Publications by authors named "Tonya Turner"

9 Publications

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Advanced glycation end products are elevated in estrogen receptor-positive breast cancer patients, alter response to therapy, and can be targeted by lifestyle intervention.

Breast Cancer Res Treat 2019 Feb 27;173(3):559-571. Epub 2018 Oct 27.

Department of Pathology & Laboratory Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA.

Purpose: Lifestyle factors associated with personal behavior can alter tumor-associated biological pathways and thereby increase cancer risk, growth, and disease recurrence. Advanced glycation end products (AGEs) are reactive metabolites produced endogenously as a by-product of normal metabolism. A Western lifestyle also promotes AGE accumulation in the body which is associated with disease phenotypes through modification of the genome, protein crosslinking/dysfunction, and aberrant cell signaling. Given the links between lifestyle, AGEs, and disease, we examined the association between dietary-AGEs and breast cancer.

Methods: We evaluated AGE levels in bio-specimens from estrogen receptor-positive (ER+) and estrogen receptor-negative (ER-) breast cancer patients, examined their role in therapy resistance, and assessed the ability of lifestyle intervention to reduce circulating AGE levels in ER+ breast cancer survivors.

Results: An association between ER status and AGE levels was observed in tumor and serum samples. AGE treatment of ER+ breast cancer cells altered ERα phosphorylation and promoted resistance to tamoxifen therapy. In a proof of concept study, physical activity and dietary intervention was shown to be viable options for reducing circulating AGE levels in breast cancer survivors.

Conclusions: There is a potential prognostic and therapeutic role for lifestyle derived AGEs in breast cancer. Given the potential benefits of lifestyle intervention on incidence and mortality, opportunities exist for the development of community health and nutritional programs aimed at reducing AGE exposure in order to improve breast cancer prevention and treatment outcomes.
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http://dx.doi.org/10.1007/s10549-018-4992-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394600PMC
February 2019

Evaluation of a Lifestyle Change Worksite Weight Management Program Across Multiple Employers and Sites.

J Occup Environ Med 2018 12;60(12):1112-1115

Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina (Dr Hales, Ms Turner, Dr Sword, Ms Nance, Dr O'Neil); College of Health Professions, Physical Therapy Division, Medical University of South Carolina, Charleston, South Carolina (Dr Sword); Weight Management Center, Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina (Dr Brown).

Objective: The aim of the study was to assess weight loss outcomes among participants (N = 1090) of a weight management program across multiple worksites (N = 10) in a retrospective analysis.

Methods: Weekly classes focused on diet, exercise, and behavior change. One employer provided incentives for weight loss and two incentivized weight loss and class attendance.

Results: Mean weight loss (N = 1090; 79.3% female) was -2.9% (SD = 3.0%). Average number of classes attended was 6.87/10 (SD = 2.9) and was significantly correlated with percent weight change (r = -0.46; P < 0.001). Participants incentivized for attendance attended significantly more classes (M = 7.5, SD = 2.8) than did those not so incentivized (M = 6.4, SD = 2.9, P < 0.001), but did not lose more weight (P = 0.24). Participants incentivized for weight loss did not lose significantly more weight than those not so incentivized (P = 0.26).

Conclusions: These data support the effectiveness of this worksite program. Utilizing incentives to promote class attendance may be beneficial for increasing engagement in similar programs.
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http://dx.doi.org/10.1097/JOM.0000000000001442DOI Listing
December 2018

Description, utilisation and results from a telehealth primary care weight management intervention for adults with obesity in South Carolina.

J Telemed Telecare 2020 Jan-Feb;26(1-2):28-35. Epub 2018 Jul 25.

Medical University of South Carolina, Charleston, USA.

Introduction: In the US, obesity rates are higher in rural areas than in urban areas. Rural access to treatment of obesity is limited by a lack of qualified clinicians and by transportation and financial barriers. We describe a telemedicine weight management programme, Wellness Connect, developed through a partnership of academic clinicians and rural primary care providers in South Carolina, and present utilisation and weight outcomes from seven patient cohorts.

Methods: Eight bi-weekly sessions were provided via telemedicine videoconferencing for groups of patients at these rural primary care clinics. Protocol-based sessions were led by registered dietitians, exercise physiologists and clinical psychologists at a central urban location.

Results: Of 138 patients who started the programme, 62% ( = 86) of patients met the criteria for completion. Completers lost an average of 3.5% (standard deviation (SD) = 3.9%) body weight, which was statistically significant ( < .001) and corresponded with an average loss of 3.8 kg (SD = 4.5 kg). There were no differences in weight change among clinics ( = .972). Overall, patients and providers reported satisfaction with the programme and identified several challenges to sustainability.

Discussion: The use of innovative telemedicine interventions continues to be necessary to alleviate barriers to accessing evidence-based services to reduce chronic diseases and decrease obesity rates among rural populations.
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http://dx.doi.org/10.1177/1357633X18789562DOI Listing
June 2020

A novel approach to training students in delivering evidence-based obesity treatment.

Fam Med 2015 May;47(5):378-82

Medical University of South Carolina.

Background And Objectives: Obesity is a major public health concern because of its prevalence, serious health consequences, and costs. Many health care providers believe they have been inadequately trained to treat obesity and, as a result, often do not address patients' weight. Despite recommendations to improve knowledge and skills so they can more effectively address obesity, health care educational curricula are already overburdened with content and have been slow to respond to these recommendations.

Methods: Interprofessional health care students voluntarily participated in an extracurricular service-learning opportunity to learn about the evidence-based treatment of obesity. A multidisciplinary team of weight management professionals taught didactic lessons and oversaw the service-learning component of training. An essential element of the training was the students' delivery of a free 10-week weight management intervention to low-income overweight and obese community residents.

Results: Patients in both the student-led (n=25) and professional-led (n=21) programs lost a statistically and clinically significant amount of weight. Additionally, there was no significant difference in weight loss between the two programs, even after taking into account differences in attendance between the two programs.

Conclusions: An extracurricular service-learning program pairing brief didactic instruction with experiential learning appears to be a viable strategy for accomplishing the important dual objectives of preparing health care students to treat obesity and providing much-needed treatment to those in our community who are least able to afford it.
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May 2015

Academy of Nutrition and Dietetics: standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in adult weight management.

J Acad Nutr Diet 2015 Apr;115(4):609-18.e40

Weight management encompasses the inter-relationship of nutrition, physical activity, and health behavior change. Nutrition is key for the prevention and treatment of obesity and chronic disease and maintenance of overall health. Thus, the Weight Management Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) in Adult Weight Management as a resource for RDNs working in weight management. This document allows RDNs to assess their current skill levels and to identify areas for further professional development in this expanding practice area. This document describes the current standards for weight management practice for RDNs. The Standards of Practice represent the four steps in the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance consist of six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standard can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for RDNs working in weight management. The Standards of Practice and Standards of Professional Performance are complementary resources for the Registered Dietitian Nutritionist in weight management.
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http://dx.doi.org/10.1016/j.jand.2014.12.018DOI Listing
April 2015

Dietary adherence and satisfaction with a bean-based high-fiber weight loss diet: a pilot study.

ISRN Obes 2013 29;2013:915415. Epub 2013 Oct 29.

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Suite 410, Charleston, SC 29425, USA.

Objective. Dietary fiber can reduce hunger and enhance satiety, but fiber intake during hypocaloric weight loss diets typically falls short of recommended levels. We examined the nutritional effects and acceptability of two high-fiber hypocaloric diets differing in sources of fiber: (a) beans or (b) fruits, vegetables, and whole grains. Methods. Subjects were 2 men, 18 women, mean age = 46.9, and mean BMI = 30.6. Subjects completed 3-day food diaries in each of the two baseline weeks. Subjects were then randomized to four weeks on one of two 1400-calorie diets including 25-35 g fiber primarily from 1.5 cups beans/day or from fruits, vegetables, and whole grains. Recommended fiber-rich foods were provided. Subjects kept weekly 3-day food diaries and were assessed weekly. Results. Diet conditions did not differ on outcome measures. Both diets increased fiber intake from 16.6 g/day (SD = 7.1) at baseline to (treatment average) 28.4 g/day (SD = 6.5) (P < 0.001). Fiber intake was consistent over treatment. Caloric intake dropped from 1623.1 kcal/day (SD = 466.9) (baseline) to 1322.2 kcal/day (SD = 275.8) (P = 0.004). Mean weight loss was 1.4 kg (SD = 1.5; P < 0.001). Energy density and self-reported hunger decreased (P's < 0.01) while self-reported fullness increased (P < 0.05). Both diets were rated as potentially acceptable as long as six months. Conclusions. Both diets significantly increased fiber intake by 75%, increased satiation, and reduced hunger. Results support increasing fiber in weight loss diets with a variety of fiber sources.
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http://dx.doi.org/10.1155/2013/915415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901975PMC
February 2014

Racism, health status, and birth outcomes: results of a participatory community-based intervention and health survey.

J Urban Health 2011 Feb;88(1):84-97

Prevention Research Center of Michigan, University of Michigan School of Public Health, Ann Arbor, MI, USA.

Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.
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http://dx.doi.org/10.1007/s11524-010-9530-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042077PMC
February 2011

Using a cultural framework to assess the nutrition influences in relation to birth outcomes among African American women of childbearing age: application of the PEN-3 theoretical model.

Health Promot Pract 2009 Jul 19;10(3):349-58. Epub 2008 Mar 19.

Nutrition Department, School of Public Health and Health Sciences, at University of Massachusetts in Amherst, Massachusetts, USA.

The purpose is to present the process and results of focus groups conducted to access information for the design of a healthy eating curriculum to reduce maternal nutritional risks and enhance protective factors among African American women in relation to birth outcomes. Sixteen younger (19 to 25 years) and 20 older African American women (45 to 60 years), respectively, participated. The PEN-3 model, (Airhihenbuwa, 1995, 1999) guided the focus groups. Most women stated that culture and family relationships impacted their food choices. Younger women expressed creativity with recipes and presented a desire to be more involved with preparing foods. Older women expressed eagerness to teach family-centered culinary skill-building classes. Both groups of women acknowledged time and budget barriers, identified the prevalence of lactose intolerance, and recognized that large grocery stores that offered food variety were not located in their community. Health professionals are encouraged to consider these findings while designing interventions targeting young African American women's nutrition in relation to birth outcomes.
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http://dx.doi.org/10.1177/1524839907301406DOI Listing
July 2009

A birth records analysis of the Maternal Infant Health Advocate Service program: a paraprofessional intervention aimed at addressing infant mortality in African Americans.

Ethn Dis 2004 ;14(3 Suppl 1):S102-7

University of Michigan, School of Public Health/Genesee County Health Department, Flint, Michigan 48502, USA.

Recognizing that no single intervention was likely to eliminate racial disparities, the Genesee County REACH 2010 partnership, utilizing both "bench" science and "trench" knowledge, developed 13 broad-based, multi-faceted interventions to eliminate infant mortality. This article provides highlights from a recent birth records comparison analysis of the Maternal Infant Health Advocate Service (MIHAS) intervention, and is solely based on the records of 111 MIHAS clients, and a random sample of 350 African-American women residing in Flint, Michigan. The MIHAS clients were more likely than the comparison sample not to have graduated from high school (56% vs 35%, respectively, P<.0001). The MIHAS clients were more likely to report at least some smoking during pregnancy (20% vs 15%, respectively, P<.05). However, after controlling for age and education, these results were no longer statistically significant. In terms of birth outcomes, the comparative odds of MIHAS clients delivering a low birth-weight infant are 1.124 (95% CI: 0.620-2.038); the odds of their delivering an infant at 37 weeks or earlier are 1.032 (0.609-1.749). Although the MIHAS clients did not have statistically better birth outcomes than those of the general African-American population in Flint, the MIHAS clients did not demonstrate the outcomes one would expect, given their higher level of risk. Based on this analysis, the MIHAS intervention may have brought its clients "up to par" with the general community on several birth outcomes.
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December 2005