Publications by authors named "Justin B Moore"

161 Publications

Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial.

JMIR Res Protoc 2021 May 14;10(5):e18984. Epub 2021 May 14.

Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States.

Background: A decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown.

Objective: The objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications.

Methods: We will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients' medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control.

Results: Our study was funded in July 2020. As of May 2021, we have enrolled 6 participants.

Conclusions: Our findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials.

Trial Registration: ClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242.

International Registered Report Identifier (irrid): PRR1-10.2196/18984.
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http://dx.doi.org/10.2196/18984DOI Listing
May 2021

Diagnosed Concussion and Undiagnosed Head Trauma is Associated with Long-term Concussion Related Symptoms in Former College Football Players.

Am J Phys Med Rehabil 2021 Apr 30. Epub 2021 Apr 30.

Kinesiology and Integrative Physiology, Hanover College, Hanover, IN Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC.

Objective: Head trauma experienced in contact football is a growing health concern, but limited research has been conducted to assess associations between head trauma exposure and long-term concussion-related symptoms (CRS) among former college football players.

Design: We surveyed 275 former college football players who were at least 10 years post competition to determine the association between head trauma exposure and CRS later in life. Respondents provided data on their youth, high school, and college playing experience, undiagnosed head injury, diagnosed concussions, and eight CRS. A Poisson regression was conducted to examine the association between playing experience and reported head trauma with reported symptom count, and significance was set at p<.05.

Results: Few participants reported diagnosed concussions in college (17.5%), but a large number reported undiagnosed football related head injuries (68.8%) that might have resulted in a concussion. A minority of participants (40.7%) reported CRS. After controlling for age, high school football participation, and non-football concussions (lifetime), diagnosed concussions in high school or college did not significantly predict concussion symptoms later in life. However, undiagnosed football head injury (range 1 to 8 injuries) reported 350% - 855% greater CRS later in life.

Conclusions: Undiagnosed head injuries, which are less likely to be managed by a healthcare professional, were significantly associated with CRS later in life. These findings suggest that proper identification and management of concussions may prevent later symptoms, but more research is needed to test this conclusion.
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http://dx.doi.org/10.1097/PHM.0000000000001782DOI Listing
April 2021

Protocol for a randomized controlled feasibility study of a coordinated parent/child weight loss intervention: Dyad Plus.

Transl J Am Coll Sports Med 2020 ;5(12)

Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.

The prevalence of in youth with overweight and obesity is a global health concern, necessitating clinical interventions to treat obesity effectively through lifestyle modification. Interventions in adolescents have demonstrated improvements in healthy eating and physical activity with only modest weight loss outcomes. Consequently, there is growing interest in developing strategies to enhance the effectiveness of clinical interventions in adolescents. Targeting the family system can be an effective approach, but existing studies have failed to examine the impact of co-enrolling both the adolescent and adult in individually tailored weight loss programs and coordinating the adolescent/adult weight loss efforts.

Purpose: This paper reports on the design and conceptual framework of the Dyad Plus study, which utilizes two weight loss clinics of the Wake Forest Baptist Medical Center: Brenner Families in training (Brenner FIT®; adolescents) and By Design (adults). Dyad Plus is a coordinated program designed to facilitate self-monitoring, positive communication, joint problem solving, and social support to increase physical activity, healthy eating, and weight loss relative to Brenner FIT alone.

Methods: A total of 45 parent/adolescent dyads are randomized to one of three conditions (n = 15 for each): Brenner FIT only, Dyad (adolescent and parent both enroll simultaneously in the age appropriate program), and Dyad Plus (both parent and adolescent enroll simultaneously, but with a coordinated component for adolescent and caregiver). This study aims to develop and pilot the coordinated intervention, establish feasibility of the intervention, and determine costs associated with implementation.

Results: The results of the study are expected in winter of 2021.

Conclusion: If proven feasible and acceptable, Dyad Plus will be tested for effectiveness in a large-scale implementation-effectiveness clinical trial.
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http://dx.doi.org/10.1249/tjx.0000000000000136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078845PMC
January 2020

Midday Nap Duration and Hypertension among Middle-Aged and Older Chinese Adults: A Nationwide Retrospective Cohort Study.

Int J Environ Res Public Health 2021 Apr 1;18(7). Epub 2021 Apr 1.

Department of Health Management, School of Health Sciences, Wuhan University, Wuhan 430071, China.

The goal of this study was to investigate the associations of midday nap duration and change in midday nap duration with hypertension in a retrospective cohort using a nationwide representative sample of middle-aged and older Chinese adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) database during 2011-2015. Information on midday nap duration was collected via a self-reported questionnaire and blood pressure was objectively measured. Hazard ratios (HR) with 95% confidence interval (CI) were estimated using Cox proportional hazards regression models to quantify the associations. A sample of 5729 Chinese adults (≥45 years old) were included in the longitudinal analysis. Relative to non-nappers, participants who napping for ≥90 min/day was associated with significantly larger HR for hypertension at four-year follow-up (HR = 1.18, 95% CI = 1.01-1.40, = 0.048). Compared with people who napped ≥90 min/day both at baseline (2011) and follow-up (2013), hypertension risk at four-year follow-up declined in individuals whose midday nap durations decreased in the 2-year study period from ≥ 90 min/day to 1-59 min/day (HR = 0.59, 95% CI = 0.36-0.97, = 0.037) and 60-89 min/day (HR = 0.68, 95% CI = 0.47-0.99, = 0.044). Among middle-aged and older Chinese adults, relative to non-nappers, people who had longer midday nap duration (≥90 min/day) were associated with significantly larger HR for hypertension and decreased napping duration may confer benefit for hypertension prevention.
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http://dx.doi.org/10.3390/ijerph18073680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037516PMC
April 2021

Systematic review of financial burden assessment in cancer: Evaluation of measures and utility among adolescents and young adults and caregivers.

Cancer 2021 Jun 13;127(11):1739-1748. Epub 2021 Apr 13.

Duke University School of Medicine & the Duke Cancer Institute, Durham, North Carolina.

The cost of cancer care is rising and represents a stressor that has significant and lasting effects on quality of life for many patients and caregivers. Adolescents and young adults (AYAs) with cancer are particularly vulnerable. Financial burden measures exist but have varying evidence for their validity and reliability. The goal of this systematic review is to summarize and evaluate measures of financial burden in cancer and describe their potential utility among AYAs and their caregivers. To this end, the authors searched PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO for concepts involving financial burden, cancer, and self-reported questionnaires and limited the results to the English language. They discarded meeting abstracts, editorials, letters, and case reports. The authors used standard screening and evaluation procedures for selecting and coding studies, including consensus-based standards for documenting measurement properties and study quality. In all, they screened 7250 abstracts and 720 full-text articles to identify relevant articles on financial burden. Eighty-six articles met the inclusion criteria. Data extraction revealed 64 unique measures for assessing financial burden across material, psychosocial, or behavioral domains. One measure was developed specifically for AYAs, and none were developed for their caregivers. The psychometric evidence and study qualities revealed mixed evidence of methodological rigor. In conclusion, several measures assess the financial burden of cancer. Measures were primarily designed and evaluated in adult patient populations with little focus on AYAs or caregivers despite their increased risk of financial burden. These findings highlight opportunities to adapt and test existing measures of financial burden for AYAs and their caregivers.
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http://dx.doi.org/10.1002/cncr.33559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113116PMC
June 2021

Experiences of midlife and older African American men living with type 2 diabetes.

Ethn Health 2021 Apr 8:1-15. Epub 2021 Apr 8.

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

Type 2 Diabetes Mellitus (T2DM) is a complicated disease that disproportionately affects African American men. Understanding the experiences of African American men living with T2DM is important for developing effective, culturally sensitive interventions. The purpose of this study was to describe how African American men view their T2DM and describe their perspectives on living with and self-managing T2DM. In-depth semi-structured qualitative interviews were conducted with 22 African American men aged 40-85 years diagnosed with T2DM. Interviews were transcribed and analyzed using NVivo 10 with thematic analysis. Disbelief, shock, and denial were commonly experienced reactions at initial diagnosis. Many participants defined diabetes using words such as 'sugar' or 'glucose' and reported an awareness of health complications caused by diabetes, such as amputations and diabetic comas. Participants expressed various perspectives and attitudes towards having diabetes, including avoidance/apathy, fatalism, guilt and shame, fear and concern, and self-mastery. The majority of men described efforts to self-manage diabetes via glucose monitoring, changing dietary habits, and exercise. Many participants expressed concern over the financial burden associated with managing diabetes and reported that high costs can hinder a patient's ability to maintain active self-monitoring and deter patients from attending needed doctor's visits. Many participants expressed confidence in their healthcare providers, although a few expressed feelings of distrust and being uninformed. Participants tended to most appreciate physicians who spent time discussing their condition and who made an effort to engage in open patient-provider communication. Living with diabetes can be emotionally, physically, and mentally challenging. Efforts to improve adoption and maintenance of self-management behaviors may benefit from sensitivity to the patient's attitude and perspectives towards diabetes self-management, assistance overcoming the financial burden of managing diabetes, and open patient-provider communication.
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http://dx.doi.org/10.1080/13557858.2021.1910206DOI Listing
April 2021

Recruitment planning for clinical trials with a vulnerable perinatal adolescent population using the Clinical Trials Transformative Initiative framework and principles of partner and community engagement.

Contemp Clin Trials 2021 Mar 15;104:106363. Epub 2021 Mar 15.

Department of Population Health Science, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America. Electronic address:

Recruitment planning is needed to establish a foundation for obesity prevention research with high risk, disadvantaged perinatal adolescent populations. In the context of developing clinical trial protocols, investigators partnered with Mississippi's Nutrition Program for Women, Infants and Children (WIC) and adopted the Clinical Trials Transformative Initiative (CTTI) framework for recruitment planning to identify and mitigate challenges to recruitment early in the clinical trial development process. The recruitment protocol consisted of 20 passive strategies grounded in principles of partner and community engagement and was flexible, accommodating, altruistic, community-focused, and minimally burdensome to partners and participants. The recruitment goal included 150 adolescent-coparticipant dyads and 145 dyads (96.7%) were successfully recruited. Investigators demonstrated the feasibility of recruiting a disadvantaged and vulnerable perinatal adolescent population that is underrepresented in health research, in one of the most persistently impoverished and poor health regions in the U.S. Four important aspects of recruitment planning using the CTTI framework are discussed including: (1) establishing partnerships with trusted community resources is a paramount investment; (2) dedicating time and resources to know and go to your community is invaluable; (3) fostering trust by offering convenient, continuous and clear communication; and (4) encouraging collaboration and participation through limiting partner and participant burden. Establishing organizational and community partnership requires a substantial amount of invaluable time and fosters recruitment success. Following the CTTI recommendations for recruitment planning led to a robust recruitment protocol that will be used in future intervention trials with an understudied perinatal adolescent population with high risk for poor maternal and fetal health outcomes.
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http://dx.doi.org/10.1016/j.cct.2021.106363DOI Listing
March 2021

Reply to the Importance of a collaborative health-related quality of life measurement strategy for adolescents and young adults with cancer.

Cancer 2021 May 26;127(10):1714-1715. Epub 2021 Jan 26.

Department of Population Health Sciences, Duke University School of Medicine, Duke Cancer Institute, Durham, North Carolina.

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http://dx.doi.org/10.1002/cncr.33418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085044PMC
May 2021

Revisiting Old Adversaries on the Other Side of the Pandemic.

Authors:
Justin B Moore

J Public Health Manag Pract 2021 Mar-Apr 01;27(2):99

Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1097/PHH.0000000000001332DOI Listing
January 2021

Effect of Coach Feedback and Awareness of Head Impact Exposure on Practice Structure in Youth Football.

J Neurotrauma 2021 May 1;38(10):1389-1398. Epub 2021 Mar 1.

Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

With the concern of concussion risk and repetitive head impacts in youth football, organizations have adopted rules that limit contact during practice. However, rule changes are not ubiquitous among organizations and are challenging to monitor and enforce. Ultimately, football practice activities are determined by coaches, but it is unknown whether providing objective data to coaches relating activities to their athletes' head impact exposure (HIE) would alter practice structure or help reduce HIE. This study evaluated the effect of coach awareness of HIE on practice structure over time. Head impact data from three intervention (56 players) and three control (38 players) teams were collected over two youth football seasons. Athletes were instrumented with the Head Impact Telemetry (HIT) System and time-synchronized video was recorded for practices and games. Impact frequencies and head accelerations were compiled into weekly HIE practice and game reports and shared with the head coach of each intervention team. Time per drill, impact rate, and impact magnitude were compared across three time frames (pre-season, mid-season, and late-season) using generalized linear models. Control teams had higher impact rates than intervention teams in all drills across time frames. Among all teams, 95th percentile linear and rotational accelerations were highest during mid-season. Among intervention teams, more time was spent on scrimmage and skill development from pre-season to late-season, with less time spent on tackling. This study suggests that receiving objective data informing HIE in practice may contribute to changes in practice structure and help inform intervention efforts to improve head impact safety in football.
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http://dx.doi.org/10.1089/neu.2020.7224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082724PMC
May 2021

A qualitative assessment of body image in adolescents and young adults (AYAs) with cancer.

Psychooncology 2021 Apr 19;30(4):614-622. Epub 2020 Dec 19.

Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Context: Among adolescents and young adults (AYAs), cancer and its treatment can disturb body image in distinct ways compared to younger or older individuals.

Objective: Since AYA body image is not well understood, this study was designed to develop a conceptual framework for body image in AYAs with cancer.

Methods: Concept elicitation interviews were conducted with 36 AYA patients [10 adolescents (15-17 years), 12 emerging adults (18-25 years), 14 young adults (26-39 years)] and health care providers (n = 36). The constant comparative method was used to analyze for themes and properties, with themes considered saturated if they were present and salient across participant sets.

Results: Twenty themes emerged from participant data. Three themes illustrate a shared understanding of patients' experience of body image: (1) physical changes produce shifts in identity and experience of self; (2) precancer body image shapes how the AYA experiences cancer-related physical changes, and (3) changes to the body are upsetting. Nine themes were unique to patients while eight themes were unique to providers. Patient body image experiences were found to evolve over time, largely affected by concerns about how others view them. Providers appeared attuned to AYA patient body image but recognized that it is not systematically addressed with patients.

Conclusion: More striking than differences between patient groups is the consistency of themes that emerged. The conceptual framework of body image developed from these data offers an important step toward addressing body image concerns for AYA patients.
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http://dx.doi.org/10.1002/pon.5610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059971PMC
April 2021

Community engagement and pediatric obesity: Incorporating social determinants of health into treatment.

J Clin Transl Sci 2019 Dec 19;4(4):279-285. Epub 2019 Dec 19.

Program in Community Engagement, Wake Forest School of Medicine, Clinical and Translational Science Institute, Winston-Salem, NC, USA.

Childhood obesity is a complex and multi-faceted problem, with contributors ranging from individual health behaviors to public policy. For clinicians who treat pediatric obesity, environmental factors that impact this condition in a child or family can be difficult to address in a clinical setting. Community-clinic partnerships are one method to address places and policies that influence a person's weight and health; however, such partnerships are typically geared toward community-located health behavior change rather than the deeper social determinants of health (SDH), limiting effective behavioral change. Community-engaged research offers a framework for developing community-clinic partnerships to address SDH germane to obesity treatment. In this paper, we discuss the relationship between SDH and pediatric obesity treatment, use of community-clinic partnerships to address SDH in obesity treatment, and how community engagement can be a framework for creating and harnessing these partnerships. We present examples of programs begun by one pediatric obesity clinic using community-engagement principles to address obesity.
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http://dx.doi.org/10.1017/cts.2019.447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681165PMC
December 2019

Universal Healthcare in the United States of America: A Healthy Debate.

Medicina (Kaunas) 2020 Oct 30;56(11). Epub 2020 Oct 30.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio-economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.
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http://dx.doi.org/10.3390/medicina56110580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692272PMC
October 2020

Targeting sedentary behavior as a feasible health strategy during COVID-19.

Transl Behav Med 2021 04;11(3):826-831

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Sedentary behavior is associated with poor physical and mental health. Targeting sedentary behavior is a simple strategy that may help counter physical and mental health concerns associated with COVID-19-related social restrictions. Of course, traditional strategies such as achieving optimal exercise and physical activity levels are also important and should be recommended. However, even under normal circumstances, the difficulty in promoting lasting exercise habits at multiple levels (e.g. individual, environment, policy) are well documented, and chances of maintaining or improving these factors is now even lower. Thus, relative to other lifestyle behaviors - sedentary behavior may be more amenable to change. Moreover, reducing sedentary behavior may be less susceptible to influence from factors associated with health disparities such as age, race, and socio-economic status compared to exercise or physical activity. Sedentary behavior is a feasible health strategy that should be targeted during COVID-19.
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http://dx.doi.org/10.1093/tbm/ibaa101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665775PMC
April 2021

Implementation Science in Practice.

J Public Health Manag Pract 2021 Mar-Apr 01;27(2):100-101

Justin B. Moore, PhD, MS, FACSM, Division of Public Health Sciences, Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.

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http://dx.doi.org/10.1097/PHH.0000000000001241DOI Listing
September 2020

COVID-19 Impact on Behaviors across the 24-Hour Day in Children and Adolescents: Physical Activity, Sedentary Behavior, and Sleep.

Children (Basel) 2020 Sep 16;7(9). Epub 2020 Sep 16.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

In the wake of the COVID-19 pandemic, social restrictions to contain the spread of the virus have disrupted behaviors across the 24-h day including physical activity, sedentary behavior, and sleep among children (5-12 years old) and adolescents (13-17 years old). Preliminary evidence reports significant decreases in physical activity, increases in sedentary behavior, and disrupted sleep schedules/sleep quality in children and adolescents. This commentary discusses the impact of COVID-19-related restrictions on behaviors across the 24-h day in children and adolescents. Furthermore, we suggest recommendations through the lens of a socio-ecological model to provide strategies for lasting behavior change to insure the health and well-being of children and adolescents during the COVID-19 pandemic.
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http://dx.doi.org/10.3390/children7090138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552759PMC
September 2020

Optimizing the measurement of health-related quality of life in adolescents and young adults with cancer.

Cancer 2020 11 10;126(22):4818-4824. Epub 2020 Sep 10.

Department of Population Health Sciences, Duke University School of Medicine, Duke Cancer Institute, Durham, North Carolina.

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http://dx.doi.org/10.1002/cncr.33155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005324PMC
November 2020

Assessing the relationship between weight stigma, stress, depression, and sleep in Chinese adolescents.

Qual Life Res 2021 Jan 9;30(1):229-238. Epub 2020 Sep 9.

Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, Hubei, China.

Introduction: Weight stigma is defined as the social devaluation of people with overweight or obesity, and its negative effects on the health of adolescents from western countries are well documented, but little is known about the relationships with health behaviors and outcomes in Asian youth. The prevalence of obesity among Chinese adolescents continues to increase, potentially causing negative evaluations of youth with obesity, and potentially reduced quality of life. The health effects of these negative evaluations of Chinese youth with obesity have received little attention.

Purpose: The purpose of this study was to examine relationships between weight stigma, stress, depression, and sleep in Chinese adolescents.

Methods: We utilized a cross-sectional study conducted in Wuhan, China. Sociodemographic, weight stigma, stress, depression, and sleep data were collected through a self-reported questionnaire. Descriptive statistics, t test, correlations, and mediation analyses were performed. A total of 1626 adolescents between 14 and 19 years of age were included in the analysis.

Results: The data showed that adolescents with weight stigma presented significantly higher level of stress and depression, lower global sleep quality, longer sleep latency, and shorter sleep duration than those without weight stigma (p < 0.05). Stress and depression mediated the relationship between weight stigma and global sleep quality (SE = 0.007, 95% CI = 0.053 to 0.081).

Conclusion: These findings suggest that adolescents who experience weight stigma may have increased stress and depressive symptoms, which are associated with poorer global sleep quality and more daytime dysfunction.
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http://dx.doi.org/10.1007/s11136-020-02620-4DOI Listing
January 2021

Effects of eHealth interventions on physical activity and weight among pregnant and postpartum women and the sociodemographic characteristics of study populations: a systematic review protocol.

JBI Evid Synth 2020 11;18(11):2396-2403

John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.

Objective: The objective of this review is to evaluate the impact of electronic health (eHealth) interventions on physical activity and weight changes among pregnant and/or postpartum populations and to describe the sociodemographic characteristics of the study populations.

Introduction: The American College of Obstetricians and Gynecologists recommends 20 minutes of daily physical activity during pregnancy and postpartum. Few pregnant women are physically active and among those who are, physical activity levels decline as pregnancy progresses and during postpartum. Behavioral eHealth interventions offer convenient and frequent accessibility at low cost and high reach. A search of the extant literature including PROSPERO, MEDLINE (PubMed), the Cochrane Database of Systematic Reviews and the JBI Database of Systematic Reviews and Implementation Reports revealed no published or in-progress reviews examining eHealth physical activity interventions among pregnant and/or postpartum populations.

Inclusion Criteria: Studies of eHealth interventions including pregnant and/or within one-year postpartum populations will be included.

Methods: This review will be conducted in accordance with JBI methodology for systematic reviews of effectiveness. The search strategy will aim to locate studies from the inception of each database. Citations will be collated, and duplicates removed. Titles and abstracts will be screened for eligibility against the inclusion criteria and relevant studies retrieved. Included studies will be appraised for methodological quality using JBI standardized critical appraisal instruments. Extracted data will include study methods, intervention design and outcomes (physical activity, weight, participant sociodemographic characteristics). The Grading of Recommendations, Assessment, Development and Evaluation approach for grading the certainty of evidence will be followed.

Systematic Review Registration Number: PROSPERO CRD42020124611.
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http://dx.doi.org/10.11124/JBISRIR-D-19-00378DOI Listing
November 2020

Association between Sleep Timing and Weight Status among 14- to 19-Year-Old Adolescents in Wuhan, China.

Int J Environ Res Public Health 2020 08 7;17(16). Epub 2020 Aug 7.

School of Health Sciences, Wuhan University, Wuhan 430071, China.

This study examined the cross-sectional and longitudinal association of sleep timing with weight status in 14- to 19-year-old adolescents in Wuhan, China. A prospective school-based study was conducted in Wuhan, China between 28 May and 29 September 2019. Data on sociodemographic information, academic performance, diet, mental health status, physical activity, sleep characteristics, body weight, and height were collected. A linear regression model and binary logistic regression model were performed. A total of 1194 adolescents were included in the analysis. Adolescents who woke up before 05:45 had higher body mass index (BMI) Z-score (odds ratio (OR) with 95% confidence interval (CI) = 1.28 (1.05, 1.57), = 0.02) and higher odds of overweight/obesity (odds ratio (OR) with 95% confidence interval (CI) = 1.74 (1.10, 2.76), = 0.02) at baseline after fully adjustment for covariates, compared with those who woke up after 05:45. Longitudinal data showed a nonsignificant association between waking up time and change in BMI Z-score ( = 0.18). No association of bedtime with weight status was observed in this sample after full adjustment ( > 0.1). Earlier waking up time might contribute to overweight and obesity in adolescents; however, more data are needed to test and elucidate this relationship.
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http://dx.doi.org/10.3390/ijerph17165703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460288PMC
August 2020

Social Media in Public Health: Strategies to Distill, Package, and Disseminate Public Health Research.

J Public Health Manag Pract 2020 Sep/Oct;26(5):489-492

Department of Social and Behavioral Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, Florida (Ms Gatewood); Departments of Family & Community Medicine (Mss Monks, Singletary, and Vidrascu and Dr Moore), Epidemiology & Prevention (Dr Moore), and Implementation Science (Dr Moore), Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Ms Gatewood is now with Centers for Disease Control and Prevention, Atlanta, Georgia. Ms Vidrascu is now with Centers of Psychiatric Excellence, Charlotte, North Carolina.

The worldwide expansion of users on the Internet has popularized the access of individuals to information that may not be obtained otherwise. Social media has fostered interactions between individuals and health organizations by changing the nature and speed of engagement. While it is known that many public health organizations use social media to engage their audiences, little is known about effective strategies and best practices for the dissemination of knowledge and audience engagement. Many barriers exist in the dissemination of public health messages, including limited funds to support information sharing. Blogs and social media networking sites can be dynamic, cost-effective communication tools with the potential to reach scientific, practitioner, and public audiences who may be missed through traditional outlets. This article describes rudimentary processes of developing a blog and using social media to disseminate public health information and potential applications in the day-to-day activities for other public health organizations. With the growing demand for instant communication and concise information, a strong Internet presence could help organizations maximize their reach and impact.
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http://dx.doi.org/10.1097/PHH.0000000000001096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410266PMC
August 2020

Situating dissemination and implementation sciences within and across the translational research spectrum.

J Clin Transl Sci 2019 Jul 29;4(3):152-158. Epub 2019 Jul 29.

Department of Family and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.

The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework's major proposition is that it situates D&I sciences as targeted "sub-sciences" of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages.
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http://dx.doi.org/10.1017/cts.2019.392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348034PMC
July 2019

Implementation evaluation of a professional development program for comprehensive school physical activity leaders.

Prev Med Rep 2020 Sep 5;19:101109. Epub 2020 May 5.

University of Northern Colorado Active Schools Institute, School of Sport and Exercise Science, Gunter Hall, Box 39, Greeley, CO 80639, USA.

The purpose of this study was to conduct an implementation monitoring evaluation of a yearlong comprehensive school physical activity program (CSPAP) professional development program across eight multi-state physical education (PE) teacher cohorts. Mixed-method data were collected during a three-year implementation period via workshop attendance sheets and evaluations, post-workshop implementation plans and artifacts, and follow-up phone interviews to enumerate and evaluate the program's process of recruitment, reach, dose delivered, dose received, fidelity, and context. Recruitment strategies reached a total of 234 PE teacher attendees across eight workshops, with 77 PE teachers (primarily female, elementary, public school teachers) completing all program requirements. Facilitators among full program completers were participation incentives and network opportunities, while common inhibitors were difficulty with online technology and perceptions of added workload. Completers submitted implementation plans with at least three action steps, ranging from 4 to 7 months to accomplish, that predominately commenced with securing administration approval as the first step (81%), focused on implementing student physical activity initiatives beyond PE (76%), and evidenced with mostly picture artifacts (78%). Implementation was facilitated by the presence of multilevel support at school and an elevated image of PE and PE teachers at school, and was inhibited by scheduling constraints, unrealistic planning, and conflicting perceptions of physical activity and PE. Overall, this evaluation reveals unique perspectives of PE teachers regarding schoolwide PA promotion and informs future efforts to target and effectively support CSPAP leaders.
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http://dx.doi.org/10.1016/j.pmedr.2020.101109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260586PMC
September 2020

Should Public Health Literacy Be a Core Requirement for College Students?

J Public Health Manag Pract 2020 Jul/Aug;26(4):304-305

Department of Environmental and Occupational Health, Texas A&M University, College Station, Texas (Dr Maddock); and Departments of Implementation Science and Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Moore).

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http://dx.doi.org/10.1097/PHH.0000000000001187DOI Listing
May 2020

A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study.

JMIR Res Protoc 2020 Jun 5;9(6):e18098. Epub 2020 Jun 5.

Department of Biostatistics & Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States.

Background: Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment.

Objective: This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program.

Methods: Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points.

Results: This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021.

Conclusions: The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial.

International Registered Report Identifier (irrid): PRR1-10.2196/18098.
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http://dx.doi.org/10.2196/18098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305562PMC
June 2020

Comprehensive School Physical Activity Program Policies and Practices Questionnaire (CSPAP-Q).

Res Q Exerc Sport 2021 Mar 25;92(1):100-110. Epub 2020 Feb 25.

Wake Forest School of Medicine.

: The Comprehensive School Physical Activity Program (CSPAP) model has recently been adopted as a national framework for physical activity (PA) promotion in schools. As a result, there is a need to develop an instrument to help leaders of PA measure policies and practices across the five component areas of a CSPAP. To address this gap, our team systematically developed and assessed the psychometric properties of the CSPAP-Q, an instrument designed to assess school policies and practices related to the five components of CSPAP. : The instrument development process began by reviewing existing school health and PA surveys. The Delphi method was then used to evaluate face and content validity through expert feedback. Thirty-eight physical education teachers completed the CSPAP-Q twice over a 14-day period to further establish validity and to assess test-retest reliability. : In total, 117 items were identified for the initial review. Upon completion of expert feedback, 22 items were eliminated and 66 items were revised. After reliability testing, three additional items were eliminated due to low test-retest agreement levels (Kappa <.40; non-significant χ). Ninety-two items were retained in the final version of the CSPAP-Q and kappa values indicated moderate to substantial agreement among items. : After validity and reliability testing, results suggest that the CSPAP-Q is a valid and reliable tool for assessing policies and practices related to CSPAP.
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http://dx.doi.org/10.1080/02701367.2019.1711008DOI Listing
March 2021

Turn up the healthy eating and activity time (HEAT): Physical activity outcomes from a 4-year non-randomized controlled trial in summer day camps.

Prev Med Rep 2020 Mar 14;17:101053. Epub 2020 Jan 14.

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

Summer day camps (SDCs) serve over 14 million children in the U.S. and are well-positioned to help children accumulate the guideline of 60 min per day (60 min/d) of moderate-to-vigorous physical activity (MVPA). The purpose of this study was to evaluate a multi-component intervention to increase the percentage of children meeting 60 min/d of MVPA. Twenty SDCs serving 3524 children (7.9 yrs., 46.2% girls, 66.1% non-Hispanic Black) participated in a 4-summer non-randomized two-group intervention. Children's accelerometer-derived MVPA was collected using accelerometers worn on the non-dominant wrist. SDCs were assigned to either 2 summers of intervention (n = 10, no intervention summer 2015, intervention summer 2016 and 2017) or 1 summer of intervention (n = 10, no intervention summer 2015 and 2016, intervention summer 2017). The final summer (July 2018) was a no intervention follow-up. Multilevel mixed effects regression models estimated changes in percent of children meeting 60 min/d of MVPA. Across all summers and SDCs, children accumulated an average of 89.2 min/day (±22.5) of MVPA. The likelihood of meeting the 60 min/d MVPA guideline was not different during intervention versus baseline summers for boys or girls (p > 0.05). Girls and boys were 3.5 (95CI = 1.5, 8.1) and 3.7 (95CI = 1.6, 8.4) times more likely to meet the 60 min/d guideline during intervention summers versus follow-up, respectively. The intervention was not successful at increasing the percentage of children meeting the 60 min/d MVPA guideline. However, children attending SDCs accumulated substantial amounts of MVPA thus efforts should focus on making SDCs an accessible setting for all children.
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http://dx.doi.org/10.1016/j.pmedr.2020.101053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976943PMC
March 2020

Fitness and Fatness Are Both Associated with Cardiometabolic Risk in Preadolescents.

J Pediatr 2020 02 20;217:39-45.e1. Epub 2019 Nov 20.

Sport & Exercise, University of Winchester, Winchester, United Kingdom.

Objective: To determine the associations between cardiorespiratory fitness (CRF) and fatness (overweight-obesity) with cardiometabolic disease risk among preadolescent children.

Study Design: This cross-sectional study recruited 392 children (50% female, 8-10 years of age). Overweight-obesity was classified according to 2007 World Health Organization criteria for body mass index. High CRF was categorized as a maximum oxygen uptake, determined using a shuttle run test, exceeding 35 mL·kg·minute in girls and 42 mL·kg·minute in boys. Eleven traditional and novel cardiometabolic risk factors were measured including lipids, glucose, glycated hemoglobin, peripheral and central blood pressure, and arterial wave reflection. Factor analysis identified underlying cardiometabolic disease risk factors and a cardiometabolic disease risk summary score. Two-way analysis of covariance determined the associations between CRF and fatness with cardiometabolic disease risk factors.

Results: Factor analysis revealed four underlying factors: blood pressure, cholesterol, vascular health, and carbohydrate-metabolism. Only CRF was significantly (P = .001) associated with the blood pressure factor. Only fatness associated with vascular health (P = .010) and carbohydrate metabolism (P = .005) factors. For the cardiometabolic disease risk summary score, there was an interaction effect. High CRF was associated with decreased cardiometabolic disease risk in overweight-obese but not normal weight children (P = .006). Conversely, high fatness was associated with increased cardiometabolic disease risk in low fit but not high fit children (P < .001).

Conclusions: In preadolescent children, CRF and fatness explain different components of cardiometabolic disease risk. However, high CRF may moderate the relationship between fatness and cardiometabolic disease risk.

Trial Registration: ACTRN 12614000433606.
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http://dx.doi.org/10.1016/j.jpeds.2019.09.076DOI Listing
February 2020

Change in Knowledge and Preferred Scenario Responses After Completion of the Advanced Life Support in Obstetrics Course in Serbia.

Fam Med 2019 Nov;51(10):850-853

Wake Forest School of Medicine, Department of Family and Community Medicine, Winston-Salem, NC.

Background And Objectives: The Advanced Life Support in Obstetrics (ALSO) course is widely utilized in the United States as an evidence-based program that bridges knowledge gaps and improves skills via hands-on training, group learning, and memorization of standardized mnemonics in a team-based approach to patient care. This reduces communication barriers among maternity care providers, ultimately decreasing potential negative outcomes. A needs assessment identified that Serbian providers would benefit from structured learning and hands-on simulation approaches in obstetrics from a structured training like the ALSO course. The objective of this study was to explore the changes in clinicians' knowledge and preferred scenario responses in managing obstetrics cases before and after participation in the ALSO course.

Methods: The ALSO training lasted 2 days and included lecture sessions, interactive workshops, a written knowledge test, and a simulated skills test. Participants completed an additional 20-item questionnaire assessing their knowledge and preferred scenario responses two weeks pre- and immediately post-ALSO training. Using a paired t test we assessed changes between pre- and posttest knowledge and preferred scenario response scores.

Results: Twenty-seven participants provided complete data. For the entire sample, the pretest mean number of correct items on the knowledge and preferred scenario response assessment was 10.8 and the posttest mean number correct was 15.2, representing an increase of 4.4 correct answers (P<.001).

Conclusions: The current results suggest that the ALSO course can successfully increase knowledge and preferred scenario responses in Serbian providers and may be a viable approach to improving birth outcomes.
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http://dx.doi.org/10.22454/FamMed.2019.326047DOI Listing
November 2019