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Miller HN, Gallis JA, Berger MB, Askew S, Egger JR, Kay MC, Finkelstein EA, de Leon M, DeVries A, Brewer A, Holder MG, Bennett GG. Correction: Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial. J Med Internet Res 2024; 26:e60137. [PMID: 38739917 DOI: 10.2196/60137] [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] [Received: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
[This corrects the article DOI: 10.2196/50330.].
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Miriam B Berger
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC, United States
| | - Eric Andrew Finkelstein
- Duke-NUS Medical School Singapore, Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | | | - Ashley Brewer
- Piedmont Health Services, Inc, Chapel Hill, NC, United States
| | - Marni Gwyther Holder
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gary G Bennett
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
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Miller HN, Gallis JA, Berger MB, Askew S, Egger JR, Kay MC, Finkelstein EA, de Leon M, DeVries A, Brewer A, Holder MG, Bennett GG. Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial. J Med Internet Res 2024; 26:e50330. [PMID: 38416574 PMCID: PMC11009856 DOI: 10.2196/50330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The prevalence of obesity and its associated comorbidities continue to rise in the United States. Populations who are uninsured and from racial and ethnic minority groups continue to be disproportionately affected. These populations also experience fewer clinically meaningful outcomes in most weight loss trials. Weight gain prevention presents a useful strategy for individuals who experience barriers to weight loss. Given the often-limited weight management resources available to patients in primary care settings serving vulnerable patients, evaluating interventions with pragmatic designs may help inform the design of comprehensive obesity care delivered in primary care. OBJECTIVE This study aims to evaluate the effectiveness of Balance, a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention, delivered to patients receiving primary care within federally qualified community health centers. METHODS Balance was a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention delivered to individuals who had a BMI of 25-40 kg/m2, spoke English or Spanish, and were receiving primary care within a network of federally qualified community health centers in North Carolina. The Balance intervention was designed to encourage behavioral changes that result in a slight energy deficit. Intervention participants received tailored goal setting and tracking, skills training, self-monitoring, and responsive health coaching from registered dietitians. Weight was measured at regular primary care visits and documented in the electronic health record. We compared the percentage of ≤3% weight gain in each arm at 24 months after randomization-our primary outcome-using individual empirical best linear unbiased predictors from the linear mixed-effects model. We used individual empirical best linear unbiased predictors from participants with at least 1 electronic health record weight documented within a 6-month window centered on the 24-month time point. RESULTS We randomized 443 participants, of which 223 (50.3%) participants were allocated to the intervention arm. At baseline, participants had a mean BMI of 32.6 kg/m2. Most participants were Latino or Hispanic (n=200, 45.1%) or non-Latino or Hispanic White (n=115, 26%). In total, 53% (n=235) of participants had at least 1 visit with weight measured in the primary time window. The intervention group had a higher proportion with ≤3% weight gain at 6 months (risk ratio=1.12, 95% CI 0.94-1.28; risk difference=9.5, 95% CI -4.5 to 16.4 percentage points). This difference attenuated to the null by 24 months (risk ratio=1.00, 95% CI 0.82-1.20; risk difference=0.2, 95% CI -12.1 to 11.0 percentage points). CONCLUSIONS In adults with overweight or obesity receiving primary care at a community health center, we did not find long-term evidence to support the dissemination of a digital health intervention for weight gain prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT03003403; https://clinicaltrials.gov/study/NCT03003403. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-019-6926-7.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Miriam B Berger
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC, United States
| | - Eric Andrew Finkelstein
- Duke-NUS Medical School Singapore, Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | | | - Ashley Brewer
- Piedmont Health Services, Inc, Chapel Hill, NC, United States
| | - Marni Gwyther Holder
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gary G Bennett
- Duke Digital Health Science Center, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
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Franz L, Viljoen M, Askew S, Brown M, Dawson G, Di Martino JM, Sapiro G, Sebolai K, Seris N, Shabalala N, Stahmer A, Turner EL, de Vries PJ. Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial. PLoS One 2024; 19:e0291883. [PMID: 38215154 PMCID: PMC10786379 DOI: 10.1371/journal.pone.0291883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. OBJECTIVES First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. METHODS This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. RESULTS Participant enrolment started in April 2023. Estimated primary completion date is March 2027. CONCLUSION The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators. TRIAL REGISTRATION NCT05551728 in Clinical Trial Registry (https://clinicaltrials.gov).
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Musaddiqah Brown
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Katlego Sebolai
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Aubyn Stahmer
- Center for Excellence in Developmental Disabilities, MIND Institute, University of California, Davis, Davis, California, United States of America
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
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Franz L, Viljoen M, Askew S, Brown M, Dawson G, Di Martino JM, Sapiro G, Sebolai K, Seris N, Shabalala N, Stahmer A, Turner EL, de Vries PJ. Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial. medRxiv 2023:2023.09.10.23295331. [PMID: 37745535 PMCID: PMC10516098 DOI: 10.1101/2023.09.10.23295331] [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] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. Objectives First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. Methods This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. Results Participant enrolment started in April 2023. Estimated primary completion date is March 2027. Conclusion The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators.
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Musaddiqah Brown
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Katlego Sebolai
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Aubyn Stahmer
- Center for Excellence in Developmental Disabilities, MIND Institute, University of California Davis, California, USA
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
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Berger MB, Chisholm M, Miller HN, Askew S, Kay MC, Bennett GG. "We bleed for our community:" A qualitative exploration of the implementation of a pragmatic weight gain prevention trial from the perspectives of community health center professionals. BMC Public Health 2023; 23:695. [PMID: 37060053 PMCID: PMC10103522 DOI: 10.1186/s12889-023-15574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Clinical trial implementation continues to shift toward pragmatic design, with the goal of increasing future adoption in clinical practice. Yet, few pragmatic trials within clinical settings have qualitatively assessed stakeholder input, especially from those most impacted by research implementation and outcomes, i.e., providers and staff. Within this context, we conducted a qualitative study of the implementation of a pragmatic digital health obesity trial with employees at a Federally qualified health center (FQHC) network in central North Carolina. METHODS Participant recruitment was conducted through purposive sampling of FQHC employees from a variety of backgrounds. Two researchers conducted semi-structured qualitative interviews and collected demographic data. Interviews were digitally recorded, professionally transcribed and double-coded by two independent researchers using NVivo 12. Coding discrepancies were reviewed by a third researcher until intercoder consensus was reached. Responses were compared within and across participants to elucidate emergent themes. RESULTS Eighteen qualitative interviews were conducted, of whom 39% provided direct medical care to patients and 44% worked at the FQHC for at least seven years. Results illuminated the challenges and successes of a pragmatically designed obesity treatment intervention within the community that serves medically vulnerable patients. Although limited time and staffing shortages may have challenged recruitment processes, respondents described early buy-in from leadership; an alignment of organizational and research goals; and consideration of patient needs as facilitators to implementation. Respondents also described the need for personnel power to sustain novel research interventions and considerations of health center resource constraints. CONCLUSIONS Results from this study contribute to the limited literature on pragmatic trials utilizing qualitative methods, particularly in community-based obesity treatment. To continue to merge the gaps between research implementation and clinical care, qualitative assessments that solicit stakeholder input are needed within pragmatic trial design. For maximum impact, researchers may wish to solicit input from a variety of professionals at trial onset and ensure that shared common goals and open collaboration between all partners is maintained throughout the trial. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (NCT03003403) on December 28, 2016.
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Affiliation(s)
- Miriam B Berger
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA.
| | - Miriam Chisholm
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Hailey N Miller
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, USA
| | - Sandy Askew
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Melissa C Kay
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
- Department of Pediatrics, Duke University, 3116 N. Duke Street, Room 1029, 27704, Durham, NC, USA
| | - Gary G Bennett
- Duke Digital Health Science Center, Duke University, 417 Chapel Drive Room 048, Campus Box 90086, Durham, NC, 27708-0086, USA
- Department of Psychology and Neuroscience, Duke University, 222 Reuben-Cooke, Durham, NC, 27708, USA
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Kay MC, Miller HN, Askew S, Spaulding EM, Chisholm M, Christy J, Yang Q, Steinberg DM. Patterns of Engagement With an Application-Based Dietary Self-Monitoring Tool Within a Randomized Controlled Feasibility Trial. AJPM Focus 2022; 1:100037. [PMID: 37791242 PMCID: PMC10546506 DOI: 10.1016/j.focus.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The Dietary Approaches to Stop Hypertension dietary pattern is a proven way to manage hypertension, but adherence remains low. Dietary tracking applications offer a highly disseminable way to self-monitor intake on the pathway to reaching dietary goals but require consistent engagement to support behavior change. Few studies use longitudinal dietary self-monitoring data to assess trajectories and predictors of engagement. We used dietary self-monitoring data from participants in Dietary Approaches to Stop Hypertension Cloud (N=59), a feasibility trial to improve diet quality among women with hypertension, to identify trajectories of engagement and explore associations between participant characteristics. Methods We used latent class growth modeling to identify trajectories of engagement with a publicly available diet tracking application and used bivariate and regression analyses to assess the associations of classifications of engagement with participant characteristics. Results We identified 2 latent classes of engagement: consistent engagers and disengagers. Consistent engagers were more likely to be older, more educated, and married or living with a partner. Although consistent engagers exhibited slightly greater changes in Dietary Approaches to Stop Hypertension score, the difference was not significant. Conclusions This study highlights an important yet underutilized methodologic approach for uncovering dietary self-monitoring engagement patterns. Understanding how certain individuals engage with digital technologies is an important step toward designing cost-effective behavior change interventions. Trial registration This study is registered at www.clinicaltrials.gov NCT03215472.
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Affiliation(s)
- Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Hailey N. Miller
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- School of Nursing, Duke University, Durham, North Carolina
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Erin M. Spaulding
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miriam Chisholm
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Jacob Christy
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- Medable, Inc., Palo Alto, California
| | - Qing Yang
- School of Nursing, Duke University, Durham, North Carolina
| | - Dori M. Steinberg
- School of Nursing, Duke University, Durham, North Carolina
- Equip Health, Inc., Carlsbad, California
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Miller HN, Berger MB, Askew S, Kay MC, Hopkins CM, Iragavarapu MS, de Leon M, Freed M, Barnes CN, Yang Q, Tyson CC, Svetkey LP, Bennett GG, Steinberg DM. The Nourish Protocol: A digital health randomized controlled trial to promote the DASH eating pattern among adults with hypertension. Contemp Clin Trials 2021; 109:106539. [PMID: 34400362 PMCID: PMC8556291 DOI: 10.1016/j.cct.2021.106539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over 100 million adults in the United States have hypertension. The DASH (Dietary Approaches to Stop Hypertension) eating pattern is an evidence-based first-line treatment option for hypertension; however, adherence to the DASH eating pattern at a population level remains low. To address this gap, we will implement Nourish, a randomized controlled efficacy trial that will leverage a commercially-available smartphone application and evidence-based behavior change principles to improve adherence to the DASH eating pattern among adults with hypertension. METHODS The Nourish trial is a two-arm, 12-month randomized control trial that will enroll adults (N = 300) with hypertension, defined as a systolic blood pressure of 120-159 mmHg; a diastolic blood pressure of 80-99 mmHg; and/or adults on blood pressure-lowering medication. Nourish will test the efficacy of a digital health intervention, as compared to the attention control arm, on DASH eating pattern adherence and blood pressure. Intervention components will include skills training, self-monitoring, personalized feedback, and responsive coaching. The primary outcome of the trial is 6-month changes in adherence to the DASH eating pattern, as measured by 24-h dietary recalls. DISCUSSION Millions of Americans remain in need of effective behavioral interventions to manage and improve their hypertension and its adverse consequences. The ubiquity of smartphones offers a promising approach to disseminate the DASH eating pattern. By leveraging these widely used smartphone applications, combined with evidence-based behavior change principles and the DASH eating plan, Nourish will demonstrate the effectiveness of a digital health intervention to improve DASH adherence, and ultimately, to reduce blood pressure. Trial Number: NCT03875.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America.
| | - Miriam B Berger
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Christina M Hopkins
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America; Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America
| | - Meghana Sai Iragavarapu
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Mia de Leon
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Megan Freed
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Cherie N Barnes
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America
| | - Qing Yang
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Crystal C Tyson
- School of Medicine, Duke University, Durham, NC, United States of America
| | - Laura P Svetkey
- School of Medicine, Duke University, Durham, NC, United States of America
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States of America; Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America
| | - Dori M Steinberg
- School of Nursing, Duke University, Durham, NC, United States of America; Equip Health, LLC, San Diego, CA, United States of America
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Bennett GG, Steinberg D, Bolton J, Gallis JA, Treadway C, Askew S, Kay MC, Pollak KI, Turner EL. Optimizing an Obesity Treatment Using the Multiphase Optimization Strategy Framework: Protocol for a Randomized Factorial Trial. JMIR Res Protoc 2021; 10:e19506. [PMID: 33459600 PMCID: PMC7850907 DOI: 10.2196/19506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Effective weight loss interventions exist, yet few can be scaled up for wide dissemination. Further, none has been fully delivered via text message. We used the multiphase optimization strategy (MOST) to develop multicomponent interventions that consist only of active components, those that have been experimentally determined to impact the chosen outcome. Objective The goal of this study is to optimize a standalone text messaging obesity intervention, Charge, using the MOST framework to experimentally determine which text messaging components produce a meaningful contribution to weight change at 6 months. Methods We designed a 6-month, weight loss texting intervention based on our interactive obesity treatment approach (iOTA). Participants are randomized to one of 32 experimental conditions to test which standalone text messaging intervention components produce a meaningful contribution to weight change at 6 months. Results The project was funded in February 2017; enrollment began in January 2018 and data collection was completed in June 2019. Data analysis is in progress and first results are expected to be submitted for publication in 2021. Conclusions Full factorial trials are particularly efficient in terms of cost and logistics when leveraged for standalone digital treatments. Accordingly, MOST has the potential to promote the rapid advancement of digital health treatments. Subject to positive findings, the intervention will be low cost, immediately scalable, and ready for dissemination. This will be of great potential use to the millions of Americans with obesity and the providers who treat them. Trial Registration ClinicalTrials.gov NCT03254940; https://clinicaltrials.gov/ct2/show/NCT03254940 International Registered Report Identifier (IRRID) RR1-10.2196/19506
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Affiliation(s)
- Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Jamiyla Bolton
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - John A Gallis
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Cayla Treadway
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, United States.,Department of Populations Health Sciences, Duke University, Durham, NC, United States
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
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9
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Steinberg DM, Kay MC, Svetkey LP, Askew S, Christy J, Burroughs J, Ahmed H, Bennett GG. Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial. JMIR Mhealth Uhealth 2020; 8:e17536. [PMID: 33284116 PMCID: PMC7752529 DOI: 10.2196/17536] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/03/2020] [Accepted: 09/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. OBJECTIVE This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. METHODS We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. RESULTS The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: -2.8 mmHg, 95% CI -1.8 to 7.4; P=.23) and diastolic (mean difference: -3.6 mmHg, 95% CI -0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. CONCLUSIONS A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. TRIAL REGISTRATION ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472.
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Affiliation(s)
- Dori M Steinberg
- Duke University School of Nursing, Durham, NC, United States.,Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States.,Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Laura P Svetkey
- Sarah W Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, United States.,Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Jacob Christy
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
| | - Jasmine Burroughs
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Hira Ahmed
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, United States.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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10
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Gallis JA, Kusibab K, Egger JR, Olsen MK, Askew S, Steinberg DM, Bennett GG. Can Electronic Health Records Validly Estimate the Effects of Health System Interventions Aimed at Controlling Body Weight? Obesity (Silver Spring) 2020; 28:2107-2115. [PMID: 32985131 PMCID: PMC8351620 DOI: 10.1002/oby.22958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 06/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to compare weight collected at clinics and recorded in the electronic health record (EHR) with primary study-collected trial weights to assess the validity of using EHR data in future pragmatic weight loss or weight gain prevention trials. METHODS For both the Track and Shape obesity intervention randomized trials, clinic EHR weight data were compared with primary trial weight data over the same time period. In analyzing the EHR weights, intervention effects were estimated on the primary outcome of weight (in kilograms) with EHR data, using linear mixed effects models. RESULTS EHR weight measurements were higher on average and more variable than trial weight measurements. The mean difference and 95% CI were similar at all time points between the estimates using EHR and study-collected weights. CONCLUSIONS The results of this study can be used to help guide the planning of future pragmatic weight-related trials. This study provides evidence that body weight measurements abstracted from the EHR can provide valid, efficient, and cost-effective data to estimate treatment effects from randomized clinical weight loss and weight management trials. However, care should be taken to properly understand the data-generating process and any mechanisms that may affect the validity of these estimates.
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Affiliation(s)
- John A. Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kristie Kusibab
- During the study, Ms. Kusibab was a Master of Science student in the Department of Biostatistics & Bioinformatics at Duke University
- PharPoint Research, Inc., Durham, NC, United States
| | - Joseph R. Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Maren K. Olsen
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Dori M. Steinberg
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
- Duke School of Nursing, Duke University, Durham, NC, United States
| | - Gary G. Bennett
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
- Corresponding Author Contact Info: Gary G. Bennett, ; 919-668-3420; 116 Allen Building, Box 90024, Durham NC 27708
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11
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Gallis JA, Bennett GG, Steinberg DM, Askew S, Turner EL. Randomization procedures for multicomponent behavioral intervention factorial trials in the multiphase optimization strategy framework: challenges and recommendations. Transl Behav Med 2019; 9:1047-1056. [PMID: 30590759 PMCID: PMC6875651 DOI: 10.1093/tbm/iby131] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The multiphase optimization strategy (MOST) is an increasingly popular framework to prepare, optimize, and evaluate multicomponent behavioral health interventions. Within this framework, it is common to use a factorial trial to assemble an optimized multicomponent intervention by simultaneously testing several intervention components. With the possibility of a large number of conditions (unique combinations of components) and a goal to balance conditions on both sample size (for statistical efficiency) and baseline covariates (for internal validity), such trials face additional randomization challenges compared to the standard two-arm trial. The purpose of the current paper is to compare and contrast potential randomization methods for factorial trials in the context of MOST and to provide guidance for the reporting of those methods. We describe the principles, advantages, and disadvantages of several randomization methods in the context of factorial trials. We then provide examples to examine current practice in the MOST-related literature and provide recommendations for reporting of randomization. We identify two key randomization decisions for MOST-related factorial trials: (i) whether to randomize to components or conditions and (ii) whether to use restricted randomization techniques, such as stratification, permuted blocks, and minimization. We also provide a checklist to assist researchers in ensuring complete reporting of randomization methods used. As more investigators use factorial trials within the MOST framework for assembling optimized multicomponent behavioral interventions, appropriate implementation and rigorous reporting of randomization procedures will be essential for ensuring the efficiency and validity of the results.
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Affiliation(s)
- John A Gallis
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Gary G Bennett
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Dori M Steinberg
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
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12
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McVay M, Steinberg D, Askew S, Bennett GG. Provider Counseling and Weight Loss Outcomes in a Primary Care-Based Digital Obesity Treatment. J Gen Intern Med 2019; 34:992-998. [PMID: 30891688 PMCID: PMC6544687 DOI: 10.1007/s11606-019-04944-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/14/2018] [Revised: 12/17/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary care-based digital health weight loss interventions offer promise for addressing obesity in underserved populations. OBJECTIVES To determine if primary care providers' weight counseling is associated with weight change during a weight loss intervention. DESIGN This is a secondary analysis of a randomized clinical trial testing a 12-month primary care-based digital health weight loss intervention. PARTICIPANTS Participants were community health center patients with body mass indexes of 30-44.9 kg/m2. INTERVENTIONS The weight loss intervention included tailored behavioral goal setting; weekly goal monitoring via text messaging or interactive voice response calls; counseling calls; skills training material; and participant-tailored recommendations for provider counseling. MAIN MEASURES At 6 and 12 months, participants' weight was measured and they reported if their provider delivered weight counseling (general or intervention-specific) at their most recent visit and their perception of providers' empathy. Providers' documentation of weight counseling was extracted from health records. KEY RESULTS Participants (n = 134-141) were predominantly female (70%) and African American (55%) with a mean age of 51 years and BMI of 36 kg/m2. Participant-reported provider weight counseling was not associated with weight change. However, participants whose providers documented intervention-specific counseling at any point during the intervention (n = 35) lost 3.1 kg (95% CI 0.4 to 5.7 kg) more than those whose providers documented only general weight counseling (n = 82) and 4.0 kg (95% CI 0.1 to 7.9 kg) more than those whose providers did not document weight counseling (n = 17). Perceptions of provider empathy were associated with greater weight loss from 6 to 12 months (0.8 kg per measure unit, 95% CI 0.07 to 1.5 kg, p = .03). CONCLUSIONS Provider counseling that focuses specifically on engagement in a weight loss intervention may enhance weight loss outcomes relative to more general weight loss advice. Counseling that enhances patients' perceptions of empathy may be most beneficial for patients' weight loss. TRIAL REGISTRATION NCT01827800.
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Affiliation(s)
- Megan McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
| | - Dori Steinberg
- School of Nursing, Duke University, Durham, NC, USA.,Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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13
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Berger MB, Steinberg DM, Askew S, Gallis JA, Treadway CC, Egger JR, Kay MC, Batch BC, Finkelstein EA, DeVries A, Brewer A, Bennett GG. The Balance protocol: a pragmatic weight gain prevention randomized controlled trial for medically vulnerable patients within primary care. BMC Public Health 2019; 19:596. [PMID: 31101037 PMCID: PMC6525404 DOI: 10.1186/s12889-019-6926-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/30/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND For patients with obesity who are not ready for or experience barriers to weight loss, clinical practice guidelines recommend provider counseling on preventing further weight gain as a first-line treatment approach. Unfortunately, evidence-based weight gain prevention interventions are not routinely available within primary care. To address this gap, we will implement a pragmatic 12-month randomized controlled trial of a digital weight gain prevention intervention delivered to patients receiving primary care within a network of Federally Qualified Community Health Centers in central North Carolina. METHODS Balance (Equilibrio in Spanish) is a pragmatic effectiveness trial that will randomize adult patients who have overweight or obesity (BMI of 25-40 kg/m2) to either: 1) a weight gain prevention intervention with tailored behavior change goals and tracking, daily weighing on a network-connected electronic scale, and responsive weight and goal coaching delivered remotely by health center registered dietitians; or 2) a usual care program with automated healthy living text messages and print materials and routine primary care. The primary outcome will be weight gain prevention at 24-months, defined as ≤3% change in baseline weight. To align with its pragmatic design, trial outcome data will be pulled from the electronic health record of the community health center network. DISCUSSION For underserved, often rurally-located patients with obesity, digital approaches to promote a healthy lifestyle can curb further weight gain. Yet enrolling medically vulnerable patients into a weight gain prevention trial, many of whom are from racial/ethnic minorities, can be difficult. Despite these potential challenges, we plan to recruit a large, diverse sample from rural areas, and will implement a remotely-delivered weight gain prevention intervention to medically vulnerable patients. Upcoming trial results will demonstrate the effectiveness of this pragmatic approach to implement and evaluate a digital weight gain prevention intervention within primary care. TRIALS REGISTRATION NCT03003403 . Registered December 28, 2016.
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Affiliation(s)
- Miriam B Berger
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA.
| | - Dori M Steinberg
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA.,Duke University School of Nursing, 307 Trent Drive, Pearson Room 2055, DUMC 3322, Durham, NC, 27708, USA
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - John A Gallis
- Duke Global Health Institute, Duke University, Trent Drive, Room 236, Durham, NC, 27708, USA
| | - Cayla C Treadway
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Trent Drive, Room 236, Durham, NC, 27708, USA
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Bryan C Batch
- Duke University Medical Center, DUMC 3031, Durham, NC, 27710, USA
| | - Eric A Finkelstein
- National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Abigail DeVries
- Piedmont Health Services, Inc., 127 Kingston Drive, Chapel Hill, NC, 27514, USA
| | - Ashley Brewer
- Piedmont Health Services, Inc., 127 Kingston Drive, Chapel Hill, NC, 27514, USA
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Campus Box 90086, Durham, NC, 27708-0086, USA.,Duke University, Department of Psychology and Neuroscience, Campus Box 90086, Durham, NC, 27708, USA
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14
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Krishnan A, Finkelstein EA, Levine E, Foley P, Askew S, Steinberg D, Bennett GG. A Digital Behavioral Weight Gain Prevention Intervention in Primary Care Practice: Cost and Cost-Effectiveness Analysis. J Med Internet Res 2019; 21:e12201. [PMID: 31102373 PMCID: PMC6543798 DOI: 10.2196/12201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 01/18/2023] Open
Abstract
Background Obesity is one of the largest drivers of health care spending but nearly half of the population with obesity demonstrate suboptimal readiness for weight loss treatment. Black women are disproportionately likely to have both obesity and limited weight loss readiness. However, they have been shown to be receptive to strategies that prevent weight gain. Objective The aim of this study was to evaluate the costs and cost-effectiveness of a digital weight gain prevention intervention (Shape) for black women. Shape consisted of adaptive telephone-based coaching by health system personnel, a tailored skills training curriculum, and patient self-monitoring delivered via a fully automated interactive voice response system. Methods A cost and cost-effectiveness analysis based on a randomized clinical trial of the Shape intervention was conducted from the payer perspective. Costs included those of delivering the program to 91 intervention participants in the trial and were summarized by program elements: self-monitoring, skills training, coaching, and administration. Effectiveness was measured in quality-adjusted life years (QALYs). The primary outcome was the incremental cost per QALY of Shape relative to usual care. Results Shape cost an average of US $758 per participant. The base-case model in which quality of life benefits decay linearly to zero 5 years post intervention cessation, generated an incremental cost-effectiveness ratio (ICER) of US $55,264 per QALY. Probabilistic sensitivity analyses suggest an ICER below US $50,000 per QALY and US $100,000 per QALY in 39% and 98% of simulations, respectively. Results are highly sensitive to durability of benefits, rising to US $165,730 if benefits end 6 months post intervention. Conclusions Results suggest that the Shape intervention is cost-effective based on established benchmarks, indicating that it can be a part of a successful strategy to address the nation’s growing obesity epidemic in low-income at-risk communities.
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Affiliation(s)
- Anirudh Krishnan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Erica Levine
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Perry Foley
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
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15
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Kay MC, Burroughs J, Askew S, Bennett GG, Armstrong S, Steinberg DM. Digital Weight Loss Intervention for Parents of Children Being Treated for Obesity: A Prospective Cohort Feasibility Trial. J Med Internet Res 2018; 20:e11093. [PMID: 30573449 PMCID: PMC6320402 DOI: 10.2196/11093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity continues to increase, and clinic-based treatment options have failed to demonstrate effectiveness. One of the strongest predictors of child weight is parent weight. Parental treatment for weight loss may indirectly reduce obesity in the child. We have previously demonstrated the effectiveness among adults of a fully automated, evidence-based digital weight loss intervention (Track). However, it is unknown if it is feasible to deliver such a treatment directly to parents with obesity who bring their child with obesity to a weight management clinic for treatment. OBJECTIVE The objective of our study was to evaluate the feasibility of and engagement with a digital weight loss intervention among parents of children receiving treatment for obesity. METHODS We conducted a 6-month pre-post feasibility trial among parents or guardians and their children aged 4-16 years presenting for tertiary care obesity treatment. Along with the standard family-based treatment protocol, parents received a 6-month digital weight loss intervention, which included weekly monitoring of personalized behavior change goals via mobile technologies. We examined levels of engagement by tracking completed weeks of self-monitoring and feasibility by assessing change in weight. RESULTS Participants (N=48) were on average 39 years old, mostly female (35/42, 82% ), non-Hispanic Black individuals (21/41, 51%) with obesity (36/48, 75%). Over a quarter had a yearly household income of <US $25,000, and about a third had the equivalent of a high school education. Children were on average 10 years old and had a body mass index of 29.8 kg/m2. The median percentage of weeks participants tracked their behaviors was 77% (18.5/24 total weeks; interquartile range [IQR] 6.3 to 100). The median number of attempts via phone or text message (short message service) required to complete one tracking week was 3.3 (IQR 2.6 to 4.9). Nearly half (23/48, 48%) had high levels of engagement, completing 80% (19/24) or more weeks of tracking. Of the 26 participants with weight measurements reported at 6 months, of which 81% (21/26) were self-reported, there was a median 2.44 kg (IQR -6.5 to 1.0) decrease in weight. CONCLUSIONS It is feasible to deliver an evidence-based digital weight loss intervention to parents or guardians whose children are enrolled in a weight management program. Given the feasibility of this approach, future studies should investigate the effectiveness of digital weight loss interventions for parents on child weight and health outcomes.
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Affiliation(s)
- Melissa C Kay
- Duke Global Digital Health Science Center, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, United States
| | - Jasmine Burroughs
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Sarah Armstrong
- Duke Center for Childhood Obesity Research, Duke Department of Pediatrics, Duke University, Durham, NC, United States
| | - Dori M Steinberg
- Duke Global Digital Health Science Center, Duke School of Nursing, Duke University, Durham, NC, United States
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16
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Bennett GG, Steinberg D, Askew S, Levine E, Foley P, Batch BC, Svetkey LP, Bosworth HB, Puleo EM, Brewer A, DeVries A, Miranda H. Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care. Am J Prev Med 2018; 55:777-786. [PMID: 30361140 PMCID: PMC6388618 DOI: 10.1016/j.amepre.2018.07.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/31/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obesity treatment is less successful for socioeconomically disadvantaged populations, particularly when delivered in primary care. Digital health strategies can extend the reach of clinical obesity treatments to care settings serving patients at highest risk. METHODS Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded within a community health center system. Participants were 351 adult patients (aged 21-65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients were randomized to usual care (n=175) or an intervention (n=176) comprising app-based self-monitoring of behavior change goals with tailored feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations, delivered via electronic health record. The primary outcome was 12-month weight change. Randomization began on June 18, 2013, final assessments were completed on September 10, 2015. Data analysis was conducted in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants at 12 months. RESULTS The Track intervention produced larger weight losses relative to usual care at 6 months (net effect: -4.4 kg, 95% CI= -5.5, -3.3, p<0.001) and 12 months (net effect: -3.8 kg, 95% CI= -5.0, -2.5, p<0.001). Intervention participants were more likely to lose ≥5% of their baseline weight at 6 months (43% vs 6%, p<0.001) and 12 months (40% vs 17%, p<0.001). Intervention participants completing ≥80% of expected self-monitoring episodes (-3.5 kg); counseling calls (-3.0 kg); or self-weighing days (-4.4 kg) lost significantly more weight than less engaged intervention participants (all p<0.01). CONCLUSIONS A digital obesity treatment, integrated with health system resources, can produce clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary care patients with elevated cardiovascular disease risk. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01827800.
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Affiliation(s)
- Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina; Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Erica Levine
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Perry Foley
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina; Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
| | - Laura P Svetkey
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Elaine M Puleo
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
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17
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Greaney ML, Askew S, Foley P, Wallington SF, Bennett GG. Linking patients with community resources: use of a free YMCA membership among low-income black women. Transl Behav Med 2018; 7:341-348. [PMID: 27484775 DOI: 10.1007/s13142-016-0431-7] [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: 12/13/2022] Open
Abstract
Given the increasing interest in expanding obesity prevention efforts to cover community-based programs, we examined whether individuals would access a YMCA for physical activity promotion. We provided a no-cost 12-month YMCA membership to socioeconomically disadvantaged black women who were randomized to the intervention arm of a weight gain prevention trial (n = 91). Analyses examined associations of membership activation and use with baseline psychosocial, contextual, health-related, and sociodemographic factors. Many participants (70.3 %) activated their memberships; however, use was low (42.2 % had no subsequent visits, 46.9 % had one to ten visits). There were no predictors of membership activation, but individuals living below/borderline the federal poverty line were more likely to use the center (1+ visits), as were those who met physical activity guidelines at baseline. More comprehensive and intensive interventions may be necessary to promote use of community resources-even when provided free-among high-risk populations of women with obesity that live in rural areas of the USA.
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Affiliation(s)
- Mary L Greaney
- Health Studies and Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Kingston, RI, 02881, USA.
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Perry Foley
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Sherrie F Wallington
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C, 20007, USA
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA.,Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA
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Greaney ML, Askew S, Wallington SF, Foley PB, Quintiliani LM, Bennett GG. The effect of a weight gain prevention intervention on moderate-vigorous physical activity among black women: the Shape Program. Int J Behav Nutr Phys Act 2017; 14:139. [PMID: 29037247 PMCID: PMC5644166 DOI: 10.1186/s12966-017-0596-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Rates of physical inactivity are high among Black women living in the United States with overweight or obesity, especially those living in the rural South. This study was conducted to determine if an efficacious weight gain prevention intervention increased moderate-vigorous physical activity (MVPA). METHODS The Shape Program, a weight gain prevention intervention implemented in community health centers in rural North Carolina, was designed for socioeconomically disadvantaged Black women with overweight or obesity. MVPA was measured using accelerometers, and summarized into 1- and 10-min bouts. We employed analyses of covariance (ANCOVA) to assess the relationship between changes in MVPA over 12 months, calculated as a change score, and intervention assignment (intervention versus usual care). RESULTS Participants completing both baseline and 12-month accelerometer assessments (n = 121) had a mean age of 36.1 (SD = 5.43) years and a mean body mass index of 30.24 kg/m2 (SD = 2.60). At baseline, 38% met the physical activity recommendation (150 min of MVPA/week) when assessed using 10-min bouts, and 76% met the recommendation when assessed using 1-min bouts. There were no significant differences in change in MVPA participation among participants randomized to the intervention from baseline to 12-months using 1-min bouts (adjusted intervention mean [95% CI]: 20.50 [-109.09 to 150.10] vs. adjusted usual care mean [95% CI]: -80.04 [-209.21 to 49.13], P = .29), or 10-min bouts (adjusted intervention mean [95% CI]: 7.39 [-83.57 to 98.35] vs. adjusted usual care mean [95% CI]: -17.26 [-107.93 to 73.40], P = .70). CONCLUSIONS Although prior research determined that the Shape intervention promoted weight gain prevention, MVPA did not increase significantly among intervention participants from baseline to 12 months. The classification of bouts had a marked effect on the prevalence estimates of those meeting physical activity recommendations. More research is needed to understand how to promote increased MVPA in weight gain prevention interventions. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov database (No. NCT00938535. Retrospectively Registered 7/10/2009).
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Affiliation(s)
- Mary L Greaney
- Department of Kinesiology and Health Studies, 25 West Independence Way, University of Rhode Island, Kingston, RI, 02881, USA.
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Sherrie F Wallington
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., 20007, USA
| | - Perry B Foley
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Lisa M Quintiliani
- Section of General Internal Medicine, Department of Medicine, Boston University, Boston, MA, 02118, USA
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA.,Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA
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Lanpher MG, Askew S, Bennett GG. Health Literacy and Weight Change in a Digital Health Intervention for Women: A Randomized Controlled Trial in Primary Care Practice. J Health Commun 2016; 21 Suppl 1:34-42. [PMID: 27043756 PMCID: PMC4935541 DOI: 10.1080/10810730.2015.1131773] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the United States, 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12-month digital health treatment aimed at preventing weight gain among overweight and Class I obese Black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. More than half (55%) of participants had low health literacy, which was more common among those with fewer years of education and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal-focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy.
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Affiliation(s)
- Michele G Lanpher
- a Department of Psychology and Neuroscience , Duke University , Durham , North Carolina , USA
- b Duke Global Digital Health Science Center , Duke Global Health Institute, Duke University , Durham , North Carolina , USA
| | - Sandy Askew
- b Duke Global Digital Health Science Center , Duke Global Health Institute, Duke University , Durham , North Carolina , USA
| | - Gary G Bennett
- a Department of Psychology and Neuroscience , Duke University , Durham , North Carolina , USA
- b Duke Global Digital Health Science Center , Duke Global Health Institute, Duke University , Durham , North Carolina , USA
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Wolin KY, Steinberg DM, Lane IB, Askew S, Greaney ML, Colditz GA, Bennett GG. Engagement with eHealth Self-Monitoring in a Primary Care-Based Weight Management Intervention. PLoS One 2015; 10:e0140455. [PMID: 26469065 PMCID: PMC4607302 DOI: 10.1371/journal.pone.0140455] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/25/2015] [Indexed: 12/19/2022] Open
Abstract
Background While eHealth approaches hold promise for improving the reach and cost-effectiveness of behavior change interventions, they have been challenged by declining participant engagement over time, particularly for self-monitoring behaviors. These are significant concerns in the context of chronic disease prevention and management where durable effects are important for driving meaningful changes. Purpose “Be Fit, Be Well” was an eHealth weight loss intervention that allowed participants to self-select a self-monitoring modality (web or interactive voice response (IVR)). Participants could change their modality. As such, this study provides a unique opportunity to examine the effects of intervention modality choice and changing modalities on intervention engagement and outcomes. Methods Intervention participants, who were recruited from community health centers, (n = 180) were expected to self-monitor health behaviors weekly over the course of the 24-month intervention. We examined trends in intervention engagement by modality (web, IVR, or changed modality) among participants in the intervention arm. Results The majority (61%) of participants chose IVR self-monitoring, while 39% chose web. 56% of those who selected web monitoring changed to IVR during the study versus no change in those who initially selected IVR. Self-monitoring declined in both modalities, but completion rates were higher in those who selected IVR. There were no associations between self-monitoring modality and weight or blood pressure outcomes. Conclusions This is the first study to compare web and IVR self-monitoring in an eHealth intervention where participants could select and change their self-monitoring modality. IVR shows promise for achieving consistent engagement.
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Affiliation(s)
| | | | - Ilana B. Lane
- Duke University, Durham, NC, United States of America
| | - Sandy Askew
- Duke University, Durham, NC, United States of America
| | - Mary L. Greaney
- University of Rhode Island, Kingston, RI, United States of America
| | - Graham A. Colditz
- Washington University in St. Louis, St. Louis, MO, United States of America
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Steinberg DM, Bennett GG, Askew S, Tate DF. Weighing every day matters: daily weighing improves weight loss and adoption of weight control behaviors. J Acad Nutr Diet 2015; 115:511-8. [PMID: 25683820 PMCID: PMC4380831 DOI: 10.1016/j.jand.2014.12.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/09/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Daily weighing is emerging as the recommended self-weighing frequency for weight loss. This is likely because it improves adoption of weight control behaviors. OBJECTIVE To examine whether weighing every day is associated with greater adoption of weight control behaviors compared with less frequent weighing. DESIGN Longitudinal analysis of a previously conducted 6-month randomized controlled trial. PARTICIPANTS/SETTING Overweight men and women in Chapel Hill, NC, participated in the intervention arm (N=47). INTERVENTION The intervention focused on daily weighing for weight loss using an e-scale that transmitted weights to a study website, along with weekly e-mailed lessons and tailored feedback on daily weighing adherence and weight loss progress. MAIN OUTCOME MEASURES We gathered objective data on self-weighing frequency from the e-scales. At baseline and 6 months, weight change was measured in the clinic and weight control behaviors (total items=37), dietary strategies, and calorie expenditure from physical activity were assessed via questionnaires. Calorie intake was assessed using an online 24-hour recall tool. STATISTICAL ANALYSES We used χ(2) tests to examine variation in discrete weight control behaviors and linear regression models to examine differences in weight, dietary strategies, and calorie intake and expenditure by self-weighing frequency. RESULTS Fifty-one percent of participants weighed every day (n=24) over 6 months. The average self-weighing frequency among those weighing less than daily (n=23) was 5.4±1.2 days per week. Daily weighers lost significantly more weight compared with those weighing less than daily (mean difference=-6.1 kg; 95% CI -10.2 to -2.1; P=0.004). The total number of weight control behaviors adopted was greater among daily weighers (17.6±7.6 vs 11.2±6.4; P=0.004). There were no differences by self-weighing frequency in dietary strategies, calorie intake, or calorie expenditure. CONCLUSIONS Weighing every day led to greater adoption of weight control behaviors and produced greater weight loss compared with weighing most days of the week. This further implicates daily weighing as an effective weight loss tool.
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Bennett GG, Steinberg DM, Stoute C, Lanpher M, Lane I, Askew S, Foley PB, Baskin ML. Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review. Obes Rev 2014; 15 Suppl 4:146-58. [PMID: 25196411 DOI: 10.1111/obr.12218] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [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: 06/06/2014] [Revised: 06/21/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
Abstract
Electronic health (eHealth) interventions have demonstrated efficacy for weight management. However, little is known about their efficacy among racial/ethnic minority populations, in whom there is a disproportionate prevalence of obesity. This systematic review evaluated the efficacy of eHealth weight management interventions among overweight and obese racial/ethnic minority adults. We required that trial samples be comprised of at least 50% racial/ethnic minorities or report outcomes by race/ethnicity. We searched five electronic databases for trials conducted through June 2012. Six papers met our eligibility criteria. These studies provide suggestive evidence that eHealth interventions can produce low magnitude, short-term weight loss among racial/ethnic minorities. Trials were methodologically sound, with high retention and participant engagement. There was no evidence detailing the efficacy of mobile health approaches, although this area is promising given high utilization rates of mobile devices among racial/ethnic minorities. More evidence, particularly from longer-term trials, is necessary to demonstrate that eHealth intervention approaches can produce clinically meaningful (≥ 5% of initial body weight) weight loss among racial/ethnic minority populations.
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Affiliation(s)
- G G Bennett
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Steinberg DM, Askew S, Lanpher MG, Foley PB, Levine EL, Bennett GG. The effect of a "maintain, don't gain" approach to weight management on depression among black women: results from a randomized controlled trial. Am J Public Health 2014; 104:1766-73. [PMID: 25033150 DOI: 10.2105/ajph.2014.302004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effect of a weight gain prevention intervention (Shape Program) on depression among socioeconomically disadvantaged overweight and obese Black women. METHODS Between 2009 and 2012, we conducted a randomized trial comparing a 12-month electronic health-based weight gain prevention intervention to usual primary care at 5 central North Carolina community health centers. We assessed depression with the Patient Health Questionnaire (PHQ-8). We analyzed change in depression score from baseline to 12- and 18-month follow-up across groups with mixed models. We used generalized estimating equation models to analyze group differences in the proportion above the clinical threshold for depression (PHQ-8 score ≥ 10). RESULTS At baseline, 20% of participants reported depression. Twelve-month change in depression scores was larger for intervention participants (mean difference = -1.85; 95% confidence interval = -3.08, -0.61; P = .004). There was a significant reduction in the proportion of intervention participants with depression at 12 months with no change in the usual-care group (11% vs 19%; P = .035). All effects persisted after we controlled for weight change and medication use. We saw similar findings at 18 months. CONCLUSIONS The Shape Program, which includes no mention of mood, improved depression among socioeconomically disadvantaged Black women.
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Affiliation(s)
- Dori M Steinberg
- All authors are with Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, NC. Gary G. Bennett and Michele G. Lanpher are also with Department of Psychology and Neuroscience, Duke University
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Lin PH, Wang Y, Levine E, Askew S, Lin S, Chang C, Sun J, Foley P, Wang H, Li X, Bennett GG. A text messaging-assisted randomized lifestyle weight loss clinical trial among overweight adults in Beijing. Obesity (Silver Spring) 2014; 22:E29-37. [PMID: 24375969 DOI: 10.1002/oby.20686] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 12/14/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The impact of a text messaging-assisted lifestyle weight loss intervention on weight change among overweight adults in Beijing was examined. METHODS It was a 6-month randomized two arm clinical trial. The control group received a brief advice session after randomization. The intervention group received three group sessions, five coaching calls, and a daily text message prompting participants to follow predetermined lifestyle goals. RESULTS A total of 123 participants were randomized. At 6 months, controls gained 0.24 ± 0.28 kg (0.21% ± 0.38%) (NS) while intervention participants lost 1.6 ± 0.28 kg (2.31% ± 0.38%) (p < 0.0001). Intervention participants decreased waist circumference (WC) (-2.69 ± 0.43 cm, p < 0.0001), percent body fat (%BF) (-0.66% ± 0.19%, p = 0.0007), and systolic/diastolic blood pressure (SBP/DBP) significantly (-1.71 ± 1.12/-3.24 ± 0.87 mmHg), while the controls had no change in WC and %BF and increased SBP/DBP by 2.43 ± 1.14/1.20 ± 0.88 mmHg (between groups: p = 0.01/p = 0.0004). CONCLUSIONS This text message-assisted lifestyle intervention was effective in reducing weight, WC, %BF, and improving BP. Coupled with the scalable feature of the intervention, this finding is intriguing in light of the potential reach of the intervention for countries like China where mobile phone penetration is high and the obesity rate continues to rise.
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Affiliation(s)
- Pao-Hwa Lin
- Department of Medicine, Nephrology division, Duke University Medical Center, Durham, North Carolina, USA
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Steinberg DM, Levine EL, Lane I, Askew S, Foley PB, Puleo E, Bennett GG. Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial. J Med Internet Res 2014; 16:e114. [PMID: 24780934 PMCID: PMC4019773 DOI: 10.2196/jmir.2996] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND eHealth interventions are effective for weight control and have the potential for broad reach. Little is known about the use of interactive voice response (IVR) technology for self-monitoring in weight control interventions, particularly among populations disproportionately affected by obesity. OBJECTIVE This analysis sought to examine patterns and predictors of IVR self-monitoring adherence and the association between adherence and weight change among low-income black women enrolled in a weight gain prevention intervention. METHODS The Shape Program was a randomized controlled trial comparing a 12-month eHealth behavioral weight gain prevention intervention to usual care among overweight and obese black women in the primary care setting. Intervention participants (n=91) used IVR technology to self-monitor behavior change goals (eg, no sugary drinks, 10,000 steps per day) via weekly IVR calls. Weight data were collected in clinic at baseline, 6, and 12 months. Self-monitoring data was stored in a study database and adherence was operationalized as the percent of weeks with a successful IVR call. RESULTS Over 12 months, the average IVR completion rate was 71.6% (SD 28.1) and 52% (47/91) had an IVR completion rate ≥80%. At 12 months, IVR call completion was significantly correlated with weight loss (r =-.22; P=.04) and participants with an IVR completion rate ≥80% had significantly greater weight loss compared to those with an IVR completion rate <80% (-1.97 kg, SE 0.67 vs 0.48 kg, SE 0.69; P=.01). Similar outcomes were found for change in body mass index (BMI; mean difference -0.94 kg, 95% CI -1.64 to -0.24; P=.009). Older, more educated participants were more likely to achieve high IVR call completion. Participants reported positive attitudes toward IVR self-monitoring. CONCLUSIONS Adherence to IVR self-monitoring was high among socioeconomically disadvantaged black women enrolled in a weight gain prevention intervention. Higher adherence to IVR self-monitoring was also associated with greater weight change. IVR is an effective and useful tool to promote self-monitoring and has the potential for widespread use and long-term sustainability. TRIAL REGISTRATION Clinicaltrials.gov NCT00938535; http://www.clinicaltrials.gov/ct2/show/NCT00938535.
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Affiliation(s)
- Dori M Steinberg
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, NC, United States.
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Ritzwoller DP, Glasgow RE, Sukhanova AY, Bennett GG, Warner ET, Greaney ML, Askew S, Goldman J, Emmons KM, Colditz GA. Economic analyses of the Be Fit Be Well program: a weight loss program for community health centers. J Gen Intern Med 2013; 28:1581-8. [PMID: 23733374 PMCID: PMC3832708 DOI: 10.1007/s11606-013-2492-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 01/04/2013] [Accepted: 04/17/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The U.S. Preventive Services Task Force has released new guidelines on obesity, urging primary care physicians to provide obese patients with intensive, multi-component behavioral interventions. However, there are few studies of weight loss in real world nonacademic primary care, and even fewer in largely racial/ethnic minority, low-income samples. OBJECTIVE To evaluate the recruitment, intervention and replications costs of a 2-year, moderate intensity weight loss and blood pressure control intervention. DESIGN A comprehensive cost analysis was conducted, associated with a weight loss and hypertension management program delivered in three community health centers as part of a pragmatic randomized trial. PARTICIPANTS Three hundred and sixty-five high risk, low-income, inner city, minority (71 % were Black/African American and 13 % were Hispanic) patients who were both hypertensive and obese. MAIN MEASURES Measures included total recruitment costs and intervention costs, cost per participant, and incremental costs per unit reduction in weight and blood pressure. KEY RESULTS Recruitment and intervention costs were estimated $2,359 per participant for the 2-year program. Compared to the control intervention, the cost per additional kilogram lost was $2,204 /kg, and for blood pressure, $621 /mmHg. Sensitivity analyses suggest that if the program was offered to a larger sample and minor modifications were made, the cost per participant could be reduced to the levels of many commercially available products. CONCLUSIONS The costs associated with the Be Fit Be Well program were found to be significantly more expensive than many commercially available products, and much higher than the amount that the Centers for Medicare and Medicaid reimburse physicians for obesity counseling. However, given the serious and costly health consequences associated with obesity in high risk, multimorbid and socioeconomically disadvantaged patients, the resources needed to provide interventions like those described here may still prove to be cost-effective with respect to producing long-term behavior change.
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Affiliation(s)
- Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO, 80237-8066, USA,
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Steinberg DM, Levine EL, Askew S, Foley P, Bennett GG. Daily text messaging for weight control among racial and ethnic minority women: randomized controlled pilot study. J Med Internet Res 2013; 15:e244. [PMID: 24246427 PMCID: PMC3841371 DOI: 10.2196/jmir.2844] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/09/2013] [Accepted: 10/13/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Daily self-monitoring of diet and physical activity behaviors is a strong predictor of weight loss success. Text messaging holds promise as a viable self-monitoring modality, particularly among racial/ethnic minority populations. OBJECTIVE This pilot study evaluated the feasibility of a text messaging intervention for weight loss among predominantly black women. METHODS Fifty obese women were randomized to either a 6-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (eg, 10,000 steps per day, no sugary drinks) along with brief feedback and tips (n=26) or to an education control arm (n=24). Weight was objectively measured at baseline and at 6 months. Adherence was defined as the proportion of text messages received in response to self-monitoring prompts. RESULTS The average daily text messaging adherence rate was 49% (SD 27.9) with 85% (22/26) texting self-monitored behavioral goals 2 or more days per week. Approximately 70% (16/23) strongly agreed that daily texting was easy and helpful and 76% (16/21) felt the frequency of texting was appropriate. At 6 months, the intervention arm lost a mean of 1.27 kg (SD 6.51), and the control arm gained a mean of 1.14 kg (SD 2.53; mean difference -2.41 kg, 95% CI -5.22 to 0.39; P=.09). There was a trend toward greater text messaging adherence being associated with greater percent weight loss (r=-.36; P=.08), but this did not reach statistical significance. There was no significant association between goal attainment and text messaging adherence and no significant predictors of adherence. CONCLUSIONS Given the increasing penetration of mobile devices, text messaging may be a useful self-monitoring tool for weight control, particularly among populations most in need of intervention. TRIAL REGISTRATION Clinicaltrials.gov: NCT00939081; http://clinicaltrials.gov/show/NCT00939081 (Archived by WebCite at http://www.webcitation.org/6KiIIcnk1).
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Affiliation(s)
- Dori M Steinberg
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, NC, United States.
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Bennett GG, Foley P, Levine E, Whiteley J, Askew S, Steinberg DM, Batch B, Greaney ML, Miranda H, Wroth TH, Holder MG, Emmons KM, Puleo E. Behavioral treatment for weight gain prevention among black women in primary care practice: a randomized clinical trial. JAMA Intern Med 2013; 173:1770-7. [PMID: 23979005 PMCID: PMC3972760 DOI: 10.1001/jamainternmed.2013.9263] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Few weight loss treatments produce clinically meaningful weight loss outcomes among black women, particularly in the primary care setting. New weight management strategies are necessary for this population. Weight gain prevention might be an effective treatment option, with particular benefits for overweight and class 1 obese black women. OBJECTIVE To compare changes in weight and cardiometabolic risk during a 12-month period among black women randomized to a primary care-based behavioral weight gain prevention intervention, relative to usual care. DESIGN, SETTING, AND PARTICIPANTS Two-arm randomized clinical trial (the Shape Program). We recruited patients from a 6-site community health center system. We randomized 194 overweight and class 1 obese (body mass index [calculated as weight in kilograms divided by height in meters squared], 25-34.9) premenopausal black women aged 25 to 44 years. Enrollment began on December 7, 2009; 12- and 18-month assessments were completed in February and October 2, 2012. INTERVENTIONS The medium-intensity intervention included tailored behavior change goals, weekly self-monitoring via interactive voice response, monthly counseling calls, tailored skills training materials, and a gym membership. MAIN OUTCOMES AND MEASURES Twelve-month change in weight and body mass index and maintenance of change at 18 months. RESULTS Participants had a mean age of 35.4 years, a mean weight of 81.1 kg, and a mean body mass index of 30.2 at baseline. Most were socioeconomically disadvantaged (79.7% with educational level less than a college degree; 74.3% reporting annual income <$30,000). The 12-month weight change was larger among intervention participants (mean [SD], -1.0 [0.5] kg), relative to usual care (0.5 [0.5] kg; mean difference, -1.4 kg [95% CI, -2.8 to -0.1 kg]; P = .04). At month 12, 62% of intervention participants were at or below their baseline weights compared with 45% of usual-care participants (P = .03). By 18 months, intervention participants maintained significantly larger changes in weight (mean difference, -1.7 kg; 95% CI, -3.3 to -0.2 kg). CONCLUSIONS AND RELEVANCE A medium-intensity primary care-based behavioral intervention demonstrated efficacy for weight gain prevention among socioeconomically disadvantaged black women. A "maintain, don't gain" approach might be a useful alternative treatment for reducing obesity-associated disease risk among some premenopausal black women. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00938535.
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Affiliation(s)
- Gary G Bennett
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina2Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
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Bennett GG, Steinberg DM, Lanpher MG, Askew S, Lane IB, Levine EL, Goodman MS, Foley PB. Availability of and ease of access to calorie information on restaurant websites. PLoS One 2013; 8:e72009. [PMID: 23977193 PMCID: PMC3747846 DOI: 10.1371/journal.pone.0072009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/10/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Offering calories on restaurant websites might be particularly important for consumer meal planning, but the availability of and ease of accessing this information are unknown. METHODS We assessed websites for the top 100 U.S. chain restaurants to determine the availability of and ease of access to calorie information as well as website design characteristics. We also examined potential predictors of calorie availability and ease of access. RESULTS Eighty-two percent of restaurants provided calorie information on their websites; 25% presented calories on a mobile-formatted website. On average, calories could be accessed in 2.35±0.99 clicks. About half of sites (51.2%) linked to calorie information via the homepage. Fewer than half had a separate section identifying healthful options (46.3%), or utilized interactive meal planning tools (35.4%). Quick service/fast casual, larger restaurants, and those with less expensive entrées and lower revenue were more likely to make calorie information available. There were no predictors of ease of access. CONCLUSION Calorie information is both available and largely accessible on the websites of America's leading restaurants. It is unclear whether consumer behavior is affected by the variability in the presentation of calorie information.
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Affiliation(s)
- Gary G. Bennett
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Dori M. Steinberg
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Michele G. Lanpher
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Sandy Askew
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Ilana B. Lane
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Erica L. Levine
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Melody S. Goodman
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States of America
| | - Perry B. Foley
- Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Warner ET, Glasgow RE, Emmons KM, Bennett GG, Askew S, Rosner B, Colditz GA. Recruitment and retention of participants in a pragmatic randomized intervention trial at three community health clinics: results and lessons learned. BMC Public Health 2013; 13:192. [PMID: 23496916 PMCID: PMC3599817 DOI: 10.1186/1471-2458-13-192] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/19/2013] [Indexed: 01/22/2023] Open
Abstract
Background Obesity and hypertension and their associated health complications disproportionately affect communities of color and people of lower socioeconomic status. Recruitment and retention of these populations in research trials, and retention in weight loss trials has been an ongoing challenge. Methods Be Fit, Be Well was a pragmatic randomized weight loss and hypertension management trial of patients attending one of three community health centers in Boston, Massachusetts. Participants were asked to complete follow-up assessments every 6-months for two years. We describe challenges encountered and strategies implemented to recruit and retain trial participants over the 24-month intervention. We also identify baseline participant characteristics associated with retention status. Retention strategies included financial incentives, contact between assessment visits, building relationships with health center primary care providers (PCPs) and staff, and putting participant convenience first. Results Active refusal rates were low with 130 of 2,631 patients refusing participation (4.9%). Of 474 eligible persons completing telephone screening, 365 (77.0%) completed their baseline visit and were randomized into the study. The study population was predominantly non-Hispanic Black (71.2%), female (68.5%) and reported annual household income of less than $35,000 (70.1%). Recruitment strategies included use of passive approval of potential participants by PCPs, use of part-time staff, and outsourcing calls to a call center. A total of 314 (86.0%) people completed the 24-month visit. Retention levels varied across study visits and intervention condition. Most participants completed three or more visits (69.6%), with 205 (56.2%) completing all four. At 24-months, lower retention was observed for males and the intervention condition. Retention strategies included building strong relationships with clinic staff, flexibility in overcoming participant barriers through use of taxi vouchers, night and weekend appointments, and keeping participants engaged via newsletters and social gatherings. Conclusion We were able to retain 86.0% of participants at 24-months. Recruitment and retention of high percentages of racial/ethnic minorities and lower income samples is possible with planning, coordination with a trusted community setting and staff (e.g. community health centers and RAs), adaptability and building strong relationships. Trial registration Clinicaltrials.gov Identifier:
NCT00661817
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Affiliation(s)
- Erica T Warner
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, USA.
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Glasgow RE, Askew S, Purcell P, Levine E, Warner ET, Stange KC, Colditz GA, Bennett GG. Use of RE-AIM to Address Health Inequities: Application in a low-income community health center based weight loss and hypertension self-management program. Transl Behav Med 2013; 3:200-210. [PMID: 23750180 DOI: 10.1007/s13142-013-0201-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [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: 12/18/2022] Open
Abstract
BACKGROUND While health inequities are well documented, and there are helpful frameworks to understand health disparities, implementation frameworks are also needed to focus the design, evaluation and reporting on interventions targeting populations at increased risk. PURPOSE Describe how the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) can be used for these purposes and illustrate its application in the context of a randomized, pragmatic weight-loss and hypertension self-management intervention. METHODS RE-AIM was used to both plan and evaluate the Be Fit Be Well program for urban community health center patients. RESULTS The RE-AIM framework helped to focus attention on and produce high rates of adoption and reach. Implementation rates varied across components. Weight losses were statistically significant, but not clinically significant. They were robust across a variety of patient characteristics, and the program was relatively low cost. Individual weight losses and blood pressure reductions were maintained throughout the 24-month period, but the program was not sustained at any of the three settings. CONCLUSION Implementation frameworks such as RE-AIM can help design pragmatic interventions that focus on both the context for disparities reduction and the ultimate goal of public health impact.
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Affiliation(s)
- Russell E Glasgow
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Foley P, Levine E, Askew S, Puleo E, Whiteley J, Batch B, Heil D, Dix D, Lett V, Lanpher M, Miller J, Emmons K, Bennett G. Weight gain prevention among black women in the rural community health center setting: the Shape Program. BMC Public Health 2012; 12:305. [PMID: 22537222 PMCID: PMC3439671 DOI: 10.1186/1471-2458-12-305] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 04/26/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Nearly 60% of black women are obese. Despite their increased risk of obesity and associated chronic diseases, black women have been underrepresented in clinical trials of weight loss interventions, particularly those conducted in the primary care setting. Further, existing obesity treatments are less effective for this population. The promotion of weight maintenance can be achieved at lower treatment intensity than can weight loss and holds promise in reducing obesity-associated chronic disease risk. Weight gain prevention may also be more consistent with the obesity-related sociocultural perspectives of black women than are traditional weight loss approaches. METHODS/DESIGN We conducted an 18-month randomized controlled trial (the Shape Program) of a weight gain prevention intervention for overweight black female patients in the primary care setting. Participants include 194 premenopausal black women aged 25 to 44 years with a BMI of 25-34.9 kg/m2. Participants were randomized either to usual care or to a 12-month intervention that consisted of: tailored obesogenic behavior change goals, self-monitoring via interactive voice response phone calls, tailored skills training materials, 12 counseling calls with a registered dietitian and a 12-month YMCA membership.Participants are followed over 18 months, with study visits at baseline, 6-, 12- and 18-months. Anthropometric data, blood pressure, fasting lipids, fasting glucose, and self-administered surveys are collected at each visit. Accelerometer data is collected at baseline and 12-months.At baseline, participants were an average of 35.4 years old with a mean body mass index of 30.2 kg/m2. Participants were mostly employed and low-income. Almost half of the sample reported a diagnosis of hypertension or prehypertension and 12% reported a diagnosis of diabetes or prediabetes. Almost one-third of participants smoked and over 20% scored above the clinical threshold for depression. DISCUSSION The Shape Program utilizes an innovative intervention approach to lower the risk of obesity and obesity-associated chronic disease among black women in the primary care setting. The intervention was informed by behavior change theory and aims to prevent weight gain using inexpensive mobile technologies and existing health center resources. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk population sample in need of evidence-based treatment strategies. TRIAL REGISTRATION The trial is registered with clinicaltrials.gov NCT00938535.
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Affiliation(s)
- Perry Foley
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
| | - Erica Levine
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
| | - Sandy Askew
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
| | - Elaine Puleo
- School of Public Health and Health Sciences, University of Massachusetts Amherst, 425 Arnold House 715 North Pleasant Street, Amherst, MA, 01003-9304, USA
| | - Jessica Whiteley
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Bryan Batch
- Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center, 200 Trent Drive, Duke South Orange Zone DUMC, Box 3031, Durham, NC, 27710, USA
| | - Daniel Heil
- Department of Health & Human Development, Montana State University, H&PE Complex, Hoseaus Room 121, Bozeman, MT, 59717, USA
| | - Daniel Dix
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
| | - Veronica Lett
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
| | - Michele Lanpher
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
| | - Jade Miller
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
| | - Karen Emmons
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW601, Boston, MA, 02215, USA
| | - Gary Bennett
- Duke Obesity Prevention Program, Duke Global Health Institute, 2812 Erwin Road, Suite 403 Box 90392, Durham, NC, 27705, USA
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Bennett GG, Warner ET, Glasgow RE, Askew S, Goldman J, Ritzwoller DP, Emmons KM, Rosner BA, Colditz GA. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. ACTA ACUST UNITED AC 2012; 172:565-74. [PMID: 22412073 DOI: 10.1001/archinternmed.2012.1] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few evidence-based weight loss treatment options exist for medically vulnerable patients in the primary care setting. METHODS We conducted a 2-arm, 24-month randomized effectiveness trial in 3 Boston community health centers (from February 1, 2008, through May 2, 2011). Participants were 365 obese patients receiving hypertension treatment (71.2% black, 13.1% Hispanic, 68.5% female, and 32.9% with less than a high school educational level). We randomized participants to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response; 18 telephone counseling calls; primary care provider endorsement; 12 optional group support sessions; and links with community resources. RESULTS At 24 months, weight change in the intervention group compared with that in the usual care group was -1.03 kg (95% CI, -2.03 to -0.03 kg). Twenty-four-month change in body mass index (calculated as weight in kilograms divided by height in meters squared) in the intervention group compared with that in the usual care group was -0.38 (95% CI, -0.75 to -0.004). Intervention participants had larger mean weight losses during the 24 months compared with that in the usual care group (area under the receiver operating characteristic curve, -1.07 kg; 95% CI, -1.94 to -0.22). Mean systolic blood pressure was not significantly lower in the intervention arm compared with the usual care arm. CONCLUSION The intervention produced modest weight losses, improved blood pressure control, and slowed systolic blood pressure increases in this high-risk, socioeconomically disadvantaged patient population. Trial Registration clinicaltrials.gov Identifier: NCT00661817.
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Affiliation(s)
- Gary G Bennett
- Duke Obesity Prevention Program, Duke University, Durham, NC 27708, USA.
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Warner ET, Wolin KY, Duncan DT, Heil DP, Askew S, Bennett GG. Differential accuracy of physical activity self-report by body mass index. Am J Health Behav 2012; 36:168-78. [PMID: 22370255 DOI: 10.5993/ajhb.36.2.3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine whether agreement between self-reported and accelerometer-measured physical activity varies by BMI category in a low-income black sample. METHODS Participants completed a questionnaire and wore an accelerometer for 4-6 days. Using one- and 10-minute bouts, accelerometers measured light, moderate, and vigorous physical activity time. RESULTS Correlations varied by obesity (nonobese: one-minute r=0.41; 10-minute r=0.47; obese: one-minute r=0.21; 10-minute r=0 .14). Agreement was highest among nonobese persons (one-minute kappa = 0.48, 10-minute kappa = 0.023; obese: one-minute kappa = -0.024, 10- minute kappa = -0.020). CONCLUSIONS We found compromised questionnaire performance among obese participants.
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Affiliation(s)
- Erica T. Warner
- Department of Epidemiology, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Kathleen Y. Wolin
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
| | - Dustin T. Duncan
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Daniel P. Heil
- Health and Human Performance, Montana State University, Bozeman, MT, USA
| | - Sandy Askew
- Senior Data Technician, Global Health Institute, Duke University, Department Psychology and Neuroscience, Durham, NC, USA
| | - Gary G. Bennett
- Duke University, Department Psychology and Neuroscience, Durham, NC, USA
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Moss EL, Askew S, Jones PW, Redman CWE, Pearmain P. Implementing the national invasive cervical cancer audit: correlation between local and regional classification. J Med Screen 2011; 17:190-4. [PMID: 21258129 DOI: 10.1258/jms.2010.010035] [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: 11/18/2022]
Abstract
OBJECTIVE To determine the accuracy of information recorded regionally and locally on the screening classification of cervical cancer cases using the national invasive cervical cancer audit categories. METHODS Comparison of the audit categorization of all cervical cancer cases diagnosed at the University Hospital of North Staffordshire (UHNS) between January 2003 and December 2006 with the classification assigned by the West Midlands Cervical Screening Quality Assurance Reference Centre (WMQARC). RESULTS Eighty-seven cases of cervical cancer were diagnosed during the three-year study period. There was agreement between the UHNS and WMQARC classification of cases in 52 cases (59.7%), moderate agreement κ = 0.51 (95% CI 0.39-0.63). The greatest disparity was seen in the classification of lapsed attenders, with nine of the 26 cases categorized as 'lapsed' by the UHNS being assigned to the 'lost to follow-up' category by WMQARC. Three cases were deemed unclassifiable by WMQARC using the national classification since the women were over the age of 70 years but had previously been enrolled in the screening programme, and currently there is no national category for these women. CONCLUSIONS Accurate and consistent classification of invasive cervical cancer cases is essential in order to obtain useful information on the efficiency of the national screening programme at a local, regional and national level. The use of a national algorithm would provide reassurance that all data used in the national evaluation of the NHS Cervical Screening Programme are consistent, meaning that robust conclusions could then be drawn from the data.
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Affiliation(s)
- E L Moss
- University Hospital of North Staffordshire, Stoke on Trent, UK
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Moss EL, Pearmain P, Askew S, Owen G, Reynolds TM, Prabakar IM, Douce G, Parkes J, Menon V, Todd RW, Redman CWE. Implementing the national invasive cervical cancer audit: a local perspective. BJOG 2010; 117:1411-6. [PMID: 20716252 DOI: 10.1111/j.1471-0528.2010.02679.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To monitor the effectiveness of the cervical screening programme and identify suboptimal management in order to improve patient care. DESIGN Retrospective study. SETTING A university hospital serving a population of 1 million people. POPULATION All women diagnosed with a cervical cancer between 2003 and 2006. METHODS Analysis of data from invasive cervical cancer reviews. MAIN OUTCOME MEASURE Categorisation of cervical cancer cases according to the Invasive Cervical Cancer Audit classification. RESULTS Eighty-seven women were diagnosed with cervical cancer during the 3-year study period. The 'lapsed attender' group accounted for the greatest number of cases (30%), followed by screen detected (26%), interval cancers (13%), never attended (12%), lost to follow-up (10%) and never invited (9%). Women who had never attended for cytology presented with higher stage disease, stage-II or above, compared with the screen-detected cases: 60% were stage II or above, compared with 13.0%, Chi-square P = 0.018. The most frequently identified screening programme problem was patient compliance, which was determined to be the principle contributing factor in 39 cases (45%) and a secondary factor in a further ten cases. CONCLUSIONS The categorisation of cervical cancer cases has the potential of yielding invaluable information for improving programme effectiveness. Patient compliance is the greatest challenge to the screening programme, and the need for regular screening and adherence to follow-up regimens needs to be reinforced in order to maximise the efficacy of the national screening programme.
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Affiliation(s)
- E L Moss
- University Hospital of North Staffordshire, Stoke on Trent, UK
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Bennett GG, Wolin KY, Okechukwu CA, Arthur CM, Askew S, Sorensen G, Emmons KM. Nativity and cigarette smoking among lower income blacks: results from the Healthy Directions Study. J Immigr Minor Health 2008; 10:305-11. [PMID: 17924192 DOI: 10.1007/s10903-007-9088-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Blacks in the United States bear the greatest disease burden associated with cigarette smoking. Previous studies have shown that the rapidly increasing population of foreign-born Blacks has lower smoking rates compared to their native-born counterparts. However, less is known about whether cigarette smoking among Blacks varies by region of birth (US, Africa, or the Caribbean), generational status, or acculturation. We examined the association between nativity and cigarette smoking among 667 Black adult men and women enrolled in the Harvard Cancer Prevention Program project. In multi-variable analyses, US-born Blacks were more likely to be smokers compared to those born in the Caribbean (OR = 0.16, 95% CI 0.08, and 0.34) or in Africa (OR = 0.24, 95% CI 0.08, and 0.74). Language acculturation was positively associated with cigarette smoking (OR = 2.62, 95% CI 1.17, and 5.85). We found that US-born Blacks were more likely to be current cigarette smokers than those born in either Caribbean or African countries. Our findings highlight the importance of intervening early new Black immigrants to stem the uptake of cigarette smoking behaviors as individuals become acculturated.
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Affiliation(s)
- Gary G Bennett
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Goenaga-Infante H, Sturgeon R, Turner J, Hearn R, Sargent M, Maxwell P, Yang L, Barzev A, Pedrero Z, Cámara C, Díaz Huerta V, Fernández Sánchez ML, Sanz-Medel A, Emese K, Fodor P, Wolf W, Goldschmidt R, Vacchina V, Szpunar J, Valiente L, Huertas R, Labarraque G, Davis C, Zeisler R, Turk G, Rizzio E, Mackay LG, Myors RB, Saxby DL, Askew S, Chao W, Jun W. Total selenium and selenomethionine in pharmaceutical yeast tablets: assessment of the state of the art of measurement capabilities through international intercomparison CCQM-P86. Anal Bioanal Chem 2007; 390:629-42. [DOI: 10.1007/s00216-007-1654-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 09/16/2007] [Accepted: 09/19/2007] [Indexed: 11/24/2022]
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Abstract
OBJECTIVE Our objective was to examine the associations of nativity, immigrant generation, and language acculturation with obesity among lower income black adult men and women. RESEARCH METHODS AND PROCEDURES Data from 551 black adult men and women were collected from participants in the Healthy Directions-Health Centers Study. Race/ethnicity and nativity were self-reported. Language acculturation was defined using participants' first language, preferred reading language, and language spoken at home. Mixed model logistic regression models were estimated to account for within-health center clustering. RESULTS Foreign-born blacks had a lower obesity risk, compared with all U.S.-born participants, in multivariable analyses [odds ratio (OR) = 0.57, 95% confidence interval (CI), 0.38, 0.84]. Among U.S.-born participants, those with foreign-born parents were significantly less likely to be obese than individuals with U.S.-born parents (OR = 0.54; 95% CI, 0.37, 0.80). Low-moderate language acculturation also decreased the odds of being obese (OR = 0.45; 95% CI, 0.23, 0.88). DISCUSSION Our findings suggest a protective effect of foreign-born status and low-moderate language acculturation on obesity risk among lower income black immigrants. These data highlight the importance of more frequently examining nativity in obesity-related research conducted among blacks.
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Affiliation(s)
- Gary G Bennett
- Harvard School of Public Health and Dana-Farber Cancer Institute, Center for Community-Based Research, 44 Binney St., SM256, Boston, MA 02115, USA.
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Bennett GG, Wolin KY, Viswanath K, Askew S, Puleo E, Emmons KM. Television viewing and pedometer-determined physical activity among multiethnic residents of low-income housing. Am J Public Health 2006; 96:1681-5. [PMID: 16873736 PMCID: PMC1551955 DOI: 10.2105/ajph.2005.080580] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We evaluated the association between television viewing and pedometer-determined physical activity among predominantly racial/ethnic minority residents of low-income housing in metropolitan Boston in 2005. METHODS We used mixed models to analyze the association between reported hours of television viewing and pedometer-determined steps per day among 486 adults. We also examined whether television viewing was associated with the achievement of 10000 steps per day. RESULTS There was a mean 3.6 hours of average daily television watching. In multivariable analyses, each hour of television viewing on an average day was associated with 144 (95% confidence interval [CI]= -276, -12) fewer steps per day and a decreased likelihood of accumulating 10,000 steps per day (odds ratio [OR]=0.84; 95% CI=0.71, 0.99). Weekday and weekend television viewing were each also associated with fewer steps per day. CONCLUSIONS Average daily television viewing was associated with reductions in total pedometer-determined physical activity levels (approximately 520 steps per day) in this lower-income sample. As part of a comprehensive physical activity promotion plan, recommendations to reduce television viewing should be made.
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Affiliation(s)
- Gary G Bennett
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass, USA.
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Mayhew J, Zheng Y, Hou Y, Vuksanovic B, Berwick J, Askew S, Coffey P. Spectroscopic analysis of changes in remitted illumination: the response to increased neural activity in brain. Neuroimage 1999; 10:304-26. [PMID: 10458944 DOI: 10.1006/nimg.1999.0460] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Imaging of neural activation has been used to produce maps of functional architecture and metabolic activity. There is some uncertainty associated with the sources underlying the intrinsic signals. It has been reported that following increased neural activity there was little increased oxygen consumption ( approximately 5%), although glucose consumption increased by approximately 50%. The research we describe uses a modification of the Beer-Lambert Law called path-length scaling analysis (PLSA) to analyze the spectra of the hemodynamic and metabolic responses to vibrissal stimulation in rat somatosensory cortex. The results of the PLSA algorithm were compared with those obtained using a linear spectrographic analysis method (we refer to this as LMCA). There are differences in the results of the analysis depending on which of the two algorithms (PLSA or LMCA) is used. Using the LMCA algorithm, we obtain results showing an increase in the volume of Hbr at approximately 2 s, following onset of stimulation but no complementary decrease in oxygenated haemoglobin (HbO(2)). These results are similar to a previous report. In contrast, after using the PLSA algorithm, the time series of the chromophore changes shows no evidence for an increase in the volume of deoxygenated haemoglobin (Hbr). However, after further analysis of the time series from the PLSA using general linear models (GLM) to remove contributions from low frequency baseline oscillations, both the HbO(2) and Hbr times series of the response to stimulation were found to be biphasic with an early decrease in saturation peaking approximately 1 s after onset of stimulation followed by a larger increase in saturation peaking at approximately 3 s. Finally, following the PLSA-then-GLM analysis procedure, we do not find convincing evidence for an increase in cytochrome oxidation following stimulation, though we demonstrate the PLSA algorithm to be capable of disassociating changes in cytochrome oxidation state from changes in hemoglobin oxygenation.
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Affiliation(s)
- J Mayhew
- Artificial Intelligence Vision Research Unit and Department of Psychology, University of Sheffield, Sheffield, S10 2TP, United Kingdom
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Mayhew J, Zhao L, Hou Y, Berwick J, Askew S, Zheng Y, Coffey P. Spectroscopic investigation of reflectance changes in the barrel cortex following whisker stimulation. Adv Exp Med Biol 1999; 454:139-48. [PMID: 9889886 DOI: 10.1007/978-1-4615-4863-8_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- J Mayhew
- AIVRU, University of Sheffield, United Kingdom
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Mayhew J, Hu D, Zheng Y, Askew S, Hou Y, Berwick J, Coffey PJ, Brown N. An evaluation of linear model analysis techniques for processing images of microcirculation activity. Neuroimage 1998; 7:49-71. [PMID: 9500835 DOI: 10.1006/nimg.1997.0311] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sequences of images of the cortical surface can be processed to reveal information about the cortical microcirculation, regional cerebral blood flow (rCBF), and changes induced by neuronal activity. This study examined the use of different analysis methodologies on intrinsic optical images taken from rat sensory motor cortex and testes. Generalized linear model (GLM) analysis was used and compared with standard signal processing methods including principal component analysis. The GLM method has been used by Friston et al. (1994, Hum. Brain Map., 1: 214-220) in the analysis of functional magnetic resonance imagery to identify regions of focal activity. We investigated the use of this method to analyze video image data of the modulation of rCBF from rat cortex. The results revealed spatiotemporal variations in rCBF in response to stimulation within local regions of cortex. The advantage of the GLM method is that it augments ordinary signal processing methods with an estimate of statistical reliability. The use of different wavelengths of illumination reveals spatial structures with different temporal relationships. In image time series data collected under green and red illumination a phase difference was found in the low frequency approximately 0.1 Hz vasomotion oscillation. This phase difference occurred in data from both cortex and testes. A possible explanation of these differences is that the spectral absorption characteristics of the tissue reflect changes in the volume proportions of the different hemoglobin derivatives in interacting with the modulation of the volume of blood. It is suggested that the combination of these effects produces the phase differences we detect.
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Affiliation(s)
- J Mayhew
- Artificial Intelligence Vision Research Unit, University of Sheffield, United Kingdom
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Mayhew JE, Askew S, Zheng Y, Porrill J, Westby GW, Redgrave P, Rector DM, Harper RM. Cerebral vasomotion: a 0.1-Hz oscillation in reflected light imaging of neural activity. Neuroimage 1996; 4:183-93. [PMID: 9345508 DOI: 10.1006/nimg.1996.0069] [Citation(s) in RCA: 267] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Imaging of scattered and reflected light from the surface of neural structures can reveal the functional architecture within large populations of neurons. These techniques exploit, as one of the principal signal sources, reflectance changes produced by local variation in blood volume and oxygen saturation related to neural activity. We found that a major source of variability in the captured light signal is a pervasive low-frequency (0.1-Hz) oscillation which apparently results from regional cerebral blood flow. This signal is present in brain parenchyma as well as the microvasculature and exhibits many characteristics of the low-frequency "vasomotion" signals observed in peripheral microcirculation. Concurrent measurements in brain with a laser Doppler flow meter contained an almost identical low-frequency signal. The presence of the 0.1-Hz oscillation in the cerebral microcirculation could underlie a portion of the previously described characteristics reported in reflected-light imaging studies. The prevalence of the oscillatory phenomena in the brain raises substantial temporal sampling issues for optical imaging and for other visualization techniques which depend on changes in regional cerebral blood dynamics, such as functional magnetic resonance imaging.
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Affiliation(s)
- J E Mayhew
- Artificial Intelligence Vision Research Unit, University of Sheffield, United Kingdom.
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Salas E, Moro MA, Askew S, Hodson HF, Butler AR, Radomski MW, Moncada S. Comparative pharmacology of analogues of S-nitroso-N-acetyl-DL-penicillamine on human platelets. Br J Pharmacol 1994; 112:1071-6. [PMID: 7524991 PMCID: PMC1910248 DOI: 10.1111/j.1476-5381.1994.tb13192.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
1. The effects of two new analogues of S-nitroso-N-acetyl-DL-penicillamine (SNAP), S-nitroso-N-formyl-DL-penicillamine (SNFP) and S-nitroso-DL-penicillamine (SNPL), on platelet function were examined in vitro. 2. SNAP and its analogues were potent inhibitors of platelet aggregation and inducers of disaggregation. 3. All compounds inhibited fibrinogen binding to platelets. 4. They also decreased the release of P-selectin from platelets. 5. Both inhibition of fibrinogen binding and release of P-selectin correlated with an increase in intraplatelet cyclic GMP concentrations. 6. At concentrations sufficient to inhibit platelet function and induce cyclic GMP formation (0.01-3 microM), the release of NO could be detected from SNPL but not from SNAP and SNFP. 7. Release of NO from all compounds was detected at concentrations > or = 10 microM. 8. Thus, the spontaneous release of NO from SNPL explains the actions of this compound on platelet function; however, platelet-mediated mechanisms may be involved in the release of NO from SNAP and SNFP.
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Affiliation(s)
- E Salas
- Wellcome Research Laboratories, Beckenham, Kent
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Abstract
The handedness distribution of 71 deaf pupils with severe learning difficulties, was found to be similar to that reported by Soper et al. (1987, American Journal of Mental Deficiency, 92, 94-102) in a mentally handicapped sample, who also found a high incidence of ambiguously handed individuals. Soper's theory, however, that the "acquired" left-handed and the ambiguously-handed are more handicapped and so, we might infer, draw more primitive human figures, was not supported. The left, ambiguously-handed and right-handed had the same scores on human figure drawing. Neither was there a difference in handedness or figure drawing between the "acquired", the "genetic" and the "unknown" cause groups; nor between males and females.
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Affiliation(s)
- P Arnold
- Department of Psychology, University of Manchester, U.K
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