Multiphase optimization strategy to establish optimal delivery of nutrition-related services in healthcare settings: A step towards clinical trial.

BACKGROUND: Minorities living in the Southern US generally have greater incidence and prevalence of cardiometabolic diseases compared to other groups. Cardiometabolic disease prevalence and risk can be reduced by focusing on diet and lifestyle modifications. There is need for holistic and integrated care models for community-based healthcare organizations who are already working with minorities. This research aimed to select and optimize essential psychosocial and structural components to address diet behaviors among racial/ethnic minorities, and/or disadvantaged background young to middle aged adult populations in Mississippi. METHODS: Nutrition360 was guided by a community-academic team using a participatory approach and included a preparation and two optimization phases to examine different approaches to dietary interventions utilizing the multiphase optimization strategy. Each intervention arm included three different modalities to identify the most feasible delivery method. The intervention was conducted at a community-based, outpatient healthcare center located in Jackson, MS. Eligible participants were between 25 and 50 years old, residents of Jackson metropolitan area, at risk for cardiovascular disease-related premature mortality, and had internet access. Individuals who completed baseline surveys were randomly assigned to an intervention group and then to modality order. Co-primary outcomes were research participant burden and cost-effectiveness and secondary outcomes were attendance, and dietary measures. RESULTS: Thirty-one, African American individuals with a mean age of 40.5 years completed baseline surveys and were randomized to an intervention program. CONCLUSION: The two most feasible and cost-effective interventions will be combined to further test this model's delivery in the real-world setting as part of the next optimization phase. REGISTRATION: ClinicalTrials.gov, NCT06286618. https://clinicaltrials.gov/study/NCT06286618.

The Medicine Wheel as a public health approach to lifestyle management interventions for indigenous populations in North America.

This analytic essay intends to elevate Medicine Wheel, or generally "four directions" teachings, to encourage a more comprehensive alignment of lifestyle intervention components with traditional ecological knowledge systems of Indigenous cultures in North America. North American Medicine Wheels provided people with a way to orient themselves both within their traditional belief systems and to the seasonal changes in their areas, improving survivability. The wheel or circle is a sacred symbol, indicating the continuity and perpetuity of all of life. The four directions are iconized in many Indigenous cultures across North America with different directions representing different aspects of our world and of ourselves, different seasons of the year and of our lives, different beings of the earth and tribes of humans with a balance among those necessary for health and wellbeing. In the context of public health, teachings of the four directions warn that a lack of balance limits our ability to achieve optimal health. While there is much public health success in lifestyle interventions, existing practice is limited by a siloed and one size fits all approach. Medicine Wheel teachings lay out a path toward more holistic and Indigenous-based lifestyle intervention that is modifiable depending on tribal teachings and needs, may appeal to a variety of Indigenous communities and is in alignment with health behavior change theory. It is a public health imperative that lifestyle management interventions are fully optimized to rigorously determine what can be achieved when interventions are implemented in a holistic and Indigenous-based manner, and in alignment with an Indigenous model of health. This more complete alignment would allow for a stronger foundation to further explore and develop social determinants (i.e., housing, employment, etc.) and structural intervention enhancements to inform public health practice and promote health equity.

Passive recruitment reach of a lifestyle management program to address obesity in the deep south during the COVID-19 pandemic.

Obesity is a significant public health concern, especially in the Deep South and in Mississippi where prevalence is among the worst in the nation paired, with other poor health outcomes and socioeconomic conditions. Lifestyle management programs that address modifiable risk factors, such as nutrition and physical activity, can be effective mitigation strategies to halt weight accumulation patterns and ameliorate metabolic risk factors for some populations. However, there is limited evidence regarding the implementation of effective practice models to address obesity risk in underserved and underrepresented populations, such as African Americans, and people in the stage of earlier adulthood. Furthermore, there is growing evidence supporting the impact of the COVID-19 pandemic on lifestyle management programs that should be considered in these populations. The purpose of this manuscript was to describe the development and telehealth implementation of a weight management program during the COVID-19 pandemic and provide a preliminary examination of recruitment strategies and baseline characteristics for enrolled participants. Passive recruitment (social media, web, email, and other media advertisements) resulted in 157 screening initiations, and 79 of those participants met the study inclusion criteria. Further, of the 79 eligible participants, 38 completed all study enrollment requirements and presented with metabolic abnormalities. The study findings add to the emerging body of evidence for how the pandemic may have impacted lifestyle management programs and is representative of an understudied and underrepresented population.

Mississippi INBRE Outreach Scholars program: adapting a summer scholars program to the virtual world amidst the COVID-19 pandemic.

The Mississippi IDeA Networks of Biomedical Research Excellence (INBRE) supported by the National Institute of General Medical Sciences (Grant P20GM103476) launched the new Mississippi INBRE Outreach Scholars (MIOS) summer research program in 2019. The program was designed to offer students community outreach and research experiences related to the study of behavioral and health disparities life sciences. The program was adapted in early 2020 to offer the program in a fully online format in the summer of 2020. This article details the program adaptations and discusses program evaluation data related to scholars' perceptions of program benefits and expectations and their confidence in research-related skills. The program evaluation was a mixed-method approach that included a qualitative postprogram survey and a pre-post quantitative survey. Scholars identified technical and communication skill building and resilience as areas of personal growth. Overall, the program met scholars' expectations for the program and significantly improved their confidence on 8 of the 19 (with confidence interval estimated differences from 0.3 to 2.56, where a difference of 1 is an improvement across 1 anchor on a Likert-type scale) various research-related tasks/skills after completion of the program. The analyses presented demonstrated that a combined qualitative and quantitative analysis approach is useful for examining the extent to which programs such as Mississippi INBRE are meeting goals of providing a rich research experience in health disparities for a diverse student body. Future longitudinal data may be examined to explore the long-term impact of MIOS on career preparation and choices and graduate education.NEW & NOTEWORTHY The Mississippi INBRE Outreach Scholars program is a summer research program for Mississippi college students that was successfully adapted to a fully online environment amidst the coronavirus-19 pandemic.

Key Focus Group Themes to Inform Weight Management Interventions in Deep South African Americans.

OBJECTIVE: To understand African Americans' perceptions, barriers, and facilitators to recruitment, enrollment, adoption, maintenance, and retention in a nutrition and physical activity promotion program. DESIGN: Four focus groups were conducted. SETTING: Two community settings located in Jackson and Hattiesburg, Mississippi. PARTICIPANTS: Participants (n = 28) were aged 18-50 years. MAIN OUTCOME MEASURE(S): Barriers and facilitators associated with healthy eating, physical activity, achieving a healthy weight, and participation in a health behavior change program. ANALYSIS: A conventional thematic content analysis approach includes data familiarization, initial code generation, initial theme generation, themes review, and team review for finalization of themes. RESULTS: Major themes related to health behaviors and participation in a behavior change program were identified by participants, including time constraints, costs, social support, consistency and self-efficacy, motivation for longevity and disease prevention, physical appearance, fear of injury/pain, social norms/stigma associated with outdoor physical activity, body criticism from family members, and having empathic and validating program staff support. CONCLUSIONS AND IMPLICATIONS: Several social determinants of health were identified as essential considerations for promoting healthy nutrition and physical activity behaviors among African American adult Mississippians. Cultural and spiritual implications were also identified. Study insights inform policy approaches for designing culturally appropriate health behavior change programs in the Deep South.

Development and Evaluation of a Measure for Social Support Provided by Friends during Lifestyle Management Programs.

Obesity is a public health crisis that contributes to chronic disease prevalence, morbidity, and mortality. Nutrition and physical activity are risk factors for many chronic diseases including cancer and cardiovascular disease, the leading causes of death in the United States. Lifestyle management programs to address obesity and potential sequelae such as chronic conditions have shown efficacy, with social support an important factor in interventions. Instruments that assess social support specifically provided by friends are lacking but could be important predictors of program success. The purpose of this study was to examine the reliability and validity of the 10-item Social Support to Eat Better and Move More instrument that was developed and designed to measure support from friends that influence dietary and physical activity behaviors during lifestyle management programs. Data were collected during a cross-sectional study using purposive sampling strategies among adult residents of two southern states. Statistical analysis was conducted to examine latent factors, internal consistency, and convergent and predictive validity. These preliminary results indicated that the Social Support to Eat Better and Move More instrument had excellent internal consistency for the overall measure (α = 0.96) as well as for informational support (α = 0.97), emotional support (α = 0.96), and encouragement (α = 0.97). The tool related well to another general social support measure as well as to diet, physical activity, and health-related variables, and it can be a useful measure in lifestyle management studies.

Social determinants of health related to stay-at-home order adherence and social distancing attitudes among a diverse Deep South population.

OBJECTIVE: To describe COVID-19 related symptoms and medical care experienced in the first six months of the pandemic as well as stay-at-home order adherence, and attitudes related to COVID-19 risk and social distancing among a diverse sample of adults in the Deep South. METHODS: Survey data were collected from 411 Louisiana and Mississippi residents for three weeks in June 2020 through social media. RESULTS: Over half (52.5%) of participants who experienced COVID-19 related symptoms (with 41.5% experiencing at least one symptom) did not feel the severity of symptoms warranted seeking medical care. 91.6% of the Deep South adults visited certain places or did activities where visiting or gathering with other people was involved during stay-at-home mandates. Religiosity/spirituality, age, education, number of children in the home, attitudes related to COVID-19 risk of complications and social distancing were related to the greater/lesser likelihood of stay-at-home order adherence. CONCLUSIONS: Various cultural and contextual factors were related to stay-at-home order adherence. Understanding how social values, life stage, socioeconomic, and geographic factors influence stay-at-home order adherence would lead to more effective policy design to improve population adherence.

The church bridge project focus group results: African American perspectives of weight management programs to improve nutrition and physical activity behaviors.

BACKGROUND: The prevalence of obesity is disproportionately high among African Americans in the Southern US. More information is needed about factors that influence participation in nutrition and physical activity programs to promote healthy weight. OBJECTIVE: The purpose of this study is to explore the weight management perceptions of young to middle aged adult African Americans. METHODS: The Church Bridge Project intervention participants were recruited for two focus groups. Qualitative data were recorded, transcribed and a thematic content analysis was conducted to identify major themes. RESULTS: Barriers included technology learning curve/burden and competing priorities. Facilitators included support, limited cost, convenience, and health. Participants perceived the term "weight management" program as overwhelming and defeating. CONCLUSION: The Church Bridge Project model confirmed social support and disease prevention as key factors for weight management. Further work should substantiate social support as a key factor to guide minority health efforts.

Perceived Family Social Support for Healthy Eating Is Related to Healthy Dietary Patterns for Native Americans: A Cross-sectional Examination.

Native Americans continue to suffer health disparities ameliorated by healthy dietary patterns. The study objective was to determine moderating effects of perceived family social support on the relationship between ethnicity and diet behaviors. Dependent variables included dietary variables, and independent variable was family social support for healthy eating. Analyses included Pearson χ and correlation, one-way analysis of variance, and regression tests. Higher social support was related to lower consumption of added sugars, sugar-sweetened beverages, and red/processed meats for Native Americans. More research is needed to confirm the moderating effect of family social support on dietary behaviors.

Handedness and lateralised tympanic membrane temperature in relation to approach-avoidance behaviour in Garnett's bushbaby (Otolemur garnettii).

Studies of handedness suggest a relationship between hemispheric specialisation and emotional processing. Recently measures of lateralised tympanic membrane temperature (TMT) have identified similar relationships (i.e., the left hemisphere is involved in approach behaviour and the right hemisphere avoidance behaviour). In the present study we examined lateralised changes in TMT in response to social interaction in 10 Garnett's bushbabies. Additionally, we examined whether handedness could be used as a predictor of approach-avoidance tendencies. We found a positive association between temperature change and both allogrooming and affiliative approach. Social behaviour did not differ between right- and left-handed bushbabies. These findings are discussed in terms of existing theories of asymmetric emotional processing. Overall, the data suggest that there is a left hemisphere specialisation for processing approach-related behaviours, which is consistent with existing models of lateralised emotional processing. Our data also indicate that TMT is a reliable, cost-effective measure of cerebral activation that is less invasive and more practical than alternative measures such as EEG, PET, and fMRI.

Age-related decline in lateralised prey capture success in Garnett's bushbaby (Otolemur garnettii).

We examined differences in prey capture success when reaching for moving prey with the preferred and non-preferred hand (as determined previously using stationary food items) in 12 Garnett's bushbabies (Otolemur garnettii). Hand preference was determined by a test of simple reaching for stationary food items. We assessed both the frequency of hand use and success rates for each hand in capturing live mealworms. We also examined the effect of age on overall prey capture success. Subjects were individually presented with live mealworms in a cup partially filled with a cornmeal medium. The preferred hand was used significantly more often than the non-preferred hand to obtain the moving prey; however, no differences were found in the frequency of usage of the left vs the right hand. Furthermore, there were no differences in the success rates of the left vs the right hand, nor the preferred vs the non-preferred hand. There was a significant negative correlation between age and prey capture success. These data suggest that age, rather than preferred hand, may be the most relevant factor in the bushbabies' prey capture success.

Is there more to yoga than exercise?

CONTEXT: Yoga is increasing in popularity, with an estimated 15 million practitioners in the United States, yet there is a dearth of empirical data addressing the holistic benefits of yoga. OBJECTIVE: To compare the physical and mental benefits of an exercise-based yoga practice to that of a more comprehensive yoga practice (one with an ethical/spiritual component). DESIGN: Students with mild to moderate depression, anxiety, or stress and who agreed to participate were assigned to one of three groups: integrated yoga, yoga as exercise, control. PARTICIPANTS: A total of 81 undergraduate students 18 years and older at a university in the southeastern United States participated in the study. MAIN OUTCOME MEASURES: Depression, anxiety, stress, hope, and salivary cortisol. RESULTS: Over time, participants in both the integrated and exercise yoga groups experienced decreased depression and stress, an increased sense of hopefulness, and increased flexibility compared to the control group. However, only the integrated yoga group experienced decreased anxiety-related symptoms and decreased salivary cortisol from the beginning to the end of the study. CONCLUSIONS: Yoga, practiced in a more integrated form, ie, with an ethical and spiritual component, may provide additional benefits over yoga practiced as an exercise regimen.

Cognitive function in children with type 1 diabetes: a meta-analysis.

OBJECTIVE: To quantify the magnitude and pattern of cognitive difficulties in pediatric type 1 diabetes as well as the effects associated with earlier disease onset and severe hypoglycemia. RESEARCH DESIGN AND METHODS: Pediatric studies of cognitive function since 1985 were identified for study inclusion using MEDLINE and PsycInfo. Effect size (ES, Cohen's d) between the diabetic and control groups, expressed in SD units, were calculated within cognitive domains to standardize meta-analysis test performance. RESULTS: The meta-analysis sample of 2,144 children consisted of 1,393 study subjects with type 1 diabetes and 751 control subjects from 19 studies. Overall, type 1 diabetes was associated with slightly lower overall cognition (ES -0.13), with small differences compared with control subjects across a broad range of domains, excluding learning and memory, which were similar for both groups. Learning and memory skills, both verbal and visual (-0.28 and -0.25), were more affected for children with early-onset diabetes (EOD) than late-onset diabetes (LOD), along with attention/executive function skills (-0.27). Compared with nondiabetic control subjects, EOD effects were larger, up to one-half SD lower, particularly for learning and memory (-0.49). Generally, seizures were associated with a negligible overall cognition ES of -0.06, with slight and inconsistent cognitive effects found on some measures, possibly reflecting the opposing effects of poorer versus better metabolic control. CONCLUSIONS: Pediatric diabetes generally relates to mildly lower cognitive scores across most cognitive domains. Cognitive effects are most pronounced and pervasive for EOD, with moderately lower performance compared with control subjects. Seizures are generally related to nominal, inconsistent performance differences.

Skew and internal consistency.

The effects of skew on the standardized item alpha were examined with Monte Carlo techniques. Alphas computed from normal variables were compared with alphas from lognormal variables, ranks, and skewed versus normal Likert-type variables. The extent and direction of skew were varied, as was the size of the population interitem correlation (rho), the number of items, and the number of categories for Likert-type variables. Because the average interitem correlation affects alpha and skew affects the average interitem correlation, the effect of skew on the average interitem correlation also was examined. Results indicated that skew decreased the average interitem correlation and produced small decreases in alpha that were largest when skew was large, rho was small, items were skewed in opposite directions, and there were fewer items.

Cortisol response to relocation stress in Garnett's bushbaby (Otolemur garnettii).

Relocation of research animals, either within a facility or from one facility to another, is assumed to be stressful. Development of appropriate research methodologies may be facilitated by understanding the extent and duration of the physiological response to relocation stress and whether the stress can be buffered by environmental or social factors, such as the presence of a cagemate. To characterize the response to relocation stress in Garnett's bushbaby, we assessed cortisol concentrations in nine female and six male bushbabies during relocation to a different facility; six of the animals were pair-housed at the time of the move and were moved with their respective cagemates. Fecal cortisol was assessed at three time points: 1) baseline (1 day prior to moving); 2) relocation (the day the animals were relocated); and 3) post-relocation (7 days after relocation). Cortisol concentrations were higher at the relocation time point than at baseline and post-relocation, which did not differ. Cortisol concentration did not differ as a function of having a cagemate during relocation. Although relocation resulted in a significant (P < 0.05) increase in cortisol excretion concentration, the levels returned to baseline within 7 days after the stressor.

Diverse research on alcohol and aggression in humans: in memory of John A. Carpenter.

This article summarizes the proceedings of a symposium, chaired and co-organized by Helene Raskin White and co-organized by Peter R. Giancola, that was presented at the 2002 RSA Meeting in San Francisco. The goal of this symposium was to integrate findings from methodologically divergent studies on the topic of alcohol-related aggression in humans. The investigators focused on isolating mediators and moderators of the alcohol-aggression relationship. Peter R. Giancola presented laboratory data demonstrating how alcohol's acute effects on aggression are moderated by individual difference and contextual factors. Mitchell E. Berman presented laboratory data on alcohol's acute effects on self-induced aggression. Helene Raskin White reviewed prospective data on how alcohol affects the intergenerational transmission of family violence. Stephen Chermack reviewed data on the impact of a family history of alcoholism and a family history of violence on the development of childhood behavioral problems and adult problems with drugs, alcohol, and violence. Finally, Kenneth E. Leonard presented data on personal and contextual factors influencing alcohol-related barroom violence.