b) contribution to intake of calories and key nutrients, and c) prevalence according to eating occasions. (3) Results: Breast milk and infant formula were commonly consumed among <12-month-olds. Among 12⁻23.9-month-olds, the most commonly consumed beverage was whole milk (67% consuming), followed by 100% juice (50% consuming). Plain drinking water was consumed by 70% of 12⁻23.9-month-olds and 78% of 24⁻47.9-month-olds. Among 12⁻47.9-month-olds, milks provided more energy and key nutrients than all other beverages. Across eating occasions, sugar-sweetened beverage (SSB) consumption, especially in the form of fruit-flavored drinks, was higher among 24⁻47.9 compared to 12⁻23.9-month-olds. Only 23⁻32% of ≥12-month-olds consumed milk or water at lunch or dinner. (4) Conclusions: Opportunities exist to improve beverage patterns. Future interventions may benefit from focusing on timely introduction of age-appropriate beverages and reducing consumption of SSBs.
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Affiliation(s)
- Melissa C Kay
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27708, USA.
| | - Emily B Welker
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27708, USA.
| | - Emma F Jacquier
- Nestlé Research Center, Vers-Chez-les-Blanc, Route du Jorat 57, Case Postale 44, 1000 Lausanne-26, Switzerland.
| | - Mary T Story
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27708, USA.
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Kay MC, Kucera KL. Mixed Methods Designs for Sports Medicine Research. Clin Sports Med 2018; 37:401-412. [PMID: 29903382 DOI: 10.1016/j.csm.2018.03.005] [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] [Indexed: 10/14/2022]
Abstract
Mixed methods research is a relatively new approach in the field of sports medicine, where the benefits of qualitative and quantitative research are combined while offsetting the other's flaws. Despite its known and successful use in other populations, it has been used minimally in sports medicine, including studies of the clinician perspective, concussion, and patient outcomes. Therefore, there is a need for this approach to be applied in other topic areas not easily addressed by one type of research approach in isolation, such as the retirement from sport, effects of and return from injury, and catastrophic injury.
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Affiliation(s)
- Melissa C Kay
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB #8700, Chapel Hill, NC 27599, USA.
| | - Kristen L Kucera
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, 209 Fetzer Hall, CB #8700, Chapel Hill, NC 27599, USA
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Register-Mihalik JK, Cameron KL, Linnan LA, Kay MC, Houston MN, Peck KY, Hennink- Kaminski HJ, Svoboda SJ, Gildner P, Kerr ZY, Guskiewicz KM, Marshall SW. Factors Associated with Intention to Disclose Concussive Symptoms among Service Academy Cadets. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538723.96055.a4] [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: 11/21/2022]
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Kay MC, Vander Vegt CB, Register-Mihalik JK. Youth Sport Coaches Perceptions and Prioritization of Sport Safety. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536137.16733.af] [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: 11/21/2022]
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Kay MC, Wasser H, Adair LS, Thompson AL, Siega‐Riz AM, Suchindran CM, Bentley ME. Consumption of obesogenic foods in non-Hispanic black mother-infant dyads. Matern Child Nutr 2018; 14:e12482. [PMID: 28627126 PMCID: PMC6651737 DOI: 10.1111/mcn.12482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 01/29/2023]
Abstract
Obesity continues to be a problem in the United States. Of particular concern is the epidemic of early childhood obesity. A significant predictor of child diet is maternal diet, but little is known about this relationship during infancy. This study examined the association between maternal and infant consumption of key food groups from 6 to 18 months using data from the Infant Care, Feeding, and Risk of Obesity Study, a prospective cohort of 217 non-Hispanic black, low-income, first-time mothers. Using data from 24-hr dietary recalls collected during in-home visits at 6, 9, 12, and 18 months, we assessed longitudinal associations between mother and child intake of both energy-dense, nutrient-poor (obesogenic) food groups and fibre-, nutrient-rich food groups using random intercept logistic regression. Both mothers and their infants had high intake of sugar-sweetened beverages, desserts, and sweets and low intake of vegetables and whole grains. Infant consumption of key food groups was strongly associated with maternal consumption, suggesting the need for focused interventions to target maternal diet as a pathway to decreasing risk for the establishment of poor dietary patterns early in life.
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Affiliation(s)
- Melissa C. Kay
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Heather Wasser
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Linda S. Adair
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Amanda L. Thompson
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of AnthropologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anna Maria Siega‐Riz
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Public Health SciencesUniversity of VirginiaUSA
| | - Chirayath M. Suchindran
- Department of BiostatisticsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Margaret E. Bentley
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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