Publications by authors named "Sara Aghaee"

10 Publications

  • Page 1 of 1

mHealth Mindfulness Intervention for Women with Moderate-to-Moderately-Severe Antenatal Depressive Symptoms: a Pilot Study Within an Integrated Health Care System.

Mindfulness (N Y) 2021 Mar 11:1-11. Epub 2021 Mar 11.

Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA.

Objectives: Traditional mindfulness-based interventions have been shown to reduce depression symptoms in pregnant women, although in-person classes may pose significant accessibility barriers, particularly during the COVID-19 pandemic. Mobile technology offers greater convenience, but little is known regarding the efficacy of self-paced, mobile-delivered (mHealth) mindfulness interventions in this population. This study tested the feasibility and acceptability of offering such an intervention for pregnant women with moderate-to-moderately-severe depression symptoms.

Methods: We conducted a single-arm trial within Kaiser Permanente Northern California (KPNC). Participants were identified through KPNC's universal perinatal depression screening program. Eligible participants included English-speaking pregnant women (<28 weeks of gestation) with moderate-to-moderately-severe depressive symptoms without a regular (<3 times/week) mindfulness/meditation practice. Participants were asked to follow a self-paced, 6-week mindfulness meditation program using a mobile app, Headspace™, 10-20 min/day. Outcome measures included feasibility, acceptability, and patient-reported outcomes (e.g., depression symptoms).

Results: Of the 27 women enrolled, 20 (74%) completed the study. Over half (55%) of participants used the app ≥50% of the days during the 6-week intervention. Responses to the semi-structured interviews indicated that women appreciated the convenience of the intervention and the ability to engage without having to attend classes or arrange childcare. We observed significant improvements in pre-postintervention scores for depression symptoms, perceived stress, sleep disturbance, and mindfulness.

Conclusions: Our study demonstrates the feasibility and acceptability of an mHealth mindfulness intervention for women with moderate-to-moderately-severe antenatal depression symptoms. The preliminary data further suggest that an efficacy trial is warranted.
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http://dx.doi.org/10.1007/s12671-021-01606-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947160PMC
March 2021

A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study.

JMIR Ment Health 2020 Nov 12;7(11):e17405. Epub 2020 Nov 12.

Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States.

Background: Approximately 20% of women suffer from postpartum depression (PPD). Due to barriers such as limited access to care, half of the women with PPD do not receive treatment. Therefore, it is critical to identify effective and scalable interventions. Traditional mindfulness programs have been effective in reducing depressive symptoms, however access remains a barrier. A self-paced mobile health (mHealth) mindfulness program may fit the lifestyle of busy mothers who are unable to attend in-person classes. However, little is known regarding the feasibility or efficacy of mHealth mindfulness interventions in postpartum women with depressive symptoms.

Objective: This study aims to assess the feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms.

Methods: We conducted a single-arm feasibility trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated health care system. Participants were identified through clinician referral and electronic health records via KPNC's universal perinatal depression screening program and recruited by the study team. Inclusion criteria included the following: English-speaking, up to 6 months postpartum with a Patient Health Questionnaire (PHQ-8) score of 10 to 19, and no regular mindfulness/meditation practice. Participants were asked to use a mindfulness app, Headspace, 10 to 20 min/day for 6 weeks. Baseline and postintervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep quality, and mindfulness). Semistructured interviews captured acceptability. Retention and adherence were used to assess feasibility.

Results: Of the 115 women who were contacted and met the eligibility criteria or declined participation before eligibility assessment, 27 (23%) were enrolled. In addition, 70% (19/27) completed the study. The mean age of participants was 31 years (SD 5.2), 30% (8/27) were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (SD 5.7). Of the women who completed the study, 100% (19/19) used the Headspace app at least once, and nearly half (9/19, 47%) used the app on ≥50% of the days during the 6-week intervention period. Of the 16 participants who completed the postintervention interview, 69% (11/16) reported that they were very or extremely satisfied with the app. Interviews indicated that women appreciated the variety of meditations and felt that the program led to reduced anxiety and improved sleep. Significant improvements in pre- and postintervention scores were observed for depressive symptoms (PHQ-8: -3.8, P=.004), perceived stress (10-item Perceived Stress Scale: -6.0, P=.005), and sleep quality (Pittsburgh Sleep Quality Index: -2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire-Short Form: 10.9, P=.01).

Conclusions: An mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms is feasible and acceptable. An efficacy trial is warranted.
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http://dx.doi.org/10.2196/17405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691085PMC
November 2020

Early life household intactness and timing of pubertal onset in girls: a prospective cohort study.

BMC Pediatr 2020 10 28;20(1):464. Epub 2020 Oct 28.

Kaiser Permanente Division of Research, 2000 Broadway, CA, 94612, Oakland, USA.

Background: Girls who experience early-life familial stress may have heightened risk of early puberty, which has adverse implications for adolescent and adult health. We assessed the association between household intactness and pubertal onset using a racially/ethnically diverse cohort of girls from Northern California.

Methods: A prospective cohort study of 26,044 girls born in 2003-10. Girls living with both parents from birth up to 6 years were considered to come from "intact" households while others constituted "non-intact" households. Pubertal development was measured using pediatrician-assessed Tanner staging for breast and pubic hair. Pubertal onset was defined as the transition from Tanner Stage 1 to 2+ for breast (thelarche) and pubic hair (pubarche). Menarche data was collected from routine well-child questionnaires. Weibull regression models accommodating left, right, and interval censoring were used to determine risk of earlier thelarche and pubarche, and logistic regressions were used to assess the risk of early menarche (age < 12).

Results: Girls exposed to non-intact households before age 2 years were at increased risk for earlier thelarche and pubarche with significant effect modification by race/ethnicity, compared with girls from intact households. The associations were strongest among Black girls (adjusted hazard ratio [HR]: 1.60, 95% confidence interval [CI]: 1.29,1.98; HR: 1.42, 95%CI: 1.15,1.77 for thelarche and pubarche, respectively). There were no significant associations among Asian/Pacific Islanders. Girls who lived in non-intact households before age 2 years were also at increased risk for earlier menarche, but without race/ethnic interaction. Adjustment for prepubertal obesity did not change these associations. Associations between living in non-intact households after age 2 years and early puberty were weaker but still significant.

Conclusions: Exposure to a non-intact household early in life may increase the risk of early puberty in girls. Future psychosocial interventions focused on improving family cohesiveness and efforts to reduce childhood stress among families that are non-intact may mitigate these negative associations, thereby preventing future adverse health effects of early puberty and health disparities.
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http://dx.doi.org/10.1186/s12887-020-02345-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592583PMC
October 2020

Pilot pragmatic randomized trial of mHealth mindfulness-based intervention for advanced cancer patients and their informal caregivers.

Psychooncology 2020 Sep 26. Epub 2020 Sep 26.

Kaiser Permanente Division of Research, Oakland, California, USA.

Objective: Assess the feasibility of conducting a cluster randomized controlled trial (RCT) comparing technology-delivered mindfulness-based intervention (MBI) programs against a waitlist control arm targeting advanced cancer patients and their informal caregivers.

Methods: Two-arm cluster RCT within Kaiser Permanente Northern California. We recruited patients with metastatic solid malignancies or hematological cancers and their informal caregivers. Intervention-group participants chose to use either a commercially available mindfulness app (10-20 min/day) or a webinar-based mindfulness course for 6 weeks. The waitlist control group received usual care. We assessed feasibility measures and obtained participant-reported data on quality of life (QoL; primary outcome) and distress outcomes (secondary) pre- and postintervention.

Results: A hundred and three patients (median age 67 years; 70% female; 81% White) and 39 caregivers (median age 66 years; 79% female; 69% White) were enrolled. Nearly all participants chose the mindfulness app over the webinar-based program. Among the participants in the intervention arm who chose the mobile-app program and completed the postintervention (6-week) survey, 21 (68%) patients and 7 (47%) caregivers practiced mindfulness at least 50% of the days during the 6-week study period. Seventy-four percent of intervention participants were "very" or "extremely" satisfied with the mindfulness program. We observed improvements in anxiety, QoL, and mindfulness among patients in the intervention arm compared to those in the control group.

Conclusions: We demonstrated the feasibility of conducting a cluster RCT of mHealth MBI for advanced cancer patients and their caregivers. Such remote interventions can be helpful particularly during the COVID-19 pandemic.
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http://dx.doi.org/10.1002/pon.5557DOI Listing
September 2020

Prevalence and correlates of initiating injection drug use before the age of 18 years in Iran: results of a national survey.

J Addict Dis 2020 Jul-Sep;38(3):334-338. Epub 2020 Jun 29.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

In this study, we sought to determine factors relating to initiating injection drug use before the age of 18 years in Iran. In this cross-sectional survey, people who inject drugs were recruited using facility-based sampling in 10 cities in Iran in 2014. Adults (≥18 year) who reported injecting drugs at least one time during the last year were included. A structured questionnaire collected behaviors related to injection, sexual risk, and HIV testing. Based on the reported age of first injection, we grouped participants into that initiating injection drug use by before 18-year old versus 18- and after 18-year old. Of 2356 participants, 199 (8.5%, 95% CI 7.4-9.6) started injecting before the age of 18 years. Initiating injection drug use before the age of 18 years were more likely to be <30-year old (39.4% vs. 19.7%,  < .001), report syringe and needle sharing (15.0% vs. 5.4%,  < .001), have sex with other men (24.3% vs. 15.6%,  < .001), and have complete knowledge about HIV (92.5% vs. 86.4%,  < .001). People who started injection at younger ages had higher risk profiles and should be prioritized for substance use treatment, harm reduction, and HIV prevention programs.
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http://dx.doi.org/10.1080/10550887.2020.1765076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936536PMC
June 2020

Everyday discrimination and telomere length in a multiethnic cohort of breast cancer survivors.

Ethn Health 2020 Mar 28:1-12. Epub 2020 Mar 28.

Cancer Prevention Institute of California, Fremont, CA, USA.

Racial/ethnic minority women have disproportionately lower breast cancer survival rates compared to white women. As minorities in the US are exposed to higher levels of discrimination, and exposure to discrimination has been associated with shorter telomere lengths (TLs), we investigated the association between perceived everyday discrimination and TL in a multiethnic sample of breast cancer survivors. We examined a cohort of 58 breast cancer survivors who participated in a pilot study to investigate biological stress. Participants were drawn from the Equality in Breast Cancer Care (EBCC) study and were asked to provide saliva samples for DNA extraction. Ordinary least squares linear regression was used to derive regression coefficients () and 95% confidence intervals (CI). Higher levels of everyday discrimination were associated with longer TLs ( = 1.04, CI: 1.01-1.07), adjusting for age, race/ethnicity, breast cancer stage, and breast cancer subtype. Luminal B subtypes were associated with longer telomeres relative to luminal A, while African Americans were less likely than Whites to have longer telomeres. Further research, particularly longitudinal studies, is needed to understand how discrimination, and other social stressors, impact biological stress and health outcomes.
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http://dx.doi.org/10.1080/13557858.2020.1739231DOI Listing
March 2020

Correction to: Breastfeeding and timing of pubertal onset in girls: a multiethnic population-based prospective cohort study.

BMC Pediatr 2019 Sep 5;19(1):317. Epub 2019 Sep 5.

Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.

Following publication of the original article [1], the authors reported that Table 4 was incorrectly presented. The revised and corrected version is shown below.
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http://dx.doi.org/10.1186/s12887-019-1671-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729063PMC
September 2019

Breastfeeding and timing of pubertal onset in girls: a multiethnic population-based prospective cohort study.

BMC Pediatr 2019 08 9;19(1):277. Epub 2019 Aug 9.

Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.

Background: Early puberty is associated with higher risk of adverse health and behavioral outcomes throughout adolescence and adulthood. US girls are experiencing earlier puberty with substantial racial/ethnic differences. We examined the association between breastfeeding and pubertal timing to identify modifiable risk factors of early puberty and potential sources of racial/ethnic differences in the timing of pubertal development.

Methods: A prospective cohort study of 3331 racially/ethnically diverse girls born at Kaiser Permanente Northern California (KPNC) between 2004 and 06. All data were obtained from KPNC electronic clinical and administrative datasets. Mother-reported duration of breastfeeding was obtained from questionnaires administered at each 'well-baby' check-up exam throughout the baby's first year and categorized as 'Not breastfed', 'Breastfed < 6 months', and 'Breastfed ≥ 6 months'. Pubertal development data used Tanner stages assessed by pediatricians during routine pediatric checkups starting at age 6. Pubertal onset was defined as transition from Tanner Stage 1 to Tanner Stage 2+ for breast (thelarche) and pubic hair (pubarche). Weibull regression models accommodating for left, right, and interval censoring were used in all analyses. Models were adjusted for maternal age, education, race/ethnicity, parity and prepubertal body mass index (BMI). We also examined race/ethnicity as a potential effect modifier of these associations.

Results: Not breastfeeding was associated with earlier onset of breast and pubic hair development compared to breastfeeding ≥6 months (adjusted hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.07-1.46; HR: 1.24; 95% CI: 1.05-1.46, respectively). Breastfeeding for < 6 months was also associated with the risk of earlier pubic hair development (HR: 1.14; 95% CI: 1.00-1.30, compared to breastfeeding ≥6 months). Inclusion of girls' prepubertal BMI slightly attenuated the association between breastfeeding and timing of breast onset but remained significant. The association between not breastfeeding and early breast development may be stronger among African American girls (HR: 1.92; 95% CI: 1.01-3.66, no breastfeeding vs. ≥6 months) than other racial/ethnic groups.

Conclusions: Breastfeeding is an independent predictor of pubertal onset in girls, and the strength of the association may vary by race/ethnicity. Providing breastfeeding support and lactation education for high risk mothers may help prevent earlier pubertal onset and promote positive health outcomes later in life.
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http://dx.doi.org/10.1186/s12887-019-1661-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688234PMC
August 2019

A Randomized Controlled Trial of mHealth Mindfulness Intervention for Cancer Patients and Informal Cancer Caregivers: A Feasibility Study Within an Integrated Health Care Delivery System.

Integr Cancer Ther 2019 Jan-Dec;18:1534735419850634

1 Kaiser Permanente Division of Research, Oakland, CA, USA.

Purpose: To assess feasibility and preliminary efficacy of a mobile/online-based (mHealth) mindfulness intervention for cancer patients and their caregivers to reduce distress and improve quality of life (QoL).

Material And Methods: Two-arm randomized controlled trial within Kaiser Permanente Northern California targeting cancer patients who received chemotherapy and their informal caregivers. The intervention group received a commercially available mindfulness program for 8 weeks. The wait-list control group received usual care. We assessed feasibility using retention and adherence rates and obtained participant-reported data on distress, QoL, sleep, mindfulness, and posttraumatic growth before and immediately after the intervention.

Results: Ninety-seven patients (median age 59 years; female 69%; 65% whites) and 31 caregivers (median age 63 years; female 58%; 77% whites) were randomized. Among randomized participants, 74% of the patients and 84% of the caregivers completed the study. Among those in the intervention arm who initiated the mindfulness program, 65% practiced at least 50% of the days during the intervention period. We observed significantly greater improvement in QoL among patients in the intervention arm compared with controls. Caregivers in the intervention group experienced increased mindfulness compared with controls. Participants appreciated the convenience of the intervention and the mindfulness skills they obtained from the program.

Conclusion: We demonstrated the feasibility of conducting a randomized trial of an mHealth mindfulness intervention for cancer patients and their informal caregivers. Results from fully powered efficacy trials would inform the potential for clinicians to use this scalable intervention to help improve QoL of those affected by cancer and their caregivers.
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http://dx.doi.org/10.1177/1534735419850634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537293PMC
December 2019

Associations of Maternal Gestational Weight Gain and Obesity With the Timing of Pubertal Onset in Daughters.

Am J Epidemiol 2019 07;188(7):1262-1269

Kaiser Permanente Division of Research, Oakland, California.

Early puberty is associated with adverse health outcomes, but little is known regarding early-life determinants influencing pubertal timing. We examined the associations between maternal gestational weight gain (GWG) and the timing of the onset of breast development (thelarche) and pubic hair development (pubarche) in a cohort of 2,070 girls born in a Kaiser Permanente Northern California facility between 2005 and 2006. Using Weibull regression models accommodating interval censoring and adjusting for important confounders, we found that excess GWG was associated with increased risk of early thelarche (hazard ratio (HR) = 1.50, 95% confidence interval (CI): 1.26, 1.78) and early pubarche (HR = 1.35, 95% CI: 1.10, 1.66). Inadequate GWG was associated with early thelarche (HR = 1.36, 95% CI: 1.08, 1.71). The associations between excess or inadequate GWG and risk of earlier thelarche were stronger if mothers were obese before or at the beginning of pregnancy (body mass index ≥30 kg body weight per m height squared) (HR = 2.01, 95% CI: 1.53, 2.63; HR = 2.08, 95% CI: 1.45, 2.98, respectively). Similar associations were found for pubarche outcome. Inclusion of girls' prepubertal body mass index slightly attenuated these associations, but they remained significant. Monitoring of maternal weight before and throughout pregnancy might help prevent early pubertal onset and subsequent negative health outcomes.
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http://dx.doi.org/10.1093/aje/kwz068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601524PMC
July 2019