Publications by authors named "Jamie L Crandell"

41 Publications

Improved individual and population-level HbA1c estimation using CGM data and patient characteristics.

J Diabetes Complications 2021 08 17;35(8):107950. Epub 2021 May 17.

Department of Management Science and Engineering, Stanford School of Engineering, Stanford, CA, USA; Division of Pediatric Endocrinology, Stanford School of Medicine, Stanford, CA, USA; Lucile Packard Children's Hospital, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford School of Medicine, Stanford, CA, USA; Clinical Excellence Research Center, Stanford School of Medicine, Stanford, CA, USA. Electronic address:

Machine learning and linear regression models using CGM and participant data reduced HbA1c estimation error by up to 26% compared to the GMI formula, and exhibit superior performance in estimating the median of HbA1c at the cohort level, potentially of value for remote clinical trials interrupted by COVID-19.
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http://dx.doi.org/10.1016/j.jdiacomp.2021.107950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316291PMC
August 2021

Post-traumatic stress disorder symptoms in non-muscle-invasive bladder cancer survivors: A population-based study.

Urol Oncol 2021 04 8;39(4):237.e7-237.e14. Epub 2020 Dec 8.

School of Nursing, Duke University, Durham, NC.

Objective: This cross-sectional study examined the prevalence of post-traumatic stress disorder (PTSD) and identified the predictive factors associated with PTSD symptoms in a population of non-muscle-invasive bladder cancer (NMIBC) survivors.

Methods: A random sample of 2,000 NMIBC survivors, identified through the North Carolina Central Cancer Registry, were sent postal mail survey. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics and hierarchical multiple linear regression were used to examine the prevalence of PTSD and to identify the factors associated with PTSD.

Results: A total of 376 participants were included in the analysis. The average PCL-5 score was 7.1 (standard deviation [SD] = 10.9, range: 0-66), where higher scores represent higher levels of PTSD symptoms. The prevalence of the provisional PTSD diagnosis was 5.3% or 6.9% (after adjusting for nonresponse). In addition, 28.7% of participants met criteria for at least one PTSD symptom cluster. After controlling for other variables, participants who were younger, had active disease or unsure of status, had more comorbidities, had lower social support, and had higher cognitive concerns reported significantly higher PTSD symptoms.

Conclusion: More than one-fourth of NMIBC survivors had PTSD symptoms. Thus, healthcare providers should assess PTSD symptoms and provide supportive care for NMIBC survivors in the survivorship phase of care.
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http://dx.doi.org/10.1016/j.urolonc.2020.11.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956138PMC
April 2021

Evaluation of a Serious Video Game to Facilitate Conversations About Human Papillomavirus Vaccination for Preteens: Pilot Randomized Controlled Trial.

JMIR Serious Games 2020 Dec 3;8(4):e16883. Epub 2020 Dec 3.

Department of Pediatrics, Children's of Alabama, University of Alabama, Birmingham, AL, United States.

Background: In the United States, the most common sexually transmitted infection, human papillomavirus (HPV), causes genital warts and is associated with an estimated 33,700 newly diagnosed cancer cases annually. HPV vaccination, especially for preteens aged 11 to 12 years, is effective in preventing the acquisition of HPV and HPV-associated cancers. However, as of 2018, completion of the 2- or 3-dose HPV vaccination series increased only from 48.6% to 51.1% in teens aged 13 to 17 years, and this increase was observed only in boys. By comparison, 88.7% of teens had more than one dose of the recommended vaccine against tetanus, diphtheria, and acellular pertussis (Tdap), and 85.1% of teens had more than one dose of meningococcal vaccine. Immunizations for Tdap, meningococcal disease, and HPV can occur at the same clinical visit but often do not.

Objective: Vaccination against HPV is recommended for routine use in those aged 11 to 12 years in the United States, yet it is underutilized. We aimed to develop an educational video game to engage preteens in the decision to vaccinate.

Methods: Land of Secret Gardens is a metaphor for protecting seedlings (body) with a potion (vaccine). We screened 131 dyads of parents and preteens from 18 primary practices in North Carolina who had not initiated HPV vaccination. We measured vaccination intentions, story immersion, and game play and documented HPV vaccination rates. A total of 55 dyads were enrolled, and we randomly assigned 28 (21 completed) to play the game and 27 (26 completed) to the comparison group.

Results: In total, 18 preteens reported playing the game. The vaccination self-efficacy score was higher in the comparison group than the intervention group (1.65 vs 1.45; P=.05). The overall mean decisional balance score trended toward greater support of vaccination, although differences between the groups were not significant.. Vaccine initiation and completion rates were higher in the intervention group (22% vs 15%; P=.31) than in the comparison group (9% vs 2%; P=.10), although the difference was not significant.

Conclusions: Video games help preteens in the decision to pursue HPV vaccination. A serious video game on HPV vaccination is acceptable to parents and preteens and can be played as intended. Gamification is effective in increasing preteen interest in HPV vaccination, as game features support decision making for HPV vaccination.

Trial Registration: ClinicalTrials.gov NCT04627298; https://www.clinicaltrials.gov/ct2/show/NCT04627298.
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http://dx.doi.org/10.2196/16883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746502PMC
December 2020

Association between diet quality indices and arterial stiffness in youth with type 1 diabetes: SEARCH for Diabetes in Youth Nutrition Ancillary Study.

J Diabetes Complications 2020 12 21;34(12):107709. Epub 2020 Aug 21.

The Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States of America. Electronic address:

Aims: We studied the association of three distinct diet quality indices and two measures of arterial stiffness in youth and young adults (YYA) aged 10 to 30 with T1D.

Methods: Cross-sectional (n = 1421) and longitudinal (n = 520) analyses were conducted in T1D YYA participating in the SEARCH for Diabetes in Youth Study. The diet quality indices included the Dietary Approaches to Stop Hypertension (DASH) index, the Healthy Eating Index 2015 (HEI-2015), and a modified Mediterranean Diet Quality Index (mKIDMED). Arterial stiffness was measured with pulse wave velocity (PWV) and augmentation index (AIx) obtained using a SphygmoCor-Vx device and tonometer.

Results: Average diet quality was moderate to poor, with mean scores of 41 (DASH, range 0-80), 55 (HEI-2015, range 0-100), 3.7 (mKIDMED, range - 3-12). None of the diet quality scores was associated with the central PWV or Aix, independent of demographic, clinical and lifestyle factors, body mass index and HbA1c. Longitudinal data yielded consistent findings with cross-sectional results.

Conclusions: This study suggests that diet quality may not function as an independent risk factor for arterial stiffening in YYA with T1D. These findings do not diminish the importance of consuming a quality diet for the management of diabetes, as demonstrated in previous work.
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http://dx.doi.org/10.1016/j.jdiacomp.2020.107709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673264PMC
December 2020

An Approach for Examining the Impact of Food Group-Based Sources of Nutrients on Outcomes with Application to PUFAs and LDL in Youth with Type 1 Diabetes.

Nutrients 2020 Mar 28;12(4). Epub 2020 Mar 28.

Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.

Traditionally, nutritional epidemiologists have utilized single nutrient or dietary pattern approaches to examine diet-health relationships. However, the former ignores that nutrients are consumed from foods within dietary patterns, and, conversely, dietary patterns may provide little information on mechanisms of action. Substitution provides a framework for estimating diet-health relationships while holding some nutrient intakes constant. We examined substitution effects of polyunsaturated fatty acids (PUFAs) in the SEARCH Nutrition Ancillary Study in the context of food group source. PUFAs were calculated from fatty acids 18:3, 20:5, and 22:6 (-3), and 18:2 and 20:4 (-6) from a food frequency questionnaire, quantified by food group. Models were adjusted for other fat intake, carbohydrates, protein, age, race, gender, and diabetes duration. Participants ( = 1441) were 14 years old on average, 51% female, with type 1 diabetes for 3.6 years. Mean intake of PUFAs was 14.9 g/day, and the highest PUFA sources were nonsolid fats, nuts, grains, red/processed meats, sweets/desserts, and high-fat chicken. PUFAs from nuts were inversely associated with low-density lipoprotein cholesterol (LDL) ( = 0.03) and PUFAs from high-fat chicken were positively associated with LDL ( < 0.01). Substituting nuts for chicken was associated with -7.4 mg/dL in LDL. These findings illustrate the importance of considering food group-based sources of nutrients when examining diet-health relationships.
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http://dx.doi.org/10.3390/nu12040941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230845PMC
March 2020

Perceptions and Behaviors Related to Contraceptive Use in the Postpartum Period Among Women With Pregestational Diabetes Mellitus.

J Obstet Gynecol Neonatal Nurs 2020 03 14;49(2):154-166. Epub 2020 Jan 14.

Objective: To describe perceptions and behaviors related to contraception and preconception care and to test the association between these perceptions and contraceptive use in the postpartum period among women with pregestational diabetes mellitus.

Design: Cross-sectional, descriptive survey.

Setting: Three high-risk obstetric clinics in the Southeastern United States.

Participants: Fifty-five women who were 18 years or older with pregestational Type 1 or Type 2 diabetes mellitus.

Methods: Between 4 and 8 weeks after birth, we used investigator-developed items and psychometrically validated scales to measure participants' perceptions and behaviors related to contraception and preconception care. We dichotomized use of contraception in the postpartum period as procedure/prescription or nonprescription/no method. We used multiple logistic regression to test the hypothesis that perceptions are associated with contraceptive use.

Results: When data were collected 4 to 8 weeks after birth, almost half (49%, n = 27) of the participants had resumed sexual activity; however, most (95%, n = 52) did not want another pregnancy in the next 18 months. Fifty-six percent (n = 31) of participants used procedure/prescription contraception, and 44% (n = 24) used nonprescription/no method. Those who perceived contraception use and preconception care to be beneficial were more likely to use procedure/prescription contraception (adjusted odds ratio = 1.52; 95% confidence interval [1.07, 2.17]).

Conclusion: When caring for women in the postpartum period, providers should be mindful that women's perceptions of the benefits of contraception and preconception care may have implications for whether their use aligns with their reproductive goals and optimizes outcomes for future pregnancies.
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http://dx.doi.org/10.1016/j.jogn.2019.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909000PMC
March 2020

Health-related quality of life among non-muscle-invasive bladder cancer survivors: a population-based study.

BJU Int 2020 01 25;125(1):38-48. Epub 2019 Sep 25.

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Objective: To examine the effect of non-muscle-invasive bladder cancer (NMIBC) diagnosis and treatment on survivors' quality of life (QoL).

Patients And Methods: Of the 5979 patients with NMIBC diagnosed between 2010 and 2014 in North Carolina, 2000 patients were randomly selected to be invited to enroll in this cross-sectional study. Data were collected by postal mail survey. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core (QLQ-C30) and the NMIBC-specific module were included in the survey to measure QoL. Descriptive statistics, t-tests, anova, and Pearson's correlation were used to describe demographics and to assess how QoL varied by sex, cancer stage, time since diagnosis, and treatment.

Results: A total of 398 survivors returned questionnaires (response rate: 23.6%). The mean QoL score for QLQ-C30 (range 0-100, higher = better QoL in all domains but symptoms) for global health status was 73.6, function domain scores ranged from 83.9 to 86.5, and scores for the top five symptoms (insomnia, fatigue, dyspnoea, pain, and financial difficulties) ranged from 14.1 to 24.3. The lowest NMIBC-specific QoL domain was sexual issues including sexual function, enjoyment, problems, and intimacy. Women had worse bowel problems, sexual function, and sexual enjoyment than men but better sexual intimacy and fewer concerns about contaminating their partner. Stage Ta had the highest global health status, followed by T1 and Tis. QoL did not vary by time since diagnosis except for sexual function. The cystectomy group (n = 21) had worse QoL in sexual function, discomfort with sexual intimacy, sexual enjoyment, and male sexual problems than the non-cystectomy group (n = 336).

Conclusion: Survivors of NMIBC face a unique burden associated with their diagnosis and the often-lifelong surveillance and treatment regimens. The finding has important implications for the design of tailored supportive care interventions to improve QoL for NMIBC survivors.
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http://dx.doi.org/10.1111/bju.14888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137766PMC
January 2020

Body Mass Index Z-Score Modifies the Association between Added Sugar Intake and Arterial Stiffness in Youth with Type 1 Diabetes: The Search Nutrition Ancillary Study.

Nutrients 2019 Jul 30;11(8). Epub 2019 Jul 30.

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.

The relationship between added sugar and arterial stiffness in youth with type 1 diabetes (T1D) has not been well-described. We used data from the SEARCH for Diabetes in Youth Study (SEARCH), an ongoing observational cohort study, to determine the association between added sugar and arterial stiffness in individuals diagnosed with T1D <20 years of age ( = 1539; mean diabetes duration of 7.9 ± 1.9 years). Added sugar intake was assessed by a food frequency questionnaire, and arterial stiffness measures included pulse wave velocity (PWV) and augmentation index. Separate multivariate linear regression models were used to evaluate the association between added sugar and arterial stiffness. Separate interaction terms were included to test for effect modification by body mass index (BMI) z-score and physical activity (PA). Overall, there was no association between added sugar and arterial stiffness ( > 0.05); however, the association between added sugar and arterial stiffness differed by BMI z-score ( for interaction = 0.003). For participants with lower BMI z-scores, added sugar intake was positively associated with PWV trunk measurements, whereas there was no association for those who had a higher BMI z-score. PA did not significantly modify the association between added sugar and arterial stiffness. Further research is needed to determine the longitudinal relationship and to confirm that obesity differentially affects this association.
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http://dx.doi.org/10.3390/nu11081752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723563PMC
July 2019

Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample.

J Midwifery Womens Health 2019 Jan 12;64(1):36-45. Epub 2018 Dec 12.

Introduction: Although elevated blood glucose is associated with adverse maternal and fetal health outcomes, evidence suggests that women with diabetes may not be receiving comprehensive reproductive health care, including family planning and preconception care. Using a population-based sample, we evaluated the relationship between contraceptive use and biomarker-identified diabetes.

Methods: This cross-sectional study used data from 5548 women in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007 to 2009. Women were aged 24 to 32 years, sexually active with men, and not pregnant. Hemoglobin A1C identified prediabetes and diabetes from blood specimens. The primary outcome was most effective contraception used in the past year: more effective (sterilization, intrauterine device, implant, combined hormonal methods, or injectable), less effective (condoms, diaphragms, spermicides, natural family planning, or withdrawal), or none. Multinomial regression models were adjusted for race and ethnicity, education, insurance, health care access, and body mass index.

Results: Of the women with diabetes, 37.6% used more effective contraception, 33.6% less effective contraception, and 28.8% none. Women with diabetes had higher odds of using no contraception, rather than more effective contraception, than women with normoglycemia (adjusted odds ratio [aOR], 1.90; 95% CI, 1.25-2.87). Women with diabetes who were undiagnosed had greater odds of using less effective contraception, rather than more effective contraception, compared with those who were diagnosed (aOR 3.39; 95% CI, 1.44-7.96). Contraceptive use did not differ between women with prediabetes and normoglycemia.

Discussion: Less effective contraceptive methods were commonly used by women with diabetes. Midwives and other women's health care providers can support women with diabetes to reach their pregnancy goals by providing preconception care and family planning.
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http://dx.doi.org/10.1111/jmwh.12936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351213PMC
January 2019

Quality of Life in Non-Muscle-Invasive Bladder Cancer Survivors: A Systematic Review.

Cancer Nurs 2019 May/Jun;42(3):E21-E33

Author Affiliations: School of Nursing (Drs Jung, Crandell, Palmer, Bryant, and Mayer), School of Medicine (Dr Nielsen), and Lineberger Comprehensive Cancer Center (Drs Nielsen, Bryant, and Mayer), The University of North Carolina at Chapel Hill; and School of Nursing, Duke University, Durham, North Carolina (Dr Smith).

Background: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 75% of newly diagnosed patients with bladder cancer. Non-muscle-invasive bladder cancer survivors have unique chronic burdens including frequent recurrences, repeated surveillance cystoscopies and treatments, and the highest lifetime medical cost per person among all cancers.

Objective: The purpose of this study was to summarize studies assessing quality of life (QOL) in NMIBC survivors.

Methods: The literature from January 2005 to March 2017 found in PubMed, CINAHL, and PsycINFO databases was reviewed systematically. Inclusion criteria were as follows: (1) research about NMIBC survivors, (2) outcomes included QOL, (3) original research article published in peer-reviewed journals, and (4) published in English.

Results: A total of 15 studies were included: 14 quantitative studies and 1 mixed-methods study. Non-muscle-invasive bladder cancer survivors had significantly lower QOL compared with the general population, especially in fatigue, physical and role functioning, and mental health. Repeated transurethral resections and intravesical treatments were associated with impaired physical function and mental health. Most NMIBC survivors had concerns of urinary and bowel problems and sexual function.

Conclusion: Despite a good prognosis, NMIBC and its treatment have a significant impact on QOL in survivors. The findings showed large burdens in NMIBC survivors and suggest that further research is needed to better understand potential opportunities to improve QOL in this population.

Implications For Practice: Oncology nurses are in the critical position for assessing symptoms and concerns. Oncology nurses should pay special attention to NMIBC survivors who have unique symptoms and burden with the aim of improving survivors' QOL.
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http://dx.doi.org/10.1097/NCC.0000000000000606DOI Listing
March 2020

Racial/Ethnic Disparities in Diabetes Diagnosis and Glycemic Control Among Women of Reproductive Age.

J Womens Health (Larchmt) 2018 10 14;27(10):1271-1277. Epub 2018 May 14.

4 Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill , School of Medicine, Chapel Hill, North Carolina.

Background: Types 1 and 2 diabetes mellitus complicate pregnancies and threaten the health of women of reproductive age and their children. Among older adults, diabetes morbidity disproportionately burdens racial/ethnic minorities, but diabetes emergence among younger adults has not been as well characterized. The objective of this study was to describe the distribution of diagnosed diabetes, undiagnosed diabetes, suboptimal preconception glycemic control, and prediabetes among women of reproductive age across racial/ethnic backgrounds.

Materials And Methods: We analyzed data collected in 2007-2008 from 6774 nonpregnant women, ages 24-32, in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Prediabetes and undiagnosed diabetes were identified by fasting glucose and glycosylated hemoglobin (A1C) and diagnosed diabetes by self-report or antihyperglycemic medication use. We used multinomial regression models to predict prediabetes or diabetes versus normoglycemia. Within women with diabetes, we used logistic regression to predict those being undiagnosed and having suboptimal preconception glycemic control based on A1C.

Results: The estimated prevalence of diabetes was 6.8%, of which 45.3% was undiagnosed. Diabetes prevalence varied by race/ethnicity (p < 0.001): 15.0% of non-Hispanic black women (75.6% undiagnosed), 7.5% of Hispanic women (48.1% undiagnosed), 4.8% of non-Hispanic white women (22.8% undiagnosed), and 4.5% of Asian women (11.4% undiagnosed). The prevalence of prediabetes was highest in non-Hispanic black (38.5%), followed by Hispanic (27.8%), Asian (25.1%), Native American (20.3%), and non-Hispanic white (16.6%) women.

Conclusions: Racial/ethnic disparities exist among women of reproductive age with prediabetes and diabetes. Meeting their healthcare needs requires addressing health inequities and coordination of diabetes management with reproductive health.
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http://dx.doi.org/10.1089/jwh.2017.6845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205045PMC
October 2018

Parenting behaviors and the well-being of children with a chronic physical condition.

Fam Syst Health 2018 Mar 27;36(1):45-61. Epub 2017 Nov 27.

School of Nursing, University of North Carolina at Chapel Hill.

Introduction: Numerous studies have identified the importance of parenting behaviors to the well-being of children with chronic physical conditions. Synthesizing the findings of these studies has potential to identify which parenting behaviors are associated with specific aspects of child well-being.

Method: We retrieved research reports addressing the relationship between parenting behaviors and well-being in children with chronic physical conditions, and categorized parenting behaviors based on Skinner, Johnson, and Snyder's (2005) core dimensions of parenting (warmth, rejection, structure, chaos, autonomy support, and coercion) Through meta-analysis, we examined relationships between parenting dimension and child well-being variables.

Results: Fifty-four reports from 47 unique studies met inclusion criteria. Parent warmth was associated with less child depression, better quality of life, better physical functioning, and fewer externalizing behavior problems. Parent rejection was associated with more child depression, internalizing/externalizing behavior problems, and poorer physical functioning. Parent structure was associated with better child physical functioning. Parent chaos was associated with poorer child physical functioning. Parent autonomy support was associated with better quality of life and fewer externalizing behavior problems. Parent coercion was associated with more child depression, poorer quality of life, poorer physical function, and more internalizing behavior problems.

Conclusion: The results identify multiple, potentially modifiable parenting dimensions associated with well-being in children with a chronic condition, which could be targeted in developing family-focused interventions. They also provide evidence that research using Skinner's core dimensions could lead to conceptualization and study of parenting behaviors in ways that would enable comparison of parenting in a variety of health and sociocultural contexts. (PsycINFO Database Record
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http://dx.doi.org/10.1037/fsh0000305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880719PMC
March 2018

Immunization effects of a communication intervention to promote preteen HPV vaccination in primary care practices.

Vaccine 2018 01 21;36(1):122-127. Epub 2017 Nov 21.

NC Child Health Research Network, Division of General Pediatrics and Adolescent Medicine, CB # 7225, 231 MacNider, University of North Carolina, Chapel Hill, NC 27599, United States. Electronic address:

Objectives: HPV vaccination at the recommended ages of 11-12 is highly effective yet has stalled well below the goal of 80% of the population. We evaluated a statewide practice-based communication intervention (tools: brochures, posters, online training for providers and resources for parents, video game for preteens) to persuade parents, preteens and providers to vaccinate against HPV. The 9-month intervention started May 1, 2015.

Methods: We compared vaccine initiation and completion rates over three 9-month periods (baseline, intervention, post-intervention) between practices enrolled in the intervention and a comparable comparison group. All practices reported to the North Carolina Immunization Registry (NCIR) and had at least 100 11- and 12-year-olds who had not completed the HPV vaccine series. Of 175 eligible practices, the 14 intervention practices included 19,398 individuals and the 161 comparison practices included 127,896 individuals. An extended Cox model was used to test the intervention effect.

Results: The intervention had a significant effect on both initiation and completion during the intervention and post-intervention periods; the estimated hazard ratio (HR) for initiation was 1.17 (p = .004) during the intervention and 1.11 (p = .005) post-intervention. Likewise, completion during the intervention period was 17% higher in intervention practices, after controlling for baseline differences. This effect increased in the post-intervention period to 30% higher (p = .03).

Conclusions: Individuals in the intervention practices were 17% more likely to initiate and complete HPV vaccination than in the comparison practices during the intervention period and the effect was sustained post-intervention. This intervention is promising for increasing rates of HPV vaccination at ages 11-12.
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http://dx.doi.org/10.1016/j.vaccine.2017.11.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725272PMC
January 2018

Vitamin D and Albuminuria in Youth with and without Type 1 Diabetes.

Horm Res Paediatr 2017 29;87(6):385-395. Epub 2017 May 29.

Department of Pediatrics, University of Washington, Seattle, Washington, USA.

Background/aims: In adults, lower vitamin D has been associated with increased albuminuria. This association has not been extensively studied in youth with or without type 1 diabetes.

Methods: We examined the cross-sectional association between vitamin D and albuminuria (urine albumin to creatinine ratio ≥30 mg/g) in 8,789 participants of the National Health and Nutrition Survey 2001-2006 (NHANES), who were 6-19 years old. Further, we examined the association between vitamin D and albuminuria in 938 participants from the SEARCH Nutritional Ancillary Study (SNAS), a longitudinal cohort of youth with type 1 diabetes.

Results: Of the NHANES participants, 5.3, 19.5, and 53.7% had vitamin D levels <30, 50 and 80 nmol/L, respectively. Albuminuria was present in 12.8% and was more common in younger children, females, non-Hispanic whites, non-obese children, and children with hypertension. After adjustments, there was no association between vitamin D and albuminuria. Among the SNAS participants with type 1 diabetes, we also found no association between baseline vitamin D and subsequent albuminuria in unadjusted or adjusted analyses.

Conclusion: We did not find an association between serum vitamin D and albuminuria in either non-diabetic youth or those with type 1 diabetes. Further research is needed to more fully understand this relationship.
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http://dx.doi.org/10.1159/000475711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568007PMC
April 2018

Dietary intake and risk of non-severe hypoglycemia in adolescents with type 1 diabetes.

J Diabetes Complications 2017 Aug 20;31(8):1340-1347. Epub 2017 Apr 20.

Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. Electronic address:

Aims: To determine the association between dietary intake and risk of non-severe hypoglycemia in adolescents with type 1 diabetes.

Methods: Type 1 adolescents from a randomized trial wore a blinded continuous glucose monitoring (CGM) system at baseline for one week in free-living conditions. Dietary intake was calculated as the average from two 24-h dietary recalls. Non-severe hypoglycemia was defined as having blood glucose <70mg/dL for ≥10min but not requiring external assistance, categorized as daytime and nocturnal (11PM-7AM). Data were analyzed using logistic regression models.

Results: Among 98 participants with 14,277h of CGM data, 70 had daytime hypoglycemia, 66 had nocturnal hypoglycemia, 55 had both, and 17 had neither. Soluble fiber and protein intake were positively associated with both daytime and nocturnal hypoglycemia. Glycemic index, monounsaturated fat, and polyunsaturated fat were negatively associated with daytime hypoglycemia only. Adjusting for total daily insulin dose per kilogram eliminated all associations.

Conclusions: Dietary intake was differentially associated with daytime and nocturnal hypoglycemia. Over 80% of type 1 adolescents had hypoglycemia in a week, which may be attributed to the mismatch between optimal insulin dose needed for each meal and actually delivered insulin dose without considering quality of carbohydrate and nutrients beyond carbohydrate.

Clinical Trial Registration: ClinicalTrials.gov identifier: NCT01286350.
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http://dx.doi.org/10.1016/j.jdiacomp.2017.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526710PMC
August 2017

The Nature of Family Engagement in Interventions for Children With Chronic Conditions.

West J Nurs Res 2017 05 5;39(5):690-723. Epub 2016 Sep 5.

1 The University of North Carolina at Chapel Hill, NC, USA.

Recognizing the bi-directional relationship between family functioning and child well-being in the context of childhood chronic conditions, researchers have tested family-focused interventions aimed at promoting both child and family well-being through improving the family's condition management capacity. Based on a sample of 70 interventions for families in which there was a child with a chronic physical condition, this analysis examined the nature of family engagement in the interventions. Data were extracted from the intervention reports using a standardized template; conventional content analysis was used to describe family engagement. Interventions varied in focus, structure, and level of family engagement. Investigators most often sought to improve condition control or management, with parent engagement focused on improving capacity to manage the treatment regimen. Few investigators addressed capacity building in the context of family functioning. Recommendations are made for reporting standards for family-focused interventions and for enhancing the family systems grounding of interventions.
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http://dx.doi.org/10.1177/0193945916664700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581947PMC
May 2017

Family Functioning and the Well-Being of Children With Chronic Conditions: A Meta-Analysis.

Res Nurs Health 2016 08 29;39(4):229-43. Epub 2016 Apr 29.

Frances Hill Fox Distinguished Professor, School of Nursing, University of North Carolina, Chapel Hill, NC.

For children with chronic conditions, well-being is closely related to how well their families function. Most prior research syntheses on family functioning and child well-being have focused on children with a single condition, thereby limiting the potential to aggregate and build on what is known across conditions. To address this challenge, research reports were reviewed and meta-analyses conducted of findings on the relationship between family functioning and child well-being across a range of chronic physical conditions. The sample was derived from a larger systematic review study that included 1,028 reports published between January 1, 2000 and March 31, 2014. The current review includes 53 studies in which a relationship between family functioning and child well-being was analyzed using one of four family measures: Family Adaptability and Cohesion Evaluation Scales, Family Environment Scale, Family Relationship Index, or Family Assessment Device. Most studies were cross-sectional and observational (n = 43, 81%). The most frequently studied conditions were diabetes, cancer, sickle cell disease, and asthma. In 37 studies, findings were sufficiently comparable to conduct meta-analyses. Significant correlations were identified between children's psychological health and seven of nine dimensions of family functioning. Significant correlations also were found between dimensions of family functioning and children's problem behaviors, social competence, quality of life, and, to a lesser extent, adherence and physical health. Of the family dimensions, cohesion and conflict were associated most strongly with child outcomes. Understanding the specific family variables, such as conflict, linked to varied child outcomes is key for intervention development. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/nur.21725DOI Listing
August 2016

Adequacy of Prenatal Care and Gestational Weight Gain.

J Womens Health (Larchmt) 2016 Feb 7;25(2):117-23. Epub 2016 Jan 7.

3 North Carolina Department of Health and Human Services , Raleigh, North Carolina.

Background: The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain.

Sample: The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women (≥18 years) who delivered singleton full-term infants in 2011 and 2012.

Methods: A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight.

Results: A total of 197,354 women (≥18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37-2.50) in overweight and 2.33 (95% CI 2.27-2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09-1.22) for underweight and 1.34 (95% CI 1.30-1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27-1.38; OR: 1.15, 95% CI 1.09-1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86-0.91).

Conclusions: Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain.
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http://dx.doi.org/10.1089/jwh.2015.5468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761831PMC
February 2016

The Contribution of Parent and Family Variables to the Well-Being of Youth With Arthritis.

J Fam Nurs 2015 Nov 29;21(4):579-616. Epub 2015 Aug 29.

University of North Carolina, Chapel Hill, USA.

Among developed countries, the reported prevalence of juvenile idiopathic arthritis (JIA) varies from 16 to 150 per 100,000. Previous reviews have identified risks faced by children with chronic conditions and indicate a relationship between parent/family characteristics and child adaptation. This analysis provides a mixed-methods synthesis of 29 research reports addressing the intersection of family life and JIA. Data were extracted using a structured template, and effect sizes were calculated for reported relationships between variables. Results were coded using a scheme that differentiated types of family factors. Meta-analysis revealed a moderately strong positive relationship between parent and child psychological functioning, and a medium negative relationship between family conflict and child psychosocial well-being, and parental depression and child physical functioning. Thematic analysis of qualitative results identified parenting challenges related to pain management and regimen demands. Results indicate that interventions to enhance parenting competence and family relationships may improve caregiver and patient outcomes.
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http://dx.doi.org/10.1177/1074840715601475DOI Listing
November 2015

Sugar-sweetened beverage intake and cardiovascular risk factor profile in youth with type 1 diabetes: application of measurement error methodology in the SEARCH Nutrition Ancillary Study.

Br J Nutr 2015 Aug 16;114(3):430-8. Epub 2015 Jul 16.

Departments of Nutrition and Medicine,University of North Carolina,Chapel Hill,NC,USA.

The SEARCH Nutrition Ancillary Study aims to investigate the role of dietary intake on the development of long-term complications of type 1 diabetes in youth, and capitalise on measurement error (ME) adjustment methodology. Using the National Cancer Institute (NCI) method for episodically consumed foods, we evaluated the relationship between sugar-sweetened beverage (SSB) intake and cardiovascular risk factor profile, with the application of ME adjustment methodology. The calibration sample included 166 youth with two FFQ and three 24 h dietary recall data within 1 month. The full sample included 2286 youth with type 1 diabetes. SSB intake was significantly associated with higher TAG, total and LDL-cholesterol concentrations, after adjusting for energy, age, diabetes duration, race/ethnicity, sex and education. The estimated effect size was larger (model coefficients increased approximately 3-fold) after the application of the NCI method than without adjustment for ME. Compared with individuals consuming one serving of SSB every 2 weeks, those who consumed one serving of SSB every 2 d had 3.7 mg/dl (0.04 mmol/l) higher TAG concentrations and 4.0 mg/dl (0.10 mmol/l) higher total cholesterol and LDL-cholesterol concentrations, after adjusting for ME and covariates. SSB intake was not associated with measures of adiposity and blood pressure. Our findings suggest that SSB intake is significantly related to increased lipid levels in youth with type 1 diabetes, and that estimates of the effect size of SSB on lipid levels are severely attenuated in the presence of ME. Future studies in youth with diabetes should consider a design that will allow for the adjustment for ME when studying the influence of diet on health status.
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http://dx.doi.org/10.1017/S0007114515002160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817246PMC
August 2015

Longitudinal associations of nutritional factors with glycated hemoglobin in youth with type 1 diabetes: the SEARCH Nutrition Ancillary Study.

Am J Clin Nutr 2015 Jun 6;101(6):1278-85. Epub 2015 May 6.

From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ).

Background: Improved glycated hemoglobin (Hb A1c) delays the progression of microvascular and macrovascular complications in individuals with type 1 diabetes (T1D). We previously showed that higher baseline intakes of n-3 (ω-3) fatty acids and leucine are associated with preserved β cell function 2 y later in youth with T1D.

Objective: In the current study, we extend this work to explore the longitudinal associations of nutritional factors with Hb A1c in youth with T1D.

Design: We included 908 T1D youth with baseline and follow-up Hb A1c measurements. Nutritional factors assessed at baseline were as follows: breastfeeding status and timing of complimentary food introduction; intakes of leucine, carbohydrates, protein, fat, and fiber estimated from a food-frequency questionnaire (FFQ); and plasma biomarkers for vitamins D and E, eicosapentaenoic acid (EPA), and docosahexaenoic acid. We fit linear regression models adjusted for baseline Hb A1c, sociodemographic variables, diabetes-related variables, time between baseline and follow-up visits, saturated fat, physical activity, and for FFQ-derived nutrients, total calories. The vitamin D model was further adjusted for season and body mass index z score.

Results: The mean ± SD age and diabetes duration at baseline was 10.8 ± 3.9 y and 10.1 ± 5.8 mo, respectively. A total of 9.3% of participants had poor Hb A1c (value ≥9.5%) at baseline, which increased to 18.3% during follow-up (P < 0.0001). Intakes of EPA (β = -0.045, P = 0.046), leucine (β = -0.031, P = 0.0004), and protein (β = -0.003, P = 0.0002) were significantly negatively associated with follow-up Hb A1c after adjustment for confounders. Intake of carbohydrates was significantly positively (β = 0.001, P = 0.003) associated with follow-up Hb A1c after adjustment for confounders.

Conclusions: Several nutritional factors may be associated with Hb A1c during early stages of disease progression in youth recently diagnosed with T1D. In addition to the overall role of major macronutrients such as carbohydrates and protein, leucine and n-3 fatty acid intakes, such as of EPA, may be important for long-term glycemic control.
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http://dx.doi.org/10.3945/ajcn.114.103747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441810PMC
June 2015

Plasma nutrient biomarkers are associated with waist-to-height ratio in youth with type 1 diabetes.

J Nutr 2015 Mar 21;145(3):579-86. Epub 2015 Jan 21.

Departments of Nutrition and Medicine and

Background: Plasma fatty acids (FAs) and micronutrients have been associated with central obesity in adults; however, previous studies of these associations in adults have yielded mixed results. In addition, no comparable research has been conducted among youth with type 1 diabetes (T1D).

Objective: We investigated the cross-sectional and longitudinal associations between plasma nutrient biomarkers and waist-to-height ratio (WHtR) in youth with T1D.

Methods: These analyses included 1324 youth aged 3-20 y at T1D diagnosis with a baseline visit in the SEARCH (Search for Diabetes in Youth) Study and a subset of 1178 of these youth with a follow-up visit an average of 23 mo (range: 16-40 mo) after their baseline visit. Plasma phospholipid FAs and vitamins were measured, and estimated desaturase activities were calculated at baseline. Anthropometric measurements and diabetes-related assessments were collected at each visit. Multiple linear regression was used to examine the association between plasma nutrient biomarkers and WHtR.

Results: In cross-sectional analysis, plasma palmitic acid (P = 0.004), dihomo-γ-linolenic acid (DGLA; P = 0.017) and Δ6 desaturase (D6D; P = 0.006) were positively correlated with WHtR after adjustment of confounders. Oleic acid (OA; P = 0.002), linoleic acid (LA; P = 0.015), Δ9 desaturase 18 (D9D-18; P = 0.027), and vitamin D (P < 0.0001) were negatively correlated with WHtR after adjustment. Weight status was an effect modifier (P < 0.05). In normal-weight youth, vitamin D (P = 0.003) was negatively associated with WHtR. In obese youth, stearic acid (P = 0.037), DGLA (P < 0.0001), and D6D (P < 0.0001) were positively associated and OA (P = 0.0008), D9D-18 (P = 0.0006), and vitamin D (P < 0.0001) were negatively associated with WHtR. In longitudinal analysis, baseline linoleic acid (P = 0.018), n-6:n-3 (ω-3:ω-6) FA ratio (P = 0.029), vitamin D (P = 0.003), and vitamin E (P < 0.0001) were negatively correlated with WHtR at follow-up only in obese participants.

Conclusions: In T1D youth, plasma FAs and vitamins are associated with WHtR and are modified by weight status. These associations are particularly marked in obese youth.
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http://dx.doi.org/10.3945/jn.114.203133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336536PMC
March 2015

Efficacy of an adapted HIV and sexually transmitted infection prevention intervention for incarcerated women: a randomized controlled trial.

Am J Public Health 2015 Apr 11;105(4):802-9. Epub 2014 Sep 11.

Catherine I. Fogel, Jamie L. Crandell, A. M. Neevel, and Sharon D. Parker are with the School of Nursing, and Becky L. White is with the Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill (UNC). Monique Carry, Amy M. Fasula, Jeffrey H. Herbst, and Deborah J. Gelaude are with the Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA.

Objectives: We tested the efficacy of an adapted evidence-based HIV-sexually transmitted infection (STI) behavioral intervention (Providing Opportunities for Women's Empowerment, Risk-Reduction, and Relationships, or POWER) among incarcerated women.

Methods: We conducted a randomized trial with 521 women aged 18 to 60 years in 2 correctional facilities in North Carolina in 2010 and 2011. Intervention participants attended 8 POWER sessions; control participants received a single standard-of-care STI prevention session. We followed up at 3 and 6 months after release. We examined intervention efficacy with mixed-effects models.

Results: POWER participants reported fewer male sexual partners than did control participants at 3 months, although this finding did not reach statistical significance; at 6 months they reported significantly less vaginal intercourse without a condom outside of a monogamous relationship and more condom use with a main male partner. POWER participants also reported significantly fewer condom barriers, and greater HIV knowledge, health-protective communication, and tangible social support. The intervention had no significant effects on incident STIs.

Conclusions: POWER is a behavioral intervention with potential to reduce risk of acquiring or transmitting HIV and STIs among incarcerated women returning to their communities.
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http://dx.doi.org/10.2105/AJPH.2014.302105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358199PMC
April 2015

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys.

Vaccine 2014 Jul 2;32(33):4171-8. Epub 2014 Jun 2.

NC Child Health Research Network, Community Engagement NC TraCS Institute - Child Health Core Home of the UNC-CH Clinical and Translational Science Awards (CTSA), United States; Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, CB # 7225, 231 MacNider, Chapel Hill, NC 27599, United States. Electronic address:

Objectives: Adoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11-12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys.

Methods: We targeted parents and providers of 9-13 year old boys in a 13 county NC region. The 3-month intervention included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers; two radio PSAs; and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9-13 year old boys increased during the intervention period in targeted counties compared to control counties (n=15) with similar demographics. To compare with other adolescent vaccines, similar models were fit for HPV vaccination in girls and meningococcal and Tdap vaccination of boys in the same age range. Moderating effects of age, race, and Vaccines for Children (VFC) eligibility on the intervention were considered.

Results: The Cox model showed an intervention effect (β=0.29, HR=1.34, p=.0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p<.0001 for all). HPV vaccination rates were highest in the 11-12 year old boys. Overall, three of every four clinic visits for Tdap and meningococcal vaccines for preteen boys were missed opportunities to administer HPV vaccination simultaneously.

Conclusions: Social marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.
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http://dx.doi.org/10.1016/j.vaccine.2014.05.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080713PMC
July 2014

African American cancer survivors: do cultural factors influence symptom distress?

J Transcult Nurs 2015 May 5;26(3):294-300. Epub 2014 May 5.

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Purpose: The purpose of this study was to examine how the cultural factors, stigma, being strong, and religiosity influence symptom distress in African American cancer survivors.

Methods: This descriptive correlational study was designed using the Sociocultural Stress and Coping Framework. Seventy-seven African American cancer survivors, recruited from oncology clinics and the community in North Carolina, completed a questionnaire that consisted of measures of demographic and illness characteristics, the Perceived Stigma Scale, the Ways of Helping Questionnaire, the Religious Involvement Scale, and the Symptom Distress Scale.

Results: The two cultural factors that were significantly associated with symptom distress were stigma (β = .23, p < .05) and organized religion (β = -.50, p < .05). No significant associations were found between being strong or nonorganized religiosity and symptom distress. The most commonly reported symptoms were fatigue (M = 2.44, SD = 1.20), pain (M = 2.26, SD = 1.43), and insomnia (M = 1.95, SD = 1.25).

Conclusions: The findings of this study indicate that the cultural factors, stigma, and organized religiosity were significantly associated with symptom distress.

Implications For Practice: The results from this study can be used to guide researchers in developing culturally appropriate interventions aimed at alleviating symptom distress in African American cancer survivors.
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http://dx.doi.org/10.1177/1043659614524251DOI Listing
May 2015

Relative validity and reliability of an FFQ in youth with type 1 diabetes.

Public Health Nutr 2015 Feb 28;18(3):428-37. Epub 2014 Mar 28.

4Department of Nutrition and Department of Medicine,University of North Carolina,Chapel Hill,NC,USA.

Objective: To evaluate the relative validity and reliability of the SEARCH FFQ that was modified from the Block Kids Questionnaire.

Design: Study participants completed the eighty-five-item FFQ twice plus three 24 h dietary recalls within one month. We estimated correlations between frequencies obtained from participants with the true usual intake for food groups and nutrients, using a two-part model for episodically consumed foods and measurement error adjustment.

Setting: The multi-centre SEARCH for Diabetes in Youth Nutrition Ancillary Study.

Subjects: A subgroup of 172 participants aged 10-24 years with type 1 diabetes.

Results: The mean correlations, adjusted for measurement error, of food groups and nutrients between the FFQ and true usual intake were 0·41 and 0·38, respectively, with 57 % of food groups and 70 % of nutrients exhibiting correlations >0·35. Correlations were high for low-fat dairy (0·80), sugar-sweetened beverages (0·54), cholesterol (0·59) and saturated fat (0·51), while correlations were poor for high-fibre bread and cereal (0·16) and folate (0·11). Reliability of FFQ intake based on two FFQ administrations was also reasonable, with 54 % of Pearson correlation coefficients ≥0·5. Reliability was high for low-fat dairy (0·7), vegetables (0·6), carbohydrates, fibre, folate and vitamin C (all 0·5), but less than desirable for low-fat poultry and high-fibre bread, cereal, rice and pasta (0·2-0·3).

Conclusions: While there is some room for improvement, our findings suggest that the SEARCH FFQ performs quite well for the assessment of many nutrients and food groups in a sample of youth with type 1 diabetes.
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http://dx.doi.org/10.1017/S1368980014000408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353637PMC
February 2015

Correlates of medical nutrition therapy and cardiovascular outcomes in youth with type 1 diabetes.

J Nutr Educ Behav 2013 Nov-Dec;45(6):661-8. Epub 2013 Jul 25.

Department of Health Sciences, Furman University, Greenville, SC.

Objectives: To examine whether the types of medical nutrition therapies (MNTs) taught to and used by youth with type 1 diabetes (T1D) vary by sociodemographic characteristics and cardiovascular (CVD) risk factors.

Design: Cross-sectional study.

Setting: The SEARCH for Diabetes in Youth study is a population-based cohort of individuals with clinical diagnosed diabetes.

Participants: A total of 1,191 individuals with T1D.

Main Outcome Measures: Types of MNTs and frequency of use.

Analysis: Bivariate analysis and multivariate linear regression (P < .05) RESULTS: More race/ethnic minorities (vs whites), individuals with parents with less than a high school education (vs high school or higher education), and overweight/obese (vs underweight/normal weight) were taught additional MNTs. For underweight/normal weight individuals exclusively taught carbohydrate counting, those who used this approach "often" had lower hemoglobin A1c (8.6% vs 8.9%) and triglycerides (73.5 vs 84.1 mg/dL) than those who used it "sometimes/never." "Often" use of additional MNTs beyond carbohydrate counting was not associated with better mean values for CVD risk factors.

Conclusions And Implications: In individuals with T1D, race/ethnic minorities, individuals with parents with less than a high school education, and overweight/obese individuals are taught more MNTs. Further research is needed to understand the effectiveness of the various MNTs on CVD risk factors, and to identify how to translate nutrition knowledge to behavior and metabolic status.
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http://dx.doi.org/10.1016/j.jneb.2013.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825757PMC
April 2014

Nutritional factors and preservation of C-peptide in youth with recently diagnosed type 1 diabetes: SEARCH Nutrition Ancillary Study.

Diabetes Care 2013 Jul;36(7):1842-50

Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Objective: To test the novel hypothesis that nutritional factors previously associated with type 1 diabetes etiology or with insulin secretion are prospectively associated with fasting C-peptide (FCP) concentration among youth recently diagnosed with type 1 diabetes.

Research Design And Methods: Included were 1,316 youth with autoantibody-positive type 1 diabetes who participated in the SEARCH for Diabetes in Youth study (baseline disease duration, 9.9 months; SD, 6.3). Nutritional exposures included breastfeeding and age at introduction of complementary foods, baseline plasma long-chain omega-3 fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), vitamin D, vitamin E, and, from a baseline food frequency questionnaire, estimated intake of the branched-chain amino acid leucine and total carbohydrate. Multiple linear regression models were conducted to relate each nutritional factor to baseline FCP adjusted for demographics, disease-related factors, and other confounders. Prospective analyses included the subset of participants with preserved β-cell function at baseline (baseline FCP ≥0.23 ng/mL) with additional adjustment for baseline FCP and time (mean follow-up, 24.3 months; SD, 8.2; n = 656). FCP concentration was analyzed as log(FCP).

Results: In adjusted prospective analyses, baseline EPA (P = 0.02), EPA plus DHA (P = 0.03), and leucine (P = 0.03) were each associated positively and significantly with FCP at follow-up. Vitamin D was unexpectedly inversely associated with FCP (P = 0.002).

Conclusions: Increased intake of branched-chain amino acids and long-chain omega-3 fatty acids may support preservation of β-cell function. This represents a new direction for research to improve prognosis for type 1 diabetes.
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http://dx.doi.org/10.2337/dc12-2084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687285PMC
July 2013

Fructose intake and cardiovascular risk factors in youth with type 1 diabetes: SEARCH for diabetes in youth study.

Diabetes Res Clin Pract 2013 May 27;100(2):265-71. Epub 2013 Mar 27.

Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH 45267-0394, United States.

Aims: High consumption of dietary fructose has been shown to contribute to dyslipidemia and elevated blood pressure in adults, but there are few data in youth, particularly those at greater risk of cardiovascular disease (CVD). The aim of this study was to examine the association between fructose intake and CVD risk factors in a diverse population of youth with type 1 diabetes (T1D).

Methods: This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, including 2085 youth ages 10-22 years with T1D, of which 22% were racial/ethnic minority and 50% were female. A semi-quantitative food frequency questionnaire was used to assess intake.

Results: Median daily fructose consumption was 7.9% of total calories. Fructose intake was positively associated with triglycerides (p<.01), but not with total cholesterol, LDL-cholesterol, HDL-cholesterol, or blood pressure after adjustment for physical activity and socio-demographic, clinical, and dietary covariates. An increase in fructose intake of 22 g (equivalent to a 12 oz can of soda) was associated with 23% higher odds of borderline/high versus low triglycerides (p<.005).

Conclusion: These data suggest that children with T1D should moderate their intake of fructose, particularly those with borderline or high triglycerides.
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http://dx.doi.org/10.1016/j.diabres.2013.03.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764988PMC
May 2013

Mapping the Mixed Methods-Mixed Research Synthesis Terrain.

J Mix Methods Res 2012 Oct 28;6(4):317-331. Epub 2011 Dec 28.

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Mixed methods-mixed research synthesis is a form of systematic review in which the findings of qualitative and quantitative studies are integrated via qualitative and/or quantitative methods. Although methodological advances have been made, efforts to differentiate research synthesis methods have been too focused on methods and not focused enough on the defining logics of research synthesis-each of which may be operationalized in different ways-or on the research findings themselves that are targeted for synthesis. The conduct of mixed methods-mixed research synthesis studies may more usefully be understood in terms of the logics of aggregation and configuration. Neither logic is preferable to the other nor tied exclusively to any one method or to any one side of the qualitative/quantitative binary.
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http://dx.doi.org/10.1177/1558689811427913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467952PMC
October 2012
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