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BACKGROUND: Studies have examined the association between dual sensory impairment and late-life cognitive outcomes in the U.S with inconsistent findings. OBJECTIVE: To examine the associations between sensory impairment and 10-year risk of dementia or Alzheimer's disease among U.S. adults aged ≥ 50. METHODS: A prospective cohort study based on the Health and Retirement Study from 2010 to 2020. Individuals aged ≥ 50 years without self-reported dementia and Alzheimer's disease in 2010 were included in the analysis. Self-reported visual and hearing impairments were measures in 2010. Main failure events included self-reported incident dementia and Alzheimer's disease over a 10-year follow-up period. Participants were categorized as having no visual or hearing impairment, visual impairment only, hearing impairment only, and dual sensory impairment. Fine-Gray competing risk regression model was applied to estimate the associations of sensory impairment with incident dementia and Alzheimer's disease, adjusted for demographic characteristics, health behaviors, and health conditions at baseline. RESULTS: Of 20,248 identified individuals, 14.6% had visual impairment only, 11.2% had hearing impairment only, and 9.1% had dual impairment at baseline. After adjusting for all covariates, dual sensory impairment was associated with higher risk of dementia (HR = 1.46, 95% CI: 1.23-1.73) and Alzheimer's disease (HR = 1.35, 95% CI: 1.03-1.76). Visual impairment only was also associated with incident dementia and Alzheimer's disease among individuals <65 years. CONCLUSION: Older adults in the U.S. with visual and hearing impairments simultaneously had a particularly greater risk of dementia and Alzheimer's disease, indicating the needs of targeted screening for timely treatment and further prevention of dementia and Alzheimer's disease.
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BACKGROUND: With an increasing proportion of older adults and the associated risk of Alzheimer's Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs. METHODS: This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives. DISCUSSION: This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk. TRIAL REGISTRATION: ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).
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Negro o Afroamericano , Demencia , Atención Plena , Caminata , Humanos , Anciano , Caminata/fisiología , Negro o Afroamericano/psicología , Demencia/etnología , Demencia/prevención & control , Demencia/psicología , Masculino , Atención Plena/métodos , Femenino , Cognición/fisiología , Persona de Mediana EdadRESUMEN
BACKGROUND: Physical activity is associated with lower risk of dementia and cognitive impairment, but existing randomized controlled trials have shown conflicting results. As cognitive decline occurs decades before the onset of dementia, physical activity interventions initiated in late life may have missed the potential window for prevention. An ideal trial of physical activity initiated from midlife and lasts till incident dementia and cognitive impairment in late life is not feasible. We aimed to estimate the effectiveness of a hypothetical physical activity intervention initiated from midlife on reducing dementia and cognitive impairment by emulating target trials using observational data. METHODS: The Health and Retirement Study was used to emulate target trials among noninstitutionalized participants aged 45 to 65 years with normal cognition who were physically inactive in the previous 2 years. Cognitive status was determined based on Langa-Weir classification of cognitive function (including immediate and delayed word recall tests, serial sevens subtraction, counting backward). Individuals were categorized as initiating physical activity or not, based on the self-reported physical activity. Intention-to-treat and per-protocol analysis were conducted with pooled logistic regression models with inverse-probability of treatment and censoring weights to estimate risk ratios (RRs), and 95% confidence intervals (95% CIs) were calculated with 200 sets of bootstrapping. RESULTS: Among 1505 participants (average age 57.6 ± 4.8 years, 67% women, 76.5% White), 72 cases of dementia and 409 cases of cognitive impairment occurred. After 12 years of follow-up, physical activity reduced dementia (RR = 0.70, 95% CI: 0.43, 0.99) for intention-to-treat analysis, and reduced dementia (RR = 0.51, 95% CI: 0.19, 0.99) and cognitive impairment (RR = 0.77, 95% CI: 0.61, 0.92) for per-protocol analysis. No significant reduction was found among older adults. CONCLUSIONS: Physical activity initiated during midlife may reduce dementia and cognitive impairment in late life, which highlights the importance of preventing cognitive outcomes at an earlier stage of life.
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BACKGROUND AND OBJECTIVES: Non-Hispanic Black populations (NHB) have a significantly higher prevalence of dementia than non-Hispanic Whites in the U.S., and the underlying risk factors may play a role in this racial disparity. We aimed to calculate risk scores for dementia among non-Hispanic White (NHW) and non-Hispanic Black populations aged 50-64 years over a period of 10 years, and to estimate potential differences of scores between NHW and NHB. RESEARCH DESIGN AND METHODS: The Health and Retirement Study from 2006 to 2016 was used to calculate the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score, a validated score for predicting dementia risk. Weighted average CAIDE score, as well as CAIDE score for modifiable factors hypertension, obese, hypercholesterolemia, physical inactivity), and non-modifiable factors (age, sex, education) were calculated for adults aged 50-64 years with normal cognition for 2006-2008, 2010-2012, 2014-2016. The associations of race with CAIDE score and elevated CAIDE score were examined. RESULTS: A total of 10,871 participants were included in the analysis. The CAIDE score showed declining trends for NHB from 2006 to 2016, while NHB consistently had a higher total CAIDE score and CAIDE score for modifiable factors from 2006 to 2016, but not for non-modifiable factors. DISCUSSION AND IMPLICATIONS: NHB had a higher level of dementia risk factors than NHW among adults aged 50-64 years in the U.S. from 2006 to 2016, and the difference is attributable to modifiable risk factors, which holds promise for risk reduction of dementia.
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Introduction: Banning the sales of loose cigarettes is recommended by Article 16 of the World Health Organization - Framework Convention on Tobacco Control. This study aims to understand the perceptions of cigarette users and tobacco vendors regarding such a ban. Methods: Using a systematic recruitment and interview protocol, we interviewed cigarette users (n = 28) and tobacco vendors (n = 28) from two Indian cities where sales of loose cigarettes were banned (Mumbai) or not banned (Delhi). Separate semi-structured interview guides were used for users and vendors. Interview questions focused on reasons for purchasing loose cigarettes, preference for buying and selling loose vs. packs, thoughts on the necessity of banning loose cigarettes, and the perceived impact of the policy ban for vendors and cigarette users. We performed thematic analysis and used NVivo for organizing transcript coding. Results: The main reasons users cited for purchasing loose cigarettes were financial constraints, social restrictions (fear of getting caught), and limiting cigarette consumption. In Mumbai, awareness of the existing ban was poor among both users and vendors. Those who were aware did not think the policy had been implemented. Users thought that loose cigarettes promoted smoking initiation and prevented them from quitting. Both users and vendors reported that a ban on loose cigarettes would reduce cigarette consumption and promote quit attempts as it would not be possible for everyone to purchase packs because of financial and social reasons. Conclusion: Users in both cities reported easy access to and widespread availability of loose cigarettes. Low awareness of the ban in Mumbai suggested inadequate enforcement. A country-wide ban on the sale of loose cigarettes could be highly effective in preventing smoking initiation and promoting quitting.
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Comercio , Productos de Tabaco , Humanos , India , Productos de Tabaco/economía , Productos de Tabaco/legislación & jurisprudencia , Comercio/estadística & datos numéricos , Adulto , Femenino , Masculino , Persona de Mediana Edad , Adulto Joven , Entrevistas como Asunto , Adolescente , Percepción , FumarRESUMEN
The number of people with Alzheimer's disease and related dementias (ADRD) in the United States is steadily increasing, with minoritized populations having a disproportionate burden of disease. One strategy to address the racial and ethnic disparities in aging is to diversify scholars in the field of aging, to increase dynamic solution development and create cultural congruence among researchers and participants. The National Institute on Aging has a committed effort to increase and diversify the number of scientists who conduct aging and ADRD research, placing a call for Centers to focus on this effort. In response to the National Institute on Aging call, the Carolina Center for Alzheimer's Disease and Minority Research, housed at the University of South Carolina, proposed a dual approach to addressing these gaps through a joint national conference and mentorship program for underrepresented minoritized faculty. After one year of the program, the participating scholars were surveyed, and successes and growth points of the program were identified to help guide the improvement of this dual approach to addressing gaps in scholar diversity in aging research.
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Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person's functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking. Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers' knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes. Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities. Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease.
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BACKGROUND: As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients' understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. OBJECTIVE: We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. METHODS: We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop's videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. RESULTS: Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. CONCLUSIONS: This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.
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PURPOSE: This paper examines community leaders' and researchers' recommendations for reaching rural communities in a southeastern U.S. state with cancer prevention and control programming. RESEARCH DESIGN: A qualitative inquiry of a grant network's research and community councils was conducted to explore members' opinions on how to engage rural communities and obtain input on how to recruit rural organizations for a mini-grants program. STUDY SAMPLE AND DATA COLLECTION: Telephone/virtual interviews were conducted with all 13 council members. Responses were analyzed using thematic analysis and findings were examined within the context of system-centric and patient-centric dimensions. RESULTS: Council members discussed limited education, lack of insurance, low socioeconomic status, health care avoidance, and transportation as barriers to cancer prevention and control. They recommended reaching rural populations by partnering with community and faith-based organizations, use of targeted multi-media, and tailored cancer education trainings. CONCLUSIONS: Findings are used for guiding outreach with rural communities and recruitment of rural organizations for a cancer-focused mini-grants initiative.
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Neoplasias , Población Rural , Humanos , Impulso (Psicología) , Escolaridad , Atención a la Salud , Neoplasias/prevención & controlRESUMEN
BACKGROUND: Research clearly demonstrates social determinants of health (SDOH) impact health outcomes. Provider consideration of patient SDOH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDOH and improved population health, research demonstrates few providers document patient SDOH. OBJECTIVE: This qualitative study aimed to better understand the barriers and facilitators of SDOH assessment, documentation, and referral in different health care settings and roles. METHODS: Individual semistructured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022, and September 2, 2022. Participants were recruited via community partners' web-based newsletters or listservs using a purposive sampling design. An interview guide with 19 questions was used to explore the following research question: How do SDOH impact patient health and what are the facilitators and barriers experienced by multidisciplinary health care providers assessing and documenting patient SDOH? RESULTS: Participants (N=5) included a neonatal intensive care unit registered nurse, a nurse practitioner, a certified nurse midwife, a family and preventive medicine physician, and a counselor (licensed clinical social worker) with careers spanning 12 to 32 years. Participant responses are presented according to the following 5 themes: participants' understanding of SDOH for the patient population, assessment and documentation practices, referrals to other providers and community-based resources, barriers and facilitators of SDOH assessment and documentation, and SDOH assessment and documentation training preferences. Overall, participants were aware of the importance of including patient SDOH in assessment and intervention but noted a variety of institutional and interpersonal barriers to assessment and documentation, including time constraints, perceptions of stigma around discussion of SDOH, and limited referral protocols. CONCLUSIONS: Incentivizing inclusion of patient SDOH in health care must be facilitated from the top down, so assessment and documentation can be universally implemented in a pragmatic way that works for providers in a variety of roles and settings for the betterment of health care quality, health equity, and improved population health outcomes. Partnering with community organizations can serve to augment health care organizations' resource and referral availability for addressing patients' social needs.
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Like cancer, Alzheimer's disease and related dementias (ADRD) comprise a global health burden that can benefit tremendously from the power of disease registry data. With an aging population, the incidence, treatment, and mortality from ADRD is increasing and changing rapidly. In the same way that current cancer registries work toward prevention and control, so do ADRD registries. ADRD registries maintain a comprehensive and accurate registry of ADRD within their state, provide disease prevalence estimates to enable better planning for social and medical services, identify differences in disease prevalence among demographic groups, help those who care for individuals with ADRD, and foster research into risk factors for ADRD. ADRD registries offer a unique opportunity to conduct high-impact, scientifically rigorous research efficiently. As research on and development of ADRD treatments continue to be a priority, such registries can be powerful tools for conducting observational studies of the disease. This perspectives piece examines how established cancer registries can inform ADRD registries' impact on public health surveillance, research, and intervention, and inform and engage policymakers.
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Background The Framingham 10-year cardiovascular disease risk score, which is based on age, sex, smoking, total cholesterol, high-density lipoprotein-cholesterol, blood pressure, and diabetes, has been found to be associated with cognitive health, but these findings have not been validated in a representative sample in the United States. We aimed to examine the associations of Framingham risk score with cognitive function among older adults in a nationally representative sample, as well as by race or ethnicity, education, and family income. Methods and Results A total of 2254 older adults ≥60 years (57% female, 79% non-Hispanic White) in the National Health and Nutrition Examination Survey 2011 to 2014 were included in the final sample for analysis. All components of the Framingham risk score were obtained with questionnaire or measured in the laboratory. Cognitive function was examined using the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task (immediate and delayed memory), Digit Symbol Substitution Test, and Animal Fluency Test. Multivariable linear regression models were used to assess the associations between Framingham risk score and test-specific and global cognition Z scores. Each incremental 5% in Framingham 10-year cardiovascular disease risk was associated with lower Z scores for Digit Symbol Substitution Test (ß=-0.06 [95% CI, -0.09 to -0.03]), delayed memory (ß=-0.05 [95% CI, -0.08 to -0.01]), immediate memory (ß=-0.07 [95% CI, -0.10 to -0.03]), and global cognition (ß=-0.05 [95% CI, -0.09 to -0.02]). Socioeconomic status, particularly race or ethnicity and monthly income levels, were strong effect measure modifiers of the associations. Conclusions Lower cardiovascular risk factors are associated with better cognitive function.
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Enfermedades Cardiovasculares , Femenino , Estados Unidos/epidemiología , Masculino , Humanos , Encuestas Nutricionales , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Cognición/fisiología , Factores de Riesgo , Memoria a Corto Plazo , Factores de Riesgo de Enfermedad Cardiaca , ColesterolRESUMEN
PURPOSE: This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence. METHODS: The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships. RESULTS: NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling. CONCLUSIONS: Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.
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Posmenopausia , Clase Social , Humanos , Femenino , Salud de la Mujer , Características de la Residencia , CaminataRESUMEN
PURPOSE: A diverse workforce trained in dissemination & implementation (D&I) science is critical for improving cancer outcomes and reducing cancer-related health disparities. This study aims to describe and evaluate impact of the Cancer Prevention and Control Research Network (CPCRN) Scholars Program in preparing scholars for collaborative careers in cancer control and implementation research and practice, and offers evaluation-driven recommendations for program improvements. METHODS: The CPCRN Scholars Workgroup conducted a sequential, mixed methods evaluation. We collected baseline and follow-up surveys and invited all 20 scholars and ten mentors to participate in an exit interview. We assessed the experience with the Scholar's program, ratings of D&I competences, progress on their project, feedback about the curriculum, and understanding of implementation science. RESULTS: Over 86% partially or fully completed their project within 9 months; 78% of scholars engaged with a CPCRN workgroup. Scholars rated the following program components as valuable: the Putting Public Health Evidence in Action (PPHEIA) training (88.9%), D&I training modules (83.3%), and webinars (kickoff webinar-88.9% and selecting theories/models-88.9%). There was an increase in D&I competencies from baseline to posttest, with the greatest in community engagement topics. About 78% reported that they were satisfied with format of the activities and increased confidence in ability to discuss D&I concepts. From the qualitative interviews, the benefit of the program was becoming more knowledgeable about D&I research and networking. CONCLUSION: The inaugural year of the program yielded positive results, particularly related to increasing knowledge about D&I science and cancer control. This program builds the capacity of students, researchers and practitioners in D&I science.
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Atención a la Salud , Neoplasias , Humanos , Mentores , Neoplasias/prevención & control , Salud Pública , Estudiantes , Evaluación de Programas y Proyectos de SaludRESUMEN
PURPOSE: To improve population health, community members need capacity (i.e., knowledge, skills, and tools) to select and implement evidence-based interventions (EBIs) to fit the needs of their local settings. Since 2002, the Centers for Disease Control and Prevention has funded the national Cancer Prevention and Control Research Network (CPCRN) to accelerate the implementation of cancer prevention and control EBIs in communities. The CPCRN has developed multiple strategies to build community members' capacity to implement EBIs. This paper describes the history of CPCRN's experience developing and lessons learned through the use of five capacity-building strategies: (1) mini-grant programs, (2) training, (3) online tools, (4) evidence academies, and (5) evaluation support for partners' capacity-building initiatives. METHODS: We conducted a narrative review of peer-reviewed publications and grey literature reports on CPCRN capacity-building activities. Guided by the Interactive Systems Framework, we developed histories, case studies, and lessons learned for each strategy. Lessons were organized into themes. RESULTS: Three themes emerged: the importance of (1) community-engagement prior to and during implementation of capacity-building strategies, (2) establishing and sustaining partnerships, and (3) co-learning at the levels of centers, networks, and beyond. CONCLUSION: CPCRN activities have increased the ability of community organizations to compete for external funds to support implementation, increased the use of evidence in real-world settings, and promoted the broad-scale implementation of cancer control interventions across more than eight states. Lessons from this narrative review highlight the value of long-term thematic networks and provide useful guidance to other research networks and future capacity-building efforts.
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Creación de Capacidad , Neoplasias , Estados Unidos , Humanos , Atención a la Salud , Centers for Disease Control and Prevention, U.S. , Neoplasias/prevención & controlRESUMEN
BACKGROUND: The US Dietary Guidelines (USDG) form the basis of nutrition guidelines, but the research informing the 3 USDG dietary patterns (Healthy US-Style [H-US], Mediterranean [Med], and vegetarian [Veg]) has been drawn largely from observational studies among White populations. OBJECTIVES: The Dietary Guidelines 3 Diets study was a 3-arm, 12-wk randomly assigned intervention among African American (AA) adults at risk of type 2 diabetes mellitus that tested the 3 USDG dietary patterns. METHODS: The AAs (ages 18-65 y, BMI 25-49.9 kg/m2, and BMI was measured in kg/m2) with ≥3 type 2 diabetes mellitus risk factors were recruited. Weight, HbA1c, blood pressure, and dietary quality (healthy eating index [HEI]) were collected at baseline and 12 wk. In addition, participants attended weekly online classes that were designed using material from the USDG/MyPlate. Repeated measures, mixed models with maximum likelihood estimation, and robust computation of standard errors were tested. RESULTS: Of the 227 participants screened, 63 were eligible (83% female; age 48.0 ± 10.6 y, BMI 35.9 ± 0.8 kg/m2) and randomly assigned to the Healthy US-Style Eating Pattern (H-US) (n = 21, 81% completion), healthy Mediterranean-style eating pattern (Med) (n = 22, 86% completion), or healthy vegetarian eating pattern (Veg) (n = 20, 70% completion) groups. Within-group, but not between groups, weight loss was significant (-2.4 ± 0.7 kg H-US, -2.6 ± 0.7 kg Med, -2.4 ± 0.8 kg Veg; P = 0.97 between group). There was also no significant difference between groups for changes in HbA1c (0.03 ± 0.05% H-US, -0.10 ± 0.05% Med, 0.07 ± 0.06% Veg; P = 0.10), systolic BP (-5.5 ± 2.7 mmHg H-US, -3.2 ± 2.5 mmHg Med, -2.4 ± 2.9 mmHg Veg; P = 0.70), diastolic blood pressure (-5.2 ± 1.8 mmHg H-US, -2.0 ± 1.7 mmHg Med, -3.4 ± 1.9 mmHg Veg; P = 0.41), or HEI (7.1 ± 3.2 H-US, 15.2 ± 3.1 Med, 4.6 ± 3.4 Veg; P = 0.06). Post hoc analyses showed that the Med group had significantly greater improvements in HEI compared to the Veg group (difference = -10.6 ± 4.6; 95% CI: -19.7, -1.4; P = 0.02). CONCLUSIONS: The present study demonstrates that all 3 USDG dietary patterns lead to significant weight loss among AA adults. However, none of the outcomes were significantly different between groups. This trial was registered at clinicaltrials.gov as NCT04981847.
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Negro o Afroamericano , Diabetes Mellitus Tipo 2 , Dieta , Pérdida de Peso , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Presión Sanguínea , Diabetes Mellitus Tipo 2/prevención & control , Hemoglobina Glucada , Política Nutricional , Dieta Saludable , Dieta Mediterránea , Dieta VegetarianaRESUMEN
Advancing environmental health literacy in support of environmental management requires inclusive science communication, especially with environmental justice communities. In order to understand experiences of environmental practitioners in the realm of science communication, the Center for Oceans and Human Health and Climate Change Interactions at the University of South Carolina conducted two studies on science communication and research translation with the center's researchers and partners. This qualitative case study follows up with a select group of environmental practitioners on emergent themes from the initial work. It explores the specific topics of understanding, trust, and access and how those can become barriers or facilitators of public engagement with environmental activities and decision making. The authors conducted seven in-depth qualitative interviews with center partners whose work focuses on environmental water quality and impacts on human and environmental health. Key results indicate that the public may have limited understanding of scientific processes, establishing trust takes time, and access should be incorporated into the design of programs and activities to ensure broader reach. Findings from this research are relevant to other partner-engaged work and environmental management initiatives and provide insights on experiences, practices, and actions for equitable and effective stakeholder engagement and collaborative partnerships.
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Confianza , Calidad del Agua , Humanos , Investigación Cualitativa , Comunicación , Toma de DecisionesRESUMEN
Funding communities through mini-grant programs builds community capacity by fostering leadership among community members, developing expertise in implementing evidence-based practices, and increasing trust in partnerships. The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) implemented the Community Health Intervention Program (CHIP) mini-grants initiative to address cancer-related health disparities among high-risk populations in rural areas of the state. One community-based organization and one faith-based organization were funded during the most recent call for proposals. The organizations implemented National Cancer Institute evidence-based strategies and programs focused on health and cancer screenings and physical activity and promotion of walking trails. Despite the potential for the COVID-19 pandemic to serve as a major barrier to implementation, grantees successfully recruited and engaged community members in evidence-based activities. These initiatives added material benefits to their local communities, including promotion of walking outdoors where it is less likely to contract the virus when socially distanced and provision of COVID-19 testing and vaccines along with other health and cancer screenings. Future mini-grants programs will benefit from learning from current grantees' flexibility in program implementation during a pandemic as well as their intentional approach to modifying program aspects as needed.
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COVID-19 , Pandemias , Humanos , Pandemias/prevención & control , Prueba de COVID-19 , COVID-19/epidemiología , COVID-19/prevención & control , South Carolina , Organización de la FinanciaciónRESUMEN
Improving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients. This paper describes the development, implementation, and evaluation of a pragmatic, clinic-based health literacy intervention in a safety-net clinic that serves uninsured and indigent patients. Study methods are guided by a previous pilot study and components recommended for pragmatic interventions. An electronic readiness assessment was distributed to out-patient clinics affiliated with a statewide hospital association. The AskMe3 tool was used for the intervention as it is evidence informed and relatively easy to implement. Implementation included ongoing dialogue between the clinic and the academic research team. Within the implementing clinic, data collected from patients via verbally administered questionnaires was analyzed using descriptive statistics and chi-squares. Interview data collected from the clinic director was analyzed qualitatively for themes. The implementing clinic had some of the lowest average scores of the 34 clinics who participated in the initial readiness assessment. Despite this, they were able to successfully implement the health literacy intervention during a global pandemic. Eighty-eight participants completed patient questionnaires at this clinic. Most patients (96%) agreed the AskMe3 questions helped them talk with the doctor or nurse at their current appointment. Most (99%) also perceived the AskMe3 tool to be very helpful when used in a clinical setting. The clinic director offered that the staff initially thought the intervention would be difficult to implement. However, implementation by clinic volunteers with encouragement and prioritization of health literacy by the clinic director contributed to success. When considering interventions for clinical settings, a pragmatic approach can help with selection and implementation of a program that fits with the realities on the ground. Further, frequent technical assistance can help resolve implementation barriers. Interventions utilizing tools such as AskMe3, because of their simplicity, allow creative solutions to capacity issues for clinics who see a need for health literacy improvements.
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COVID-19 , Alfabetización en Salud , Humanos , Proyectos Piloto , Pandemias , COVID-19/epidemiología , COVID-19/prevención & control , Instituciones de Atención AmbulatoriaRESUMEN
The associations of patterns of depressive symptoms, including trajectories of depressive symptoms and significant depressive symptoms among older adults over a long period of time with incident dementia are not frequently studied. We aimed to examine the associations of patterns of depressive symptoms among older adults with incident dementia. Participants of the Health and Retirement Study from 1994 to 2018 with information of incident dementia and complete measurements of depressive symptoms were included. Depressive symptoms assessed on 8 waves between 1994 and 2010 using the 8-item Center for Epidemiologic Studies Depression (CES-D) Scale. Significant depressive symptoms were defined as ≥4 points in the CES-D. Trajectories of depressive symptoms and significant depressive symptoms were identified. Cox proportional hazards models were used to examine the associations of patterns of depressive symptoms with incident dementia. A total of 6317 participants were included in the analysis. Over the follow-up period of 8 years, trajectories of "increase from mild" (hazards ratio (HR): 1.84, 95% confidence interval (CI): 1.29, 2.63) and "persistently high" (HR: 1.76, 95% CI: 1.17, 2.65) depressive symptoms were associated with higher risk of incident dementia, after adjustment for covariates. Future studies are needed to examine the interaction of depression in different stages of life on incident dementia. Studies are also expected to estimate the effect of preventing dementia through reducing depressive symptoms.