Prevention Research Center Publications

Permanent URI for this collection

https://hdl.handle.net/20.500.14038/191

ABOUT THIS COLLECTION

The Prevention Research Center at UMass Chan Medical School (PRC) is committed to working toward optimal health of communities, families and individuals. Founded in 2009 as part of the CDC's Prevention Research Center Network, our mission is to prevent disease, promote health and advance health equity through the integration of community engaged research, practice, policy and education. With a focus on integrating our work into the Greater Worcester’s collaborative public health system, we also seek to be a research partner that addresses real-world challenges across Massachusetts, and a national model for research that connects academia, public health, community and health care systems. This site is a repository of publications produced by PRC faculty, staff, students and community partners.

QUESTIONS?

Contact escholarship@umassmed.edu with your questions.

Browse

Organization Theory for Implementation Science (OTIS): reflections and recommendations
(2024-12-13) Birken, Sarah A; Baloh, Jure; Kegler, Michelle C; Huang, Terry T-K; Lee, Matthew; Adsul, Prajakta; Ryan, Grace; Peluso, Alexandra; Wagi, Cheyenne; Randazzo, Aliza; Mullins, Megan A; Morrill, Kristin E; Ko, Linda K; Population and Quantitative Health Sciences; Prevention Research Center
Organizations exert influence on the implementation of evidence-based practices and other innovations that are independent of the influence of organizations' individual constituents. Despite their influence, nuanced explanations of organizations' influence remain limited in implementation science. Organization theories are uniquely suited to offer insights and explain organizational influences on implementation. In this paper, we describe the efforts of the Cancer Prevention and Control Research Network's (CPCRN) Organization Theory for Implementation Science (OTIS) workgroup to equip implementation scientists with theory-guided understanding of organizational influences on implementation. We provide a set of recommendations for future efforts to enhance implementation through the use of organization theories and OTIS tools.
Cost and activity analysis for a citywide patient navigation intervention to engage underserved patients in breast cancer treatment: Findings from the Translating Research Into Practice study
(2025-01-01) Rajabiun, Serena; Cabral, Howard J; Chen, Clara A; Lloyd-Travaglini, Christine; Dugas, Julianne N; Amburgey, Deborah; Fitzgerald, Madyson; Lemon, Stephenie C; Haas, Jennifer S; Freund, Karen M; Battaglia, Tracy; Population and Quantitative Health Sciences; Prevention Research Center
Background: Patient navigation is an evidence-based intervention for reducing delays in cancer care for underserved populations. There are limited economic evaluations of patient navigation in the US health care system and few have considered costs at various phases along the implementation spectrum. Having economic data, including costs and cost savings, can support sustainability of patient navigation programs. This study presents findings from a cost and activity analysis of a citywide hospital-based patient navigation program to engage women in timely breast cancer treatment post-diagnosis. Methods: This study was conducted as part of Translating Research Into Practice (TRIP), a citywide patient navigation hybrid effectiveness-implementation research study conducted at five cancer care hospitals in Boston, Massachusetts. The authors surveyed participating patient navigators and supervisors about their tasks and level of effort over consecutive 10-day periods from 2019 to 2021. Patient navigators documented the time spent on activities in accordance with an 11-step protocol across five sites. Cost data were collected from annual fiscal year end expenditure hospital administrative databases at concurrent time frames. Descriptive analyses were used to calculate average time on tasks, cost per activity and cost per outcome. Cost savings were estimated by calculating the additional persons engaged in timely entry to treatment compared to a matched control group with respect to hospitalization and emergency room costs averted. Results: Average time spent per day on TRIP-specific navigation activities was approximately 3 hours (range, 0-8 hours) and the average time per patient per day was 25 minutes (n = 7 navigators). Total costs for clinical site interventions were $218,394 for startup and $392,407 for maintenance costs over the study period. A total of 223 patients were served during the intervention period with an average cost per patient of $979 for startup and $1759 for maintenance. Potential costs savings with the TRIP navigation program from averted hospitalization and emergency room visits for 63 additional patients who received timely treatment is estimated at $21,798-$30,429 and $2536-$5692 per patient, respectively, compared to treatment as usual. Conclusions: The economic evaluation in this study provides insight into startup and implementation costs for uptake and scalability of navigation programs across a citywide system. The information may be useful for payors in reimbursing navigation activities and health systems in planning for high quality navigation programs to ensure patient-centered and timely treatment for women diagnosed with breast cancer.
Advancing Equitable Participation in Pediatric Clinical Trials Through Cognitive Interviewing
(2025-01-01) Ryan, Grace W; Goulding, Melissa; Mejia Agudelo, Deicy; Simms, Stephanie; Spano, Michelle; Arenas, Juliana; Becker, Sarah; Radu, Sonia; Lemon, Stephenie C; Rosal, Milagros; Pbert, Lori; Trivedi, Michelle; Population and Quantitative Health Sciences; Prevention Research Center; Pediatrics
School Nurse Practices Related to Blood Pressure Screening, and Identification and Monitoring of High Blood Pressures in Youth
(2024-12-16) Goulding, Melissa; Branley, Claire; O'Brien, Mary Jane; Hayman, Laura L; Lemon, Stephenie C; Population and Quantitative Health Sciences; Prevention Research Center
Despite rising prevalence of high blood pressure among youth, literature on school nurses' practices related to youth blood pressure is limited. We aimed to describe school nurses' current practices related to blood pressure screening and identification and monitoring of high blood pressures. We conducted a web-based national survey of currently practicing school nurses and received 195 responses across 37 states. All participants reported having a blood pressure cuff, nearly all (98%) reported confidence measuring children's blood pressure, and 82% reported interest in doing more to support children's cardiovascular health. Blood pressure measurement by school nurses was common (73% reported "sometimes" or "often" and 25% reported "seldomly"). However, only 32% stated hypertension impacts their students and only 19% endorsed having enough time to complete all their necessary tasks. In describing school nurse's current practices related to youth blood pressure, we highlight opportunities for expanding this role and considerations for doing so.
Medication for Opioid Use Disorders (MOUD) Providers' Experiences with Recovery Courts: Qualitative Study of Individual and Systemic Factors Impacting Interagency Collaboration
(2024-12-04) Pivovarova, Ekaterina; Taxman, Faye S; Boland, Alexandra K; Andraka-Christou, Barbara; De La Cruz, Barbara A; Smelson, David; Lemon, Stephenie C; Friedmann, Peter D; Prevention Research Center; Population and Quantitative Health Sciences; Family Medicine and Community Health; Medicine
Background: Recovery courts mandate substance use disorder treatment as an alternative to prosecution or incarceration but lack internal resources to offer treatment. Hence, recovery courts must rely on community-based providers to ensure access to care. Interagency collaborations between recovery courts and providers of medications for opioid use disorders (MOUD) are often challenging. This qualitative study aimed to understand community-based MOUD providers' perspectives on collaboration with recovery courts. Methods: Semi-structured, hourlong interviews were conducted with 24 providers from 11 community agencies about their experiences and perceptions of working with recovery courts. Consolidated Framework for Implementation Research informed study design, coding, and analysis. Results: At the individual-level domain, lack of knowledge about recovery courts and overall negative impressions of the criminal legal system were impediments to collaboration. Inner setting factors such as staffing shortages and provider roles in establishing therapeutic relationships limited active engagement in interagency collaboration. Outer setting domains such as communication barriers (eg, requirement of multiple release forms, lack of knowledge about who needed what information and when) and nonresponse from the courts were frequently referenced. Providers, however, also noted that direct experience with recovery court staff, especially in person, and recognition of mutual agency goals to ensure individuals receive proper care and remain in the community served as facilitators. Discussion: While interagency collaboration is essential to ensuring that individuals in recovery courts can access MOUD, providers identify individual- and system-level barriers that impact collaboration with recovery courts. Results from providers mirror findings from recovery court staff that note communication barriers, distrust toward external agencies, and limited resources for active collaboration. Findings highlight areas where implementation strategies to improve collaboration can be targeted to ensure that individuals in recovery courts can access and remain in MOUD treatment.
Health Care Workers' Perspectives on Collecting Sexual Orientation and Gender Identity in the Adult Primary Care Setting
(2024-10-02) LeClair, Amy M; Rose, Raviv; Barker, Olivia; Carpenter, Eilish; Concannon, Thomas W; Boehmer, Ulrike; Blazey-Martin, Deborah; Bird, Chloe E; Freund, Karen M; Lemon, Stephenie C; Population and Quantitative Health Sciences; Prevention Research Center
Background: Despite numerous calls for standardized collection of sexual orientation and gender identity (SOGI) data in clinical settings, uptake of this practice still lags. Objectives: This study conducted a preimplementation assessment of staff attitudes toward SOGI data collection within an adult primary care practice in an urban academic medical center in the northeastern United States. Research design: We created a process map of the flow of patient data from the point of registration to the clinical encounter to identify all staff roles associated with registration and patient demographic data collection. We purposively sampled staff members across these roles and conducted semistructured virtual interviews between November 2021 and February 2022. The research team used deductive and inductive coding and conducted a thematic analysis to identify barriers and facilitators to implementation. Subjects: Nine clinical staff and eleven nonclinical staff were interviewed. Measures: Participants were asked about their general experiences with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients, their perspectives on collecting this data, and potential barriers and facilitators to incorporating this into the workflow. Results: The main themes that emerged were the relevance of SOGI data to the clinical practice; concerns about patient acceptability; the prevalence of cis-gender, heteronormative assumptions; and concerns about linguistic, cultural, and generational differences. Differences were noted between clinical and nonclinical staff. Conclusions: Greater education is needed to help both clinical and nonclinical staff understand how patients' SOGI demographics can be used to provide affirming, patient-centered care. Implementation strategies can be tailored to address specific barriers at the individual, organizational, and social levels.
Developing personas to inform the design of digital interventions for perinatal mental health
(2024-11-01) Zimmermann, Martha; Yonkers, Kimberly A; Tabb, Karen M; Schaefer, Ana; Peacock-Chambers, Elizabeth; Clare, Camille A; Boudreaux, Edwin D; Lemon, Stephenie C; Byatt, Nancy; Tulu, Bengisu; Psychiatry; Prevention Research Center; Population and Quantitative Health Sciences; Emergency Medicine
Objectives: Digital interventions are increasingly in demand to address mental health concerns, with significant potential to reach populations that disproportionately face barriers to accessing mental health care. Challenges with user engagement, however, persist. The goal of this study was to develop user personas to inform the development of a digital mental health intervention (DMHI) for a perinatal population. Materials and methods: We used participatory User-Centered Design (UCD) methods to generate and validate personas (ie, representative profiles of potential users). We applied this methodology to a case example of an Anxiety Sensitivity Intervention. Phases included (1) Characteristic identification, (2) Persona generation, (3) Persona consolidation, (4) Persona validation, and (5) Persona refinement. Advisory Council members with lived expertise of perinatal mental health conditions generated 6 personas. We used cluster analysis and qualitative analysis to consolidate personas. We used participant interviews with perinatal individuals experiencing depression or anxiety and economic marginalization (n = 12) to qualitatively validate and refine these personas. Results: We identified 4 user personas with potentially unique design needs that we characterized as being "Resilient," "Lonely," "Overwhelmed," and "Aware." Discussion: Personas generated through this process had distinct characteristics and design implications including the need to prioritize (1) content personalization, (2) additional content describing support options and resources (eg, doulas, midwives), (3) careful consideration of the type of information provided by users, and (4) transparent options for information and data sharing. Conclusion: DMHIs will need to be adapted for relevance for a perinatal population. The personas we developed are suggestive of the need for design considerations specific to distinct potential user groups within this population.
The Association between Food Insecurity and Insomnia Symptoms among Young Adults in Puerto Rico and the Mediating Role of Psychological Distress Symptoms
(2024-09-28) Vázquez-Colón, Natalia; López-Cepero, Andrea; Amaya, Claudia; Tucker, Katherine L; Kiefe, Catarina I; Person, Sharina D; Rosal, Milagros C; Pérez, Cynthia M; Population and Quantitative Health Sciences; Prevention Research Center; Biostatistics and Health Services Research
Residents of Puerto Rico face a high burden of food insecurity (FI), which has been associated with insomnia symptoms (IS). However, this association remains understudied in Puerto Rican young adults, a vulnerable group experiencing an elevated prevalence of FI and poor sleep. We evaluated the association between FI and IS and the mediating role of psychological distress symptoms among young adults in Puerto Rico. Data are derived from the PR-OUTLOOK cohort (2020-2023) of adults aged 18-29 y. We assessed FI with the six-item USDA Household Food Security Scale and IS with the 5-item Women's Health Initiative Insomnia Rating Scale. Psychological distress symptoms included depressive symptoms (CES-D-10), anxiety (STAI-10), and perceived stress (PSS-4). Poisson's regression models estimated prevalence ratios (PRs) with 95% confidence intervals (CIs). The Karlson-Holm-Breen method estimated the mediation percentage of each psychological distress symptom on the association between FI and IS. Notably, 24.8% of participants experienced FI, and 30.4% reported elevated IS. FI was associated with IS (PR = 1.41, 95% CI = 1.24, 1.60), an association partially mediated by depressive (31.6%), perceived stress (17.6%), and anxiety symptoms (17.2%), accounting for 35.8% of the mediation percentage. Future research should confirm these findings using objective assessments of sleep and psychosocial stress.
Longitudinal Family Functioning and Mental Health in Transgender and Nonbinary Youth and Their Families
(2023-12-21) Katz-Wise, Sabra L; Sarda, Vishnudas; Line, Emmett C; Marchwinski, Breana; Budge, Stephanie L; Godwin, Eli G; Moore, Lb M; Ehrensaft, Diane; Rosal, Milagros C; Thomson, Katharine A; Population and Quantitative Health Sciences; Prevention Research Center
This study examined concordance of family members' perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13-17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14-24 years) from 30 families from the U.S. New England region. Family members completed an online survey every 6-8 months for 5 waves between December 2015 and Feb 2019. Surveys assessed family functioning (quality of communication, satisfaction with family) and the following mental health-related outcomes: depression and anxiety symptoms, non-suicidal self-injury, suicidality, self-esteem, and resilience. Analyses tested concordance of family functioning and mental health across family members. Reports of family functioning changed over time, and family members were not consistently concordant in their reports of family functioning. Caregivers perceived a higher quality family communication than TNBY at all waves and higher than siblings at some waves. Perceptions of family satisfaction did not show a clear pattern between family member types across waves. The greatest concordance of perceived family functioning was between caregivers and siblings and between TNBY and siblings. Across all waves, TNBY reported more severe depression and anxiety symptoms than their caregivers and siblings, and more non-suicidal self-injury than their siblings. Compared to siblings, TNBY reported higher self-esteem, but less resilience. This study highlights opportunities for intervention in clinical work with TNBY and their families. Providers working with families with TNBY should use family systems approaches to support the mental health of all family members.
Barriers and facilitators to home blood pressure monitoring in women with pregnancies complicated by hypertensive disorders: a qualitative study
(2024-08-09) Kovell, Lara C; Denu, Mawulorm; Revoori, Ritika; Sadaniantz, Katherine; Staples, Brooke; Chiriboga, Germán; Forrester, Sarah N; Lemon, Stephenie C; Moore Simas, Tiffany A; Person, Sharina D.; McManus, David D; Mazor, Kathleen M; Biostatistics and Health Services Research; Medicine; Obstetrics and Gynecology; Pediatrics; Population and Quantitative Health Sciences; Prevention Research Center; Psychiatry
Background/objective: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality in the US. Improved diagnosis and treatment of HDP may be achieved through home blood pressure monitoring (HBPM). However, there are challenges to effective HBPM during pregnancy. This qualitative study was conducted to explore patients' perspectives and experiences with HBPM. Methods: Pregnant or recently postpartum women with HDP (≥18 years) were recruited from an academic medical center to virtual focus groups from March to September 2023. The discussions centered on experiences with HDP and barriers and facilitators to HBPM. Qualitative thematic analysis was performed. Results: Among 20 participants, the mean age was 33.8 (SD 5.9) years, with 35% Hispanic and 35% Black/African-American. Facilitators to HBPM included understanding the parameters/purpose of HBPM, prior experience with healthcare/duration of hypertension, free access to HBPM equipment and decision support, creating a routine, external support/counseling (e.g., partner/healthcare/family), and technology support. Barriers to HBPM included uncertainty/lack of training about the HBPM process, accessing/using HBPM equipment, the belief that clinic monitoring was sufficient/achieving good control, and activation barriers to making HBPM a priority (e.g., fear of affirming the diagnosis, higher priorities/life stressors). Conclusion: Many of the barriers to HBPM in pregnancy can be overcome through patient education/counseling, technology support, clinician/family reinforcement, and better access to validated blood pressure monitors. Given the importance of HBPM in improving outcomes for HDP, it is important for healthcare providers and policy makers to work to reduce barriers and amplify facilitators to HBPM for better adoption.
Stopping use of E-cigarettes and smoking combustible cigarettes: findings from a large longitudinal digital smoking cessation intervention study in the United States
(Springer Science and Business Media LLC, 2024-09-27) Lee, Donghee N; Faro, Jamie M; Stevens, Elise M; Pbert, Lori; Yang, Chengwu; Sadasivam, Rajani S; Biostatistics and Health Services Research; Obstetrics and Gynecology; Population and Quantitative Health Sciences; Prevention Research Center
Objective: Digital interventions have been widely implemented to promote tobacco cessation. However, implementations of these interventions have not yet considered how participants' e-cigarette use may influence their quitting outcomes. We explored the association of e-cigarette use and quitting smoking within the context of a study testing a digital tobacco cessation intervention among individuals in the United States who were 18 years and older, smoked combustible cigarettes, and enrolled in the intervention between August 2017 and March 2019. Results: We identified four e-cigarette user groups (n = 990) based on the participants' baseline and six-month e-cigarette use (non-users, n = 621; recently started users, n = 60; sustained users, n = 187; recently stopped users, n = 122). A multiple logistic regression was used to estimate the adjusted odds ratios (AOR) of six-month quit outcome and the e-cigarette user groups. Compared to e-cigarette non-users, the odds of quitting smoking were significantly higher among recently stopped users (AOR = 1.68, 95% CI [1.06, 2.67], p = 0.03). Participants who were most successful at quitting combustible cigarettes also stopped using e-cigarettes at follow-up, although many sustained using both products. Findings suggest that digital tobacco cessation interventions may carefully consider how to promote e-cigarette use cessation among participants who successfully quit smoking. Trial registration: ClinicalTrials.gov identifier NCT03224520 (July 21, 2017).
A pediatric primary care practice-based obesity intervention to support families: a cluster-randomized clinical trial
(2024-07-30) Pbert, Lori; Druker, Sue; Crawford, Sybil; Frisard, Christine; Bram, Jennifer; Olendzki, Barbara; Andersen, Victoria; Hazelton, Jennifer; Simone, Dante; Trivedi, Michelle; Ryan, Grace W; Schneider, Kristin; Geller, Alan C; Pediatrics; Population and Quantitative Health Sciences; Prevention Research Center; Tan Chingfen Graduate School of Nursing
Objective: The American Academy of Pediatrics recommends that pediatric practices help families make lifestyle changes to improve BMI, but provider time and access to treatment are limited. This study compared the effectiveness of two pediatric practice-based referral interventions in reducing BMI. Methods: In this cluster-randomized clinical trial, 20 pediatric primary care practices were randomized to telephonic coaching (Fitline Coaching) or mailed workbook (Fitline Workbook). Parents and their 8- to 12-year-old children with BMI ≥ 85th percentile completed assessments at baseline and at 6 and 12 months post baseline. Primary outcomes were 12-month BMI percentile and z score. Results: A total of 501 children and their parents received Fitline Coaching (n = 243) or Fitline Workbook (n = 258); 26.8% had overweight, 55.4% had obesity, and 17.8% had severe obesity. Mean (SD) age was 10.5 (1.4), and 47.5% were female. BMI percentile improved in both groups; 12-month decline in continuous BMI z score was not statistically significant in either group. However, 20.8% of telephonic coaching participants and 12.4% of workbook participants achieved a clinically significant reduction of at least 0.25 in BMI z score, a significant between-group difference (p = 0.0415). Conclusions: Both low-intensity interventions were acceptable and produced modest improvements in BMI percentile. One in five children in the telephonic coaching condition achieved clinically meaningful BMI z score improvements. However, more research is needed before such a program could be recommended for pediatric primary care practice.
The Impact of a Lifestyle Intervention on Cardiometabolic Risk Factors among Postpartum Hispanic Women with Overweight and Obesity in a Randomized Controlled Trial (Proyecto Mamá)
(2024-08-07) Wagner, Kathryn A; Pekow, Penelope; Marcus, Bess; Rosal, Milagros C; Braun, Barry; Manson, JoAnn E; Whitcomb, Brian W; Sievert, Lynnette Leidy; Chasan-Taber, Lisa; Population and Quantitative Health Sciences; Prevention Research Center
Introduction: Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity. Methods: Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time. Results: In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was -0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = -0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05). Discussion: Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance.
Development of a family-level intervention for families with transgender and/or nonbinary youth: Lessons and recommendations
(2024-08-12) Katz-Wise, Sabra L; Godwin, Eli G; Medzhitova, Yuliya; Moore, L B M; Parsa, Neeki; Hill, Amy; Oparah, Ngozi; Bogart, Laura M; Rosal, Milagros C; Pullen Sansfaçon, Annie; Ehrensaft, Diane; Nishman, Melissa MacNish; Austin, S Bryn; Population and Quantitative Health Sciences; Prevention Research Center
Family support plays an important role in promoting resilience and health among transgender and/or nonbinary youth (TNBY), but family members often experience barriers to supporting their TNBY, including minority-adjacent stress stemming from exposure to structural stigma and antitransgender legislation. TNBY and their families need effective family-level interventions developed using community-based participatory research (CBPR), which integrates community members (e.g., TNBY, family members, service providers for families with TNBY) into the intervention development process to ensure the resulting intervention is relevant and useful. Informed by findings from the Trans Teen and Family Narratives Project, we used CBPR to develop the Trans Teen and Family Narratives Conversation Toolkit, a family-level intervention designed to educate families about TNBY and facilitate conversations about gender. The toolkit was developed across 1.5 years (June 2019 to January 2021) using four integrated phases: (1) content development: digital storytelling workshop with TNBY; (2) content review: digital storyteller interviews and user focus groups; (3) content development: study team content synthesis and website development; and (4) content review: website review by TNBY, family members, and mental health providers, and intervention refinement. This article outlines the intervention development process, describes strategies employed to navigate challenges encountered along the way, and shares key learnings to inform future CBPR intervention development efforts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Pediatric and Adolescent Hypertension: A Multidisciplinary Call to Action
(2024-09-01) Goulding, Melissa; Rea, Corinna J; Flynn, Joseph T; Pediatrics; Population and Quantitative Health Sciences; Prevention Research Center
Heightened awareness and the rising prevalence of hypertension in children and adolescents has brought pediatric hypertension to the forefront of pediatric primary care. It has also made clear the need for public health programs and evidence-based lifestyle interventions to effectively prevent and manage this condition in youth. However, given that the ultimate aim of such efforts is to reduce rates of adult cardiovascular disease, how to best measure their success during childhood is unclear. In this perspective, we describe current challenges and gaps in research related to this dilemma while highlighting the need for multidisciplinary collaboration between pediatric primary care providers, researchers, public health practitioners, and hypertension experts to move toward effective prevention and management of this condition.
Randomized non-inferiority trial comparing an asynchronous remotely-delivered versus clinic-delivered lifestyle intervention
(2024-08-27) Pagoto, Sherry L; Goetz, Jared M; Xu, Ran; Wang, Monica L; Palmer, Lindsay; Lemon, Stephenie C; Population and Quantitative Health Sciences; Prevention Research Center
Objective: Lifestyle interventions are effective, but those delivered via in-person group meetings have poor scalability and reach. Research is needed to establish if remotely delivered lifestyle interventions are non-inferior to in-person delivered lifestyle interventions. Methods: We conducted a randomized non-inferiority trial (N = 329) to compare a lifestyle intervention delivered remotely and asynchronously via an online social network (Get Social condition) to one delivered via in-person groups (Traditional condition). We hypothesized that the Get Social condition would result in a mean percent weight loss at 12 months that was not inferior to the Traditional condition. Additional outcomes included intervention delivery costs per pound lost and acceptability (e.g., convenience, support, modality preferences). Results: At 12 months, no significant difference in percent weight change was observed between the Get Social and Traditional conditions (2.7% vs. 3.7%, p = 0.17) however, criteria for non-inferiority were not met. The Get Social condition costs $21.45 per pound lost versus $26.24 for the Traditional condition. A greater percentage of Get Social condition participants rated participation as convenient (65% vs 44%; p = 0.001). Conclusions: Results revealed a remotely-delivered asynchronous lifestyle intervention resulted in slightly less weight loss than an in-person version but may be more economical and convenient. Trial registration: ClinicalTrials.gov NCT02646618; https://clinicaltrials.gov/ct2/show/NCT02646618 .
Preventing diabetes: What overweight and obese adults with prediabetes in the United States report about their providers' communication and attempted weight loss
(2024-08-11) Demosthenes, Emmanuella J; Freedman, Jason; Hernandez, Camila; Shennette, Lisa; Frisard, Christine; Lemon, Stephenie C; Gerber, Ben S; Amante, Daniel J; Morningside Graduate School of Biomedical Sciences; Population and Quantitative Health Sciences; Prevention Research Center; T.H. Chan School of Medicine; Jason Freedman; Camila Hernandez
Objective: To investigate what overweight or obese adults with prediabetes in the United States report being told by providers about 1) having prediabetes, 2) diabetes risk, and 3) losing weight and the associations of these communications with attempted weight loss. Methods: Data from 2015 to 2018 National Health and Nutrition Examination Surveys (NHANES) for adults with a body mass index in the overweight or obesity ranges and HbA1c in the prediabetes range were examined (n = 2085). Patient reported data on what providers told them about having prediabetes, being at risk for diabetes, and losing weight were compared with attempted weight loss. Results: Most participants (66.4%) reported never being told they had prediabetes nor being at risk for diabetes, 13.0% reported being told they had prediabetes, 10.6% at risk for diabetes, and 8.0% both messages. 18.3% of participants reported being told to lose weight. Participants who reported being told they had prediabetes and at increased diabetes risk were more likely to report attempted weight loss (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1-3.2). Reporting that they were told to lose weight was not significantly associated with an increase in reported weight loss attempts. Conclusions: In this cohort of individuals with overweight/obesity and prediabetic HbA1c values, low rates communications with providers about prediabetes and diabetes risk were reported. When both were discussed, patients reported greater attempted weight loss. These findings draw attention to the potential impact that provider communications about prediabetes and diabetes risk may have on lifestyle behavior change.
Performance of and Severe Acute Respiratory Syndrome Coronavirus 2 Diagnostics Based on Symptom Onset and Close Contact Exposure: An Analysis From the Test Us at Home Prospective Cohort Study
(2024-05-31) Herbert, Carly; Wang, Biqi; Lin, Honghuang; Yan, Yi; Hafer, Nathaniel; Pretz, Caitlin; Stamegna, Pamela; Wright, Colton; Suvarna, Thejas; Harman, Emma; Schrader, Summer; Nowak, Chris; Kheterpal, Vik; Orvek, Elizabeth; Wong, Steven; Zai, Adrian; Barton, Bruce A; Gerber, Ben S; Lemon, Stephenie C; Filippaios, Andreas; Gibson, Laura; Greene, Sharone; Colubri, Andres; Achenbach, Chad; Murphy, Robert; Heetderks, William; Manabe, Yukari C; O'Connor, Laurel; Fahey, Nisha; Luzuriaga, Katherine; Broach, John; Roth, Kristian; McManus, David D; Soni, Apurv; Biostatistics and Health Services Research; Center for Clinical and Translational Science; Emergency Medicine; Medicine; Microbiology and Physiological Systems; Pediatrics; Population and Quantitative Health Sciences; Prevention Research Center; Program in Molecular Medicine
Background: Understanding changes in diagnostic performance after symptom onset and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure within different populations is crucial to guide the use of diagnostics for SARS-CoV-2. Methods: The Test Us at Home study was a longitudinal cohort study that enrolled individuals across the United States between October 2021 and February 2022. Participants performed paired antigen-detection rapid diagnostic tests (Ag-RDTs) and reverse-transcriptase polymerase chain reaction (RT-PCR) tests at home every 48 hours for 15 days and self-reported symptoms and known coronavirus disease 2019 exposures immediately before testing. The percent positivity for Ag-RDTs and RT-PCR tests was calculated each day after symptom onset and exposure and stratified by vaccination status, variant, age category, and sex. Results: The highest percent positivity occurred 2 days after symptom onset (RT-PCR, 91.2%; Ag-RDT, 71.1%) and 6 days after exposure (RT-PCR, 91.8%; Ag-RDT, 86.2%). RT-PCR and Ag-RDT performance did not differ by vaccination status, variant, age category, or sex. The percent positivity for Ag-RDTs was lower among exposed, asymptomatic than among symptomatic individuals (37.5% (95% confidence interval [CI], 13.7%-69.4%) vs 90.3% (75.1%-96.7%). Cumulatively, Ag-RDTs detected 84.9% (95% CI, 78.2%-89.8%) of infections within 4 days of symptom onset. For exposed participants, Ag-RDTs detected 94.0% (95% CI, 86.7%-97.4%) of RT-PCR-confirmed infections within 6 days of exposure. Conclusions: The percent positivity for Ag-RDTs and RT-PCR tests was highest 2 days after symptom onset and 6 days after exposure, and performance increased with serial testing. The percent positivity of Ag-RDTs was lowest among asymptomatic individuals but did not differ by sex, variant, vaccination status, or age category.
Vaping cessation support recommendations from adolescents who vape: a qualitative study
(2024-06-17) Pbert, Lori; Dubé, Catherine E; Nagawa, Catherine S; Simone, Dante P; Wijesundara, Jessica G; Sadasivam, Rajani S; Population and Quantitative Health Sciences; Prevention Research Center
Background: Youth vaping is a serious public health concern, being more prevalent than any other tobacco use. To inform cessation interventions, we explored what adolescents perceive as their reasons for quitting and strategies to help them quit. Method: Semi-structured interviews were conducted with a convenience sample of 11 adolescents reporting vaping in the past 90 days and recruited from a high school in Massachusetts. Interviews were transcribed and dual-coded. Inductive thematic analysis was employed, and thematic summaries were prepared. Results: Reasons adolescents reported for quitting included cost, experiencing "nic-sick" from nicotine withdrawal or excess intake, negative impacts on mood, concentration, or health, and experiencing symptoms of nicotine dependence. Nearly all tried to quit multiple times. Barriers to quitting included exposure to vaping, access to vape products, stress, and "cool" new products or flavors. Quit strategies included avoiding others vaping, seeking social support to quit, addressing peer pressure to continue vaping, learning successful quit strategies from peers, and using distraction strategies or alternatives to vaping. Conclusion: Many adolescents who vape want to quit, and most have tried multiple times. Interventions need to engage adolescents with varying reasons to quit, barriers, and quit strategy preferences. Clinical trial registration: This study is registered through ClinicalTrials.gov. The trial registration number is NCT05140915. The trial registration date is 11/18/2021.
The Puerto Rico Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk (PR-OUTLOOK) Study: Design and Methods
(2024-06-26) Pérez, C M; Kiefe, Catarina I.; Person, Sharina D.; Tucker, K L; Torres, P; Sandoval, E; Boneu, C; Ramírez, Z; Mattei, J; Rodríguez-Orengo, J; Almodóvar-Rivera, I; Rosal, Milagros C; Biostatistics and Health Services Research; Population and Quantitative Health Sciences; Prevention Research Center
The Puerto Rico (PR) Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk Study (PR-OUTLOOK) is investigating overall and component-specific cardiovascular health (CVH) and cardiovascular disease (CVD) risk factors in a sample of young (age 18-29) Puerto Rican adults in PR (target n=3,000) and examining relationships between individual-, family/social- and neighborhood-level stress and resilience factors and CVH and CVD risk factors. The study is conducting standardized measurements of CVH and CVD risk factors and demographic, behavioral, psychosocial, neighborhood, and contextual variables and establishing a biorepository of blood, saliva, urine, stool, and hair samples. The assessment methods are aligned with other National Heart, Lung, and Blood Institute funded studies: the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) of adults 30-75 years, the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the Boston Puerto Rican Health Study (BPRHS), and the Coronary Artery Risk Development in Young Adults (CARDIA). PR-OUTLOOK data and its biorepository will facilitate future longitudinal studies of the temporality of associations between stress and resilient factors and CVH and CVD risk factors among young Puerto Ricans, with remarkable potential for advancing the scientific understanding of these conditions in a high-risk but understudied young population.

Browse

Recent Publications