Black Veterans Experiences with and Recommendations for Improving Weight-Related Health Care: A Photovoice Study.

BACKGROUND: Non-Hispanic Black or African American (hereafter Black) veterans lose less weight than other users of the Veterans Health Administration's (VHA) weight management program (MOVE!), despite higher enrollment. OBJECTIVE: To understand factors that affect weight loss disparities between Black veterans and other veterans. DESIGN: Qualitative study using Photovoice methods. PARTICIPANTS: Self-identified Black veterans in MOVE! across the USA (two women, seven men). APPROACH: We conducted six virtual Photovoice sessions with Black veterans. Session one provided orientation to the goal of understanding factors that might affect weight loss disparities. Participants chose missions related to weight management and VHA care, bringing photos or other media (e.g., poems) to discuss during remaining sessions. Facilitators/participants identified themes related to each session in real time. Between and after sessions, facilitators/investigators conducted rapid qualitative analysis of transcripts/audio to group similar themes, identify illustrative quotes/photos/other media, and prepare dissemination products (e.g., this manuscript). Participants provided feedback on the manuscript during an additional session. KEY RESULTS: Themes were identified across three categories: (1) Food in Our Lives and Health Care; (2) Body Image; and (3) Healthcare Bias and Discrimination. The emotional impact of food and the negative effects of bias and discrimination on health care quality and trust were especially salient. Participants provided recommendations for weight-related and general care. Notable recommendations included the need for VHA to hire and retain providers-especially Black providers-who understand and respect Black patients and are committed to delivering evidence-based, culturally sensitive care. In addition, weight management care should be tailored to individual patients' diets and health beliefs and deemphasize body mass index. CONCLUSIONS: Photovoice resulted in concrete targets that could reduce health disparities. Institutions should consider Photovoice and similar approaches to build trust with and incorporate input from marginalized communities. This approach requires sustained commitment from leaders to engage stakeholders and implement solutions.

The propensity to sign-track is associated with externalizing behavior and distinct patterns of reward-related brain activation in youth.

Externalizing behaviors in childhood often predict impulse control disorders in adulthood; however, the underlying bio-behavioral risk factors are incompletely understood. In animals, the propensity to sign-track, or the degree to which incentive motivational value is attributed to reward cues, is associated with externalizing-type behaviors and deficits in executive control. Using a Pavlovian conditioned approach paradigm, we quantified sign-tracking in 40 healthy 9-12-year-olds. We also measured parent-reported externalizing behaviors and anticipatory neural activations to outcome-predicting cues using the monetary incentive delay fMRI task. Sign-tracking was associated with attentional and inhibitory control deficits and the degree of amygdala, but not cortical, activation during reward anticipation. These findings support the hypothesis that youth with a propensity to sign-track are prone to externalizing tendencies, with an over-reliance on subcortical cue-reactive brain systems. This research highlights sign-tracking as a promising experimental approach delineating the behavioral and neural circuitry of individuals at risk for externalizing disorders.

Treatment receipt patterns among individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders.

OBJECTIVE: To determine latent classes of treatment receipt among people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) and describe each class by demographics, disease characteristics, and psychiatric diagnoses. METHOD: Participants were National Epidemiologic Survey on Alcohol and Related Conditions-III respondents with lifetime PTSD and SUD (n = 1,349; mean age 40.3; 62.5% female; 30.9% non-White or Hispanic-White). Cross-sectional data were collected using the DSM-5 Alcohol Use Disorder and Associated Disabilities Interview Schedule. Latent class analysis was used to identify subgroups of participants with different patterns of treatment receipt. RESULTS: Of the patients, 36% received at least 1 SUD treatment while 84% received at least 1 mental health (MH) treatment. Six latent classes were identified: no treatment (17.3%), outpatient MH (34.0%), outpatient + inpatient MH (17.9%), SUD (7.3%), SUD + outpatient MH (15.7%), and SUD + outpatient MH + inpatient MH (7.7%). The SUD treatment classes evidenced greater social instability, had higher alcohol use disorder symptom severity, and used more drug types than the non-SUD classes. Classes receiving inpatient MH treatment had a greater incidence of additional comorbid conditions and suicidal behaviors. Across all 6 classes, most respondents met diagnostic criteria for chronic PTSD (overall: 68.9%) while fewer met diagnostic criteria for chronic SUD (overall: 38.7%). CONCLUSIONS: Most people with lifetime PTSD and SUD have sought either SUD or MH treatment or both, with substantially greater receipt of MH treatment. This comorbid group has complex clinical presentations that differ depending upon treatment subgroup, and for most, their PTSD persisted despite high rates of treatment engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Weight-Related Differences in Salience, Default Mode, and Executive Function Network Connectivity in Adolescents.

OBJECTIVE: The current study examined whether adolescents with weight status ranging from lean to obesity showed weight-related differences in the default mode network (DMN), the executive function network (EFN), and the salience network (SN). METHODS: One hundred sixty-four adolescents participated in a resting-state functional connectivity scan. A general linear model was used to examine differences in scan patterns among adolescents with lean weight, overweight, and obesity. RESULTS: Adolescents with obesity compared with those with lean weight showed stronger within-SN connectivity among the medial orbitofrontal cortex, olfactory tubercle, and pallidum; however, they showed lower connectivity between the amygdala and SN regions (nucleus accumbens, thalamus, putamen). Those with obesity also showed lower connectivity between SN (amygdala, caudate) and DMN (parahippocampus, hippocampus, precuneus) regions. Adolescents with obesity compared with those with lean weight showed lower connectivity between SN (medial orbitofrontal cortex) and EFN (ventrolateral prefrontal cortex) regions. CONCLUSIONS: Obesity appears to be related to stronger connectivity within and between regions implicated in determining the salience of stimuli, which may have implications for reward processing. Lower connectivity between SN and EFN regions may suggest that executive-control efforts are going "off-line" when salience and reward-processing regions are engaged in adolescents who have obesity.

The 5As team patient study: patient perspectives on the role of primary care in obesity management.

BACKGROUND: Over 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients' perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this perspective, and more effective management strategies. METHODS: Qualitative study employing semi-structured interviews and thematic analysis, with a sample of 28 patients from a cohort of 255 patients living with obesity and receiving care to support their weight management in a large Primary Care Network of family practices in Alberta. RESULTS: Four illustrative themes emerged: (1) the patient-physician relationship plays an important role in the adequacy of obesity management; (2) patients have clear expectations of substantive conversations with their primary care team; (3) complex conditions affect weight and patients require assistance tailored to individual obesity drivers; (4) current services provide support in important ways (accessibility, availability, accountability, affordability, consistency of messaging), but are not yet meeting patient needs for individual plans, advanced education, and follow-up opportunities. CONCLUSIONS: Patients have clear expectations that their primary care physician asks them about weight within a supportive therapeutic relationship. They see obesity as a complex phenomenon with multiple drivers. They want their healthcare providers to assess and address their root causes - not simplistic advice to "eat less, move more". Patients felt that the current services were positive resources, but expressed needs for tailored weight management plans, and longer-term follow-up.