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Turner K, Kim DW, Gonzalez BD, Gore LR, Gurd E, Milano J, Riccardi D, Byrne M, Al-Jumayli M, de Castria TB, Laber DA, Hoffe S, Costello J, Robinson E, Chadha JS, Rajasekhara S, Hume E, Hagen R, Nguyen OT, Nardella N, Parker N, Carson TL, Tabriz AA, Hodul P. Support Through Remote Observation and Nutrition Guidance (STRONG), a digital health intervention to reduce malnutrition among pancreatic cancer patients: A study protocol for a pilot randomized controlled trial. Contemp Clin Trials Commun 2024; 38:101271. [PMID: 38440777 PMCID: PMC10910065 DOI: 10.1016/j.conctc.2024.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024] Open
Abstract
Background Malnutrition is a common and distressing condition among pancreatic cancer patients. Fewer than a quarter of pancreatic cancer patients receive medical nutrition therapy (MNT), important for improving nutritional status, weight maintenance, quality of life and survival. System, provider, and patient level barriers limit access to MNT. We propose to examine the feasibility of a 12-week multi-level, digital health intervention designed to expand MNT access among pancreatic cancer patients. Methods Individuals with advanced pancreatic cancer starting chemotherapy (N = 80) will be 1:1 randomized to the intervention or usual care. The Support Through Remote Observation and Nutrition Guidance (STRONG) intervention includes system-level (e.g., routine malnutrition and screening), provider-level (e.g., dietitian training and web-based dashboard), and patient-level strategies (e.g., individualized nutrition plan, self-monitoring of dietary intake via Fitbit, ongoing goal monitoring and feedback). Individuals receiving usual care will be referred to dietitians based on their oncologists' discretion. Study assessments will be completed at baseline, 4-, 8-, 12-, and 16-weeks. Results Primary outcomes will be feasibility (e.g., recruitment, retention, assessment completion) and acceptability. We will collect additional implementation outcomes, such as intervention adherence, perceived usability, and feedback on intervention quality via an exit interview. We will collect preliminary data on outcomes that may be associated with the intervention including malnutrition, quality of life, treatment outcomes, and survival. Conclusion This study will advance our knowledge on the feasibility of a digital health intervention to reduce malnutrition among individuals with advanced pancreatic cancer. Trial registration: NCT05675059, registered on December 9, 2022.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Dae Won Kim
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Laurence R. Gore
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, USA
| | - Erin Gurd
- Department of Nutrition Therapy, Moffitt Cancer Center, USA
| | - Jeanine Milano
- Department of Nutrition Therapy, Moffitt Cancer Center, USA
| | - Diane Riccardi
- Department of Nutrition Therapy, Moffitt Cancer Center, USA
| | - Margaret Byrne
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | | | - Tiago Biachi de Castria
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Damian A. Laber
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, USA
| | - James Costello
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, USA
| | - Edmondo Robinson
- Department of Oncological Sciences, University of South Florida, USA
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, USA
- Center for Digital Health, Moffitt Cancer Center, USA
| | | | | | - Emma Hume
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Ryan Hagen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Nicole Nardella
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
| | - Nathan Parker
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Tiffany L. Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
| | - Pamela Hodul
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, USA
- Department of Oncological Sciences, University of South Florida, USA
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Carson TL, Byrd DA, Smith KS, Carter D, Gomez M, Abaskaron M, Little RB, Holmes ST, van Der Pol WJ, Lefkowitz EJ, Morrow CD, Fruge AD. A case-control study of the association between the gut microbiota and colorectal cancer: exploring the roles of diet, stress, and race. Gut Pathog 2024; 16:13. [PMID: 38468325 PMCID: PMC10929127 DOI: 10.1186/s13099-024-00608-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The gut microbiota is associated with risk for colorectal cancer (CRC), a chronic disease for which racial disparities persist with Black Americans having a higher risk of CRC incidence and mortality compared to other groups. Given documented racial differences, the gut microbiota may offer some insight into previously unexplained racial disparities in CRC incidence and mortality. A case-control analysis comparing 11 women newly diagnosed with CRC with 22 cancer-free women matched on age, BMI, and race in a 1:2 ratio was conducted. Information about participants' diet and perceived stress levels were obtained via 24-h Dietary Recall and Perceived Stress Scale-10 survey, respectively. Participants provided stool samples from which microbial genomic DNA was extracted to reveal the abundance of 26 genera chosen a priori based on their previously observed relevance to CRC, anxiety symptoms, and diet. RESULTS Significantly lower alpha diversity was observed among cancer-free Black women compared to all other race-cancer status combinations. No group differences were observed when comparing beta diversity. Non-Hispanic White CRC cases tended to have higher relative abundance of Fusobacteria, Gemellaceae, and Peptostreptococcus compared to all other race-cancer combination groups. Perceived stress was inversely associated with alpha diversity and was associated with additional genera. CONCLUSIONS Our findings suggest that microbiome-CRC associations may differ by racial group. Additional large, racially diverse population-based studies are needed to determine if previously identified associations between characteristics of the gut microbiome and CRC are generalizable to Black women and other racial, ethnic, and gender groups.
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Affiliation(s)
- Tiffany L Carson
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
| | - Doratha A Byrd
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kristen S Smith
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Daniel Carter
- Auburn University, 1161 W. Samford Avenue, Auburn, AL, 36849, USA
| | - Maria Gomez
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | | | - Rebecca B Little
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | | | - William J van Der Pol
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Elliot J Lefkowitz
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Casey D Morrow
- University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Andrew D Fruge
- Auburn University, 1161 W. Samford Avenue, Auburn, AL, 36849, USA
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Huang S, Riccardi D, Pflanzer S, Redwine LS, Gray HL, Carson TL, McDowell M, Thompson Z, Hubbard JJ, Pabbathi S. Survivors Overcoming and Achieving Resiliency (SOAR): Mindful Eating Practice for Breast Cancer Survivors in a Virtual Teaching Kitchen. Nutrients 2023; 15:4205. [PMID: 37836489 PMCID: PMC10574766 DOI: 10.3390/nu15194205] [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: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
The practice of mindful eating brings awareness to food choices, brings attention to the eating experience, and encourages selecting and preparing food that is both satisfying and nourishing. We examined mindful eating in breast cancer survivors following a 9-week, multidisciplinary virtual teaching kitchen intervention called Survivors Overcoming and Achieving Resiliency (SOAR). SOAR engaged participants through weekly cooking classes that also taught multiple domains of mindfulness. Participants (n = 102) were breast cancer survivors and completed the Mindful Eating Questionnaire (MEQ) prior to and after completion of the intervention. Linear regression analyses examined relationships between the aspects of mindful eating and body mass index (BMI). Wilcoxon (paired) rank sum tests evaluated the significance of the change in the MEQ total sum and subscales scores. A total of 102 participants completed both the pre- and post-intervention surveys. The mean change between the pre- and post-SOAR MEQ summary scores was 0.12 (sd = 0.30; Wilcoxon p-value = 0.0003). All MEQ subscale scores significantly increased with the exception of the distraction subscale. The MEQ summary scores increased for participants across both BMI stratifications. The SOAR teaching kitchen represents one of the first interventions that is tailored for breast cancer survivors and combines behavioral strategies from mindful eating training to nutritional knowledge and culinary medicine pedagogy in a virtual teaching kitchen. Further research is needed to examine whether mindful eating practices among cancer survivors result in sustainable healthy eating behaviors and food choices consistent with the cancer risk reduction guidelines.
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Affiliation(s)
- Sherri Huang
- Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Diane Riccardi
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Sonya Pflanzer
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Laura S. Redwine
- Osher Center for Integrative Health, Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, FL 33134, USA
| | - Heewon L. Gray
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tiffany L. Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Marc McDowell
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Zachary Thompson
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Jesse J. Hubbard
- Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Smitha Pabbathi
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Buro AW, Carson TL, Small BJ, Fan W, Oswald LB, Jim HSL, Salas E, Zambrano K, Bryant C, Yamoah K, Gwede CK, Park JY, Gonzalez BD. Sociocultural factors associated with physical activity in Black prostate cancer survivors. Support Care Cancer 2023; 31:482. [PMID: 37479918 PMCID: PMC10388711 DOI: 10.1007/s00520-023-07898-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Prostate cancer disproportionately affects Black men. Physical activity protects long-term health and quality of life outcomes in prostate cancer survivors. This study aimed to identify sociocultural factors related to physical activity among Black prostate cancer survivors to inform culturally tailored intervention development. METHODS This secondary analysis included data from 257 men who identified as Black or African American and were diagnosed with prostate cancer between 2013 and 2018. Participants completed validated self-report measures of perceived history of racial discrimination, religiosity, fatalism, sociodemographic (e.g., age, ethnicity, income) and clinical characteristics (e.g., years since diagnosis, comorbidity burden), and leisure-time physical activity. Regression analyses were conducted to examine the associations between sociocultural factors and mild, moderate, and vigorous physical activity. RESULTS Participants were on average 68.7 years old (SD = 7.7), and most were non-Hispanic (97.3%), married (68.9%), reported an annual household income above $50,000 (57.1%), received at least some college education (74.1%), and were overweight or had obesity (78.5%). Participants reported on average 88.1 (SD = 208.6) min of weekly mild physical activity, and most did not meet guidelines for weekly moderate (80.5%) or vigorous (73.0%) physical activity. After adjusting for covariates, older age and greater religiosity were associated with mild physical activity (ps ≤ 0.05). Higher levels of fatalism were associated with lower odds of meeting guidelines for moderate physical activity (OR = 0.87, 95% CI = 0.77-0.99). CONCLUSIONS Sociocultural factors such as religiosity and fatalism may be associated with some forms of physical activity in Black prostate cancer survivors. These findings suggest that incorporating faith-based practices into health behavior interventions may be appropriate for this population.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA.
- College of Population Health, University of New Mexico, Albuquerque, NM, USA.
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
| | - Brent J Small
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Wenyi Fan
- Biostatistics and Bioinformatics Shared Resource, Moffitt Cancer Center, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
| | - Endrina Salas
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
| | - Kellie Zambrano
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
| | - Crystal Bryant
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
| | - Kosj Yamoah
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
| | - Jong Y Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, USA
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Buro AW, Sauls R, Stern M, Carson TL. A qualitative study of stress experiences, health behaviors, and intervention preferences in young adult cancer survivors. Support Care Cancer 2023; 31:295. [PMID: 37093353 PMCID: PMC10123481 DOI: 10.1007/s00520-023-07756-w] [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: 12/02/2022] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To inform behavioral intervention development, this study examined experiences and unmet needs related to stress, diet, and physical activity in young adult (YA) cancer survivors. METHODS Twenty-three semi-structured interviews were conducted with a purposive sample of YA cancer survivors (n = 12 aged 18-29 years; n = 11 aged 30-39 years; 57% racial or ethnic minority) between May and July 2022 via Zoom. Data were analyzed using a coding reliability approach to thematic analysis. RESULTS Stressor-related themes included health and health care, economic stability, social and community context, and balancing responsibilities. Transition to independent adulthood was discussed among younger participants (18-29 years). Coping-related themes included letting go, keeping anchored in faith, and distraction. Older participants (30-39 years) reported more diverse coping strategies. Routine and consistency and the impact of stress were themes aligning with health behaviors. Control was a cross-cutting theme regarding stressors, coping, and health behaviors. Themes related to intervention preferences included individualized approach, expert-based content, peer support, integrative self-care, and manageability. Younger participants preferred multiple intervention formats (e.g., website, tracking logs). CONCLUSIONS Findings highlighted unmet needs regarding social and environmental stressors in YA cancer survivors and a preference for individualized, expert-based content and peer support in stress management-enhanced behavioral interventions. Such interventions may be tailored for specific age groups to account for differences in stress experiences and intervention preferences.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
| | - Rachel Sauls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Marilyn Stern
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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Crowder SL, Jim HSL, Hogue S, Carson TL, Byrd DA. Gut microbiome and cancer implications: Potential opportunities for fermented foods. Biochim Biophys Acta Rev Cancer 2023; 1878:188897. [PMID: 37086870 DOI: 10.1016/j.bbcan.2023.188897] [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: 02/07/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
There is a critical opportunity to improve response to immunotherapies and overall cancer survivorship via dietary interventions targeted to modify the gut microbiome, and in turn, potentially enhance anti-cancer immunity. A promising dietary intervention is fermented foods, which may alter gut microbiome composition and, in turn, improve immunity. In this article, we summarize the state of the literature pertaining to the gut microbiome and response to immunotherapy and other cancer treatments, potential clinical implications of utilizing a fermented foods dietary approach to improve cancer treatment outcomes, and existing gaps in the literature regarding the implementation of fermented food interventions among individuals with cancer or with a history of cancer. This review synthesizes a compelling rationale across different disciplines to lay a roadmap for future fermented food dietary intervention research aimed at modulating the gut microbiome to reduce cancer burden.
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Affiliation(s)
- Sylvia L Crowder
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Stephanie Hogue
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Doratha A Byrd
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Martin SL, Cardel MI, Carson TL, Hill JO, Stanley T, Grinspoon S, Steger F, Blackman Carr LT, Ashby-Thompson M, Stewart D, Ard J, Stanford FC. Increasing diversity, equity, and inclusion in the fields of nutrition and obesity: A roadmap to equity in academia. Am J Clin Nutr 2023; 117:659-671. [PMID: 36907515 PMCID: PMC10273076 DOI: 10.1016/j.ajcnut.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Research shows that a diverse faculty improves academic, clinical, and research outcomes in higher education. Despite that, persons in minority groups, usually categorized by race or ethnicity, are underrepresented in academia (URiA). The Nutrition Obesity Research Centers (NORCs), supported by the NIDDK, hosted workshops on five separate days in September and October 2020. NORCs convened these workshops to identify barriers and facilitators for diversity, equity, and inclusion (DEI) and provide specific recommendations to improve DEI within obesity and nutrition for individuals from URiA groups. Recognized experts on DEI presented each day, after which the NORCs conducted breakout sessions with key stakeholders who engage in nutrition and obesity research. The breakout session groups included early-career investigators, professional societies, and academic leadership. The consensus from the breakout sessions was that glaring inequities affect URiA in nutrition and obesity, particularly related to recruitment, retention, and advancement. Recommendations from the breakout sessions to improve DEI across the academe focused on six themes: (1) recruitment, (2) retention, (3) advancement, (4) intersectionality of multiple challenges (e.g., being Black and a woman), (5) funding agencies, and (6) implementation of strategies to address problems related to DEI.
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Affiliation(s)
- Samantha L Martin
- Department of Obstetrics and Gynecology University of Alabama at Birmingham Birmingham, Alabama, USA; Center for Women's Reproductive Health University of Alabama at Birmingham Birmingham, Alabama, USA.
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida Gainesville, Florida, USA; Center for Integrative Cardiovascular and Metabolic Diseases University of Florida, Gainesville, Florida, USA; WW International, Inc. New York, New York, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior Moffitt Cancer Center Tampa, Florida, USA
| | - James O Hill
- Nutrition Obesity Research Center University of Alabama at Birmingham Birmingham, Alabama, USA
| | - Takara Stanley
- Department of Medicine, Metabolism Unit Massachusetts General Hospital, and Harvard School Boston, Massachusetts, USA; Pediatric Endocrinology Massachusetts General Hospital, and Harvard Medical School Boston, Massachusetts, USA; Nutrition Obesity Research Center at Harvard (NORCH) Harvard Medical School Boston, Massachusetts, USA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit Massachusetts General Hospital, and Harvard School Boston, Massachusetts, USA; Nutrition Obesity Research Center at Harvard (NORCH) Harvard Medical School Boston, Massachusetts, USA; Department of Epidemiology and Prevention Wake Forest School of Medicine, Wake Forest Baptist Medical Center Winston-Salem, North Carolina USA
| | - Felicia Steger
- Department of Nutrition University of Alabama at Birmingham Birmingham, Alabama, USA
| | - Loneke T Blackman Carr
- Department of Nutritional Sciences, College of Agriculture, Health and Natural Resources University of Connecticut Storrs, Connecticut, USA
| | - Maxine Ashby-Thompson
- Department of Pediatrics Columbia University, New York Obesity Research Center New York, New York, USA
| | - Delisha Stewart
- Department of Nutrition University of North Carolina Chapel Hill, Nutrition Research Institute Kannapolis, North Carolina, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention Wake Forest University Winston-Salem, North Carolina, USA
| | - Fatima Cody Stanford
- Pediatric Endocrinology Massachusetts General Hospital, and Harvard Medical School Boston, Massachusetts, USA; Nutrition Obesity Research Center at Harvard (NORCH) Harvard Medical School Boston, Massachusetts, USA; Department of Epidemiology and Prevention Wake Forest School of Medicine, Wake Forest Baptist Medical Center Winston-Salem, North Carolina USA
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8
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Martin SL, Cardel MI, Carson TL, Hill JO, Stanley T, Grinspoon S, Steger F, Blackman Carr LT, Ashby-Thompson M, Stewart D, Ard J, Stanford FC. Increasing diversity, equity, and inclusion in the fields of nutrition and obesity: A road map to equity in academia. Obesity (Silver Spring) 2023; 31:1240-1254. [PMID: 36896568 DOI: 10.1002/oby.23704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 03/11/2023]
Abstract
Research shows that a diverse faculty improves academic, clinical, and research outcomes in higher education. Despite that, persons in minority groups, usually categorized by race or ethnicity, are underrepresented in academia (URiA). The Nutrition Obesity Research Centers (NORCs), supported by the National Institute of Diabetes and Digestive and Kidney Diseases, hosted workshops on five separate days in September and October 2020. NORCs convened these workshops to identify barriers and facilitators for diversity, equity, and inclusion (DEI) and provide specific recommendations to improve DEI within obesity and nutrition for individuals from URiA groups. Recognized experts on DEI presented each day, after which the NORCs conducted breakout sessions with key stakeholders who engage in nutrition and obesity research. The breakout session groups included early-career investigators, professional societies, and academic leadership. The consensus from the breakout sessions was that glaring inequities affect URiA in nutrition and obesity, particularly related to recruitment, retention, and advancement. Recommendations from the breakout sessions to improve DEI across academia focused on six themes: (1) recruitment, (2) retention, (3) advancement, (4) intersectionality of multiple challenges (e.g., being Black and a woman), (5) funding agencies, and (6) implementation of strategies to address problems related to DEI.
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Affiliation(s)
- Samantha L Martin
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, Florida, USA
- WW International, Inc., New York, New York, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - James O Hill
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Takara Stanley
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital, and Harvard School, Boston, Massachusetts, USA
- Pediatric Endocrinology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital, and Harvard School, Boston, Massachusetts, USA
- Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Felicia Steger
- Department of Nutrition, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Loneke T Blackman Carr
- Department of Nutritional Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, Connecticut, USA
| | - Maxine Ashby-Thompson
- Department of Pediatrics, Columbia University, New York Obesity Research Center, New York, New York, USA
| | - Delisha Stewart
- Department of Nutrition, University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, North Carolina, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Fatima Cody Stanford
- Pediatric Endocrinology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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9
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Buro AW, Crowder SL, Rozen E, Stern M, Carson TL. Lifestyle Interventions with Mind-Body or Stress-Management Practices for Cancer Survivors: A Rapid Review. Int J Environ Res Public Health 2023; 20:3355. [PMID: 36834048 PMCID: PMC9964062 DOI: 10.3390/ijerph20043355] [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] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
This rapid review examined current evidence on lifestyle interventions with stress-management or mind-body practices that assessed dietary and/or physical activity outcomes among cancer survivors. Searches were conducted in PubMed, Embase, and PsycINFO based on Cochrane Rapid Reviews Methods Group rapid review recommendations using the keywords "diet," "physical activity," "mind-body," "stress," and "intervention." Of the 3624 articles identified from the initial search, 100 full-text articles were screened, and 33 articles met the inclusion criteria. Most studies focused on post-treatment cancer survivors and were conducted in-person. Theoretical frameworks were reported for five studies. Only one study was tailored for adolescent and young adult (AYA) cancer survivors, and none included pediatric survivors. Nine studies reported race and/or ethnicity; six reported that ≥90% participants were White. Many reported significant findings for diet and/or physical activity-related outcomes, but few used complete, validated dietary intake methods (e.g., 24-h recall; n = 5) or direct measures of physical activity (e.g., accelerometry; n = 4). This review indicated recent progress on evaluating lifestyle interventions with stress-management or mind-body practices for cancer survivors. Larger controlled trials investigating innovative, theory-based, personalized interventions that address stress and health behaviors in cancer survivors-particularly racial/ethnic minority and pediatric and AYA populations-are needed.
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Affiliation(s)
- Acadia W. Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Sylvia L. Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Emily Rozen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Marilyn Stern
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL 33612, USA
| | - Tiffany L. Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
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Chandler-Laney P, Biggio JR, Tipre M, Carson TL, Bae S, Everett AB, Baskin ML. Relationship Between Race and Gestational Weight Gain in Pregnancy and Early Life in the South Birth-Cohort Study. Matern Child Health J 2023; 27:356-366. [PMID: 36662382 DOI: 10.1007/s10995-022-03584-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate whether differences in gestational weight gain (GWG) and adverse perinatal outcomes exist for Black and White women who are overweight or have obesity (OW/OB) at entry to prenatal care. METHODS We enrolled 183 pregnant women with BMI 25-45 kg/m2 (71% black, 29% white) prior to 14 weeks gestation. Data were collected on demographic, medical history, diet and physical activity during pregnancy. Relationships between race and maternal outcomes and infant outcomes were assessed using multivariable logistic regression models. RESULTS The average age of pregnant women were 26 years (±4.8), with a mean BMI of 32.1 (±5.1) kg/m2 at the time of enrollment. At delivery, 60 women (33%) had GWG within Institute of Medicine recommendations and 69% had at least one comorbidity. No significant differences by race were found in GWG (in lbs) (11±7.5 vs. 11.4±7.3, p=0.2006) as well as other perinatal outcomes including maternal morbidity, LBW and PTB. Race differences were noted for gestational diabetes, total energy expenditure and average daily calorie intake, but these differences did not result in significant differences in GWG or maternal morbidity. CONCLUSION The lack of racial differences in GWG and perinatal outcomes demonstrated in this study differs from prior literature and could potentially be attributed to small sample size. Findings suggest that race differences in GWG and perinatal outcomes may diminish for women with a BMI in the overweight or obese range at conception.
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Affiliation(s)
- Paula Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Meghan Tipre
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, H. Lee Moffit Cancer Center & Research Institute, Tampa, FL, USA
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA
| | - Alysha B Everett
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), 1717 11th Ave S, MT 618, 35294-4410, Birmingham, AL, USA.
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Carson TL, Byrd DA, Smith KS, Carter D, Abaskaron M, Little RB, Holmes ST, van Der Pol WJ, Lefkowitz EJ, Morrow CD, Fruge AD, Gomez M. A case-control study of the association between the gut microbiota and colorectal cancer: exploring the roles of diet, stress, and race. Res Sq 2023:rs.3.rs-2475944. [PMID: 36711747 PMCID: PMC9882682 DOI: 10.21203/rs.3.rs-2475944/v1] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The gut microbiota is associated with risk for colorectal cancer (CRC), a chronic disease for which racial disparities persist with Black Americans having a higher risk of CRC incidence and mortality compared to other groups. Given documented racial differences, the gut microbiota may offer some insight into previously unexplained racial disparities in CRC incidence and mortality. A case-control analysis comparing 11 women newly diagnosed with CRC with 22 cancer-free women matched on age, BMI, and race in a 1:2 ratio was conducted. Information about participants' diet and perceived stress levels were obtained via 24-hour Dietary Recall and Perceived Stress Scale-10 survey, respectively. Participants provided stool samples from which microbial genomic DNA was extracted to reveal the abundance of 26 genera chosen a priori based on their previously observed relevance to CRC, anxiety symptoms, and diet. Results Significantly lower alpha diversity was observed among cancer-free Black women compared to all other race-cancer status combinations. No group differences were observed when comparing beta diversity. Non-Hispanic White CRC cases tended to have higher relative abundance of Fusobacteria, Gemellaceae, and Peptostreptococcus compared to all other race-cancer combination groups. Perceived stress was inversely associated with alpha diversity and was associated with additional genera. Conclusions Our findings suggest that microbiome-CRC associations may differ by racial group. Additional large, racially diverse population-based studies are needed to determine if previously identified associations between characteristics of the gut microbiome and CRC are generalizable to Black women and other racial, ethnic, and gender groups.
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Carson TL, Buro AW, Miller D, Peña A, Ard JD, Lampe JW, Yi N, Lefkowitz E, William VDP, Morrow C, Wilson L, Barnes S, Demark-Wahnefried W. Rationale and study protocol for a randomized controlled feeding study to determine the structural- and functional-level effects of diet-specific interventions on the gut microbiota of non-Hispanic black and white adults. Contemp Clin Trials 2022; 123:106968. [PMID: 36265810 PMCID: PMC10095329 DOI: 10.1016/j.cct.2022.106968] [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: 04/27/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Colorectal cancer (CRC), the third leading cause of cancer-related deaths in the US, has been associated with an overrepresentation or paucity of several microbial taxa in the gut microbiota, but causality has not been established. Black men and women have among the highest CRC incidence and mortality rates of any racial/ethnic group. This study will examine the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on gut microbiota and fecal metabolites associated with CRC risk. METHODS A generally healthy sample of non-Hispanic Black and white adults (n = 112) is being recruited to participate in a parallel-arm randomized controlled feeding study. Participants are randomized to receive the DASH diet or a standard American diet for a 28-day period. Fecal samples are collected weekly throughout the study to analyze changes in the gut microbiota using 16 s rRNA and selected metagenomics. Differences in bacterial alpha and beta diversity and taxa that have been associated with CRC (Bacteroides, Fusobacterium, Clostridium, Lactobacillus, Bifidobacterium, Ruminococcus, Porphyromonas, Succinivibrio) are being evaluated. Covariate measures include body mass index, comorbidities, medication history, physical activity, stress, and demographic characteristics. CONCLUSION Our findings will provide preliminary evidence for the DASH diet as an approach for cultivating a healthier gut microbiota across non-Hispanic Black and non-Hispanic White adults. These results can impact clinical, translational, and population-level approaches for modification of the gut microbiota to reduce risk of chronic diseases including CRC. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov, identifier NCT04538482, on September 4, 2020 (https://clinicaltrials.gov/ct2/show/NCT04538482).
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Affiliation(s)
- Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America.
| | - Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Darci Miller
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Alissa Peña
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Johanna W Lampe
- Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Elliot Lefkowitz
- Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Van Der Pol William
- Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Casey Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Landon Wilson
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America; Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Stephen Barnes
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America; Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
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Little RB, Murillo AL, Van Der Pol WJ, Lefkowitz EJ, Morrow CD, Yi N, Carson TL. Diet Quality and the Gut Microbiota in Women Living in Alabama. Am J Prev Med 2022; 63:S37-S46. [PMID: 35725139 PMCID: PMC9219556 DOI: 10.1016/j.amepre.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The gut microbiota is associated with obesity and modulated by individual dietary components. However, the relationships between diet quality and the gut microbiota and their potential interactions with weight status in diverse populations are not well understood. This study examined the associations between overall diet quality, weight status, and the gut microbiota in a racially balanced sample of adult females. METHODS Female participants (N=71) residing in Birmingham, Alabama provided demographics, anthropometrics, biospecimens, and dietary data in this observational study from March 2014 to August 2014, and data analysis was conducted from August 2017 to March 2019. Weight status was defined as a BMI (weight [kg]/height [m2]) <30 kg/m2 for non-obese participants and ≥30 kg/m2 for participants who were obese. Dietary data collected included an Automated Self-Administered 24-Hour recall and Healthy Eating Index-2010 (HEI-2010) score. Diet quality was defined as having a high HEI score (≥median) or a low HEI score (<median). The fecal microbiota was collected, and the 16S ribosomal RNA gene was amplified to profile the microbiota composition. Differences in diet quality based on weight status were assessed using 2-sample t-tests. The associations between diet quality, gut microbiota, and weight status were analyzed using negative binomial models. RESULTS Participants (43 Black, 28 White) aged 40.39±13.86 years who were non-obese (56%) and obese (44%) were studied. Greater alpha diversity was observed among those with higher Healthy Eating Index scores (p=0.037) but did not differ by weight status. Higher abundances of Bacteroidetes (p=0.006) and Firmicutes (p=0.042) were associated with a higher HEI score. Higher Bacteriodetes levels were observed among non-obese (p=0.006). CONCLUSIONS Diet quality measured by the HEI was associated with alpha diversity of the gut microbiota among adult females. Abundances of phyla that have been linked with weight status (Bacteroidetes and Firmicutes) were positively associated with diet quality.
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Affiliation(s)
- Rebecca B Little
- Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Anarina L Murillo
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island.
| | - William J Van Der Pol
- Biomedical Informatics, UAB Center for Clinical and Translational Science, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Elliot J Lefkowitz
- Biomedical Informatics, UAB Center for Clinical and Translational Science, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Microbiology, School of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Casey D Morrow
- Department of Cell, Developmental and Integrative Biology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Abstract
Background: Chronic psychological stress has been associated with several adverse health outcomes, including obesity. Black women report higher levels of psychological stress than White women and carry a disproportionate burden of chronic conditions associated with psychological stress, including obesity. Research also suggests that in addition to generic stressors, Black women also experience race- and gender-related stress. To further explore this, we conducted structured focus groups to examine Black women's perspectives about stress. Materials and Methods: Using the nominal group technique, three sessions (total, n = 33) were conducted exclusively with Black women to solicit responses to the following questions: (1) What are the top sources of stress for women? (2) What are the top stressors specifically for Black women? and (3) How do these stressors affect weight? Using a systematic method, participants ranked responses in order of importance. Responses were compiled and tabulated to identify which statements were viewed as most important by respondents. Results: Mean age and body mass index of participants were 43.0 ± 10.1 years and 35.1 ± 7.9 kg/m2, respectively. The top 3 responses for question 1 were health, family, and relationships. Safety of children and raising Black children, being the head of the family, and finances were the top responses for question 2. Emotional eating, not enough time for exercise, and eating fast food due to lack of time or money were voted as the top reasons as to how stressors influence women's weight. Discussion: Our findings are consistent with previous work reporting that, along with generic stress, race- and gender-related stress contribute to the overall experiences of Black women. This work adds qualitative depth to allow for a better understanding of the unique sources of stress for Black women. These gender- and race-related stressors should be considered when offering stress management interventions for weight loss and general health promotion among Black women.
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Affiliation(s)
- Meghan Tipre
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tiffany L. Carson
- Division of Population Sciences, Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute
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Carson TL, Cardel MI, Stanley TL, Grinspoon S, Hill JO, Ard J, Mayer-Davis E, Stanford FC. Racial and ethnic representation among a sample of nutrition- and obesity-focused professional organizations in the United States. Obesity (Silver Spring) 2022; 30:292-296. [PMID: 34658155 PMCID: PMC9708392 DOI: 10.1002/oby.23310] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Obesity is a chronic disease that disproportionately affects individuals from nonmajority racial/ethnic groups in the United States. Research shows that individuals from minority racial/ethnic backgrounds consider it important to have access to providers from diverse backgrounds. Health care providers and scientists from minority racial/ethnic groups are more likely than their non-Hispanic White counterparts to treat or conduct research on patients from underrepresented groups. The objective of this study was to characterize the racial/ethnic diversity of nutrition- and obesity-focused professional organizations in the United States. METHODS This study assessed race/ethnicity data from several obesity-focused national organizations including The Obesity Society, the Academy of Nutrition and Dietetics (AND), the American Society for Nutrition, and the American Board of Obesity Medicine (ABOM). Each organization was queried via emailed survey to provide data on racial/ethnic representation among their membership in the past 5 years and among elected presidents from 2010 to 2020. RESULTS Two of the three professional societies queried did not systematically track race/ethnicity data at the time of query. Limited tracking data available from AND show underrepresentation of Black (2.6%), Asian (3.9%), Latinx (3.1%), Native Hawaiian or Pacific Islander (1.3%), or indigenous (American Indian or Alaskan Native: 0.3%) individuals compared with the US population. Underrepresentation of racial/ethnic minorities was also reported for ABOM diplomates (Black: 6.0%, Latinx: 5.0%, Native American: 0.2%). Only AND reported having racial/ethnic diversity (20%) among the organization's presidents within the previous decade (2010-2020). CONCLUSIONS Findings suggest that (1) standardized tracking of race and ethnicity data is needed to fully assess diversity, equity, and inclusion, and (2) work is needed to increase the diversity of membership and leadership at the presidential level within obesity- and nutrition-focused professional organizations. A diverse cadre of obesity- and nutrition-focused health care professionals is needed to further improve nutrition-related health outcomes, including obesity, cardiovascular disease, diabetes, and undernutrition, in this country.
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Affiliation(s)
- Tiffany L. Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
- WW International, Inc., New York City, New York, USA
| | - Takara L. Stanley
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James O. Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fatima Cody Stanford
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Nolan TS, Ivankova N, Carson TL, Spaulding AM, Dunovan S, Davies S, Enah C, Meneses K. Life after breast cancer: 'Being' a young African American survivor. Ethn Health 2022; 27:247-274. [PMID: 31642349 DOI: 10.1080/13557858.2019.1682524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
Objective: In the United States, 26,534 young women (≤45 years) were diagnosed with breast cancer in 2017. Young African American (AA) women have higher incidence and mortality rates than Whites and Hispanics. Yet, few published studies describe survivorship (life after breast cancer diagnosis) experiences among this group. Here, we explore the lived experience of young AA breast cancer survivorship (via quality of life [QOL]).Design: This phenomenological study was framed by the QOL Applied to Breast Cancer model. Fifteen young AA survivors from the Southern U. S. participated in two semi-structured interviews. Methods of transcendental phenomenology were used for data collection and analysis.Results: Five themes emerged from participants' (mean age = 35 years; survivorship = 4 years) descriptions of survivorship experience: (1) actively managing spiritual self, (2) actively managing physical self, (3) actively managing psychological self, (4) actively managing social self, and (5) seeking survivorship knowledge. Participants perceived survivorship as a labile 'new normal' and 'ongoing struggle,' in which spirituality and survivorship knowledge were key to restructuring their lives.Conclusions: Survivorship among young AA survivors was more fluid and complex than the QOL model explained. Findings describe young AA breast cancer survivorship and indicate areas of potential strengths and distress. Healthcare providers and ancillary staff must exercise cultural competence to assess and anticipate young AA survivors' needs and concerns. Implementing targeted survivorship interventions, accounting for cultural contexts (e.g. high spirituality) and need for age-specific survivorship information, may improve QOL among young AA survivors.
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Affiliation(s)
- Timiya S Nolan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Nataliya Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Shanon Dunovan
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Susan Davies
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Comfort Enah
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Buro AW, Baskin M, Miller D, Ward T, West DS, Gore LR, Gwede CK, Epel E, Carson TL. Rationale and study protocol for a randomized controlled trial to determine the effectiveness of a culturally relevant, stress management enhanced behavioral weight loss intervention on weight loss outcomes of black women. BMC Public Health 2022; 22:193. [PMID: 35090433 PMCID: PMC8795937 DOI: 10.1186/s12889-022-12519-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Obesity is a persistent public health concern and a risk factor for many chronic diseases including at least 13 different cancers. Adult Black females have the highest prevalence of obesity (57%) compared to other racial/gender groups in the U.S. Although behavioral weight loss (BWL) interventions have demonstrated effectiveness, Black females tend to lose less weight than White counterparts. The higher prevalence of chronic psychological stress reported by Black females may contribute to their disproportionate prevalence of obesity and observed suboptimal weight loss. This study will examine the effectiveness of a 12-month culturally-targeted, stress management-enhanced BWL intervention on weight loss and stress reduction among Black females in a fully-powered randomized, controlled trial. METHODS Adult Black females with obesity (n = 340) will be randomized to either a culturally targeted stress management-enhanced BWL intervention (BWL-Stress) or the same BWL intervention alone (BWL-alone). The primary outcome is weight change at month 6. Secondary outcomes will include changes in stress measures (e.g., perceived stress, cortisol), energy intake, and physical activity at month 6. We will also assess process measures (e.g., treatment adherence, treatment burden). Each outcome will also be evaluated at month 12 to assess longer-term effects of the intervention. DISCUSSION This novel approach for enhancing an evidence-based BWL program with culturally-targeted stress management strategies for Black females addresses an understudied barrier to effective weight management among a population at high risk for obesity and obesity-related chronic diseases. This study will potentially elucidate psychological or behavioral mechanisms linking our novel intervention to study outcomes. If the intervention is proven to be effective, this study will have significant clinical and public health implications for weight management among Black females. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov , identifier NCT04335799t , on April 6, 2020.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Monica Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darci Miller
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Tayler Ward
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Delia Smith West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - L Robert Gore
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Elissa Epel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA.
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Carson TL, Cardel MI, Stanley TL, Grinspoon S, Hill JO, Ard J, Mayer-Davis E, Stanford FC. Racial and ethnic representation among a sample of nutrition- and obesity-focused professional organizations in the United States. Am J Clin Nutr 2021; 114:1869-1872. [PMID: 34718383 PMCID: PMC8634609 DOI: 10.1093/ajcn/nqab284] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity is a chronic disease that disproportionately affects individuals from nonmajority racial/ethnic groups in the United States. Research shows that individuals from minority racial/ethnic backgrounds consider it important to have access to providers from diverse backgrounds. Health care providers and scientists from minority racial/ethnic groups are more likely than non-Hispanic whites to treat or conduct research on patients from underrepresented groups. OBJECTIVES To characterize the racial/ethnic diversity of nutrition- and obesity-focused professional organizations in the United States. METHODS This study assessed race/ethnicity data from several obesity-focused national organizations including The Obesity Society, the Academy of Nutrition and Dietetics (AND), the American Society for Nutrition, and the American Board of Obesity Medicine (ABOM). Each organization was queried via emailed survey to provide data on racial/ethnic representation among their membership in the past 5 y and among elected presidents from 2010 to 2020. RESULTS Two of the 3 professional societies queried did not systematically track race/ethnicity data at the time of query. Limited tracking data available from AND show underrepresentation of black (2.6%), Asian (3.9%), Latinx (3.1%), Native Hawaiian or Pacific Islander: (1.3%), or indigenous (American Indian or Alaskan Native: 0.3%) individuals compared with the US population. Underrepresentation of racial/ethnic minorities was also reported for ABOM diplomates (black: 6.0%, Latinx: 5.0%, Native American: 0.2%). Only AND reported having racial/ethnic diversity (20%) among the organization's presidents within the previous decade (2010-2020). CONCLUSIONS Findings suggest that 1) standardized tracking of race and ethnicity data is needed to fully assess diversity, equity, and inclusion, and 2) work is needed to increase the diversity of membership and leadership at the presidential level within obesity- and nutrition-focused professional organizations. A diverse cadre of obesity- and nutrition-focused health care professionals is needed to further improve nutrition-related health outcomes, including obesity, cardiovascular disease, diabetes, and undernutrition, in this country.
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Affiliation(s)
- Tiffany L Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida; Gainesville, FL, USA
- WW International, Inc., New York City, NY, USA
| | - Takara L Stanley
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatima Cody Stanford
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medicine, Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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19
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Brown JC, Carson TL, Thompson HJ, Agurs-Collins T. The Triple Health Threat of Diabetes, Obesity, and Cancer-Epidemiology, Disparities, Mechanisms, and Interventions. Obesity (Silver Spring) 2021; 29:954-959. [PMID: 34029445 PMCID: PMC8152945 DOI: 10.1002/oby.23161] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes are both chronic, relapsing, progressive diseases that are recognized as risk factors for the development of multiple types of cancer. In a recent symposium titled "Hitting A Triple-Diabetes, Obesity, and the Emerging Links to Cancer Risk," convened by The Obesity Society during ObesityWeek 2019, experts in the field presented the current science and highlighted existing research gaps. Topics included (1) the epidemiology of obesity and diabetes and their links to cancer risk; (2) racial and ethnic differences in obesity, diabetes, and cancer risk; (3) biological mechanisms common to obesity and diabetes that may increase cancer risk; and (4) innovative interventions that can be used to prevent the development of cancers related to obesity and diabetes. This report provides an overview of the symposium and describes key research gaps and pressing questions in need of answers to advance the field. The collective burden of obesity, diabetes, and cancer represents one of the largest public health challenges of the century. Although the symposium was titled "hitting a triple," it was recognized that being able to disrupt the linkages among obesity, diabetes, and cancer would be a "grand slam" for public health and medicine.
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Affiliation(s)
- Justin C. Brown
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, USA
- LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA 70112, USA
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA, 70112, USA
| | - Tiffany L. Carson
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33617, USA
| | | | - Tanya Agurs-Collins
- National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA
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20
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Moumne O, Hampe ME, Montoya-Williams D, Carson TL, Neu J, Francois M, Rhoton-Vlasak A, Lemas DJ. Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review. J Perinat Med 2021; 49:402-411. [PMID: 33554571 DOI: 10.1515/jpm-2020-0367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/04/2020] [Accepted: 12/10/2020] [Indexed: 11/15/2022]
Abstract
The vaginal microbiome undergoes dramatic shifts before and throughout pregnancy. Although the genetic and environmental factors that regulate the vaginal microbiome have yet to be fully elucidated, high-throughput sequencing has provided an unprecedented opportunity to interrogate the vaginal microbiome as a potential source of next-generation therapeutics. Accumulating data demonstrates that vaginal health during pregnancy includes commensal bacteria such as Lactobacillus that serve to reduce pH and prevent pathogenic invasion. Vaginal microbes have been studied as contributors to several conditions occurring before and during pregnancy, and an emerging topic in women's health is finding ways to alter and restore the vaginal microbiome. Among these restorations, perhaps the most significant effect could be preterm labor (PTL) prevention. Since bacterial vaginosis (BV) is known to increase risk of PTL, and vaginal and oral probiotics are effective as supplemental treatments for BV prevention, a potential therapeutic benefit exists for pregnant women at risk of PTL. A new method of restoration, vaginal microbiome transplants (VMTs) involves transfer of one women's cervicovaginal secretions to another. New studies investigating recurrent BV will determine if VMTs can safely establish a healthy Lactobacillus-dominant vaginal microbiome. In most cases, caution must be taken in attributing a disease state and vaginal dysbiosis with a causal relationship, since the underlying reason for dysbiosis is usually unknown. This review focuses on the impact of vaginal microflora on maternal outcomes before and during pregnancy, including PTL, gestational diabetes, preeclampsia, and infertility. It then reviews the clinical evidence focused on vaginal restoration strategies, including VMTs.
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Affiliation(s)
- Olivia Moumne
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mary E Hampe
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Magda Francois
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Alice Rhoton-Vlasak
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Dominick J Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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21
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Molina K, Baskin ML, Long D, Carson TL. Psychological and behavioral pathways between perceived stress and weight change in a behavioral weight loss intervention. J Behav Med 2021; 44:822-832. [PMID: 34003418 DOI: 10.1007/s10865-021-00231-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.
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Affiliation(s)
- Kristine Molina
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, USA
| | - Monica L Baskin
- School of Medicine, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin Long
- School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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22
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Smith KS, Frugé AD, van der Pol W, Caston NE, Morrow CD, Demark-Wahnefried W, Carson TL. Gut microbial differences in breast and prostate cancer cases from two randomised controlled trials compared to matched cancer-free controls. Benef Microbes 2021; 12:239-248. [PMID: 33789551 DOI: 10.3920/bm2020.0098] [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] [Indexed: 02/06/2023]
Abstract
Implicated in several chronic diseases, the gastrointestinal microbiome is hypothesised to influence carcinogenesis. We compared faecal microbiota of newly diagnosed treatment-naïve overweight and obese cancer patients and matched controls. Cases were enrolled in presurgical weight-loss trials for breast (NCT02224807) and prostate (NCT01886677) cancers and had a body mass index (BMI) ≥25 kg/m2. Cancer-free controls were matched 1:1 by age (±5 years), race, gender, and BMI (±5 kg/m2). All participants provided faecal samples; isolated bacterial DNA were PCR amplified at the V4 region of the 16S rRNA gene and analysed using the QIIME pipeline. Tests compared cases versus controls, then separately by gender. Microbial alpha-diversity and beta-diversity were assessed, and relative abundance of Operational Taxonomic Units (OTU's) were compared at the genus level, with false discovery rate (FDR) correction. 22 overweight and obese cancer patients were matched with 22 cancer-free controls, with an average BMI of 30.5±4.3 kg/m2, age 54.4±5.3 years, and 54.5% were black. Fourteen matches were made between breast cancer cases and healthy female controls, and 8 matches were made with prostate cancer cases and healthy male controls. Comparison of all cases and controls revealed no differences in alpha diversity, though prostate cancer patients had higher Chao1 (P=0.006) and Observed Species (P=0.036) than cancer-free males. Beta-diversity metrics were significantly different between cases and controls (P<0.03 for all tests in whole sample and in men), though only unweighted Unifrac was different in women (P=0.005). Kruskal Wallis tests indicated significant differences among 16 genera in all matches, 9 in female, and 51 in male. This study suggests the faecal microbiota of treatment-naive breast and prostate cancer patients differs from controls, though larger samples are needed to substantiate these findings. Trial registration: NIH Clinical Trials, NCT01886677, NCT02224807, registered 26 June 2013, 25 Aug 2014 (respectively) - retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01886677; https://clinicaltrials.gov/ct2/show/NCT02224807.
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Affiliation(s)
- K S Smith
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL 36849, USA
| | - A D Frugé
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL 36849, USA
| | - W van der Pol
- University of Alabama at Birmingham, Center for Clinical and Translational Science, Birmingham, AL 35233, USA
| | - N E Caston
- University of Alabama at Birmingham, Division of Hematology and Oncology, Birmingham, AL 35233, USA
| | - C D Morrow
- University of Alabama at Birmingham, Department of Cell, Developmental, and Integrative Biology, Birmingham, AL 35233, USA
| | - W Demark-Wahnefried
- University of Alabama at Birmingham, Department of Nutrition Science, Birmingham, AL 35233, USA
| | - T L Carson
- University of Alabama at Birmingham, Department of Preventive Medicine, Birmingham, AL 35233, USA
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23
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Miller PL, Carson TL. Abstract PO034: Mechanisms and microbial Influences on CTLA-4 and PD-1-based immunotherapy in the treatment of cancer: A narrative review. Cancer Immunol Res 2021. [DOI: 10.1158/2326-6074.tumimm20-po034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The relationship between gastrointestinal (GI) bacteria and the response to anti-CTLA-4 and anti-PD-1 immunotherapy in the treatment of cancer can potentially be enhanced to allow patients to maximally respond to these treatments. Insight into the complex interaction between gut microbiota and the human adaptive immune system will help guide future immunotherapeutic cancer treatments to allow a more robust clinical response and fewer adverse effects in patients requiring these drugs. This review highlights these interactions as well as the potential for the creation of “oncomicrobiotics” that would selectively tailor one’s GI bacteria to maximally respond to anti-CTLA-4 and anti-PD-1 treatments.
Main Body: CTLA-4 is an antigen on the surface of T cells which, upon stimulation, leads to inhibition of activated T cells to terminate the immune response. However, many types of tumor cells can upregulate CTLA-4 in the tumor microenvironment, allowing these cells to evade targeting and destruction by the body’s immune system by prematurely inhibiting T cells. Increased representation of Bacteriodes fragilis and Burkholderia cepacia in the GI tract of patients receiving CTLA-4-based immunotherapy led to a stronger therapeutic effect while minimizing adverse side effects such as colitis. In addition, introducing bacteria involved in vitamin B and polyamine transport to the GI tracts of patients treated with anti-CTLA-4 drugs led to increased resistance to colitis while maintaining therapeutic efficacy. PD-1 is another molecule upregulated in many tumor microenvironments which acts in a similar manner to CTLA-4 to tone down the anti-neoplastic actions of T cells. Antibodies to PD-1 have shown promise to help allow the body’s natural immune response to appropriately target and destroy tumor cells. The presence of Bifidobacterium, namely Bifidobacterium breve and longum, in the GI tracts of cancer patients has the potential to create a more robust immune response to anti-PD-1 drugs while limiting medication-induced adverse effects. The development of “oncomicrobiotics” has the potential to help tailor one’s gut microbiota to allow patients to maximally respond to immunotherapy without sacrificing increases in toxicity. These oncomicrobiotics may possibly include antibiotics, probiotics, postbiotics and/or prebiotics. However, many challenges lie ahead in the creation of oncomicrobiotics.
Conclusion: The creation of oncomicrobiotics may allow many patients receiving anti-CTLA-4 and PD-1 immunotherapy to experience prolonged survival and a better quality of life.
Citation Format: Peter L. Miller, Tiffany L. Carson. Mechanisms and microbial Influences on CTLA-4 and PD-1-based immunotherapy in the treatment of cancer: A narrative review [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2020 Oct 19-20. Philadelphia (PA): AACR; Cancer Immunol Res 2021;9(2 Suppl):Abstract nr PO034.
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Miller PL, Carson TL. Mechanisms and microbial influences on CTLA-4 and PD-1-based immunotherapy in the treatment of cancer: a narrative review. Gut Pathog 2020; 12:43. [PMID: 32944086 PMCID: PMC7488430 DOI: 10.1186/s13099-020-00381-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023] Open
Abstract
Background The relationship between gastrointestinal (GI) bacteria and the response to anti-CTLA-4 and anti-PD-1 immunotherapy in the treatment of cancer can potentially be enhanced to allow patients to maximally respond to these treatments. Insight into the complex interaction between gut microbiota and the human adaptive immune system will help guide future immunotherapeutic cancer treatments to allow a more robust clinical response and fewer adverse effects in patients requiring these drugs. This review highlights these interactions as well as the potential for the creation of “oncomicrobiotics” that would selectively tailor one’s GI bacteria to maximally respond to anti-CTLA-4 and anti-PD-1 treatments will fewer adverse effects. Main body CTLA-4 is an antigen on the surface of T cells which, upon stimulation, leads to inhibition of activated T cells to terminate the immune response. However, many types of tumor cells can upregulate CTLA-4 in the tumor microenvironment, allowing these cells to evade targeting and destruction by the body’s immune system by prematurely inhibiting T cells. Increased representation of Bacteroides fragilis, Burkholderia cepacia and the Faecalibacterium genus in the GI tract of patients receiving CTLA-4-based immunotherapy led to a stronger therapeutic effect while minimizing adverse side effects such as colitis. In addition, by introducing bacteria involved in vitamin B and polyamine transport to the GI tracts of patients treated with anti-CTLA-4 drugs led to increased resistance to colitis while maintaining therapeutic efficacy. PD-1 is another molecule upregulated in many tumor microenvironments which acts in a similar manner to CTLA-4 to tone down the anti-neoplastic actions of T cells. Antibodies to PD-1 have shown promise to help allow the body’s natural immune response to appropriately target and destroy tumor cells. The presence of Bifidobacterium breve and longum, Akkermansia muciniphila and Faecalibacterium prausnitzii in the GI tracts of cancer patients has the potential to create a more robust immune response to anti-PD-1 drugs and prolonged survival. The development of “oncomicrobiotics” has the potential to help tailor one’s gut microbiota to allow patients to maximally respond to immunotherapy without sacrificing increases in toxicity. These oncomicrobiotics may possibly include antibiotics, probiotics, postbiotics and/or prebiotics. However, many challenges lie ahead in the creation of oncomicrobiotics. Conclusion The creation of oncomicrobiotics may allow many patients receiving anti-CTLA-4 and PD-1 immunotherapy to experience prolonged survival and a better quality of life.
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Affiliation(s)
- Peter L Miller
- University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Tiffany L Carson
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham School of Medicine, 1717 11th Ave S, Birmingham, AL 35205 USA
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Wang ML, Behrman P, Dulin A, Baskin ML, Buscemi J, Alcaraz KI, Goldstein CM, Carson TL, Shen M, Fitzgibbon M. Addressing inequities in COVID-19 morbidity and mortality: research and policy recommendations. Transl Behav Med 2020; 10:516-519. [PMID: 32542349 PMCID: PMC7337775 DOI: 10.1093/tbm/ibaa055] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic is the greatest global public health crisis since the 1918 influenza outbreak. As of early June, the novel coronavirus has infected more than 6.3 million people worldwide and more than 1.9 million in the United States (US). The total number of recorded deaths due to COVID-19 are growing at an alarming rate globally (³383,000) and nationally (³109,000) Evidence is mounting regarding the heavier burden of COVID-19 infection, morbidity, and mortality on the underserved populations in the US. This commentary focuses on this global health pandemic and how mitigation of the virus relies heavily on health behavior change to slow its spread, highlighting how the pandemic specifically affects the most socially and economically disadvantaged populations in the US. The commentary also offers short, intermediate and long-term research and policy focused recommendations. Both the research and policy recommendations included in this commentary emphasize equity-driven: (1) research practices, including applying a social determinants and health equity lens on monitoring, evaluation, and clinical trials activities on COVID-19; and (2) policy actions, such as dedicating resources to prioritize high-risk communities for testing, treatment, and prevention approaches and implementing organizational, institutional, and legislative policies that address the social and economic barriers to overall well-being that these populations face during a pandemic. It is our hope that these recommendations will generate momentum in delivering timely, effective, and lifesaving changes.
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Affiliation(s)
- Monica L Wang
- Boston University School of Public Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | - Megan Shen
- Weill Cornell Medicine, New York, NY, USA
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Affiliation(s)
- Doratha A Byrd
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Emily Vogtmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Kaiser KA, Carson TL, Dhurandhar EJ, Neumeier WH, Cardel MI. Biobehavioural approaches to prevention and treatment: A call for implementation science in obesity research. Obes Sci Pract 2020; 6:3-9. [PMID: 32128237 PMCID: PMC7042105 DOI: 10.1002/osp4.384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022] Open
Abstract
Much progress has been made in the last 30 years in understanding the causes and mechanisms that contribute to obesity, yet widely available and successful strategies for prevention and treatment remain elusive at population levels. This paper discusses the biobehavioural framework and provides suggestions for applying it to enable greater progress in the science of obesity prevention and treatment, including an increased focus on implementation of science strategies. The objective is to promote a re-evaluation of current views about preventing and treating obesity within a unified biobehavioural framework. Further integration of research exploring how both behavioural and biological components interact is a critical step forward.
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Affiliation(s)
- Kathryn A. Kaiser
- Department of Health Behavior, School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabama
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
| | - Tiffany L. Carson
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
- Division of Preventive Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Emily J. Dhurandhar
- Department of Kinesiology and Sport ManagementTexas Tech UniversityLubbockTexas
| | - William H. Neumeier
- United States Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Michelle I. Cardel
- Department of Health Outcomes & Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFlorida
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28
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Affiliation(s)
- Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, UAB School of Medicine, Birmingham, Alabama
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29
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Carson TL, Little RB, Townsend S. Preliminary feasibility for recruiting and retaining black and white females to provide fecal samples for longitudinal research. Gut Pathog 2019; 11:43. [PMID: 31462930 PMCID: PMC6710875 DOI: 10.1186/s13099-019-0324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
As the associations between the gut microbiota and numerous health outcomes become more evident, it is important to conduct longitudinal microbiome research to advance the field beyond the identification of associations. It is also necessary to include individuals who have historically been underrepresented in biomedical research in longitudinal microbiome studies to better understand and eliminate racial/ethnic health disparities. This paper describes our experiences in recruiting and retaining participants for an ongoing, longitudinal microbiome study for which the main results will be reported at a later time. This article provides preliminary evidence of the feasibility of recruiting and retaining a racially diverse sample of females (97% completion for invited participants) for longitudinal microbiome research.
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Affiliation(s)
- Tiffany L Carson
- 1Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South MT 639, Birmingham, AL 35294-4410 USA.,2Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL USA
| | - Rebecca B Little
- 3Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South MT 518K, Birmingham, AL 35294-4410 USA
| | - Sh'Nese Townsend
- 4Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South MT 518E, Birmingham, AL 35294-4410 USA
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30
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Johnson ER, Affuso O, Levitan EB, Carson TL, Baskin ML. Body image and dissatisfaction among rural Deep South African American women in a weight loss intervention. J Health Psychol 2019; 24:1167-1177. [PMID: 28810419 DOI: 10.1177/1359105317694489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/07/2023] Open
Abstract
Body image perception may impact health-promoting behaviors as well as knowledge regarding health risks associated with obesity. Our cross-sectional analysis evaluated body image and its association with body mass index among overweight and obese treatment-seeking African American women (N = 409). Differences between current and desired body image were captured using the Pulvers scale. Results indicated the presence of body image dissatisfaction among participants (median = 2.00, interquartile range: 2.00-3.00), with greater dissatisfaction observed at higher categories of body mass index. Additionally, receiver operating curves demonstrated the ability of the Pulvers scale to correctly identify participants classified by body mass index. Further research is needed to identify factors that influence body image perception.
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Carson TL, Aguilera A, Brown SD, Peña J, Butler A, Dulin A, Jonassaint CR, Riley I, Vanderbom K, Molina KM, Cené CW. A Seat at the Table: Strategic Engagement in Service Activities for Early-Career Faculty From Underrepresented Groups in the Academy. Acad Med 2019; 94:1089-1093. [PMID: 30649021 PMCID: PMC6626695 DOI: 10.1097/acm.0000000000002603] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Many academic institutions strive to promote more diverse and inclusive campuses for faculty, staff, and students. As part of this effort, these institutions seek to include individuals from historically underrepresented groups (URGs)-such as women, people from racial/ethnic minority populations, persons with disabilities-on committees and in other service activities. However, given the low number of faculty members from URGs at many institutions, these faculty members tend to receive more requests to provide service to the institution or department (e.g., serving on committees, mentoring) than their counterparts from majority groups. Faculty members from URGs, especially early-career faculty, thus risk becoming overburdened with providing service at the expense of working on other scholarly activities required for promotion and tenure (i.e., conducting research, publishing). Although many scholars and others have written about this "minority tax" and its implications for early-career faculty from underrepresented racial/ethnic minority groups, fewer have published about how this tax extends beyond racial/ethnic minorities to women and persons with disabilities. Further, the literature provides scant practical advice on how to avoid overburdening early-career faculty from URGs. Here, a group of multidisciplinary early- and mid-career faculty members from URGs seek to provide their peers from URGs with practical strategies for both evaluating the appropriateness of service requests and declining those that are not a good fit. The authors also provide institutional leaders with actionable recommendations to prevent early-career faculty from URGs from becoming overburdened with service.
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Affiliation(s)
- Tiffany L Carson
- T.L. Carson is assistant professor, Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; ORCID: https://orcid.org/0000-0002-8180-4523. A. Aguilera is associate professor, School of Social Welfare, University of California, Berkeley, Berkeley, California, and Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0003-1773-8768. S.D. Brown is research scientist I, Division of Research, Kaiser Permanente Northern California, Oakland, California; ORCID: https://orcid.org/0000-0002-3920-0945. J. Peña is assistant professor, Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York. A. Butler is assistant professor, Department of Pediatrics, Baylor College of Medicine, Houston, Texas. A. Dulin is Manning Assistant Professor, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island. C.R. Jonassaint is assistant professor, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. I. Riley is medical instructor, Division of Pulmonary & Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina. K. Vanderbom is implementation science coordinator, National Center on Health, Physical Activity, and Disability, University of Alabama at Birmingham/Lakeshore Research Collaborative, Birmingham, Alabama; ORCID: https://orcid.org/0000-0002-4799-954X. K.M. Molina is assistant professor, Department of Psychology, University of Illinois at Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-9127-993X. C.W. Cené is associate professor, Division of General Internal Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Kroeger EN, Carson TL, Baskin ML, Langaigne A, Schneider CR, Bertrand B, Herbey II, Harper LM, Biggio JR, Chandler-Laney PC. Reasons for Late-Night Eating and Willingness to Change:A Qualitative Study in Pregnant Black Women. J Nutr Educ Behav 2019; 51:598-607. [PMID: 30579893 PMCID: PMC6511485 DOI: 10.1016/j.jneb.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/16/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Late-night eating during pregnancy is associated with greater risk for gestational diabetes. The purposes of this study were to describe reasons why women engage in late-night eating and to understand perceptions about changing this behavior. DESIGN Focus groups using a semi-structured interview script. SETTING Urban university-affiliated obstetric clinic. PARTICIPANTS Low-income black women (n = 18) with overweight/obesity at entry to prenatal care. PHENOMENON OF INTEREST Late-night eating. ANALYSIS Exhaustive approach coding responses to specific questions. RESULTS Individual and interpersonal contributors to late-night eating included hunger, altered sleep patterns, fetal movement, and the influence of others. Food choices were largely driven by taste and convenience. Some women reported that they could alter nightly eating patterns, whereas others would consider changing only if late-night eating were associated with a severe illness or disability for the child. CONCLUSIONS AND IMPLICATIONS There was considerable heterogeneity among the participants of this study regarding reasons for late-night eating during pregnancy and attitudes toward changing this behavior. Although the themes identified from this study cannot be generalized, they may be useful to inform future studies. Future research might develop strategies to overcome individual and social factors that contribute to late-night eating during pregnancy.
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Affiliation(s)
- Elizabeth N Kroeger
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL.
| | - Tiffany L Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Monica L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Alana Langaigne
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Camille R Schneider
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Brenda Bertrand
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Ivan I Herbey
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lorie M Harper
- Division of Maternal Fetal Medicine, Department of Obstetrics, University of Alabama at Birmingham, Birmingham, AL
| | - Joseph R Biggio
- Women's Service Line, Ochsner Health System, New Orleans, LA
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Nolan TS, Ivankova N, Carson TL, Spaulding A, Davies S, Enah C, Meneses K. Perceptions of a Breast Cancer Survivorship Intervention: Pearls of Wisdom from Young African American Women. J Adolesc Young Adult Oncol 2018; 8:165-171. [PMID: 30407099 DOI: 10.1089/jayao.2018.0055] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE African American (AA) women ages 20-44 develop breast cancer at higher rates compared with Caucasian women. These young survivors (<45 years) also have disparate quality of life (QOL). Little is known about survivorship information needs of young AA survivors. The purpose of this study was to explore young AA survivors' perceptions of an existing QOL intervention for breast cancer survivors, identifying information needs to address using a targeted intervention. METHODS Two semistructured interviews were conducted with each of 15 young AA survivors who had completed breast cancer treatment. This article focuses on the second interview in which young AA survivors reviewed intervention materials and described their perceptions of the intervention. Content analysis was used to identify themes, which were validated by participants. RESULTS Participants (n: 15; mean age at study entry: 35 years) reported that the existing evidence-based intervention discussed relevant but general survivorship information. They suggested adapting the information for young AA survivors: addition of content geared toward finances, how to better communicate to manage dating and relationships, how to engage in healthful activities, and how to find local resources for any stage of survivorship. Furthermore, they suggested multiple modes of information delivery and inclusion of diverse imagery. CONCLUSION Engaging young AA survivors yielded pearls of wisdom, highlighting the general nature of an existing intervention and suggesting adaptations to meet young AA survivors' information needs. Applying such pearls can be a powerful method to target survivorship interventions for this disparate group of cancer survivors.
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Affiliation(s)
- Timiya S Nolan
- 1 College of Nursing, The Ohio State University , Columbus, Ohio
| | - Nataliya Ivankova
- 2 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
| | - Tiffany L Carson
- 3 School of Medicine, and University of Alabama at Birmingham , Birmingham, Alabama
| | - Amelia Spaulding
- 1 College of Nursing, The Ohio State University , Columbus, Ohio
| | - Susan Davies
- 4 School of Public Health, University of Alabama at Birmingham , Birmingham, Alabama
| | - Comfort Enah
- 2 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
| | - Karen Meneses
- 2 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
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Shikany JM, Carson TL, Hardy CM, Li Y, Sterling S, Hardy S, Walker CM, Baskin ML. Assessment of the nutrition environment in rural counties in the Deep South. J Nutr Sci 2018; 7:e27. [PMID: 30402218 PMCID: PMC6218927 DOI: 10.1017/jns.2018.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/31/2018] [Accepted: 09/21/2018] [Indexed: 11/23/2022] Open
Abstract
The nutrition environment, including food store type, may influence dietary choices, which in turn can affect risk of obesity and related chronic diseases such as CHD, diabetes and cancer. The objective of the present study was to elucidate the extent to which healthy foods are available and affordable in various rural food outlets. A subset of the nutrition environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S). The NEMS-S instrument assessed the availability and price of healthy foods (e.g. low-fat/non-fat milk, lean meats and reduced-fat dinner entrées) compared with less healthy counterparts (e.g. whole milk, non-lean meats and regular dinner entrées). The NEMS-S also assessed the quality of fresh fruits and vegetables. Availability, prices and quality of healthy foods were compared between grocery stores (n 24) and convenience stores (n 67) in nine rural counties in Alabama. Mean availability subscale score (possible range 0 to 30; higher score indicates a greater number of healthier foods were available) for grocery stores was 22·6 (sd 8·1), compared with 6·6 (sd 5·2) in convenience stores (P < 0·0001); and mean price subscale score (possible range -9 to 18; higher score indicates that healthier options were less expensive than the less healthy options) for grocery stores was 2·4 (sd 2·7), compared with 0·7 (sd 1·2) in convenience stores (P = 0·0080). Mean total NEMS-S score (possible range -9 to 54) in grocery stores was 29·8 (sd 10·9) compared with 7·3 (sd 7·1) in convenience stores (P < 0·0001). Both grocery and convenience stores could be strategic points of intervention to improve the nutrition environment in the counties that were surveyed.
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Affiliation(s)
- James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Tiffany L. Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Claudia M. Hardy
- Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-3300, USA
| | - Yufeng Li
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Samara Sterling
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Birmingham, AL 35294-3360, USA
| | - Sharonda Hardy
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Cordie M. Walker
- Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-3300, USA
| | - Monica L. Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
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Carson TL, Wang F, Cui X, Jackson BE, Van Der Pol WJ, Lefkowitz EJ, Morrow C, Baskin ML. Associations Between Race, Perceived Psychological Stress, and the Gut Microbiota in a Sample of Generally Healthy Black and White Women: A Pilot Study on the Role of Race and Perceived Psychological Stress. Psychosom Med 2018; 80:640-648. [PMID: 29901485 PMCID: PMC6113071 DOI: 10.1097/psy.0000000000000614] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Racial health disparities persist among black and white women for colorectal cancer. Understanding racial differences in the gut microbiota and related covariates (e.g., stress) may yield new insight into unexplained colorectal cancer disparities. METHODS Healthy non-Hispanic black or white women (age ≥19 years) provided survey data, anthropometrics, and stool samples. Fecal DNA was collected and isolated from a wipe. Polymerase chain reaction was used to amplify the V4 region of the 16SrRNA gene and 250 bases were sequenced using the MiSeq platform. Microbiome data were analyzed using QIIME. Operational taxonomic unit data were log transformed and normalized. Analyses were conducted using linear models in R Package "limma." RESULTS Fecal samples were analyzed for 80 women (M (SD) age = 39.9 (14.0) years, 47 black, 33 white). Blacks had greater average body mass index (33.3 versus 27.5 kg/m, p < .01) and waist circumference (98.3 versus 86.6 cm, p = .003) than whites. Whites reported more stressful life events (p = .026) and greater distress (p = .052) than blacks. Final models accounted for these differences. There were no significant differences in dietary variables. Unadjusted comparisons revealed no racial differences in alpha diversity. Racial differences were observed in beta diversity and abundance of top 10 operational taxonomic units. Blacks had higher abundances than whites of Faecalibacterium (p = .034) and Bacteroides (p = .038). Stress was associated with abundances of Bifidobacterium. The association between race and Bacteroides (logFC = 1.72, 0 = 0.020) persisted in fully adjusted models. CONCLUSIONS Racial differences in the gut microbiota were observed including higher Bacteroides among blacks. Efforts to cultivate an "ideal" gut microbiota may help reduce colorectal cancer risk.
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Affiliation(s)
- Tiffany L. Carson
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham; Birmingham, AL
- Comprehensive Cancer Center, University of Alabama at Birmingham
| | - Fuchenchu Wang
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham; Birmingham, AL
| | - Xiangqin Cui
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham; Birmingham, AL
| | - Bradford E. Jackson
- Center for Outcomes Research, JPS Health Network; Fort Worth, TX
- Department of Biostatistics and Epidemiology; UNT Health Science Center, School of Public Health; Fort Worth, TX
| | | | - Elliot J. Lefkowitz
- Center for Clinical and Translational Sciences, University of Alabama at Birmingham
- Department of Microbiology, University of Alabama at Birmingham; Birmingham, AL
| | - Casey Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham; Birmingham, AL
| | - Monica L. Baskin
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham; Birmingham, AL
- Comprehensive Cancer Center, University of Alabama at Birmingham
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Carson TL, Wang F, Cui X, Jackson BE, Pol LVD, Lefkowitz EJ, Morrow C, Baskin M. Abstract A59: Racial comparisons of the gut microbiota of generally healthy black and white women for insights into colorectal cancer disparities. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Racial health disparities persist among black and white women for colorectal cancer (CRC). Since the gut microbiota has been linked to CRC, understanding racial differences in the gut microbiota may yield new insight into unexplained disparities in CRC incidence. Generally healthy non-Hispanic black or white females who were at least 19 years old provided survey data, anthropometrics, and stool samples. Fecal DNA was collected and isolated from a wipe. PCR was used to amplify the V4 region of the 16SrRNA gene and 250 bases were sequenced using the MiSeq platform. Microbiome data were analyzed using the QIIME package. OTU data were log transformed and normalized. Linear models in R Package “limma” were used to test statistical significance differences. Fecal samples were analyzed for 80 females (47 black, 33 white). Mean age and BMI were 39.9 years and 30.1 kg/m2, respectively. Blacks had a higher average BMI than whites (33.3 vs. 27.5 kg/m2; p<0.01) and larger waist circumference (98.3 vs. 86.6 cm; p<0.01). Unadjusted comparisons revealed no racial differences in alpha diversity. Racial differences were observed in beta diversity and abundance of top-10 OTUs. Blacks had higher abundances than whites of Faecalibacterium (p=0.03) and Bacteroides (p=0.04). The association between race and Bacteroides (logFC=1.72; 0=0.02) persisted in fully adjusted models. Black race was associated with a higher abundance of Bacteroides, which has been linked to CRC. Other racial differences in the gut microbiota were also observed. Efforts to cultivate an “ideal” gut microbiota may help reduce CRC risk and health disparities.
Citation Format: Tiffany L. Carson, Fuchenchu Wang, Xiangqin Cui, Bradford E. Jackson, Liam Van Der Pol, Elliot J. Lefkowitz, Casey Morrow, Monica Baskin. Racial comparisons of the gut microbiota of generally healthy black and white women for insights into colorectal cancer disparities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A59.
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Affiliation(s)
| | | | - Xiangqin Cui
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Casey Morrow
- University of Alabama at Birmingham, Birmingham, AL
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Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Carney OO, Neu J, Carson TL. The Neonatal Microbiome and Its Partial Role in Mediating the Association between Birth by Cesarean Section and Adverse Pediatric Outcomes. Neonatology 2018; 114:103-111. [PMID: 29788027 PMCID: PMC6532636 DOI: 10.1159/000487102] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 09/19/2017] [Accepted: 01/23/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cesarean sections (CS) are among the most commonly performed surgical procedures in the world. Epidemiologic data has associated delivery by CS with an increased risk of certain adverse health outcomes in children, such as asthma and obesity. OBJECTIVE To explore what is known about the effect of mode of delivery on the development of the infant microbiome and discuss the potentially mediating role of CS-related microbial dysbiosis in the development of adverse pediatric health outcomes. Recommendations for future inquiry are also provided. METHODS This study provides a narrative overview of the literature synthesizing the findings of literature retrieved from searches of PubMed and other computerized databases and authoritative texts. RESULTS Emerging evidence suggests that mode of delivery is involved in the development of the neonatal microbiome and may partially explain pediatric health outcomes associated with birth by CS. Specifically, the gut microbiome of vaginally delivered infants more closely resembles their mothers' vaginal microbiome and thus more commonly consists of potentially beneficial microbiota such as Lactobacillus, Bifidobacterium, and Bacteroides. Conversely, the microbiome of infants born via CS shows an increased prevalence of either skin flora or potentially pathogenic microbial communities such as Klebsiella, Enterococcus, and Clostridium. CONCLUSIONS Mode of delivery plays an important role in the development of the postnatal microbiome but likely tells only part of the story. More comprehensive investigations into all the pre- and perinatal factors that have the potential to contribute to the neonatal microbiome are warranted.
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Affiliation(s)
- Diana Montoya-Williams
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Dominick J Lemas
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Lisa Spiryda
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Keval Patel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - O'neshia Olivia Carney
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Sterling SR, Bertrand B, Judd S, Carson TL, Chandler-Laney P, Baskin ML. Longitudinal Analysis of Nut-Inclusive Diets and Body Mass Index Among Overweight and Obese African American Women Living in Rural Alabama and Mississippi, 2011-2013. Prev Chronic Dis 2017; 14:E82. [PMID: 28934081 PMCID: PMC5609494 DOI: 10.5888/pcd14.160595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction Nuts, when eaten alongside other nutritionally rich foods, may decrease obesity and related chronic disease risks, which are high among African American women in the rural South. We monitored changes in nut intake, other obesity-related foods (fruits, vegetables, red or processed meats, added sugars), and body mass index (BMI) over a 2-year weight loss intervention among 383 overweight and obese African American women in rural Alabama and Mississippi. Methods Two dietary recalls were administered at 4 points over 24 months. Mann–Whitney tests compared differences in median food group intake between nut consumers and non-nut consumers, and t tests identified BMI differences between groups. Mixed linear models tested the relationship between nut intake and intake of the select food groups, and between nut intake and BMI over time. Results Overall nut consumers ate more fruits and vegetables and less red meat than non-nut consumers. Nut consumers had lower BMI values than non-nut consumers. Weight loss by the end of the intervention was significant for nut consumers but not for non-nut consumers, even after accounting for kilocalorie consumption and physical activity engagement. Conclusion Nut consumption is associated with consumption of other nutritionally rich foods and lower BMI among African American women in rural Alabama and Mississippi. Future interventions should target increasing daily nut intake, decreasing added sugar intake, and identifying strategies to encourage positive dietary changes to continue after an intervention.
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Affiliation(s)
- Samara R Sterling
- Department of Nutrition Science, School of Health Professions, University of Alabama at Birmingham, Webb 449 1675 University Blvd, Birmingham, AL 35294-3361. E-mail:
| | - Brenda Bertrand
- Department of Nutrition Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tiffany L Carson
- Division of Preventive Medicine, School of Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula Chandler-Laney
- Department of Nutrition Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monica L Baskin
- Division of Preventive Medicine, School of Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. What Are Optimal Cesarean Section Rates in the U.S. and How Do We Get There? A Review of Evidence-Based Recommendations and Interventions. J Womens Health (Larchmt) 2017; 26:1285-1291. [PMID: 28825512 DOI: 10.1089/jwh.2016.6188] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cesarean sections (CSs) are the most commonly performed surgical procedures in the world today. Global epidemiological studies from the last decade suggest that the optimal CS rates in developed countries exist somewhere between 15% and 19%. Despite these findings, CS rates in the United States have remained stable at slightly over 32% over the past 10 years. Using primary and secondary literature published from 2010 to 2015, this review discusses how optimal CS rates were developed. In addition, we define a category of potentially avoidable CS (i.e., those conducted on nulliparous low-risk women who present with vertex infants at term) and explore how CS in this population appear to be one of the main drivers of high CS rates overall. The institutional, provider, and patient-related factors, which may be related to higher-than-recommended rates of CS, particularly those conducted in low-risk women, will be discussed. This review will then delve into clinician and patient-oriented interventions that have been shown to effectively reduce the rate of potentially avoidable CS. Our analysis showed that large-scale, multifaceted interventions that include audit and feedback cycles as well as peer review strategies were the most effective in decreasing rates of potentially avoidable CS. This review concludes with an agenda for future research into interventions that aim to achieve optimal CS rates.
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Affiliation(s)
- Diana Montoya-Williams
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Dominick J Lemas
- 2 Department of Health Outcomes and Policy, University of Florida , Gainesville, Florida
| | - Lisa Spiryda
- 3 Department of Obstetrics and Gynecology, University of Florida , Gainesville, Florida
| | - Keval Patel
- 4 Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida
| | - Josef Neu
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Tiffany L Carson
- 5 Division of Preventive Medicine, Department of Medicine, University of Alabama , Birmingham, Alabama
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Ard JD, Carson TL, Shikany JM, Li Y, Hardy CM, Robinson JC, Williams AG, Baskin ML. Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial. J Intern Med 2017; 282:102-113. [PMID: 28514081 PMCID: PMC6136898 DOI: 10.1111/joim.12622] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities. OBJECTIVE To test the effectiveness of an evidence-based behavioural weight loss intervention delivered by community health advisors to African American women in the rural south. DESIGN AND METHODS Overweight or obese African American women (30-70 years) from eight counties in Mississippi and Alabama participated in a 24-month randomized controlled trial of an evidence-based behavioural weight loss programme augmented with community strategies to support healthy lifestyles (Weight Loss Plus, N = 154) compared to the weight loss programme alone (Weight Loss Only, N = 255). This study reports on 6-month outcomes on primary (weight change) and secondary (waist circumference, blood pressure, lipids, fasting blood glucose) outcomes, coinciding with the completion of the intensive weight loss phase. RESULTS Weight Loss Only participants lost an average of 2.2 kg (P < 0.001). Weight Loss Plus participants lost an average of 3.2 kg (P < 0.001). The proportion of the total sample that lost at least 5% of their body weight was 27.1% with no difference between treatment groups. Similarly, we observed statistically significant reductions in blood pressure, waist circumference and triglycerides in each treatment group, with no statistical differences between groups. CONCLUSION Trained lay health staff and volunteers from the rural southern USA were able to deliver a translation of a high-intensity behavioural intervention targeted to African American women, resulting in clinically meaningful weight loss and improvement in other metabolic outcomes in a significant proportion of participants.
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Affiliation(s)
- J D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - T L Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Y Li
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C M Hardy
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J C Robinson
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - A G Williams
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Sterling S, Judd S, Bertrand B, Carson TL, Chandler-Laney P, Baskin ML. Dietary Patterns Among Overweight and Obese African-American Women Living in the Rural South. J Racial Ethn Health Disparities 2017; 5:141-150. [PMID: 28281179 DOI: 10.1007/s40615-017-0351-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Obesity and chronic diseases disproportionately affect African-American women in the rural South (US) and may be influenced by adherence to a typical Southern-style diet. There is a need to examine dietary patterns of this population and to determine if consumption of nutritionally rich foods like nuts is associated with consumption of other nutritious foods. The objectives of this study were to identify (1) dietary patterns of overweight/obese African-American women in the rural South; (2) the role that nuts play in the diet; (3) and adherence to federal food group recommendations across dietary patterns. METHODS Secondary data analysis of two baseline 24-h dietary recalls was performed on 383 overweight/obese African-American women enrolled in a weight loss intervention in Alabama and Mississippi between 2011 and 2013. Cluster analysis identified dietary patterns. t tests and chi-square tests tested demographic and dietary differences across clusters. The proportion of women in each cluster who met federal recommendations for fruit, vegetable, nuts, added sugar, and sodium intake was calculated. RESULTS Two dietary patterns were found. Nut intake frequency was higher in cluster 2 (P < .001), which was characterized by a higher intake frequency of fruits and vegetables, but high mean daily intake of added sugar (12.26 ± 7.67 tsp) and sodium (2800 ± 881 mg). Ninety-two percent of participants in this cluster consumed red/processed meats daily. CONCLUSION Even among women in this population who consume a more plant-based dietary pattern containing nuts, there is still a need to decrease intake of added sugar, sodium, and red meat.
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Affiliation(s)
- Samara Sterling
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Webb 449 1675 University Blvd, Birmingham, AL, 35294-3361, USA.
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, RPHB 327, 1530 3rd Avenue South, Birmingham, AL, 35294-0022, USA
| | - Brenda Bertrand
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Webb 534 1720 2nd Avenue South, Birmingham, AL, 35294-3360, USA
| | - Tiffany L Carson
- Division of Preventive Medicine, School of Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, MT 639 1720 2nd Avenue South, Birmingham, AL, 35294-4410, USA
| | - Paula Chandler-Laney
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Webb 413 1720 2nd Avenue South, Birmingham, AL, 35294-3360, USA
| | - Monica L Baskin
- Division of Preventive Medicine, School of Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, MT 618 1717 11th Avenue South, Birmingham, AL, 35294-4410, USA
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Lampard AM, Nishi A, Baskin ML, Carson TL, Davison KK. The Activity Support Scale for Multiple Groups (ACTS-MG): Child-reported Physical Activity Parenting in African American and Non-Hispanic White Families. Behav Med 2016; 42:112-9. [PMID: 25350515 PMCID: PMC4412752 DOI: 10.1080/08964289.2014.979757] [Citation(s) in RCA: 16] [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] [Indexed: 02/08/2023]
Abstract
This study aimed to assess the psychometric properties of a child-report, multidimensional measure of physical activity (PA) parenting, the Activity Support Scale for Multiple Groups (ACTS-MG), in African American and non-Hispanic white families. The ACTS-MG was administered to children aged 5 to 12 years. A three factor model of PA parenting (Modeling of PA, Logistic Support, and Restricting Access to Screen-based Activities) was tested separately for mother's and fathers' PA parenting. The proposed three-factor structure was supported in both racial groups for mothers' PA parenting and in the African American sample for fathers' PA parenting. Factorial invariance between racial groups was demonstrated for mother's PA parenting. Building on a previous study examining the ACTS-MG parent-report, this study supports the use of the ACTS-MG child-report for mothers' PA parenting. However, further research is required to investigate the measurement of fathers' PA parenting across racial groups.
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Affiliation(s)
- Amy M. Lampard
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA,School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Akihiro Nishi
- Yale Institute for Network Science, New Haven, CT, USA,Department of Sociology, Yale University, New Haven, CT, USA
| | - Monica L. Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L. Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
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Carson TL, Desmond R, Hardy S, Townsend S, Ard JD, Meneses K, Partridge EE, Baskin ML. A study of the relationship between food group recommendations and perceived stress: findings from black women in the Deep South. J Obes 2015; 2015:203164. [PMID: 25821595 PMCID: PMC4364113 DOI: 10.1155/2015/203164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/23/2014] [Accepted: 02/14/2015] [Indexed: 11/29/2022] Open
Abstract
Black women in the Deep South experience excess morbidity/mortality from obesity-related diseases, which may be partially attributable to poor diet. One reason for poor dietary intake may be high stress, which has been associated with unhealthy diets in other groups. Limited data are available regarding dietary patterns of black women in the Deep South and to our knowledge no studies have been published exploring relationships between stress and dietary patterns among this group. This cross-sectional study explored the relationship between stress and adherence to food group recommendations among black women in the Deep South. Participants (n = 355) provided demographic, anthropometric, stress (PSS-10), and dietary (NCI ASA-24 hour recall) data. Participants were obese (BMI = 36.5 kg/m(2)) and reported moderate stress (PSS-10 score = 16) and minimal adherence to Dietary Guidelines for Americans food group recommendations (1/3 did not meet recommendations for any food group). Participants reporting higher stress had higher BMIs than those reporting lower stress. There was no observed relationship between stress and dietary intake in this sample. Based on these study findings, which are limited by potential misreporting of dietary intake and limited variability in stress measure outcomes, there is insufficient evidence to support a relationship between stress and dietary intake.
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Affiliation(s)
- Tiffany L. Carson
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
- *Tiffany L. Carson:
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Sharonda Hardy
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Sh'Nese Townsend
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA
| | - Karen Meneses
- Department of Nursing, School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Edward E. Partridge
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Monica L. Baskin
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
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Johnson ER, Carson TL, Affuso O, Hardy CM, Baskin ML. Relationship between social support and body mass index among overweight and obese African American women in the rural deep South, 2011-2013. Prev Chronic Dis 2014; 11:E224. [PMID: 25539128 PMCID: PMC4279865 DOI: 10.5888/pcd11.140340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION African American women in the Deep South of the United States are disproportionately obese, a condition strongly influenced by their social environment. The objective of this study was to characterize the prevalence of social support from family and friends for healthy eating and exercise in rural communities. METHODS This study is an analysis of a subgroup (N = 195) of overweight and obese African American women from a larger ongoing weight loss trial (N = 409) in rural communities of the Alabama Black Belt and Mississippi Delta. The Social Support and Eating Habits Survey and Social Support and Exercise Survey were used to measure support from family and friends for healthy eating and exercise, respectively. Linear regression was conducted to determine the association between social support factors and body mass index (BMI). RESULTS Concurrently prevalent in our sample were encouraging support for healthy eating (family, median,14.0; range, 5.0-25.0; friends, median, 13.0; range 5.0-25.0) and discouraging support for healthy eating (family, median, 12.0; range, 5.0-25.0; friends, median, 11.0; range, 5.0-25.0). Median scores for support for exercise received in the form of participation from family and friends were 24.0 (range 10.0-48.0) and 24.0 (range 10.0-50.0), respectively. The median score for support for exercise in the form of rewards and punishment from family was 3.0 (range, 3.0-11.0). Social support factors were not associated with BMI. CONCLUSION Overweight and obese African American women in the rural Deep South experience minimal social support from family and friends for healthy eating and exercise. Given the evidence that social support promotes healthy behaviors, additional research on ways to increase support from family and friends is warranted.
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Affiliation(s)
| | | | - Olivia Affuso
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave S, MT 618, Birmingham, AL 35294-4410. E mail:
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Wingo BC, Carson TL, Ard J. Differences in weight loss and health outcomes among African Americans and whites in multicentre trials. Obes Rev 2014; 15 Suppl 4:46-61. [PMID: 25196406 DOI: 10.1111/obr.12212] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [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: 06/09/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 01/16/2023]
Abstract
The efficacy of behavioural lifestyle interventions (BLI) for weight loss and prevention and treatment of diabetes and hypertension is well established but may vary among racial/ethnic subgroups. This report reviews literature from 1990 to 2012 to determine if outcomes were similar among African Americans (AA) and whites participating in multicentre BLIs funded by the National Institutes of Health. We identified seven relevant trials that reported subgroup analyses for AA. On average, AA lost less weight at 6 months (AA: -1.6 to -7.5 kg; whites: -3.8 to -8.2 kg), but also had less or similar weight regain compared with whites. There were no reported differences between races in diabetes incidence. Three analyses reported no differences in blood pressure; however, a fourth reported that AA women were the only group that did not experience a significant change in blood pressure. Despite increased attention to cultural relevance, race-specific differences in weight loss persist in trials spanning 20 years; however, risk factor modification was similar across race/ethnic groups. Additional research is needed to understand the mechanisms of risk factor modification, and potential for weight change to promote even greater risk factor modification for AA than has been observed to date.
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Affiliation(s)
- B C Wingo
- Department of Occupational Therapy, UAB, Birmingham, AL, USA
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Carson TL, Hidalgo B, Ard JD, Affuso O. Dietary interventions and quality of life: a systematic review of the literature. J Nutr Educ Behav 2014; 46:90-101. [PMID: 24183706 PMCID: PMC3982833 DOI: 10.1016/j.jneb.2013.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 05/31/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To systematically review the literature to examine whether there has been adequate assessment of the effects of dietary intervention on quality of life (QOL) independent of weight loss, assess which instruments are being used to measure nutrition-related QOL, identify gaps in the literature, and suggest future directions. DESIGN Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. RESULTS A total of 24 studies were eligible for inclusion. The Short Form-36 Health Survey was the most widely used instrument to assess QOL. Other disease-specific instruments were used. Several different dietary approaches (eg, low carbohydrate, low calorie, low fat, combinations) were recommended. Across studies, QOL generally improved after participating in behavioral weight loss interventions, but findings revealed a lack of evidence to definitively determine whether reported changes in QOL were a result of weight loss or independent of it. CONCLUSIONS AND IMPLICATIONS It is important to consider how making broad dietary recommendations for all individuals might affect overall QOL in both positive and negative directions when considering factors other than weight loss and health improvement. If dietary interventions are adversely affecting QOL in other domains (eg, social, economic) and this relationship is not being detected or reported by current research practices, barriers for successful and sustainable dietary changes may not be fully understood.
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Affiliation(s)
- Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.
| | - Bertha Hidalgo
- Department of Biostatistics, Section on Statistical Genetics, University of Alabama at Birmingham; Birmingham, AL
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Olivia Affuso
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health; University of Alabama at Birmingham, Birmingham, AL
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Affuso O, Kaiser KA, Carson TL, Ingram KH, Schwiers M, Robertson H, Abbas F, Allison DB. Association of run-in periods with weight loss in obesity randomized controlled trials. Obes Rev 2014; 15:68-73. [PMID: 24118736 PMCID: PMC3885242 DOI: 10.1111/obr.12111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 11/30/2022]
Abstract
Study-level design characteristics that inform the optimal design of obesity randomized controlled trials (RCTs) have been examined in few studies. A pre-randomization run-in period is one such design element that may influence weight loss. We examined 311 obesity RCTs published between 1 January 2007 and 1 July 2009 that examine d weight loss or weight gain prevention as a primary or secondary end-point. Variables included run-in period, pre-post intervention weight loss, study duration (time), intervention type, percent female and degree of obesity. Linear regression was used to estimate weight loss as a function of (i) run-in (yes/no) and (ii) run-in, time, percent female, body mass index and intervention type. Interaction terms were also examined. Approximately 19% (18.6%) of the studies included a run-in period, with pharmaceutical studies having the highest frequency. Although all intervention types were associated with weight loss (Mean = 2.80 kg, SD = 3.52), the inclusion of a pre-randomization run-in was associated with less weight loss (P = 0.0017) compared with studies that did not include a run-in period. However, this association was not consistent across intervention types. Our results imply that in trials primarily targeting weight loss in adults, run-in periods may not be beneficial for improving weight loss outcomes in interventions.
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Affiliation(s)
- Olivia Affuso
- Department of Epidemiology. School of Public Health. University of Alabama at Birmingham. Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn A. Kaiser
- Office of Energetics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L. Carson
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katherine H. Ingram
- Department of Exercise Science and Sports Management, Kennesaw State University, Kennesaw, GA, USA
| | | | | | - Firas Abbas
- Department of Internal Medicine, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - David B. Allison
- Office of Energetics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Carson TL, Hardy CM, Greene E, Carter PL, James G, Partridge EE, Baskin ML. Considerations for bio-specimen collection among black women residing in the rural Deep South participating in a cancer prevention study. J Community Genet 2013; 5:257-63. [PMID: 24338206 DOI: 10.1007/s12687-013-0178-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,
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Carson TL, Eddings KE, Krukowski RA, Love SJ, Harvey-Berino JR, West DS. Examining social influence on participation and outcomes among a network of behavioral weight-loss intervention enrollees. J Obes 2013; 2013:480630. [PMID: 23840944 PMCID: PMC3690255 DOI: 10.1155/2013/480630] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/24/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022] Open
Abstract
Research suggests that social networks, social support, and social influence are associated with weight trajectories among treatment- and non-treatment-seeking individuals. This study examined the impact of having a social contact who participated in the same group behavioral weight-control intervention in the absence of specific social support training on women engaged in a weight-loss program. Participants (n = 92; 100% female; 54% black; mean age: 46 ± 10 years; mean BMI: 38 ± 6) were grouped based upon whether or not they reported a social contact enrolled previously/concurrently in our behavioral weight-control studies. Primary outcomes were 6-month weight change and treatment adherence (session attendance and self-monitoring). Half of the participants (53%) indicated that they had a social contact; black women were more likely to report a social contact than white women (67.3% versus 39.5%; P < 0.01). Among participants with a social contact, 67% reported at least one contact as instrumental in the decision to enroll in the program. Those with a contact lost more weight (5.9 versus 3.7 kg; P = 0.04), attended more group sessions (74% versus 54%; P < 0.01), and submitted more self-monitoring journals (69% versus 54%; P = 0.01) than those without a contact. Participants' weight change was inversely associated with social contacts' weight change (P = 0.04). There was no association between participant and contact's group attendance or self-monitoring. Social networks may be a promising vehicle for recruiting and engaging women in a behavioral weight-loss program, particularly black women. The role of a natural social contact deserves further investigation.
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Affiliation(s)
- T L Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Abstract
Basic laboratory evaluation of water quality for livestock should include measurement of TDS, sulfate, nitrate-nitrite, and coliform bacteria. Supplementary water tests may include pH, sodium, iron, magnesium, chloride, calcium, potassium, manganese, and contaminants specific to the situation. Using the best-quality drinking water available contributes to the optimal production of livestock. Restricted quantity of drinking water or drinking water containing excessive levels of nitrate, TDS, sulfate, and other constituents can affect growth and production of all classes of animals. Drinking-water quality and availability should be evaluated as a cause of poor performance or nonspecific disease conditions in livestock. It is important that attempts to evaluate water quality include obtaining a thorough history, making astute observations, and asking intelligent questions. A thorough laboratory examination of animal specimens and water samples should be evaluated in view of existing standards for livestock drinking-water quality.
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Affiliation(s)
- T L Carson
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, USA
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