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Poster Session E
E1 - Using YOLO Deep Learning and Google Images to Detect Physical Environment Features Affecting Behavioral Symptoms of Dementia
Poster Number: E1Time: 05:00 PM - 05:50 PM
Topics: Aging, Digital Health
Objective: Behavioral symptoms of dementia (BSD) result from a complex interplay of dynamic factors, such as relations with caregivers, care tasks, and the care physical environment (PE). The role of PE in triggering or mitigating BSD remains largely unexplored. Given that home care settings are often the preferred choice for individuals with dementia, the personalized nature of these environments—tailored to individual family units—holds immense potential for BSD interventions. A therapeutic environment could serve as a valuable cue for the effective management of dementia behaviors. With the lack of home environment objective data, such as images or videos, a simulation using a general environment image from a publicly available source could provide a feasibility assessment of an environmental feature classification. Therefore, the purpose of this study was to create a simulation system for detecting BSD-related PE.
Methods: This study employed a deep learning framework commonly known as ‘You Only Look Once’ (YOLO). We created a machine-learning model using 1000 images from publicly available Google Images. The images were obtained from a focused search using the terms ‘environment,’ ‘home environment,’ ‘physical environment,’ ‘behavior,’ ‘dementia,’ and ‘dementia behavior.’ We used 80% of 1000 images for model training and the remaining 20% for model testing.
Results: This model was able to classify 20 PE features with a precision-recall area under a curve (PR-AUC) of 0.71. Preliminary model simulation shows promising accuracy and reliability for detecting environmental factors and could be applied in future ethical and practical feasibility studies.
Conclusion: The key contribution of this research was using Google Images to simulate training the YOLO algorithm for automated detecting of PE features that could be potential triggers of dementia behaviors in home settings, where most people living with dementia receive care.
Implications: This algorithm is the first step in a future systematic investigation of effective strategies to manage BPSD in a home setting using an app-based intervention.
Keywords: dementia behavior, machine learning, home environment
Keywords: Aging, Alzheimer's diseaseMethods: This study employed a deep learning framework commonly known as ‘You Only Look Once’ (YOLO). We created a machine-learning model using 1000 images from publicly available Google Images. The images were obtained from a focused search using the terms ‘environment,’ ‘home environment,’ ‘physical environment,’ ‘behavior,’ ‘dementia,’ and ‘dementia behavior.’ We used 80% of 1000 images for model training and the remaining 20% for model testing.
Results: This model was able to classify 20 PE features with a precision-recall area under a curve (PR-AUC) of 0.71. Preliminary model simulation shows promising accuracy and reliability for detecting environmental factors and could be applied in future ethical and practical feasibility studies.
Conclusion: The key contribution of this research was using Google Images to simulate training the YOLO algorithm for automated detecting of PE features that could be potential triggers of dementia behaviors in home settings, where most people living with dementia receive care.
Implications: This algorithm is the first step in a future systematic investigation of effective strategies to manage BPSD in a home setting using an app-based intervention.
Keywords: dementia behavior, machine learning, home environment
Authors:
Presenter - Chunhong Xiao, PhD, BSN, RN,
PhD, BSN, RN,
The University of Alabama at Birmingham, School of Nursing
Co-Author - Frank Puga, Ph.D.,
Ph.D.,
University of Alabama at Birmingham
Co-Author - Lijun Ma,
MA, AMNP student,
UAB School of Nursing
Co-Author - Rita Jablonski,
PhD, CRNP, FAAN, FGSA,
UAB School of Nursing
Co-Author - Arie Nakhmani,
PhD,
University of Alabama at Birmingham/School of Electrical and Computer Engineering
E2 - Development and Validation of the QUALity of Interactions Inventory (QUALII): Findings from the initial Delphi Survey
Poster Number: E2Time: 05:00 PM - 05:50 PM
Topics: Aging, Methods and Measurement
Background: The daily care interactions between staff and older adults in residential care settings such as assisted living (AL) has a profound impact upon the resident behaviors and their well-being. A comprehensive measure which can both guide the desired practice of positive care interactions and evaluate the impact of practice can support the daily care interactions and further help to manage residents’ behavioral symptoms and promote resident well-being. Such comprehensive measure of care interactions, especially focused on dementia care in AL settings is lacking. Thus, we developed QUALity of Interactions Inventory (QUALII)— a five domain 21-item comprehensive tool to support practice of positive care interactions in ALs.
Purpose: This study aims to evaluate the content validity of the initial version of QUALII following the first round of Delphi survey.
Methods: Utilizing Delphi survey approach, we examined the content validity of QUALII with a panel of N=10 clinical and academic experts in dementia care and communication; surveys were administered electronically. Content Validity Index (CVI) was computed for each item (I-CVI) and overall scale (S-CVI); qualitative feedback and responses were examined using content analysis.
Results: The expert panel included individuals with diverse background and experience including nursing, recreation/activity, dementia research, and clinical or program administration with 4 to 40 years of experience in current role and 4 to 45 years of experience in geriatrics and gerontology in general. The initial version of QUALII demonstrated some content validity for individual QUALII items (Item relevance I-CVI range= 0.70 to 1.00; Item clarity I-CVI range= 0.70 to 1.00) and good content validity for the overall QUALII tool (S-CVI Average= 0.91). The qualitative responses illustrated the need to revise some items related to supporting resident expression, pace of care, and resident engagement during interactions and included suggestions for item revisions.
Conclusion: The lower I-CVI values indicate a need for further revision of QUALII items to enhance item relevance and clarity. Upon further validation, it is expected that the QUALII will emerge as a psychometrically sound instrument for use in guiding and evaluating practices of positive care interactions in dementia care in clinical settings such as AL, and in the development and testing of interventions to promote positive care interactions.
Keywords: Aging, Alzheimer's diseasePurpose: This study aims to evaluate the content validity of the initial version of QUALII following the first round of Delphi survey.
Methods: Utilizing Delphi survey approach, we examined the content validity of QUALII with a panel of N=10 clinical and academic experts in dementia care and communication; surveys were administered electronically. Content Validity Index (CVI) was computed for each item (I-CVI) and overall scale (S-CVI); qualitative feedback and responses were examined using content analysis.
Results: The expert panel included individuals with diverse background and experience including nursing, recreation/activity, dementia research, and clinical or program administration with 4 to 40 years of experience in current role and 4 to 45 years of experience in geriatrics and gerontology in general. The initial version of QUALII demonstrated some content validity for individual QUALII items (Item relevance I-CVI range= 0.70 to 1.00; Item clarity I-CVI range= 0.70 to 1.00) and good content validity for the overall QUALII tool (S-CVI Average= 0.91). The qualitative responses illustrated the need to revise some items related to supporting resident expression, pace of care, and resident engagement during interactions and included suggestions for item revisions.
Conclusion: The lower I-CVI values indicate a need for further revision of QUALII items to enhance item relevance and clarity. Upon further validation, it is expected that the QUALII will emerge as a psychometrically sound instrument for use in guiding and evaluating practices of positive care interactions in dementia care in clinical settings such as AL, and in the development and testing of interventions to promote positive care interactions.
Authors:
Author - Anju Paudel,
PhD, MGS, RN,
Penn State Ross and Carol Nese College of Nursing
Co-Author - Marie Boltz,
PhD, RN, GNP-BC, FGSA, FAAN,
Penn State Ross and Carol Nese College of Nursing
Co-Author - Elizabeth Galik,
PhD, CRNP, FAAN, FANP,
University of Maryland School of Nursing
Co-Author - Beth Howd,
PhD Candidate,
Pennsylvania State University
E3 -Higher Level of Perceived Senior Center Quality is Associated with Better Health Outcomes among Older Adults
Poster Number: E3Time: 05:00 PM - 05:50 PM
Topics: Aging, Social and Environmental Context and Health
Background: Senior centers represent an important place for many older adults to engage in social, recreational, and health related activities/programs. However, there is a limited understanding of senior center’s role in healthy aging. The purpose of this study was to examine how older adults’ perception of senior center quality is associated with their health.
Methods: Data were collected in 2023 using self-administered survey with 1,615 older adults at 24 senior centers in Southern California. Perceived senior center quality (PSCQ) was measured using 8 items adapted from Park Quality Scale. PSCQ scale addressed senior center’s built/social environment and programming. Health outcomes included physical health and mental health (measured using SF-12 questionnaire), anxiety/depression (measured using PHQ-4 Scale), and loneliness (measured using 3-item UCLA Loneliness Scale). Linear mixed effects models were used to examine the relationship between PSCQ and each heath outcome while controlling for age, gender, race/ethnicity, marital status, and education level.
Results: On average, the participants were 74 years old. Seventy-three percent were female, 40% were married, and 37% had college or higher degrees. In terms of race/ethnicity, 36% were Non-Hispanic Whites, 27% were Non-Hispanic Asian/Hawaiian/Pacific Islanders, and 29% were Hispanics. After controlling for socio-demographic variables, higher level of PSCQ was associated with lower loneliness (b=-.27, p<.01), lower anxiety/depression (b=-.27, p<.05), and better mental health (b=1.2, p<.01). The relationship between PSCQ and physical health was positive but not statistically significant.
Conclusions: Higher level of perceived senior center quality is associated with better older adults’ health. Improving the quality of senior centers may enhance older adults’ health and wellbeing. Future study should examine potential mechanisms underlying senior center’s effect on health.
Keywords: Mental health, EnvironmentMethods: Data were collected in 2023 using self-administered survey with 1,615 older adults at 24 senior centers in Southern California. Perceived senior center quality (PSCQ) was measured using 8 items adapted from Park Quality Scale. PSCQ scale addressed senior center’s built/social environment and programming. Health outcomes included physical health and mental health (measured using SF-12 questionnaire), anxiety/depression (measured using PHQ-4 Scale), and loneliness (measured using 3-item UCLA Loneliness Scale). Linear mixed effects models were used to examine the relationship between PSCQ and each heath outcome while controlling for age, gender, race/ethnicity, marital status, and education level.
Results: On average, the participants were 74 years old. Seventy-three percent were female, 40% were married, and 37% had college or higher degrees. In terms of race/ethnicity, 36% were Non-Hispanic Whites, 27% were Non-Hispanic Asian/Hawaiian/Pacific Islanders, and 29% were Hispanics. After controlling for socio-demographic variables, higher level of PSCQ was associated with lower loneliness (b=-.27, p<.01), lower anxiety/depression (b=-.27, p<.05), and better mental health (b=1.2, p<.01). The relationship between PSCQ and physical health was positive but not statistically significant.
Conclusions: Higher level of perceived senior center quality is associated with better older adults’ health. Improving the quality of senior centers may enhance older adults’ health and wellbeing. Future study should examine potential mechanisms underlying senior center’s effect on health.
Authors:
Presenter - Xiao Zhang,
California State University Northridge
Co-Author - Hui Xie,
PhD,
California State University Northridge
Co-Author - Brenda Jauregui,
California State University Northridge
Co-Author - Maryna Bankovska,
California State University Northridge
Co-Author - Cinthia Camacho,
California State University Northridge
Author - Bing Han,
Ph.D,
Kaiser Permanente Southern California
Author - Deborah Cohen,
MD,
Kaiser Permanente Southern California
E4 - Exploring the Feasibility and Acceptability of a Single-Session Online ACT Intervention for Adults Recently Diagnosed with Dementia
Poster Number: E4Time: 05:00 PM - 05:50 PM
Topics: Aging, Quality of Life
Receiving a dementia diagnosis is associated with increased depression, suicidality, and decreased quality of life (QoL). While mental health interventions have been developed for adults with dementia, they are often lengthy, resource-intensive, and require in-person treatment, creating significant accessibility barriers. Brief, online interventions have proven effective in enhancing mental health and QoL across a wide range of age groups and health conditions. To increase access to mental health care for adults with dementia, we worked with clinicians and gerontologists to develop Compassion Compass, an online, single-session intervention using acceptance and commitment therapy (ACT). The current mixed-methods study examined the preliminary feasibility and acceptability of this program among adults with a recent self-reported dementia diagnosis. Twelve participants (7 male, 5 female) aged 35–83 (M=64.2, SD=12.8), completed assessments at baseline, post-intervention, and 2- and 4-week follow-up. Dementia diagnoses included Alzheimer’s disease (n=2), Lewy body dementia (n=2), frontotemporal dementia (n=6), and primary progressive aphasia (n=2). Recruitment proved to be challenging, highlighting feasibility issues in reaching this population. Despite this, preliminary results indicated high program adherence, with a 100% completion rate. Satisfaction ratings were positive, with an average system usability score of 85.8 out of 100. Most (92%) participants strongly agreed they were satisfied with the program and found it helpful; 83% reported it felt well-suited to their needs. All participants agreed that the program could benefit others under high stress, and 75% indicated no need for further personalization. Qualitative interviews further supported high program acceptability, with participants offering concrete examples of useful content and how they integrated ACT principles into their everyday lives. These preliminary results suggest that a single-session, online intervention may be an acceptable approach for enhancing QoL in adults recently diagnosed with dementia. Considerations to improve feasibility for larger studies are needed, such as establishing partnerships with healthcare providers and neurology clinics for recruitment. Full study data (N=20), expected by December 2024, will offer a more comprehensive evaluation of the program's effectiveness.
Keywords: Aging, Quality of lifeAuthors:
Co-Author - Heather Kelley,
PhD,
Utah State University
Co-Author - Ty Aller,
PhD,
Utah State University
Co-Author - Carter Davis,
PhD,
Utah State University
Co-Author - Michael Levin,
PhD,
Utah State University
E5 - Mapping Trajectories and Predictors of Behavioral and Psychological Symptoms of Dementia: A Scoping Review
Poster Number: E5Time: 05:00 PM - 05:50 PM
Topics: Aging, Multiple Health Behavior Change
Objective: Behavioral and psychological symptoms of dementia (BPSDs) frequently occur co-occur, the following complex and dynamic patterns. While significant research has examined the BPSD occurrence, severity, and frequency, limited studies have examined their temporal trajectories and associated predictors. The purpose of this scoping review was to examine what is known in the literature on BPSD trajectories, including analytical approaches and predictors.
Methods: Guided by Arksey and O’Malley’s framework, we conducted a scoping review across four databases, supplemented by CitationChaser and manual searches. A total of 2,157 studies were reviewed, and 21 were included in the final synthesis.
Results: All included studies employed longitudinal designs with sampling periods ranging from multiple daily assessments to yearly intervals. The pooled sample consisted of 6,045 participants, including 1,179 nursing home residents and 4,866 community-dwelling individuals aged 53 to 85 years. Analytical methods included linear mixed models, growth mixture modeling, logistic regression, and group-based trajectory analysis. The Neuropsychiatry Inventory was most commonly used to assess BPSD, with 67% of studies utilizing it. Most studies identified three trajectory groups based on rate of progression (e.g., slow vs. rapid), variation over time (e.g., stable, increasing, decreasing, or fluctuating patterns), and severity progression (e.g., low, moderate, or severe). These trajectories were also associated with distal outcomes, such as cognitive decline and functional limitations of persons living with dementia. Predictors of BPSD trajectories included dementia severity, dementia type, age at onset, daycare attendance, sleep disturbances, functional ability, gender, time of day, impaired mobility, education, caregiving environment, and environmental stressors.
Conclusions: Trajectory analyses provide valuable insights into the dynamic nature of BPSD over time. Identifying predictors and patterns of BPSD trajectories can enhance understanding of when and how these symptoms emerge and progress during the course of dementia.
Implications: Understanding BPSD trajectories can inform ecologically valid early-stage interventions to manage symptoms effectively in both community and nursing home settings, potentially mitigating symptom progression and improving care outcomes.
Keywords: Dementia, Behavioral symptoms, Trajectory modeling
Keywords: Longitudinal research, Alzheimer's diseaseMethods: Guided by Arksey and O’Malley’s framework, we conducted a scoping review across four databases, supplemented by CitationChaser and manual searches. A total of 2,157 studies were reviewed, and 21 were included in the final synthesis.
Results: All included studies employed longitudinal designs with sampling periods ranging from multiple daily assessments to yearly intervals. The pooled sample consisted of 6,045 participants, including 1,179 nursing home residents and 4,866 community-dwelling individuals aged 53 to 85 years. Analytical methods included linear mixed models, growth mixture modeling, logistic regression, and group-based trajectory analysis. The Neuropsychiatry Inventory was most commonly used to assess BPSD, with 67% of studies utilizing it. Most studies identified three trajectory groups based on rate of progression (e.g., slow vs. rapid), variation over time (e.g., stable, increasing, decreasing, or fluctuating patterns), and severity progression (e.g., low, moderate, or severe). These trajectories were also associated with distal outcomes, such as cognitive decline and functional limitations of persons living with dementia. Predictors of BPSD trajectories included dementia severity, dementia type, age at onset, daycare attendance, sleep disturbances, functional ability, gender, time of day, impaired mobility, education, caregiving environment, and environmental stressors.
Conclusions: Trajectory analyses provide valuable insights into the dynamic nature of BPSD over time. Identifying predictors and patterns of BPSD trajectories can enhance understanding of when and how these symptoms emerge and progress during the course of dementia.
Implications: Understanding BPSD trajectories can inform ecologically valid early-stage interventions to manage symptoms effectively in both community and nursing home settings, potentially mitigating symptom progression and improving care outcomes.
Keywords: Dementia, Behavioral symptoms, Trajectory modeling
Authors:
Presenter - Chunhong Xiao, PhD, BSN, RN,
PhD, BSN, RN,
The University of Alabama at Birmingham, School of Nursing
Co-Author - Adelais Markaki,
PhD, RN, CNS, PHCNS‐BC, FAAN,
UAB School of Nursing
Co-Author - Abbey Poe,
BSN, RN ,PhD Candidate,
UAB School of Nursing
Co-Author - Rita A. Jablonski,
PhD, CRNP, FAAN, FGSA,
University of Alabama at Birmingham
Co-Author - Arie Nakhmani,
PhD,
University of Alabama at Birmingham, Electrical and Computer Engineering
Co-Author - David E. Vance,
PhD, MGS, FAAN,
UAB School of Nursing
Co-Author - Frank Puga, Ph.D.,
Ph.D.,
University of Alabama at Birmingham
E6 - Digital Information-Seeking Behaviors Among Cancer Survivors: Associations with Sociodemographic Determinants, Cancer History, and Perceived Health
Poster Number: E6Time: 05:00 PM - 05:50 PM
Topics: Cancer, Digital Health
Background:
Research demonstrates that cancer patients who are well-informed about their condition experience numerous benefits including better coping strategies, greater participation in medical decisions, and decreased anxiety. Over the past decade, information has become increasingly available via online resources; however, few studies have explored the associations between digital information seeking and sociodemographic factors, clinical cancer characteristics, and perceived health.
Methods:
We used data from the National Cancer Institute Health Information National Trends Survey – Surveillance, Epidemiology, and End Results Program (HINTS-SEER), which contains survey data from a sample of 1,234 US cancer survivors whose diagnoses had been reported to one of three SEER program registries in Iowa, New Mexico, and the Greater San Francisco Bay Area. The surveys were administered in 2021, and we assessed information-seeking behavior via questions including “Have you looked for information about cancer from any source?” and “In the past 12 months, have you used a computer, smartphone, or other electronic means to look for health or medical information for yourself?" Multivariable logistic regression models were used to examine associations between information-seeking behaviors and sociodemographic factors, cancer site, stage at diagnosis, time since cancer diagnosis and the end of treatment, health effects of cancer treatment, and perceived general health.
Results:
Looking for cancer-specific information was significantly more common among females (vs. males, OR: 1.51 95% CI: 1.08-2.12), older adults (75+ vs. 18-64, OR: 2.27, 95% CI: 1.47-3.50) and single/never married individuals (vs. married/living as married, OR: 3.97, 95% CI: 1.59-9.91). Factors associated with digital health information seeking included being female (vs. male, OR: 1.36, 95% CI: 1.00-1.86) and higher income ($100,000+ vs. <$50,000, OR: 1.99, 95% CI: 1.33-2.97). Lower odds were found among older adults (75+ vs. 18-64, OR: 0.24, 95% CI: 0.15-0.37) and widowed individuals (vs. married/living as married, OR: 0.55, 95% CI: 0.35-0.85). Neither cancer site nor stage at diagnosis were significantly associated with looking for cancer-specific information or digital health information seeking.
Conclusion:
Various factors are strongly associated with digital information seeking and can inform targeted interventions to improve health information access and utilization among cancer survivors.
Keywords: Cancer, Health communicationResearch demonstrates that cancer patients who are well-informed about their condition experience numerous benefits including better coping strategies, greater participation in medical decisions, and decreased anxiety. Over the past decade, information has become increasingly available via online resources; however, few studies have explored the associations between digital information seeking and sociodemographic factors, clinical cancer characteristics, and perceived health.
Methods:
We used data from the National Cancer Institute Health Information National Trends Survey – Surveillance, Epidemiology, and End Results Program (HINTS-SEER), which contains survey data from a sample of 1,234 US cancer survivors whose diagnoses had been reported to one of three SEER program registries in Iowa, New Mexico, and the Greater San Francisco Bay Area. The surveys were administered in 2021, and we assessed information-seeking behavior via questions including “Have you looked for information about cancer from any source?” and “In the past 12 months, have you used a computer, smartphone, or other electronic means to look for health or medical information for yourself?" Multivariable logistic regression models were used to examine associations between information-seeking behaviors and sociodemographic factors, cancer site, stage at diagnosis, time since cancer diagnosis and the end of treatment, health effects of cancer treatment, and perceived general health.
Results:
Looking for cancer-specific information was significantly more common among females (vs. males, OR: 1.51 95% CI: 1.08-2.12), older adults (75+ vs. 18-64, OR: 2.27, 95% CI: 1.47-3.50) and single/never married individuals (vs. married/living as married, OR: 3.97, 95% CI: 1.59-9.91). Factors associated with digital health information seeking included being female (vs. male, OR: 1.36, 95% CI: 1.00-1.86) and higher income ($100,000+ vs. <$50,000, OR: 1.99, 95% CI: 1.33-2.97). Lower odds were found among older adults (75+ vs. 18-64, OR: 0.24, 95% CI: 0.15-0.37) and widowed individuals (vs. married/living as married, OR: 0.55, 95% CI: 0.35-0.85). Neither cancer site nor stage at diagnosis were significantly associated with looking for cancer-specific information or digital health information seeking.
Conclusion:
Various factors are strongly associated with digital information seeking and can inform targeted interventions to improve health information access and utilization among cancer survivors.
Authors:
Presenter - Roberto M. Benzo, III,
Ph.D.,
The Ohio State University
Co-Author - Rujul Singh,
BS,
The Ohio State University
Co-Author - Macy K. Tetrick,
BS,
The Ohio State University
Co-Author - James L. Fisher,
PhD,
The Ohio State University
E7 - Social-Environmental Adverse Events, Stress and Inflammation: A Longitudinal Cohort Study of Hispanic Breast Cancer Patients in Puerto Rico
Poster Number: E7Time: 05:00 PM - 05:50 PM
Topics: Cancer, Social and Environmental Context and Health
Objective/ Purpose: This study aimed to map the 12-month trajectory of circulatory cytokines and depression/anxiety symptoms while examining its relationship with Social Environmental Adversity (SEA) exposure.
Methods: 175 Hispanic breast cancer (BC) patients (stages I-III) were recruited. Patients completed surveys that included the PHQ-8, Adverse Childhood Events (ACE) questionnaire, and the Trauma History Questionnaire. Blood serum and BC tumor samples are being collected. Follow-up assessments will conclude in March 2024.
Results: Participants mean age was 55.69. At baseline, 41.9% reported depression and 35.5% anxiety symptoms. Crime exposure was reported by 43.1%, while 100% experienced general disasters. Sexual/physical abuse was reported by 36.3%, while 25.5% reported exposure to more than 4 ACE events. Correlations were found between depression and serum cortisol levels (p=.026). Depression symptoms were correlated (< 0.05) with several cytokines (MIP, IL-8, FGF2, and IL-1RA). Anxiety symptoms were correlated (< 0.05) with IL-8, MIP, MCP3, TGF, and MIPß. Additional longitudinal analyses are being performed to map the trajectory of circulatory cytokines tumor-associated myeloid/lymphoid-derived cells and examine their relationship with depression/anxiety symptoms.
Conclusion : Findings suggest a complex interplay between immune and mental health factors, emphasizing the need for further exploration into the underlying mechanisms behind these observations. Exposure to traumatic SEA events among our cohort highlights the need to address social inequities.
Keywords: Cancer, StressMethods: 175 Hispanic breast cancer (BC) patients (stages I-III) were recruited. Patients completed surveys that included the PHQ-8, Adverse Childhood Events (ACE) questionnaire, and the Trauma History Questionnaire. Blood serum and BC tumor samples are being collected. Follow-up assessments will conclude in March 2024.
Results: Participants mean age was 55.69. At baseline, 41.9% reported depression and 35.5% anxiety symptoms. Crime exposure was reported by 43.1%, while 100% experienced general disasters. Sexual/physical abuse was reported by 36.3%, while 25.5% reported exposure to more than 4 ACE events. Correlations were found between depression and serum cortisol levels (p=.026). Depression symptoms were correlated (< 0.05) with several cytokines (MIP, IL-8, FGF2, and IL-1RA). Anxiety symptoms were correlated (< 0.05) with IL-8, MIP, MCP3, TGF, and MIPß. Additional longitudinal analyses are being performed to map the trajectory of circulatory cytokines tumor-associated myeloid/lymphoid-derived cells and examine their relationship with depression/anxiety symptoms.
Conclusion : Findings suggest a complex interplay between immune and mental health factors, emphasizing the need for further exploration into the underlying mechanisms behind these observations. Exposure to traumatic SEA events among our cohort highlights the need to address social inequities.
Authors:
Co-Author - Cristina Peña-Vargas,
PhD,
Ponce Health Sciences University-Ponce Research Institute
Co-Author - Zindie Rodríguez-Castro,
MD,
Ponce Health Sciences University-Ponce Research Institute
Co-Author - Normarie Torres-Blasco, PhD,
PhD,
Ponce Health Science University-Ponce Research Institute
Co-Author - Guillermo Armaiz-Pena,
PhD,
Ponce Health Sciences University-Ponce Research Institute
E8 - You can’t manage what you can’t measure: Evaluating sources of exercise oncology program referrals to inform scalability efforts
Poster Number: E8Time: 05:00 PM - 05:50 PM
Topics: Cancer, Physical Activity
Exercise oncology (ExOnc) programs have numerous benefits for cancer survivors, including attenuating treatment-related side effects and improving quality of life. Yet, knowledge of and access to these programs remains limited. Receiving a provider ExOnc referral is positively associated with program enrollment; however, little is known about referral patterns. PURPOSE: To describe recent referral patterns to a Colorado ExOnc program (BfitBwell). METHODS: In this retrospective study, we analyzed data collected from BfitBwell between February 1, 2023, and September 1, 2024. BfitBwell is a 12-week individualized exercise program for adults (≥18 years) diagnosed with cancer who are receiving or recently completed cancer treatment (≤6-months). At enrollment, participants were asked how they were referred to BfitBwell and staff recorded if a formal electronic health record (EHR) referral was received. The prevalence of each referral source and formal EHR referrals were calculated. Differences in demographic variables for participants who did and did not receive a formal EHR referral were explored using t-tests and chi-square tests. RESULTS: BfitBwell participants (n=128) were 55.0±13.8 years of age (range: 23-85 years), and the majority were female (n=86; 67.2%). The most common cancer types were breast (n=49; 38.3%), hematologic (n=20; 15.6%), and prostate (n=14; 10.9%). Most participants were referred to BfitBwell by a physician, advanced practice provider, or nurse (n=58; 45.3%) or other allied healthcare provider (n=22; 17.2%). Other referral sources included program advertising (n=21; 16.4%), friends or family (n=9; 7.0%), and research studies (n=9; 7.0%). Only 27.3% of participants (n=35) received a formal EHR referral to BfitBwell. There were no significant differences in age, body mass index, race, ethnicity, sex, or cancer type between participants who did and did not receive a formal EHR referral (p>0.05). CONCLUSIONS: While nearly two-thirds of participants were referred to BfitBwell by a healthcare provider, less than a third of participants received a formal EHR referral. Three cancer types made up the majority of diagnoses among BfitBwell participants, suggesting that program awareness likely varies across oncology clinics. Our findings highlight the opportunity to address the drivers of limited formal EHR referrals as compared to informal referrals, which could inform scalability efforts to improve ExOnc program enrollment.
Keywords: Cancer survivorship, ExerciseAuthors:
Presenter - Emily Dunston,
PhD, MS,
University of Colorado Anschutz
Co-Author - Amy Huebschmann,
MD, MSc, FACP, FSBM,
University of Colorado Anschutz
Co-Author - Jared Scorsone,
BS,
University of Colorado Anschutz
Co-Author - Ryan Marker,
PT, PhD,
University of Colorado Anschutz
E9 - Moderating effect of cancer-related fatigue on physical activity in breast cancer survivors: An exploratory analysis of the Fit2Thrive intervention
Poster Number: E9Time: 05:00 PM - 05:50 PM
Topics: Cancer, Physical Activity
Background: Cancer-related fatigue (CRF) is a common consequence of breast cancer (BC). Increased moderate to vigorous physical activity (MVPA) is associated with lower CRF among breast cancer survivors (BCS) and is the first-line treatment for CRF. However, CRF is a common barrier to MVPA among BCS. mHealth MVPA interventions might increase MVPA among BCS with CRF, but existing mHealth interventions are not tailored for BCS with CRF. This study examines whether baseline CRF moderates the effect of Fit2Thrive, a remote MVPA intervention for BCS, on daily MVPA.
Methods: Using Multiphase Optimization Strategy methodology, inactive BCS [n=269; Mage=52.5; SD=9.9)] received a core intervention (Fitbit + Fit2Thrive app) and were randomized to “on” or “off” conditions of five additional components: support calls, deluxe app, online gym, buddy, and text messages. Fit2Thrive was delivered for 12 weeks with a 12-week maintenance period. Baseline CRF was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue short form. Scores were coded as binary to indicate clinically elevated fatigue (T-score>55). Daily MVPA was measured via accelerometry at baseline, 12 and 24 weeks. Moderating effects of CRF on time and intervention component were estimated using generalized linear mixed effects models with a gamma distribution and log link function.
Results: The moderating effect of baseline CRF on daily MVPA at weeks 12 and 24 was statistically significant; BCS with CRF demonstrated significantly smaller increases in MVPA at 12 (β=-0.27; p=0.0002) and 24 (β=-0.22; p=0.002) weeks. The moderation effect of baseline CRF was significant for text messages at week 12 (β=0.38; p=0.007) and the deluxe Fit2Thrive app at week 24 (β=-0.50; p=0.0005). For BCS with CRF, increases in daily MVPA were greater at week 12 when text messages were “on” vs. “off” and smaller at week 24 when the deluxe app was “on” vs. “off.” Baseline CRF did not demonstrate a significant moderating effect on any other intervention components.
Conclusions: mHealth MVPA interventions designed for the general BCS population might be less efficacious for those with CRF. Effects of individual intervention components on MVPA may vary as a function of baseline CRF status. Future research should explore how to best tailor mHealth interventions for BCS with CRF to optimize MVPA outcomes among this large, in-need group of BCS.
Keywords: Cancer survivorship, FatigueMethods: Using Multiphase Optimization Strategy methodology, inactive BCS [n=269; Mage=52.5; SD=9.9)] received a core intervention (Fitbit + Fit2Thrive app) and were randomized to “on” or “off” conditions of five additional components: support calls, deluxe app, online gym, buddy, and text messages. Fit2Thrive was delivered for 12 weeks with a 12-week maintenance period. Baseline CRF was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue short form. Scores were coded as binary to indicate clinically elevated fatigue (T-score>55). Daily MVPA was measured via accelerometry at baseline, 12 and 24 weeks. Moderating effects of CRF on time and intervention component were estimated using generalized linear mixed effects models with a gamma distribution and log link function.
Results: The moderating effect of baseline CRF on daily MVPA at weeks 12 and 24 was statistically significant; BCS with CRF demonstrated significantly smaller increases in MVPA at 12 (β=-0.27; p=0.0002) and 24 (β=-0.22; p=0.002) weeks. The moderation effect of baseline CRF was significant for text messages at week 12 (β=0.38; p=0.007) and the deluxe Fit2Thrive app at week 24 (β=-0.50; p=0.0005). For BCS with CRF, increases in daily MVPA were greater at week 12 when text messages were “on” vs. “off” and smaller at week 24 when the deluxe app was “on” vs. “off.” Baseline CRF did not demonstrate a significant moderating effect on any other intervention components.
Conclusions: mHealth MVPA interventions designed for the general BCS population might be less efficacious for those with CRF. Effects of individual intervention components on MVPA may vary as a function of baseline CRF status. Future research should explore how to best tailor mHealth interventions for BCS with CRF to optimize MVPA outcomes among this large, in-need group of BCS.
Authors:
Presenter - Payton Solk,
MS,
Northwestern University Feinberg School of Medicine
Co-Author - Juned Siddique,
DrPH,
Northwestern University Feinberg School of Medicine
Co-Author - David Cella, PhD,
Northwestern University Feinberg School of Medicine
Co-Author - Sofia F. Garcia, PhD,
Northwestern University
Co-Author - Bonnie Spring, PhD, ABPP, FSBM,
Northwestern University
Co-Author - Frank J. Penedo, PhD, FSBM,
University of Miami
Co-Author - Kerry S. Courneya, PhD,
University of Alberta
Co-Author - Ron Ackermann,
MD,
Northwestern University
Co-Author - Siobhan M. Phillips, PhD, MPH, FSBM,
Northwestern University
E10 - Pubertal status changes and cancer treatment among English and Spanish-speaking pediatric cancer survivors with obesity
Poster Number: E10Time: 05:00 PM - 05:50 PM
Topics: Cancer, Obesity
Background: Pubertal status changes remain common among children with obesity and across races/ethnicities. However, for pediatric cancer survivors (PCS), research is limited to pubertal status changes after cancer treatment (e.g., chemotherapy, radiation, surgery), not addressing race/ethnic differences. Integrating perspectives in behavioral medicine is crucial to developing equitable interventions for PCS. This project aims to examine pubertal status among PCS with obesity as a function of gender, race/ethnicity, and treatment.
Methods: All PCS (aged 7-14 years old), English and Spanish-speaking, participating in an ongoing randomized control lifestyle behavioral intervention (NOURISH-T+) completed a pubertal screening questionnaire assessing the development of body hair, facial hair, deepening of the voice, increased growth, skin becoming oily or greasy, and menstruation. Physicians were asked to complete a treatment questionnaire providing treatment type (chemotherapy, radiation, surgery). Chi-square analyses were conducted to determine if a relationship exists between pubertal status across gender, race/ethnicity, and treatment type.
Results: There were 128 PCS participants in the sample, 51.2% female. The majority were English speakers (73.6%), and the average BMI percentile was 97%, with an average age of 12.1 years. Race distribution was 37.2% white, 21.7% black, and 34.1% Hispanic/Latino. Among PCS demographics, significantly more females started growing body hair (p=.004), developing oily, greasy, or pimply skin (p=.012), and growing facial hair (p=.04). No significance was found between race/ethnicity and pubertal status. Across cancer treatment types for those that received surgery, significantly more PCS did not start developing body hair (p=.008), experience voice deepening among male PCS (p=.002), develop oily, greasy, or pimply skin (p=.007), nor grow taller much faster (p=.023). Conversely, significantly more PCS, across both genders, that underwent chemotherapy developed oily, greasy, or pimply skin (p<.001).
Conclusion: The study found that gender and cancer treatment types showed significant associations with pubertal development in pediatric cancer survivors, underscoring the importance of personalized follow-up care. Bridging perspectives in behavioral medicine is crucial to customize care strategies for the diverse needs of pediatric cancer survivors.
Keywords: Cancer survivorship, Health disparitiesMethods: All PCS (aged 7-14 years old), English and Spanish-speaking, participating in an ongoing randomized control lifestyle behavioral intervention (NOURISH-T+) completed a pubertal screening questionnaire assessing the development of body hair, facial hair, deepening of the voice, increased growth, skin becoming oily or greasy, and menstruation. Physicians were asked to complete a treatment questionnaire providing treatment type (chemotherapy, radiation, surgery). Chi-square analyses were conducted to determine if a relationship exists between pubertal status across gender, race/ethnicity, and treatment type.
Results: There were 128 PCS participants in the sample, 51.2% female. The majority were English speakers (73.6%), and the average BMI percentile was 97%, with an average age of 12.1 years. Race distribution was 37.2% white, 21.7% black, and 34.1% Hispanic/Latino. Among PCS demographics, significantly more females started growing body hair (p=.004), developing oily, greasy, or pimply skin (p=.012), and growing facial hair (p=.04). No significance was found between race/ethnicity and pubertal status. Across cancer treatment types for those that received surgery, significantly more PCS did not start developing body hair (p=.008), experience voice deepening among male PCS (p=.002), develop oily, greasy, or pimply skin (p=.007), nor grow taller much faster (p=.023). Conversely, significantly more PCS, across both genders, that underwent chemotherapy developed oily, greasy, or pimply skin (p<.001).
Conclusion: The study found that gender and cancer treatment types showed significant associations with pubertal development in pediatric cancer survivors, underscoring the importance of personalized follow-up care. Bridging perspectives in behavioral medicine is crucial to customize care strategies for the diverse needs of pediatric cancer survivors.
Authors:
Author - Rachel Sauls,
MPH,
University of North Carolina at Chapel Hill
Co-Author - Flandra Ismajli,
University of South Florida
Co-Author - Heewon Gray,
Ph.D.,
University of South Florida
Co-Author - Marilyn Stern, PhD,
University of South Florida
E11 - Impact of Reiki Therapy on Mood State Changes in Patients with Breast and Prostate Cancer Receiving Hormone Therapy
Poster Number: E11Time: 05:00 PM - 05:50 PM
Topics: Cancer, Mental Health
Background: Patients with breast and prostate cancer receiving hormone therapy are highly susceptible to mood changes such as concentration loss, depression, anxiety, and mood swings that can negatively impact quality of life. Reiki is a technique where therapy is delivered to the patient with either no or very light physical touch whereas traditional massage therapy uses pressure and movement by the therapist to manipulate soft tissue. The National Cancer Care Network recommends massage for treatment of cancer related fatigue, the primary outcome of the randomized controlled trial (RCT). We evaluated mood changes in patients receiving hormone therapy who were treated with Reiki or traditional massage.
Methods: Eighty-seven patients, breast cancer (n=56) and prostate cancer (n=31) receiving hormone therapy and reported a fatigue level ≥4/10 participated in this RCT. Participants were randomly assigned to one of three treatment arms for four weeks: Arm 1: 2 massage treatments, Arm 2: 2 Reiki treatments and Arm 3: 4 Reiki treatments. For analysis arms 2 and 3 were combined to assess the effects of Reiki. Mood States were assessed using the Profile of Mood States (POMS) questionnaire, that measures six primary mood dimensions: Tension-Anxiety (T/A), Depression-Dejection (D/D), Anger-Hostility (A/H), Vigor-Activity (V/A), Fatigue-Inertia (F/I) and Confusion-Bewilderment (C/B). Results of all mood states are used to calculate total mood disturbance (TMD). Assessments were made pre and post intervention by paired t-test.
Results: In the Reiki group, significant improvements were observed in mean score change (MSC) from pre to post intervention in D/D, MSC -0.59 (p=.035), F/I, MSC -1.58 (p=.001), C/B, MSC -0.76 (p=.008) and TMD, MSC -4.43 (p=.007). Improvements trending towards significance were also noted in T/A, MSC -0.42, A/H, MSC -0.51, and V/A, MSC 0.34. In contrast the massage group did not show significant improvements in any of the measured mood states. No impact was observed in MSC for the mood states A/H and D/D, with a positive MSC of 0.04 and 0.06 respectively.
Conclusion: The POMS analysis revealed that Reiki but not traditional massage therapy, led to significant within-group improvements in multiple mood states. These results need to be confirmed with a larger RCT, but they suggest that Reiki may present a non-pharmacologic therapeutic to enhance mood states and improve overall quality of life in cancer patients receiving hormone therapy.
Keywords: Mood, Quality of lifeMethods: Eighty-seven patients, breast cancer (n=56) and prostate cancer (n=31) receiving hormone therapy and reported a fatigue level ≥4/10 participated in this RCT. Participants were randomly assigned to one of three treatment arms for four weeks: Arm 1: 2 massage treatments, Arm 2: 2 Reiki treatments and Arm 3: 4 Reiki treatments. For analysis arms 2 and 3 were combined to assess the effects of Reiki. Mood States were assessed using the Profile of Mood States (POMS) questionnaire, that measures six primary mood dimensions: Tension-Anxiety (T/A), Depression-Dejection (D/D), Anger-Hostility (A/H), Vigor-Activity (V/A), Fatigue-Inertia (F/I) and Confusion-Bewilderment (C/B). Results of all mood states are used to calculate total mood disturbance (TMD). Assessments were made pre and post intervention by paired t-test.
Results: In the Reiki group, significant improvements were observed in mean score change (MSC) from pre to post intervention in D/D, MSC -0.59 (p=.035), F/I, MSC -1.58 (p=.001), C/B, MSC -0.76 (p=.008) and TMD, MSC -4.43 (p=.007). Improvements trending towards significance were also noted in T/A, MSC -0.42, A/H, MSC -0.51, and V/A, MSC 0.34. In contrast the massage group did not show significant improvements in any of the measured mood states. No impact was observed in MSC for the mood states A/H and D/D, with a positive MSC of 0.04 and 0.06 respectively.
Conclusion: The POMS analysis revealed that Reiki but not traditional massage therapy, led to significant within-group improvements in multiple mood states. These results need to be confirmed with a larger RCT, but they suggest that Reiki may present a non-pharmacologic therapeutic to enhance mood states and improve overall quality of life in cancer patients receiving hormone therapy.
Authors:
Author - Jeremy McGuire PhD,
University of Rochester
Co-Author - Michelle Janelsins PhD,
PhD,
University of Rochester
Co-Author - Lindsey Mattick, PhD,
PhD,
University of Rochester
Co-Author - Viktor Clark, PhD, MS, BS,
PhD, MS, BS,
University of Rochester
Co-Author - Ramos-Santiago, Jeffrey W,
PhD,
University of Rochester
Co-Author - Kevin Spath,
MS,
University of Rochester
Co-Author - Luke Peppone PhD,
PhD,
University of Rochester
E12 - Screening Colonoscopy Behavior Among Adults With High Body Mass Index
Poster Number: E12Time: 05:00 PM - 05:50 PM
Topics: Cancer, Obesity
Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening helps in detecting cancer in the early stages and facilitates better prognosis. Colonoscopy is the gold standard for CRC screening. High body mass index (BMI >25.0 kg/m2) can increase the risk of many health conditions including heart attack, stroke, type 2 diabetes, and cancer. More than 60% of the U.S. adult population are overweight. This study examined the prevalence and likelihood of screening colonoscopy uptake among adults 18 years and older based on body mass index (BMI) and associated sociodemographic factors.
Methods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for this cross-sectional study. Chi-square/Fisher's exact test and binary logistic regression analysis were used to calculate the prevalence and odds of screening colonoscopy uptake respectively.
Results: Most of the adults included in the analysis (N=285,329) were females (49.2%), White (73.1%), 60-69 years (28.0%), had more than high school education (66.0%), and health insurance coverage (88.2%). More than 66% reported having high BMI, and the weighted prevalence of screening colonoscopy for this group was 69.2%, compared to 67.6% for those without high BMI. Adults with high BMI were 1.07 times (Confidence Interval (C.I.) =1.05, 1.09; p<0.001) more likely to have a screening colonoscopy compared to those without high BMI. The odds of screening colonoscopy uptake were higher for individuals older than 45-49 years (Odds ratio (OR) ≥4.22, C.I.=4.06, 16.10; p<0.001) with high school or greater than high school education (OR ≥1.49, C.I.=1.42, 2.25; p<0.001). Compared to Whites, Blacks were more likely to have screening colonoscopy (OR =1.14, C.I.=1.09, 1.19; p<0.001), and the other racial/ethnic groups were less likely (OR ≥0.56, C.I.=0.53, 0.86; p<0.001). Those without health insurance coverage had lower odds (OR =0.25, C.I.=0.24, 0.27; p<0.001) of screening colonoscopy compared to those with health insurance coverage.
Conclusion: Though adults with high BMI are more likely to report having a screening colonoscopy, there were observed differences in uptake among subgroups of this population based on sociodemographic factors such as race, age, educational attainment, and health insurance coverage. Tailored interventions and programs for increasing screening colonoscopy uptake among disadvantaged subgroups are needed.
Keywords: Screening, ObesityMethods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for this cross-sectional study. Chi-square/Fisher's exact test and binary logistic regression analysis were used to calculate the prevalence and odds of screening colonoscopy uptake respectively.
Results: Most of the adults included in the analysis (N=285,329) were females (49.2%), White (73.1%), 60-69 years (28.0%), had more than high school education (66.0%), and health insurance coverage (88.2%). More than 66% reported having high BMI, and the weighted prevalence of screening colonoscopy for this group was 69.2%, compared to 67.6% for those without high BMI. Adults with high BMI were 1.07 times (Confidence Interval (C.I.) =1.05, 1.09; p<0.001) more likely to have a screening colonoscopy compared to those without high BMI. The odds of screening colonoscopy uptake were higher for individuals older than 45-49 years (Odds ratio (OR) ≥4.22, C.I.=4.06, 16.10; p<0.001) with high school or greater than high school education (OR ≥1.49, C.I.=1.42, 2.25; p<0.001). Compared to Whites, Blacks were more likely to have screening colonoscopy (OR =1.14, C.I.=1.09, 1.19; p<0.001), and the other racial/ethnic groups were less likely (OR ≥0.56, C.I.=0.53, 0.86; p<0.001). Those without health insurance coverage had lower odds (OR =0.25, C.I.=0.24, 0.27; p<0.001) of screening colonoscopy compared to those with health insurance coverage.
Conclusion: Though adults with high BMI are more likely to report having a screening colonoscopy, there were observed differences in uptake among subgroups of this population based on sociodemographic factors such as race, age, educational attainment, and health insurance coverage. Tailored interventions and programs for increasing screening colonoscopy uptake among disadvantaged subgroups are needed.
Authors:
Presenter - Benjamin Ansa,
MD, PhD,
Augusta University
Co-Author - Wonder King Selassie Hatekah,
Augusta University
Co-Author - Alaina Head,
Augusta University
Co-Author - Zola Johnson,
Augusta University
Co-Author - Beulah Ansa,
MS,
Augusta University
Co-Author - Darryl Nettles,
PhD,
Augusta University
Co-Author - Katherine Hatcher, MS,
MS,
Augusta University
E13 - Does Social Support Impact the Association Between Pain Interference and Intrusive Thoughts in Older Women with Breast Cancer?
Poster Number: E13Time: 05:00 PM - 05:50 PM
Topics: Cancer, Pain
Background: Women with breast cancer (BC) often experience pain interference with daily activities, which may serve as a reminder of the diagnosis and exacerbate intrusive thoughts about BC. The health-related quality of life model from Ferrans et al. (2005) suggests that emotional social support influences the effects of physical symptoms (e.g., pain) on psychological adaptation. In this study, we examined if pain interference was associated with BC-related intrusive thoughts and whether social attachment buffers this relationship. Further, we explored if this social attachment effect differentially impacted women of different age groups.
Methods: Women (N=109) who had undergone surgery for newly diagnosed BC (Stage 0-III) were recruited for a stress management study before beginning adjuvant therapies. At baseline, participants self-reported their BC-related intrusive thoughts (Impact of Event Scale Revised-Intrusion subscale), pain interference (Brief Pain Inventory Short Form-Pain Interference subscale), and social support (Social Provisions Scale-Attachment subscale). First, a linear regression model assessed the moderating effect of social attachment on the association of pain interference and BC-related intrusive thoughts, controlling for age, BC stage, and days since surgery. For the exploratory analyses, this regression model was also tested separately in middle-aged (aged 50-64; N=76) and older (aged ≥65; N=33) participants.
Results: Among all participants, pain interference was significantly associated with greater BC-related intrusive thoughts (β = 0.10; SE = 0.03; p = .001) and the interaction between pain interference and social attachment significantly predicted lower BC-related intrusive thoughts (β = -0.03; SE = 0.01; p = .02). The interaction between pain interference and social attachment remained significant in predicting lower BC-related intrusive thoughts among older adults (β = -0.11; SE = 0.04; p = .01) but not among middle-aged adults (β = -0.03; SE = 0.02; p = .08).
Conclusions: Findings suggest that pain interference is associated with higher BC-related intrusive thoughts and that social attachment buffers this relationship, particularly among older BC patients. For older women, the distress sequelae of pain experiences during BC treatment may be mitigated by increasing interpersonal communication skills for enhancing social support via psychosocial interventions.
Keywords: Pain, Social supportMethods: Women (N=109) who had undergone surgery for newly diagnosed BC (Stage 0-III) were recruited for a stress management study before beginning adjuvant therapies. At baseline, participants self-reported their BC-related intrusive thoughts (Impact of Event Scale Revised-Intrusion subscale), pain interference (Brief Pain Inventory Short Form-Pain Interference subscale), and social support (Social Provisions Scale-Attachment subscale). First, a linear regression model assessed the moderating effect of social attachment on the association of pain interference and BC-related intrusive thoughts, controlling for age, BC stage, and days since surgery. For the exploratory analyses, this regression model was also tested separately in middle-aged (aged 50-64; N=76) and older (aged ≥65; N=33) participants.
Results: Among all participants, pain interference was significantly associated with greater BC-related intrusive thoughts (β = 0.10; SE = 0.03; p = .001) and the interaction between pain interference and social attachment significantly predicted lower BC-related intrusive thoughts (β = -0.03; SE = 0.01; p = .02). The interaction between pain interference and social attachment remained significant in predicting lower BC-related intrusive thoughts among older adults (β = -0.11; SE = 0.04; p = .01) but not among middle-aged adults (β = -0.03; SE = 0.02; p = .08).
Conclusions: Findings suggest that pain interference is associated with higher BC-related intrusive thoughts and that social attachment buffers this relationship, particularly among older BC patients. For older women, the distress sequelae of pain experiences during BC treatment may be mitigated by increasing interpersonal communication skills for enhancing social support via psychosocial interventions.
Authors:
Presenter - Millan Kanaya,
BS,
University of Miami
Co-Author - Sarah Webster,
BA,
University of Miami
Co-Author - Rachel Plotke,
BA,
University of Miami
Co-Author - Paula Popok,
MS,
University of Miami
Co-Author - Emily Walsh,
MS,
University of Miami
Co-Author - Jenna Hansen,
BS,
University of Miami
Co-Author - Mason Krueger,
MS,
University of Miami
Co-Author - Michael Antoni,
PhD,
University of Miami
E14 - Disrupted Circadian Rhythms and Cancer-related Fatigue Among Prostate Cancer Survivors
Poster Number: E14Time: 05:00 PM - 05:50 PM
Topics: Cancer, Methods and Measurement
Background: Cancer-related fatigue (CRF) is a pervasive symptomatic toxicity of cancer and its treatment that negatively impacts survivors’ prognosis and quality of life. The underlying pathophysiology of CRF is not well understood, which impedes the development of efficacious treatments. Research demonstrates that patients with cancer experience disruption to the circadian clock system which can continue years into survivorship and may be associated with and/or cause CRF. Circadian rhythms are 24-hour entrainable, endogenous, biological processes essential for maintaining nearly all behavioral and physiological processes. Quantifying the level of disruption to circadian rhythms may represent a biomarker of overall homeostatic dysregulation contributing to CRF. The purpose of this study was to examine the degree of circadian disruption in prostate cancer survivors and whether that differed according to fatigue levels via a novel biomarker of circadian clock gene expression signature, clock correlation distance (CCD).
Methods: In a convenience sample of prostate cancer survivors (N=28; 46% on ADT) and healthy cancer-free controls (n=14), CRF was assessed via Multidimensional Fatigue Symptom Inventory (MFSI Total; higher score indicates worse fatigue). RNA-sequencing from stored blood samples was utilized to calculate CCD for each group. We calculated the difference in CCDs (ΔCCD) between healthy cancer-free controls and prostate cancer survivors. A positive ΔCCD indicates worse circadian disruption. In stratified analyses, ΔCCD of prostate cancer survivors with high and low fatigue scores (MFSI, cut at median: 3) were calculated separately in comparison to controls. We used permutation to recalculate the ΔCCD 1,000 times to evaluate the probability that the ΔCCD is greater than would be expected by chance (one-sided p-value).
Results: Compared to healthy cancer-free controls, prostate cancer survivors had significantly worse circadian disruption (ΔCCD: 1.71; p=0.018). In stratified analyses, this association persisted among prostate cancer survivors with higher fatigue scores (ΔCCD: 2.15; p=0.025). Prostate cancer survivors with lower fatigue scores did not differ from healthy cancer-free controls (ΔCCD: 1.48; p=0.093).
Discussion: Our results indicate prostate cancer survivors have significantly worse circadian disruption than their healthy cancer-free counterparts, especially among those with higher fatigue levels. Larger confirmatory studies are needed.
Keywords: Fatigue, Cancer survivorshipMethods: In a convenience sample of prostate cancer survivors (N=28; 46% on ADT) and healthy cancer-free controls (n=14), CRF was assessed via Multidimensional Fatigue Symptom Inventory (MFSI Total; higher score indicates worse fatigue). RNA-sequencing from stored blood samples was utilized to calculate CCD for each group. We calculated the difference in CCDs (ΔCCD) between healthy cancer-free controls and prostate cancer survivors. A positive ΔCCD indicates worse circadian disruption. In stratified analyses, ΔCCD of prostate cancer survivors with high and low fatigue scores (MFSI, cut at median: 3) were calculated separately in comparison to controls. We used permutation to recalculate the ΔCCD 1,000 times to evaluate the probability that the ΔCCD is greater than would be expected by chance (one-sided p-value).
Results: Compared to healthy cancer-free controls, prostate cancer survivors had significantly worse circadian disruption (ΔCCD: 1.71; p=0.018). In stratified analyses, this association persisted among prostate cancer survivors with higher fatigue scores (ΔCCD: 2.15; p=0.025). Prostate cancer survivors with lower fatigue scores did not differ from healthy cancer-free controls (ΔCCD: 1.48; p=0.093).
Discussion: Our results indicate prostate cancer survivors have significantly worse circadian disruption than their healthy cancer-free counterparts, especially among those with higher fatigue levels. Larger confirmatory studies are needed.
Authors:
Author - Lindsey Mattick, PhD,
PhD,
University of Rochester
Co-Author - Po-Ju Lin, PhD, MPH, RD,
PhD, MPH, RD,
University of Rochester Medical Center
Co-Author - Sindhuja Kadambi,
MD,
University of Rochester Medical Center
Co-Author - Viktor Clark, PhD, MS, BS,
PhD, MS, BS,
University of Rochester
Co-Author - Jeremy McGuire,
PhD,
University of Rochester Medical Center
Co-Author - Karen Mustian,
PhD MPH,
University of Rochester Medical Center
Co-Author - Brian Altman,
PhD MS,
University of Rochester Medical Center
E15 - Understanding the Effects of Cancer-related Factors on the Association Between Physical Activity, Self-efficacy, Social Support, and Exercise Barriers in Breast Cancer Survivors.
Poster Number: E15Time: 05:00 PM - 05:50 PM
Topics: Cancer, Physical Activity
Background: Long-term effects of breast cancer and its treatment can negatively impact survivors’ physical activity behaviors. Social cognitive theory (SCT) constructs (self-efficacy, social support, exercise barriers) can be determinants of physical activity, but it is unclear if cancer-related factors affect these relationships. We examined associations between physical activity and self-efficacy, social support, and exercise barriers interference in breast cancer survivors and whether cancer-related factors moderated these relationships.
Methods: This is a cross-sectional study of baseline data from 341 post-primary treatment breast cancer survivors enrolled in a randomized controlled trial testing a web-based diet and exercise intervention. Measures included SCT-constructs (barriers self-efficacy, social support, and exercise barriers interference) and moderate-to-vigorous physical activity (MVPA) measured by accelerometry and self-report. Pearson’s correlation coefficients examined associations between SCT-constructs and MVPA. Regression analyses assessed whether cancer-related factors (stage [DCIS/stage I vs. stage II/III], time since diagnosis [≤24 months vs. >24 months], history of chemotherapy [yes vs. no], history of radiation [yes vs. no], and current hormone therapy status) moderated the associations between SCT constructs and MVPA.
Results: A modest inverse association existed between exercise barrier interference and self-reported MVPA (r= -0.272, p<0.001); and accelerometry-measured MVPA (r= -0.128, p=0.020). No other SCT variables were statistically significantly associated with MVPA levels. Stage and history of chemotherapy were found to moderate the association between social support and self-reported MVPA such that the association was stronger among survivors diagnosed with DCIS/stage I vs. stage II/III (b= 4.14, p=0.043, CI= -2.20-10.49) and weaker among individuals with history of chemotherapy vs. no history of chemotherapy (b= -5.02, p=0.026, CI= -11.51-1.47); these associations were independent of one another. No other moderating effects were found.
Conclusion: Cancer stage and previous chemotherapy moderated the association between social support and MVPA. Targeting social support in early-stage breast cancer survivors or who did not receive chemotherapy may improve intervention effectiveness.
Keywords: Cancer, Physical activityMethods: This is a cross-sectional study of baseline data from 341 post-primary treatment breast cancer survivors enrolled in a randomized controlled trial testing a web-based diet and exercise intervention. Measures included SCT-constructs (barriers self-efficacy, social support, and exercise barriers interference) and moderate-to-vigorous physical activity (MVPA) measured by accelerometry and self-report. Pearson’s correlation coefficients examined associations between SCT-constructs and MVPA. Regression analyses assessed whether cancer-related factors (stage [DCIS/stage I vs. stage II/III], time since diagnosis [≤24 months vs. >24 months], history of chemotherapy [yes vs. no], history of radiation [yes vs. no], and current hormone therapy status) moderated the associations between SCT constructs and MVPA.
Results: A modest inverse association existed between exercise barrier interference and self-reported MVPA (r= -0.272, p<0.001); and accelerometry-measured MVPA (r= -0.128, p=0.020). No other SCT variables were statistically significantly associated with MVPA levels. Stage and history of chemotherapy were found to moderate the association between social support and self-reported MVPA such that the association was stronger among survivors diagnosed with DCIS/stage I vs. stage II/III (b= 4.14, p=0.043, CI= -2.20-10.49) and weaker among individuals with history of chemotherapy vs. no history of chemotherapy (b= -5.02, p=0.026, CI= -11.51-1.47); these associations were independent of one another. No other moderating effects were found.
Conclusion: Cancer stage and previous chemotherapy moderated the association between social support and MVPA. Targeting social support in early-stage breast cancer survivors or who did not receive chemotherapy may improve intervention effectiveness.
Authors:
Author - Erica Schleicher,
PhD,
University of Pittsburgh
Co-Author - Gregory Pavela,
University of Alabama at Birmingham
Co-Author - Wendy Demark-Wahnefried, PhD, RD,
PhD, RD,
University of Alabama at Birmingham
Co-Author - Kevin Fontaine,
PhD,
University of Alabama at Birmingham
Co-Author - Nataliya Ivankova,
PhD,
University of Alabama at Birmingham
Co-Author - Maria Pisu, PhD,
PhD,
University of Alabama at Birmingham
Co-Author - Michelle Martin,
RN,
University of Alabama at Birmingham
Co-Author - Yu-Mei M. Schoenberger, PhD, MPH,
PhD, MPH,
University of Alabama at Birmingham
Co-Author - Robert Oster,
PhD,
University of Alabama at Birmingham
Co-Author - Kelly-Marie Kenzik,
PhD,
University of Alabama at Birmingham
Co-Author - Laura Q. Rogers, MD MPH,
MD MPH,
University of Alabama at Birmingham
E16 - Empowering Black Prostate Cancer Survivors: A Community Advisory Board Approach to Enhancing Engagement and Research Outcomes
Poster Number: E16Time: 05:00 PM - 05:50 PM
Topics: Cancer, Community Engagement
Background: Black men continue to face higher mortality rates from prostate cancer (CaP) than other racial groups. Despite comprising 36.3% of the population, racial and ethnic minorities, particularly Blacks, remain underrepresented in clinical trials. To promote health equity, community-driven approaches like Community Advisory Boards (CABs) that incorporate diverse perspectives can inform approaches by enhancing access, engagement, and participation in clinical trials for underrepresented populations.
Objective: This presentation will describe the formation of a CAB composed of Black CaP survivors, and how the CAB has played a critical role in collaboratively shaping the health outcomes research agenda and culturally relevant interventions within the Multidisciplinary Health Outcomes Research and Economics (MORE) Lab.
Methods: Rooted in community engagement and integrated knowledge translation, a purposive sampling method was used to recruit eight members, including Black men with CaP, and a Black public health professional. The CAB met monthly via Zoom since 2021 to shape MORE lab research, enhance community engagement, and develop culturally relevant interventions. Meetings were audio-recorded, with minutes kept for transparency. Members attended at least 9 of 12 annual meetings and received $1,000 annually.
Results: Most participants were Native-born Black men (50%) residing in the Southeast (50%), with 37% having some college education. The CAB has significantly shaped the research agenda of the MORE lab and has enhanced community engagement among Black men with CaP. Their collaborative efforts have informed the development of culturally tailored research strategies, grant applications, peer-reviewed articles, and outreach initiatives, including virtual town halls, media engagements, and a book club focused on advocacy and wellness. The CAB’s contributions have also influenced targeted health campaigns, improved recruitment strategies, and fostered trust between researchers and the Black community, ultimately leading to more effective and ethical research practices.
Conclusion: The MORE Lab CAB has been vital in addressing health disparities, demonstrating the role of CABs in advancing health equity and ethical research. Ongoing assessments will inform the refinement of future strategies. The success of the MORE Lab CAB offers a model for implementing similar approaches to address disparities in other underserved populations.
Keywords: Cancer, Health promotionObjective: This presentation will describe the formation of a CAB composed of Black CaP survivors, and how the CAB has played a critical role in collaboratively shaping the health outcomes research agenda and culturally relevant interventions within the Multidisciplinary Health Outcomes Research and Economics (MORE) Lab.
Methods: Rooted in community engagement and integrated knowledge translation, a purposive sampling method was used to recruit eight members, including Black men with CaP, and a Black public health professional. The CAB met monthly via Zoom since 2021 to shape MORE lab research, enhance community engagement, and develop culturally relevant interventions. Meetings were audio-recorded, with minutes kept for transparency. Members attended at least 9 of 12 annual meetings and received $1,000 annually.
Results: Most participants were Native-born Black men (50%) residing in the Southeast (50%), with 37% having some college education. The CAB has significantly shaped the research agenda of the MORE lab and has enhanced community engagement among Black men with CaP. Their collaborative efforts have informed the development of culturally tailored research strategies, grant applications, peer-reviewed articles, and outreach initiatives, including virtual town halls, media engagements, and a book club focused on advocacy and wellness. The CAB’s contributions have also influenced targeted health campaigns, improved recruitment strategies, and fostered trust between researchers and the Black community, ultimately leading to more effective and ethical research practices.
Conclusion: The MORE Lab CAB has been vital in addressing health disparities, demonstrating the role of CABs in advancing health equity and ethical research. Ongoing assessments will inform the refinement of future strategies. The success of the MORE Lab CAB offers a model for implementing similar approaches to address disparities in other underserved populations.
Authors:
Author - Motolani Adedipe,
University of Oklahoma Health Sciences Center
Presenter - Gaurav Kumar, MBBS, MPH and PhD,
MBBS, MPH and PhD,
University of Oklahoma Health Sciences Center
Co-Author - Parisa Ghasemi,
MD,
University of Oklahoma Health Sciences Center
Co-Author - Darla E. Kendzor, PhD,
PhD,
University of Oklahoma Health Sciences Center
E17 - Current Tobacco Use Among Cancer Survivors: Examining the Role of Family Conflict and Dysfunction
Poster Number: E17Time: 05:00 PM - 05:50 PM
Topics: Cancer, Tobacco Control and Nicotine-Related Behavior
Background: Tobacco use increases cancer-specific mortality and recurrence risk. Despite health risks, many cancer survivors use tobacco. Research suggests that negative family dynamics can be common among cancer survivors with a tobacco use history. Thus, the current study examined the association between family conflict, family dysfunction, and current tobacco use years after a cancer diagnosis.
Methods: Participants were recruited from an NCI-designated comprehensive cancer center in Virginia. Eligible participants identified via electronic medical record were at least 18 years of age, received a cancer diagnosis between 2010-2023, and used tobacco within 180 days of their cancer diagnosis. Participants (N=174) completed a REDCap survey reporting on their current tobacco use status (e.g. current vs. former), socio-demographics, tobacco use history, and current physical and psychosocial functioning, including family conflict and dysfunction. Logistic regression models examined the association between family conflict or family dysfunction and current tobacco use status.
Results: Among the current sample, 64.1% (n=98) of participants reported currently using tobacco. Bivariate analyses showed that race, annual household income, financial insecurity, years since diagnosis, physical health-related quality of life, depressed/anxious mood, social support, and family cohesion were significantly associated with tobacco use status (p <.05). In unadjusted logistic regression models, higher family conflict (Odds Ratio (OR)= 1.23, 95% CI: 1.01, 1.49, p=.039) and higher family dysfunction (OR = 1.87; 95% CI: 1.04, 3.38, p=.037) were associated with greater likelihood of current tobacco use, though these variables did not remain significant after covariates were included. A separate unadjusted logistic regression model, however, suggested that financial insecurity moderated the association between family conflict and tobacco use status such that cancer survivors with greater family conflict and who have difficulty meeting their basic expenses were two times more likely to be a current tobacco user (OR = 2.24, 95% CI: 1.06, 4.72, p = .035).
Conclusion: Family conflict, family dysfunction, and financial insecurity are factors that may contribute to current tobacco use among cancer survivors years after diagnosis. Improving negative family dynamics and managing financial stress may be a critical component of tobacco treatment delivered to this patient population.
Keywords: Cancer survivorship, Tobacco useMethods: Participants were recruited from an NCI-designated comprehensive cancer center in Virginia. Eligible participants identified via electronic medical record were at least 18 years of age, received a cancer diagnosis between 2010-2023, and used tobacco within 180 days of their cancer diagnosis. Participants (N=174) completed a REDCap survey reporting on their current tobacco use status (e.g. current vs. former), socio-demographics, tobacco use history, and current physical and psychosocial functioning, including family conflict and dysfunction. Logistic regression models examined the association between family conflict or family dysfunction and current tobacco use status.
Results: Among the current sample, 64.1% (n=98) of participants reported currently using tobacco. Bivariate analyses showed that race, annual household income, financial insecurity, years since diagnosis, physical health-related quality of life, depressed/anxious mood, social support, and family cohesion were significantly associated with tobacco use status (p <.05). In unadjusted logistic regression models, higher family conflict (Odds Ratio (OR)= 1.23, 95% CI: 1.01, 1.49, p=.039) and higher family dysfunction (OR = 1.87; 95% CI: 1.04, 3.38, p=.037) were associated with greater likelihood of current tobacco use, though these variables did not remain significant after covariates were included. A separate unadjusted logistic regression model, however, suggested that financial insecurity moderated the association between family conflict and tobacco use status such that cancer survivors with greater family conflict and who have difficulty meeting their basic expenses were two times more likely to be a current tobacco user (OR = 2.24, 95% CI: 1.06, 4.72, p = .035).
Conclusion: Family conflict, family dysfunction, and financial insecurity are factors that may contribute to current tobacco use among cancer survivors years after diagnosis. Improving negative family dynamics and managing financial stress may be a critical component of tobacco treatment delivered to this patient population.
Authors:
Author - Kendall Fugate-Laus, MS,
MS,
Virginia Commonwealth University
Co-Author - Jamie Hill,
BS,
Virginia Commonwealth University
Co-Author - Bridget Xia,
MS,
University of Virginia
Co-Author - Caitlyn Poff,
University of Virginia
Co-Author - Emma Mantoan,
BS,
Virginia Commonwealth University
Co-Author - Bernard F. Fuemmeler, PhD, MPH, FSBM,
PhD, MPH, FSBM,
Virginia Commonwealth University
Co-Author - Rashelle B. Hayes, PhD, FSBM,
PhD, FSBM,
Virginia Commonwealth University
E18 - Increased Sedentary Behavior Predicts Worse Successive Symptom Burden During Chemotherapy for Breast Cancer
Poster Number: E18Time: 05:00 PM - 05:50 PM
Topics: Cancer, Physical Activity
Breast cancer survivors (BCS) undergoing chemotherapy (CT) show a significant increase in time engaged in sedentary behavior (SB); however, limited research exists on how SB affects common, negative CT side effects. This study used ecological momentary assessment and waist-worn accelerometers to examine the relationship between increased SB and subsequent momentary symptom ratings during CT.
BCS (N=67, Mage= 48.5±10.4 years) undergoing CT for early-stage BC wore an accelerometer on their hip during waking hours and completed symptom (affect, anxiety, depression, fatigue, pain, and cognitive functioning) rating surveys four times per day for ten consecutive days (3 days pre-, day of, and 6 days post-CT) at the beginning, middle, and last cycles of CT. Each minute of wear time was categorized as SB (yes/no). The number of minutes spent in SB in the 2 hours before each prompt was calculated. Variance was decomposed by calculating each person’s mean SB minutes during these pre-prompt periods (between-subject) and the difference between this person mean and the SB minutes before a given survey (within-subject).
Mixed models were used to examine the relationship between the between and within-person variation of SB minutes and the change in subsequent symptom ratings. Models controlled for cycle of CT, time of day, weekday, and CT day status. A total of 6765 of 7947 total surveys were answered (85.1%); 306 surveys (3.9%) did not have two hours of valid wear time preceding the survey and were removed from the analysis. Participants engaged in an average of 88.52 (SD=20.34) SB minutes in the two hours before a prompt. Engagement in 10 more minutes of SB than usual was significantly (p<.01) associated with increased odds of rating a worse mood (OR=1.11), worse cognitive function (OR=1.09) and greater depression (OR=1.05), fatigue (OR=1.12), and pain (OR=1.09). Engagement in 10 more minutes of SB compared to the average across all participants was significantly (p<.01) associated with increased odds of rating a worse mood (OR=2.79) and greater fatigue (OR=3.04).
Findings indicate that after engaging in more SB than average during CT, BCS reported worse ratings on all treatment-related side effects except for anxiety. Future research should develop and test SB reduction interventions during CT to examine how to reduce CT side effects effectively.
Keywords: Cancer, Physical activityBCS (N=67, Mage= 48.5±10.4 years) undergoing CT for early-stage BC wore an accelerometer on their hip during waking hours and completed symptom (affect, anxiety, depression, fatigue, pain, and cognitive functioning) rating surveys four times per day for ten consecutive days (3 days pre-, day of, and 6 days post-CT) at the beginning, middle, and last cycles of CT. Each minute of wear time was categorized as SB (yes/no). The number of minutes spent in SB in the 2 hours before each prompt was calculated. Variance was decomposed by calculating each person’s mean SB minutes during these pre-prompt periods (between-subject) and the difference between this person mean and the SB minutes before a given survey (within-subject).
Mixed models were used to examine the relationship between the between and within-person variation of SB minutes and the change in subsequent symptom ratings. Models controlled for cycle of CT, time of day, weekday, and CT day status. A total of 6765 of 7947 total surveys were answered (85.1%); 306 surveys (3.9%) did not have two hours of valid wear time preceding the survey and were removed from the analysis. Participants engaged in an average of 88.52 (SD=20.34) SB minutes in the two hours before a prompt. Engagement in 10 more minutes of SB than usual was significantly (p<.01) associated with increased odds of rating a worse mood (OR=1.11), worse cognitive function (OR=1.09) and greater depression (OR=1.05), fatigue (OR=1.12), and pain (OR=1.09). Engagement in 10 more minutes of SB compared to the average across all participants was significantly (p<.01) associated with increased odds of rating a worse mood (OR=2.79) and greater fatigue (OR=3.04).
Findings indicate that after engaging in more SB than average during CT, BCS reported worse ratings on all treatment-related side effects except for anxiety. Future research should develop and test SB reduction interventions during CT to examine how to reduce CT side effects effectively.
Authors:
Presenter - Shirlene D. Wang,
PhD,
Northwestern University
Co-Author - Juned Siddique,
DrPH,
Northwestern University
Co-Author - Jason Fanning,
PhD,
Wake Forest University
Co-Author - Payton Solk,
MA,
Northwestern University Feinberg School of Medicine
Co-Author - Julia Starikovsky,
MA,
Northwestern University
Co-Author - Kristina Hasanaj, PhD,
PhD,
Northwestern University
Co-Author - Jean M. Reading,
PhD,
University of Illinois Chicago
Co-Author - Julia Frey,
BA,
Northwestern University
Co-Author - Lauren Wang,
BA,
Northwestern University
Co-Author - Cesar A. Santa Maria,
MD, MSCI,
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Co-Author - William Gradishar,
MD,
Northwestern University
Co-Author - Seema Khan,
MD,
Northwestern University
Co-Author - Swati Khulkarni,
MD,
Northwestern University
Co-Author - Siobhan M. Phillips,
PhD, MPH, FSBM,
Northwestern University
E19 - Illness perceptions and causal attributions among adolescents and young adults with cancer: Relationships with psychological and psychosocial outcomes
Poster Number: E19Time: 05:00 PM - 05:50 PM
Topics: Cancer, Quality of Life
Background: Cancer during adolescence and young adulthood is associated with significant distress. The developmental “off-time” nature of cancer may have implications for the way in which adolescents and young adults (AYA) understand the different aspects of their cancer, which can affect well-being. Illness perceptions are the formulated beliefs that patients have about their illness, including how much cancer affects their lives and causal attributions of cancer. We examined relationships between illness perceptions and causal attributions on well-being outcomes.
Method: AYA (N=50, Mage=22.3) completed measures of illness perception and well-being. Illness perceptions were measured across eight domains including an open-ended question asking AYA to list factors that they believe caused their cancer. A total illness perception score was calculated; higher scores indicated a more negative perception of cancer. Open ended responses were categorized into lifestyle, genetics, chemical/environmental, chance, and prior health condition in accordance with prior research. Well-being assessed psychological and psychosocial outcomes (anxiety, depression, peer relationships).
Results: Majority of AYA attributed their cancer to lifestyle/stress (40%), followed by genetics (34%), chemical/environmental (34%), chance (32%), and a prior health condition (22%). Regression analyses found that illness perceptions were positively associated with depression (β=0.54, p<0.01) and anxiety (β=0.50, p<0.01) and negatively associated with peer relations (β=-0.45, p<0.01). Causal attribution of a prior health condition was positively associated with depression (β=0.32, p<0.05) and anxiety (β=0.32, p<0.05), whereas a genetic-related causal attribution (β=0.32, p<0.05) was positively associated with peer relations. Post hoc analyses revealed that AYA holding onto perceptions that cancer affects their life, in general and emotionally, had higher levels of anxiety/depression and lower peer relations.
Conclusion: Our findings suggest that more negative illness perceptions were associated with higher anxiety and depression and lower peer relations and point to certain causal attributions that are more likely to be associated with these outcomes. Understanding AYAs illness perceptions and attributions can help to provide more personalized care and provides talking points for health-care providers aimed at psychoeducation around AYAs cancer diagnosis and trajectory.
Keywords: Health beliefs, Quality of lifeMethod: AYA (N=50, Mage=22.3) completed measures of illness perception and well-being. Illness perceptions were measured across eight domains including an open-ended question asking AYA to list factors that they believe caused their cancer. A total illness perception score was calculated; higher scores indicated a more negative perception of cancer. Open ended responses were categorized into lifestyle, genetics, chemical/environmental, chance, and prior health condition in accordance with prior research. Well-being assessed psychological and psychosocial outcomes (anxiety, depression, peer relationships).
Results: Majority of AYA attributed their cancer to lifestyle/stress (40%), followed by genetics (34%), chemical/environmental (34%), chance (32%), and a prior health condition (22%). Regression analyses found that illness perceptions were positively associated with depression (β=0.54, p<0.01) and anxiety (β=0.50, p<0.01) and negatively associated with peer relations (β=-0.45, p<0.01). Causal attribution of a prior health condition was positively associated with depression (β=0.32, p<0.05) and anxiety (β=0.32, p<0.05), whereas a genetic-related causal attribution (β=0.32, p<0.05) was positively associated with peer relations. Post hoc analyses revealed that AYA holding onto perceptions that cancer affects their life, in general and emotionally, had higher levels of anxiety/depression and lower peer relations.
Conclusion: Our findings suggest that more negative illness perceptions were associated with higher anxiety and depression and lower peer relations and point to certain causal attributions that are more likely to be associated with these outcomes. Understanding AYAs illness perceptions and attributions can help to provide more personalized care and provides talking points for health-care providers aimed at psychoeducation around AYAs cancer diagnosis and trajectory.
Authors:
Presenter - Katie Darabos,
PhD,
Rutgers University
Co-Author - Shannon Desbiens,
BA,
Rutgers University
Co-Author - Sean McHugh,
BS,
Rutgers University
E20 - YOGA FOR PATIENTS UNDERGOING RADIOTHERPY AND THEIR SPOUSES: RESULTS OF A 3-ARM RANDOMIZED CONTROLLED TRIAL
Poster Number: E20Time: 05:00 PM - 05:50 PM
Topics: Cancer, Physical Activity
Background: Radiotherapy (RT) as a definitive or adjuvant cancer treatment improves localized cancer outcomes at the cost of debilitating toxicities and physical performance declines. Yoga therapy delivered concurrently to RT may buffer against treatment-related sequelae. Given the high distress rates of patients’ spouses/partners, involving a spousal caregiver in the intervention may have additional benefits. We randomized patient-caregiver dyads to either a dyadic yoga (DY), patient yoga (PY) or usual care (UC) control arm. We hypothesized that patients in both yoga arms report improved quality of life (QOL) and perform better on an objective physical performance test than those in the UC arm. The comparison between the DY vs PY group was considered exploratory.
Methods: Patients with a diagnosis of head and neck or breast cancer completed the 6-minute walk test (6MWT) prior to starting at least 25 fractions of RT over 5 weeks. Patients and caregivers also completed QOL assessments (SF-36) at baseline and were then randomized to the DY, PY or UC arm. Both yoga programs consisted of 15 sessions delivered parallel to the patients’ 5-week RT schedule via videoconference (i.e., Zoom). All participants were reassessed on the last day of patients’ RT and again 3 months later.
Results: 150 patients and caregivers were randomized. Adherence in both yoga arms was high (mean session attendance: DY=12.0; PY=12.1). Intent to treat analyses using multi-level modeling across the follow-up period revealed that patients in the DY arm performed significantly better on the 6MWT than those in the UC arm (F=4.91, p=.03). The planned comparisons between the PY vs UC (F=3.44, p=.07) and DY vs PY (F=.05, p=.82) were not significant. None of the comparisons for the self-reported physical QOL scores (PCS of SF-36) were significant. Regarding mental QOL (MCS of SF-36), the comparison between the DY and UC arms was significant (F=4.61, p=.04) favoring the DY group. The DY vs PY and PY vs UC comparisons were not significant (LSM: DY=50.3; PY=48.5; UC=46.5). No significant group differences for caregivers’ mental and physical QOL scores were found.
Conclusion: Yoga, particularly when delivered to patient-caregiver dyads, appears to be a beneficial supportive care strategy for patients undergoing RT. We revealed significantly improved patient physical performance and mental QOL relative to a UC comparison group.
Keywords: Cancer, Quality of lifeMethods: Patients with a diagnosis of head and neck or breast cancer completed the 6-minute walk test (6MWT) prior to starting at least 25 fractions of RT over 5 weeks. Patients and caregivers also completed QOL assessments (SF-36) at baseline and were then randomized to the DY, PY or UC arm. Both yoga programs consisted of 15 sessions delivered parallel to the patients’ 5-week RT schedule via videoconference (i.e., Zoom). All participants were reassessed on the last day of patients’ RT and again 3 months later.
Results: 150 patients and caregivers were randomized. Adherence in both yoga arms was high (mean session attendance: DY=12.0; PY=12.1). Intent to treat analyses using multi-level modeling across the follow-up period revealed that patients in the DY arm performed significantly better on the 6MWT than those in the UC arm (F=4.91, p=.03). The planned comparisons between the PY vs UC (F=3.44, p=.07) and DY vs PY (F=.05, p=.82) were not significant. None of the comparisons for the self-reported physical QOL scores (PCS of SF-36) were significant. Regarding mental QOL (MCS of SF-36), the comparison between the DY and UC arms was significant (F=4.61, p=.04) favoring the DY group. The DY vs PY and PY vs UC comparisons were not significant (LSM: DY=50.3; PY=48.5; UC=46.5). No significant group differences for caregivers’ mental and physical QOL scores were found.
Conclusion: Yoga, particularly when delivered to patient-caregiver dyads, appears to be a beneficial supportive care strategy for patients undergoing RT. We revealed significantly improved patient physical performance and mental QOL relative to a UC comparison group.
Authors:
Author - Jason Bentley, PhD,
PhD,
University of Houston - Clear Lake
Co-Author - David Rosenthal,
MD,
The University of Texas MD Anderson Cancer Center
Co-Author - Rosangela Silva,
MBA,
The University of Texas MD Anderson Cancer Center
Co-Author - Yisheng Li,
PhD,
The University of Texas MD Anderson Cancer Center
Co-Author - Sania Yousuf,
MPH,
The University of Texas MD Anderson Cancer Center
Co-Author - Eduardo Bruera,
MD,
The University of Texas MD Anderson Cancer Center
Co-Author - Lorenzo Cohen, PhD,
PhD,
The University of Texas MD Anderson Cancer Center
Co-Author - Kathrin Milbury, PhD,
PhD,
University of Texas MD Anderson Cancer Center
E21 - Exercise in Neuro-Oncology: Bridging Perspectives of Patients and Caregivers
Poster Number: E21Time: 05:00 PM - 05:50 PM
Topics: Cancer, Physical Activity
Exercise is a well-evidenced behaviour change resource. The Alberta Cancer Exercise-Neuro-Oncology (ACE-Neuro) study delivered an exercise program for individuals living with and beyond brain cancer between 2021-23. To support continued implementation and bridge the evidence-to-practice gap, the purpose of the present study was to gather patient and caregiver perspectives of program delivery. Neuro-oncology patients across Alberta were enrolled in the 12-week exercise program, which included twice weekly sessions and assessments of patient-reported outcomes and functional as well as the use of a Garmin activity tracker. Semi-structured interviews were conducted with patients and caregivers across program delivery either in-person or via ZOOM. Interviews gathered perspectives of program feasibility, impact on outcomes, facilitators and barriers to participation, and implementation into neuro-oncology care. Photo elicitation was used to augment interviews. Interviews were transcribed verbatim and analyzed using interpretive description. N=28 patients and n=9 caregivers completed interviews, with the majority via ZOOM (n=26). Mean interview length was 49:33 +/- 9:22 minutes. Patients were 51 +/- 11.9 years in age (range 32-83), 57% were female (n=16), and glioblastoma was the most common diagnosis (n=9). Caregivers included spouses (n=7), parents (n=1), and children (n=1) and were mostly female (n=6). Emerging data highlights the themes of how ACE-Neuro is accessible and feasible, a key pillar of well-being, and requires system-level buy-in to support scalability and sustainability. Overall, participants felt satisfied with the program for enhancing their physical and psychosocial outcomes and appreciated the positive motivational climate of sessions for building community and supporting adherence and self-efficacy. Facilitators to participation included a flexible and tailored approach to delivery, trained exercise specialists, and having a choice for format of delivery. Barriers to participation included using the Garmin activity tracker and managing the challenges of a brain tumour diagnosis. Participants also spoke to the need for systematic referral processes to exercise programming. Implementing patient-centred exercise programming requires gathering the perspectives of patients and their families. Ongoing engagement with participants and the clinical team will support building programming that can be implemented sustainably within neuro-oncology care.
Keywords: Physical activity, CancerAuthors:
Presenter - Julia T. Daun,
MSc,
Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
Co-Author - Tana Dhruva,
MSc,
Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
Co-Author - Mannat Bansal,
MSc,
Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
Co-Author - Meghan H. McDonough,
PhD,
Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
Co-Author - Gloria Roldan Urgoiti,
MD, MSc,
Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
Co-Author - Lauren C. Capozzi,
MD, PhD,
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
Co-Author - Jacob C. Easaw,
MD,
Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
Co-Author - Margaret L. McNeely,
PT, PhD,
Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
Co-Author - George J. Francis,
MD,
Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
Co-Author - S. Nicole Culos-Reed,
PhD,
Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
E22 - The relationship between social determinants of health and physical functioning in breast cancer survivors: Examining psychosocial buffers
Poster Number: E22Time: 05:00 PM - 05:50 PM
Topics: Cancer, Social and Environmental Context and Health
Women disadvantaged by the social, economic, and environmental systems in which they live are disproportionately diagnosed with breast cancer and experience worse cancer-related health outcomes, including worse physical functioning. While simultaneously actively working towards health equity at the societal level, it is critical to identify individual-level factors that may buffer the effects of social disadvantage on physical health among cancer survivors. This study aimed to explore the moderating roles of four modifiable psychosocial factors (e.g., emotion regulation skills, physical activity, sleep disturbance, and social support) on the relationship between social disadvantage and physical functioning among recent breast cancer survivors.
Breast cancer survivors (N=255, Mage=56.09, 75.3% Non-Hispanic White) within 6 months of completing active cancer treatment completed self-report measures including physical function (SF-12), emotion regulation skills (DERS-18), physical activity (GLTQ), social support (MOS-SS), and sleep disturbance (PROMIS-SD). Zip codes from patient medical records were used to obtain social deprivation index (SDI) scores (Robert Graham Center, 2018), a metric of cumulative social determinants of health (SDOH) developed to examine relationships between social disadvantage and health outcomes. Separate linear regression models with bootstrapping (5,000 estimates) were conducted using the SPSS PROCESS macro (Hayes, 2017) to assess the moderating role of each psychosocial variable on the relationship between social disadvantage and physical functioning, controlling for age and cancer treatment type.
Sleep disturbance (B = -.014, SE = .001, bootstrapped 95% CI = -.027, -.001) moderated the association between SDI and physical function, while emotion regulation, physical activity, and social support did not (ps > .05). A simple slopes analysis revealed that for breast cancer survivors with high (1SD above mean) sleep disturbance, greater social disadvantage was associated with lower physical functioning (B = -0.22, p = .004). Social disadvantage was not associated with physical functioning at low (B = .01, p = .94) nor average (B = -0.10, p = .07) sleep disturbance.
Findings reveal that better sleep quality may buffer the otherwise deleterious impact of social adversity on physical functioning among recent breast cancer survivors, which can inform intervention targets for reducing the burden of social adversity in this population.
Keywords: Cancer survivorship, Health disparitiesBreast cancer survivors (N=255, Mage=56.09, 75.3% Non-Hispanic White) within 6 months of completing active cancer treatment completed self-report measures including physical function (SF-12), emotion regulation skills (DERS-18), physical activity (GLTQ), social support (MOS-SS), and sleep disturbance (PROMIS-SD). Zip codes from patient medical records were used to obtain social deprivation index (SDI) scores (Robert Graham Center, 2018), a metric of cumulative social determinants of health (SDOH) developed to examine relationships between social disadvantage and health outcomes. Separate linear regression models with bootstrapping (5,000 estimates) were conducted using the SPSS PROCESS macro (Hayes, 2017) to assess the moderating role of each psychosocial variable on the relationship between social disadvantage and physical functioning, controlling for age and cancer treatment type.
Sleep disturbance (B = -.014, SE = .001, bootstrapped 95% CI = -.027, -.001) moderated the association between SDI and physical function, while emotion regulation, physical activity, and social support did not (ps > .05). A simple slopes analysis revealed that for breast cancer survivors with high (1SD above mean) sleep disturbance, greater social disadvantage was associated with lower physical functioning (B = -0.22, p = .004). Social disadvantage was not associated with physical functioning at low (B = .01, p = .94) nor average (B = -0.10, p = .07) sleep disturbance.
Findings reveal that better sleep quality may buffer the otherwise deleterious impact of social adversity on physical functioning among recent breast cancer survivors, which can inform intervention targets for reducing the burden of social adversity in this population.
Authors:
Co-Author - Katherine E. Gnall,
MS,
University of Connecticut
Co-Author - Crystal L. Park,
PhD, FSBM,
University of Connecticut
Co-Author - Caroline Salafia,
MA,
University of Connecticut
Co-Author - Keith M. Bellizzi,
PhD, MPH, FSBM,
University of Connecticut
E23 - A Range of Experiences: How People with Low Grade Glioma Describe Initial Diagnosis and Treatment
Poster Number: E23Time: 05:00 PM - 05:50 PM
Topics: Cancer, Community Engagement
Background: Primarily seen in younger adults, low grade glioma (LGG) is a rare, malignant brain tumor that may cause significant disability and increased mortality. LGG is a less commonly studied form of brain cancer, leading to a paucity of data on early diagnosis and treatment experiences. To address this gap, we conducted a secondary analysis of data from qualitative interviews with people previously enrolled in the LGG Registry. The Registry conducts research on social, epidemiological, and genomic factors in the diagnosis and treatment of LGG.
Objective: To describe the lived experience of initial diagnosis and treatment of LGG Registry participants.
Methods: Structured qualitative interviews were conducted in July-August 2023 to elicit recommendations for the Registry’s research recruitment and enrollment processes. Interviews were recorded and professionally transcribed. Interviewers asked about participants’ experiences with LGG diagnosis and treatment to establish rapport and gain context for enrollment experiences. A portion of the data set was coded and analyzed using qualitative content analysis. Findings pertaining to enrollment logistics are reported elsewhere.
Results: We interviewed 21 current LGG Registry participants. Participants reported a spectrum of diagnosis and treatment experiences. When asked what prompted diagnosis, some detailed singular moments of severe symptoms and seeking emergency care. Others described experiencing vague symptoms over months to years before receiving a formal diagnosis. Some participants reported little impact of symptoms on their daily lives, and returning to work and hobbies shortly after recovering from surgery. Others reported debilitating symptoms and effects on their lives, such as lost employment or separating from a spouse. Some participants spoke about severe and constant emotional impacts, while others described resignation, acceptance, or even optimism about their LGG diagnosis.
Discussion: An analysis of data collected from people with LGG yielded rich, nuanced findings about the experience and impact of LGG in pivotal times of their lives (e.g., mid-career, while raising young children). Participants described highly variable experiences with diagnosis and treatment, often situating these experiences in larger disease narratives. This range of experiences arose from a small data set, underscoring the need for research to more comprehensively explore lived experiences of people with LGG.
Keywords: Cancer, Quality of lifeObjective: To describe the lived experience of initial diagnosis and treatment of LGG Registry participants.
Methods: Structured qualitative interviews were conducted in July-August 2023 to elicit recommendations for the Registry’s research recruitment and enrollment processes. Interviews were recorded and professionally transcribed. Interviewers asked about participants’ experiences with LGG diagnosis and treatment to establish rapport and gain context for enrollment experiences. A portion of the data set was coded and analyzed using qualitative content analysis. Findings pertaining to enrollment logistics are reported elsewhere.
Results: We interviewed 21 current LGG Registry participants. Participants reported a spectrum of diagnosis and treatment experiences. When asked what prompted diagnosis, some detailed singular moments of severe symptoms and seeking emergency care. Others described experiencing vague symptoms over months to years before receiving a formal diagnosis. Some participants reported little impact of symptoms on their daily lives, and returning to work and hobbies shortly after recovering from surgery. Others reported debilitating symptoms and effects on their lives, such as lost employment or separating from a spouse. Some participants spoke about severe and constant emotional impacts, while others described resignation, acceptance, or even optimism about their LGG diagnosis.
Discussion: An analysis of data collected from people with LGG yielded rich, nuanced findings about the experience and impact of LGG in pivotal times of their lives (e.g., mid-career, while raising young children). Participants described highly variable experiences with diagnosis and treatment, often situating these experiences in larger disease narratives. This range of experiences arose from a small data set, underscoring the need for research to more comprehensively explore lived experiences of people with LGG.
Authors:
Author - Carly Ritger,
University of Colorado School of Medicine
Author - Juliana G. Barnard,
University of Colorado School of Medicine
Co-Author - Liz Salmi,
Beth Israel Deaconess Medical Center
Co-Author - Ifeoma Perkins,
MD,
University of Colorado School of Medicine
Co-Author - Lindsay Lennox,
University of Colorado School of Medicine
Co-Author - Kisori Thomas,
University of Colorado School of Medicine
Presenter - Bethany M. Kwan,
PhD, MSPH, FSBM,
University of Colorado School of Medicine
E24 - What Family and Friends Have to Do with It: The Influence of Perceived HPV Vaccine Disapproval from Family and Friends on College Students' Vaccine Decision-Making Stages
Poster Number: E24Time: 05:00 PM - 05:50 PM
Topics: Cancer, Decision Making
HPV is the most common STI on college campuses, yet vaccination rates remain low. During emerging adulthood, students balance independence with social influence (e.g., parents, friends) when making health decisions (e.g., HPV vaccination). The context of perceived vaccine disapproval may affect decisions across the stages of the Precaution Adoption Process Model (PAPM). Qualitative evidence links parental vaccine disapproval with being uninterested in vaccination. Thus, family and friend disapproval may increase the risk of being in earlier PAPM stages (1-4) compared to the later stage (5: deciding to vaccinate). Data were from a baseline assessment of an ongoing HPV vaccine intervention study for unvaccinated college students aged 18-26 (N=729). Using multinomial logistic regression, we assessed the relative risk (RRRs) of being in earlier stages (1-4) compared to Stage 5 (i.e., deciding to vaccinate), controlling for severity, susceptibility, knowledge, and demographics. Marginal effects were used to assess how perceived disapproval influenced the probability of being in each stage. Compared to Stage 5, stronger disapproval from friends was linked to increased risk of being in Stages 1 (aware; RRR=1.48, p=.005), 2 (unengaged; RRR=1.67, p<.001), 3 (undecided; RRR=1.56, p<.001), and 4 (decided not to act; RRR=1.66, p=.006). Marginal effects revealed that stronger friend disapproval was associated with a higher probability of being unengaged (Stage 2; dy/dx=.04, p=.003) and a lower probability of deciding to get vaccinated (Stage 5; dy/dx=-.05, p<.001). Stronger disapproval from family was only associated with an increased risk of being in Stage 2 (RRR=1.25, p=.010) and Stage 3 (RRR=1.24, p=.020). Marginal effects showed family disapproval was linked to a reduced probability of deciding to vaccinate (dy/dx=-.02, p=.012). The impact of perceived disapproval varies by context. Friend disapproval is a significant barrier across all four early stages, reducing vaccination likelihood. Family disapproval mainly affects those unengaged or undecided, with less influence on those aware or against vaccination. Interventions may use expert opinions, success stories, and autonomy-empowering strategies to target family concerns for those aware but ambivalent. Reducing the impact of friend disapproval could involve peer education, social norm campaigns, and decision aids (tools that promote value reflection and simulate scenarios) for students in earlier stages.
Keywords: Health behavior change, CancerAuthors:
Co-Author - Yusi Aveva Xu, Ph.D.,
Ph.D.,
UT MD Anderson Cancer Center
Co-Author - Celia Ching Yee Wong, Ph.D,
Ph.D,
University of Houston
Co-Author - Lenna Dawkins-Moultin, PhD,
PhD,
MD Anderson Cancer Center
Co-Author - Qian Lu, MD, PhD, FSBM,
MD, PhD, FSBM,
The University of Texas MD Anderson Cancer Center
E25 - Insurance Instability and Rurality: Key Factors in HPV Missed Vaccination Opportunities Among Latino/a and American Indian/Alaska Native Children/Adolescents
Poster Number: E25Time: 05:00 PM - 05:50 PM
Topics: Cancer, Child and Family Health
Background:
Despite over a decade of availability, U.S. HPV vaccination rates remain low, with rural adolescents lagging 10-16 percentage points behind their urban peers, leading to preventable HPV-related cancers. This study examines the impact of rurality and insurance stability on HPV missed vaccination opportunities (HPV-MVOs) among children/adolescents (C/A).
Methods:
We analyzed Utah Statewide Immunization Information Systems (USIIS) data from 1/1/2017 to 5/19/2023, focusing on 685,614 C/A aged 9-18 years with race/ethnicity data. Insurance stability was categorized based on public insurance use. HPV-MVOs were identified as instances where a vaccination visit occurred, but the individual received an immunization other than the HPV vaccine that was due or overdue, using a 3-week shifting time window. Logistic regression and mediation analyses, guided by prior research and Directed Acyclic Graphs (DAGs), were used to assess the impact of rurality and insurance stability on HPV-MVO. Effect Measure Modification (EMM) was examined to explore how these relationships differ across racial and ethnic groups. Mediation analysis investigated the role of insurance stability in mediating rurality’s effect on HPV-MVO, with race/ethnicity as potential confounders. Moderated mediation assessed how rurality’s impact on insurance stability varies by racial/ethnic group. Analyses performed in R.
Results:
Of C/A aged 9-18, 47.1% did not receive any HPV doses, and 70% had at least one HPV-MVO, averaging 2.14 HPV-MVO per individual (SD=1.56). Rural C/A had a slightly higher likelihood of missing an HPV dose compared to urban peers (OR=1.04, 95% CI: 1.02-1.06). Latino/a C/A had higher odds (OR=1.26, 95% CI: 1.13-1.42) of experiencing HPV-MVO, while American Indian/Alaska Native, Biracial, Black, and Hawaiian/Pacific Islander C/A had lower odds compared to White C/A. Insurance stability paradoxically increased the likelihood of HPV-MVO (aOR=1.15, p<0.001). About 17.7% of rurality’s effect on HPV-MVO was mediated by insurance stability (p<0.001). Moderated mediation revealed significant interactions, with American Indian/Alaska Native and Asian C/A showing greater reductions in HPV-MVO with stable insurance compared to White C/A. Latino/a C/A showed no significant difference from White C/A.
Conclusions:
Insurance stability partially mediates the effect of rurality on HPV-MVO and varies across racial and ethnic groups, highlighting the need for tailored interventions.
Keywords: Cancer, ChildrenDespite over a decade of availability, U.S. HPV vaccination rates remain low, with rural adolescents lagging 10-16 percentage points behind their urban peers, leading to preventable HPV-related cancers. This study examines the impact of rurality and insurance stability on HPV missed vaccination opportunities (HPV-MVOs) among children/adolescents (C/A).
Methods:
We analyzed Utah Statewide Immunization Information Systems (USIIS) data from 1/1/2017 to 5/19/2023, focusing on 685,614 C/A aged 9-18 years with race/ethnicity data. Insurance stability was categorized based on public insurance use. HPV-MVOs were identified as instances where a vaccination visit occurred, but the individual received an immunization other than the HPV vaccine that was due or overdue, using a 3-week shifting time window. Logistic regression and mediation analyses, guided by prior research and Directed Acyclic Graphs (DAGs), were used to assess the impact of rurality and insurance stability on HPV-MVO. Effect Measure Modification (EMM) was examined to explore how these relationships differ across racial and ethnic groups. Mediation analysis investigated the role of insurance stability in mediating rurality’s effect on HPV-MVO, with race/ethnicity as potential confounders. Moderated mediation assessed how rurality’s impact on insurance stability varies by racial/ethnic group. Analyses performed in R.
Results:
Of C/A aged 9-18, 47.1% did not receive any HPV doses, and 70% had at least one HPV-MVO, averaging 2.14 HPV-MVO per individual (SD=1.56). Rural C/A had a slightly higher likelihood of missing an HPV dose compared to urban peers (OR=1.04, 95% CI: 1.02-1.06). Latino/a C/A had higher odds (OR=1.26, 95% CI: 1.13-1.42) of experiencing HPV-MVO, while American Indian/Alaska Native, Biracial, Black, and Hawaiian/Pacific Islander C/A had lower odds compared to White C/A. Insurance stability paradoxically increased the likelihood of HPV-MVO (aOR=1.15, p<0.001). About 17.7% of rurality’s effect on HPV-MVO was mediated by insurance stability (p<0.001). Moderated mediation revealed significant interactions, with American Indian/Alaska Native and Asian C/A showing greater reductions in HPV-MVO with stable insurance compared to White C/A. Latino/a C/A showed no significant difference from White C/A.
Conclusions:
Insurance stability partially mediates the effect of rurality on HPV-MVO and varies across racial and ethnic groups, highlighting the need for tailored interventions.
Authors:
Presenter - Kaila Christini,
Huntsman Cancer Institute, Kepka Research Lab
Chair - Deanna L. Kepka, PhD, MPH,
PhD, MPH,
University of Utah, College of Nursing and Huntsman Cancer Institute
Co-Author - Echo L. Warner, PhD MPH,
PhD MPH,
University of Utah College of Nursing
Co-Author - Simon C. Brewer,
PhD,
Geography Department, University of Utah
Co-Author - Stephen G. Gubler,
Huntsman Cancer Institute at the University of Utah
Co-Author - Becca Slagle,
Huntsman Cancer Insititute
E26 - Clinically meaningfully change in psychological distress and relationship closeness for older patients with advanced cancer and their caregivers through a dyadic life review (DLR) intervention
Poster Number: E26Time: 05:00 PM - 05:50 PM
Topics: Cancer, Mental Health
Background: Older adults with advanced cancer (PT) and their caregivers (CG) experience mutually reinforcing distress. Few supportive care interventions address distress in both PTs and CGs.
Objective: Assess the response rate for psychological distress and relationship closeness and quality in a telehealth Dyadic Life Review (DLR) feasibility study for older patients with advanced cancer (≥65, stage III/IV of any type) and caregivers (≥50).
Methods: DLR, an 8-week telehealth therapy, aims to reduce distress by enhancing relationships through joint exploration of childhood to present experiences. Unidimensional Relationship Closeness Scale (URCS) (range 1-7; higher score indicating more closeness) and National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) (range 1-10; higher score indicating higher distress) measured closeness and distress. The Dyadic Adjustment Scale (DAS) was used to assess the quality of relationships in terms of satisfaction (range 0 - 5), cohesion (range 0 - 5), consensus (range 0 - 5), and affection (range 0-4) between partners or close dyads (higher scores indicate better relationship quality). We determined the standardized response mean (SRM) by calculating the ratio of the individual change to the standard deviation of change scores in closeness and distress. For health outcomes, an SRM of 0.3 represents the lower bound for clinically meaningful change.
Results: PT and CG dyads (n=19; 38 PT and CG combined) were enrolled. PTs were mean age 77 (range 67-91), white (95%), and male (63%). CGs were mean age 70 (range 52-81), white (95%), and female (74%), majority of dyads were spouses. Twelve dyads completed the entire intervention; 67% PTs and 50% of CGs showed clinically meaningful change in distress; 56% PTs had increased relationship closeness; and 58% CGs showed increased relationship quality.
Conclusions: DLR may improve PT’s closeness and distress, and may support caregivers' relationship quality with the patient. Future studies should include distressed caregivers to examine DLR effects and/or examine CG-specific outcomes (e.g., caregiving burden). These findings support the potential of DLR as a dyad-focused intervention to enhance psychosocial outcomes in both patients and caregivers, warranting further investigation in larger trials.
Keywords: Cancer, InterventionObjective: Assess the response rate for psychological distress and relationship closeness and quality in a telehealth Dyadic Life Review (DLR) feasibility study for older patients with advanced cancer (≥65, stage III/IV of any type) and caregivers (≥50).
Methods: DLR, an 8-week telehealth therapy, aims to reduce distress by enhancing relationships through joint exploration of childhood to present experiences. Unidimensional Relationship Closeness Scale (URCS) (range 1-7; higher score indicating more closeness) and National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) (range 1-10; higher score indicating higher distress) measured closeness and distress. The Dyadic Adjustment Scale (DAS) was used to assess the quality of relationships in terms of satisfaction (range 0 - 5), cohesion (range 0 - 5), consensus (range 0 - 5), and affection (range 0-4) between partners or close dyads (higher scores indicate better relationship quality). We determined the standardized response mean (SRM) by calculating the ratio of the individual change to the standard deviation of change scores in closeness and distress. For health outcomes, an SRM of 0.3 represents the lower bound for clinically meaningful change.
Results: PT and CG dyads (n=19; 38 PT and CG combined) were enrolled. PTs were mean age 77 (range 67-91), white (95%), and male (63%). CGs were mean age 70 (range 52-81), white (95%), and female (74%), majority of dyads were spouses. Twelve dyads completed the entire intervention; 67% PTs and 50% of CGs showed clinically meaningful change in distress; 56% PTs had increased relationship closeness; and 58% CGs showed increased relationship quality.
Conclusions: DLR may improve PT’s closeness and distress, and may support caregivers' relationship quality with the patient. Future studies should include distressed caregivers to examine DLR effects and/or examine CG-specific outcomes (e.g., caregiving burden). These findings support the potential of DLR as a dyad-focused intervention to enhance psychosocial outcomes in both patients and caregivers, warranting further investigation in larger trials.
Authors:
Author - Lee Kehoe,
PhD, LMHC,
University of Rochester Medical Center
Co-Author - Sindhuja Kadambi,
MD,
University of Rochester Medical Center
Co-Author - Charles S. Kamen, PhD, MPH,
PhD, MPH,
University of Rochester Medical Center
Co-Author - Allison Magnuson,
MD,
University of Rochester Medical Center
Co-Author - Michael Sohn,
PhD,
University of Rochester Medical Center
Co-Author - Kathi L. Heffner, PhD,
PhD,
University of Rochester
Co-Author - Supriya Mohile,
MD, MS,
University of Rochester Medical Center
Co-Author - Kim Van Orden, PhD,
PhD,
University of Rochester
E27 - Preferences of African American Colorectal Cancer Survivors informing a community-based cardiovascular risk reduction intervention: An exploratory and feasibility pilot study
Poster Number: E27Time: 05:00 PM - 05:50 PM
Topics: Cardiovascular Disease, Community Engagement
Background: Colorectal cancer (CRC) survivors experience elevated cardiovascular disease (CVD) risk due to various factors (e.g., treatment effects, lifestyle behaviors, age). CVD is a leading cause of mortality in cancer survivors, accounting for 42% of non-cancer deaths in a cohort study of CRC survivors. Following a heart-healthy diet and using communal coping strategies are linked to positive health outcomes for chronic disease despite gaps in cancer research and populations with health disparities. This pilot study used lived experience of Black CRC survivors to inform components of a tailored behavioral intervention (e.g., topic priorities, protocol acceptability, recruitment and measure feasibility).
Methods: Black CRC survivors (n = 5) between 18-65 years old, or a family/friend (n = 5) of a CRC survivor, recruited via electronic health record, research registry, and flyers, attended online focus groups that were recorded, transcribed, and analyzed. Dyads (CRC survivor + friend, n = 10 adults) then cooked a heart-healthy recipe (food box provided), in which the meal preparation was audio-recorded/transcribed. A text analysis program (LIWC-22) produced a continuous communal coping score from transcripts (we-talk ratio). All participants received e-gift cards. Dyads also completed skin carotenoid scanner (Veggie Meter), saliva sample (frozen and analyzed for inflammatory biomarkers – IL6 and CRP), and a follow-up interview. Descriptive statistics were computed for all data.
Results: Focus groups offered patient-centered insights on survivorship support needs, recipe preferences, protocol acceptability, and intervention topics and length. Everyone (N = 20) rated healthy eating, fun, and medication as extremely/very important intervention topics; five other topics had more variable importance ratings. Desired intervention length was 1-hour sessions lasting 3 to 4 months for the majority. Meal preparation tasks were an acceptable and feasible way to obtain objective communal coping we-talk scores for survivors (M = 0.8, SD = .12) and friends (M = .77, SD = 0.08). Saliva collection, while feasible, presented some challenges, including difficulty producing 2 ml of saliva from some participants, data label errors, and values outside of the curve.
Conclusion: A behavioral intervention focused on communal coping skills and heart-healthy diets could successfully support post-treatment CRC survivors to achieve and maintain healthy lifestyle behaviors.
Keywords: Cancer survivorship, Cardiovascular diseaseMethods: Black CRC survivors (n = 5) between 18-65 years old, or a family/friend (n = 5) of a CRC survivor, recruited via electronic health record, research registry, and flyers, attended online focus groups that were recorded, transcribed, and analyzed. Dyads (CRC survivor + friend, n = 10 adults) then cooked a heart-healthy recipe (food box provided), in which the meal preparation was audio-recorded/transcribed. A text analysis program (LIWC-22) produced a continuous communal coping score from transcripts (we-talk ratio). All participants received e-gift cards. Dyads also completed skin carotenoid scanner (Veggie Meter), saliva sample (frozen and analyzed for inflammatory biomarkers – IL6 and CRP), and a follow-up interview. Descriptive statistics were computed for all data.
Results: Focus groups offered patient-centered insights on survivorship support needs, recipe preferences, protocol acceptability, and intervention topics and length. Everyone (N = 20) rated healthy eating, fun, and medication as extremely/very important intervention topics; five other topics had more variable importance ratings. Desired intervention length was 1-hour sessions lasting 3 to 4 months for the majority. Meal preparation tasks were an acceptable and feasible way to obtain objective communal coping we-talk scores for survivors (M = 0.8, SD = .12) and friends (M = .77, SD = 0.08). Saliva collection, while feasible, presented some challenges, including difficulty producing 2 ml of saliva from some participants, data label errors, and values outside of the curve.
Conclusion: A behavioral intervention focused on communal coping skills and heart-healthy diets could successfully support post-treatment CRC survivors to achieve and maintain healthy lifestyle behaviors.
Authors:
Co-Presenter - Atheena Kuriakose,
University of Florida
Co-Presenter - Esha Chakraborti,
University of Florida
Co-Presenter - Tara Fenelon,
University of Florida
Co-Author - Jeanette Andrade,
PhD,
University of Florida
Co-Author - Sofia Acevedo,
University of Florida
Co-Author - Juan R. Vilaro,
MD,
University of Florida
Co-Author - Katherine Hitchcock,
MD,
University of Florida
Co-Presenter - Melissa J. Vilaro, MPH, PhD,
MPH, PhD,
University of Florida
E28 - Mammography discussions: What women in their 40s want to talk to their doctor about, and what they actually talk about, after receiving a mammography decision aid
Poster Number: E28Time: 05:00 PM - 05:50 PM
Topics: Decision Making, Cancer
Purpose: From 2009-2024 the United States Preventive Services Task Force (USPSTF) recommended that women make an informed choice about when to begin mammography screening. Now the USPSTF recommends all women screen at age 40, but still emphasize that women should be informed. The purpose of this research was to inform women about mammography and then assess what women want to discuss, and actually discuss, with their doctor.
Methods: 469 female participants ages 39-49 with an upcoming annual well visit and no breast cancer history were recruited through the University of Colorado and University of Pennsylvania health systems. Participants received a mammography decision aid (DA) with information about benefits, false positives, overdiagnosis and their personal Gail model breast cancer risk score. Then participants reported whether they intended to talk to their doctor about mammography and what topics they wanted to discuss. After the appointment participants reported what was discussed.
Results: After the DA, 357 participants intended to talk to their doctor about mammography and 301 did so. Participants who did not talk to their doctor often had an existing screening plan or other priorities for the visit. Many participants wanted to talk about their cancer risk (76%) and screening preferences (75%), but only 46% actually talked about their cancer risk and 55% talked about their preferences. Many wanted to talk about screening benefits (59%) and screening harms (57%); 57% talked about benefits but only 31% talked about harms. 23% wanted to talk about costs and 26% about where to get screened; 9% actually talked about costs and 42% talked about where to get screened.
Conclusions: After reading a DA, many women wanted to talk to their doctor about screening but frequently did not talk about the topics they prioritized, especially personal cancer risk and screening preferences. Doctors may not address many of patients’ key questions about mammography.
Keywords: Cancer screening, Decision makingMethods: 469 female participants ages 39-49 with an upcoming annual well visit and no breast cancer history were recruited through the University of Colorado and University of Pennsylvania health systems. Participants received a mammography decision aid (DA) with information about benefits, false positives, overdiagnosis and their personal Gail model breast cancer risk score. Then participants reported whether they intended to talk to their doctor about mammography and what topics they wanted to discuss. After the appointment participants reported what was discussed.
Results: After the DA, 357 participants intended to talk to their doctor about mammography and 301 did so. Participants who did not talk to their doctor often had an existing screening plan or other priorities for the visit. Many participants wanted to talk about their cancer risk (76%) and screening preferences (75%), but only 46% actually talked about their cancer risk and 55% talked about their preferences. Many wanted to talk about screening benefits (59%) and screening harms (57%); 57% talked about benefits but only 31% talked about harms. 23% wanted to talk about costs and 26% about where to get screened; 9% actually talked about costs and 42% talked about where to get screened.
Conclusions: After reading a DA, many women wanted to talk to their doctor about screening but frequently did not talk about the topics they prioritized, especially personal cancer risk and screening preferences. Doctors may not address many of patients’ key questions about mammography.
Authors:
Presenter - Laura Scherer,
University of Colorado
Co-Author - Carmen Lewis,
University of Colorado
Co-Author - Kirsten McCaffery,
University of Sydney
Co-Author - Jolyn Hersch,
University of Sydney
Co-Author - Joseph Cappella,
University of Pennsylvania
Co-Author - Brad Morse,
University of Colorado
Co-Author - Channing Tate,
University of Colorado
Co-Author - Kelly Arnett,
University of Colorado
Co-Author - Bridget Mosely,
University of Colorado
Co-Author - Heather Smyth,
University of Colorado
Co-Author - Tamar Parmet, MSW,
MSW,
University of Colorado Denver
Co-Author - Marilyn Schapira,
University of Pennsylvania
E29 - Faith and Immunity: Exploring the Association of Religious Factors on Human Papillomavirus Vaccine Uptake Among Indiana Adults
Poster Number: E29Time: 05:00 PM - 05:50 PM
Topics: Decision Making, Integrative Health and Spirituality
Religion is a notable psychosocial factor that influences vaccination decision-making behavior; understanding the role of religious factors in Human Papillomavirus (HPV) vaccine uptake is crucial. This cross-sectional study examines the relationship between religiosity and HPV vaccine uptake among Indiana adults (ages 18-45 years) and investigates whether vaccination confidence mediates this relationship. Religiosity was measured by examining the frequency of attendance at religious meetings on a scale of 1 (never) to 6 (>1/week), then grouped into 3 categories (low, middle, high). A mean score of HPV vaccination confidence was measured using nine items and vaccine uptake used a binary (yes/no) categorization if the person had ever received any vaccines. We used multivariable logistic regression to analyze the association between religiosity, sociodemographic factors, and HPV vaccination uptake. We conducted a Structural Equation Modelling (SEM) mediation analysis to assess the indirect, direct, and total effects of religiosity on HPV vaccine uptake, with vaccination confidence as a potential mediator. Most of our sample were women (n=160, 52.6%), religiously affiliated (n=157, 51.6%), and had never received the HPV vaccine (n=160, 52.6%). We found that higher religiosity (aOR=2.76, 95% CI:1.15-6.62) and vaccination confidence (aOR=3.13, 95% CI:2.06-4.77) were associated with increased odds of HPV vaccine uptake, while being older (aOR=0.91, 95% CI: 0.87-0.95) or being male (aOR=0.50, 95% CI: 0.28-0.91) were associated with decreased odds of HPV vaccine uptake. The indirect effect of religiosity on HPV vaccine uptake through HPV vaccination confidence was not significant while the direct effect was significant, indicating no mediation effect. Future studies should explore other potential mediators and develop targeted interventions to increase vaccine uptake among populations with varying levels of religiosity.
Keywords: Health disparities, SpiritualityAuthors:
Presenter - Alfu Laily,
Purdue University
Co-Author - Robert Duncan,
Colorado State University
Co-Author - Randolph D. Hubach,
Purdue University
Co-Author - Kathryn J. LaRoche,
Purdue University
Co-Author - Natalia M. Rodriguez,
Purdue University
Co-Author - Gregory D. Zimet, PhD,
Indiana University
Co-Author - Laura M. Schwab Reese,
Purdue University
Co-Author - Monica L. Kasting, PhD,
Purdue University
E30 - ENHANCING QUALITY OF LIFE THROUGH PHYSICAL ACTIVITY IN CHILDREN DIAGNOSED WITH A BRAIN TUMOR: PARENTS AS KEY FACILITATORS
Poster Number: E30Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Physical Activity
Background and aims. Children diagnosed with a pediatric brain tumor (PBT) are living longer but have deficits that can affect their overall quality of life (QoL). Physical activity (PA) can enhance a multitude of health outcomes in these patients. Therefore, this study aimed to better understand the relationship between PA and QoL in children with PBT.
Methods. A total of 36 PBT patients (aged between 5 and 18 years old) were included in this study. Using the PedsQL generic core scales and self-reported weekly minutes of PA, we performed a linear regression to assess the relationship between children’s PA and their QoL. We assessed the moderating role of parents’ PA using the PROCESS macro, and we investigated the correlation between children’s PA and parents’ PA. All analyses were performed with 5000 bootstrap samples and controlled for the child’s sex, age at study, type of treatment, and treatment status.
Results. We found that children’s PA accounted for 25% of the variance in their QoL (R2=0.25), and that children’s PA was a significant predictor of their overall QoL (B=0.33, p=0.019, 95%CI[0.010, 0.059]). Although parents’ PA did not moderate this relationship (c=-0.0001, p=0.593, 95%CI[-0.0003, 0.0002]), we found that there was a strong correlation between children’s PA and parents’ PA (r=0.80, p<0.001).
Conclusion. This study highlighted the important role of PA to improve QoL in children diagnosed with a PBT. Parents’ levels of PA should not be disregarded in the development and implementation of future interventions because although they do not directly moderate the relationship between their child’s PA and QoL, children whose parents engage in more PA also tend to engage in more PA, which can ultimately improve their QoL.
Keywords: Quality of life, Physical activityMethods. A total of 36 PBT patients (aged between 5 and 18 years old) were included in this study. Using the PedsQL generic core scales and self-reported weekly minutes of PA, we performed a linear regression to assess the relationship between children’s PA and their QoL. We assessed the moderating role of parents’ PA using the PROCESS macro, and we investigated the correlation between children’s PA and parents’ PA. All analyses were performed with 5000 bootstrap samples and controlled for the child’s sex, age at study, type of treatment, and treatment status.
Results. We found that children’s PA accounted for 25% of the variance in their QoL (R2=0.25), and that children’s PA was a significant predictor of their overall QoL (B=0.33, p=0.019, 95%CI[0.010, 0.059]). Although parents’ PA did not moderate this relationship (c=-0.0001, p=0.593, 95%CI[-0.0003, 0.0002]), we found that there was a strong correlation between children’s PA and parents’ PA (r=0.80, p<0.001).
Conclusion. This study highlighted the important role of PA to improve QoL in children diagnosed with a PBT. Parents’ levels of PA should not be disregarded in the development and implementation of future interventions because although they do not directly moderate the relationship between their child’s PA and QoL, children whose parents engage in more PA also tend to engage in more PA, which can ultimately improve their QoL.
Authors:
Author - Ariane Levesque,
PhD candidate,
Université de Montréal
Co-Author - Deepika Pugalenthi Saravanan,
MD student,
Penn State College of Medicine
Co-Author - Sébastien Perreault,
MD,
Université de Montréal
Co-Author - Serge Sultan,
PhD,
Université de Montréal
Co-Author - Leandra Desjardins,
PhD,
Université de Montréal
Co-Author - Émélie Rondeau,
MSc,
Université de Montréal
Co-Author - Laurianne Buron,
PhD Student,
Université de Montréal
Co-Author - Nidhi B. Shah,
DO,
Penn State College of Medicine
Co-Author - Michael Hayes,
PhD,
Penn State College of Medicine
Co-Author - Lucia Romo,
PhD,
Université Paris Nanterre
Co-Author - Daniel Curnier,
PhD,
Université de Montréal
Co-Author - Laurence Kern,
PhD,
Ecole de Psychologues Praticiens
Presenter - Maxime Caru, PhD, PhD,
PhD, PhD,
Penn State College of Medicine
E31 - Latent Class Trajectories of Sleep Disturbance Post-Cancer Treatment: Cognitive and Emotional Predictors of Class Membership
Poster Number: E31Time: 05:00 PM - 05:50 PM
Topics: Sleep, Cancer
Sleep disturbance is common in cancer survivorship. Studies have primarily examined sleep cross-sectionally or longitudinally, with few assessing within-group trajectories over time. Understanding these trajectories and their unique predictors is crucial for early assessment and intervention. This study aimed to model sleep disturbance trajectories and their psychosocial predictors (i.e., emotion dysregulation, anxiety, depression, and illness beliefs) among cancer survivors post-treatment.
501 adults (69.9% female; 70.1% non-Hispanic White) who had recently completed treatment for breast, colorectal, or prostate cancer completed self-report measures of sleep disturbance at five timepoints: baseline (within ~3 months post-primary cancer treatment) and four subsequent three-month intervals. Psychosocial predictors were assessed at baseline. Growth mixture modeling with multiple imputation examined trajectories of sleep disturbance post-cancer treatment. Logistic regressions estimated associations between psychosocial predictors and class membership.
Three sleep disturbance trajectories were identified: i) consistently high (8.6%), (ii) consistently low (30.9%), and iii) moderate but slightly improving (60.5%). Compared to the consistently low group, the odds of being in the consistently high group increased by 3.2 for each 1-point increase in emotion dysregulation, 1.4 for anxiety, 1.4 for depression, 1.2 for beliefs about greater illness consequences, and 1.1 for beliefs about a longer illness timeline. The odds of being in the moderate but slightly improving group increased by 1.7 for emotion dysregulation, 1.2 for anxiety, 1.1 for depression, and 1.1 for both beliefs about greater illness consequences and a longer timeline.
Most participants experienced substantial sleep disturbance, with many having moderate disturbances that improved slightly over time and a small group with high persistent disturbance. Higher levels of emotion dysregulation, anxiety, depression, and negative illness beliefs were associated with increased odds of being classified into the consistently high or moderate but improving sleep disturbance groups. Notably, emotion dysregulation more than tripled the odds of being in the consistently high sleep disturbance group. These findings underscore the importance of emotional and cognitive factors, particularly emotion dysregulation, in sleep disturbances among cancer survivors and highlight potential intervention targets.
Keywords: Cancer survivorship, Abnormal sleep501 adults (69.9% female; 70.1% non-Hispanic White) who had recently completed treatment for breast, colorectal, or prostate cancer completed self-report measures of sleep disturbance at five timepoints: baseline (within ~3 months post-primary cancer treatment) and four subsequent three-month intervals. Psychosocial predictors were assessed at baseline. Growth mixture modeling with multiple imputation examined trajectories of sleep disturbance post-cancer treatment. Logistic regressions estimated associations between psychosocial predictors and class membership.
Three sleep disturbance trajectories were identified: i) consistently high (8.6%), (ii) consistently low (30.9%), and iii) moderate but slightly improving (60.5%). Compared to the consistently low group, the odds of being in the consistently high group increased by 3.2 for each 1-point increase in emotion dysregulation, 1.4 for anxiety, 1.4 for depression, 1.2 for beliefs about greater illness consequences, and 1.1 for beliefs about a longer illness timeline. The odds of being in the moderate but slightly improving group increased by 1.7 for emotion dysregulation, 1.2 for anxiety, 1.1 for depression, and 1.1 for both beliefs about greater illness consequences and a longer timeline.
Most participants experienced substantial sleep disturbance, with many having moderate disturbances that improved slightly over time and a small group with high persistent disturbance. Higher levels of emotion dysregulation, anxiety, depression, and negative illness beliefs were associated with increased odds of being classified into the consistently high or moderate but improving sleep disturbance groups. Notably, emotion dysregulation more than tripled the odds of being in the consistently high sleep disturbance group. These findings underscore the importance of emotional and cognitive factors, particularly emotion dysregulation, in sleep disturbances among cancer survivors and highlight potential intervention targets.
Authors:
Author - Mariel Emrich,
University of Connecticut
Co-Author - Keith M. Bellizzi,
PhD, MPH, FSBM,
University of Connecticut
Co-Author - Zachary Magin, MS,
University of Connecticut
Co-Author - Katherine E. Gnall, MS,
University of Connecticut
Co-Author - Crystal L. Park,
PhD, FSBM,
University of Connecticut
E32 - Sunburns and potential correlates among Hispanic individuals
Poster Number: E32Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Health of Marginalized Populations
Background: Skin cancer is the most common cancer in the United States, and in the past two decades, melanoma—the deadliest type—has increased by 20% among Hispanic population. Therefore, it is critical to reduce ultraviolet (UV) radiation and sunburn, which are primary preventable risk factors for both non-melanoma skin cancer (NMSC) and melanoma. This study examined the sunburns and factors contributing to sunburns among Hispanic individuals via a national sample.
Methods: The current study utilized the subsample of Hispanic individuals (N = 903) from the nationally representative 2020 Health Information National Trends Survey (HINTS 6), in which data were collected from March 7, 2022 and concluded on November 8, 2022. Logistical regression was used to examine the association between factors and sunburn history among Hispanic individuals.
Results: More than 27% of the Hispanic individuals reported having at least one sunburn from too much sun exposure in the past year. About 26% of the Hispanic individuals reported that their sunburns were associated with job outside or working outside of home; more than 23% were intentionally sunbathing while getting the sunburns; and almost 88% respondents reported being in recreational activities while they got the sunburns, whereas 17% respondents reported that they got the sunburns during their day-to-day activities. Age and sharing the same health perspectives with most people in one’s social media networks were significantly associated with sunburn history in the past 12 months. Older age groups and Hispanics individuals who reported that most people in their social media networks had the same views about health were more likely to have sunburns.
Conclusions: The findings from this study highlight a significant prevalence of sunburn among Hispanic individuals, with more than a quarter of the participants reporting at least one sunburn in the past year. Intentional sunbathing and outdoor work were key contributors. Additionally, older individuals and those with similar health views in their social circles were more likely to report sunburns. These findings highlight the need for targeted sun protection interventions, focusing on both recreational sun exposure and outdoor work-related risks, while leveraging social networks to promote sun safety among Hispanics.
Keywords: Sun safety, LatinoMethods: The current study utilized the subsample of Hispanic individuals (N = 903) from the nationally representative 2020 Health Information National Trends Survey (HINTS 6), in which data were collected from March 7, 2022 and concluded on November 8, 2022. Logistical regression was used to examine the association between factors and sunburn history among Hispanic individuals.
Results: More than 27% of the Hispanic individuals reported having at least one sunburn from too much sun exposure in the past year. About 26% of the Hispanic individuals reported that their sunburns were associated with job outside or working outside of home; more than 23% were intentionally sunbathing while getting the sunburns; and almost 88% respondents reported being in recreational activities while they got the sunburns, whereas 17% respondents reported that they got the sunburns during their day-to-day activities. Age and sharing the same health perspectives with most people in one’s social media networks were significantly associated with sunburn history in the past 12 months. Older age groups and Hispanics individuals who reported that most people in their social media networks had the same views about health were more likely to have sunburns.
Conclusions: The findings from this study highlight a significant prevalence of sunburn among Hispanic individuals, with more than a quarter of the participants reporting at least one sunburn in the past year. Intentional sunbathing and outdoor work were key contributors. Additionally, older individuals and those with similar health views in their social circles were more likely to report sunburns. These findings highlight the need for targeted sun protection interventions, focusing on both recreational sun exposure and outdoor work-related risks, while leveraging social networks to promote sun safety among Hispanics.
Authors:
Presenter - Zhaomeng Niu, PhD,
PhD,
Rutgers University of New Jersey
E33 - Social Connection and Cardiovascular Health in the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)
Poster Number: E33Time: 05:00 PM - 05:50 PM
Topics: Cardiovascular Disease, Social and Environmental Context and Health
Purpose: Social connection comprises three elements: 1) perceived social support (support), 2) social network size (network size), and 3) relationship quality, such as family cohesion (cohesion). While social relationships are known to protect cardiovascular health (CVH), most studies have focused on only one or two elements, leading to conflicting findings, especially among Hispanics/Latinos. This study explored how all three aspects of social connection relate to CVH, as defined by the American Heart Association’s Life’s Essential 8 (LE8), in Hispanic/Latino adults. Methods: We examined CVH changes over six years (2008-2011 to 2014-2017) in 5,314 participants from the HCHS/SOL. CVH health factors (CVHF; lipids, glucose, blood pressure, BMI) and health behaviors (CVHB; diet, physical activity, sleep, smoking) scores were derived and combined to generate LE8 scores. Multivariable linear regression models controlled for sociodemographic factors, depression and anxiety symptoms, sample weights, and design factors. Baseline scores were controlled for longitudinal analyses, where CVHF was the sole outcome. Interaction and stratified analyses by age groups (18-44, 45+) were also performed. Results: Most of the population was female (56.5%) with a mean age of 42.4 years, representing diverse Hispanic/Latino backgrounds. No longitudinal relationships were found between support, network size, or cohesion with CVHF. However, at baseline, a significant age group interaction was observed for network size (B=1.91, 95% CI 1.10,2.72, p<.001) with CVHF, with a larger network size related to better CVHF in those over 45 years (B=1.14, 95% CI .67,1.61, p<.001) and worse CVHF in those 18-44 years (B=-.93, 95% CI -1.29, -.57, p<.001). There was an age-group interaction for network size with LE8 scores (B=1.15, 95% CI .63, 1.67, p<.001), with greater network size related to greater LE8 scores in the population over 45 years (B=1.38, 95% CI 1.05, 1.71, p<.001) but no significant relation among those 18-44 years. Greater network size was related to better CVHB scores (B=1.48, 95% CI 1.10,1.87, p<.001) and overall LE8 scores (B=.76, 95% CI .52,1.10, p<.001) at baseline. Cohesion and support did not relate to baseline CVH scores. Conclusions: The quantity of social connections, but not support and family cohesion, related to CVH at baseline, but not changes over time. The impact of network size on CHV may differ by age group.
Keywords: Latino, Social supportAuthors:
Author - Heidy Mendez-Rodriguez,
SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
Co-Author - Gregory A. Talavera, MD, MPH,
MD, MPH,
San Diego State University
Co-Author - Jessica L. McCurley, PhD, MPH,
PhD, MPH,
San Diego State University
Co-Author - Scott C. Roesch, PhD,
PhD,
San Diego State University
Co-Author - Carlos Rosas, PhD,
PhD,
University of California San Diego
Co-Author - Jeanean B. Naqvi,
PhD,
Carnegie Mellon University
Co-Author - Linda C. Gallo, PhD, FSBM,
PhD, FSBM,
San Diego State University
E34 - ASSOCIATION BETWEEN INTEROCEPTIVE ACCURACY AND SELF-CARE IN PATIENTS WITH HEART FAILURE AND MILD COGNITIVE IMPAIRMENT
Poster Number: E34Time: 05:00 PM - 05:50 PM
Topics: Cardiovascular Disease, Quality of Life
Significance: Interoceptive accuracy (IA) is the objective accuracy in detecting internal bodily sensations. Among patients with heart failure (HF), increased IA might translate into greater ability to monitor HF symptoms and better self-care maintenance and management. The heartbeat tracking test (HTT), a validated objective interoception measure, assesses the ability to accurately perceive heartbeats. In past studies, patients have accurately perceived between 55% to 82% of their heartbeats. However, there is limited research utilizing HTT to measure IA among individuals with HF, and no studies have assessed the association between HTT and HF self-care.
Methods: Participants were a subsample of 48 adults with a confirmed diagnosis of HF and mild cognitive impairment (MCI) (scores 15-26 on MoCA) participating in an ongoing randomized controlled trial. At baseline, participants completed assessments of IA (HTT) and HF self-care (Self-Care Heart Failure Index, SCHFI). The IA score was calculated as the average proportion of perceived to actual heartbeats over three trials. Participants were then grouped as follows: 1) no IA (0 heartbeats perceived), 2) low IA (scores at or below the median), 3) high IA (scores above the median). We conducted three separate linear regression models with IA group as predictors and the three SCHFI scales (self-care maintenance, self-care monitoring, self-care management) as outcomes, controlling for age and education level.
Results: The average age of participants was 73 years (SD = 11.3). Most (52.1%) were female and White (79.2%). The average HTT score was 0.35 (accurately perceiving 35% of heartbeats) (SD = 0.31), with 29% in the no IA group (no heartbeats perceived), 19% in the low IA group (at or below the median), and 50% in the high IA group (above the median). There were no significant relationships between IA group and self-care maintenance or monitoring. Higher HTT group was associated with greater self-care management (β = 2.37, 95% CI = 0.14, 4.61, p = .04).
Conclusions: In this sample of individuals with co-morbid HF and MCI, the average HTT score was low, indicating that individuals with HF have low interoceptive accuracy. However, higher IA was associated with greater self-care management. Higher IA may motivate patients with HF and MCI to take action when experiencing symptoms.
Keywords: Cardiovascular disease, Health behaviorsMethods: Participants were a subsample of 48 adults with a confirmed diagnosis of HF and mild cognitive impairment (MCI) (scores 15-26 on MoCA) participating in an ongoing randomized controlled trial. At baseline, participants completed assessments of IA (HTT) and HF self-care (Self-Care Heart Failure Index, SCHFI). The IA score was calculated as the average proportion of perceived to actual heartbeats over three trials. Participants were then grouped as follows: 1) no IA (0 heartbeats perceived), 2) low IA (scores at or below the median), 3) high IA (scores above the median). We conducted three separate linear regression models with IA group as predictors and the three SCHFI scales (self-care maintenance, self-care monitoring, self-care management) as outcomes, controlling for age and education level.
Results: The average age of participants was 73 years (SD = 11.3). Most (52.1%) were female and White (79.2%). The average HTT score was 0.35 (accurately perceiving 35% of heartbeats) (SD = 0.31), with 29% in the no IA group (no heartbeats perceived), 19% in the low IA group (at or below the median), and 50% in the high IA group (above the median). There were no significant relationships between IA group and self-care maintenance or monitoring. Higher HTT group was associated with greater self-care management (β = 2.37, 95% CI = 0.14, 4.61, p = .04).
Conclusions: In this sample of individuals with co-morbid HF and MCI, the average HTT score was low, indicating that individuals with HF have low interoceptive accuracy. However, higher IA was associated with greater self-care management. Higher IA may motivate patients with HF and MCI to take action when experiencing symptoms.
Authors:
Author - Danusha Selva Kumar, PhD,
PhD,
Alpert Medical School at Brown University, Lifespan Cardiovascular Institute, The Miriam Hospital
Co-Author - Barbara Riegel, PhD,
PhD,
University of PA School of Nursing
Co-Author - Hila Pond, BS,
BS,
Lifespan
Co-Author - Christopher Liu,
Lifespan
Co-Author - Natalie Keirns, PhD,
PhD,
The Miriam Hospital/Brown Medical School
Co-Author - Giulia Locatelli,
PhD,
University of Milano-Bicocca, Department of Medicine and Surgery, Italy
Co-Author - Janice Tripolone,
MS, MAT,
Lifespan Cardiovascular Institute, The Miriam Hospital
Co-Author - Christopher Breault,
BS,
Survey Research Center, Brown University, School of Public Health
Co-Author - Elena Salmoirago-Blotcher, MD, PhD, FSBM,
MD, PhD, FSBM,
Cardiovascular Institute, The Miriam Hospital
E35 - Identifying predictors of intervention effectiveness: A moderator analysis of the Strong Hearts, Healthy Communities 2.0 trial
Poster Number: E35Time: 05:00 PM - 05:50 PM
Topics: Cardiovascular Disease, Multiple Health Behavior Change
Introduction: Heterogeneity in response to interventions has been observed in many trials of behavioral interventions and could limit the effectiveness of these interventions in improving public health. Strong Hearts, Healthy Communities (SHHC) is a multilevel intervention that targets individual, social, and environmental influences on diet and physical activity to reduce cardiovascular disease (CVD) risk. Results of the SHHC 2.0 trial indicated significant improvement in CVD risk (AHA Simple 7), weight, physical activity, and diet quality. The purpose of this analysis is to identify potential moderators of intervention effects in the SHHC 2.0 trial.
Methods: The SHHC 2.0 trial was a cluster-randomized trial conducted in 11 rural communities. Women (n=182) at elevated risk of CVD were enrolled and communities were randomized to receive either: 1) the SHHC 2.0 intervention or 2) delayed intervention. We used mixed linear models to evaluate the between-group differences in weight loss, systolic blood pressure, hemoglobin A1c (HbA1c), and triglycerides with an interaction term to evaluate potential baseline moderators: demographics, BMI, health history, quality of life, and mental health (depression, anxiety, and resilience).
Results: There was no difference in intervention effects across age, income, or BMI. Higher levels of depressive symptoms were associated with greater weight loss (0.52 kg per point on the PHQ-8, p=0.002). Participants with a PHQ score > 10 demonstrated a greater weight loss (6.45 kg, p=0.003) and reduction in HbA1c (0.31%, p=0.024). Participants with a history of hypertension experienced greater reductions in systolic blood pressure (7.71 mmHg, p=0.022). Moderators identified to have a greater impact on triglycerides included being in a relationship (32.49 mg/dL, p=0.002) and greater resilience, as measured by the Brief Resilience Scale (36.00 mg/dL per point increase, p<0.001).
Discussion: The significant moderators identified suggest greater benefit within some at-risk groups (individuals with elevated depressive symptoms and history of hypertension). We note that the trial was not powered to evaluate moderator effects, so these results should be interpreted with caution. However, these results can inform future iterations of the SHHC 2.0 intervention to continue to improve effectiveness across the entire target population.
Keywords: Cardiovascular disease, InterventionsMethods: The SHHC 2.0 trial was a cluster-randomized trial conducted in 11 rural communities. Women (n=182) at elevated risk of CVD were enrolled and communities were randomized to receive either: 1) the SHHC 2.0 intervention or 2) delayed intervention. We used mixed linear models to evaluate the between-group differences in weight loss, systolic blood pressure, hemoglobin A1c (HbA1c), and triglycerides with an interaction term to evaluate potential baseline moderators: demographics, BMI, health history, quality of life, and mental health (depression, anxiety, and resilience).
Results: There was no difference in intervention effects across age, income, or BMI. Higher levels of depressive symptoms were associated with greater weight loss (0.52 kg per point on the PHQ-8, p=0.002). Participants with a PHQ score > 10 demonstrated a greater weight loss (6.45 kg, p=0.003) and reduction in HbA1c (0.31%, p=0.024). Participants with a history of hypertension experienced greater reductions in systolic blood pressure (7.71 mmHg, p=0.022). Moderators identified to have a greater impact on triglycerides included being in a relationship (32.49 mg/dL, p=0.002) and greater resilience, as measured by the Brief Resilience Scale (36.00 mg/dL per point increase, p<0.001).
Discussion: The significant moderators identified suggest greater benefit within some at-risk groups (individuals with elevated depressive symptoms and history of hypertension). We note that the trial was not powered to evaluate moderator effects, so these results should be interpreted with caution. However, these results can inform future iterations of the SHHC 2.0 intervention to continue to improve effectiveness across the entire target population.
Authors:
Presenter - Chad D. Rethorst, PhD,
PhD,
Texas A&M Agrilife Research
Co-Author - Margaret Demment,
Texas A&M Agrilife Research
Co-Author - Seungyeon Ha,
Texas A&M University
Co-Author - Meredith Graham, MS,
MS,
Texas A&M Agrilife Research
Co-Author - Sara C. Folta, PhD,
PhD,
Tufts University
Co-Author - Galen Eldridge,
Texas A&M Agrilife Research
Co-Author - Rebecca A. Seguin-Fowler, PhD,
PhD,
Texas A&M AgriLife Research
E36 - Sex differences in the psychological profiles of patients with spontaneous coronary artery dissection (SCAD): Preliminary data from the MINDSET Study
Poster Number: E36Time: 05:00 PM - 05:50 PM
Topics: Cardiovascular Disease, Mental Health
Background: Spontaneous Coronary Artery Dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, especially in females. Psychological distress before and after SCAD appears common, yet sex differences remain understudied. Exploring these differences could guide tailored interventions to improve mental and cardiac outcomes for both sexes. This study aimed to characterize sex differences in psychological profiles of patients with SCAD.
Methods: Adult patients diagnosed with SCAD within the past 3 years were recruited from 7 cardiac care hospitals across Canada. Participants completed questionnaires assessing sociodemographics and validated psychological measures including: Patient Health Questionnaire-9 (PHQ-9) for depression, Generalized Anxiety Disorder-7 (GAD-7) for generalized anxiety, Cardiac Anxiety Questionnaire (CAQ) for cardiac-related anxiety, and PTSD Checklist (PCL-5) for posttraumatic stress symptoms. Sex differences were analyzed using t-tests for continuous and chi-square tests for categorical variables.
Results: The study included 285 participants (84.0% female; 75.4% White; mean age = 53.3 years). Females and males reported similar rates of emotional stressors prior to SCAD (53%), however, females had higher rates of pre-existing mental health conditions (30.7% vs. 9.1%, p = .032) and were more likely to receive psychopharmaceutical treatment (37.0% vs 10.0%, p = .015). After SCAD, females reported significantly higher scores (mean ± range) than males on the PHQ-9 (6.5±5.6 vs. 3.2±2.8, p < .001), CAQ (27.6±12.2 vs. 14.5±3.2, p = .003), and PCL-5 (14.7±14.8 vs. 7.6±8.4, p = .001). Similarly, the proportion of females with scores in the clinically diagnostic range on post-SCAD testing were higher than males for the following mental health measures: 25.1% vs 0% for depression, 21.3% vs 4.5% for anxiety, 55.4% vs 20.0% for cardiac anxiety, and 13.9% vs 0% for traumatic stress.
Conclusion: Our preliminary findings suggest that females with SCAD not only have higher rates of preexisting mental health conditions but also experience significantly more psychological distress post-SCAD compared with males. These results highlight the need for routine psychological screening and the potential development of tailored interventions to improve mental health outcomes and overall recovery after SCAD, especially in females.
Keywords: Cardiovascular disease, Mental healthMethods: Adult patients diagnosed with SCAD within the past 3 years were recruited from 7 cardiac care hospitals across Canada. Participants completed questionnaires assessing sociodemographics and validated psychological measures including: Patient Health Questionnaire-9 (PHQ-9) for depression, Generalized Anxiety Disorder-7 (GAD-7) for generalized anxiety, Cardiac Anxiety Questionnaire (CAQ) for cardiac-related anxiety, and PTSD Checklist (PCL-5) for posttraumatic stress symptoms. Sex differences were analyzed using t-tests for continuous and chi-square tests for categorical variables.
Results: The study included 285 participants (84.0% female; 75.4% White; mean age = 53.3 years). Females and males reported similar rates of emotional stressors prior to SCAD (53%), however, females had higher rates of pre-existing mental health conditions (30.7% vs. 9.1%, p = .032) and were more likely to receive psychopharmaceutical treatment (37.0% vs 10.0%, p = .015). After SCAD, females reported significantly higher scores (mean ± range) than males on the PHQ-9 (6.5±5.6 vs. 3.2±2.8, p < .001), CAQ (27.6±12.2 vs. 14.5±3.2, p = .003), and PCL-5 (14.7±14.8 vs. 7.6±8.4, p = .001). Similarly, the proportion of females with scores in the clinically diagnostic range on post-SCAD testing were higher than males for the following mental health measures: 25.1% vs 0% for depression, 21.3% vs 4.5% for anxiety, 55.4% vs 20.0% for cardiac anxiety, and 13.9% vs 0% for traumatic stress.
Conclusion: Our preliminary findings suggest that females with SCAD not only have higher rates of preexisting mental health conditions but also experience significantly more psychological distress post-SCAD compared with males. These results highlight the need for routine psychological screening and the potential development of tailored interventions to improve mental health outcomes and overall recovery after SCAD, especially in females.
Authors:
Author - Lisa-Marie Maukel,
PhD,
University of Ottawa Heart Institute, Ottawa, ON, Canada
Co-Author - Thais Coutinho,
PhD,
Mayo Clinic Cardiology, Rochester, MN, USA
Co-Author - Sharon Mulvagh,
MD,
Dalhousie University, Halifax, NS, Canada
Co-Author - Christine Pacheco,
MD,
Université de Montréal, Montréal, QC, Canada
Co-Author - Karen Bouchard,
PhD,
University of Ottawa Heart Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
Co-Author - Derek So,
MD,
University of Ottawa Heart Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
Co-Author - Mina Madan,
MD,
University of Toronto, Toronto, ON, Canada
Co-Author - Jacqueline Saw,
MD,
University of British Columbia, Vancouver, BC, Canada
Co-Author - Jennifer Reed,
PhD,
University of Ottawa Heart Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
Co-Author - Shuangbo Liu,
MD,
University of Manitoba, Winnipeg, MB, Canada
Co-Author - Louise Sun,
MD,
University of Ottawa Heart Institute, Ottawa, ON, Canada; Stanford University School of Medicine, Stanford, CA, USA
Co-Author - Helen Robert,
Patient partner of the University of Ottawa Heart Institute, Ottawa, ON, Canada
Co-Author - Nadia Lappa,
Patient partner of the University of Ottawa Heart Institute, Ottawa, ON, Canada
Co-Author - Heather Tulloch,
PhD, C. Psych,
University of Ottawa Heart Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
E37 - Inflammatory Gene Expression is Related to Fatigue, but not Depression and Anxiety Symptoms, in Children and Adolescents
Poster Number: E37Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Stress
Background: Fatigue is a common, but underappreciated, complaint among children and adolescents that can disrupt daily functioning. Understanding the biological underpinnings of fatigue during development is needed to inform treatments appropriate for this age group. While inflammation plays a causal role in fatigue during adulthood, little research has examined this relationship during development. As circulating inflammatory markers are typically low in childhood, measuring inflammatory gene expression can reveal more upstream and earlier-emerging aspects of inflammatory biology.
Methods: In this study, we examined concurrent associations between inflammatory gene expression and fatigue symptoms in a sample of N=65 children and adolescents (mean age = 12.77, range = 7-17 years) with varied exposure to caregiving-related early life adversity (crEA): N=26 with significant exposure (maltreatment and/or extended parental separation) and N=39 without history of maltreatment or parental separation. To assess the specificity of associations between inflammatory gene expression and fatigue versus general ill-health, we also tested associations with internalizing (i.e., anxiety and depression) symptoms. Children provided dried blood spot samples for analysis of RNA transcripts from an a priori specified set of 19 pro-inflammatory genes, and children and caregivers completed questionnaires on children’s fatigue and internalizing symptoms. Multilevel linear modeling, treating expression values within each gene as a repeated measure of inflammatory gene expression, was used for analysis.
Results: We found that higher inflammatory gene expression was associated with more self-reported fatigue symptoms. We also found an age-by-inflammatory gene expression interaction on caregiver proxy-reported fatigue symptoms, such that there was a positive relationship between inflammatory gene expression and fatigue for children in the sample older than 14.74 years. Inflammatory gene expression was not significantly related to internalizing symptoms. CrEA did not predict inflammatory gene expression; controlling for crEA, inflammatory gene expression remained significantly related to fatigue symptoms. Findings suggest inflammatory processes may be uniquely related to fatigue symptoms in childhood and adolescence. Pending replication and further research that assesses causality, they also point towards new directions for fatigue treatments during childhood development.
Keywords: Fatigue, Immune functionMethods: In this study, we examined concurrent associations between inflammatory gene expression and fatigue symptoms in a sample of N=65 children and adolescents (mean age = 12.77, range = 7-17 years) with varied exposure to caregiving-related early life adversity (crEA): N=26 with significant exposure (maltreatment and/or extended parental separation) and N=39 without history of maltreatment or parental separation. To assess the specificity of associations between inflammatory gene expression and fatigue versus general ill-health, we also tested associations with internalizing (i.e., anxiety and depression) symptoms. Children provided dried blood spot samples for analysis of RNA transcripts from an a priori specified set of 19 pro-inflammatory genes, and children and caregivers completed questionnaires on children’s fatigue and internalizing symptoms. Multilevel linear modeling, treating expression values within each gene as a repeated measure of inflammatory gene expression, was used for analysis.
Results: We found that higher inflammatory gene expression was associated with more self-reported fatigue symptoms. We also found an age-by-inflammatory gene expression interaction on caregiver proxy-reported fatigue symptoms, such that there was a positive relationship between inflammatory gene expression and fatigue for children in the sample older than 14.74 years. Inflammatory gene expression was not significantly related to internalizing symptoms. CrEA did not predict inflammatory gene expression; controlling for crEA, inflammatory gene expression remained significantly related to fatigue symptoms. Findings suggest inflammatory processes may be uniquely related to fatigue symptoms in childhood and adolescence. Pending replication and further research that assesses causality, they also point towards new directions for fatigue treatments during childhood development.
Authors:
Presenter - Francesca Querdasi,
C.Phil.,
University of California, Los Angeles
Co-Author - Julienne E. Bower, PhD,
PhD,
University Of California, Los Angeles
Co-Author - Steve Cole,
Ph.D.,
University of California, Los Angeles
Co-Author - Naomi Gancz,
M.A.,
University of California, Los Angeles
Co-Author - Kristen Chu,
M.A.,
University of California, Los Angeles
Co-Author - Emily Towner,
C.Phil.,
University of Cambridge
Co-Author - Eason Taylor,
Works Counseling Center
Co-Author - bridget callaghan,
Ph.D.,
University of California, Los Angeles
E38 - Barriers to Medication Adherence after Pediatric Hematopoietic Stem Cell Transplant and Associations with Social Determinants of Health: A Mixed-Methods Pilot Study
Poster Number: E38Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Social and Environmental Context and Health
Introduction: Children receiving hematopoietic stem cell transplant (HCT) face intense outpatient regimens. Poor medication adherence increases risk for potentially fatal complications, yet little research examines adherence barriers and associations with social determinants of health (SDOH). Thus, we explored barriers to medication adherence and SDOH in the first 100 days post-HCT.
Methods: Caregivers (n=15) of children aged 0-18 years enrolled at HCT discharge and completed 11 weekly visits. Caregivers reported barriers (0=no, 1=yes) on the Barriers Scale (BS) (18 barriers; enrollment and exit), Medication Adherence Measure (MAM) (13 barriers; weekly), and qualitative interviews. Addresses were coded for SDOH variables: Child Opportunity Index (COI; scale: 1-5)–higher scores=more neighborhood resources and Area Deprivation Index (ADI; scale: 1-100)–higher scores=areas more disadvantaged in health outcomes. Descriptive statistics,¬ correlations, and paired t-tests were conducted, while two investigators analyzed qualitative themes.
Results: The sample was 73% female (n=11), 67% White (n=10), 80% non-Hispanic/Latino (n=12), and followed on average for 4.47 weeks (SD=3.16). On the BS, 87% of caregivers (n=13) reported more barriers (M=3.25, SD=2.14) at enrollment than at exit (M=1.00, SD=1.20); t(11)=5.48, p=<.001. On the weekly MAM, caregivers (n=15) reported more barriers on week 1 (M=1.00, SD=1.36) than 10 (M=0.27, SD=.59). Across the MAM, BS, and interviews, the most frequent barriers were child refusing (n=9), distaste (n=9), forgetting (n=8), and difficulties swallowing (n=7) medications (e.g., “He doesn't care too much for the medicine, so that's been a struggle; it’s a lot of medicines and he's so little”). Average MAM weekly barriers were associated with less child opportunity (COI r=-.44) and more neighborhood disadvantage (ADI r=.47). BS and SDOH were not associated.
Discussion: Children receiving HCT and their caregivers experience significantly more medication adherence barriers (behavioral and physical) immediately following discharge than two months later. Although barriers declined over time, they were associated with fewer community opportunities and greater area deprivation. This pilot data informed a larger intervention trial to improve adherence post-HCT, suggests greater attention to medication adherence barriers post-discharge is needed, and can guide clinical care. Future research is needed on the influence of SDOH on adherence.
Keywords: Children's health, Health disparitiesMethods: Caregivers (n=15) of children aged 0-18 years enrolled at HCT discharge and completed 11 weekly visits. Caregivers reported barriers (0=no, 1=yes) on the Barriers Scale (BS) (18 barriers; enrollment and exit), Medication Adherence Measure (MAM) (13 barriers; weekly), and qualitative interviews. Addresses were coded for SDOH variables: Child Opportunity Index (COI; scale: 1-5)–higher scores=more neighborhood resources and Area Deprivation Index (ADI; scale: 1-100)–higher scores=areas more disadvantaged in health outcomes. Descriptive statistics,¬ correlations, and paired t-tests were conducted, while two investigators analyzed qualitative themes.
Results: The sample was 73% female (n=11), 67% White (n=10), 80% non-Hispanic/Latino (n=12), and followed on average for 4.47 weeks (SD=3.16). On the BS, 87% of caregivers (n=13) reported more barriers (M=3.25, SD=2.14) at enrollment than at exit (M=1.00, SD=1.20); t(11)=5.48, p=<.001. On the weekly MAM, caregivers (n=15) reported more barriers on week 1 (M=1.00, SD=1.36) than 10 (M=0.27, SD=.59). Across the MAM, BS, and interviews, the most frequent barriers were child refusing (n=9), distaste (n=9), forgetting (n=8), and difficulties swallowing (n=7) medications (e.g., “He doesn't care too much for the medicine, so that's been a struggle; it’s a lot of medicines and he's so little”). Average MAM weekly barriers were associated with less child opportunity (COI r=-.44) and more neighborhood disadvantage (ADI r=.47). BS and SDOH were not associated.
Discussion: Children receiving HCT and their caregivers experience significantly more medication adherence barriers (behavioral and physical) immediately following discharge than two months later. Although barriers declined over time, they were associated with fewer community opportunities and greater area deprivation. This pilot data informed a larger intervention trial to improve adherence post-HCT, suggests greater attention to medication adherence barriers post-discharge is needed, and can guide clinical care. Future research is needed on the influence of SDOH on adherence.
Authors:
Author - Madeline R. Peek,
BA,
The Abigail Wexner Research Institute at Nationwide Children's Hospital
Co-Author - Anna L. Olsavsky,
PhD,
The Abigail Wexner Research Institute at Nationwide Children's Hospital
Co-Author - Rajinder Bajwa,
MD,
The Ohio State University, Nationwide Children’s Hospital
Co-Author - Ahna L. Pai,
PhD, FSBM,
1The Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Ohio State University, Nationwide Children’s Hospital
Co-Author - Cynthia A. Gerhardt,
PhD,
The Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Ohio State University, Nationwide Children’s Hospital
Co-Author - Micah Skeens,
PhD, APRN, FAAN,
The Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Ohio State University, Nationwide Children’s Hospital
E39 - Bath, Bluey, and Bed: A Qualitative Study of Barriers and Facilitators to Nightly Screen-time in Preschoolers at Risk for Inadequate Sleep
Poster Number: E39Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Sleep
Introduction
The purpose of this study was to describe barriers and facilitators to non-screen-time bedtime routines, including no screen-time at bedtime. Prior research indicates an appropriate balance of sleep and screen-time is a critical contributor to children’s physical and mental development. Promoting bedtime routines and eliminating screen-time before bed may help facilitate appropriate amounts of both behaviors. Nonetheless, few preschoolers meet screen-time guidelines (≤1 hour/day), potentially due to nightly screen-time.
Methods:
Parents of preschoolers (ages 3-4 years, 58% White, 51% male) at risk for inadequate sleep (meeting few [0 or 1] of the 24-hour movement guidelines for physical activity, screen-time, or sleep) participated in a cross-sectional qualitative study. Trained interviewers conducted semi-structured interviews (mean: 45 minutes) focused on children’s weekly habits and barriers and facilitators to healthy sleep and screen-time practices. Thematic analysis was performed using an iterative process, and applicable codes were reviewed to create themes.
Results:
Interviews were conducted with 42 parents. Most reported screen-time at night (88%, 37/42), mainly within 30-minutes (42%, 18/42), or 30-minutes to 1-hour before bedtime (22%, 9/42). Accordingly, screen-time was used as part of children’s bedtime routines; for example, preschoolers would watch TV after bath-time and before going to bed. Main barriers to non-screen bedtime routines were identified: 1) TV in the preschooler bedroom, 2) use of screen-time as a wind-down activity during bedtime, and 3) caring for younger siblings and preschoolers joining older sibling’s screen-time routines. Some parents (19%, 8/42) reported using melatonin to address hyperactivity after screen-time in their bedtime routine. The only identified facilitator of non-screen-time bedtime routines was screen limiting practices, such as forbidding nightly screen-time or using a timer to limit evening activities.
Conclusion:
In this sample, screen-time use within the bedtime routine was prevalent, with family and parent practices contributing. Family bedtime routines and modifications to the preschooler bedroom environment (e.g., removing TV from bedroom) could be targeted to reduce screen-time before bed, thus limiting child screen-time and improving sleep patterns.
Keywords: Children's health, Sleep disordersThe purpose of this study was to describe barriers and facilitators to non-screen-time bedtime routines, including no screen-time at bedtime. Prior research indicates an appropriate balance of sleep and screen-time is a critical contributor to children’s physical and mental development. Promoting bedtime routines and eliminating screen-time before bed may help facilitate appropriate amounts of both behaviors. Nonetheless, few preschoolers meet screen-time guidelines (≤1 hour/day), potentially due to nightly screen-time.
Methods:
Parents of preschoolers (ages 3-4 years, 58% White, 51% male) at risk for inadequate sleep (meeting few [0 or 1] of the 24-hour movement guidelines for physical activity, screen-time, or sleep) participated in a cross-sectional qualitative study. Trained interviewers conducted semi-structured interviews (mean: 45 minutes) focused on children’s weekly habits and barriers and facilitators to healthy sleep and screen-time practices. Thematic analysis was performed using an iterative process, and applicable codes were reviewed to create themes.
Results:
Interviews were conducted with 42 parents. Most reported screen-time at night (88%, 37/42), mainly within 30-minutes (42%, 18/42), or 30-minutes to 1-hour before bedtime (22%, 9/42). Accordingly, screen-time was used as part of children’s bedtime routines; for example, preschoolers would watch TV after bath-time and before going to bed. Main barriers to non-screen bedtime routines were identified: 1) TV in the preschooler bedroom, 2) use of screen-time as a wind-down activity during bedtime, and 3) caring for younger siblings and preschoolers joining older sibling’s screen-time routines. Some parents (19%, 8/42) reported using melatonin to address hyperactivity after screen-time in their bedtime routine. The only identified facilitator of non-screen-time bedtime routines was screen limiting practices, such as forbidding nightly screen-time or using a timer to limit evening activities.
Conclusion:
In this sample, screen-time use within the bedtime routine was prevalent, with family and parent practices contributing. Family bedtime routines and modifications to the preschooler bedroom environment (e.g., removing TV from bedroom) could be targeted to reduce screen-time before bed, thus limiting child screen-time and improving sleep patterns.
Authors:
Author - Chelsea Kracht,
PhD,
University of Kansas Medical Center
Co-Author - Olivia Harding,
BA,
University of Kansas Medical Center
Co-Author - Grace Bolamperti,
BA,
University of Kansas Medical Center
Co-Author - Madigan Snodgrass,
BA,
University of Kansas Medical Center
Co-Author - Jerica Berge,
PhD,
University of Colorado, Anschutz Medical
Co-Author - Monique LeBlanc,
PhD,
Southeastern Louisiana University
Co-Author - Robert L. Newton, Jr., PhD, FSBM,
PhD, FSBM,
Pennington Biomedical Research Center
Co-Author - Ryan E. Rhodes, PhD, FSBM,
PhD, FSBM,
University of Victoria
Co-Author - Leanne M. Redman, PhD,
PhD,
Pennington Biomedical Research Center
E40 - Hispanic/Latino parental practices and their influences on children’s screen time
Poster Number: E40Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Social and Environmental Context and Health
Background: Sedentary behaviors can have negative health effects on children. Research has shown that parenting styles can influence a child's sedentary behaviors such as the amount of screen time among children. This research study aims to examine Hispanic/Latino parenting approaches and their influence on children's screen time.
Methods: Cross-sectional data of 190 children, ages 10-13 years old (M=11.11, SD=1.064), participating in the Eat, Play, Go! study was analyzed. Children were asked if their parents monitor their physical activity; this was answered on a 0-4 scale (0= never to 4= always), that was re-coded to a dichotomous variable (1=low monitoring, 2=high monitoring). Children were also asked if their parents praised them for being physically active; this was answered on a 0-4 scale (0= never to 4= always), that was re-coded to 1=low praise and 2=high praise. Children were also asked how often their parents disciplined them for playing video games without permission; this was also answered on a 0-4 scale and re-coded to 1= low discipline and 2=high discipline. Chi-square test examined the relationship between the three parenting questions and children’s screen time coded as 1=meeting recommended screen time (<2hours) and 2=exceeding recommended scree time.
Results: Among children whose parents provided low monitoring for physical activity, the majority exceeded recommended screen time compared to children with parents who provide high monitoring for physical activity, X2(1, N=187) = 5.55, p<.01. Children who were praised more for doing physical activity compared to children who had low praise relating to physical activity were more likely to meet the recommended screen time, X2(1, N=188) = 6.28, p<.01. No differences in screen time were observed based on parental discipline related to screen time, X2(1, N=190) =.01, p >.53.
Conclusion: In this study positive parenting practices such as monitoring and praise for physical activity were associated with less screen time. Conversely, the negative practice of discipline for screen time was not associated with less screen time. Future studies should further examine positive parenting practices as well as consider other factors that may lead to high screen time among children.
Keywords: Latino, Health behavior changeMethods: Cross-sectional data of 190 children, ages 10-13 years old (M=11.11, SD=1.064), participating in the Eat, Play, Go! study was analyzed. Children were asked if their parents monitor their physical activity; this was answered on a 0-4 scale (0= never to 4= always), that was re-coded to a dichotomous variable (1=low monitoring, 2=high monitoring). Children were also asked if their parents praised them for being physically active; this was answered on a 0-4 scale (0= never to 4= always), that was re-coded to 1=low praise and 2=high praise. Children were also asked how often their parents disciplined them for playing video games without permission; this was also answered on a 0-4 scale and re-coded to 1= low discipline and 2=high discipline. Chi-square test examined the relationship between the three parenting questions and children’s screen time coded as 1=meeting recommended screen time (<2hours) and 2=exceeding recommended scree time.
Results: Among children whose parents provided low monitoring for physical activity, the majority exceeded recommended screen time compared to children with parents who provide high monitoring for physical activity, X2(1, N=187) = 5.55, p<.01. Children who were praised more for doing physical activity compared to children who had low praise relating to physical activity were more likely to meet the recommended screen time, X2(1, N=188) = 6.28, p<.01. No differences in screen time were observed based on parental discipline related to screen time, X2(1, N=190) =.01, p >.53.
Conclusion: In this study positive parenting practices such as monitoring and praise for physical activity were associated with less screen time. Conversely, the negative practice of discipline for screen time was not associated with less screen time. Future studies should further examine positive parenting practices as well as consider other factors that may lead to high screen time among children.
Authors:
Co-Author - Melawhy L. Garcia, MPH, PhD,
MPH, PhD,
California State University Long Beach
Co-Author - Patricia Trinidad,
California State University, Long Beach
E41 - Adolescent participation in school- or community-based activity predicts engagement with negative behavioral outcomes
Poster Number: E41Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Community Engagement
Adolescent delinquent behavior (DB) presents significant social, community, and public safety challenges within the United States, with profound implications for long-term youth outcomes. Adolescents exhibiting DB are at heightened risk for adverse outcomes, including severe mental and physical health issues, increased likelihood of incarceration, poverty, and comorbid conditions. This study investigates the association between youth engagement in school-based and community-based activities and behavioral outcomes, specifically focusing on youth delinquent behavior (YDB). Using nationally representative data from the 2022 National Survey on Drug Use and Health, a binary indicator was established to identify engagement in any delinquent behaviors over the previous year. The study sample comprised 11,969 adolescents aged 12-17 years, including a demographic breakdown of 51.5% males, 49.9% White, 13.6% Black/African American, 25.6% Hispanic, and 10.6% identifying as other ethnicities.
Initial descriptive and univariable regression analyses were conducted to explore patterns, while multivariable regression models provided a more detailed examination of associations. Findings reveal that adolescents who participated in only two school activities had higher odds of engaging in DB compared to peers with fewer activities (adjusted odds ratio [aOR] = 1.58; 95% confidence interval [CI]: 1.24-1.89; p = 0.003). However, engagement in community-based activities showed no significant impact on DB likelihood, irrespective of the frequency of participation. Furthermore, Black/African American adolescents (aOR = 1.72; 95% CI: 1.39-2.14; p < .0001) and those experiencing more than one residential relocation within the past year (aOR = 1.47; 95% CI: 1.27-1.71; p < .0001) exhibited increased tendencies toward delinquent behavior.
These results highlight the importance of directing resources to support and expand structured youth programs within schools, with a particular focus on minority populations. Understanding the factors associated with reduced DB can guide the development of programs aimed at enhancing youth engagement, especially within communities with limited resources. The study urges policymakers and educational administrators to evaluate and strengthen school-based resources to foster youth well-being, reduce delinquency, and promote community health.
Keywords: Systems, AdolescentsInitial descriptive and univariable regression analyses were conducted to explore patterns, while multivariable regression models provided a more detailed examination of associations. Findings reveal that adolescents who participated in only two school activities had higher odds of engaging in DB compared to peers with fewer activities (adjusted odds ratio [aOR] = 1.58; 95% confidence interval [CI]: 1.24-1.89; p = 0.003). However, engagement in community-based activities showed no significant impact on DB likelihood, irrespective of the frequency of participation. Furthermore, Black/African American adolescents (aOR = 1.72; 95% CI: 1.39-2.14; p < .0001) and those experiencing more than one residential relocation within the past year (aOR = 1.47; 95% CI: 1.27-1.71; p < .0001) exhibited increased tendencies toward delinquent behavior.
These results highlight the importance of directing resources to support and expand structured youth programs within schools, with a particular focus on minority populations. Understanding the factors associated with reduced DB can guide the development of programs aimed at enhancing youth engagement, especially within communities with limited resources. The study urges policymakers and educational administrators to evaluate and strengthen school-based resources to foster youth well-being, reduce delinquency, and promote community health.
Authors:
Co-Author - Satish K. Kedia, PhD, MPH, MS,
PhD, MPH, MS,
University of Memphis
Co-Author - Xichen Mou,
PhD, MS,
University of Memphis
Co-Author - Angelia Sanders,
PhD,
University of Memphis
E42 - Parental influences on Hispanic/Latino children’s fruit and vegetable consumption
Poster Number: E42Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Diet, Nutrition, and Eating Disorders
Authors:
Alexis Pope
Melawhy Garcia, MPH, PhD
Patricia Trinidad, MPH
Title: Parental influences on Hispanic/Latino children’s fruit and vegetable consumption
Background: Most children do not meet the recommended dietary guidelines. Evidence shows that parents’ confidence in influencing their children’s eating habits can impact their children’s intake of fruits and vegetables (FV).
Purpose: To examine the relationship between parents’ confidence levels in influencing their children’s consumption of FV.
Method: Baseline data from 189 Latino children (10-13 years old) and their parents from the Eat, Play, Go! Obesity prevention study were examined. Parent and child surveys were collected to assess socio-demographics and parental confidence in their ability to create healthy eating habits for their children. Chi-square tests were conducted to assess the relationship between parent’s confidence and children's FV consumption. Parent’s confidence was recoded as a dichotomous variable: (1) not confident and (2) confident. Daily FV consumption were recoded to: (1) eat fruits or vegetables everyday (2) does not eat fruits or vegetables every day. Meeting dietary guidelines for FV were recoded as follows: (1) eats 1 serving of fruit daily (2) does not meet guideline (1) eats two servings of vegetables daily (2) does not meet guideline.
Results: Children whose parents were confident in their ability to have their child eat more vegetables reported eating at least two servings of vegetables per day X2(2,N=189)=8.56, p=.003. Children whose parents reported confidence in their ability to have their child eat more vegetables per day, more children met the dietary guidelines for vegetable X2(1,n=189)=3.01, p=.08. There were no significant differences for consumption of daily fruit intake or meeting dietary guidelines for fruit among children whose parents were confident compared to those who were not confident.
Conclusion: Based on the results, we can conclude parent’s abilities to influence children to eat more servings of vegetables can be effective in increasing consumption. Children usually need more encouragement from their parents to eat vegetables compared to fruits.
Keywords: Diet, NutritionAlexis Pope
Melawhy Garcia, MPH, PhD
Patricia Trinidad, MPH
Title: Parental influences on Hispanic/Latino children’s fruit and vegetable consumption
Background: Most children do not meet the recommended dietary guidelines. Evidence shows that parents’ confidence in influencing their children’s eating habits can impact their children’s intake of fruits and vegetables (FV).
Purpose: To examine the relationship between parents’ confidence levels in influencing their children’s consumption of FV.
Method: Baseline data from 189 Latino children (10-13 years old) and their parents from the Eat, Play, Go! Obesity prevention study were examined. Parent and child surveys were collected to assess socio-demographics and parental confidence in their ability to create healthy eating habits for their children. Chi-square tests were conducted to assess the relationship between parent’s confidence and children's FV consumption. Parent’s confidence was recoded as a dichotomous variable: (1) not confident and (2) confident. Daily FV consumption were recoded to: (1) eat fruits or vegetables everyday (2) does not eat fruits or vegetables every day. Meeting dietary guidelines for FV were recoded as follows: (1) eats 1 serving of fruit daily (2) does not meet guideline (1) eats two servings of vegetables daily (2) does not meet guideline.
Results: Children whose parents were confident in their ability to have their child eat more vegetables reported eating at least two servings of vegetables per day X2(2,N=189)=8.56, p=.003. Children whose parents reported confidence in their ability to have their child eat more vegetables per day, more children met the dietary guidelines for vegetable X2(1,n=189)=3.01, p=.08. There were no significant differences for consumption of daily fruit intake or meeting dietary guidelines for fruit among children whose parents were confident compared to those who were not confident.
Conclusion: Based on the results, we can conclude parent’s abilities to influence children to eat more servings of vegetables can be effective in increasing consumption. Children usually need more encouragement from their parents to eat vegetables compared to fruits.
Authors:
Author - Alexis Pope,
Center for Latino Community Health
Co-Author - Melawhy L. Garcia,
MPH, PhD,
Center for Latino Community Health
Co-Author - Patricia Trinidad,
MPH,
California State University, Long Beach
E43 - Healthcare providers’ experience and perspectives of integrating climate-sensitive health counselling into clinical practice: a mixed-methods study
Poster Number: E43Time: 05:00 PM - 05:50 PM
Topics: Climate Change and Health, Integrated Primary Care
Background: Climate change poses a significant threat to both the environment and public health that requires immediate, international responses. Health professionals are uniquely placed within this context to advocate for climate action and communicate health risks of climate change. Climate-sensitive health counselling (CSHC), a novel concept that has recently gained traction, integrates climate-related communication into health counselling, aiming to raise awareness and encourage climate action and lifestyle changes. The current study explores healthcare providers’ experiences and perspectives of CSHC implementation.
Methods: This mixed-methods study comprised an online quantitative survey and qualitative interviews with healthcare providers in Singapore. The survey assessed awareness and concerns related to climate change, perceived importance, confidence, motivation, and opportunity for implementing CSHC, alongside sociodemographic data. Semi-structured interviews explored barriers and facilitators of CSHC in clinical practice.
Findings: Seventy-four healthcare providers in Singapore participated in the survey (mean age = 38.4, 62.2% female, 74.3% Chinese), primarily doctors (40.5%) and nurses (33.8%). Over half expressed anxiety about climate change and its health impacts. Most providers (60%-95%) viewed CSHC as important and beneficial for patients, yet less than 40% felt knowledgeable or confident in addressing climate health issues. Approximately two-thirds were reluctant to integrate CSHC into routine care, with less than 20% performing it regularly. Interviews with 16 healthcare providers echoed these findings, highlighting barriers such as lack of expertise, time constraints, competing priorities, and patient disinterest, alongside enablers like guidelines and resources on CSHC, interest and sense of responsibility for climate action, and recognition for CSHC. Participants also emphasised a need for thorough transformation of the health system to facilitate CSHC as part of climate-resilient healthcare.
Conclusion: Healthcare providers recognise the importance of CSHC but face significant barriers to its implementation. Despite high awareness of climate change’s health impacts, practical integration is hindered by knowledge gaps, time constraints, and competing priorities. There is a need for systemic support to foster a climate-resilient and sustainable healthcare system that effectively addresses the health implications of climate change.
Keywords: Health communication, Health behaviorsMethods: This mixed-methods study comprised an online quantitative survey and qualitative interviews with healthcare providers in Singapore. The survey assessed awareness and concerns related to climate change, perceived importance, confidence, motivation, and opportunity for implementing CSHC, alongside sociodemographic data. Semi-structured interviews explored barriers and facilitators of CSHC in clinical practice.
Findings: Seventy-four healthcare providers in Singapore participated in the survey (mean age = 38.4, 62.2% female, 74.3% Chinese), primarily doctors (40.5%) and nurses (33.8%). Over half expressed anxiety about climate change and its health impacts. Most providers (60%-95%) viewed CSHC as important and beneficial for patients, yet less than 40% felt knowledgeable or confident in addressing climate health issues. Approximately two-thirds were reluctant to integrate CSHC into routine care, with less than 20% performing it regularly. Interviews with 16 healthcare providers echoed these findings, highlighting barriers such as lack of expertise, time constraints, competing priorities, and patient disinterest, alongside enablers like guidelines and resources on CSHC, interest and sense of responsibility for climate action, and recognition for CSHC. Participants also emphasised a need for thorough transformation of the health system to facilitate CSHC as part of climate-resilient healthcare.
Conclusion: Healthcare providers recognise the importance of CSHC but face significant barriers to its implementation. Despite high awareness of climate change’s health impacts, practical integration is hindered by knowledge gaps, time constraints, and competing priorities. There is a need for systemic support to foster a climate-resilient and sustainable healthcare system that effectively addresses the health implications of climate change.
Authors:
Co-Author - Frederick Hui Fei Chan,
MSc, PHD candidate,
Lee Kong Chian School of Medicine, Nanyang Technological University
Co-Author - Rachel Koh,
BSC Hon,
Lee Kong Chian School of Medicine, Nanyang Technological University
E44 - Associations among Self-Regulation constructs and red meat consumption for climate change mitigation
Poster Number: E44Time: 05:00 PM - 05:50 PM
Topics: Climate Change and Health, Multiple Health Behavior Change
Climate change is the biggest public health threat facing humanity, altering people’s exposures to extreme heat and weather events, air pollution, infectious diseases, quality of food and water, and stresses to mental health and well-being. The Sixth Assessment Report of the Intergovernmental Panel on Climate Change revealed immediate and deep greenhouse gas emissions reductions are required across all sectors if we are to limit global warming to 1.5C above pre-industrial levels, after which point the health impacts of climate change will be far more severe for people and the planet. In the U.S., it is estimated that agriculture, including forestry and land use practices, is responsible for over 20% of emissions globally. One individual-level behavior that lowers greenhouse gas (GHG) emissions is reducing red meat consumption. Yet there is a paucity of research on the beliefs, attitudes, and behaviors of U.S. residents related to this behavior. Our research team used the Self-Regulation Stage model to develop the Environmental Behavior Survey measuring individual-level behaviors contributing to GHG emissions. This presentation will provide preliminary results on the relationship between Self-Regulation constructs and red meat reduction for climate change mitigation. The sample (n=4,936) consisted of 67% Caucasian, 17% Hispanic/Latino, 11% Black, 4% Asian, and 1% other; 54% female; age range 18-88 with an average age of 46 years. Weekly red meat consumption ranged from never (8%) to daily (6%) with most participants reporting consuming red meat 2-3 times per week. Psychosocial constructs derived from the Self-Regulation Stage model were significantly (**p<.01) correlated with red meat consumption: attitude (r=.410)**, habit (r=.233)**, emotions (r=.224)**), personal norms (r=.179)**, perceived behavioral control (r=.216)**, social norms (r=.207**, and problem awareness (r=.233**). Multiple linear regression models demonstrated that attitude (B=212)**, habit (B=.09)**, social norms (B=.069)**, and perceived behavioral control (B=.14)** were significant predictors of weekly red meat consumption. The overall regression was statistically significant [(R2=.14, F (8,4593) = 91.89, p<.001)]. Results indicate that constructs from the Self-Regulation Stage model are significantly associated with red meat consumption and can guide the development of specific behavioral interventions targeting individuals in specific stages in regard to red meat consumption.
Keywords: Behavior Change, Eating behaviorsAuthors:
Presenter - Alexandra Elisabeth Van Den Berg,
PhD, MPH,
UTHealth SPH
Co-Author - Aida Nielsen,
MPH,
UTHealth School of Public Health
Co-Author - Katherine Janda,
Phd, MPH,
Baylor University
Co-Author - Kimberley Morgan,
MPH,
UTHealth School of Public Health
Co-Author - Taylor Levy,
MPH,
UTHealth School of Public Health
Co-Author - Kevin Lanza, PhD,
PhD,
UTHealth Houston School of Public Health in Austin
E45 - Promoting Physical Activity and Physical Literacy Among Newcomer Children and Youth: A Delphi using a Multidisciplinary Community-Academic Partnership Approach
Poster Number: E45Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Physical Activity
Background: The increasing waves of immigration in Canada present unique challenges and opportunities for promoting the health and well-being of newcomer children and youth. Enhancing opportunities for Physical activity (PA) and Physical Literacy (PL) have been recognized as cost-effective strategies to support the settlement of newcomers by enhancing physical and mental health and fostering social connections. This study aimed to identify key priorities for promoting PA and PL among newcomer children and youth using a multidisciplinary community-academic partnership (CAP) approach.
Methods: We held two summits in Calgary, Alberta in 2022 and 2023 to purposefully bring together academics, community partners, and social and systemic actors from sectors such as sports, education, and settlement services. The purpose of the summits were to facilitate discussions and activities around the development of sustainable CAPs for promoting PA and PL.
Using a modified Delphi approach, we conducted multiple rounds of qualitative and quantiative data collection to discuss and rank priorities. Several sources of data were used to understand the rankings including surveys, discussions of Strengths/Weaknesses/Opportunities/Threats, and thematic mapping.
Results: Participants identified several key priorities for establishing strong CAPs: the need for coordinated systems that provide equitable access to PA and PL, securing funding, building trust, and fostering collaboration among organizations and community-based actors. Importantly, participants emphasized the inclusion of newcomer families, children, and youth in co-designing solutions to ensure culturally relevant and sustainable interventions. Several challenges were also identified, including limited resources, organizational capacity, competing priorities, and a lack of coordination, all of which pose barriers to achieving long-term sustainability.
Conclusions: Our findings underscore the importance of strong multi-sectoral partnerships and the active involvement of social and systemic actors in the design and implementation of PA and PL interventions for newcomer youth.
Keywords: Low-income and minority groups, Physical activityMethods: We held two summits in Calgary, Alberta in 2022 and 2023 to purposefully bring together academics, community partners, and social and systemic actors from sectors such as sports, education, and settlement services. The purpose of the summits were to facilitate discussions and activities around the development of sustainable CAPs for promoting PA and PL.
Using a modified Delphi approach, we conducted multiple rounds of qualitative and quantiative data collection to discuss and rank priorities. Several sources of data were used to understand the rankings including surveys, discussions of Strengths/Weaknesses/Opportunities/Threats, and thematic mapping.
Results: Participants identified several key priorities for establishing strong CAPs: the need for coordinated systems that provide equitable access to PA and PL, securing funding, building trust, and fostering collaboration among organizations and community-based actors. Importantly, participants emphasized the inclusion of newcomer families, children, and youth in co-designing solutions to ensure culturally relevant and sustainable interventions. Several challenges were also identified, including limited resources, organizational capacity, competing priorities, and a lack of coordination, all of which pose barriers to achieving long-term sustainability.
Conclusions: Our findings underscore the importance of strong multi-sectoral partnerships and the active involvement of social and systemic actors in the design and implementation of PA and PL interventions for newcomer youth.
Authors:
Co-Author - Matthew Kwan, PhD,
PhD,
Brock University
Co-Author - Tanvir Turin Chowdhury,
PhD,
University of Calgary
Co-Author - Sarah Wellman-Earl,
MSc,
Brock University
Co-Author - Gavin McCormack,
PhD,
University of Calgary
Co-Author - Kabir Hosein,
Sport for Life
Co-Author - Jennifer Konopaki,
WinSport
E46 - PARTICIPANT PERSPECTIVES FROM A FOOD AS MEDICINE SCREENING & REFERRAL HUB PILOT
Poster Number: E46Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy, Social and Environmental Context and Health
Introduction: Food as medicine interventions are increasingly recognized for their role in improving food insecurity and health outcomes. At the same time, all hospitals must screen for social determinants of health, including food insecurity. There is general encouragement for screening, but there is no streamlined process for clinics to refer patients for health related social needs which are tailored for diet-sensitive diseases. To address these pain points, a food as medicine referral hub was piloted in Kentucky.
Methods: Two Kentucky ambulatory clinics, one metro and one rural, screened patients for food insecurity using the Hunger Vital Signs. Patients who screened positive with hypertension or type 2 diabetes, aged 18-64, and wanted food assistance were referred by clinics into the hub. Patients were contacted to enroll and allocated to: medically tailored meals (MTMs), online grocery RX, or meal kits. All programs followed recommended dietary guidelines and provided delivery. Data were collected on demographics, food security, and participant feedback. Clinics provided BMI, blood pressure, and HbA1c at baseline and post intervention. Descriptive statistics were conducted to compare means and percentages across programs. ANOVA was used with Bonferroni correction to make comparisons within and between study arms.
Results: From Nov 2023-Mar 2024, 124 patients were referred and 75 enrolled (60% enrollment rate) in a food as medicine program: MTM (n=21), grocery Rx (n=28), or meal kits (n=26). Significant decreases in systolic blood pressure were observed in the MTM (-9.67mmHg ; 95% CI: 1.34, 17.99) and grocery Rx (-6.89 mmHg; 95% CI: .36, 13.43) arms with no significant change in the meal kit arm. Participant satisfaction was high across programs: 84% in MTM, 86% in grocery Rx, and 91% in meal kits would recommend and 44% in MTM, 67% in grocery Rx, and 72% in meal kits would participate if program was not free. Completion rates were 86% in MTM, 82% in grocery Rx, and 96% in meal kits. All three programs requested greater variety of food options.
Discussion: Our study provides key steps in feasibility of a referral hub between clinical and community partners. Results indicate potential for food as medicine programs to be clinically effective and have high patient satisfaction. Next steps include scale across a wide range of health care providers, longer-term follow-up among patients, and randomization to detect differences across diverse programs.
Keywords: Diabetes, Health policyMethods: Two Kentucky ambulatory clinics, one metro and one rural, screened patients for food insecurity using the Hunger Vital Signs. Patients who screened positive with hypertension or type 2 diabetes, aged 18-64, and wanted food assistance were referred by clinics into the hub. Patients were contacted to enroll and allocated to: medically tailored meals (MTMs), online grocery RX, or meal kits. All programs followed recommended dietary guidelines and provided delivery. Data were collected on demographics, food security, and participant feedback. Clinics provided BMI, blood pressure, and HbA1c at baseline and post intervention. Descriptive statistics were conducted to compare means and percentages across programs. ANOVA was used with Bonferroni correction to make comparisons within and between study arms.
Results: From Nov 2023-Mar 2024, 124 patients were referred and 75 enrolled (60% enrollment rate) in a food as medicine program: MTM (n=21), grocery Rx (n=28), or meal kits (n=26). Significant decreases in systolic blood pressure were observed in the MTM (-9.67mmHg ; 95% CI: 1.34, 17.99) and grocery Rx (-6.89 mmHg; 95% CI: .36, 13.43) arms with no significant change in the meal kit arm. Participant satisfaction was high across programs: 84% in MTM, 86% in grocery Rx, and 91% in meal kits would recommend and 44% in MTM, 67% in grocery Rx, and 72% in meal kits would participate if program was not free. Completion rates were 86% in MTM, 82% in grocery Rx, and 96% in meal kits. All three programs requested greater variety of food options.
Discussion: Our study provides key steps in feasibility of a referral hub between clinical and community partners. Results indicate potential for food as medicine programs to be clinically effective and have high patient satisfaction. Next steps include scale across a wide range of health care providers, longer-term follow-up among patients, and randomization to detect differences across diverse programs.
Authors:
Co-Author - Christa Mayfield,
MS,
University of Kentucky
Co-Author - Ethan Cosson,
University of Kentucky
Co-Author - Joshua Bush,
PhD,
University of Kentucky
Co-Author - Alison Gustafson,
PhD, MPH, RDN,
University of Kentucky
E47 - Evaluating Photovoice Exhibits: Obtaining and Using Feedback from Community Members Living in an HIV Hotspot
Poster Number: E47Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Health of Marginalized Populations
Objective: Memphis, Tennessee ranks 2nd nationally for HIV incidence and is situated in the Biblebelt of the U.S. South. Coupled with the region’s conservative roots and pervasive HIV stigma, Memphis is an HIV epicenter with inequitable access to HIV prevention and care for Black same gender loving men (SGL) and Black transwomen. To showcase these inequities and understand how HIV stigma is internalized among people living with HIV (PLWH/LWH), a photovoice project sharing lived experiences with HIV stigma was disseminated via exhibits at community events in the Memphis region. This study aims to evaluate how these community-based dissemination efforts elicit changes in behaviors and attitudes among exhibit viewers.
Methods: Thirty-five storyboards, created primarily by Black SGL or transwomen LWH, were exhibited for community members at 33 community events. Researchers facilitated recorded discussions with exhibit attendees and administered demographic and evaluative surveys. Surveys, audio recordings of facilitator-attendee interactions, and field notes denoting exhibit attendees’ interactions were analyzed for patterns via theme analysis.
Findings: Emergent themes suggest attendees that notably engage with storyboards show positive changes in attitudes regarding HIV. Attendees initially exhibiting avoidant behaviors, such as evading interaction with the exhibit, are most likely to contemplate HIV-related topics upon active discussion with an exhibit facilitator. Avoidant behaviors ease upon an attendee’s connection to a shared emotion expressed in a storyboard. Attendees frequently mention storyboards providing actionable methods for attendees to personally address stigma. Exhibit attendees who express an intention to change stigmatizing behavior, do so most when interacting with storyboards eliciting universal emotions, such as loneliness, isolation, exclusion, and church hurt.
Implications: Photovoice, when used in combination with supplemental components like facilitator-led engagement at exhibits, is a powerful tool for social change. Moreover, the evaluation of exhibit attendee responses is helpful in understanding how, and in what ways, social change is catalyzed within the local community. This information is essential to improving HIV prevention efforts by establishing factors vital to changes in community beliefs regarding marginalized populations.
Keywords: Participatory research, HIVMethods: Thirty-five storyboards, created primarily by Black SGL or transwomen LWH, were exhibited for community members at 33 community events. Researchers facilitated recorded discussions with exhibit attendees and administered demographic and evaluative surveys. Surveys, audio recordings of facilitator-attendee interactions, and field notes denoting exhibit attendees’ interactions were analyzed for patterns via theme analysis.
Findings: Emergent themes suggest attendees that notably engage with storyboards show positive changes in attitudes regarding HIV. Attendees initially exhibiting avoidant behaviors, such as evading interaction with the exhibit, are most likely to contemplate HIV-related topics upon active discussion with an exhibit facilitator. Avoidant behaviors ease upon an attendee’s connection to a shared emotion expressed in a storyboard. Attendees frequently mention storyboards providing actionable methods for attendees to personally address stigma. Exhibit attendees who express an intention to change stigmatizing behavior, do so most when interacting with storyboards eliciting universal emotions, such as loneliness, isolation, exclusion, and church hurt.
Implications: Photovoice, when used in combination with supplemental components like facilitator-led engagement at exhibits, is a powerful tool for social change. Moreover, the evaluation of exhibit attendee responses is helpful in understanding how, and in what ways, social change is catalyzed within the local community. This information is essential to improving HIV prevention efforts by establishing factors vital to changes in community beliefs regarding marginalized populations.
Authors:
Co-Author - Reighan Diehl,
The University of Memphis School of Public Health
Co-Author - Michelle Teti,
The University of Missouri
Co-Presenter - Andrea Williams Stubbs, MPA,
MPA,
The University of Memphis School of Public Health
Co-Author - Daniel Thompson,
Headliners Memphis
E48 - Parent Recommendations for the Adaptation of Family Eats: An Online Obesity Prevention Program for Parents of 9-12-Year Old Black Children
Poster Number: E48Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Child and Family Health
Background: The Family Eats Program is an 8-episode, evidence-based online obesity prevention program to help parents of 9-12-year-old Black children create a healthy home food environment and promote healthy eating behaviors. To enhance its acceptability and cultural relevance for community implementation, a CAB of parents of 9-12-year-old Black children was convened to review the program and recommendations made by a previous CAB (i.e., key stakeholders in the Black community who resided in the Houston Metropolitan Statistical Area).
Methods: The CAB included 15 parents of 9-12-year-old Black children who participated in a mixed methods study (online surveys, telephone interviews). Surveys assessed program content, structure, delivery format, and implementation strategies, incorporating feedback from the previous CAB. Interviews validated survey responses and explored additional perspectives about the program. Descriptive statistics were computed for the survey responses. Interviews were digitally recorded, transcribed, and coded using hybrid thematic analysis.
Results: CAB participants were B/AA mothers (100%), 30-39 years old (60%), and married (53.3%). All mothers liked the program topics, and most (93.3%) liked the program’s purpose. Feedback was mixed on the number of sessions (53.3% liked it a lot, 46.7% liked it a little), while 73.3% considered 3 months to complete the program realistic. While the program content was well-received, more than half (53.3%) disliked the appearance of the program characters, supporting prior recommendations to diversify skin tones and facial expressions. Most agreed that the implementation strategies (e.g., incentives for participation, expand definition of family structure, ensure recipes are easy, flavorful, and visually appealing) shared by the previous CAB would be effective.
Conclusion: Engaging a parent-only CAB provided valuable insights to refine the Family Eats Program, ensuring its acceptability and culturally appropriateness among B/AA families. Incorporating parent perspectives is essential for the developing effective child obesity prevention programs.
Keywords: Children's health, NutritionMethods: The CAB included 15 parents of 9-12-year-old Black children who participated in a mixed methods study (online surveys, telephone interviews). Surveys assessed program content, structure, delivery format, and implementation strategies, incorporating feedback from the previous CAB. Interviews validated survey responses and explored additional perspectives about the program. Descriptive statistics were computed for the survey responses. Interviews were digitally recorded, transcribed, and coded using hybrid thematic analysis.
Results: CAB participants were B/AA mothers (100%), 30-39 years old (60%), and married (53.3%). All mothers liked the program topics, and most (93.3%) liked the program’s purpose. Feedback was mixed on the number of sessions (53.3% liked it a lot, 46.7% liked it a little), while 73.3% considered 3 months to complete the program realistic. While the program content was well-received, more than half (53.3%) disliked the appearance of the program characters, supporting prior recommendations to diversify skin tones and facial expressions. Most agreed that the implementation strategies (e.g., incentives for participation, expand definition of family structure, ensure recipes are easy, flavorful, and visually appealing) shared by the previous CAB would be effective.
Conclusion: Engaging a parent-only CAB provided valuable insights to refine the Family Eats Program, ensuring its acceptability and culturally appropriateness among B/AA families. Incorporating parent perspectives is essential for the developing effective child obesity prevention programs.
Authors:
Author - Chishinga S. Callender, BA, MS,
BA, MS,
Baylor College of Medicine-USDA/ARS Children's Nutrition Research Center
Co-Author - Julie Miranda,
MS,
Baylor College of Medicine-USDA/ARS Children's Nutrition Research Center
Co-Author - Sophia Huang,
Baylor College of Medicine - USDA/ARS Children's Nutrition Research Center
Co-Author - Jayna Dave, PhD,
PhD,
Baylor College of Medicine - USDA/ARS Children's Nutrition Research Center
Co-Author - Maria Jibaja-Weiss,
EdD,
Baylor College of Medicine
Co-Author - Jane Richards Montealegre,
PhD ,
MD Anderson Cancer Center
Co-Author - Debbe I. Thompson, PhD,
PhD,
USDA/ARS, Baylor College of Medicine
E49 - Evaluating Trust in Medical Research among Black and Latino Adults in Maryland, Washington D.C., and Virginia: Critical Considerations
Poster Number: E49Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Methods and Measurement
Background: Trust in medical research is crucial for effective community engagement in research. It enhances diversity in research participation and improves satisfaction with research studies. While distrust in medical research has been reported among Black and Latino communities, minimal research quantifies the level and nature of trust in medical research. We aimed to explore the level and correlates of trust in medical research among Black and Latino adults (N=1,221) in Maryland (74%), Washington D.C. (22%), and Virginia (4%).
Methods: We analyzed cross-sectional data from the Community Engagement Alliance - Washington D.C., Maryland, and Virginia (CEAL-DMV), a community-engaged research study conducted between March and June 2024. The Perceptions of Research Trustworthiness scale, included in the Common Survey 3.0, was used to assess trust. We employed logistic regression analyses to explore relationships among variables and utilized geographic information system to examine regional differences in trust in medical research.
Results: Participants completed the survey in English (75%) or Spanish (25%). The mean age of participants was 44 years (+14) and the majority were Black (62%), and female (63%). Most had high school education or less (48%), household income ≥ $35,000 (51%), high health literacy (62%), and health insurance coverage (87%). Over half reported high trust in medical research (55%). The adjusted logistic regression model showed that identifying as Black (OR=0.503, p=<0.001) compared to other races and having some college (OR=0.571, p=0.018) compared to having less than high school education were associated with lower odds of trust in medical research. Having high health literacy (OR=1.732, p=<0.001) compared to low health literacy, and residing in D.C. and Virginia (OR=1.743, p=<0.001) compared to Maryland were associated with higher odds of trust in medical research. Significant trust was observed in ZIP codes surrounding Washington, D.C., and certain areas of Montgomery County, whereas elevated distrust was prevalent in metropolitan regions like Baltimore and Prince George’s County.
Conclusion: We found high levels of distrust in medical research among Black and Latino adults in the DMV area. Concerted efforts are needed to address distrust in research, particularly among Black populations, individuals with limited health literacy, and regions with high levels of medical research distrust to improve diversity in research.
Keywords: Research methods, DisparitiesMethods: We analyzed cross-sectional data from the Community Engagement Alliance - Washington D.C., Maryland, and Virginia (CEAL-DMV), a community-engaged research study conducted between March and June 2024. The Perceptions of Research Trustworthiness scale, included in the Common Survey 3.0, was used to assess trust. We employed logistic regression analyses to explore relationships among variables and utilized geographic information system to examine regional differences in trust in medical research.
Results: Participants completed the survey in English (75%) or Spanish (25%). The mean age of participants was 44 years (+14) and the majority were Black (62%), and female (63%). Most had high school education or less (48%), household income ≥ $35,000 (51%), high health literacy (62%), and health insurance coverage (87%). Over half reported high trust in medical research (55%). The adjusted logistic regression model showed that identifying as Black (OR=0.503, p=<0.001) compared to other races and having some college (OR=0.571, p=0.018) compared to having less than high school education were associated with lower odds of trust in medical research. Having high health literacy (OR=1.732, p=<0.001) compared to low health literacy, and residing in D.C. and Virginia (OR=1.743, p=<0.001) compared to Maryland were associated with higher odds of trust in medical research. Significant trust was observed in ZIP codes surrounding Washington, D.C., and certain areas of Montgomery County, whereas elevated distrust was prevalent in metropolitan regions like Baltimore and Prince George’s County.
Conclusion: We found high levels of distrust in medical research among Black and Latino adults in the DMV area. Concerted efforts are needed to address distrust in research, particularly among Black populations, individuals with limited health literacy, and regions with high levels of medical research distrust to improve diversity in research.
Authors:
Author - Joyline Chepkorir,
Johns Hopkins University
Co-Author - Wura Olawole,
MS,
Johns Hppkins University School of Nursing
Co-Author - Zaib Hussain,
MBBS, MPH,
Johns Hopkins University School of Medicine
Author - Hailey Miller, PhD, RN,
Johns Hopkins University
Co-Author - Yvonne Bronner,
PhD, MS, BS,
Morgan State University
Co-Author - Gloria Cain,
PhD, MSW,
Howard University School of Social Work
Co-Author - Sarah Stevens,
MPH, MA,
Johns Hppkins University School of Nursing
Co-Author - Gloria Ng'eno,
MPA, DrPH,
Morgan State University
Author - Cheryl Himmelfarb,
PhD, MSN, BS,
Johns Hppkins University School of Nursing
E50 - Understanding the Context Through Social Network Analysis and Community Readiness to Increase Implementation Effectiveness
Poster Number: E50Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Health of Marginalized Populations
In 2022, the United Nations General Assembly recognized the right to a clean, healthy, and sustainable environment as a fundamental human right, underscoring its vital role in adolescent well-being and development. This study focuses on El Pozón, Cartagena, Colombia, an area marked by rapid urbanization, social inequities, and challenging living conditions. The intervention, The Our Voice Citizen Science Initiative (OVCSI), employs an action research methodology that empowers marginalized communities—in this case school-age students—to identify environmental barriers to their health and well-being, propose actionable changes, and mobilize community and decision makers’ support.
Research indicates that 60% to 80% of health-related change strategies fail during implementation (Kahn et al., 2014; Kotter, 2007), with this gap more pronounced in low- and middle-income countries (Yamey, 2012). To address these challenges, we propose an innovative community engagement strategy designed to enhance OVCSI’s capacity for effective implementation in resource-limited settings, which often involve complex networks of decision-makers. Understanding these stakeholder dynamics requires a systemic and action-oriented approach that aligns with behavioral medicine principles.
We initiated a social network analysis, starting with the principal of the public school as the initial node, identifying five collaborative contacts and expanding the network based on referrals until saturation was reached. Analyzing the network, we selected six key actors using betweenness centrality, assessing their roles as bridges in the network. We interviewed these individuals and utilized the Community Readiness Tool (CRT), a 37-item questionnaire designed to facilitate community change (Pleasted et al., 1998).
Community readiness is crucial for planning and evaluating complex interventions and significantly influences intervention success (Edwards et al., 2000). Based on CRT results, we will propose targeted interventions and strategic nudges to enhance stakeholders’ and the broader community's readiness to implement the environmental changes advocated by adolescents. We anticipate that these actions will foster behavioral shifts, encouraging healthier lifestyle choices and enhanced community engagement, ultimately leading to improved health outcomes for adolescents in El Pozón.
Keywords: Adolescents, Built environmentResearch indicates that 60% to 80% of health-related change strategies fail during implementation (Kahn et al., 2014; Kotter, 2007), with this gap more pronounced in low- and middle-income countries (Yamey, 2012). To address these challenges, we propose an innovative community engagement strategy designed to enhance OVCSI’s capacity for effective implementation in resource-limited settings, which often involve complex networks of decision-makers. Understanding these stakeholder dynamics requires a systemic and action-oriented approach that aligns with behavioral medicine principles.
We initiated a social network analysis, starting with the principal of the public school as the initial node, identifying five collaborative contacts and expanding the network based on referrals until saturation was reached. Analyzing the network, we selected six key actors using betweenness centrality, assessing their roles as bridges in the network. We interviewed these individuals and utilized the Community Readiness Tool (CRT), a 37-item questionnaire designed to facilitate community change (Pleasted et al., 1998).
Community readiness is crucial for planning and evaluating complex interventions and significantly influences intervention success (Edwards et al., 2000). Based on CRT results, we will propose targeted interventions and strategic nudges to enhance stakeholders’ and the broader community's readiness to implement the environmental changes advocated by adolescents. We anticipate that these actions will foster behavioral shifts, encouraging healthier lifestyle choices and enhanced community engagement, ultimately leading to improved health outcomes for adolescents in El Pozón.
Authors:
Author - Eduardo De La Vega-Taboada,
Ph.D,
Stanford
E51 - Using Motivational Message Matching to Promote COVID-19 Vaccination Intentions: Leveraging Independent and Interdependent Self-Construal
Poster Number: E51Time: 05:00 PM - 05:50 PM
Topics: Decision Making, Health Communication and Policy
Delivering effective messages to promote vaccination requires understanding the characteristics of the people targeted. For example, people are motivated in part by their independent and interdependent self-construal (SC); how much they consider themselves versus others. Literature on motivational message matching (MM), including the minimal work on COVID-19 vaccination, has shown mixed results. It is unknown whether positive and negative matching can enhance or harm message persuasiveness with vaccination, and whether SC is a good target for MM with COVID-19 vaccines.
To examine the possible MM effect of COVID-19 booster vaccine messages targeted towards neutral, independent, or interdependent SC, we recruited a sample of U.S. adults (N = 406) in December 2023 who had not received the latest COVID-19 booster vaccine. In a pre-registered study, participants were randomly assigned to one of three pilot-tested messages, which targeted the motivations of a person with an independent SC, an interdependent SC, or neither (neutral). The messages were short news-like stories encouraging them to get a new COVID-19 booster. The inclusion of a neutral message condition allowed us to assess both positive and negative matching effects, rather than the relative effect of matched and mismatched messages on vaccination intentions.
We found a significant main effect of message condition such that those in the independent-message condition had higher vaccination intentions than those in the interdependent and neutral message conditions. We did not find our hypothesized interaction between SC and message condition indicating the benefit of matched messages, but instead found an unexpected effect: as interdependent SC scores increased, people’s vaccination intentions increased more in the independent (mismatched) message relative to the neutral message (β = .37, p < .05).
This study provides an empirically robust implementation of the principles behind MM. The results do not support a positive or negative motivational message matching effect, but rather display an overall benefit of independent-targeted messages for increasing COVID-19 vaccination intentions. In a U.S. context, it is possible these SCs exert different degrees of influence on people’s health-messaging perceptions. More research using such robust methods will help increase understanding of MM, including when it may be effectively applied.
Keywords: Health communication, Health behavior changeTo examine the possible MM effect of COVID-19 booster vaccine messages targeted towards neutral, independent, or interdependent SC, we recruited a sample of U.S. adults (N = 406) in December 2023 who had not received the latest COVID-19 booster vaccine. In a pre-registered study, participants were randomly assigned to one of three pilot-tested messages, which targeted the motivations of a person with an independent SC, an interdependent SC, or neither (neutral). The messages were short news-like stories encouraging them to get a new COVID-19 booster. The inclusion of a neutral message condition allowed us to assess both positive and negative matching effects, rather than the relative effect of matched and mismatched messages on vaccination intentions.
We found a significant main effect of message condition such that those in the independent-message condition had higher vaccination intentions than those in the interdependent and neutral message conditions. We did not find our hypothesized interaction between SC and message condition indicating the benefit of matched messages, but instead found an unexpected effect: as interdependent SC scores increased, people’s vaccination intentions increased more in the independent (mismatched) message relative to the neutral message (β = .37, p < .05).
This study provides an empirically robust implementation of the principles behind MM. The results do not support a positive or negative motivational message matching effect, but rather display an overall benefit of independent-targeted messages for increasing COVID-19 vaccination intentions. In a U.S. context, it is possible these SCs exert different degrees of influence on people’s health-messaging perceptions. More research using such robust methods will help increase understanding of MM, including when it may be effectively applied.
Authors:
Co-Author - Maya Rogers,
University of Minnesota
Co-Author - Alex J. Rothman, PhD, FSBM,
PhD, FSBM,
University of Minnesota
Co-Author - Traci Mann, PhD,
PhD,
University of Minnesota
E53 - Cognitive, Affective, Social, and Environmental Factors Influencing Decision-Making about Self-Managed Abortion
Poster Number: E53Time: 05:00 PM - 05:50 PM
Topics: Decision Making, Women's Health
BACKGROUND. Self-managed abortion is any action taken to end a pregnancy outside the formal healthcare system, including taking mifepristone and/or misoprostol, without the supervision of a medical provider. Prior research has demonstrated that racially minoritized and low-resourced people are more likely to engage in self-managed medication abortion, particularly in states with the most restrictive bans. It is unclear, however, what factors influence the decision to undertake self-managed medication abortion. Understanding the criteria that people weigh when making the decision to self-manage a medication abortion has critical implications for future intervention and policy work.
METHODS. This formative project was the first step in the development of a discrete choice experiment that will assess preferences for attributes of self-managed medication abortion. Individuals aged 18-44 from four Appalachian states participated in 60-minute semi-structured individual in-depth interviews via Zoom. Recruitment occurred until data saturation was reached. The interview guide was developed using the Theoretical Domains Framework. Trained interviewers assessed cognitive, affective, social, and environmental influences on medication abortion decision processes as well as other emergent factors.
Interview recordings were transcribed verbatim. Deductive content analysis was conducted to identify and categorize the resulting themes, followed by an inductive approach using open coding to identify any new categories and themes. Results were member checked with 5 study participants to verify findings.
RESULTS. Of the 81 eligible, 21 completed an interview. Median age was 32 years (range: 21-44). Two people identified as gender nonbinary; all others identified as female. Six participants were Black, one Asian American, one biracial, 13 were white. Analysis of interview data revealed five primary themes of influence on self-managed medication abortion: 1) availability of resources; 2) social support; 3) local legality of abortion care access; 4) personal medical issues; and 5) medical provider involvement.
CONCLUSIONS. This work offers unique insight on the cognitive, affective, social, and environmental influences on self-managed medication abortion decision-making. This is a significant departure from the limited research describing preferences or motivations for undertaking a self-managed abortion, which is disproportionately descriptive.
Keywords: Pregnancy, Decision makingMETHODS. This formative project was the first step in the development of a discrete choice experiment that will assess preferences for attributes of self-managed medication abortion. Individuals aged 18-44 from four Appalachian states participated in 60-minute semi-structured individual in-depth interviews via Zoom. Recruitment occurred until data saturation was reached. The interview guide was developed using the Theoretical Domains Framework. Trained interviewers assessed cognitive, affective, social, and environmental influences on medication abortion decision processes as well as other emergent factors.
Interview recordings were transcribed verbatim. Deductive content analysis was conducted to identify and categorize the resulting themes, followed by an inductive approach using open coding to identify any new categories and themes. Results were member checked with 5 study participants to verify findings.
RESULTS. Of the 81 eligible, 21 completed an interview. Median age was 32 years (range: 21-44). Two people identified as gender nonbinary; all others identified as female. Six participants were Black, one Asian American, one biracial, 13 were white. Analysis of interview data revealed five primary themes of influence on self-managed medication abortion: 1) availability of resources; 2) social support; 3) local legality of abortion care access; 4) personal medical issues; and 5) medical provider involvement.
CONCLUSIONS. This work offers unique insight on the cognitive, affective, social, and environmental influences on self-managed medication abortion decision-making. This is a significant departure from the limited research describing preferences or motivations for undertaking a self-managed abortion, which is disproportionately descriptive.
Authors:
Author - JaNelle Ricks,
DrPH, MPA,
The Ohio State University College of Public Health
Co-Author - Emily Neiman,
MS, APRN-CNM, FACNM, C-EFM,
The Ohio State University College of Nursing
Co-Author - Laxmi Sureshkumar,
MPH,
The Ohio State University College of Public Health
E54 - To Eat or to Treat? Food Insecurity’s Impact on Diabetes Management & SNAP’s Role in Reducing Diabetes Burden
Poster Number: E54Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Social and Environmental Context and Health
Food insecurity (FI) affects about 10% of U.S. households and is associated with 2.1 higher odds of diabetes in low-income adults. Individuals facing financial barriers may rely on medication “scrimping” to alleviate high costs. Research on the relationship between FI, diabetes, and diabetes self-management is under-explored. It is also unclear as to how food assistance policies, like SNAP, may have spillover benefits on reducing diabetes and its costs. Thus, it is critical to examine the mechanisms linking FI and diabetes (and medication scrimping), as well as explore how SNAP may reduce diabetes burden.
A systematic scoping review of the literature was conducted using HOLLIS and PubMed databases. Inclusion criteria included full-text, peer-reviewed articles published between 2014-2024. A total of 11 articles met the criteria and were included for review.
Findings suggest a bidirectional relationship between FI and diabetes, in that a consistent inadequate diet of cheap, high-caloric foods elicits poor glycemic control. Managing symptoms becomes challenging due to higher medical costs and, in turn, these increased out-of-pocket expenditures inhibit food affordability. FI individuals with diabetes have six times higher odds of medication scrimping behaviors (e.g. skipping medications, delaying filling prescriptions) compared to food-secure individuals, which may lead to higher mortality rates and hospitalizations. Lastly, there are spillover benefits of implementing SNAP policy interventions, notably that SNAP participants are significantly less likely to report cost-related medication non-adherence than eligible non-participants. Enacting a combined incentive/disincentive SNAP policy would produce the largest health gains over a lifetime: averting 146,590 diabetes cases and gaining nearly 2.5 million QALYS.
FI is a significant risk factor for worsening diabetes, as it forces patients to make tradeoffs between spending money on healthy food and managing diabetes. Failing to follow diabetes management recommendations increases the risk of avoidable complications and unnecessary costs. However, programs like SNAP may alleviate diabetes burden and indirectly influence medication adherence by reducing out-of-pocket food expenditures. Future research should explore ways to identify low-income patients with diabetes for FI (e.g. social determinants of health screenings) and focus on understudied populations (i.e. patients with gestational and pre-diabetes).
Keywords: Diabetes, Health disparitiesA systematic scoping review of the literature was conducted using HOLLIS and PubMed databases. Inclusion criteria included full-text, peer-reviewed articles published between 2014-2024. A total of 11 articles met the criteria and were included for review.
Findings suggest a bidirectional relationship between FI and diabetes, in that a consistent inadequate diet of cheap, high-caloric foods elicits poor glycemic control. Managing symptoms becomes challenging due to higher medical costs and, in turn, these increased out-of-pocket expenditures inhibit food affordability. FI individuals with diabetes have six times higher odds of medication scrimping behaviors (e.g. skipping medications, delaying filling prescriptions) compared to food-secure individuals, which may lead to higher mortality rates and hospitalizations. Lastly, there are spillover benefits of implementing SNAP policy interventions, notably that SNAP participants are significantly less likely to report cost-related medication non-adherence than eligible non-participants. Enacting a combined incentive/disincentive SNAP policy would produce the largest health gains over a lifetime: averting 146,590 diabetes cases and gaining nearly 2.5 million QALYS.
FI is a significant risk factor for worsening diabetes, as it forces patients to make tradeoffs between spending money on healthy food and managing diabetes. Failing to follow diabetes management recommendations increases the risk of avoidable complications and unnecessary costs. However, programs like SNAP may alleviate diabetes burden and indirectly influence medication adherence by reducing out-of-pocket food expenditures. Future research should explore ways to identify low-income patients with diabetes for FI (e.g. social determinants of health screenings) and focus on understudied populations (i.e. patients with gestational and pre-diabetes).
Authors:
Co-Author - Marie Plaisime,
Dr.,
Harvard T.H. Chan School of Public Health
E55 - Risk Factors Influencing Insulin Use and Prescription Filling Among REAL-T Young Adults with T1D
Poster Number: E55Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Social and Environmental Context and Health
Introduction: Insulin is essential for managing T1D, yet many young adults face systemic barriers that limit access and consistent use. This study examined factors associated with using less insulin than prescribed and not filling insulin prescriptions over a 12-month period.
Methods: A secondary analysis was conducted using data from the Resilient Empowered Active Living Telehealth (REAL-T) study, a randomized controlled trial of young adults with T1D (n=209, ≥1 year since diagnosis, A1c ≥7.5%). Participants self-reported insulin use quarterly over one year by answering: “In the past three months, did you use less insulin than prescribed?” and “Did you not fill an insulin prescription?” Logistic regression was used to examine predictors, including self-education, insurance type (e.g., Medicaid Managed Care [MMC]), unmet social needs, physician contact (from the DSMQ), and residence in a Medicaid non-expansion state. Models adjusted for race/ethnicity and gender.
Results: After excluding nine participants with missing data, 200 participants (61% female, 45% Hispanic/Latinx, mean age 24.2 ± 3.8 years) were analyzed. Over 12 months, 48.5% reported using less insulin, and 33.5% reported not filling prescriptions. Each additional unmet social need (OR = 1.753, 95% CI: 1.32–2.327, P < 0.001) and living in a Medicaid non-expansion state (OR = 3.373, 95% CI: 1.374–8.278, P = 0.008) increased odds of limited insulin use. For not filling prescriptions, each unmet social need (OR = 1.4, 95% CI: 1.036–1.891, P = 0.029), living in a non-expansion state (OR = 11.771, 95% CI: 4.437–31.228, P < 0.001), and having MMC insurance (OR = 16.178, 95% CI: 2.648–98.846, P = 0.003) increased the odds.
Conclusion: Insulin access and use are likely limited by state Medicaid policies, restrictions in Medicaid insurance plans, and unmet social needs. Addressing these barriers is critical for ensuring equitable insulin availability for young adults with T1D.
Keywords: Diabetes, Social supportMethods: A secondary analysis was conducted using data from the Resilient Empowered Active Living Telehealth (REAL-T) study, a randomized controlled trial of young adults with T1D (n=209, ≥1 year since diagnosis, A1c ≥7.5%). Participants self-reported insulin use quarterly over one year by answering: “In the past three months, did you use less insulin than prescribed?” and “Did you not fill an insulin prescription?” Logistic regression was used to examine predictors, including self-education, insurance type (e.g., Medicaid Managed Care [MMC]), unmet social needs, physician contact (from the DSMQ), and residence in a Medicaid non-expansion state. Models adjusted for race/ethnicity and gender.
Results: After excluding nine participants with missing data, 200 participants (61% female, 45% Hispanic/Latinx, mean age 24.2 ± 3.8 years) were analyzed. Over 12 months, 48.5% reported using less insulin, and 33.5% reported not filling prescriptions. Each additional unmet social need (OR = 1.753, 95% CI: 1.32–2.327, P < 0.001) and living in a Medicaid non-expansion state (OR = 3.373, 95% CI: 1.374–8.278, P = 0.008) increased odds of limited insulin use. For not filling prescriptions, each unmet social need (OR = 1.4, 95% CI: 1.036–1.891, P = 0.029), living in a non-expansion state (OR = 11.771, 95% CI: 4.437–31.228, P < 0.001), and having MMC insurance (OR = 16.178, 95% CI: 2.648–98.846, P = 0.003) increased the odds.
Conclusion: Insulin access and use are likely limited by state Medicaid policies, restrictions in Medicaid insurance plans, and unmet social needs. Addressing these barriers is critical for ensuring equitable insulin availability for young adults with T1D.
Authors:
Author - Anya R. Khurana,
University of Southern California
Author - Pey Lee,
MS,
Center for Economic and Social Research at the USC Dornsife, University of Southern California
Author - Jennifer K. Raymond,
MD, MCR,
Department of Pediatrics, Keck School of Medicine, University of Southern California
Author - Steven Fox,
MD, MPH,
Schaeffer Center for Health Policy and Economics, USC
Author - Gabrielle Granados,
OTR/L,
USC
Author - Elizabeth Pyatak, PhD, OTR/L, CDCES,
PhD, OTR/L, CDCES,
University of Southern California
E56 - Momentary Assessment of Insulin Habit Automaticity and Insulin Adherence in People with Type 1 Diabetes
Poster Number: E56Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Multiple Health Behavior Change
Objective: New ways to reduce the burden of insulin therapy for people living with type 1 diabetes (T1D) are needed. Habit automaticity may support this objective by reducing the cognitive demand associated with taking insulin. This study aimed to understand whether near real-time insulin habit automaticity is associated with insulin adherence at mealtimes in a real-life setting.
Methods: Sixty-three adults with T1D completed momentary assessments three times daily for seven days. Each assessment included questions related to participants’ most recent meal regarding context, cues or prompts, insulin use, and insulin habit automaticity using the Self-Report Behavioral Automaticity Index. Participants who reported not taking insulin before their meal were prompted to explain their reason for omission. Insulin adherence was assessed by self-report and objective review of insulin device data collected at each momentary assessment. We used Spearman correlations to assess associations between participant mean and variability values for automaticity and adherence; mixed-effects models were used for the momentary associations of automaticity with adherence.
Results: We found a positive correlation between insulin habit automaticity and adherence (r=.26, p=.04). Variability in insulin habit automaticity was negatively associated with insulin adherence (r =-.47, p<.001) and positively associated with variability in insulin adherence (r=.47, p<.001). We assessed the association of momentary insulin habit automaticity scores with likelihood of insulin adherence at each respective EMA timepoint. With every one-point increase in momentary insulin automaticity score, the likelihood of insulin adherence for a given meal increased by approximately 10% (95% CI = 4%, 16%, p < .001).
Conclusions: Our findings indicate that insulin habit automaticity may be important in the context of greater insulin adherence for people with T1D. As insulin may be taken in a variety of contexts and in response to many cues, future studies are needed to understand factors that support the development of automaticity related to taking insulin.
Keywords: Health behaviors, DiabetesMethods: Sixty-three adults with T1D completed momentary assessments three times daily for seven days. Each assessment included questions related to participants’ most recent meal regarding context, cues or prompts, insulin use, and insulin habit automaticity using the Self-Report Behavioral Automaticity Index. Participants who reported not taking insulin before their meal were prompted to explain their reason for omission. Insulin adherence was assessed by self-report and objective review of insulin device data collected at each momentary assessment. We used Spearman correlations to assess associations between participant mean and variability values for automaticity and adherence; mixed-effects models were used for the momentary associations of automaticity with adherence.
Results: We found a positive correlation between insulin habit automaticity and adherence (r=.26, p=.04). Variability in insulin habit automaticity was negatively associated with insulin adherence (r =-.47, p<.001) and positively associated with variability in insulin adherence (r=.47, p<.001). We assessed the association of momentary insulin habit automaticity scores with likelihood of insulin adherence at each respective EMA timepoint. With every one-point increase in momentary insulin automaticity score, the likelihood of insulin adherence for a given meal increased by approximately 10% (95% CI = 4%, 16%, p < .001).
Conclusions: Our findings indicate that insulin habit automaticity may be important in the context of greater insulin adherence for people with T1D. As insulin may be taken in a variety of contexts and in response to many cues, future studies are needed to understand factors that support the development of automaticity related to taking insulin.
Authors:
Author - Jenine Yager Stone,
MSN, FNP-C,
Vanderbilt University
Co-Author - Mary S. Dietrich,
PhD, MS,
Vanderbilt University
Co-Author - Lindsay S. Mayberry,
PhD, FSBM,
Vanderbilt University Medical Center
Co-Author - Kate Clouse,
PhD, MPH,
Vanderbilt University
Co-Author - Shelagh A. Mulvaney,
PhD,
Vanderbilt University
E57 - Social Determinants of Health Barriers in Chinese Americans at Risk for Type 2 Diabetes
Poster Number: E57Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Social and Environmental Context and Health
Objectives: This study aimed to describe social determinants of health (SDOH) barriers among Chinese Americans who are at risk of developing type 2 diabetes (T2D) in New York City (NYC).
Methods: We used baseline data from a randomized controlled trial that tests a diabetes prevention program tailored to Chinese Americans. Baseline data were collected from 2 cohorts in July 2023 and June 2024, involving Chinese Americans aged 18-70, recruited from community-based organizations in NYC. The surveys were administered by community health workers in Mandarin Chinese. SDOH barriers were assessed using a 14-item self-report questionnaire developed by the NYU Langone Health Brooklyn Family Health Center. This questionnaire covers multiple SDOH domains, including food, housing, transportation, education, finances, childcare, social environment, legal issues, and substance abuse. Each item scored 1 for “Yes” and 0 for “No”. For each completed questionnaire, a total score is calculated by summing the 14 items.
Results: We recruited 150 participants in the trial (mean age 50±12.6 years, 82.7% female, 77.3% married, 68% employed, 54% had a high school education or less, 37.3% had an annual household income < $25,000, and 87.9% had limited English proficiency). A total of 146 provided complete SDOH data, which were included in the analysis. Participants reported an average of 2.5±2.3 SDOH barriers, with 82.2% experiencing at least 1 SDOH barrier. The top five SDOH barriers identified were problems related to education and English literacy (52.7%), racial discrimination (33.6%), unstable housing (26.0%), limited health access and social services support (17.8%), and childcare (15.8 %).
Conclusions: The results indicate that a large proportion of Chinese Americans at risk for T2D face SDOH barriers. These barriers may affect their ability to navigate healthcare systems , highlighting the importance of assessing and addressing SDOH barriers for minoritized populations.
Keywords: Diabetes, Health disparitiesMethods: We used baseline data from a randomized controlled trial that tests a diabetes prevention program tailored to Chinese Americans. Baseline data were collected from 2 cohorts in July 2023 and June 2024, involving Chinese Americans aged 18-70, recruited from community-based organizations in NYC. The surveys were administered by community health workers in Mandarin Chinese. SDOH barriers were assessed using a 14-item self-report questionnaire developed by the NYU Langone Health Brooklyn Family Health Center. This questionnaire covers multiple SDOH domains, including food, housing, transportation, education, finances, childcare, social environment, legal issues, and substance abuse. Each item scored 1 for “Yes” and 0 for “No”. For each completed questionnaire, a total score is calculated by summing the 14 items.
Results: We recruited 150 participants in the trial (mean age 50±12.6 years, 82.7% female, 77.3% married, 68% employed, 54% had a high school education or less, 37.3% had an annual household income < $25,000, and 87.9% had limited English proficiency). A total of 146 provided complete SDOH data, which were included in the analysis. Participants reported an average of 2.5±2.3 SDOH barriers, with 82.2% experiencing at least 1 SDOH barrier. The top five SDOH barriers identified were problems related to education and English literacy (52.7%), racial discrimination (33.6%), unstable housing (26.0%), limited health access and social services support (17.8%), and childcare (15.8 %).
Conclusions: The results indicate that a large proportion of Chinese Americans at risk for T2D face SDOH barriers. These barriers may affect their ability to navigate healthcare systems , highlighting the importance of assessing and addressing SDOH barriers for minoritized populations.
Authors:
Co-Author - Haili Song,
NYU Grossman School of Medicine
Co-Author - Yun Shi,
NYU Grossman School of Medicine
Co-Author - Mary Sevick,
NYU Grossman School of Medicine
Co-Author - Huilin Li,
NYU Grossman School of Medicine
Co-Author - Jeannette M. Beasley, PhD, MPH, RD,
PhD, MPH, RD,
NYU Steinhardt
Co-Author - Stella Yi,
NYU Grossman School of Medicine
Co-Author - Ora Z. Friedman,
NYU Grossman School of Medicine
Co-Author - Lu Hu,
New York University Grossman School of Medicine
E58 - Recruitment and Retention of Young Adults (YA) with Type 1 Diabetes (T1D) in a Behavioral Intervention Trial
Poster Number: E58Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Child and Family Health
Engaging YAs with T1D in research is challenging due to developmental transitions, residential changes, and competing priorities. Transfer from pediatric to adult care complicates health outcome data collection. We report on recruitment and retention rates of YAs with T1D for a 1-year randomized behavioral transition intervention trial comparing Peer Mentor support (PM) to usual care (UC). Methods: We recruited YAs after their final pediatric T1D appointment. Participants completed questionnaires at baseline, 6- and 12-months. HbA1c was collected via chart-review (with release for adult records at 12 mos) and home kits at baseline and 12 mos. A subset were invited for qualitative interviews at 12 mos. YA-focused retention strategies included conducting study activities remotely, maintaining regular contact, rechecking mailing addresses/phone numbers, arranging courier pickups for HbA1c kits/releases, communicating at YAs’ preferred times and methods, mentioning study benefits/incentives with participation reminders, and periodically sending useful “swag” items with the study logo, birthday cards, and newsletters. Results: Staff prescreened 611 YAs, made contact/confirmed eligibility with 152, and 115 consented (76%). Excluding 14 with incomplete baseline data and 1 withdrawn, the final sample was 100. Mean age was 19.9±1.3 yrs and HbA1c=8.8±2.0%. Participants were 58% female, 12% Black, 25% Hispanic, 54% non-Hispanic White, 9% all others. Reasons to participate included: Opportunity to participate in research (96%), Wanted to help young adults with diabetes (92%), Wanted to give back (90%), Money for time/effort in the study (84%), and other reasons (e.g., wanting help with transition, possibility to be paired with PM, 31%). Retention rates were: 92% completed surveys at 6 and 12 mos (90 and 88% PM, 94 and 97% UC), 85% returned HbA1c kits at 12 mos (84% PM, 87% UC), and 1 (UC) withdrew at 12 mos. We received releases of information from 58% and completed 27 qualitative interviews (met thematic saturation). Discussion: Using flexible, developmentally sensitive approaches, this study illustrates successful recruitment and retention of a diverse sample of YAs in a yearlong behavioral trial, despite pandemic-related challenges. Conducting meaningful research, being persistent, and adequately budgeting for staff time, shipping fees, and incentives are necessary to sustain YA engagement and rigorously evaluate transition interventions.
Keywords: Intervention, DiabetesAuthors:
Author - Sahar S. Eshtehardi,
Baylor College of Medicine and Texas Children's Hospital
Author - Stephanie D. Camey,
Baylor College of Medicine and Texas Children's Hospital
Author - Samantha A. Carrreon,
Baylor College of Medicine and Texas Children's Hospital
Author - Wendy Levy,
Baylor College of Medicine and Texas Children's Hospital
Author - Charles G. Minard,
Baylor College of Medicine
Author - Sarah K Lyons,
Baylor College of Medicine and Texas Children's Hospital
Author - Siripoom McKay,
Baylor College of Medicine and Texas Children's Hospital
Author - Randi Streisand,
Children's National Hospital and George Washington University School of Medicine
Author - Barbara J Anderson,
Baylor College of Medicine
Author - Tricia Tang,
University of British Columbia
Author - Marisa E Hilliard,
Baylor College of Medicine and Texas Children's Hospital
E59 - Association among sleep quality, eating behaviors with glucose control in type 2 diabetes measured by continuous glucose monitoring
Poster Number: E59Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Diet, Nutrition, and Eating Disorders
Background. Sleep and eating are important lifestyle factors influencing glucose control. Most studies have utilized HbA1c, a long-term glucose measure, to assess these relationships. However, continuous glucose monitoring (CGM) offers the potential to examine these relationships more closely in time and to measure glucose variability (i.e., glucose level fluctuations). This study aimed to examine the relationship among sleep, eating and glucose outcomes measured by CGM among individuals with type 2 diabetes.
Methods. Participants (n=67) with type 2 diabetes completed demographic surveys, Pittsburgh Sleep Quality Index (PSQI), and Diabetes and Eating Problem Survey-Revised (DEPS-R). Self-reported body weight was collected. Glucose variability (% coefficient of variation [CV] for glucose—stable CV is ≤33%; Time in Range [TIR, 70-180 mg/dL]—recommended TIR is ≥70%) and mean glucose levels over 14 days were obtained via CGM.
Results. The sample was predominantly female (70%), with a mean age of 61.96 years (SD=9.37) (Non-Hispanic White, 74.2 %; Non-Hispanic Black, 15.1%; Non-Hispanic Asian 1.5%). Mean TIR was 75.88% (SD=24.38), and mean CV was 23.31% (SD=6.44). The mean PSQI score was 9.42 (SD=4.14), indicating poor sleep quality (cult-off >5). Mean total sleep time per PSQI was 6.37 hours (SD=1.34). The mean DEPS-R score was 31.27 (SD=8.93), indicating disordered eating behaviors (cult-off >20). In bivariate analyses, mean glucose levels were significantly associated with sleep quality (r=0.26, p<0.05) and diabetes eating problem (r=0.40, p<0.01). Total sleep time (r=-0.27, p<0.05) and sleep quality (r=0.38, p<0.01) were also associated with diabetes eating problems. Body weight correlated with mean glucose (r=0.33, p<0.01) and CV (r=-0.26, p<0.05). In multiple regression analyses, better sleep quality (lower PSQI score) (coefficient ± SE, 0.31±0.11, P<0.01) and fewer diabetes eating problems (coefficient ± SE, 0.35±0.13, P<0.01) were associated with lower mean glucose levels, controlling for age and body weight. The relationships among sleep, diabetes eating, and glucose variability (CV) did not reach statistical significance.
Conclusion. Better sleep quality and fewer diabetes-related eating problems were associated with better glucose outcomes as measured by CGM. Future studies with large sample sizes and real-time lifestyle measurements are warranted to further understand the relationship between sleep, eating and glucose variability.
Keywords: Diabetes, Eating behaviorsMethods. Participants (n=67) with type 2 diabetes completed demographic surveys, Pittsburgh Sleep Quality Index (PSQI), and Diabetes and Eating Problem Survey-Revised (DEPS-R). Self-reported body weight was collected. Glucose variability (% coefficient of variation [CV] for glucose—stable CV is ≤33%; Time in Range [TIR, 70-180 mg/dL]—recommended TIR is ≥70%) and mean glucose levels over 14 days were obtained via CGM.
Results. The sample was predominantly female (70%), with a mean age of 61.96 years (SD=9.37) (Non-Hispanic White, 74.2 %; Non-Hispanic Black, 15.1%; Non-Hispanic Asian 1.5%). Mean TIR was 75.88% (SD=24.38), and mean CV was 23.31% (SD=6.44). The mean PSQI score was 9.42 (SD=4.14), indicating poor sleep quality (cult-off >5). Mean total sleep time per PSQI was 6.37 hours (SD=1.34). The mean DEPS-R score was 31.27 (SD=8.93), indicating disordered eating behaviors (cult-off >20). In bivariate analyses, mean glucose levels were significantly associated with sleep quality (r=0.26, p<0.05) and diabetes eating problem (r=0.40, p<0.01). Total sleep time (r=-0.27, p<0.05) and sleep quality (r=0.38, p<0.01) were also associated with diabetes eating problems. Body weight correlated with mean glucose (r=0.33, p<0.01) and CV (r=-0.26, p<0.05). In multiple regression analyses, better sleep quality (lower PSQI score) (coefficient ± SE, 0.31±0.11, P<0.01) and fewer diabetes eating problems (coefficient ± SE, 0.35±0.13, P<0.01) were associated with lower mean glucose levels, controlling for age and body weight. The relationships among sleep, diabetes eating, and glucose variability (CV) did not reach statistical significance.
Conclusion. Better sleep quality and fewer diabetes-related eating problems were associated with better glucose outcomes as measured by CGM. Future studies with large sample sizes and real-time lifestyle measurements are warranted to further understand the relationship between sleep, eating and glucose variability.
Authors:
Author - Soohyun Nam,
PhD,
Yale University
Co-Author - Minjung Lee,
PhD,
Yale University
Co-Author - Sangchoon Jeon,
PhD,
Yale University
E60 - Latent profiles of disordered eating behaviors among sexual and gender diverse youth in the United States
Poster Number: E60Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Social and Environmental Context and Health
Purpose: Disordered eating behaviors (DEBs) are associated with the development of eating disorders and other physical and mental illnesses. While it is known that sexual and gender diverse youth (SGDY) are at elevated risk of DEBs, which factors most strongly drive the manifestation of specific patterns of DEBs among SGDY are not well-understood. In the present study, we identified common patterns of DEBs among SGDY and subsequently examined which social identities and experiences were associated with each pattern of DEBs.
Methods: This study uses data from the 2022 LGBTQ National Teen Survey (n = 10,761), a nationwide survey of SGDY between the ages of 13 and 18 administered that includes data on frequency of participation in three DEBs: restriction, binge-eating, and purging. We first conducted a Latent Profile Analysis (LPA) to determine profiles of engagement in DEBs. We then performed multinomial logistic regression to determine the association of gender identity, sexual orientation, race, ethnicity, four types of bullying victimization (gender-based, sexual orientation-based, race-based, and weight-based), and LGBTQ-specific parental acceptance with profile membership. We performed analysis of variance (ANOVA) and post-hoc t-tests to determine differences in co-occurring depressive and anxiety symptoms among profiles.
Results: Three latent profiles emerged: (1) Restriction & Binge-eating (28.6%), (2) No DEBs (36.9%), (3) Restriction Only (34.4%). All four types of bullying victimization were significantly associated with increased odds of belonging to the two disordered profiles (Restriction & Binge-eating and Restriction Only). Weight-based bullying victimization was associated with the highest odds of belonging to the Restriction & Binge-eating profile, while parental acceptance was most strongly associated with not belonging to either disordered profile. Finally, the Restriction & Binge-eating profile was associated with greater depressive and anxiety symptoms than the Restriction Only profile.
Conclusion: Binge-eating distinguished the two patterns of DEBs among SGDY, with the Restriction & Binge-eating profile associated with worse social experiences and outcomes. Bullying and parental acceptance had greater influence on DEB profile membership than identity variables, underscoring the need for social rather than individual interventions that aim to foster safer and more supportive environments for SGDY.
Keywords: Eating behaviors, Health disparitiesMethods: This study uses data from the 2022 LGBTQ National Teen Survey (n = 10,761), a nationwide survey of SGDY between the ages of 13 and 18 administered that includes data on frequency of participation in three DEBs: restriction, binge-eating, and purging. We first conducted a Latent Profile Analysis (LPA) to determine profiles of engagement in DEBs. We then performed multinomial logistic regression to determine the association of gender identity, sexual orientation, race, ethnicity, four types of bullying victimization (gender-based, sexual orientation-based, race-based, and weight-based), and LGBTQ-specific parental acceptance with profile membership. We performed analysis of variance (ANOVA) and post-hoc t-tests to determine differences in co-occurring depressive and anxiety symptoms among profiles.
Results: Three latent profiles emerged: (1) Restriction & Binge-eating (28.6%), (2) No DEBs (36.9%), (3) Restriction Only (34.4%). All four types of bullying victimization were significantly associated with increased odds of belonging to the two disordered profiles (Restriction & Binge-eating and Restriction Only). Weight-based bullying victimization was associated with the highest odds of belonging to the Restriction & Binge-eating profile, while parental acceptance was most strongly associated with not belonging to either disordered profile. Finally, the Restriction & Binge-eating profile was associated with greater depressive and anxiety symptoms than the Restriction Only profile.
Conclusion: Binge-eating distinguished the two patterns of DEBs among SGDY, with the Restriction & Binge-eating profile associated with worse social experiences and outcomes. Bullying and parental acceptance had greater influence on DEB profile membership than identity variables, underscoring the need for social rather than individual interventions that aim to foster safer and more supportive environments for SGDY.
Authors:
Presenter - Nora Y. Sun,
Harvard University
Author - Antonia E. Caba,
University of Connecticut, Storrs, CT
Author - Leah M. Lessard,
University of Connecticut, Rudd Center for Food Policy and Health, Hartford, CT
Author - Megan S. Paceley,
University of Connecticut, School of Social Work, Hartford, CT
Author - Lisa A. Eaton,
University of Connecticut, Storrs, CT
Author - Ryan J. Watson,
University of Connecticut, Storrs, CT
E61 - Prevalence and Presentation of Eating Disorders in a National, Population-Based Sample of College Students
Poster Number: E61Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Health of Marginalized Populations
Purpose: Eating disorders (EDs) are serious, prevalent illnesses in college students, yet limited research exists on prevalence and presentations of EDs across racial/ethnic groups in population-based samples. This study examined ED prevalence in college students by race/ethnicity, and among those with EDs, compared ED behaviors, weight/shape concerns (WSC), and psychiatric comorbidities by race/ethnicity. Methods: 31,285 students at 26 U.S. colleges completed a population-based mental health screen. Prevalence of anorexia nervosa (AN), binge/purge-type (BP) EDs, and ED risk was examined across racial/ethnic groups (i.e., Hispanic, Asian, Black, Multiracial, White). Among those with AN or BP EDs, frequencies of ED behaviors (i.e., bingeing, vomiting, diuretic/laxative use), WSC, and prevalence of psychiatric comorbidities (i.e., generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, depression, PTSD, alcohol use disorder (AUD), insomnia) were assessed across racial/ethnic groups. Chi-square tests were used for categorical outcomes and one-way ANOVAs for continuous. Results: There were significant differences in prevalence of AN, BP EDs, and ED risk across groups (ps<.05). Asian students had higher rates of AN (2.5%) than Black (0.4%), White (1.7%), and Hispanic (1.4%) students; AN prevalence in Black students was significantly lower than all groups (ps<.05). Hispanic students (16.6%) had higher rates of BP EDs than Asian (13.0%), Black (12.5%), and White students (13.8%); Hispanic students (4.8%) also had higher ED risk rates than Asian (2.4%), Multiracial (2.5%), and White students (3.5%) (ps<.05). Among those with EDs (n=4,012), there were no differences in bingeing or vomiting across groups, and Hispanic students had higher diuretic/laxative use and WSC than Asian students (ps<.05). Hispanic students had higher rates of GAD (58.6%) than Asian students (47.0%) and higher insomnia (42.9%) than White students (34.1%); White students had higher AUD (56.5%) than all groups (32.0-45.4%) (ps<.05). Conclusion: Prevalence of EDs was largely similar across racial/ethnic groups, and where differences emerged, minoritized students often had greater prevalence. Among those with EDs, Hispanic students exhibited greater rates of some ED behaviors and comorbidities. Results highlight the need for routine screening for EDs on college campuses, particularly in racial/ethnic minority students, for whom EDs historically have been under-identified
Keywords: Minority health, ScreeningAuthors:
Presenter - Carli Howe,
Washington University in St. Louis
Co-Author - Seung Yeon Baik,
The Pennsylvania State University
Co-Author - Laura D’Adamo,
Drexel University
Co-Author - Mia Kouveliotes,
Washington University in St. Louis
Co-Author - Zhaoyi Pan,
Washington University in St. Louis
Co-Author - Lawrence Monocello,
Washington University in St. Louis
Co-Author - Marie-Laure Firebaugh,
Washington University in St. Louis
Co-Author - Daniel Eisenberg,
University of California, Los Angeles
Co-Author - Michelle Newman,
The Pennsylvania State University
Co-Author - Denise Wilfley,
Washington University in St. Louis
Co-Author - Ellen Fitzsimmons-Craft,
Washington University in St. Louis
E62 - Associations Between Memory Processes and Loss of Control Eating Among Adults with Overweight or Obesity
Poster Number: E62Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Obesity
Research in human and animal models has demonstrated relationships between overeating, obesity, and memory deficits, and has implicated the hippocampus in both episodic memory and satiety. Literature investigating relationships between hippocampal-dependent memory processes and binge eating or loss of control (LOC) eating is nascent but emerging. We sought to examine relationships between LOC eating and verbal memory among adults with overweight or obesity (OW/OB) seeking weight-loss treatment to further elucidate these relationships. As part of baseline assessments, 164 adults with OW/OB completed the Eating Disorder Examination and a verbal list learning task modified with food words (VLLT-Food). We compared 51 adults who endorsed at least one episode of LOC (mean age = 44.69 (12.36) years; mean body mass index (BMI) = 33.8 (5.2) kg/m2; female = 88%; 51.0% Non-Hispanic White; 19.6% Hispanic, and 29.4% Non-Hispanic Non-White) with 113 participants without any LOC (mean age = 44.74 (12.56) years; mean BMI = 34.8 (4.9) kg/m2; female = 74%; 60.2% Non-Hispanic White; 23.9% Hispanic, and 15.9% Non-Hispanic Non-White). Linear regression models adjusting for participant ethnicity and BMI showed that those with LOC had significantly lower t-score (adjusted for age and gender) on recall across trials 1-5 than those without LOC (b=-3.63, se=1.53, p=0.02). Those with LOC also demonstrated reduced use of advantageous semantic clustering during trials 1-5 (b=-0.38, se=0.19, p = 0.047). Scores on learning slope, recall consistency, and the use of subjective (i.e., idiosyncratic) clustering strategies on trials 1-5, short-delay free recall and discriminability, and long-delay free recall, discriminability, and semantic clustering did not differ between those with and without LOC (ps>0.35). However, differences between groups on trial 1-5 discriminability, serial clustering, and short-delay semantic clustering did not reach significance but were in the expected direction (ps<0.25). This preliminary analysis provides evidence that LOC eating may be related to hippocampal-dependent memory processes and provides rationale for more research needed in this area.
Keywords: Binge eating, Cognitive factorsAuthors:
Author - Ellen K. Pasquale, MS,
MS,
SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
Co-Author - David R. Strong, Phd,
PhD,
University of California, San Diego
Co-Author - Dawn Eichen,
PhD,
University of California, San Diego
Co-Author - Carol B. Peterson, PhD,
PhD,
University of Minnesota
Co-Author - Kerri N. Boutelle, PhD,
PhD,
University of California, San Diego
E63 - Indigenous SIPin: Proof-of-Concept of a Sugar-Sweetened Beverage Reduction Intervention for Native American Men
Poster Number: E63Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Health of Marginalized Populations
In the United States, sugar-sweetened beverages (SSB) are the largest single food source of calories and strong data consistently documents relationships among high SSB consumption and numerous health issues (e.g., obesity, diabetes, heart disease). SSB intake is disproportionately high among Native Americans (NA) and NA bear a disparate burden of SSB-related disease. Despite the availability of effective SSB interventions, none have been specifically developed for NA men. Thus, we partnered with Indigenous community organizations in urban and sub-urban areas to conduct proof-of-concept testing of a lacrosse-based, SSB intervention for NA men using the Orbit Model framework.
We developed the 6-month intervention (Indigenous SIPin), which consisted of 12 group lessons delivered before and after lacrosse games, 12 2–3-minute recap videos for those who missed lessons, and 27 short messaging service (SMS)/text messages. Indigenous values (e.g., Good Mind) were interwoven throughout the curriculum. Indigenous staff delivered the intervention between July 2020 to June 2023.
Weekly reoccurring lacrosse games were organized to recruit participants. Thirty men were recruited and ten completed both baseline and 6-month follow-up assessments. The sample’s average age was 32.1 (SD 9.1) years, with the majority employed full time (63.3%), and reporting an educational level of at least post high school training or some college (70.0%). Average SSB kcal intake was over recommended levels (328+66) kcal/day. Participants attended an average of 3.8 out of 12 lessons (26.6% attended at least half), clicked to view 1.8 out of 12 recap videos, and clicked to view 4.8 of 27 text messages. There were no significant changes in SSB intake from baseline to 6-month follow-up. The majority reported high levels of program satisfaction.
Our study highlights the importance of proof-of-concept studies in NA communities as an essential first step in the research continuum. COVID-19 delayed study activities and contributed to several challenges. Arenas closed unpredictably, resulting in last-minute changes to locations that were not convenient for all participants to reach. Further, some participants decided to play in the lacrosse playoffs associated with a different series of lacrosse games that took place during intervention sessions. Including sports other than lacrosse and having a consistent arena for intervention games may improve Indigenous SIPin's feasibility in a future study.
Keywords: Nutrition, Community interventionWe developed the 6-month intervention (Indigenous SIPin), which consisted of 12 group lessons delivered before and after lacrosse games, 12 2–3-minute recap videos for those who missed lessons, and 27 short messaging service (SMS)/text messages. Indigenous values (e.g., Good Mind) were interwoven throughout the curriculum. Indigenous staff delivered the intervention between July 2020 to June 2023.
Weekly reoccurring lacrosse games were organized to recruit participants. Thirty men were recruited and ten completed both baseline and 6-month follow-up assessments. The sample’s average age was 32.1 (SD 9.1) years, with the majority employed full time (63.3%), and reporting an educational level of at least post high school training or some college (70.0%). Average SSB kcal intake was over recommended levels (328+66) kcal/day. Participants attended an average of 3.8 out of 12 lessons (26.6% attended at least half), clicked to view 1.8 out of 12 recap videos, and clicked to view 4.8 of 27 text messages. There were no significant changes in SSB intake from baseline to 6-month follow-up. The majority reported high levels of program satisfaction.
Our study highlights the importance of proof-of-concept studies in NA communities as an essential first step in the research continuum. COVID-19 delayed study activities and contributed to several challenges. Arenas closed unpredictably, resulting in last-minute changes to locations that were not convenient for all participants to reach. Further, some participants decided to play in the lacrosse playoffs associated with a different series of lacrosse games that took place during intervention sessions. Including sports other than lacrosse and having a consistent arena for intervention games may improve Indigenous SIPin's feasibility in a future study.
Authors:
Co-Author - Rodney Haring,
Roswell Park Comprehensive Cancer Center
Co-Author - Jamie Zoellner, PhD, RD,
PhD, RD,
University of Virginia
Co-Author - Han Yu,
Roswell Park Comprehensive Cancer Center
Co-Author - Elizabeth DiCarlo,
Roswell Park Comprehensive Cancer Center
Co-Author - Corinne Porter,
Roswell Park Comprehensive Cancer Center
Co-Author - Will Maybee,
Roswell Park Comprehensive Cancer Center
E64 - Evaluating the Effects of Different Body Image Movements on Body Image
Poster Number: E64Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Mental Health
The pervasive influence of social media has intensified concerns about body image, with negative body image consistently linked to poor health outcomes, including eating disorders, depression, and low self-esteem. While the body positivity movement has emerged as a popular strategy to address body dissatisfaction by promoting acceptance of all body types, it faces criticism for perpetuating self-objectification, limited diversity, and pressure to suppress negative emotions. In contrast, the emerging body neutrality movement emphasizes the functionality of the body over appearance, fostering realistic and inclusive self-perception. Despite its potential, research on body neutrality remains scarce. This study aimed to compare the effects of body positivity and body neutrality on body satisfaction when individuals are prompted by insecurities. Utilizing an experimental design, participants (N = 54; Age M = 19.75, SD = 1.05; 79.6% female; 66.6% White ) were randomly assigned to body positive (n = 30) or body neutral (n = 24) conditions, and wrote reflective statements countering their insecurities using principles of either movement. Pre- and post-intervention measures assessed appearance and functionality satisfaction were compared for both groups. Preliminary results showed significant improvement in the body satisfaction (t = -6.21, df = 53, p < .001) between before (M = 60.7) and after (M = 66.52) the writing exercise of both groups (i.e., body positive and body neutral groups). This finding suggests doing a simple exercise to counter body insecurities improves one’s body satisfaction which may further protect against negative eating behaviors.
Keywords: Mental health, Weight controlAuthors:
Chair - Patricia Cabral, PhD,
PhD,
Occidental College
E65 - Psychological Interventions for Internalized Weight Stigma: A Systematic Scoping Review of Feasibility, Acceptability, and Preliminary Efficacy
Poster Number: E65Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Mental Health
Objectives: Internalized weight stigma (IWS) is highly prevalent and associated with deleterious mental and physical health outcomes, including depression, chronic stress, and disordered eating. Initiatives are needed to address IWS and promote effective coping and resilience among individuals who are exposed to weight stigma. Psychological interventions aimed at reducing IWS may represent a promising approach for changing individuals’ self-stigmatizing beliefs, increasing self-esteem and empowerment, and promoting effective coping. We conducted a systematic scoping review of the literature on psychological interventions for IWS and explored their intervention components, feasibility, acceptability, and preliminary efficacy at reducing IWS and related negative physiological and psychological health outcomes.
Methods: Eight databases were searched. Inclusion criteria included: (1) psychological intervention; (2) published in English; and (3) included IWS as an outcome. Exclusion criteria included: (1) commentary or review; and (2) not a psychological intervention. A narrative review framework was used to synthesize results.
Results: Of 161 articles screened, 20 were included. Of the 13 studies that reported on feasibility/acceptability and engagement metrics, 8 studies reported high acceptability ratings, with participants finding the interventions relevant and useful. Of the 10 studies that evaluated interventions focused on IWS, 6 reported high acceptability. Sixteen of 20 included studies observed significant reductions in IWS that were maintained over follow-up periods; among the 11 studies with control conditions, 6 studies found greater significant decreases in IWS in the intervention group relative to controls. Of the 10 studies that evaluated interventions focused on IWS specifically, 8 found significant reductions in IWS across conditions; of the 7 of those with control conditions, 4 found significantly greater decreases in the intervention conditions. Studies observed significant improvements in numerous physical and mental health outcomes.
Conclusions: Findings highlight the potential for psychological interventions to promote improved health and wellbeing in individuals with IWS. Future research is needed to rigorously evaluate interventions using randomized controlled trials and examine the mechanisms through which these interventions impact IWS and related health outcomes.
Keywords: Mental health, Eating behaviorsMethods: Eight databases were searched. Inclusion criteria included: (1) psychological intervention; (2) published in English; and (3) included IWS as an outcome. Exclusion criteria included: (1) commentary or review; and (2) not a psychological intervention. A narrative review framework was used to synthesize results.
Results: Of 161 articles screened, 20 were included. Of the 13 studies that reported on feasibility/acceptability and engagement metrics, 8 studies reported high acceptability ratings, with participants finding the interventions relevant and useful. Of the 10 studies that evaluated interventions focused on IWS, 6 reported high acceptability. Sixteen of 20 included studies observed significant reductions in IWS that were maintained over follow-up periods; among the 11 studies with control conditions, 6 studies found greater significant decreases in IWS in the intervention group relative to controls. Of the 10 studies that evaluated interventions focused on IWS specifically, 8 found significant reductions in IWS across conditions; of the 7 of those with control conditions, 4 found significantly greater decreases in the intervention conditions. Studies observed significant improvements in numerous physical and mental health outcomes.
Conclusions: Findings highlight the potential for psychological interventions to promote improved health and wellbeing in individuals with IWS. Future research is needed to rigorously evaluate interventions using randomized controlled trials and examine the mechanisms through which these interventions impact IWS and related health outcomes.
Authors:
Presenter - Laura D'Adamo,
Drexel University
Author - Abigail T. Shonrock,
East Carolina University
Author - Lawrence Monocello,
Washington University in St. Louis
Author - Jake Goldberg,
Washington University in St. Louis
Author - Lauren H. Yaeger,
Washington University in St. Louis
Author - Rebecca L. Pearl, PhD,
University of Florida
Author - Denise E. Wilfley, PhD,
Washington University School of Medicine
E66 - The Relationship between Financial Strain and Self-Rated Health among Black Adults: Sleep and Loneliness as Mediators
Poster Number: E66Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Health of Marginalized Populations
Background: Health disparities between Black and White adults persist, with Black adults experiencing higher rates of premature death, despite having similar levels of education and employment. Financial strain, defined as the perceived ability to meet basic needs, plays a significant role in these health disparities. Although it has been found that financial strain is associated with adverse health outcomes in Black adults, it is unknown the mechanisms by which financial strain affects these outcomes.
Objectives: To address this critical knowledge gap, this study investigated how financial strain is associated with physical and mental health through loneliness and sleep quality (i.e., mediators) among Black adults.
Methods: We conducted a cross-sectional analysis of Project CHURCH, a cohort study initiated by The University of Texas MD Anderson Cancer Center in partnership with Houston-area Black churches. Structural equation modeling was employed to estimate the direct and indirect effects of the predictor on the outcome via the mediator, while adjusting for covariates (e.g., age, sex, comorbidity), in a sample of 1,040 Black men and women. Missing values were addressed using missForest imputation. To obtain the standard errors (SEs) of the effect estimates, we applied bootstrapping with 2000 iterations.
Results: For physical health, there was a significant indirect effect (b=-0.044, SE=0.016, p=.006). Specifically, financial strain was associated with poor sleep quality, which, in turn was linked to worse physical health. However, the indirect effect of financial strain on physical health via loneliness was not significant (b=0.006, SE=0.015, p=0.705). For mental health, financial strain had a significant indirect effect through both loneliness (b=-0.078, SE=0.021, p<0.001) and sleep quality (b=-0.034, SE=0.015, p=0.018). In this case, financial strain was associated with increased loneliness and poor sleep quality, both of which, in turn, were negatively associated with mental health.
Conclusions: This study is among the few that explicitly examined the mechanisms through which financial strain affects health among Black adults. Given the findings that financial strain negatively impacts both physical and mental health via sleep quality and/or loneliness, interventions aimed at improving sleep quality and reducing loneliness in Black adults, would be beneficial in mitigating the adverse health effects of financial strain in this underserved population.
Keywords: Socioeconomic, Minority healthObjectives: To address this critical knowledge gap, this study investigated how financial strain is associated with physical and mental health through loneliness and sleep quality (i.e., mediators) among Black adults.
Methods: We conducted a cross-sectional analysis of Project CHURCH, a cohort study initiated by The University of Texas MD Anderson Cancer Center in partnership with Houston-area Black churches. Structural equation modeling was employed to estimate the direct and indirect effects of the predictor on the outcome via the mediator, while adjusting for covariates (e.g., age, sex, comorbidity), in a sample of 1,040 Black men and women. Missing values were addressed using missForest imputation. To obtain the standard errors (SEs) of the effect estimates, we applied bootstrapping with 2000 iterations.
Results: For physical health, there was a significant indirect effect (b=-0.044, SE=0.016, p=.006). Specifically, financial strain was associated with poor sleep quality, which, in turn was linked to worse physical health. However, the indirect effect of financial strain on physical health via loneliness was not significant (b=0.006, SE=0.015, p=0.705). For mental health, financial strain had a significant indirect effect through both loneliness (b=-0.078, SE=0.021, p<0.001) and sleep quality (b=-0.034, SE=0.015, p=0.018). In this case, financial strain was associated with increased loneliness and poor sleep quality, both of which, in turn, were negatively associated with mental health.
Conclusions: This study is among the few that explicitly examined the mechanisms through which financial strain affects health among Black adults. Given the findings that financial strain negatively impacts both physical and mental health via sleep quality and/or loneliness, interventions aimed at improving sleep quality and reducing loneliness in Black adults, would be beneficial in mitigating the adverse health effects of financial strain in this underserved population.
Authors:
Author - Gwynn Elizabeth Durham,
Tilman J. Fertitta Family College of Medicine
Co-Author - Hannah Winter,
Tilman J. Fertitta Family College of Medicine
Co-Author - Seokhun Kim,
University of Texas Health Science Center
Co-Author - Lorna H. McNeill, MPH, PhD, FSBM,
MPH, PhD, FSBM,
University of Texas MD Anderson Cancer Center
Co-Author - Dalnim Cho, PhD,
PhD,
The University of Texas MD Anderson Cancer Center
E67 - More Frequent Use of AI Health Coach is Associated with Higher Nutritional Quality of Food Choices
Poster Number: E67Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Multiple Health Behavior Change
Background: Traditional face-to-face coaching methods for weight loss (WL) are not scalable, and are not sufficient to support the number of adults that need such support due to the ever-growing global prevalence of overweight and obesity. AI coaching within mobile applications offers an opportunity to effectively support a vast number of adults living with overweight and obesity; and, we are seeing a rise in the utilization of such methods. Successful AI health coaching should improve health-related behaviors such as healthy eating.
This evaluation assessed the association between interactions with an AI coach and outcomes from a Nutrition Score (NS) designed to support weight loss and healthy eating within a mobile application.
Methods: Eligible app users from July 1, 2023 to June 30, 2024 who used the NS feature minimum 5 times per week for at least 75% of the weeks during the first 3 months in the app. The NS accounts for calorie density, protein, fiber, sugar, saturated and unsaturated fats, calcium and salt, and offers four ratings of food entries: Low, Fair, Good, or Optimal. Each meal score from Low to Optimal was assigned a number from 1 to 4. Average meal score and share of Optimal scores were variables of interest. The number of days with AI health coach interactions was the independent variable. Linear regression was adjusted for gender, age, fasting protocol, initial BMI category, and the average number of meal logs per week.
Results: The study involved 26,146 users. 66.35% were women, 35.5% were 60+ years. Median BMI was 32 (IQR 28.8–36.3) kg/m2. The median number of days with the AI health coach was 8 (IQR 3–19). The mean meal score was 2.87 (SD 0.32) and the share of Optimal scores was 21.2 (IQR 10.8–32.3)%. Share of Optimal scores in users who did not interact with the AI health coach was 5.1 (IQR 1.9–11.2)% and was 15.6 (6.6–26.7)%, 21.2 (12.3–31.5)%, 24.8 (16.1–34.7)%, 27.5 (19.1–37.7)% and 28.4 (19.6–38.8)% for those who interacted with the AI health coach on 1–4, 5–9, 10–19, 20–29, and 30+ days within the first 3 months. In the linear regression analysis, each additional 10 days spent in dialogs with the AI health coach were associated with an additional 2.7 pp increase in the share of Optimal scores (p-value < 0.001).
Conclusions: Higher usage of the AI health coach is associated with a higher average meal score and increased share of Optimal meals, indicating an improvement in nutritional quality of food choices.
Keywords: Nutrition, Behavior ChangeThis evaluation assessed the association between interactions with an AI coach and outcomes from a Nutrition Score (NS) designed to support weight loss and healthy eating within a mobile application.
Methods: Eligible app users from July 1, 2023 to June 30, 2024 who used the NS feature minimum 5 times per week for at least 75% of the weeks during the first 3 months in the app. The NS accounts for calorie density, protein, fiber, sugar, saturated and unsaturated fats, calcium and salt, and offers four ratings of food entries: Low, Fair, Good, or Optimal. Each meal score from Low to Optimal was assigned a number from 1 to 4. Average meal score and share of Optimal scores were variables of interest. The number of days with AI health coach interactions was the independent variable. Linear regression was adjusted for gender, age, fasting protocol, initial BMI category, and the average number of meal logs per week.
Results: The study involved 26,146 users. 66.35% were women, 35.5% were 60+ years. Median BMI was 32 (IQR 28.8–36.3) kg/m2. The median number of days with the AI health coach was 8 (IQR 3–19). The mean meal score was 2.87 (SD 0.32) and the share of Optimal scores was 21.2 (IQR 10.8–32.3)%. Share of Optimal scores in users who did not interact with the AI health coach was 5.1 (IQR 1.9–11.2)% and was 15.6 (6.6–26.7)%, 21.2 (12.3–31.5)%, 24.8 (16.1–34.7)%, 27.5 (19.1–37.7)% and 28.4 (19.6–38.8)% for those who interacted with the AI health coach on 1–4, 5–9, 10–19, 20–29, and 30+ days within the first 3 months. In the linear regression analysis, each additional 10 days spent in dialogs with the AI health coach were associated with an additional 2.7 pp increase in the share of Optimal scores (p-value < 0.001).
Conclusions: Higher usage of the AI health coach is associated with a higher average meal score and increased share of Optimal meals, indicating an improvement in nutritional quality of food choices.
Authors:
Author - Rosemary Huntriss,
BSc, MSc, MRes, RD,
Simple.Life Apps, Inc., Dover, DE, US
Co-Author - Dimitri Nikogosov,
MD,
Simple.Life Apps, Inc., Dover, DE, US
Co-Author - Rodion Salimgaraev,
MD,
Simple.Life Apps, Inc., Dover, DE, US
E68 - Relationship between the Healthy Eating Index and Metabolic Syndrome Risk among Adolescent Populations (12-19 yrs): An NHANES 2009-2018 analysis
Poster Number: E68Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Child and Family Health
Metabolic syndrome (MetS) is a group of interrelated risk factors that increases the risk of future cardiovascular and metabolic diseases. Understanding how MetS is related to specific dietary factors can help researchers, practitioners, and policymakers to develop interventions to prevent or reduce MetS. This study evaluated the relationship between Healthy Eating Index (HEI) scores and MetS status within adolescent populations utilizing the National Health and Nutrition Evaluation Survey (NHANES). We conducted a cross-sectional analysis using NHANES data from 5 waves, 2009-2018 , to examine the relationship between MetS status and HEI score among adolescents (12-19-years-old). Bivariate analyses were used to identify factors related to MetS status, which were further examined in multivariable regression models. Additional sub analyses were performed to evaluate the relationship between HEI’s 13 individual components (e.g., total fruits, fatty acids), MetS and its components (waist circumference, triglyceride, blood pressure, fasting glucose, and HDL-cholesterol). The overall weighted prevalence of MetS within the sample was 6.40% (n=2236 ; mean age 15.47±0.06 years; 52.03% male; and 54.85% non-Hispanic white [NH-White]). HEI total score was lower for those with MetS (43.87±0.88) vs. those without MetS (47.28±0.39) (t=3.64, p=<0.001) and it was a significant protective factor for MetS risk in the bivariate (OR=0.980, 95%CI:0.963-0.996 , p=0.017) and multivariable models (OR=0.973, 95% CI:0.954, 0.993, p=0.010). In sub analyses, higher amounts of fatty acids and lower amounts of saturated fats were found to significantly (p<0.05) reduce odds of MetS risk (aOR=0.884, aOR=0.898), HDL-cholesterol risk (aOR=0.953, aOR=0.950), and glucose risk (aOR=0.960, aOR=0.920). No other components of HEI were related to reduced risk. HEI total score and some of its specific nutrient components were found to significantly reduce the odds of MetS risk among adolescents. Based on the results of this study, increasing the ratio of unsaturated fatty acids to saturated fatty acids by one HEI point could reduce risk by up to 12%. Foods that could be emphasized to improve this ratio include salmon, walnuts, soybeans, and tofu. Similarly, reducing saturated fats by one HEI point could reduce risk by up to 10%. Food that could be limited include red meat, cheese and other full-fat dairy products, and processed meats.
Keywords: Nutrition, Population healthAuthors:
Co-Author - Jacob Szeszulski, PhD,
PhD,
Texas A&M AgriLife Research
Co-Author - Timothy A. Erickson,
PhD,
Texas A&M University School of Public Health
E69 - Weight Bias Internalization and Disordered Eating: Examining the Role of Sexual Orientation in a Sample of Women who Binge Eat
Poster Number: E69Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Health of Marginalized Populations
Disordered eating (i.e., binge eating, restriction, purging) impacts multiple areas of health, including cardiovascular and reproductive health, and weight status. Weight bias internalization (WBI), or self-directed negative attitudes about oneself due to weight, is a significant, yet understudied correlate of disordered eating and is associated with negative health outcomes. Risk for disordered eating is particularly important to consider among historically marginalized groups, such as sexual minority women (i.e., lesbian, bisexual, queer), who are at an increased risk relative to their heterosexual peers for negative health outcomes. Given the exacerbating effect of minority stress on health risks, WBI may differentially impact sexual minority and heterosexual women. This study aimed to examine associations between WBI and various disordered eating symptoms (i.e., binge eating, restriction, cognitive restraint, purging, excessive exercise, muscle building) among heterosexual and sexual minority women, and examine whether sexual orientation moderates these associations. Participants were 316 young adult women (Mage=25.3, SD=3.4) with diverse sexual orientations (51% heterosexual, 49% sexual minority) who binge eat. Measures of disordered eating behaviors and WBI were collected via an online survey. Results revealed most disordered eating symptoms (i.e., binge eating, restriction, cognitive restraint, excessive exercise, muscle building) were similarly prevalent across sexual orientation groups (ps>.06), with the exception of purging, which heterosexual women were significantly more likely to engage in than sexual minority women (p=.008). WBI was significantly associated with all disordered eating symptoms (ps<.035), except dietary restriction (p=.32), such that greater WBI was associated with higher engagement in disordered eating. Sexual minority status did not significantly moderate any of the WBI-disordered eating associations (ps>.10). Findings suggest WBI and disordered eating rates and associations appear largely similar regardless of sexual orientation, among a sample of young women who binge eat. Further research may address gaps in knowledge of risk factors and longitudinal impact of WBI on disordered eating in other populations (e.g., non-binge eating samples, sexual minority subgroups, other genders). Such research could aid in the development of treatment and prevention strategies aimed at reducing the impact of WBI for all women.
Keywords: Sexual orientation, Health disparitiesAuthors:
Presenter - Meredith I. Turner,
Virginia Consortium Program in Clinical Psychology
Co-Author - Abby Braitman, PhD,
PhD,
Old Dominion University
Co-Author - Kristin E. Heron, PhD, FSBM,
PhD, FSBM,
Old Dominion University
E70 - Using Google Search Ads to Promote Firearm Safety in Military Veterans: A Mixed Methods Study
Poster Number: E70Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Military and Veterans' Health
Objective: An estimated 40,000 Google searches occur every second, and Google Ads are increasingly used in public health campaigns. While industry data suggest industry average of a ~3-6% click-through rate (CTR) on search ads, there is a scarcity of research examining their impact on awareness about health hazards, including firearms injuries and deaths. The Department of Veterans Affairs (VA) conducted a national paid media campaign called "Keep It Secure” to address firearms safety in military veterans. This study aimed to characterize the types of Google searches included in the campaign and determine their association with campaign engagement.
Methods: We used an immersion/crystallization method to qualitatively identify categories and verify classifications until pattern saturation was reached, resulting in categorization of 47,387 out of 59,587 unique Google searches contained in the campaign. We applied generalized mixed modeling to compare proportion of ads with clicks, and average CTR across search categories.
Results: Using Google Ads, the Keep It Secure campaign resulted in a total of 1,849,077 impressions and 342,747 clicks to the campaign website, for an overall CTR of 18.5%. We identified 10 overarching search categories: Gun Storage, General VA Inquiries, Veteran Resources, Prevention, Mental Health, Crisis Line, Suicidal Ideation, Safety Class, Policy, and Homelessness. Searches unrelated to firearms or suicide were associated with higher campaign engagement. Searches related to homelessness (52.6%, standard error [SE]=2.4%), veteran resources (45.1%, SE=0.7%), and general VA topics (40.9%, SE=0.5%) had the highest proportion of ad clicks, while searches related to suicidal ideation had the lowest (10.9%, SE=0.6%). Further, after excluding searches with no clicks, Policy searches had the highest CTR (39.1%, SE=0.8%), Mental Health (17.0%, SE=0.8%), Crisis Line (16.1%, SE=0.8%), Suicidal Ideation (15.4%, SE=1.5%), and Prevention (14.2%, SE=0.8%) had the lowest CTRs.
Conclusions: Using Google Ads in a national firearms safety campaign was effective at generating campaign awareness and resulted in an overall high rate of engagement compared to industry averages. For firearms safety among veterans, targeting users searching for information of general interest to the VA and veterans may be useful targets for firearms safety campaigns.
Keywords: Public health, Health promotionMethods: We used an immersion/crystallization method to qualitatively identify categories and verify classifications until pattern saturation was reached, resulting in categorization of 47,387 out of 59,587 unique Google searches contained in the campaign. We applied generalized mixed modeling to compare proportion of ads with clicks, and average CTR across search categories.
Results: Using Google Ads, the Keep It Secure campaign resulted in a total of 1,849,077 impressions and 342,747 clicks to the campaign website, for an overall CTR of 18.5%. We identified 10 overarching search categories: Gun Storage, General VA Inquiries, Veteran Resources, Prevention, Mental Health, Crisis Line, Suicidal Ideation, Safety Class, Policy, and Homelessness. Searches unrelated to firearms or suicide were associated with higher campaign engagement. Searches related to homelessness (52.6%, standard error [SE]=2.4%), veteran resources (45.1%, SE=0.7%), and general VA topics (40.9%, SE=0.5%) had the highest proportion of ad clicks, while searches related to suicidal ideation had the lowest (10.9%, SE=0.6%). Further, after excluding searches with no clicks, Policy searches had the highest CTR (39.1%, SE=0.8%), Mental Health (17.0%, SE=0.8%), Crisis Line (16.1%, SE=0.8%), Suicidal Ideation (15.4%, SE=1.5%), and Prevention (14.2%, SE=0.8%) had the lowest CTRs.
Conclusions: Using Google Ads in a national firearms safety campaign was effective at generating campaign awareness and resulted in an overall high rate of engagement compared to industry averages. For firearms safety among veterans, targeting users searching for information of general interest to the VA and veterans may be useful targets for firearms safety campaigns.
Authors:
Author - Alan R. Teo,
MD,
VA Portland Health Care System
Co-Author - Sean P.M. Rice,
PhD, MS,
School of Public Health, Oregon Health & Science University-Portland State University
Co-Author - Summer Newell,
PhD, MPH,
VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)
E71 - The Impact of Providing Guided Choice in a Virtual Prevention Program
Poster Number: E71Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Decision Making
Background: Virtual programs grounded in evidence-based health behavior strategies can provide effective between-visit care to improve health outcomes for individuals with cardiometabolic disease risk. Personalization may promote compassionate and engaging patient-centered care in these programs. We evaluated the impact on program engagement of providing members enrolled in a virtual lifestyle prevention program (Omada for Prevention) the opportunity to make a guided decision about the theme of the curriculum they receive vs providing content in a standardized order.
Methods: The intervention group consisted of members who indicated managing food cravings as a barrier to engaging in healthy lifestyle behaviors in a survey at program baseline. They were given the opportunity to select their “learning paths” at baseline and again at week 4. Paths are 3-4 week focus areas of content around specific health behavior topics surfaced based on member inputs and core curriculum needs. The usual care group was identified using 1:1 propensity score matching to members who indicated other food and drink related barriers and received standardized curriculum without the opportunity to select their learning paths. Member engagement metrics were compared through the first 7 program weeks, which included the first 2 learning paths. Chi-squared tests were used to evaluate categorical variable differences and t-tests were used to evaluate mean differences in continuous variables.
Results: Members were 72% female, 72% white, and had an average baseline BMI of 34.7 with no significant differences between the intervention (n=1373) and usual care (n=1436) groups. During the first 4-week path, intervention members were 9% more likely to establish rapport (i.e. send a message in response to outreach) with their care team and 4.5% more likely to set goals (both p<.01) compared to the usual care group. After 7 weeks, the intervention group had sent 20% more messages per week to the care team (p<.01), set 13% more goals (p<.01), and had 6% more physically active days (p=0.05) compared to the usual care group.
Conclusion: Virtual prevention program members who had the opportunity to choose their learning paths engaged with the program significantly more in a number of meaningful ways than members who were not given the option to choose. Results suggest that empowering members with moments of guided choice could meaningfully support the uptake of health behavior change strategies.
Keywords: Health behavior change, InterventionMethods: The intervention group consisted of members who indicated managing food cravings as a barrier to engaging in healthy lifestyle behaviors in a survey at program baseline. They were given the opportunity to select their “learning paths” at baseline and again at week 4. Paths are 3-4 week focus areas of content around specific health behavior topics surfaced based on member inputs and core curriculum needs. The usual care group was identified using 1:1 propensity score matching to members who indicated other food and drink related barriers and received standardized curriculum without the opportunity to select their learning paths. Member engagement metrics were compared through the first 7 program weeks, which included the first 2 learning paths. Chi-squared tests were used to evaluate categorical variable differences and t-tests were used to evaluate mean differences in continuous variables.
Results: Members were 72% female, 72% white, and had an average baseline BMI of 34.7 with no significant differences between the intervention (n=1373) and usual care (n=1436) groups. During the first 4-week path, intervention members were 9% more likely to establish rapport (i.e. send a message in response to outreach) with their care team and 4.5% more likely to set goals (both p<.01) compared to the usual care group. After 7 weeks, the intervention group had sent 20% more messages per week to the care team (p<.01), set 13% more goals (p<.01), and had 6% more physically active days (p=0.05) compared to the usual care group.
Conclusion: Virtual prevention program members who had the opportunity to choose their learning paths engaged with the program significantly more in a number of meaningful ways than members who were not given the option to choose. Results suggest that empowering members with moments of guided choice could meaningfully support the uptake of health behavior change strategies.
Authors:
Presenter - Susan Devaraj,
PhD, MS, RD,
Omada Health
Co-Author - Sean Zion,
PhD,
Omada Health
Co-Author - Sarah Linke, PhD, MPH,
PhD, MPH,
Omada Health
E72 - Why people who inject drugs accepted vaccination against COVID after completing a technology-based intervention
Poster Number: E72Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Community Engagement
Due to stigma and a lack of access to healthcare people who inject drugs (PWID) face dramatically increased risk from COVID-19. Among African American and Latino PWID, these risks are exacerbated by widespread structural racism. Although vaccines became widely available free of charge in 2021, and numerous agencies offered financial incentives to vaccinate, many highly vulnerable PWID remain completely unvaccinated against COVID and decline opportunities to vaccinate when offered.
To address this, our team collaborated with a community-based harm reduction organization in East Harlem, NYC, to develop and evaluate a technology-based intervention designed to increase vaccination against COVID among PWID. We first conducted a series of formative interviews (n=50) to determine barriers to vaccination among our target population, and ways media could potentially encourage people to accept vaccination when offered (preliminary results reported at SBM 2022.) Based on our findings, we developed an intervention incorporating video and MMS messaging in English and Spanish then conducted a clinical trial with people who report injection drug use in the past 90 days and who had never vaccinated against COVID-19.
The video was developed specifically to respond to barriers identified in formative research, including misinformation about vaccine dangers (e.g. side effects), and to build upon facilitators (i.e. desire to protect older family members or children). Both were mentioned by participants as reasons they vaccinated post-intervention. Data also indicate that including recognizable community members in our intervention messaging, enabling participants to ask questions without pressure, and to return for multiple intervention visits in a trusted community-based setting, contributed to participant decisions to vaccinate.
Evaluation data show that before our study, many participants never had an opportunity to discuss benefits of vaccination in a supportive, non-stigmatizing environment. As initially suggested by our formative work, providing basic health education in a community setting and creating intervention messaging that emphasizes the perspectives of peers rather than physicians, resulted in decisions to vaccinate among people who had previously declined. Similar approaches may facilitate positive changes in other health behaviors among additional populations that experience health disparities.
Keywords: e-Health, Community interventionTo address this, our team collaborated with a community-based harm reduction organization in East Harlem, NYC, to develop and evaluate a technology-based intervention designed to increase vaccination against COVID among PWID. We first conducted a series of formative interviews (n=50) to determine barriers to vaccination among our target population, and ways media could potentially encourage people to accept vaccination when offered (preliminary results reported at SBM 2022.) Based on our findings, we developed an intervention incorporating video and MMS messaging in English and Spanish then conducted a clinical trial with people who report injection drug use in the past 90 days and who had never vaccinated against COVID-19.
The video was developed specifically to respond to barriers identified in formative research, including misinformation about vaccine dangers (e.g. side effects), and to build upon facilitators (i.e. desire to protect older family members or children). Both were mentioned by participants as reasons they vaccinated post-intervention. Data also indicate that including recognizable community members in our intervention messaging, enabling participants to ask questions without pressure, and to return for multiple intervention visits in a trusted community-based setting, contributed to participant decisions to vaccinate.
Evaluation data show that before our study, many participants never had an opportunity to discuss benefits of vaccination in a supportive, non-stigmatizing environment. As initially suggested by our formative work, providing basic health education in a community setting and creating intervention messaging that emphasizes the perspectives of peers rather than physicians, resulted in decisions to vaccinate among people who had previously declined. Similar approaches may facilitate positive changes in other health behaviors among additional populations that experience health disparities.
Authors:
Author - Ian Aronson,
Ph.D.,
NDRI-USA
Author - Quiles,
NDRI-USA
Presenter - Anthony Cramer,
NDRI-USA
Author - Brittney Vargas-Estrella,
OnPoint NYC
Author - Brent Gibson,
Ph.D,
OnPoint NYC
Author - Synn Stern,
RN, MPH,
OnPoint NYC
Author - Alex S. Bennett,
Ph.D,
NYU School of Global Public Health
E73 - A scoping review of frameworks used for cultural adaptation of digital behavioral interventions
Poster Number: E73Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Methods and Measurement
Few frameworks exist to guide the cultural adaptation of digital behavioral interventions to ensure reach, relevance, appropriateness, and engagement among historically marginalized and underrepresented groups. We conducted a scoping review of the literature to identify and characterize the cultural adaptation frameworks used, highlighting the common and unique features across frameworks, and to summarize the adaptation process and methods used.
We conducted a systematic search of studies published between 2007-2024 using five academic databases. Articles were included if peer-reviewed, in English language, reported the cultural adaptation of an existing, efficacious behavioral intervention for digital delivery in racial, ethnic, or LGBTQ+ minorities, or rural and resource-poor settings. At least two co-authors independently extracted data from included articles using an a priori developed web-based extraction form. Inter-rater reliability was high, and conflicts were resolved with adjudication if necessary.
Of 90 articles included, 72 were from the global north, 33 quantitative, 29 qualitative, and 28 mixed methods. Clinical outcomes included mental health (n=24), metabolic conditions (n=19), substance use (n=16), infectious diseases (n=9), cardiovascular disease (n=6), cancer (n=5), and other diagnoses (n=11). Twelve articles reported adaptations made for people of marginalized race, 16 for people of marginalized ethnicity, 8 for LGBTQ+ people, 13 for resource-poor settings, 5 for people in rural areas, and 35 for more than one group. Only 30 articles explicitly mentioned a guiding framework for the adaptation process, 8 described guiding principles or theories with no clear framework, and 52 did not mention how adaptation was guided.
Findings indicate that most cultural adaptation of digital health interventions are completed without frameworks to inform the appropriateness and relevance for marginalized groups. Many cultural adaptation processes were employed for digital interventions for behavioral and metabolic conditions; few were employed for infectious and chronic diseases. There is a gap in adapted digital health interventions for people living in rural areas and LGBTQ+ persons.
These findings support the need for a more systematized, evidence-based approach to culturally adapting digital behavioral health interventions to make them more appropriate, scalable, and effective in the groups of marginalized people they are intended to benefit.
Keywords: Technologies, Minority groupsWe conducted a systematic search of studies published between 2007-2024 using five academic databases. Articles were included if peer-reviewed, in English language, reported the cultural adaptation of an existing, efficacious behavioral intervention for digital delivery in racial, ethnic, or LGBTQ+ minorities, or rural and resource-poor settings. At least two co-authors independently extracted data from included articles using an a priori developed web-based extraction form. Inter-rater reliability was high, and conflicts were resolved with adjudication if necessary.
Of 90 articles included, 72 were from the global north, 33 quantitative, 29 qualitative, and 28 mixed methods. Clinical outcomes included mental health (n=24), metabolic conditions (n=19), substance use (n=16), infectious diseases (n=9), cardiovascular disease (n=6), cancer (n=5), and other diagnoses (n=11). Twelve articles reported adaptations made for people of marginalized race, 16 for people of marginalized ethnicity, 8 for LGBTQ+ people, 13 for resource-poor settings, 5 for people in rural areas, and 35 for more than one group. Only 30 articles explicitly mentioned a guiding framework for the adaptation process, 8 described guiding principles or theories with no clear framework, and 52 did not mention how adaptation was guided.
Findings indicate that most cultural adaptation of digital health interventions are completed without frameworks to inform the appropriateness and relevance for marginalized groups. Many cultural adaptation processes were employed for digital interventions for behavioral and metabolic conditions; few were employed for infectious and chronic diseases. There is a gap in adapted digital health interventions for people living in rural areas and LGBTQ+ persons.
These findings support the need for a more systematized, evidence-based approach to culturally adapting digital behavioral health interventions to make them more appropriate, scalable, and effective in the groups of marginalized people they are intended to benefit.
Authors:
Co-Author - Kassandra I. Alcaraz, PhD, MPH,
PhD, MPH,
Johns Hopkins University
Co-Author - Acadia W. Buro, PhD,
PhD,
University of New Mexico Health Sciences Center
Co-Author - Rosario Costas-Muñiz, PhD,
PhD,
Memorial Sloan Kettering Cancer Center
Co-Author - Sherecce Fields, PhD,
PhD,
Texas A&M University
Co-Author - Kristin Heron, PhD,
PhD,
Old Dominion University
Co-Author - Kelseanna Hollis-Hansen, MPH, PHD,
MPH, PHD,
UT Southwestern Medical Center
Co-Author - Isabelle S. Kusters,
PhD, MPH,
University of Houston-Clear Lake
Co-Author - Brian Lo, PhD, MPH, RD,
PhD,
University of Guelph
Co-Author - Veronica P.S. Njie-Carr,
RN, PhD,
University of Maryland, Baltimore School of Nursing
Co-Author - Emily Panza, PhD,
Brown Alpert Medical School/The Miriam Hospital
Co-Author - Patricia Pedreira,
MS,
Duke University Medical Center
Co-Author - Giovanna Porta,
MS,
University of Pittsburgh Medical Center
Co-Author - Kayla E. Sall, PhD,
PhD,
Alpert Medical School of Brown University
Co-Author - Tylar Schmitt,
BA,
University of Pittsburgh Medical Center
Co-Author - Dylan Serpas,
MS,
University of South Florida
Co-Author - Rachel Suppok,
MLIS,
University of Pittsburgh
Co-Author - Adati Tarfa, PharmD, MS, PhD,
PharmD, MS, PhD,
Yale University
Co-Author - Guillermo Wippold,
PhD,
University of South Carolina
Co-Author - Jean Yi,
PhD,
Fred Hutchinson Cancer Center
E74 - Assessing Feasibility, Acceptability, and Usability of a Digital Health Self-Monitoring Pilot Program for Veterans with Type 2 Diabetes
Poster Number: E74Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Diabetes
Increasing adoption of digital technologies for healthcare has the potential for a new dimension in self-management of chronic disease, but many lack the support necessary to make these tools useful in the day-to-day management of their conditions. The Veterans Affairs Healthcare System is prioritizing how Veterans can access, utilize, and benefit from these technologies. We assessed the feasibility, acceptability, and usability of a self-monitoring program offering digital health wearables to promote self-management among Veterans with type 2 diabetes.
Adults receiving care at the Veterans Medical Center in West Haven Connecticut with type 2 diabetes, using a continuous glucose monitor, and consenting to share their data were eligible to participate in the program. Participants were given a smartwatch (Fitbit) and mobile diet-tracking application to collect biometric data. Participants received a weekly report that incorporated various data elements (e.g., diet, sleep, physical activity, medication) visualized all-in-one-place, and discussed the report with a health coach to gain insights and strategies for behavioral change. A post-program REDCap survey was sent to participants for program evaluation, which included questions about feasibility, acceptability, and usability (e.g. Feasibility of Intervention [FIM, Cronbach’s alpha=0.89 ], Acceptability of Intervention [AIM, Cronbach’s alpha=0.85 ], Intervention Appropriateness Measure [IAM, Cronbach’s alpha=0.91], each measure has 4 items, completely disagree [1] to completely agree [5]; System Usability Score [SUS], 10 items, score range 0 to 100; Net Promoter Score [NPS], 1 item, score range -100 to 100).
All 12 participants (25% female, median age 68, 21% non-white/multiracial, 23% not married, 42% <50K household income; 92% GED/high school) completed the program. The majority of participants (>80%) responded “completely agree” or “agree” to questions regarding the program’s feasibility, acceptability, and intervention appropriateness. Usability was demonstrated by SUS of 87.5 (85 = excellent), indicating high perceived usability, and NPS of 36 (>20 = favorable), indicating participants found value in the program.
High perceived feasibility, usability, and acceptability of this self-monitoring program, which leverages digital health tools to integrate diverse data streams into a single platform, highlights a promising new approach to supporting Veterans in the self-management of type-2 diabetes.
Keywords: Diabetes, e-HealthAdults receiving care at the Veterans Medical Center in West Haven Connecticut with type 2 diabetes, using a continuous glucose monitor, and consenting to share their data were eligible to participate in the program. Participants were given a smartwatch (Fitbit) and mobile diet-tracking application to collect biometric data. Participants received a weekly report that incorporated various data elements (e.g., diet, sleep, physical activity, medication) visualized all-in-one-place, and discussed the report with a health coach to gain insights and strategies for behavioral change. A post-program REDCap survey was sent to participants for program evaluation, which included questions about feasibility, acceptability, and usability (e.g. Feasibility of Intervention [FIM, Cronbach’s alpha=0.89 ], Acceptability of Intervention [AIM, Cronbach’s alpha=0.85 ], Intervention Appropriateness Measure [IAM, Cronbach’s alpha=0.91], each measure has 4 items, completely disagree [1] to completely agree [5]; System Usability Score [SUS], 10 items, score range 0 to 100; Net Promoter Score [NPS], 1 item, score range -100 to 100).
All 12 participants (25% female, median age 68, 21% non-white/multiracial, 23% not married, 42% <50K household income; 92% GED/high school) completed the program. The majority of participants (>80%) responded “completely agree” or “agree” to questions regarding the program’s feasibility, acceptability, and intervention appropriateness. Usability was demonstrated by SUS of 87.5 (85 = excellent), indicating high perceived usability, and NPS of 36 (>20 = favorable), indicating participants found value in the program.
High perceived feasibility, usability, and acceptability of this self-monitoring program, which leverages digital health tools to integrate diverse data streams into a single platform, highlights a promising new approach to supporting Veterans in the self-management of type-2 diabetes.
Authors:
Author - Joshua Lacko,
MPH,
VA HSR&D
Co-Author - Garrett Ash,
PHD,
Yale School of Medicine, VA Connecticut Healthcare System
Co-Author - Dora Lendvai, PhD,
PhD,
VA Connecticut Healthcare System
Co-Author - Erin Der-Mcleod,
MS,
VA HSR&D
Co-Author - Rebecca Kinney,
MPH, PHD,
Veterans Healthcare Administration
Co-Author - Vanessa Chuang,
UCLA
Co-Author - Varmin Samuel,
MD,
VA Connecticut Healthcare System
Co-Author - Zhaoping Li,
MD,
VA HSR&D
Co-Author - Constance Fung,
MD,
VA HSR&D
Co-Author - Selene Mak,
PHD, MPH,
VA HSR&D
E75 - College Students’ OpennessTowards Mobile-Based Mental Health Applications
Poster Number: E75Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Stress
Once in college, three-fourths of all lifetime mental health disorders have an onset between 18-24 years. Marginalized groups are at an even higher risk of for developing both mental and physical health related concerns. For example, individuals coming from a lower socio-economic status (SES) are more prone to experience high-stress levels, and anxiety disorders are more common within lower-education and lower-income groups. Yet, information regarding college student attitudes on targeted mental health interventions is limited. Accessibility barriers, such as insufficient or no health insurance coverage or inconvenient location or business hours, and availability factors, such as inadequate or complete absence of available treatment and long waitlists to enter treatment, are critical factors that impede college students from accessing care. In the era of digitalization, technology has been considered as a possible mediator to deconstruct such barriers to care. Furthermore, current college students are among one of the first generations to have grown up alongside the existence of social media and the widespread use of devices such as laptops and smartphones, and may prefer technology-based interventions. In the relatively new mobile health application (MHA) field, research examining college students' attitudes towards mindfulness stress management MHA is limited and further lacking is examining attitudes along socioeconomic status (SES), ethnicity, and first-generation college students (FGCS) status. The researchers generated and administered a web-based questionnaire, “Attitudes Towards Stress Management Mobile Apps Questionnaire” to college students that were recruited in a classroom setting. Female college students were found to be more interested in using stress and anxiety self-help applications because they are conveniently available for use on their phone. Additionally, it was found that when compared to black, indigenous, and people of color (BIPOC) students, white students are more likely to download mental health self-help applications that have been recommended by friends/family and healthcare professionals. The findings have important implications in the administration of mobile mental-health based interventions. Future research could focus specifically on how to tailor digital interventions to the needs and preferences of specific populations.
Keywords: Mobile phone, TechnologiesAuthors:
Co-Author - Juliann Sergi McBrayer,
Ed.D.,
Georgia Southern University
Co-Author - Steven Tolman,
Ed.D.,
Georgia Southern University
Co-Author - Pamela Wells,
Ph.D.,
Georgia Southern University
Co-Author - Monika Krah,
Georgia Southern University
E76 - HIV Medication Safety, Efficacy, and Side Effects from Four Artificial Intelligence Platforms: A Thematic Analysis
Poster Number: E76Time: 05:00 PM - 05:50 PM
Topics: Digital Health, HIV/AIDS
Background: Artificial intelligence (AI) chatbots have dramatically shifted people’s access to healthcare information. Individuals living with or at risk for HIV require access to precise and specialized care information to address their health-related concerns. Despite the surge in AI usage, a dearth of empirical evidence evaluating AI-delivered HIV health information remains. The aims of this study were to examine the complexity of content provided by AI platforms and the availability of actionable information related to the safety, side effects, and efficacy of HIV prevention and medication treatments.
Methods: Across four weeks, four AI platforms (ChatGPT 3.5, ChatGPT 4.0, Google Bard, and HIV.Gov Chatbot) were asked unique questions (n=38) regarding the safety, side effects, and efficacy of medications used to prevent and treat HIV. AI chatbot responses (n=608) were recorded verbatim – separated by week and platform – and qualitatively inspected for key themes. Dual-coder content analysis was employed to examine the consistency of codes across weeks and platforms via NVivo. AI-delivered responses were evaluated for their complexity (number of themes in a response) and availability of actionable information (number of recommendations to consult with a healthcare professional).
Results: Health Recommendations to speak with a medical professional for further information were present in most of the responses across platforms. Gastrointestinal side effects were the most prevalent side effect coded, while lactic acidosis, a potentially fatal side effect, was the least coded. ChatGPT 4.0 produced the highest frequency of codes and greatest degree of content complexity. Google Bard produced the greatest sum of codes and had the greatest variance in their response complexity. HIV.Gov Chatbot exhibited both the lowest frequency and sum of codes.
Conclusions: Across four weeks, AI platforms consistently provided health information on the safety, side effects, and efficacy of HIV medications. The safety and efficacy of medications were never questioned across platforms. Consistent with the specialized care required to treat and prevent HIV, all AI platforms emphasized consulting with a medical professional to receive personalized care.
This work was funded by the National Institute on Alcohol Abuse and Alcoholism grant R01AA030486 and the National Institute on Drug Abuse grant R61/R33 DA048439.
Keywords: HIV, Health communicationMethods: Across four weeks, four AI platforms (ChatGPT 3.5, ChatGPT 4.0, Google Bard, and HIV.Gov Chatbot) were asked unique questions (n=38) regarding the safety, side effects, and efficacy of medications used to prevent and treat HIV. AI chatbot responses (n=608) were recorded verbatim – separated by week and platform – and qualitatively inspected for key themes. Dual-coder content analysis was employed to examine the consistency of codes across weeks and platforms via NVivo. AI-delivered responses were evaluated for their complexity (number of themes in a response) and availability of actionable information (number of recommendations to consult with a healthcare professional).
Results: Health Recommendations to speak with a medical professional for further information were present in most of the responses across platforms. Gastrointestinal side effects were the most prevalent side effect coded, while lactic acidosis, a potentially fatal side effect, was the least coded. ChatGPT 4.0 produced the highest frequency of codes and greatest degree of content complexity. Google Bard produced the greatest sum of codes and had the greatest variance in their response complexity. HIV.Gov Chatbot exhibited both the lowest frequency and sum of codes.
Conclusions: Across four weeks, AI platforms consistently provided health information on the safety, side effects, and efficacy of HIV medications. The safety and efficacy of medications were never questioned across platforms. Consistent with the specialized care required to treat and prevent HIV, all AI platforms emphasized consulting with a medical professional to receive personalized care.
This work was funded by the National Institute on Alcohol Abuse and Alcoholism grant R01AA030486 and the National Institute on Drug Abuse grant R61/R33 DA048439.
Authors:
Author - Stephen Beegle,
Purdue University
Presenter - Luis A. Gomez,
Purdue University
Co-Author - Jason T. Blackard,
University of Cincinnati College of Medicine
Co-Author - Bingfang Yan,
University of Cincinnati
Co-Author - Jaime Robertson,
University of Cincinnati College of Medicine
Co-Author - Kevin T. Fedders,
University of Cincinnati College of Medicine
Co-Author - Linh Dinh,
University of Cincinnati
Co-Author - L. Adrienne Crusey,
University of Cincinnati College of Medicine
Co-Author - Shaina Horner,
University of Cincinnati College of Medicine
Co-Author - Heidi L. Meeds,
University of Cincinnati College of Medicine
Co-Author - William Liu,
University of Cincinnati
Co-Author - T. Dylanne Twitty,
University of Cincinnati
Co-Author - Jennifer L. Brown, PhD, FSBM,
PhD, FSBM,
Purdue University
E77 - Examining engagement amongst mobile health app users: a 6-month latent class analysis study
Poster Number: E77Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Multiple Health Behavior Change
BACKGROUND: Mobile health application (mHealth app) effectiveness may be limited by low engagement. Increasing understanding of factors influencing engagement may help. mHealth app subscription and renewal are two metrics of interest to commercial app publishers. PURPOSE: To identify homogenous user subgroups (i.e., behavioural phenotypes) within a paid mHealth app context and examine associations with subscription and renewal. METHODS: A 6-month latent class analysis (LCA) study was conducted with new users of the WayBetter app, an mHealth app with financial incentives. Users completing a 7-day free trial between November 2, 2023 and January 3, 2024 were included. LCA produced phenotypes using (1) purpose-built survey responses (e.g., socio-demographics, previous health behaviours, personality traits), (2) device assessed health data (e.g., daily step count), and (3) 7-day trial period engagement data (e.g., number of app opens). Odds ratios (OR; p<0.05) assessed associations between phenotypes and 6-month subscription (i.e., $69 USD) and 6-month renewal (i.e., additional $69 USD). RESULTS: The total sample included 934 users (Age [SD]=42.00 [9.65] years; % women=91.10%). Based on key LCA fit indices (e.g., Vuong-Lo-Mendell-Rubin likelihood test=467.16, p=0.032), and theoretical interpretability, five distinct phenotypes were formed: (1) Highly Engaged Subscribers, (2) Subscribers with Multimorbidity, (3) Healthy Subscribers, (4) Non-subscribers with Multimorbidity, and (5) Healthy Non-Subscribers. Phenotypes 1, 2, and 3 had greater odds of subscribing (OR=21.31, [8.56,53.06]; OR=7.11, [4.04,12.50]; OR=8.28, [4.26,16.08], respectively) than phenotype 4 (OR=0.82, [0.48,1.41]), compared to phenotype 5, the reference. As well, the odds phenotypes 1, 2, 3 and 4 renewed were OR=1.06, [0.62,1.81]; OR=0.900, [0.54,1.49]; OR=0.99, [1.0,1.8], OR=0.5, [0.3,0.7], respectively (compared to the reference class phenotype 5). CONCLUSION: Behavioural phenotypes likely or not to subscribe were identified using data collected during the 7-day free trial period. These may be targeted with future intervention.
Keywords: Behavior Change, e-HealthAuthors:
Author - Julia Incitti,
Western University
E78 - Exploring Behavior Change Techniques in Large-Scale Digital Health Interventions (DHIs) for Effective Health Promotion
Poster Number: E78Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Multiple Health Behavior Change
Background: DHI designers use The Theory and Techniques Tool (TTT) to analyze evidence from a range of behavior change interventions. Complementary data from large-scale reinforcement learning (RL) driven DHIs (promoting vaccination, preventive cancer screenings, annual well visits, diabetes management, and digital engagement) can extend TTT’s usefulness and generalizability.
Objective: To summarize Behavior Change Technique-Mechanism of Action (BCT-MoA) links from RL-driven DHIs that complement and challenge TTT evidence.
Methods: We created a heat map of 39 BCTs and 19 MoAs, with 98 cells populated with data from DHIs. Each cell represents the outcome of using the BCT-MoA link. Outcomes are defined as the proportion of people who completed the target behavior (e.g., got COVID-19 vaccine, attended screening) after receiving a message with content leveraging the BCT-MOA link, normalized within each DHI.
Results: Outcomes were analyzed from 12 DHIs reaching 3,618,518 people. The BCTs with the highest attribution rates were problem solving, social support (unspecified), prosocial, goal setting, information about emotional consequences, conserving mental resources, commitment, and instruction on how to perform a behavior. Problem solving linked to 'Environmental Context and Resources' (ECR) had a 91% attribution rate for colonoscopy interventions, meaning that when a message using problem solving and MoA ECR was sent, 91% of the time, this message was the last message received before the person took action. Commitment consistency linked with 'Values' had a 100% attribution rate for COVID-19 vaccinations, 63%-100% for mammograms, and 41% for colonoscopies. These BCTs-MoAs pairings have "inconclusive evidence" in the TTT.
Conclusion: Studying BCT-MOA links in DHIs can complement the TTT and contribute to building effective health promotion initiatives. However, the context in which BCTs are used may also have an impact on their effectiveness and this warrants further research.
Keywords: Effectiveness, TechnologiesObjective: To summarize Behavior Change Technique-Mechanism of Action (BCT-MoA) links from RL-driven DHIs that complement and challenge TTT evidence.
Methods: We created a heat map of 39 BCTs and 19 MoAs, with 98 cells populated with data from DHIs. Each cell represents the outcome of using the BCT-MoA link. Outcomes are defined as the proportion of people who completed the target behavior (e.g., got COVID-19 vaccine, attended screening) after receiving a message with content leveraging the BCT-MOA link, normalized within each DHI.
Results: Outcomes were analyzed from 12 DHIs reaching 3,618,518 people. The BCTs with the highest attribution rates were problem solving, social support (unspecified), prosocial, goal setting, information about emotional consequences, conserving mental resources, commitment, and instruction on how to perform a behavior. Problem solving linked to 'Environmental Context and Resources' (ECR) had a 91% attribution rate for colonoscopy interventions, meaning that when a message using problem solving and MoA ECR was sent, 91% of the time, this message was the last message received before the person took action. Commitment consistency linked with 'Values' had a 100% attribution rate for COVID-19 vaccinations, 63%-100% for mammograms, and 41% for colonoscopies. These BCTs-MoAs pairings have "inconclusive evidence" in the TTT.
Conclusion: Studying BCT-MOA links in DHIs can complement the TTT and contribute to building effective health promotion initiatives. However, the context in which BCTs are used may also have an impact on their effectiveness and this warrants further research.
Authors:
Presenter - Sasha Clynes,
DrPH,
Lirio
Co-Author - Sarah Deedat, PhD,
PhD,
Lirio
Co-Author - Amy Bucher,
PhD, MA,
Lirio
Co-Author - Eva Susanne Blazek,
PhD,
Stripe
E79 - Digital mind-body interventions to improve mental well-being in pregnant racial and ethnic minority women: A systematic review
Poster Number: E79Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Integrative Health and Spirituality
Background:
Up to 54% of racial and ethnic minority (REM) women suffer from mental health challenges such as perinatal depression and are faced with a greater risk of poor fetal and maternal health outcomes. REMs also face barriers to accessing mental health treatment such as a lack of insurance and/or high cost (3). Digital mind-body interventions (MBI’s) may reduce mental health challenges, increase mindfulness, and be more accessible. However, the research in REM populations is limited. This systematic review aimed to report the effectiveness and adherence of digital MBI’s to improve mental well-being in REM pregnant women.
Methods:
A search for relevant studies was conducted in 3 databases (PubMed, PsychInfo, SCOPUS/Web of Science). Data was extracted and entered into Covidence. Articles were screened by two independent researchers. The CASP checklist was used for quality assessment. Studies were considered eligible if they included 1) pregnant women, 2) at least 50% of sample was REM, 3) interventions that incorporated the use of mindfulness through an eHealth or mHealth delivery channel (i.e., mobile phone or smartphone, social media, internet-based website, or SMS text messaging), and 4) the primary outcome was related to mental health and/or well-being (i.e., stress, anxiety, depression, emotional well-being, mindfulness, and/or resilience).
Results:
Electronic searches returned 313 records. After removal of duplicates, a total of 237 abstracts were identified. Following screening, 46 full text articles were assessed for eligibility and 7 met the inclusion criteria. Three studies were conducted in the US. The included studies utilized mindfulness-based stress reduction, reflection exercises, meditation, and monitoring and acceptance training and the majority were delivered via mobile phone. The studies assessed depression, stress, anxiety, pregnancy specific distress, perceived stress, mindfulness, affect, and/or self-efficacy using a variety of validated tools with most reporting positive changes. In studies that reported adherence, completion rates ranged from 8% to 89% of the sample completing the intervention. Adherence to daily practices was generally low.
Conclusion:
Our findings suggest that digital MBI’s may be promising for improving mental health outcomes in REM pregnant women. However, there are limited studies conducted in the US with racially diverse samples. There is a need for more rigorous trials in REM pregnant women.
Keywords: Pregnancy, MindfulnessUp to 54% of racial and ethnic minority (REM) women suffer from mental health challenges such as perinatal depression and are faced with a greater risk of poor fetal and maternal health outcomes. REMs also face barriers to accessing mental health treatment such as a lack of insurance and/or high cost (3). Digital mind-body interventions (MBI’s) may reduce mental health challenges, increase mindfulness, and be more accessible. However, the research in REM populations is limited. This systematic review aimed to report the effectiveness and adherence of digital MBI’s to improve mental well-being in REM pregnant women.
Methods:
A search for relevant studies was conducted in 3 databases (PubMed, PsychInfo, SCOPUS/Web of Science). Data was extracted and entered into Covidence. Articles were screened by two independent researchers. The CASP checklist was used for quality assessment. Studies were considered eligible if they included 1) pregnant women, 2) at least 50% of sample was REM, 3) interventions that incorporated the use of mindfulness through an eHealth or mHealth delivery channel (i.e., mobile phone or smartphone, social media, internet-based website, or SMS text messaging), and 4) the primary outcome was related to mental health and/or well-being (i.e., stress, anxiety, depression, emotional well-being, mindfulness, and/or resilience).
Results:
Electronic searches returned 313 records. After removal of duplicates, a total of 237 abstracts were identified. Following screening, 46 full text articles were assessed for eligibility and 7 met the inclusion criteria. Three studies were conducted in the US. The included studies utilized mindfulness-based stress reduction, reflection exercises, meditation, and monitoring and acceptance training and the majority were delivered via mobile phone. The studies assessed depression, stress, anxiety, pregnancy specific distress, perceived stress, mindfulness, affect, and/or self-efficacy using a variety of validated tools with most reporting positive changes. In studies that reported adherence, completion rates ranged from 8% to 89% of the sample completing the intervention. Adherence to daily practices was generally low.
Conclusion:
Our findings suggest that digital MBI’s may be promising for improving mental health outcomes in REM pregnant women. However, there are limited studies conducted in the US with racially diverse samples. There is a need for more rigorous trials in REM pregnant women.
Authors:
Co-Author - Jennifer Green,
PhD,
Exercise and Nutritional Sciences
Co-Author - Destiny Akins,
Exercise and Nutritional Sciences
Co-Author - Michelle Liu,
San Diego State University
Co-Author - Margaret Henderson,
San Diego State University
E80 - Identifying and addressing challenges in onboarding Veterans with type 2 diabetes to a clinical improvement program utilizing digital technology
Poster Number: E80Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Dissemination and Implementation
The affordability and widespread adoption of consumer-grade wearable devices (e.g. smartwatches) and mobile applications (e.g., diet logging) have made these tools increasingly popular for monitoring physical activity, sleep, and diet. However, unfamiliarity with using technology is a major barrier to participation in interventions utilizing digital health tools. We report on the feasibility and acceptability of a comprehensive orientation for participants in a clinical improvement program for adults with type 2 diabetes.
Adults with type 2 diabetes receiving care at the Veterans Administration Connecticut endocrinology clinic and using a continuous glucose monitor were eligible to participate in the program. After an initial intake to determine eligibility, we obtained verbal consent to participate in the program and mailed each participant a smartwatch. Once the device was received, an orientation was scheduled with the participant to set-up the smartwatch, establish data-sharing connections on 2 dashboards, and initiate 2 mobile applications. We evaluated device use, data completeness, and documented the technical challenges encountered including participant questions and solutions to resolve these issues. We also queried participants on the facilitators and barriers to the orientation.
A total of 12 participants (Female [n=3]; age range 37-72; Non-white/multiracial [n=3]; high school diploma/GED [n=10], prefer not to answer [n=2]) have successfully onboarded to the program. Reported technology barriers included: unable to access previous device account (n=3), connectivity problems with wireless syncing (n=5), and reluctance to log diet electronically (n=4). Individual setup sessions averaged 41.25 mins (<30 mins [n=3], 30-45 mins [n=3], 45 mins-1 hr [n=5], >1 hr [n=1]) to resolve these issues, resulting in 100% participant retention and between 77% and 100% data completeness across the device/apps. Preliminary findings from exit interviews indicated that efforts to improve familiarity with technology enhanced participant engagement and retention.
We demonstrated the feasibility and acceptability of a comprehensive orientation, highlighting its important role in fostering participant engagement. The documentation and dissemination of technical difficulties and solutions can help other teams develop standard procedures to minimize attrition due to device-related reasons and improve user experience with digital health interventions.
Keywords: Self-efficacy, e-HealthAdults with type 2 diabetes receiving care at the Veterans Administration Connecticut endocrinology clinic and using a continuous glucose monitor were eligible to participate in the program. After an initial intake to determine eligibility, we obtained verbal consent to participate in the program and mailed each participant a smartwatch. Once the device was received, an orientation was scheduled with the participant to set-up the smartwatch, establish data-sharing connections on 2 dashboards, and initiate 2 mobile applications. We evaluated device use, data completeness, and documented the technical challenges encountered including participant questions and solutions to resolve these issues. We also queried participants on the facilitators and barriers to the orientation.
A total of 12 participants (Female [n=3]; age range 37-72; Non-white/multiracial [n=3]; high school diploma/GED [n=10], prefer not to answer [n=2]) have successfully onboarded to the program. Reported technology barriers included: unable to access previous device account (n=3), connectivity problems with wireless syncing (n=5), and reluctance to log diet electronically (n=4). Individual setup sessions averaged 41.25 mins (<30 mins [n=3], 30-45 mins [n=3], 45 mins-1 hr [n=5], >1 hr [n=1]) to resolve these issues, resulting in 100% participant retention and between 77% and 100% data completeness across the device/apps. Preliminary findings from exit interviews indicated that efforts to improve familiarity with technology enhanced participant engagement and retention.
We demonstrated the feasibility and acceptability of a comprehensive orientation, highlighting its important role in fostering participant engagement. The documentation and dissemination of technical difficulties and solutions can help other teams develop standard procedures to minimize attrition due to device-related reasons and improve user experience with digital health interventions.
Authors:
Author - Selene Mak,
MPH, PHD,
VA HSR&D
Co-Author - Joshua E. Lacko,
VA
Co-Author - Erin Der-Mcleod,
MS,
VA HSR&D
Co-Author - Rebecca Kinney,
PHD,
VA Connecticut Healthcare System
Co-Author - Dora Lendvai, PhD,
PhD,
VA Connecticut Healthcare System
Co-Author - Constance Fung,
MD,
VA HSR&D
Co-Author - Garrett Ash,
PHD,
VA Connecticut Healthcare System
E81 - Development of a User-Centered Framework for Digital Health Interventions
Poster Number: E81Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Community Engagement
Background: Digital health interventions are promising avenues for intervening on health behaviors, as they allow researchers to meet participants in the contexts (i.e., times and places) where interventions can be most impactful. The compelling influence of participants’ contexts and preferences on retention and participant engagement in an intervention warrants a stronger emphasis on the target audience (end user) during intervention development. User-centered design is an example of a widely accepted, cross-disciplinary method of incorporating end users’ perspectives into the design process. However, there is a lack of guidance on how to apply user-centered design principles in the development of digital health interventions.
Objective: To develop the User-Center Design Framework for Digital Health Interventions (UCD-4-DHI), a framework that considers the contexts of all users of the intervention and bridges perspectives between intervention participants, researchers, and others involved in the development and implementation process.
Methods: Framework development occurred synergistically and iteratively with the development of the Know How program, a digital health intervention for parents with low-income who live in rural areas. As such, the UCD-4-DHI is grounded in the principles of user-centered design and intervention design, and supported by the parallel development of an intervention.
Results: The UCD-4-DHI integrates each of the 4 principles of user-centered design—a) understand context of use, b) specify user requirements, c) design solutions, and d) evaluate against requirements—throughout the 4 stages of digital intervention design—1) Planning & Resources, 2) Intervention Design, 3) Digital Design, and 4) Delivery & Testing. For each stage, the UCD-4-DHI provides a description of the stage’s relevance to behavioral interventionists and presents target actions to complete. Lessons learned throughout the Know How program development process were incorporated into the framework, as were digital considerations for various users.
Conclusion: The UCD-4-DHI provides a systematic approach for applying the principles of user-centered design in developing digital health interventions within paradigms in which behavioral interventionists operate. Systematic approaches to developing and reporting on digital interventions can enhance their reproducibility and ultimately move the field forward towards more rigorous, community engaged, digital approaches.
Keywords: Low-income, TechnologiesObjective: To develop the User-Center Design Framework for Digital Health Interventions (UCD-4-DHI), a framework that considers the contexts of all users of the intervention and bridges perspectives between intervention participants, researchers, and others involved in the development and implementation process.
Methods: Framework development occurred synergistically and iteratively with the development of the Know How program, a digital health intervention for parents with low-income who live in rural areas. As such, the UCD-4-DHI is grounded in the principles of user-centered design and intervention design, and supported by the parallel development of an intervention.
Results: The UCD-4-DHI integrates each of the 4 principles of user-centered design—a) understand context of use, b) specify user requirements, c) design solutions, and d) evaluate against requirements—throughout the 4 stages of digital intervention design—1) Planning & Resources, 2) Intervention Design, 3) Digital Design, and 4) Delivery & Testing. For each stage, the UCD-4-DHI provides a description of the stage’s relevance to behavioral interventionists and presents target actions to complete. Lessons learned throughout the Know How program development process were incorporated into the framework, as were digital considerations for various users.
Conclusion: The UCD-4-DHI provides a systematic approach for applying the principles of user-centered design in developing digital health interventions within paradigms in which behavioral interventionists operate. Systematic approaches to developing and reporting on digital interventions can enhance their reproducibility and ultimately move the field forward towards more rigorous, community engaged, digital approaches.
Authors:
Presenter - Shariwa Oke, MS,
Cornell University
Co-Author - Susan L. Johnson,
PhD,
University of Colorado Anschutz Medical Campus
Co-Author - Laura Bellows, PhD, MPH, RDN,
Cornell University
E82 - Tailoring Implementation Strategies Based on Clinician Perceptions of Referrals to a Digital Mental Health Intervention
Poster Number: E82Time: 05:00 PM - 05:50 PM
Topics: Dissemination and Implementation, Digital Health
Introduction: Digital mental health interventions (DMHIs) are effective but their integration into routine clinical practice remains low. We are conducting an implementation trial to study strategies to increase patient referral to a coached DMHI for depression and anxiety, IntelliCare Plus, in the Division of Ambulatory Care Coordination (ACC) in a large academic health system. This analysis seeks to understand how ACC care coordinators perceive the process of offering IntelliCare Plus to patients, to inform iterations to our implementation strategies.
Methods: All ACC care coordinators can offer patients IntelliCare Plus as part of the division-wide rollout. Additionally, ACC care coordinators and leadership (N=26) were invited to participate in optional research activities. Eleven care coordinators (42%; hereafter called “participants”) consented to the research. Prior to offering IntelliCare Plus to patients, participants were asked to complete baseline surveys assessing their perceptions of IntelliCare Plus and their readiness for implementation using the Normalization Measurement Development questionnaire (NoMAD) and Organizational Change Recipients’ Beliefs Scale (OCRBS), respectively.
Results: Most participants (91%) saw the potential value of referring their patients to IntelliCare Plus for their work, are open to working with colleagues in new ways to use IntelliCare Plus, and reported feeling prepared to be a part of implementing IntelliCare Plus. Further, 82% believed staff understand the purpose of IntelliCare Plus and agreed it is worthwhile. However, just 64% believed they could easily integrate IntelliCare Plus into their existing work, and 27% said that they value the effects IntelliCare Plus has had on their work already. Additionally, 55% felt that sufficient training was provided to enable staff to implement IntelliCare Plus, and 55% believed sufficient resources are available to support implementing IntelliCare Plus.
Discussion: Despite care coordinators expressing favorable attitudes toward offering patients IntelliCare Plus, their beliefs regarding sufficient training and available resources suggest a need for additional implementation strategies to promote self-efficacy in care coordinators’ ability to support implementation and value its effects on their work. We plan to iterate our second implementation strategy package to provide more detailed resources and tailored training that support integration into ACC’s workflow.
Keywords: Research to practice translation, Mental healthMethods: All ACC care coordinators can offer patients IntelliCare Plus as part of the division-wide rollout. Additionally, ACC care coordinators and leadership (N=26) were invited to participate in optional research activities. Eleven care coordinators (42%; hereafter called “participants”) consented to the research. Prior to offering IntelliCare Plus to patients, participants were asked to complete baseline surveys assessing their perceptions of IntelliCare Plus and their readiness for implementation using the Normalization Measurement Development questionnaire (NoMAD) and Organizational Change Recipients’ Beliefs Scale (OCRBS), respectively.
Results: Most participants (91%) saw the potential value of referring their patients to IntelliCare Plus for their work, are open to working with colleagues in new ways to use IntelliCare Plus, and reported feeling prepared to be a part of implementing IntelliCare Plus. Further, 82% believed staff understand the purpose of IntelliCare Plus and agreed it is worthwhile. However, just 64% believed they could easily integrate IntelliCare Plus into their existing work, and 27% said that they value the effects IntelliCare Plus has had on their work already. Additionally, 55% felt that sufficient training was provided to enable staff to implement IntelliCare Plus, and 55% believed sufficient resources are available to support implementing IntelliCare Plus.
Discussion: Despite care coordinators expressing favorable attitudes toward offering patients IntelliCare Plus, their beliefs regarding sufficient training and available resources suggest a need for additional implementation strategies to promote self-efficacy in care coordinators’ ability to support implementation and value its effects on their work. We plan to iterate our second implementation strategy package to provide more detailed resources and tailored training that support integration into ACC’s workflow.
Authors:
Author - Emily Tack,
BA,
Northwestern University Feinberg School of Medicine
Co-Author - Tanvi Lakhtakia,
BA,
Northwestern University Feinberg School of Medicine
Co-Author - Charles Krause,
MPH,
Northwestern University Feinberg School of Medicine
Co-Author - Zara Mir,
MS,
Northwestern University Feinberg School of Medicine
Co-Author - Andrew Berry,
PhD,
Northwestern University Feinberg School of Medicine
Co-Author - David Mohr,
PhD,
Northwestern University Feinberg School of Medicine
Co-Author - Margaret Banker,
PhD,
Northwestern University Feinberg School of Medicine
Co-Author - JD Smith,
PhD,
University of Utah
Co-Author - Emily Lattie,
PhD,
Northwestern University Feinberg School of Medicine
Co-Author - Andrea Graham,
PhD,
Northwestern University Feinberg School of Medicine
E83 - Evaluating non-registry recruitment strategies for a digital intervention: A comparison of method effectiveness
Poster Number: E83Time: 05:00 PM - 05:50 PM
Topics: Cancer, Community Engagement
Background: A major challenge for intervention research is that most interventions that demonstrate a beneficial impact are not tested in effectiveness or dissemination trials and are not conducive to “real world” delivery or use. As a result, they do not reach the general population and may not be received by those who most need them. To address this gap, our project evaluated the reach and acceptance of an evidence-based digital intervention, MySmartSkin, to examine other recruitment methods including social media, electronic health record systems, and health care practitioners.
Objective: To evaluate acceptance rates of a variety of recruitment strategies in a hybrid type II randomized trial, MySmartSkin.
Methods: This study aims to recruit 150 melanoma survivors (3-5 years post-surgery) who are currently cancer-free using nontraditional, mostly unpaid, recruitment strategies. To date, the following strategies have been utilized: social media (paid Facebook advertisements and influencer and organization posts), electronic health record ascertainment (EPIC), and health care provider engagement. Of these strategies, Facebook advertisements were the only paid source while the rest were unpaid. To streamline enrollment, an online eligibility screener was created, and the QR code and URL were disseminated. Although social media has wide reach, fake entries were a concern, and data quality measures were put in place. If deemed eligible by the screener, a member of the study staff contacted the potential participants by phone to confirm eligibility and obtain oral consent.
Results: Of the 100 participants currently enrolled in the study recruited by nontraditional sources, the majority (71%) came from social media sources: 57 from Instagram influencers; 13 from Facebook advertisements or groups, and 1 from Twitter. The remaining 29 participants came from EPIC email blasts (24%), health care provider promotion (3%), clinicaltrials.gov (1%), and patient forums (1%). Despite the recruitment success over 8 months, almost 1300 poor quality entries have been removed from the screener pool.
Conclusions: Nontraditional sources, especially social media, can be effective for intervention research recruitment. Key challenges were managing poor-quality entries, requiring additional safeguards. These findings highlight the value of nontraditional unpaid methods to reach a broader audience for real-world interventions. Additional analyses will assess cost-effectiveness.
Keywords: Behavior Change, CancerObjective: To evaluate acceptance rates of a variety of recruitment strategies in a hybrid type II randomized trial, MySmartSkin.
Methods: This study aims to recruit 150 melanoma survivors (3-5 years post-surgery) who are currently cancer-free using nontraditional, mostly unpaid, recruitment strategies. To date, the following strategies have been utilized: social media (paid Facebook advertisements and influencer and organization posts), electronic health record ascertainment (EPIC), and health care provider engagement. Of these strategies, Facebook advertisements were the only paid source while the rest were unpaid. To streamline enrollment, an online eligibility screener was created, and the QR code and URL were disseminated. Although social media has wide reach, fake entries were a concern, and data quality measures were put in place. If deemed eligible by the screener, a member of the study staff contacted the potential participants by phone to confirm eligibility and obtain oral consent.
Results: Of the 100 participants currently enrolled in the study recruited by nontraditional sources, the majority (71%) came from social media sources: 57 from Instagram influencers; 13 from Facebook advertisements or groups, and 1 from Twitter. The remaining 29 participants came from EPIC email blasts (24%), health care provider promotion (3%), clinicaltrials.gov (1%), and patient forums (1%). Despite the recruitment success over 8 months, almost 1300 poor quality entries have been removed from the screener pool.
Conclusions: Nontraditional sources, especially social media, can be effective for intervention research recruitment. Key challenges were managing poor-quality entries, requiring additional safeguards. These findings highlight the value of nontraditional unpaid methods to reach a broader audience for real-world interventions. Additional analyses will assess cost-effectiveness.
Authors:
Author - Alexis Schaefer,
Rutgers Cancer Institute
Author - Sharon XManne, PhD,
PhD,
Rutgers Cancer Institute of New Jersey
Author - Carolyn Heckman, PhD, FSBM,
PhD, FSBM,
Rutgers Cancer Institute of NJ
Author - Sara Frederick, MS,
MS,
Rutgers CINJ
Author - Justin Solleder,
MA,
Rutgers Cancer
E84 - Disseminating yoga for public health: Integrating target population input into the dissemination science model
Poster Number: E84Time: 05:00 PM - 05:50 PM
Topics: Dissemination and Implementation, Integrative Health and Spirituality
Background
Distribution of information related to behavioral medicine interventions is a public health challenge. One lead dissemination model includes four key constructs: the source (researchers); the audience (public health or clinical personnel impacted); the channel (ways by which information is shared); and the message (the language and content). Since dissemination science aims to change behavior at the system and setting levels, most models do not include the end-users’ preferences or information-seeking practices. This may inadvertently contribute to the scientific lag-time when information on the specific language, imagery, and cultural considerations is not sought before public health or clinical practice interventions begin. For example, certain populations may want to hear about behavioral health information in different ways from their counterparts. This is especially true of interventions that remain controversial in some populations and settings, such as yoga. Yoga is a comprehensive mind-body-spirit system that can improve population health, but misinformation abounds. Certain end users – such as those living in larger bodies or Black and Indigenous people of color (BIPOC)— are not receiving important information related to the relevance of yoga for their bodies and communities.
Methods
We collected open-ended survey data from a sample of potential yoga end-users to understand preferences for yoga health messages, sources, and channels. We shared infographic image sets with varying benefits of yoga to determine which health messages resonated with participants and how these messages might be improved.
Results
Participants (N = 150, mean age 36 years; 50% female; 54% BIPOC; 29% with larger body shapes), resulting in over 3800 meaning units of qualitative data. Desirable message features include more inclusive imagery, content that elicits feelings of calm, pragmatic information (e.g., accessibility), and content on yoga-specific benefits that do not “overpromise.”
Conclusions
Data from a large, representative survey provides concrete strategies for disseminating yoga health messages for diverse populations. Ongoing data analysis will lead to an overall dissemination model for ensuring potential practitioners, health providers, yoga industry affiliates, and yoga researchers are equipped with the desired information that affirms unity, connection, and belonging of yoga to their target populations.
Keywords: Dissemination, Complementary MedicineDistribution of information related to behavioral medicine interventions is a public health challenge. One lead dissemination model includes four key constructs: the source (researchers); the audience (public health or clinical personnel impacted); the channel (ways by which information is shared); and the message (the language and content). Since dissemination science aims to change behavior at the system and setting levels, most models do not include the end-users’ preferences or information-seeking practices. This may inadvertently contribute to the scientific lag-time when information on the specific language, imagery, and cultural considerations is not sought before public health or clinical practice interventions begin. For example, certain populations may want to hear about behavioral health information in different ways from their counterparts. This is especially true of interventions that remain controversial in some populations and settings, such as yoga. Yoga is a comprehensive mind-body-spirit system that can improve population health, but misinformation abounds. Certain end users – such as those living in larger bodies or Black and Indigenous people of color (BIPOC)— are not receiving important information related to the relevance of yoga for their bodies and communities.
Methods
We collected open-ended survey data from a sample of potential yoga end-users to understand preferences for yoga health messages, sources, and channels. We shared infographic image sets with varying benefits of yoga to determine which health messages resonated with participants and how these messages might be improved.
Results
Participants (N = 150, mean age 36 years; 50% female; 54% BIPOC; 29% with larger body shapes), resulting in over 3800 meaning units of qualitative data. Desirable message features include more inclusive imagery, content that elicits feelings of calm, pragmatic information (e.g., accessibility), and content on yoga-specific benefits that do not “overpromise.”
Conclusions
Data from a large, representative survey provides concrete strategies for disseminating yoga health messages for diverse populations. Ongoing data analysis will lead to an overall dissemination model for ensuring potential practitioners, health providers, yoga industry affiliates, and yoga researchers are equipped with the desired information that affirms unity, connection, and belonging of yoga to their target populations.
Authors:
Author - Samantha M. Harden, PhD,
PhD,
Virginia Tech
Co-Author - Mary Frazier,
Virginia Tech
Co-Author - Bradley J Frick,
Virginia Tech
Co-Author - Laurden Stauffer,
Virginia Tech
Co-Author - Therese Osborn,
Virginia Tech
Co-Author - Hannah Hill,
Virginia Tech
Co-Author - Morgan Gregg,
Virginia Tech
E85 - Clinical research recruitment and retention of marginalized communities: Perspectives and feedback on a professional development course
Poster Number: E85Time: 05:00 PM - 05:50 PM
Topics: Education, Training, and Career Development, Education, Training, and Career Development
Diversity and inclusion are vital in clinical research. Generating generalizability results requires recruiting and retaining diverse participants who are representative of clinical populations. Research staff should thus be knowledgeable about diversity and inclusion, yet few formal trainings exist on best practices for engaging racial/ethnic minority populations. Here we describe research staff feedback on “Faster Together: Enhancing the Recruitment of Marginalized Communities in Clinical Trials,” an open online course developed by transdisciplinary scholars from the Vanderbilt Recruitment Innovation Center. This professional development course consists of 8 interactive modules designed to educate researchers on engagement, recruitment, and retention of underrepresented populations. The course includes videos of scientific experts, recommended readings, and knowledge quizzes. Here, research staff (N=17) from two institutions, the Kaiser Permanente Northern California Division of Research and University of California, Davis, were invited to complete a modified online version of the feedback survey originally used to develop the course. Staff completed the course and provided feedback between January - August 2024. Feedback items were assessed dichotomously or on 5-point Likert scales. The survey response rate was 70.6% (12/17), 10 of whom completed all items. Of the 10 who completed demographic items, most identified with a racial/ethnic minority group (90%); education ranged from high school or less to postgraduate, with 70% having a 4-year college degree; and research experience ranged from 0 to 6-10 years, with 60% having 1-5 years’ experience. Respondents felt the course increased their content knowledge (100%; 12/12) and overall was extremely/very (90%; 9/10), or somewhat helpful (10%; 1/10). All respondents (100%; 12/12) somewhat or strongly agreed that minority recruitment and retention can be enhanced by improving education and practices, and intended to work with team members to achieve this. All (100%; 12/12) were somewhat or very likely to change their practices as a result of the training. Results closely align with course developers’ prior reports. Such trainings may increase skills and intentions to promote minority participation in clinical research. Staff perspectives may inform decisions about using this training to promote inclusive recruitment and retention in clinical research.
Keywords: Career development, TrainingAuthors:
Author - Siedah Garrison,
MPH,
University of California, Davis
Co-Author - Andrea Millman,
MA,
Kaiser Permanente Division of Research
Co-Author - Ashna Kambhampati,
University of California, Davis
Co-Author - Monique Hedderson,
PhD,
Kaiser Permanente Division of Research
Co-Author - Assiamira Ferrara,
MD, PhD,
Kaiser Permanente Division of Research
Co-Author - Susan D. Brown, PhD, FSBM,
PhD, FSBM,
University of California, Davis
E86 - A qualitative study of using behavioural science in applied contexts: Health partnerships and public health
Poster Number: E86Time: 05:00 PM - 05:50 PM
Topics: Education, Training, and Career Development, Dissemination and Implementation
Introduction: The first global resolution on behavioural science for health by the World Health Organisation reflects the increasing call for the application of behavioural science in multiple contexts. Coupled with the proposal to move behavioural science interventions up stream, this necessitates developing capacity and capability in the application of behavioural science and, preferably, the generation of behavioural research data. We aimed to explore the experience of applying behavioural science in public health during covid and in health partnerships (collaborations between high-, low- and / or middle-income countries for health systems strengthening).
Methods: We interviewed applied psychologists working in global health partnerships (n=15) or in public health (n=10) and public health practitioners (n=7). We conducted a deductive analysis based on normalisation process theory on the health partnership data and inductive thematic analysis on the public health data.
Results: We report three themes from public health: 1) Challenges and facilitators of translation of behavioural science into public health, 3) The unique public health context of translation and 3) Recommendations to support future behavioural science translation. We report four themes from health partnerships: 1) The challenges of enabling coherence within the health partnerships, 2) Building relationships within the health partnership, 3) Exploring the communal and individual effort carried out within the health partnership and 4) Reflecting on the work carried out within the health partnership.
Discussion: In both contexts, barriers and facilitators included factors related to relationships between people, such as networks and teams; the expertise of individuals; and those related to materials.
Conclusion: Both people and materials were seen as important in facilitating behavioural science in practice. Future research could explore how different materials are used and how relationships can be nurtured to facilitate applications. In global contexts, future work should critically evaluate behavioural models, methods and measures for use outside
Western, Educated, Industrialised, Rich and Democratic (WEIRD) communities.
Keywords: Evidence based, InterdisciplinaryMethods: We interviewed applied psychologists working in global health partnerships (n=15) or in public health (n=10) and public health practitioners (n=7). We conducted a deductive analysis based on normalisation process theory on the health partnership data and inductive thematic analysis on the public health data.
Results: We report three themes from public health: 1) Challenges and facilitators of translation of behavioural science into public health, 3) The unique public health context of translation and 3) Recommendations to support future behavioural science translation. We report four themes from health partnerships: 1) The challenges of enabling coherence within the health partnerships, 2) Building relationships within the health partnership, 3) Exploring the communal and individual effort carried out within the health partnership and 4) Reflecting on the work carried out within the health partnership.
Discussion: In both contexts, barriers and facilitators included factors related to relationships between people, such as networks and teams; the expertise of individuals; and those related to materials.
Conclusion: Both people and materials were seen as important in facilitating behavioural science in practice. Future research could explore how different materials are used and how relationships can be nurtured to facilitate applications. In global contexts, future work should critically evaluate behavioural models, methods and measures for use outside
Western, Educated, Industrialised, Rich and Democratic (WEIRD) communities.
Authors:
Co-Author - Suyesh Amatya,
University Of Manchester
Co-Author - Chloe Ashton,
University Of Manchester
Co-Author - Eleanor Bull,
Derbyshire County Council
Co-Author - Angel Chater, PhD,
PhD,
University of Bedfordshire
Co-Author - Lesley Lewis,
Somerset County Council
Co-Author - Shreya Reddy,
University of Manchester
Co-Author - Gilian Shorter,
Queens University Belfast
Co-Author - Rebecca Turner,
University of Manchester
Co-Author - Ellie Whittaker,
North Yorkshire County Council
Co-Author - Jo Hart, PhD,
PhD,
University of Manchester
E88 - Cancer Prevention Amid Conflicting Health Information: Associations Between Perceived Conflict in Expert Recommendations and Cancer Prevention-Related Cognitions
Poster Number: E88Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy, Cancer
Background: In cancer prevention, where risk factors and screening guidelines are often changing, conflicting information presents a significant challenge for the promotion of preventive behaviors. The link between conflicting information and individual behavior is mediated by relevant health cognitions and it is at this juncture where cancer prevention communication efforts are typically targeted. This study seeks to understand the relationship between two types of perceived conflict in health expert recommendations and personal and general cancer prevention-related cognitions.
Methods: Through the Health Information National Trends Survey (HINTS) 6 (2022), a nationally representative sample of US adults (N=6,252) rated perceptions of two types of conflict in health expert recommendations: contemporaneous (i.e., contradictory at a single time point) and temporal (i.e., changing over time) (dichotomized: often/very often, never/rarely). Two items assessed personal cognitions related to cancer prevention: perceived cancer risk and cancer worry. Three items assessed general cognitions: cancer fatalism (i.e., everything causes cancer, there’s not much you can do to prevent it) and confusion (i.e., it is difficult to know which recommendations to follow). Weighted logistic regression models examined associations between each type of perceived conflict and each health cognition separately, adjusting for age, birth sex, race/ethnicity, income, health numeracy, digital health literacy, and cancer experience (survivor, family history, caregiver).
Results: Perceiving contemporaneous, but not temporal, conflict often/very often (versus never/rarely) was associated with higher odds of believing that everything causes cancer (aOR=1.49, p=.01) and believing that there are so many recommendations about preventing cancer (aOR=1.33, p=.03). Perceived cancer risk, cancer worry, and the belief that there’s not much you can do to prevent cancer were not associated with either type of perceived conflict.
Conclusion: Perceived contemporaneous conflict, but not temporal conflict, is related to higher odds of fatalism in cancer causes and confusion in cancer recommendations, suggesting that contemporaneous conflict may have more negative effects. Perceived conflict is also associated with general, as opposed to personal, cancer cognitions. Future work should evaluate strategies to mitigate the potentially harmful consequences of conflicting information on cancer prevention.
Keywords: Health communication, CancerMethods: Through the Health Information National Trends Survey (HINTS) 6 (2022), a nationally representative sample of US adults (N=6,252) rated perceptions of two types of conflict in health expert recommendations: contemporaneous (i.e., contradictory at a single time point) and temporal (i.e., changing over time) (dichotomized: often/very often, never/rarely). Two items assessed personal cognitions related to cancer prevention: perceived cancer risk and cancer worry. Three items assessed general cognitions: cancer fatalism (i.e., everything causes cancer, there’s not much you can do to prevent it) and confusion (i.e., it is difficult to know which recommendations to follow). Weighted logistic regression models examined associations between each type of perceived conflict and each health cognition separately, adjusting for age, birth sex, race/ethnicity, income, health numeracy, digital health literacy, and cancer experience (survivor, family history, caregiver).
Results: Perceiving contemporaneous, but not temporal, conflict often/very often (versus never/rarely) was associated with higher odds of believing that everything causes cancer (aOR=1.49, p=.01) and believing that there are so many recommendations about preventing cancer (aOR=1.33, p=.03). Perceived cancer risk, cancer worry, and the belief that there’s not much you can do to prevent cancer were not associated with either type of perceived conflict.
Conclusion: Perceived contemporaneous conflict, but not temporal conflict, is related to higher odds of fatalism in cancer causes and confusion in cancer recommendations, suggesting that contemporaneous conflict may have more negative effects. Perceived conflict is also associated with general, as opposed to personal, cancer cognitions. Future work should evaluate strategies to mitigate the potentially harmful consequences of conflicting information on cancer prevention.
Authors:
Presenter - Hoda Fakhari,
MS,
Northwestern University
Co-Author - Irina Iles,
PhD, MPH,
National Cancer Institute
Co-Author - Wen-Ying Sylvia Chou,
PhD, MPH,
National Cancer Institute
Co-Author - Nicole Senft Everson,
PhD,
National Cancer Institute
E89 - “Quality care has to include culturally appropriate care”: Key Informant Perspectives on Wellbeing and Healthcare for the LGBTQ+ Community in Central Ohio
Poster Number: E89Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Social and Environmental Context and Health
Background: Columbus, Ohio is home to the 15th largest LGBTQ+ population in the United States, yet no formal LGBTQ+ Community Health Needs Assessment has been conducted. The purpose of Columbus INSIGHT is to identify priority wellbeing and healthcare assets and concerns among LGBTQ+ adults living in Central Ohio for community improvement and intervention development.
Methods: We conducted semi-structured interviews with 21 Key Informant (KI) leaders in the Central Ohio LGBTQ+ community about social determinants of health (SDOH), physical and mental health and wellbeing, and healthcare in their community. Audio files were transcribed and redacted for anonymity. We developed an a priori codebook informed by the Minority Stress Model and the SDOH, and inductive codes were added as they emerged from the data. Two researchers coded data independently; discrepancies were discussed and resolved via consensus.
Results: The majority of (16) KIs resided in Franklin County. KIs mostly identified as white (13) and Black (6). KIs identified as cisgender female (9), cisgender male (9), transgender female (1), and gender queer or nonbinary (2). KIs represented mostly Business (7), Community (6), and Healthcare (4) industries. Preliminary findings suggest that KIs view the LGBTQ+ as thriving in Columbus but identified concerns of perceived safety and access to social, economic, and healthcare resources due to anti-LGBTQ+ policies. Identified gaps in key SDOH include affordable housing and transportation. KIs identified sexually transmitted infections, substance use, and mental health as top population health concerns. While KIs described physical and mental healthcare as available to the LGBTQ+ community, they shared concerns with provider cultural humility, LGBTQ+-specific health knowledge, and restrictive state policy. KIs identified transgender; Black, Indigenous, and People of Color; low-income; youth; and seniors as priority populations for social, health, and healthcare intervention.
Conclusion and Next Steps: Findings highlight the importance of SDOH, including the policy environment, on LGBTQ+ social, mental, and physical wellbeing and offer opportunities for researchers, policymakers, government agencies, and community organizations to support LGBTQ+ population health by attending to broader structural forces impacting the LGBTQ+ community. Findings will be presented to Central Ohio health agencies for inclusion in future Community Health Improvement Plans.
Keywords: Health disparities, Minority healthMethods: We conducted semi-structured interviews with 21 Key Informant (KI) leaders in the Central Ohio LGBTQ+ community about social determinants of health (SDOH), physical and mental health and wellbeing, and healthcare in their community. Audio files were transcribed and redacted for anonymity. We developed an a priori codebook informed by the Minority Stress Model and the SDOH, and inductive codes were added as they emerged from the data. Two researchers coded data independently; discrepancies were discussed and resolved via consensus.
Results: The majority of (16) KIs resided in Franklin County. KIs mostly identified as white (13) and Black (6). KIs identified as cisgender female (9), cisgender male (9), transgender female (1), and gender queer or nonbinary (2). KIs represented mostly Business (7), Community (6), and Healthcare (4) industries. Preliminary findings suggest that KIs view the LGBTQ+ as thriving in Columbus but identified concerns of perceived safety and access to social, economic, and healthcare resources due to anti-LGBTQ+ policies. Identified gaps in key SDOH include affordable housing and transportation. KIs identified sexually transmitted infections, substance use, and mental health as top population health concerns. While KIs described physical and mental healthcare as available to the LGBTQ+ community, they shared concerns with provider cultural humility, LGBTQ+-specific health knowledge, and restrictive state policy. KIs identified transgender; Black, Indigenous, and People of Color; low-income; youth; and seniors as priority populations for social, health, and healthcare intervention.
Conclusion and Next Steps: Findings highlight the importance of SDOH, including the policy environment, on LGBTQ+ social, mental, and physical wellbeing and offer opportunities for researchers, policymakers, government agencies, and community organizations to support LGBTQ+ population health by attending to broader structural forces impacting the LGBTQ+ community. Findings will be presented to Central Ohio health agencies for inclusion in future Community Health Improvement Plans.
Authors:
Author - Monica Stanwick,
The Ohio State University
Co-Author - Wilson Figueroa,
PhD,
The Ohio State University
Co-Author - Rory O'Malley,
The Ohio State University
Co-Author - Cherod Bowens,
The Ohio State University
Co-Author - Joanne G. Patterson, PhD,MSW, MPH,
PhD,MSW, MPH,
The Ohio State University
E90 - “I am completely alone in this journey”: Experiences of Transgender and Gender Diverse Populations in Cancer Crowdfunding
Poster Number: E90Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Cancer
Purpose: In part due to structural forces such as anti-LGBTQ+ stigma and discrimination, LGBTQ+ cancer survivors report significantly more illness-related financial hardship than non-LGBTQ+ survivors. LGBTQ+ cancer survivors may turn to cost-coping strategies like crowdfunding to afford medical care. While greater LGBTQ+ financial hardship is well-documented, evidence suggests that transgender and gender diverse (TGD) survivors may be at even greater risk, but most studies do not specifically examine TGD survivors. We describe the cancer-related crowdfunding experiences of TGD cancer survivors.
Methods: We created a dataset of LGBTQ+ crowdfunding campaigns collected from GoFundMe in November 2022, which included campaign titles, descriptions, and metadata. We compared the crowdfunding amount raised between TGD and lesbian, gay, bisexual (LGB) campaigns using summary statistics and independent t-tests. Amount raised was log transformed prior to statistical testing; untransformed means are presented below. Two cycles of inductive qualitative coding were performed on a randomly selected subset of N=100 campaigns by the study team and members of a LGBTQ+ study advisory board to ensure LGBTQ+ perspectives were centered in the analysis.
Results: Of the 538 LGBTQ+ cancer campaigns, 175 were TGD (32.5%), 295 (54.8%) were LGB, campaigns, and 68 (12.6%) used broad LGBTQ+ language could not be classified into one category. We found that TGD campaigns raised almost half of what LGB campaigns raised ($7,782 vs $12,724, p<0.0001). Emerging patterns from the qualitative analysis revealed that TGD campaigns compared to LGB campaigns had: 1) more mentions of stigma in healthcare spaces (75% TGD vs 25% LGB), and 2) fewer mentions of caregiver support (7% vs 93%). TGD cancer campaigns raised significantly less money, were more likely to report stigma, and less likely to mention non-financial support from caregivers compared to LGB cancer campaigns.
Conclusions: Stigma specific to TGD cancer survivors and a lack of caregiver support could be moderators in the relationship between gender identity and overall amount raised in crowdfunding, but more community-based research is needed to contextualize this disparity in TGD cancer crowdfunding. TGD cancer survivors have unique and understudied needs, which should continue to be explored through further research and tailored interventions for survivors and healthcare providers.
Keywords: Cancer, Minority groupsMethods: We created a dataset of LGBTQ+ crowdfunding campaigns collected from GoFundMe in November 2022, which included campaign titles, descriptions, and metadata. We compared the crowdfunding amount raised between TGD and lesbian, gay, bisexual (LGB) campaigns using summary statistics and independent t-tests. Amount raised was log transformed prior to statistical testing; untransformed means are presented below. Two cycles of inductive qualitative coding were performed on a randomly selected subset of N=100 campaigns by the study team and members of a LGBTQ+ study advisory board to ensure LGBTQ+ perspectives were centered in the analysis.
Results: Of the 538 LGBTQ+ cancer campaigns, 175 were TGD (32.5%), 295 (54.8%) were LGB, campaigns, and 68 (12.6%) used broad LGBTQ+ language could not be classified into one category. We found that TGD campaigns raised almost half of what LGB campaigns raised ($7,782 vs $12,724, p<0.0001). Emerging patterns from the qualitative analysis revealed that TGD campaigns compared to LGB campaigns had: 1) more mentions of stigma in healthcare spaces (75% TGD vs 25% LGB), and 2) fewer mentions of caregiver support (7% vs 93%). TGD cancer campaigns raised significantly less money, were more likely to report stigma, and less likely to mention non-financial support from caregivers compared to LGB cancer campaigns.
Conclusions: Stigma specific to TGD cancer survivors and a lack of caregiver support could be moderators in the relationship between gender identity and overall amount raised in crowdfunding, but more community-based research is needed to contextualize this disparity in TGD cancer crowdfunding. TGD cancer survivors have unique and understudied needs, which should continue to be explored through further research and tailored interventions for survivors and healthcare providers.
Authors:
Author - Cindy Turner,
MPH,
Huntsman Cancer Institute, University of Utah
Co-Author - Austin R. Waters, MSPH,
MSPH,
University of North Carolina Chapel Hill
Co-Author - Mary Killela,
PhD, RN,
Huntsman Cancer Institute, University of Utah
Co-Author - Lauren Ghazal,
PhD,
University of Rochester School of Nursing
Co-Author - Matt Poquadeck,
MS,
University of Rochester/Wilmot Cancer Institute
Co-Author - Caleb W. Easterly,
BA,
University of North Carolina at Chapel Hill
Co-Author - Anne C. Kirchhoff, PhD, MPH,
PhD, MPH,
Huntsman Cancer Institute, University of Utah
Co-Author - Stephen A. Rains,
PhD,
University of Arizona Department of Communication
Co-Author - Kristin G. Cloyes, PhD,
PhD,
Oregon Health & Science University
Co-Author - Echo L. Warner,
PhD MPH,
University of Utah College of Nursing
E92 - Examining the feasibility, acceptability, and preliminary efficacy of a six-week at-home strength training intervention for Black women
Poster Number: E92Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Physical Activity
Physical activity (PA) is protective against many health conditions such as cardiovascular disease (CVD), obesity, and all-cause mortality. Black women have some of the highest rates of non-communicable diseases associated with a lack of PA. Most previous PA studies for Black women have focused on aerobic PA. The current pilot randomized controlled trial evaluated the feasibility and acceptability of an at-home strength training intervention. The current study also examined the effect of a physical activity intervention (PAI) on PA and psychosocial variables, compared to a wait-list-control (WLC) group. Low-active Black women (< 90 minutes MVPA per week; n = 36; mean age = 44.0, + / 12.6) were randomized to either the six-week PAI or WLC. PAI were sent workouts and demonstration videos weekly via email, engaged in a weekly group Zoom counseling and exercise session, and were in a social media motivational group chat. The overall program had a high satisfaction rate (all components of the program had over 75% favorability, except for the motivational messages). Attendance at the Zoom counseling sessions was 48%. PAI significantly increased their self-reported PA from baseline to post-test, p < .05. No other significant effects were observed for any other variable. Focus groups provided insight for future interventions. Future research should focus on building community partnerships and building authentic connections between participants. This was one of the first studies to explore a physical activity program for Black women that emphasized strength training and utilized home-based methodology.
Keywords: Physical activity, Health disparitiesAuthors:
Author - Kaitlyn Swinney,
PhD,
University of Texas
Co-Author - Daheia J. Barr-Anderson, PhD, MSPH, BS,
PhD, MSPH, BS,
University of North Carolina Charlotte
Co-Author - Dunja Antunovic,
PhD,
University of Minnesota
Co-Author - Jaime Slaughter-Acey,
PhD, MPH,
University of North Carolina, Charlotte
Author - Velma Harris,
MA,
University of Minnesota
Co-Author - Karmeal Fairley,
BS,
University of Minnesota
Co-Author - Tytiana Seay,
University of Minnesota
Co-Author - Beth Lewis,
PhD,
University of Minnesota
E93 - Identifying the financial toxicity experiences of childhood cancer survivors through partnership with a community organization serving rural and minoritized families
Poster Number: E93Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Cancer
Background: Financial toxicity (FT) refers to cancer-related economic distress and hardship, and disproportionately affects adolescent/young adult (AYA) survivors and minoritized groups. This study explored the FT experiences of AYA survivors of childhood cancer and their parents, and the perspective of staff members of a community-based cancer support organization in a rural region with majority Hispanic/Latino (H/L) residents and high rates of non-English language preference.
Methods: A needs assessment study was conducted in partnership with Jacob’s Heart, a nonprofit organization that serves predominantly H/L families of childhood cancer in a rural region in California. English- and Spanish-speaking AYA survivors, parents, and Jacob’s Heart staff members completed semi-structured interviews. Qualitative data were analyzed using an applied thematic analysis approach.
Results: Participants included 12 AYAs, 11 parents, and 7 organization staff. Material hardship was characterized by direct and indirect medical costs (e.g., time, transportation), which impacted parents’ employment, required balancing caregiving and financial needs, and caused economic strain. Behavioral effects of FT included adaptations to meet basic needs; cost-coping behaviors included skipping medical visits. Parents and survivors experienced financial stress and worry, exacerbated by disruption in parents’ employment and income, transportation pressures of living in a rural area, challenges obtaining or maintaining insurance coverage, and lack of a safety net. Support needs and resources were described.
Conclusions: AYA survivors of childhood cancer and their parents experience long-lasting FT across multiple domains, which is exacerbated by socioeconomic and structural factors. Interventions targeting FT should partner with community-based organizations to reach vulnerable populations.
Keywords: Cancer survivorship, Health disparitiesMethods: A needs assessment study was conducted in partnership with Jacob’s Heart, a nonprofit organization that serves predominantly H/L families of childhood cancer in a rural region in California. English- and Spanish-speaking AYA survivors, parents, and Jacob’s Heart staff members completed semi-structured interviews. Qualitative data were analyzed using an applied thematic analysis approach.
Results: Participants included 12 AYAs, 11 parents, and 7 organization staff. Material hardship was characterized by direct and indirect medical costs (e.g., time, transportation), which impacted parents’ employment, required balancing caregiving and financial needs, and caused economic strain. Behavioral effects of FT included adaptations to meet basic needs; cost-coping behaviors included skipping medical visits. Parents and survivors experienced financial stress and worry, exacerbated by disruption in parents’ employment and income, transportation pressures of living in a rural area, challenges obtaining or maintaining insurance coverage, and lack of a safety net. Support needs and resources were described.
Conclusions: AYA survivors of childhood cancer and their parents experience long-lasting FT across multiple domains, which is exacerbated by socioeconomic and structural factors. Interventions targeting FT should partner with community-based organizations to reach vulnerable populations.
Authors:
Co-Author - Catherine Benedict, PhD,
PhD,
Stanford University School of Medicine
Co-Author - Kelley Bloomer,
MA, MS,
Stanford University School of Medicine
Co-Author - Elle Billman,
BA,
Icahn School of Medicine at Mount Sinai
Co-Author - Mary Smith,
BS,
Jacob’s Heart Children’s Cancer Support Services
Co-Author - Heidi Boynton,
BS,
Jacob’s Heart Children’s Cancer Support Services
Co-Author - Lidia Schapira,
MD,
Stanford Comprehensive Cancer Institute
Co-Author - Stephanie Smith,
MD,
Stanford University School of Medicine
E94 - Bringing it all together: Ensuring sustainability for Arizona's Community Health Worker (CHW) Workforce
Poster Number: E94Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Education, Training, and Career Development
Introduction:
Community Health Workers (CHWs) play a pivotal role in connecting community members with needed care and resources, advocating for individuals and communities, and improving quality and cultural competence of service delivery. Arizona State University was awarded a HRSA grant to establish the Community Health Worker Training Program (CHW-TP) to address a shortage of health care workers and improve health among underserved communities. The ASU program prepares trainees for voluntary CHW certification through completion of a standardized curriculum to build core competencies and specialized experience working in the field with one of our community partners. This submission presents pragmatic recommendations to ensure sustainability of the CHW workforce as it enters its final year of grant support.
Method:
Development and rollout of the ASU CHW-TP utilized continuous quality improvement processes for refinement based on emerging needs. Pragmatic recommendations and next steps were established through review and synthesis of team meeting notes and consultation with stakeholders, including current past trainees, community partners, and ASU faculty. Key barriers and proposed solutions are discussed using levels of the socio-ecological model.
Results:
Interacting and overlapping barriers to CHW workforce development and sustainability were identified at policy, environmental, organizational, interpersonal, and intrapersonal levels. Top priorities for next steps included greater clarity regarding CHW scope and career progression relative to similar positions (e.g., peer recovery support specialists, behavioral health techs/paraprofessionals, doulas), viable alternative payment models, and expanded support for billing and payer contract negotiations. Salary support was associated with higher trainee satisfaction and reduced turnover, though a noted discrepancy remains between organizations expressed interest in CHWs and ability to pay a living wage for their services. Inadequate support for personal health-related social needs was the primary reason for individual attrition.
Conclusion:
CHW workforce development and sustainability requires additional, intentional efforts to address complex barriers spanning policy, environmental, and organizational levels. Given the overlapping and interacting nature of these barriers, a combination of top-down (e.g. policy driven) and bottom-up approaches (CHW/champion-driven) seem most likely to be impactful.
Keywords: Health disparities, Health promotionCommunity Health Workers (CHWs) play a pivotal role in connecting community members with needed care and resources, advocating for individuals and communities, and improving quality and cultural competence of service delivery. Arizona State University was awarded a HRSA grant to establish the Community Health Worker Training Program (CHW-TP) to address a shortage of health care workers and improve health among underserved communities. The ASU program prepares trainees for voluntary CHW certification through completion of a standardized curriculum to build core competencies and specialized experience working in the field with one of our community partners. This submission presents pragmatic recommendations to ensure sustainability of the CHW workforce as it enters its final year of grant support.
Method:
Development and rollout of the ASU CHW-TP utilized continuous quality improvement processes for refinement based on emerging needs. Pragmatic recommendations and next steps were established through review and synthesis of team meeting notes and consultation with stakeholders, including current past trainees, community partners, and ASU faculty. Key barriers and proposed solutions are discussed using levels of the socio-ecological model.
Results:
Interacting and overlapping barriers to CHW workforce development and sustainability were identified at policy, environmental, organizational, interpersonal, and intrapersonal levels. Top priorities for next steps included greater clarity regarding CHW scope and career progression relative to similar positions (e.g., peer recovery support specialists, behavioral health techs/paraprofessionals, doulas), viable alternative payment models, and expanded support for billing and payer contract negotiations. Salary support was associated with higher trainee satisfaction and reduced turnover, though a noted discrepancy remains between organizations expressed interest in CHWs and ability to pay a living wage for their services. Inadequate support for personal health-related social needs was the primary reason for individual attrition.
Conclusion:
CHW workforce development and sustainability requires additional, intentional efforts to address complex barriers spanning policy, environmental, and organizational levels. Given the overlapping and interacting nature of these barriers, a combination of top-down (e.g. policy driven) and bottom-up approaches (CHW/champion-driven) seem most likely to be impactful.
Authors:
Presenter - Mindy L. McEntee, PhD,
PhD,
Arizona State University
Co-Author - Binoli Herath,
Arizona State University
Co-Author - Sharon Czarnek,
Czarnek Consulting
E95 - Psychological and Behavioral Changes Among At-Risk Black and White Sexual Minority and Sexual Nonminority Women During the Coronavirus (COVID-19) Pandemic
Poster Number: E95Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Women's Health
The coronavirus (COVID-19) pandemic devastated individuals nationwide, with some groups enduring greater detrimental consequences than others. Studies evaluating well-being among subpopulations of women, racial/ethnic minorities, and emerging adults revealed increased stress, insomnia, anxiety, disordered eating, and substance use during the pandemic. Mental and physical health disparities for racial and sexual minority groups pre-COVID-19 were also exacerbated during the pandemic. The current study expands existing research by taking an intersectional approach to investigate Black and White sexual minority and sexual nonminority women’s health-related experiences during the pandemic. From February 2021 to July 2022 a community sample of 227 young adult women who binge eat (82 White SNM [sexual nonminority], 35 Black SNM, 75 White SM [sexual minority], 32 Black SM) completed an online survey assessing psychological (i.e., mood, stress, and anxiety) and health behavior (i.e., disturbance in sleeping, eating, and drinking) changes during the COVID-19 pandemic. One-way ANOVAs were performed to evaluate the effects of race x sexual orientation group (i.e., White SNM, Black SNM, White SM, Black SM) on psychological and behavioral outcomes. Results demonstrated significant subgroup differences on all psychological and behavioral variables assessed. Planned contrasts showed White SM women scored significantly worse than Black and White SNM women on mood (p<.001; p<.001), anxiety (p=.009; p<.001), and stress (p=.008; p<.001). Behaviorally, White SM women endorsed the poorest sleep quality (p=.030; p<.001) and ate less nutritious food (p=.002), and Black SM women’s drinking increased the most in frequency and quantity (p=.049; p=.011) as compared to other groups. Overall, results suggest having at least one marginalizing identity was associated with greater deleterious psychological and behavioral changes during the COVID-19 pandemic. Further, identifying as a “double minority” was associated with the highest risk of increased drinking. These findings highlight differential patterns of mental and behavioral health outcomes among people with diverse and intersecting identities. Future interventions focused on teaching adaptive coping mechanisms during times of great stress (e.g., the pandemic) should consider the ways in which interventions may need to be adapted for people with intersecting minority identities.
Keywords: Women's health, Quality of lifeAuthors:
Presenter - Kayla Pitchford,
MS,
The Virginia Consortium Program in Clinical Psychology
Co-Author - Abby Braitman,
PhD,
Old Dominion University
Co-Author - Alyssa Giannone,
MS,
The Virginia Consortium Program in Clinical Psychology
Co-Author - Kristin E. Heron,
PhD, FSBM,
Old Dominion University
E96 - Transactional sex and its associated factors among men who have sex with men in Nepal
Poster Number: E96Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , HIV/AIDS
Background
Transactional sex, which involves the exchange of sex for money, goods, or other items of value, has been associated with adverse health outcomes such as HIV and other sexually transmitted infections (STIs), mental health challenges, and substance use. While extensive research has explored the occurrence of transactional sex among cisgender and transgender women, there is a lack of comprehensive understanding regarding its prevalence and correlates among men who have sex with men (MSM), particularly in Nepal. Thus, this study aimed to examine the prevalence of transactional sex and explore the related behavioral characteristics among MSM in Nepal.
Methods
A cross-sectional survey was conducted among MSM in Kathmandu Valley, Nepal, between October and December 2022 (N=250). We collected information on participants' socio-demographic characteristics, sexual and other behavioral characteristics, and their engagement in transactional sex. Bivariate and multivariate logistic regression analyses were performed to determine the factors associated with transactional sex.
Results
Participants' mean age was 27.6 (8.9) years. Overall, 16.4% of participants reported having engaged in transactional sex within the past six months. Individuals who have more financial dependents [B:342, S.E:.140, ꞵ:1.4] and experienced police detention [aOR: 4.8, 95% CI: 1.07-19.6] were more likely to have engaged in transactional sex. Conversely, MSM who reported to have engaged in condomless sex [aOR: 0.2, 95% CI: 0.06-0.1] were less likely to engage in transactional sex.
Conclusion
The study findings underscore the relatively high prevalence of transactional sex among MSM in Nepal. There is an urgent need for targeted sexual health interventions and tailored policies addressing the specific needs of this high-risk group.
Keywords: HIV, Minority healthTransactional sex, which involves the exchange of sex for money, goods, or other items of value, has been associated with adverse health outcomes such as HIV and other sexually transmitted infections (STIs), mental health challenges, and substance use. While extensive research has explored the occurrence of transactional sex among cisgender and transgender women, there is a lack of comprehensive understanding regarding its prevalence and correlates among men who have sex with men (MSM), particularly in Nepal. Thus, this study aimed to examine the prevalence of transactional sex and explore the related behavioral characteristics among MSM in Nepal.
Methods
A cross-sectional survey was conducted among MSM in Kathmandu Valley, Nepal, between October and December 2022 (N=250). We collected information on participants' socio-demographic characteristics, sexual and other behavioral characteristics, and their engagement in transactional sex. Bivariate and multivariate logistic regression analyses were performed to determine the factors associated with transactional sex.
Results
Participants' mean age was 27.6 (8.9) years. Overall, 16.4% of participants reported having engaged in transactional sex within the past six months. Individuals who have more financial dependents [B:342, S.E:.140, ꞵ:1.4] and experienced police detention [aOR: 4.8, 95% CI: 1.07-19.6] were more likely to have engaged in transactional sex. Conversely, MSM who reported to have engaged in condomless sex [aOR: 0.2, 95% CI: 0.06-0.1] were less likely to engage in transactional sex.
Conclusion
The study findings underscore the relatively high prevalence of transactional sex among MSM in Nepal. There is an urgent need for targeted sexual health interventions and tailored policies addressing the specific needs of this high-risk group.
Authors:
Presenter - Md. Safaet Hossain Sujan,
University of Connecticut
Co-Author - Kiran Paudel,
University of Connecticut
Co-Author - Kamal Gautam,
University of Connecticut
Co-Author - Antoine Khati,
University of Connecticut
Co-Author - Jeffrey Wickersham,
PhD,
Yale University
Co-Author - Manisha Dhakal,
Blue Diamond Society, Kathmandu, Nepal
Co-Author - Toan Ha,
PhD,
University of Pittsburgh
Co-Author - Roman Shrestha,
PhD, MPH,
University of Connecticut
E97 - Multi-Level Stigma Exposure and Social Health: The Mediating Role of Shame
Poster Number: E97Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Social and Environmental Context and Health
Background: Among sexual minorities, stigma operating at multiple levels (i.e., structural, interpersonal, and individual) adversely affects social health (Doyle & Barreto, 2023)—defined as “adequate quantity and quality of relationships in a particular context to meet an individual’s need for meaningful human connection (Doyle & Link, 2024, p. 1). However, mechanisms through which stigma affects social health remain understudied. One mechanism that has received attention is shame, an affective response to social disapproval accompanied by feelings of inferiority (Tangney et al., 1996). Shame has been shown to mediate the relationship between interpersonal- and individual-level stigma and loneliness (Mereish & Poteat, 2015). However, evidence is limited by cross-sectional study design, inadequate when testing for mediation. In addition, the role of structural stigma has yet to be tested. This study addresses these gaps by examining whether stigma at structural, interpersonal, and individual levels is indirectly associated with change in social health through shame.
Methods: Data was collected through the Pathways to Longitudinally Understanding Stress (PLUS) study, a longitudinal and population-based cohort study in Sweden (N=559), and the National Study of Stigma and Sexual Health (NSASH), a longitudinal probability-based cohort study in the United States (N=371). Participants completed stigma measures including family rejection, identity concealment, internalized homonegativity, and rejection sensitivity. State-level structural stigma was measured by a composite of 8 structural stigma indicators. Participants completed a measure of shame and of thwarted belonging needs.
Results: In the PLUS cohort, significant longitudinal indirect associations between stigma exposure and change in belonging needs through shame were present for family rejection (B=.03, 95% CI [.01, .06], identity concealment (B=.02, 95% CI [.01, .04]), and rejection sensitivity (B=.02, 95% CI [.01, .05]), but not for internalized homonegativity (B=.01, 95% CI [-.01, .03]). In the NSASH cohort, there was a significant indirect association between state-level structural stigma and belonging needs through shame (B=.05, 95% CI [.01, .08]). Models controlled for age, education, and relationship status.
Discussion: Results from two longitudinal and representative samples provide the strongest evidence to date that shame is one mechanism through which stigma negatively affects social health.
Keywords: Minority health, Sexual orientationMethods: Data was collected through the Pathways to Longitudinally Understanding Stress (PLUS) study, a longitudinal and population-based cohort study in Sweden (N=559), and the National Study of Stigma and Sexual Health (NSASH), a longitudinal probability-based cohort study in the United States (N=371). Participants completed stigma measures including family rejection, identity concealment, internalized homonegativity, and rejection sensitivity. State-level structural stigma was measured by a composite of 8 structural stigma indicators. Participants completed a measure of shame and of thwarted belonging needs.
Results: In the PLUS cohort, significant longitudinal indirect associations between stigma exposure and change in belonging needs through shame were present for family rejection (B=.03, 95% CI [.01, .06], identity concealment (B=.02, 95% CI [.01, .04]), and rejection sensitivity (B=.02, 95% CI [.01, .05]), but not for internalized homonegativity (B=.01, 95% CI [-.01, .03]). In the NSASH cohort, there was a significant indirect association between state-level structural stigma and belonging needs through shame (B=.05, 95% CI [.01, .08]). Models controlled for age, education, and relationship status.
Discussion: Results from two longitudinal and representative samples provide the strongest evidence to date that shame is one mechanism through which stigma negatively affects social health.
Authors:
Author - Brianna McDaniel,
Santa Clara University Department of Public Health
Co-Author - Micah Lattanner,
PhD,
Santa Clara University Department of Public Health
E98 - Perceived Social Support and Health Behaviors Among Black Adults: Stress and Loneliness as Mediating Factors
Poster Number: E98Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Community Engagement
Background: Black adults face significant health disparities, with sedentary behavior and physical inactivity contributing to these inequities. While social support plays a key role in increasing physical activity and reducing sedentary behavior, its specific influence on these behaviors in Black adults is not fully understood. Specifically, although social support can alleviate stress and loneliness—both of which are known to hinder physical activity (PA) and promote sedentary behavior—the ways in which stress and loneliness mediate the effects of social support on these behaviors in Black adults remain unclear. Understanding these mechanisms is crucial for developing culturally relevant interventions that empower Black adults to adopt more active lifestyles and reduce health disparities.
Objectives: This study investigated the indirect relationship between perceived social support and health behaviors (PA and sedentary behavior) mediated by stress and loneliness among Black adults.
Methods: We performed a cross-sectional analysis of Project CHURCH, a community-based participatory study by The University of Texas MD Anderson Cancer Center in partnership with Black churches in Houston, developed to engage the Black community in overcoming cancer research participation barriers. Structural equation modeling assessed direct and indirect effects of the predictor on the outcome via the mediator, adjusting for covariates in 1,827 Black adults. Bootstrapping with 2,000 iterations provided standard errors (SEs) for effect estimates. Missing data were addressed using missForest imputation.
Results: Social support had a significant indirect effect on PA (b=0.004, SE=0.002, p=0.018) and sedentary behavior (b=-0.927, SE=0.369, p=0.012) via perceived stress. Specifically, higher social support reduced stress, which was associated with more PA and fewer sedentary hours. Social support also indirectly influenced PA (ab=0.007, SE=0.003, p=0.021) and sedentary behavior (ab=-3.062, SE=0.653, p<0.001) through loneliness; social support reduced loneliness, which was associated with increased PA and fewer sedentary hours.
Conclusions: Higher levels of social support are linked to reduced physical inactivity and sedentary behaviors among Black adults, with stress and loneliness as mediators. Future research should aim to strengthen social support networks to reduce psychosocial stressors and loneliness and improve health outcomes in this underserved population.
Keywords: Social support, Minority healthObjectives: This study investigated the indirect relationship between perceived social support and health behaviors (PA and sedentary behavior) mediated by stress and loneliness among Black adults.
Methods: We performed a cross-sectional analysis of Project CHURCH, a community-based participatory study by The University of Texas MD Anderson Cancer Center in partnership with Black churches in Houston, developed to engage the Black community in overcoming cancer research participation barriers. Structural equation modeling assessed direct and indirect effects of the predictor on the outcome via the mediator, adjusting for covariates in 1,827 Black adults. Bootstrapping with 2,000 iterations provided standard errors (SEs) for effect estimates. Missing data were addressed using missForest imputation.
Results: Social support had a significant indirect effect on PA (b=0.004, SE=0.002, p=0.018) and sedentary behavior (b=-0.927, SE=0.369, p=0.012) via perceived stress. Specifically, higher social support reduced stress, which was associated with more PA and fewer sedentary hours. Social support also indirectly influenced PA (ab=0.007, SE=0.003, p=0.021) and sedentary behavior (ab=-3.062, SE=0.653, p<0.001) through loneliness; social support reduced loneliness, which was associated with increased PA and fewer sedentary hours.
Conclusions: Higher levels of social support are linked to reduced physical inactivity and sedentary behaviors among Black adults, with stress and loneliness as mediators. Future research should aim to strengthen social support networks to reduce psychosocial stressors and loneliness and improve health outcomes in this underserved population.
Authors:
Co-Author - Gwynn Elizabeth Durham,
Tilman J. Fertitta Family College of Medicine
Co-Author - Seokhun Kim,
University of Texas Health Science Center
Co-Author - Lorna H. McNeill, MPH, PhD, FSBM,
MPH, PhD, FSBM,
University of Texas MD Anderson Cancer Center
Co-Author - Dalnim Cho, PhD,
PhD,
The University of Texas MD Anderson Cancer Center
E99 - Association Between In Utero Cannabis Exposure and Infant Birth Weight and Growth Trajectories
Poster Number: E99Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Child and Family Health
Background: With the recent legalization and rise in cannabis use in the U.S. (National Conference of State Legislatures, 2024; Volkow et al., 2019), it's crucial to understand the health risks of in utero cannabis exposure. While this exposure is linked to adverse infant health outcomes (Avalos et al., 2024), it's unclear if there are additional risks related to birth weight and growth in infants from historically marginalized communities. This study evaluates associations among in utero cannabis exposure and infant birth weight and growth trajectory through 6 months of age in a predominantly Black and African American and low-income population. We hypothesized that in utero cannabis exposure would predict lower infant birth weight and an atypical weight trajectory by 6 months of age. Methods: Caregiver/infant dyads (n=120) were recruited as a part of a randomized controlled trial assessing a responsive parenting intervention in pediatric primary care. Maternal cannabis exposure (defined as a positive urine toxicology screen for THC), birthweight, and relevant infant data were collected via infants’ electronic medical records upon enrollment in the study. Infant anthropometric measurements were collected at the infants’ 6-month well-child visit. Atypical (i.e., rapid or slow) weight gain was determined by conditional weight gain scores. A linear regression examined associations of in utero cannabis exposure with birth weight, after adjusting for control variables (i.e., gestational age, sex, household income, infant race, and infant ethnicity). Results: Results showed that infants exposed to cannabis in utero had lower birth weights compared to unexposed infants (b=-0.34, p=.006), above and beyond control variables. Additionally, we observed high proportions of infants with atypical weight trajectories (i.e., rapid weight gain=56% and slow weight gain=37.5%) at 6-months of age among infants with in utero cannabis exposure. Conclusions: Results of this study support recent research indicating associations among in utero cannabis exposure and low birth weight, which suggest that in utero cannabis exposure may additionally impact infant weight trajectories. These findings may encourage practitioners treating individuals who are currently pregnant or trying to conceive to discuss the potential adverse infant health outcomes associated with in utero cannabis exposure.
Keywords: Low-income and minority groups, GrowthAuthors:
Presenter - Sarah E. Francis,
B.A.,
Cincinnati Children's Hospital Medical Center
Co-Author - Devanshi J. Patel,
PhD,
Cincinnati Children's Hospital Medical Center
Co-Author - Constance A. Mara,
PhD,
Cincinnati Children's Hospital Medical Center
Co-Author - Tiffany M. Rybak,
PhD,
Cincinnati Children's Hospital Medical Center
E100 - Assessing Doulas' Roles and Experiences in Clinical Environments: Insights from a Nationwide Survey
Poster Number: E100Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Women's Health
Background
Doulas have demonstrated their ability to improve birth outcomes, particularly for minoritized communities, including Black, Brown, Indigenous, and Pacific Islander women and birthing persons of color. While research shows doulas’ positive impact on maternal health, a gap in knowledge persists about doulas’ experiences and perceptions in hospital and clinical settings. In collaboration with the New Jersey Health Care Quality Institute (NJHCQI), an exploratory survey was distributed to doulas nationwide. Data was collected from July 2023 to September 2023.
Methods
The survey was created by a HealthConnect One full-time employee and was electronically disseminated to doulas who administer care in a clinical setting between July 2023 and September 2023. Survey questions were open-ended and elicited qualitative responses. Braun and Clarke Multidirectional 6–Phase Guide was used by an evaluator employed by HealthConnect One to interpret and analyze the data, which took approximately three months.
Results
Themes from the analysis indicate the importance of collaboration between doulas and hospital staff to enhance the birthing experience. Doulas often stress the importance of streamlined communication with medical personnel to create a positive and supportive environment for mothers and birthing persons. They also report experiencing secondary trauma from supporting clients through negative birthing experiences, adding to their professional distress. Data showcased frustrations about unclear hospital policies, doula certification requirements, and other nuances that adversely impact doulas’ jobs. Despite the challenges, there were themes of doulas supporting empowering and collaborative births with the clinical staff, underscoring the dichotomous nature of the role.
Conclusion
This survey effectively demonstrated themes that showed the importance of centering doulas’ voices and experiences within the hospital and clinical setting. Data should be used to provide education for both doulas and providers, which may strengthen these relationships and improve clinical and social support collaboration. Further, the findings should be used to inform hospital policies about doulas. Given the current state of maternal health in the U.S. and the positive impact of doulas on birth outcomes, particularly for BIPOC communities, these findings highlight the need for ongoing support and evaluation of birth workers to benefit pregnant women and birthing persons.
Keywords: Minority health, Research to practice translationDoulas have demonstrated their ability to improve birth outcomes, particularly for minoritized communities, including Black, Brown, Indigenous, and Pacific Islander women and birthing persons of color. While research shows doulas’ positive impact on maternal health, a gap in knowledge persists about doulas’ experiences and perceptions in hospital and clinical settings. In collaboration with the New Jersey Health Care Quality Institute (NJHCQI), an exploratory survey was distributed to doulas nationwide. Data was collected from July 2023 to September 2023.
Methods
The survey was created by a HealthConnect One full-time employee and was electronically disseminated to doulas who administer care in a clinical setting between July 2023 and September 2023. Survey questions were open-ended and elicited qualitative responses. Braun and Clarke Multidirectional 6–Phase Guide was used by an evaluator employed by HealthConnect One to interpret and analyze the data, which took approximately three months.
Results
Themes from the analysis indicate the importance of collaboration between doulas and hospital staff to enhance the birthing experience. Doulas often stress the importance of streamlined communication with medical personnel to create a positive and supportive environment for mothers and birthing persons. They also report experiencing secondary trauma from supporting clients through negative birthing experiences, adding to their professional distress. Data showcased frustrations about unclear hospital policies, doula certification requirements, and other nuances that adversely impact doulas’ jobs. Despite the challenges, there were themes of doulas supporting empowering and collaborative births with the clinical staff, underscoring the dichotomous nature of the role.
Conclusion
This survey effectively demonstrated themes that showed the importance of centering doulas’ voices and experiences within the hospital and clinical setting. Data should be used to provide education for both doulas and providers, which may strengthen these relationships and improve clinical and social support collaboration. Further, the findings should be used to inform hospital policies about doulas. Given the current state of maternal health in the U.S. and the positive impact of doulas on birth outcomes, particularly for BIPOC communities, these findings highlight the need for ongoing support and evaluation of birth workers to benefit pregnant women and birthing persons.
Authors:
Co-Author - Kanan Brent,
HealthConnect One
E101 - Exploring the impact of Superwoman Schema on longitudinal variation of Social Isolation among Black Women Living with Systemic Lupus Erythematosus
Poster Number: E101Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Women's Health
Background: Intersectional health inequities in systemic lupus erythematous (SLE), a chronic autoimmune disease afflicting mostly Black women, suggest a need to center Black women’s health . Social isolation (SI) is a facet of living with SLE which has been associated with disease processes and contributes to impaired social functioning. The Superwoman Schema (SWS) captures how Black women may interpret their surrounding world, rooted in a specific sociocultural context. SWS is an important framing for SI because behaviors implicit in SWS, such as self-sacrifice or masking pain, may be associated with SI and further downstream SLE outcomes.
Objective: Assess the predictive ability of SWS on longitudinal variation of SI among a cohort of Black women living with SLE.
Methods: The sample is from the Georgians Organized Against Lupus (GOAL) cohort study. Responses were collected across three waves (2015-2019). The wave 1 (W1) sample included 584 Black women. The mean age and disease duration was 48 (SD=13.3) and 16 (SD=10.0) years respectively. We measured SWS using the Woods-Giscombé Superwoman Schema Questionnaire and SI using Patient Reported Outcomes Measurement Information System Short Form. We used a two-level multi-level modeling approach to assess differential change trajectories of SI depending on SWS.
Results. SWS was assessed at W1. SI was assessed at all time points. Descriptive plots suggested a reduction in SI over time. Our final model showed a statistically significant SWS x time interaction term (beta= -0.01, p=0.008) and coefficients for time (beta= 0.32, p=0.025) and SWS (beta= 0.35, p<0.001). These results suggest that a higher initial SWS score corresponds to greater initial SI but also a steeper reduction in SI over time. The final model explained 20% of variance among individuals.
Conclusion: Our results suggest that SI generally declines over time. Higher initial SWS was associated with higher SI but also with a steeper reduction in SI over time . These findings align with previous work describing SWS as a “doubled-edged” sword, meaning that SWS may afford individuals with both health promoting and health damaging consequences. Future work should examine variation of SI by subdomains of SWS and further operationalize pathways between social context and social processes that shape health inequities, particularly in populations such as those living with SLE given the disproportionate prevalence among Black women.
Keywords: Autoimmune disease, CultureObjective: Assess the predictive ability of SWS on longitudinal variation of SI among a cohort of Black women living with SLE.
Methods: The sample is from the Georgians Organized Against Lupus (GOAL) cohort study. Responses were collected across three waves (2015-2019). The wave 1 (W1) sample included 584 Black women. The mean age and disease duration was 48 (SD=13.3) and 16 (SD=10.0) years respectively. We measured SWS using the Woods-Giscombé Superwoman Schema Questionnaire and SI using Patient Reported Outcomes Measurement Information System Short Form. We used a two-level multi-level modeling approach to assess differential change trajectories of SI depending on SWS.
Results. SWS was assessed at W1. SI was assessed at all time points. Descriptive plots suggested a reduction in SI over time. Our final model showed a statistically significant SWS x time interaction term (beta= -0.01, p=0.008) and coefficients for time (beta= 0.32, p=0.025) and SWS (beta= 0.35, p<0.001). These results suggest that a higher initial SWS score corresponds to greater initial SI but also a steeper reduction in SI over time. The final model explained 20% of variance among individuals.
Conclusion: Our results suggest that SI generally declines over time. Higher initial SWS was associated with higher SI but also with a steeper reduction in SI over time . These findings align with previous work describing SWS as a “doubled-edged” sword, meaning that SWS may afford individuals with both health promoting and health damaging consequences. Future work should examine variation of SI by subdomains of SWS and further operationalize pathways between social context and social processes that shape health inequities, particularly in populations such as those living with SLE given the disproportionate prevalence among Black women.
Authors:
Presenter - Jerik Leung,
Rollins School of Public Health, Emory University
Co-Author - Regine Haardörfer,
PhD,
Rollins School of Public Health, Emory University
Co-Author - Charmayne Dunlop-Thomas,
MS, MPH,
Emory University School of Medicine
Co-Author - Tené T. Lewis, PhD,
PhD,
Emory University
Co-Author - Cam Escoffery, PhD, MPH,
PhD, MPH,
Rollins School of Public Health
Co-Author - S. Sam Lim,
MD, MPH,
Emory University School of Medicine
E102 - Syndemic Conditions, Community Connectedness, and Sexual HIV Risk: A Moderated Indirect Effects Analysis of Pre-Exposure Prophylaxis Uptake Among Sexual Minority Men in Taiwan
Poster Number: E102Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Health of Marginalized Populations
Background: In Taiwan, sexual minority men (SMM; e.g., gay, bisexual, and other men who have sex with men) face a disproportionate burden of HIV, driven in part by syndemic conditions (e.g., binge drinking, substance use, depression, internalized homonegativity, and sexual victimization). While community connectedness has been shown to influence health outcomes, its impact on HIV risk and the uptake of pre-exposure prophylaxis (PrEP) among SMM in Taiwan remains underexplored. This study investigates the interplay between syndemic conditions, sexual HIV risk, community connectedness, and PrEP uptake in this population.
Methods: A cross-sectional survey was conducted in April–May 2023 among HIV-negative or status-unknown SMM in Taiwan (N=416; Mage=32.0; SD=9.0). Participants completed validated measures for syndemic conditions, sexual HIV risk, community connectedness, and PrEP uptake. Using the PROCESS macro with bootstrapping, we examined a moderated indirect effects model, adjusting for demographic covariates.
Results: Nearly one-quarter (24.3%) of participants reported experiencing at least two syndemic conditions. Syndemic conditions were positively associated with sexual HIV risk, and this association was amplified among participants with higher levels of community connectedness. Additionally, syndemic conditions indirectly associated with PrEP uptake through increased sexual HIV risk, but this indirect effect was only significant when community connectedness was at moderate or high levels. In other words, community connectedness strengthened the pathway from syndemic conditions to sexual HIV risk, which, in turn, increased the likelihood of PrEP uptake.
Conclusions: Community connectedness plays a dual role in HIV prevention among SMM in Taiwan, intensifying the link between syndemic conditions and sexual HIV risk while also facilitating PrEP uptake. These findings emphasize the need for interventions addressing both individual-level syndemic conditions and structural factors like community integration. Tailored strategies should prioritize SMM with higher syndemic burdens, fostering community engagement through peer education and culturally sensitive outreach. Simultaneously, efforts must ensure inclusivity, addressing barriers for those with weaker community ties. By integrating psychosocial support with community-based approaches, public health programs can mitigate HIV risk and enhance PrEP uptake in this marginalized population.
Keywords: HIV, Minority healthMethods: A cross-sectional survey was conducted in April–May 2023 among HIV-negative or status-unknown SMM in Taiwan (N=416; Mage=32.0; SD=9.0). Participants completed validated measures for syndemic conditions, sexual HIV risk, community connectedness, and PrEP uptake. Using the PROCESS macro with bootstrapping, we examined a moderated indirect effects model, adjusting for demographic covariates.
Results: Nearly one-quarter (24.3%) of participants reported experiencing at least two syndemic conditions. Syndemic conditions were positively associated with sexual HIV risk, and this association was amplified among participants with higher levels of community connectedness. Additionally, syndemic conditions indirectly associated with PrEP uptake through increased sexual HIV risk, but this indirect effect was only significant when community connectedness was at moderate or high levels. In other words, community connectedness strengthened the pathway from syndemic conditions to sexual HIV risk, which, in turn, increased the likelihood of PrEP uptake.
Conclusions: Community connectedness plays a dual role in HIV prevention among SMM in Taiwan, intensifying the link between syndemic conditions and sexual HIV risk while also facilitating PrEP uptake. These findings emphasize the need for interventions addressing both individual-level syndemic conditions and structural factors like community integration. Tailored strategies should prioritize SMM with higher syndemic burdens, fostering community engagement through peer education and culturally sensitive outreach. Simultaneously, efforts must ensure inclusivity, addressing barriers for those with weaker community ties. By integrating psychosocial support with community-based approaches, public health programs can mitigate HIV risk and enhance PrEP uptake in this marginalized population.
Authors:
Presenter - Daniel Mayo,
MS,
National Taiwan University
Co-Author - Poyao Huang,
PhD,
National Taiwan University
E103 - The influence of parental communication about sex on subsequent sexual behaviors and attitudes among Asian and Latino young adults
Poster Number: E103Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Health of Marginalized Populations
Young people in the United States (U.S.) are exposed to various sources of sexual health education - in particular, parental sex-communication has been found to reduce sexual risk behaviors among young adults (CDC, 2019; Coakley et al., 2017). However, among Latino and Asian families, sex-related topics are often considered taboo (Aragón & Cooke-Jackson, 2021; Katz, 2002; Lee et al., 2013; Trinh & Kim, 2021). This study aimed to examine the relationship between parental sex-communication and behaviors among Asian and Latino young adults. Three hypotheses were tested: (H1) Asian and Latino youth are less likely to report parental sex-communication than non-Hispanic White youth; (H2) Parental sex-communication among Asian and Latino youth are associated with more negative attitudes toward sexual communication as well as lower safe-sex self-efficacy; and, (H3) Lack of parental sex-communication, negative attitudes toward sex communication, and lower safe-sex self-efficacy are related to higher sexual risk behaviors among both groups. An online survey was distributed among a sample of 205 Asian (n = 63), Latino (n = 48), and non-Hispanic White (n = 94) youth (Age M = 20.05, SD = 1.20; 53% females; 70% sexually active) at a small liberal arts college in Southern California. Results found that a significantly lower percentage of Asian youth reported parental sex conversations (39.7%) in comparison to Latino (69.6%) and White (32.3%) youth (χ2 = 14.07, df = 2, p < .001). Moreover, parental sex communication predicted attitudes toward sex communication among Latinos (β = 1.12, S.E. = 0.49, p = .03), which subsequently predicted sexual risk (i.e., STIs; β = -0.72, S.E. = 0.22, p = .01). Among Asian youth, negative attitudes toward sex discussions predicted sexual risk behaviors (i.e., inconsistent barrier method utilization; β = 0.37, S.E. = 0.30, p = .03). Also, among Latino youth, cultural values significantly predicted sexual risk behaviors (β = -1.12, S.E. = 0.47, p = .03). Attitudes toward sex and sexual risk behaviors among Asian youth may be influenced by non-familial sources due to a lack of parental discussion about sex. Conversely, Latino youths’ attitudes and sexual risk behaviors appear to be influenced by parental sex-discussions. Strategies aimed at reducing sexual risk among young people should aim to provide guidance for parents on navigating taboo topics and sensitive discussions among Asian and Latino families.
Keywords: Sexual behavior, Minority healthAuthors:
Author - Disha Shah,
Occidental College
Co-Author - Zahra Noorani,
Occidental College
Co-Author - Grace Fernandez,
Occidental College
Co-Author - Kylie Castro,
Occidental College
Co-Author - Joomi Park,
Occidental College
Co-Author - Sarah Sakura Shireman,
Occidental College
Co-Author - Angelica Ortiz Alvarez,
Occidental College
Co-Author - Patricia Cabral, PhD,
PhD,
Occidental College
E104 - Associations between sex-education sources and sexual risk behaviors among young adults
Poster Number: E104Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Health Communication and Policy
Sex education resources for youth in the U.S. are wide-ranging from comprehensive to abstinence-only. Sex education programs aimed at increasing safe-sex self-efficacy may be successful at reducing negative sexual health outcomes. This study examines the effects of sexual education on the sexual self-efficacy and risk behaviors of young adults. Participants (N = 137) included young adults between 17 and 24 years old (M age = 19.51, SD = 1.29) and were predominantly identified as female (77.4%). Participants were asked to complete two online surveys regarding their sexual health behaviors, sexual health education, and perceived support for their sexual identity. We hypothesized that (H1) comprehensive sex education will be positively associated with safe-sex self-efficacy; those who received comprehensive sex education would report higher safe-sex self-efficacy in comparison to those who did not. Furthermore (H2), comprehensive sex education will be negatively associated with sexual risk behaviors; individuals who received comprehensive sex education would report lower engagement in sexual risk behaviors including early sex initiation, multiple sex partners, and low use of barrier/condom methods to prevent sexually transmitted infections (STIs). Over 78% of the sample reported having received sex education prior to college. More than 41% of the sample indicated receiving a comprehensive sex education whereas 11% reported abstinence-only instruction. The type of sex education received did not predict safe-sex self-efficacy but did predict sexual behaviors such as the number of sexual partners. Lacking comprehensive sex education was related to a high number of lifetime sexual partners (M number of sexual partners = 4.34, SD = 4.03; B = 1.54, S.E. = 0.73, p < .05). In sum, this study indicates the importance of comprehensive sexual education in helping to mitigate risky sexual behavior.
Keywords: Sexual behavior, EducationAuthors:
Author - Julia Hutchinson,
Occidental College
Co-Author - Bunyaon Srisuponvanit,
Occidental College
Co-Author - Olivia Stiles,
Occidental College
Co-Author - Grace Fernandez,
Occidental College
Co-Author - Zahra Saleem Noorani,
Occidental College
Co-Author - Kylie Renee Castro,
Occidental College
Co-Author - Disha Shah,
Occidental College
Co-Author - Martina Long,
Occidental College
Co-Author - Sean Vargas,
Occidental College
Co-Author - Patricia Cabral, PhD,
PhD,
Occidental College
E105 - Associations Between Housing Security and Resilience Among Latinx People Living with HIV
Poster Number: E105Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Health of Marginalized Populations
Background
Latino/a/x and Spanish-speaking populations in the U.S. are disproportionately impacted by HIV, with outcomes often worsened by housing instability. We examined whether housing stability associates with HIV treatment engagement and adherence, and the role of resilience on this association.
Methods
Between January 2020 and August 2023 (off and on during COVID-19 waves), 72 people with HIV (PWH) were recruited from a community HIV clinic in East Los Angeles. Participants were primarily Latino/Hispanic (80%), cis-male (80%), and 58.6% foreign-born. Online surveys were collected in Spanish and English in-person, over the phone, or remotely and included measures of housing stability, HIV care engagement, resilience, and ART adherence. Of the participants, 19 completed qualitative 1-on-1 interviews. Housing stability was assessed on a 10-point scale (1 =not at all sure, 10 =very sure of stability over following year). Engagement in HIV care was scored on a 10-item scale, rating perceived connection to HIV care from 1 (not true) to 5 (true almost all the time). Correlation and regression analyses explored these relationships with subgroup comparisons by language.
Results
Housing stability was positively associated with engagement in HIV care (r =.28, p =.026) and resilience (r =.27, p =.041). Unadjusted linear regression analysis by language showed housing stability was strongly associated with engagement in care for Spanish speakers (B =1.6, p =.004) but not for English speakers. Resilience did not directly moderate the housing-HIV care engagement relationship. Logistic regression showed that better engagement in HIV care was linked to a 13% reduction in the likelihood of 4-day ART treatment interruption. Qualitative interviews echoed these findings. Participants frequently highlighted housing security as crucial for HIV care engagement.
Conclusion
Housing stability bolstered PWH’s ability to engage in HIV care and treatment adherence, especially among Spanish-speaking Latino/a/x PWH, highlighting resilience. Housing instability is a structural determinant that demands policy-level and community interventions critical for ending the HIV epidemic in marginalized communities. Culturally and linguistically tailored interventions that address housing stability and foster resilience may substantially improve care retention and health outcomes for Latinx individuals with HIV, offering a critical avenue for reducing HIV disparities in vulnerable communities.
Keywords: HIV, LatinoLatino/a/x and Spanish-speaking populations in the U.S. are disproportionately impacted by HIV, with outcomes often worsened by housing instability. We examined whether housing stability associates with HIV treatment engagement and adherence, and the role of resilience on this association.
Methods
Between January 2020 and August 2023 (off and on during COVID-19 waves), 72 people with HIV (PWH) were recruited from a community HIV clinic in East Los Angeles. Participants were primarily Latino/Hispanic (80%), cis-male (80%), and 58.6% foreign-born. Online surveys were collected in Spanish and English in-person, over the phone, or remotely and included measures of housing stability, HIV care engagement, resilience, and ART adherence. Of the participants, 19 completed qualitative 1-on-1 interviews. Housing stability was assessed on a 10-point scale (1 =not at all sure, 10 =very sure of stability over following year). Engagement in HIV care was scored on a 10-item scale, rating perceived connection to HIV care from 1 (not true) to 5 (true almost all the time). Correlation and regression analyses explored these relationships with subgroup comparisons by language.
Results
Housing stability was positively associated with engagement in HIV care (r =.28, p =.026) and resilience (r =.27, p =.041). Unadjusted linear regression analysis by language showed housing stability was strongly associated with engagement in care for Spanish speakers (B =1.6, p =.004) but not for English speakers. Resilience did not directly moderate the housing-HIV care engagement relationship. Logistic regression showed that better engagement in HIV care was linked to a 13% reduction in the likelihood of 4-day ART treatment interruption. Qualitative interviews echoed these findings. Participants frequently highlighted housing security as crucial for HIV care engagement.
Conclusion
Housing stability bolstered PWH’s ability to engage in HIV care and treatment adherence, especially among Spanish-speaking Latino/a/x PWH, highlighting resilience. Housing instability is a structural determinant that demands policy-level and community interventions critical for ending the HIV epidemic in marginalized communities. Culturally and linguistically tailored interventions that address housing stability and foster resilience may substantially improve care retention and health outcomes for Latinx individuals with HIV, offering a critical avenue for reducing HIV disparities in vulnerable communities.
Authors:
Author - Sebastian Castillo Cario,
University of California, San Francisco, School of Medicine
Co-Author - John Sauceda,
PhD,
UCSF, Department of Medicine, Division of Prevention Science
Co-Author - Ronald A. Brooks,
PhD,
UCLA, Department of Family Medicine, Los Angeles, CA
Co-Author - Robert Contreras,
MBA,
Bienestar Human Services
E106 - Integrating Community Voices in NeuroHIV: Community Perspectives on Health Literacy, Stigma, and Research Engagement
Poster Number: E106Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Community Engagement
Background: Despite clinical advances, people living with HIV (PLWH) still face complications from both HIV infection and treatment neurotoxicity. A major issue is HIV-associated neurocognitive disorders (NeuroHIV), caused by HIV infecting the central nervous system. These disorders disproportionately affect racial and ethnic minorities, often exacerbated by social determinants. Addressing these challenges requires examining HIV-related health disparities, particularly in vulnerable communities. The Comprehensive NeuroHIV Center, funded by NIMH, has undertaken this mission in partnership with Temple and Drexel Universities. The Community Partnership and Disparities Core (CPDC) was created with the center to build connections between community providers, PLWH, and researchers to inform NeuroHIV science, engage communities, and mitigate health disparities. Objective: The CPDC conducted a community needs assessment to identify concerns related to NeuroHIV and improve the dissemination of research findings to enhance the neurological health and well-being of PLWH. Methods and participants: Semi-structured interviews were conducted with HIV researchers (N=12), PLWH (N=13), and healthcare or social service providers working with PLWH (N=14). Interviews were transcribed, and thematic categories were identified through an iterative coding process. The present examination focuses on the PLWH group’s NeuroHIV familiarity, perceptions, knowledge gaps, and attitudes toward HIV-related research. Results: Findings highlight the impact of NeuroHIV on PLWH’s brain health, care needs, and daily challenges, influenced by stigma and social determinants. About 46% of PLWH were familiar with the term "NeuroHIV," but many lacked a full understanding of its effects on brain health. While participants showed general HIV-related health literacy, they expressed a desire to learn more about their diagnosis but were unsure where to find credible information. Attitudes toward research were shaped by previous experiences with clinical HIV research and healthcare. Recommendations include improving access to NeuroHIV information, addressing stigma, and enhancing direct engagement between researchers and PLWH. Conclusion: These findings provide actionable insights to support PLWH’s access to essential information and resources, emphasizing the need for accessible educational materials, leveraging local HIV service agencies, and fostering opportunities for researcher-community engagement.
Keywords: HIV, Research to practice translationAuthors:
Presenter - Caseem C. Luck,
M.S.,
Temple University College of Public Health
Co-Author - Kathryn Devlin,
PhD.,
Department of Psychological and Brain Sciences, Drexel University College of Arts and Sciences
Co-Author - Maria Schultheis,
PhD.,
Department of Psychological and Brain Sciences, Drexel University College of Arts and Sciences
Co-Author - Esther Chernak,
MD, MPH,
Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health
Co-Author - Katie Singley, MPH,
MPH,
Temple University Risk Communication Lab
Co-Author - Alex Rotaru,
MPH,
Department of Social and Behavioral Sciences, Temple University College of Public Health
Co-Author - Eberechukwu Rita Moneke,
MPH,
Department of Social and Behavioral Sciences, Temple University College of Public Health
Co-Author - Oluwaseyi Akinboboye,
M.A.,
Drexel University College of Medicine
Co-Author - Molly Piacentini,
B.S,
Department of Social and Behavioral Sciences, Temple University College of Public Health
Co-Author - Omari Coker,
B.S.,
Department of Social and Behavioral Sciences, Temple University College of Public Health
Co-Author - Arianna Vacio,
B.S.,
Department of Social and Behavioral Sciences, Temple University College of Public Health
Co-Author - Atharva Biydae,
B.S.,
Department of Social and Behavioral Sciences, Temple University College of Public Health
Co-Author - Murad Wali,
Department of Social and Behavioral Sciences, Temple University College of Public Health
Co-Author - Sarah Bauerle Bass, PhD, MPH, FSBM,
PhD, MPH, FSBM,
Temple University
E107 - High levels of PrEP stigma were associated with suboptimal PrEP care engagement among sexual and gender minority (SGM) young people who have sex with men and use substances
Poster Number: E107Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Substance Misuse
Background
Sexual and gender minority (SGM) young people who have sex with men and use substances are at increased risk of HIV acquisition due to intersecting vulnerabilities. These individuals encounter significant barriers in accessing crucial HIV prevention services, including pre-exposure prophylaxis (PrEP). Stigma associated with PrEP use represents an additional obstacle to PrEP care engagement within this population. The current study aims to characterize PrEP-related stigma among a sample of substance-using SGM young people and examine its impact on PrEP uptake and adherence among this group.
Methods
We used baseline data from a randomized comparative trial assessing the acceptability, appropriateness, and feasibility of a novel Machine-Learning HIV intervention. Using the pre-validated HIV PrEP Stigma Scale, we assessed PrEP stigma among participants and collected sociodemographic characteristics and self-reported PrEP use history. We conducted multivariable logistic regressions to examine the associations between PrEP stigma and PrEP uptake and adherence, adjusting for sociodemographic factors that showed significant differences in PrEP stigma levels.
Results
The study sample consisted of 412 racially and ethnically diverse participants (mean age 24.5 years: SD = 3.1). Higher levels of PrEP stigma were associated with younger age and being bisexual (compared to gay, p<0.05). Participants who identified as non-binary and transgender also experienced high levels of PrEP stigma compared to cisgender men (p<0.001 for both). In multivariable models, with each unit increase in PrEP stigma score, the odds of using current PrEP use decreased by approximately 52% and among those using PrEP, the odds of having excellent PrEP adherence decrease by 63% (p<0.001).
Conclusion
Our results highlight the elevated levels of PrEP stigma experienced by SGM young people who have sex with men and use substances, emphasizing the critical need for focused attention on stigma reduction to efforts promote PrEP care engagement. Findings underscore the importance of targeted interventions and policy initiatives aimed at reducing PrEP-related stigma, particularly among sexual and gender minority communities, to effectively meet their HIV prevention needs. Future research should focus on understanding the intersectional factors contributing to PrEP stigma to inform the design and delivery of innovative stigma reduction interventions to enhance the PrEP care engagement.
Keywords: AIDS, SexualitySexual and gender minority (SGM) young people who have sex with men and use substances are at increased risk of HIV acquisition due to intersecting vulnerabilities. These individuals encounter significant barriers in accessing crucial HIV prevention services, including pre-exposure prophylaxis (PrEP). Stigma associated with PrEP use represents an additional obstacle to PrEP care engagement within this population. The current study aims to characterize PrEP-related stigma among a sample of substance-using SGM young people and examine its impact on PrEP uptake and adherence among this group.
Methods
We used baseline data from a randomized comparative trial assessing the acceptability, appropriateness, and feasibility of a novel Machine-Learning HIV intervention. Using the pre-validated HIV PrEP Stigma Scale, we assessed PrEP stigma among participants and collected sociodemographic characteristics and self-reported PrEP use history. We conducted multivariable logistic regressions to examine the associations between PrEP stigma and PrEP uptake and adherence, adjusting for sociodemographic factors that showed significant differences in PrEP stigma levels.
Results
The study sample consisted of 412 racially and ethnically diverse participants (mean age 24.5 years: SD = 3.1). Higher levels of PrEP stigma were associated with younger age and being bisexual (compared to gay, p<0.05). Participants who identified as non-binary and transgender also experienced high levels of PrEP stigma compared to cisgender men (p<0.001 for both). In multivariable models, with each unit increase in PrEP stigma score, the odds of using current PrEP use decreased by approximately 52% and among those using PrEP, the odds of having excellent PrEP adherence decrease by 63% (p<0.001).
Conclusion
Our results highlight the elevated levels of PrEP stigma experienced by SGM young people who have sex with men and use substances, emphasizing the critical need for focused attention on stigma reduction to efforts promote PrEP care engagement. Findings underscore the importance of targeted interventions and policy initiatives aimed at reducing PrEP-related stigma, particularly among sexual and gender minority communities, to effectively meet their HIV prevention needs. Future research should focus on understanding the intersectional factors contributing to PrEP stigma to inform the design and delivery of innovative stigma reduction interventions to enhance the PrEP care engagement.
Authors:
Author - Chenglin Hong,
PhD, MSW, MPH,
University of Connecticut
E108 - Exploration of Attitudes and Beliefs Toward Psychedelic-Assisted Therapies (PAT) for Cancer-Related Psychosocial Symptoms in Healthcare Providers, Patients and Policy Makers
Poster Number: E108Time: 05:00 PM - 05:50 PM
Topics: Integrative Health and Spirituality, Cancer
Background: Psychedelic-assisted therapy (PAT) may represent a paradigm shift in the treatment of common cancer-related psychosocial problems. Clinical trials have demonstrated strong preliminary evidence for therapeutic benefits for treating depression, anxiety and existential distress. While psychedelics are currently prohibited substances in most countries, growing evidence may motivate people with cancer to try psychedelics on their own, which has implications for patient safety. Hence, it is crucial to explore attitudes and beliefs about PAT to determine whether and how to safely implement access and treatment within the oncology context.
Methods: A locally developed 98-item quantitative survey on attitudes toward current treatments for psychosocial symptoms; perceived knowledge, attitudes and beliefs about psychedelic-assisted therapy; perceived safety and therapeutic potential of PAT; personal experience with psychedelics; perceived barriers to use of psychedelics in oncology care; preferences for potential implementation; clinical preparedness for using psychedelics in oncology contexts (HCPs only), and demographic, clinical and psychosocial health data was administered to people living with cancer (n=545), healthcare providers (n=180) and administrators/policy makers (n=36) across Canada.
Results: Participants were 55% females, 57% White, from 9 provinces, indicating good sample diversity. 71% of participants indicated they were “somewhat” to “very” knowledgeable about psychedelics for people with cancer; 63% agreed that administering psychedelics to people with cancer is safe [provided treatment conditions are carefully controlled]. The largest barriers to PAT were perceived safety concerns (43%). Psilocybin was rated most favourably among specific psychedelic compounds, with 79% perceiving psilocybin as “somewhat” or “very” effective in treating psychosocial symptoms for people with cancer. Only 16% of participants had prior personal experience with psilocybin; of those 84% indicated their experience had been positive. Crucially, 94% of people with cancer indicated they want access to PAT in their healthcare region.
Conclusions: There are high levels of interest and support for PAT across all three groups, with generally positive attitudes in this sample, particularly towards the use of psilocybin-assisted therapy. Further clinical research should investigate PAT efficacy and feasibility for delivery within the healthcare system.
Keywords: Complementary Medicine, CancerMethods: A locally developed 98-item quantitative survey on attitudes toward current treatments for psychosocial symptoms; perceived knowledge, attitudes and beliefs about psychedelic-assisted therapy; perceived safety and therapeutic potential of PAT; personal experience with psychedelics; perceived barriers to use of psychedelics in oncology care; preferences for potential implementation; clinical preparedness for using psychedelics in oncology contexts (HCPs only), and demographic, clinical and psychosocial health data was administered to people living with cancer (n=545), healthcare providers (n=180) and administrators/policy makers (n=36) across Canada.
Results: Participants were 55% females, 57% White, from 9 provinces, indicating good sample diversity. 71% of participants indicated they were “somewhat” to “very” knowledgeable about psychedelics for people with cancer; 63% agreed that administering psychedelics to people with cancer is safe [provided treatment conditions are carefully controlled]. The largest barriers to PAT were perceived safety concerns (43%). Psilocybin was rated most favourably among specific psychedelic compounds, with 79% perceiving psilocybin as “somewhat” or “very” effective in treating psychosocial symptoms for people with cancer. Only 16% of participants had prior personal experience with psilocybin; of those 84% indicated their experience had been positive. Crucially, 94% of people with cancer indicated they want access to PAT in their healthcare region.
Conclusions: There are high levels of interest and support for PAT across all three groups, with generally positive attitudes in this sample, particularly towards the use of psilocybin-assisted therapy. Further clinical research should investigate PAT efficacy and feasibility for delivery within the healthcare system.
Authors:
Author - Haley Schuman,
BSc,
University of Calgary
Co-Author - Julie Deleemans,
PhD,
University of Calgary
Co-Author - Tina Nguyen,
BSc,
University of Calgary
E110 - Perceived and enacted stigma and associated factors among gay, bisexual, and other men who have sex with men in Nepal: A nationwide cross-sectional survey
Poster Number: E110Time: 05:00 PM - 05:50 PM
Topics: Health of Marginalized Populations , Mental Health
Abstract
Background: Men who have sex with men (MSM) widely reported stigmatization for their same-sex practices. Stigma is a multi-dimensional concept that encompasses perceived, enacted, internalized, and anticipated stigma. Despite its complexities, stigma-related research has mostly focused on specific kinds of sexual stigma among MSM, while identification and understanding of perceived and enacted stigma are crucial in many aspects. Thus, the present study aimed to explore the levels of perceived and enacted stigma and their associated factors among MSM in Nepal.
Methods: A nationwide cross-sectional study was conducted online among 842 participants between April and May 2024. A convenient sampling technique was utilized to recruit participants. The Neiland’s Sexual Stigma Scale (NSS-10) was employed to assess perceived and enacted stigma. Bivariate and multivariate linear regression analysis examined the relationship between the independent and outcome variables.
Results: Participant's mean age was 27.6 (SD=7.1) years. The mean score of the perceived and enacted stigma were 9.3 (SD=6.8) and 5.6 (SD=5.1) respectively. Participants who were engaged in anal sex in the past 12 months, [B:1.5, S.E:0.2, ꞵ:0.2, p-value: <0.01], [B:1.5, S.E:0.3, ꞵ:0.2, p-value: <0.01] and had depressive symptoms [B:1.2, S.E:0.1, ꞵ:0.2, p-value: <0.01], [B:1.3, S.E:0.2, ꞵ:0.2, p-value: <0.01] had increased perceived and enacted stigma. Conversely, participants who were involved in sex parties [B: -0.5, S.E:0.2, ꞵ: -0.1, p-value: 0.017], [B: -0.5, S.E:0.2, ꞵ: -0.1, p-value: 0.017] and were engaged in condomless sex in the past 12 months [B: -0.4, S.E:0.2, ꞵ:-0.1, p-value: 0.0579], [B:-0.4, S.E:0.2, ꞵ:-0.1, p-value: 0.059] had reported lower perceived and enacted stigma.
Conclusion: The study showed a high level of perceived and enacted stigma among MSM in Nepal. These findings emphasize the importance of a comprehensive approach to combat such stigmas in Nepal by adopting and upholding anti-discrimination laws that preserve MSM's rights.
Keywords: Sexual abuse, Mental healthBackground: Men who have sex with men (MSM) widely reported stigmatization for their same-sex practices. Stigma is a multi-dimensional concept that encompasses perceived, enacted, internalized, and anticipated stigma. Despite its complexities, stigma-related research has mostly focused on specific kinds of sexual stigma among MSM, while identification and understanding of perceived and enacted stigma are crucial in many aspects. Thus, the present study aimed to explore the levels of perceived and enacted stigma and their associated factors among MSM in Nepal.
Methods: A nationwide cross-sectional study was conducted online among 842 participants between April and May 2024. A convenient sampling technique was utilized to recruit participants. The Neiland’s Sexual Stigma Scale (NSS-10) was employed to assess perceived and enacted stigma. Bivariate and multivariate linear regression analysis examined the relationship between the independent and outcome variables.
Results: Participant's mean age was 27.6 (SD=7.1) years. The mean score of the perceived and enacted stigma were 9.3 (SD=6.8) and 5.6 (SD=5.1) respectively. Participants who were engaged in anal sex in the past 12 months, [B:1.5, S.E:0.2, ꞵ:0.2, p-value: <0.01], [B:1.5, S.E:0.3, ꞵ:0.2, p-value: <0.01] and had depressive symptoms [B:1.2, S.E:0.1, ꞵ:0.2, p-value: <0.01], [B:1.3, S.E:0.2, ꞵ:0.2, p-value: <0.01] had increased perceived and enacted stigma. Conversely, participants who were involved in sex parties [B: -0.5, S.E:0.2, ꞵ: -0.1, p-value: 0.017], [B: -0.5, S.E:0.2, ꞵ: -0.1, p-value: 0.017] and were engaged in condomless sex in the past 12 months [B: -0.4, S.E:0.2, ꞵ:-0.1, p-value: 0.0579], [B:-0.4, S.E:0.2, ꞵ:-0.1, p-value: 0.059] had reported lower perceived and enacted stigma.
Conclusion: The study showed a high level of perceived and enacted stigma among MSM in Nepal. These findings emphasize the importance of a comprehensive approach to combat such stigmas in Nepal by adopting and upholding anti-discrimination laws that preserve MSM's rights.
Authors:
Presenter - Md Safaet Hossain Sujan,
University of Connecticut
Co-Author - Kiran Paudel, BPH,
BPH,
University of Connecticut
Co-Author - Kamal Gautam,
University of Connecticut
Co-Author - Jeffrey Wickersham,
Yale School of Medicine
Co-Author - Roman Shrestha, PhD, MPH,
PhD, MPH,
University of Connecticut
E111 - The STOP Method: A Tool for Navigating Weight Loss Misinformation on Social Media
Poster Number: E111Time: 05:00 PM - 05:50 PM
Topics: Obesity, Digital Health
Background:
While social media and online communities have been successfully used in behavioral weight loss interventions, there is a high prevalence of misinformation online. Effective methods to assist and train individuals in identifying and handling health misinformation online are lacking. This study aimed to pilot test brief educational videos to support adults in navigating weight-related misinformation online.
Methods:
We developed three brief videos using evidence-based strategies to educate adults about weight-related health misinformation on social media. The videos focus on our novel mnemonic approach, the STOP method: Is someone trying to Sell you something? Does it sound Too good to be true? Is it Out of step with messages from trusted sources? Does it focus on fast Progress? We recruited adults (BMI≥25 kg/m2, interested in weight management strategies) to provide feedback on the videos via semi-structured interviews including reporting their self-efficacy to spot and handle misinformation. The target sample was 10-15 adults. Interviews were transcribed verbatim and analyzed with an emerging themes approach.
Results:
Participants (N=14) were 64.3% female, 57.1.% non-Hispanic white, with an average age of 44.7 years and BMI 31.5 kg/m2. After watching the videos, 57.1% of participants reported increased self-efficacy in identifying misinformation, but few were more confident in handling misinformation. Interviews revealed several themes. Participants found the STOP method to be accessible and concise; they would use it for navigating weight loss information and would recommend it to others. They felt the videos effectively introduced the STOP method and its application and had minor suggestions to the script for improved clarity and video suggestions to add visual appeal and engagement. Participants said they would be more likely to view such videos if recommended by their doctor due to established trust. Many participants already had high self-efficacy and pre-existing strategies for ignoring inaccurate content online.
Conclusions:
The STOP method was acceptable, and the brief videos were well-received. Results will direct video refinement and inform the development of measures to capture changes in knowledge of and self-efficacy to manage health misinformation. Final videos and educational materials will be embedded into a future randomized weight-loss trial utilizing online social communities.
Keywords: Obesity, e-HealthWhile social media and online communities have been successfully used in behavioral weight loss interventions, there is a high prevalence of misinformation online. Effective methods to assist and train individuals in identifying and handling health misinformation online are lacking. This study aimed to pilot test brief educational videos to support adults in navigating weight-related misinformation online.
Methods:
We developed three brief videos using evidence-based strategies to educate adults about weight-related health misinformation on social media. The videos focus on our novel mnemonic approach, the STOP method: Is someone trying to Sell you something? Does it sound Too good to be true? Is it Out of step with messages from trusted sources? Does it focus on fast Progress? We recruited adults (BMI≥25 kg/m2, interested in weight management strategies) to provide feedback on the videos via semi-structured interviews including reporting their self-efficacy to spot and handle misinformation. The target sample was 10-15 adults. Interviews were transcribed verbatim and analyzed with an emerging themes approach.
Results:
Participants (N=14) were 64.3% female, 57.1.% non-Hispanic white, with an average age of 44.7 years and BMI 31.5 kg/m2. After watching the videos, 57.1% of participants reported increased self-efficacy in identifying misinformation, but few were more confident in handling misinformation. Interviews revealed several themes. Participants found the STOP method to be accessible and concise; they would use it for navigating weight loss information and would recommend it to others. They felt the videos effectively introduced the STOP method and its application and had minor suggestions to the script for improved clarity and video suggestions to add visual appeal and engagement. Participants said they would be more likely to view such videos if recommended by their doctor due to established trust. Many participants already had high self-efficacy and pre-existing strategies for ignoring inaccurate content online.
Conclusions:
The STOP method was acceptable, and the brief videos were well-received. Results will direct video refinement and inform the development of measures to capture changes in knowledge of and self-efficacy to manage health misinformation. Final videos and educational materials will be embedded into a future randomized weight-loss trial utilizing online social communities.
Authors:
Co-Author - Chrishann Walcott,
University of Florida
Co-Author - Hannah Lavoie, MS CHES, ACSM-PAPHS,
MS CHES, ACSM-PAPHS,
University of Florida
Co-Author - Megan McVay,
PhD,
University of Florida
Co-Author - Francesca Wilkins,
MS,
University of Florida
Co-Author - Montserrat Carrera Seoane,
PhD,
University of Florida
E112 - Trauma-Focused Evidence-Based Psychotherapy for Posttraumatic Stress Disorder Delivered via Synchronous Video Telehealth in the Veterans Health Administration
Poster Number: E112Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Dissemination and Implementation
Trauma-focused evidence-based psychotherapy (EBP) is the recommended treatment for posttraumatic stress disorder (PTSD). During and after the COVID-19 pandemic, Veterans health Administration (VHA) policies encouraged increased delivery of general mental health services via clinical video telehealth (CVT) to better serve veterans. However, it remains unclear how these policy changes impact the way veterans are currently receiving PTSD EBP services. Our goal in the current project was to describe the percentage as well as the demographic, military, and clinical characteristics of veterans receiving PTSD EBPs via CVT vs. in-person. Using data from the VHA electronic health record, we identified a national cohort of all-era veterans who received individual PTSD EBP for the first time between 4/2022-4/2023 (n = 24,897). We used VHA clinic stop codes and Current Procedural Terminology codes to identify PTSD EBP delivery modality (CVT vs. in-person). Next, we used multivariable hierarchical Bayesian logistic regression to model the probability of receiving at least 50% of EBP care via CVT. In our sample, 74.4% of veterans who received PTSD EBP used CVT for at least one EBP session and 66.8% of veterans received at least half of their EBP sessions by CVT. Female veterans (Cohen’s d = 0.24; 90% CI = 0.18, 0.29) were more likely to have received their PTSD EBP via CVT, with additional strong and positive interaction effects for Black female veterans, Hispanic female veterans, female officer veterans, and Black officer veterans. CVT delivery of PTSD EBPs was more common than in-person delivery of PTSD EBPs. Consistent with underlying trends in telehealth services, women veterans and particularly women, racial/ethnic minority veterans were more likely to receive PTSD EBP via CVT. Prior work has hypothesized that participation in telehealth treatment may be preferable for women and racial/ethnic minority veterans due to harassment experienced with in person care or to overcome practical barriers to treatment engagement (e.g., transportation, childcare). Future research designed to contextualize the observed differences in CVT delivery of PTSD EBPs should consider the role of social determinants of health in selecting treatment modality.
Keywords: Tele-health, TraumaAuthors:
Presenter - Nicholas Holder,
San Francisco Veterans Affairs Health Care System; University of California San Francisco
Co-Author - Adam Batten,
San Francisco Veterans Affairs Health Care System; University of California San Francisco
Co-Author - Brian Shiner,
White River Junction Veterans Affairs Health Care System; National Center for Posttraumatic Stress Disorder, Executive Division; Geisel School of Medicine at Dartmouth
Co-Author - Shira Maguen, PhD,
PhD,
San Francisco Veterans Affairs Health Care System; University of California San Francisco
E113 - Pubertal Development, Internalizing Symptoms, and Physical Activity in Adolescent Girls
Poster Number: E113Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Women's Health
Background: Puberty brings physical, cognitive, hormonal, and social changes for adolescent girls. Internalizing symptoms (depression, anxiety) heighten as girls reach menarche, especially among those who mature earlier than their peers. Meanwhile, physical activity (PA) decreases across the pubertal transition, and these declines may be exacerbated among earlier maturers.
Objective: The current study examined pubertal development (status and timing) and its associations with internalizing symptoms and PA.
Methods: Participants include 146 premenarchal girls assigned female at birth (Mage=11.13, SDage=0.93). Anxiety and depression symptoms were assessed with NIH PROMIS short forms. PA was measured using a) actigraphs, which participants wore for seven days, and b) parent report of how many days (0-7) their child engaged in 60 minutes or more of PA over the past week. Pubertal status was assessed using the Tanner Stage Developmental scale (i.e., model pictures of breasts and pubic hair best fitting the participant). Pubertal timing was assessed using residualized pubertal status scores adjusting for age. Linear regressions were run to examine associations between pubertal development, internalizing symptoms, and PA.
Results: On average, most participants did not exhibit clinical levels of either depression (75% within normal limits, 9.7% mild, 6.9% moderate, and 8.3% severe) or anxiety (71.7% within normal limits, 13.1% mild, 8.3% moderate, and 6.9% severe). Actigraphy-measured PA indicated that participants engaged in light PA exclusively (M = 304.23, SD = 79.45) with an average of 4.27 days of PA per week as reported by parents. Significant associations were found between pubertal status and a) depression R2 = .055, β = .234, p = .005 and b) anxiety (R2 = .053, β = .231, p = .005) and pubertal timing and a) depression (R2 = .041, β = .203, p = .015) and b) anxiety (R2 = .040, β = .200, p = .016). Girls with more advanced and earlier puberty compared to their same-aged peers reported higher levels of internalizing symptoms. No significant associations were found between pubertal development and PA or PA and internalizing symptoms.
Discussion: Findings suggest that early maturing girls are at greater risk for internalizing symptoms even prior to the onset of menstruation. Future research should focus on the longitudinal trajectories of PA, internalizing symptoms, and pubertal development across the menarchal transition.
Keywords: Depression, Women's healthObjective: The current study examined pubertal development (status and timing) and its associations with internalizing symptoms and PA.
Methods: Participants include 146 premenarchal girls assigned female at birth (Mage=11.13, SDage=0.93). Anxiety and depression symptoms were assessed with NIH PROMIS short forms. PA was measured using a) actigraphs, which participants wore for seven days, and b) parent report of how many days (0-7) their child engaged in 60 minutes or more of PA over the past week. Pubertal status was assessed using the Tanner Stage Developmental scale (i.e., model pictures of breasts and pubic hair best fitting the participant). Pubertal timing was assessed using residualized pubertal status scores adjusting for age. Linear regressions were run to examine associations between pubertal development, internalizing symptoms, and PA.
Results: On average, most participants did not exhibit clinical levels of either depression (75% within normal limits, 9.7% mild, 6.9% moderate, and 8.3% severe) or anxiety (71.7% within normal limits, 13.1% mild, 8.3% moderate, and 6.9% severe). Actigraphy-measured PA indicated that participants engaged in light PA exclusively (M = 304.23, SD = 79.45) with an average of 4.27 days of PA per week as reported by parents. Significant associations were found between pubertal status and a) depression R2 = .055, β = .234, p = .005 and b) anxiety (R2 = .053, β = .231, p = .005) and pubertal timing and a) depression (R2 = .041, β = .203, p = .015) and b) anxiety (R2 = .040, β = .200, p = .016). Girls with more advanced and earlier puberty compared to their same-aged peers reported higher levels of internalizing symptoms. No significant associations were found between pubertal development and PA or PA and internalizing symptoms.
Discussion: Findings suggest that early maturing girls are at greater risk for internalizing symptoms even prior to the onset of menstruation. Future research should focus on the longitudinal trajectories of PA, internalizing symptoms, and pubertal development across the menarchal transition.
Authors:
Presenter - Kirby Knapp,
BA,
Loyola University Chicago
Co-Author - Colleen Conley,
PhD,
Loyola University Chicago
Co-Author - Amy Bohnert,
PhD,
Loyola University Chicago
Co-Author - Frank Tu,
MD, MPH,
NorthShore University HealthSystem
Co-Author - Kevin Hellman,
PhD,
NorthShore University HealthSystem
E114 - Help-Seeking Behaviors in Adolescents and Young Adults with Nonsuicidal Self-Injury: An Integrative Review
Poster Number: E114Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Decision Making
BACKGROUND: Nonsuicidal self-injury (NSSI) is a growing public health issue associated with adverse health outcomes (e.g., suicide attempts) in adolescents and young adults, with a U.S. prevalence of 20%. A primary concern in this population is the reluctance to seek help. While help-seeking is recognized as crucial for facilitating early access to resources and improving health outcomes, little is known about how help-seeking behaviors may vary across developmental stages.
OBJECTIVES: The central purpose of this systematic integrative review is to examine help-seeking behaviors in adolescents and young adults, with a focus on identifying the forms, components (i.e., antecedents, types of help, sources, consequences), and factors. Another purpose is to compare the patterns between adolescents and young adults.
METHODS: A literature search across seven databases was conducted for research reports on help-seeking behaviors in adolescents and young adults with NSSI.
OUTCOMES: Of 1,063 articles found with the search, 16 reports were included in this review. The majority were cross-sectional studies published from 2010 through 2023. Eight articles focused on adolescents, and eight on young adults, with samples largely comprising White females in school-based settings. In both populations, three forms of help-seeking behaviors were identified: disclosure, help-seeking itself, and mental health service use. Disclosure was the most prevalent, and all three forms were more prevalent in young adults than adolescents. Prevalence varied based on contextual factors, such as issue specificity (NSSI vs. general psychological distress) and independence (voluntary vs. involuntary). Similar help-seeking patterns were observed in both age groups, with one notable developmental difference. Lack of recognizing NSSI as a problem functioned as a barrier to help-seeking, and individuals mostly relied on social networks rather than professionals for problem-focused help or support. The nature of responses (positive/negative) was associated with substantial differences in health outcomes.
CONCLUSION: Recognizing the complexity of help-seeking is crucial. Future research should consider additional contextual variables and employ longitudinal designs to capture long-term mechanisms of help-seeking. It contributes to the development of guidelines to encourage help-seeking, enhance peer and family support, and increase professionals’ capacity as sources of help.
Keywords: Mental health, AdolescentsOBJECTIVES: The central purpose of this systematic integrative review is to examine help-seeking behaviors in adolescents and young adults, with a focus on identifying the forms, components (i.e., antecedents, types of help, sources, consequences), and factors. Another purpose is to compare the patterns between adolescents and young adults.
METHODS: A literature search across seven databases was conducted for research reports on help-seeking behaviors in adolescents and young adults with NSSI.
OUTCOMES: Of 1,063 articles found with the search, 16 reports were included in this review. The majority were cross-sectional studies published from 2010 through 2023. Eight articles focused on adolescents, and eight on young adults, with samples largely comprising White females in school-based settings. In both populations, three forms of help-seeking behaviors were identified: disclosure, help-seeking itself, and mental health service use. Disclosure was the most prevalent, and all three forms were more prevalent in young adults than adolescents. Prevalence varied based on contextual factors, such as issue specificity (NSSI vs. general psychological distress) and independence (voluntary vs. involuntary). Similar help-seeking patterns were observed in both age groups, with one notable developmental difference. Lack of recognizing NSSI as a problem functioned as a barrier to help-seeking, and individuals mostly relied on social networks rather than professionals for problem-focused help or support. The nature of responses (positive/negative) was associated with substantial differences in health outcomes.
CONCLUSION: Recognizing the complexity of help-seeking is crucial. Future research should consider additional contextual variables and employ longitudinal designs to capture long-term mechanisms of help-seeking. It contributes to the development of guidelines to encourage help-seeking, enhance peer and family support, and increase professionals’ capacity as sources of help.
Authors:
Presenter - Nani Kim,
PhD student, BSN, RN,
University of Texas at Austin
Author - Cara C. Young, PhD APRN FNP-C,
PhD APRN FNP-C FAANP FAAN,
The University of Texas at Austin
Author - Bora Kim,
PhD, RN,
Cizik School of Nursing, The University of Texas Health Science Center at Houston
Author - Lynn Rew, EdD, RN, FAAN,
EdD, RN, FAAN,
The University of Texas At Austin
Author - Nicholas J. Westers,
PsyD,
University of Texas Southwestern Medical Center at Dallas
E115 - Supporting clients’ trauma recovery: Psychosocial correlates of current practice of trauma-informed care among frontline nurses in Hong Kong
Poster Number: E115Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Integrated Primary Care
Background: Given that frontline nurses are often the contact points for trauma-exposed patients, exploring their perceptions and skills to provide trauma-informed care (TIC; an approach recognizing the impact of trauma on health and providing safe/collaborative settings for those clients) are important. Western studies have suggested that TIC is beneficial to clients’ trauma adjustments and that nurses recognize the importance of TIC yet feel unsure about how to practice TIC in their work settings. Relevant studies are limited in the Asian context. This study investigated Hong Kong nurses’ perceptions towards TIC and factors associated with their recent TIC practice.
Methods: Nurses (N=252) with experiences caring for trauma-exposed patients in hospitals and community settings (e.g., accidents, terminal illnesses, mental health problems) were recruited through nursing associations in Hong Kong between February and March 2024. They completed an online cross-sectional survey measuring their sociodemographic characteristics, TIC-related perceptions, and recent TIC practice.
Results: Most of the participants viewed TIC favorably and recognized the impact of trauma on patients’ health, but perceived a low level of competence in TIC. Hierarchical regression analysis results indicated nurses with personal trauma history (β=0.23, p<.001), fewer perceived barriers on TIC implementation (β=-0.16, p<.05), more organizational facilitators for TIC implementation (β=0.14, p<.05), higher perceived competence in TIC (β=0.19, p<.01), and higher perceived familiarity in the concept of TIC (β=0.30, p<.001) were more likely to practice TIC. However, favorable attitudes about TIC and higher knowledge about impact of trauma on patients’ health were not associated with current TIC practice (ps>.05).
Implications: The study identified the factors associated with TIC practice among Hong Kong nurses caring for trauma-exposed patients. The presence of positive attitudes towards TIC and knowledge about the impacts of trauma might not be sufficient to translate into TIC practice. On the other hand, our findings highlight the importance of increasing nurses’ competence/skills in practicing TIC, reducing implementation barriers, and enhancing organizational support for adoption of TIC. Future efforts should focus on developing comprehensive training programs for nurses about TIC practice, plus fostering organizational environments to support sustainable TIC in healthcare settings.
Keywords: Trauma, Mental healthMethods: Nurses (N=252) with experiences caring for trauma-exposed patients in hospitals and community settings (e.g., accidents, terminal illnesses, mental health problems) were recruited through nursing associations in Hong Kong between February and March 2024. They completed an online cross-sectional survey measuring their sociodemographic characteristics, TIC-related perceptions, and recent TIC practice.
Results: Most of the participants viewed TIC favorably and recognized the impact of trauma on patients’ health, but perceived a low level of competence in TIC. Hierarchical regression analysis results indicated nurses with personal trauma history (β=0.23, p<.001), fewer perceived barriers on TIC implementation (β=-0.16, p<.05), more organizational facilitators for TIC implementation (β=0.14, p<.05), higher perceived competence in TIC (β=0.19, p<.01), and higher perceived familiarity in the concept of TIC (β=0.30, p<.001) were more likely to practice TIC. However, favorable attitudes about TIC and higher knowledge about impact of trauma on patients’ health were not associated with current TIC practice (ps>.05).
Implications: The study identified the factors associated with TIC practice among Hong Kong nurses caring for trauma-exposed patients. The presence of positive attitudes towards TIC and knowledge about the impacts of trauma might not be sufficient to translate into TIC practice. On the other hand, our findings highlight the importance of increasing nurses’ competence/skills in practicing TIC, reducing implementation barriers, and enhancing organizational support for adoption of TIC. Future efforts should focus on developing comprehensive training programs for nurses about TIC practice, plus fostering organizational environments to support sustainable TIC in healthcare settings.
Authors:
Author - Nelson C.Y. Yeung, PhD,
PhD,
The Chinese University of Hong Kong
Author - Irene Chen,
The Chinese University of Hong Kong
E116 - The Role of Social Support and Self-Determination in Leisure Activities on Affect and Stress: An Ecological Momentary Assessment Study
Poster Number: E116Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Stress
Background: Leisure activities play a crucial role in buffering the effects of stress on psychological well-being. However, few studies have explored these stress-buffering effects empirically in daily life. Utilizing Ecological Momentary Assessment (EMA), we explore how leisure-generated social support and leisure-generated self-determination moderate the relationship between perceived stress and positive affect (PA) among adults in Taiwan. Methods: Adults in Taiwan (N=132, 65.9% female, Mage = 24.95, range= 18-66) completed EMA surveys three times daily for seven days. Participants reported their current activity ('learning,' 'work,' 'maintenance,' 'leisure,' 'others') and perceptions of social support and self-determination during leisure activities on a five-point Likert scale. PA was measured using five items (happy, enjoyable, contented, relaxed, energetic) on a five-point Likert scale, with mean scores analyzed. Multilevel modeling examined the moderating effects of momentary leisure-generated social support and self-determination on the relationships between perceived stress and PA, adjusting for covariates (age, sex, marital status, employment status, and frequency of leisure activities). Results: The study yielded 2,081 EMA occasions (response rate = 75.07%) from 132 adults. Multilevel models revealed that social support (b = 0.32, p < .05) and self-determination (b = 0.55, p < .05) during leisure activities moderated the relationship between perceived stress and PA, indicating that social support and self-determination mitigated the negative effect of momentary stress on PA. Specifically, the association between momentary perceived stress and momentary PA was stronger during occasions when individuals engaged in leisure activities with higher-than-usual levels of support and self-determination. Simple slope analyses revealed that when social support was low (-1 SD), momentary perceived stress was significantly related to decreased momentary PA (β = -0.55, p = .023). Additionally, when self-determination was high (+1 SD), momentary perceived stress was significantly related to enhanced momentary PA (β = 0.49, p = .048). Conclusion: This study advances our understanding of how leisure activities and psychosocial factors interact to buffer stress in daily life. Findings suggest that fostering self-determination and social support through leisure activities can benefit stress management and enhance affective state.
Keywords: Mood, StressAuthors:
Presenter - Shang-Ti Chen,
National Dong Hwa University
Co-Author - Meesong Kang,
National Dong Hwa University
Co-Author - Jinshil Hyun,
Albert Einstein College of Medicine
Co-Author - Chih-Hsiang Yang,
University of South Carolina
E117 - How do mental health and wellbeing researchers define yoga? A systematic review
Poster Number: E117Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Integrative Health and Spirituality
Background
Poor quality of life and disease burden associated with mental ill-health are rising in prominence worldwide. Behavioral interventions are critical to improving mental health and wellbeing. Yoga, an increasingly popular intervention consisting of physical and psychological principles, demonstrates promising effects on mental health and wellbeing outcomes. However, yoga, with its Eastern origins, remains poorly defined and described as a behavioral intervention, limiting the interpretation, replicability, and implementation of results. The objective of this systematic review was to determine how yoga for mental health and wellbeing is defined and described in recent peer-reviewed literature.
Methods
We searched six databases from 2013 to August 2024 using terms relating to ‘yoga’, ‘mental health’, ‘wellbeing’ and ‘intervention’. Randomized controlled trials of yoga interventions that had a validated measure of mental ill-health, wellbeing, or quality of life as a primary outcome were included. The primary outcomes of this review were definitions and descriptions of yoga interventions. Inductive qualitative analysis of yoga definitions and descriptions is ongoing.
Results
Of 5206 studies identified, 132 were included. Preliminary qualitative analysis of a subsample of 66 studies (50%) resulted in a total of 548 meaning units (MU). Ongoing analysis on definitions (88 MU) suggests that mental health and wellbeing researchers define yoga as a mind-body (48 MU) or mind-body-spirit (28 MU) practice (19 MU) or intervention (10 MU). Mental health and wellbeing researchers also described components of yoga (147 MU), including mental practices such as meditation or mindfulness (39 MU), movement such as static postures and stretching (37 MU), breath practices (37 MU), and relaxation (30 MU).
Conclusions
This review, as the first comprehensive analysis of how yoga is defined and described in mental health and wellbeing research, provides recommendations for future yoga-based research. Preliminary findings suggest yoga is operationalized as a ‘mind-body’ or ‘mind-body-spirit’ practice consisting of multiple components (i.e., mental, physical, breathing, relaxation). Further analysis will elucidate descriptions of practices (e.g., intervention core components) and explore comparisons of yoga definitions and descriptions by geographical location and population.
Keywords: Mental health, Complementary MedicinePoor quality of life and disease burden associated with mental ill-health are rising in prominence worldwide. Behavioral interventions are critical to improving mental health and wellbeing. Yoga, an increasingly popular intervention consisting of physical and psychological principles, demonstrates promising effects on mental health and wellbeing outcomes. However, yoga, with its Eastern origins, remains poorly defined and described as a behavioral intervention, limiting the interpretation, replicability, and implementation of results. The objective of this systematic review was to determine how yoga for mental health and wellbeing is defined and described in recent peer-reviewed literature.
Methods
We searched six databases from 2013 to August 2024 using terms relating to ‘yoga’, ‘mental health’, ‘wellbeing’ and ‘intervention’. Randomized controlled trials of yoga interventions that had a validated measure of mental ill-health, wellbeing, or quality of life as a primary outcome were included. The primary outcomes of this review were definitions and descriptions of yoga interventions. Inductive qualitative analysis of yoga definitions and descriptions is ongoing.
Results
Of 5206 studies identified, 132 were included. Preliminary qualitative analysis of a subsample of 66 studies (50%) resulted in a total of 548 meaning units (MU). Ongoing analysis on definitions (88 MU) suggests that mental health and wellbeing researchers define yoga as a mind-body (48 MU) or mind-body-spirit (28 MU) practice (19 MU) or intervention (10 MU). Mental health and wellbeing researchers also described components of yoga (147 MU), including mental practices such as meditation or mindfulness (39 MU), movement such as static postures and stretching (37 MU), breath practices (37 MU), and relaxation (30 MU).
Conclusions
This review, as the first comprehensive analysis of how yoga is defined and described in mental health and wellbeing research, provides recommendations for future yoga-based research. Preliminary findings suggest yoga is operationalized as a ‘mind-body’ or ‘mind-body-spirit’ practice consisting of multiple components (i.e., mental, physical, breathing, relaxation). Further analysis will elucidate descriptions of practices (e.g., intervention core components) and explore comparisons of yoga definitions and descriptions by geographical location and population.
Authors:
Co-Author - Masha Remskar,
BSc, MSc,
University Of Bath
Co-Author - Karsen S. Barley,
Virginia Tech
Co-Author - Danielle E. David,
BS, BA,
Virginia Tech
Co-Author - Marina Z. Guillen,
BS,
Virginia Tech
Co-Author - Daryn E. Olsen,
BS,
Virginia Tech
Co-Author - Kayla M. Markley,
BS,
Virginia Tech
Co-Author - Samantha M. Harden,
PhD,
Virginia Tech
Co-Author - Jacinta Brinsley,
PhD,
University of South Australia
E118 - Maladaptive coping skills in young adults diagnosed with metabolic syndrome: Implications for future health risks
Poster Number: E118Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Cardiovascular Disease
Background: Adaptive emotion regulation and coping skills serve as a buffer against many forms of psychopathology, with a growing interest in understanding how these skills may mitigate health risks. Prior work emphasizes the utility of training these skills earlier in life, showing a protective effect that adaptative emotion regulation can have on the incidence and severity of health issues as one ages. However, less is known about relationships between emotion regulation skills and health in young adulthood. A better understanding of this relationship may help identify intervention points to prevent exacerbation of health issues throughout aging. This study therefore examined if young adults with metabolic syndrome used more adaptive and less maladaptive emotion regulation strategies compared to those without metabolic syndrome.
Methods: As part of a larger study examining barriers to and facilitators of health in young adults with metabolic syndrome, participants diagnosed with metabolic syndrome (n=17) and those without metabolic syndrome (n=50) aged 18-39 completed self-report measures of coping strategies and emotion regulation abilities. Metabolic syndrome was diagnosed via a cardiometabolic assessment that participants completed as part of their study participation.
Results: Compared to young adults without metabolic syndrome, those with metabolic syndrome reported a greater use of emotional suppression (t=-1.67, Mdiff=-2.61, p=.04), emotional avoidance (t=-2.28, Mdiff=-1.57, p=.01), and denial (t=-5.05, Mdiff=-2.46, p<.001). In contrast, there were no differences between groups in their use of adaptive coping and emotion regulation strategies, including cognitive reappraisal, acceptance, and use of social support (ps .18-.31).
Conclusion: These results highlight disparities in emotion regulation skills use among young adults diagnosed with metabolic syndrome, specifically in relation to individuals with metabolic syndrome using more maladaptive strategies. Inconsistent with hypotheses, our results showed differences between groups on maladaptive emotion regulation, but not adaptive emotion regulation skills. Although future research is needed, these results highlight that using psychological interventions to reduce maladaptive coping may buffer against health risks in young adults, therefore promoting health as they age.
Keywords: Metabolic regulation, EmotionsMethods: As part of a larger study examining barriers to and facilitators of health in young adults with metabolic syndrome, participants diagnosed with metabolic syndrome (n=17) and those without metabolic syndrome (n=50) aged 18-39 completed self-report measures of coping strategies and emotion regulation abilities. Metabolic syndrome was diagnosed via a cardiometabolic assessment that participants completed as part of their study participation.
Results: Compared to young adults without metabolic syndrome, those with metabolic syndrome reported a greater use of emotional suppression (t=-1.67, Mdiff=-2.61, p=.04), emotional avoidance (t=-2.28, Mdiff=-1.57, p=.01), and denial (t=-5.05, Mdiff=-2.46, p<.001). In contrast, there were no differences between groups in their use of adaptive coping and emotion regulation strategies, including cognitive reappraisal, acceptance, and use of social support (ps .18-.31).
Conclusion: These results highlight disparities in emotion regulation skills use among young adults diagnosed with metabolic syndrome, specifically in relation to individuals with metabolic syndrome using more maladaptive strategies. Inconsistent with hypotheses, our results showed differences between groups on maladaptive emotion regulation, but not adaptive emotion regulation skills. Although future research is needed, these results highlight that using psychological interventions to reduce maladaptive coping may buffer against health risks in young adults, therefore promoting health as they age.
Authors:
Presenter - Megan Renna,
PhD,
University of Southern Mississippi
Co-Author - Faith Wilbourne,
MA,
University of Southern Mississippi
Co-Author - Sonal Johal,
MA,
University of Southern Mississippi
Co-Author - Kylee Behringer,
BA,
University of Southern Mississippi
Co-Author - Kelsey Bonfils,
PhD,
University of Southern Mississippi
Co-Author - Holly Huye,
PhD,
University of Southern Mississippi
Co-Author - Stephanie Smith,
PhD,
University of Southern Mississippi
Co-Author - Tanner Thorsen,
PhD,
University of Southern Mississippi
Co-Author - Jon Stavres,
PhD,
University of Southern Mississippi
Co-Author - Austin Graybeal,
PhD,
University of Southern Mississippi
E119 - Cognitive Difficulties and Caregiver Burden in Dyads of Individuals with Chiari Malformation and their Caregivers
Poster Number: E119Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Stress
Introduction: Chiari Malformation (CM) is a chronic health condition characterized by the displacement of the cerebellum and disruption of cerebrospinal fluid. Individuals with CM (ICMs) may have associated cognitive difficulties, including in executive functions, attention, working memory, visuospatial, and perceptual domains. Additionally, ICMs often report psychological symptoms and chronic pain. ICMs’ cognitive difficulties, psychological symptoms, and pain may increase caregiver burden; however, little is known about the relationships among these variables in the context of CM.
Methods: Women with CM and their caregiver (i.e., romantic partner, family member, or friend who lives with the ICM) were recruited online using social networking sites. Both members of the dyad completed the Cognitive Difficulties Scale. ICMs completed the Brief Pain Inventory and Depression, Anxiety, and Stress Scale (DASS-21). Caregivers completed the Zarit Burden Interview (ZBI). Hierarchical linear regression was used to examine the proportion of variance in caregiver burden explained by pain ratings, depression and anxiety, and cognitive difficulties (as reported by the ICM and the caregiver separately).
Results: Thirty-one ICM-Caregiver Dyads were included in the sample. ICMs self-rated higher cognitive difficulties (M=71, SD=36) compared to their caregivers’ ratings of the ICMs cognitive difficulties (M=39, SD=29). Most ICMs reported that their cognitive difficulties had increased (64%) since their diagnosis with CM and 26% had been diagnosed with cognitive impairment. Levels of caregiver burden were mild-moderate (M=27, SD=14). ICM-reported cognitive difficulties explained a significant portion (15%) of variance in caregiver burden over and above ICM-rated pain, and ICM-rated depression and anxiety, F(1, 24=.8.64, p=.01); results were similar when caregiver reports of cognitive difficulties were used (F(1,24)=5.17, p=.03).
Conclusion: ICMs have moderate levels of cognitive difficulties that significantly impact their caregivers’ report of burden above and beyond ratings of pain, depression, and anxiety. ICMs may benefit from additional support, such as stress reduction, psychotherapy, and cognitive skills training. Caregivers may benefit from additional resources to prevent burden such as individual psychotherapy, stress management resources, and instrumental support.
Keywords: Caregiving, Cognitive factorsMethods: Women with CM and their caregiver (i.e., romantic partner, family member, or friend who lives with the ICM) were recruited online using social networking sites. Both members of the dyad completed the Cognitive Difficulties Scale. ICMs completed the Brief Pain Inventory and Depression, Anxiety, and Stress Scale (DASS-21). Caregivers completed the Zarit Burden Interview (ZBI). Hierarchical linear regression was used to examine the proportion of variance in caregiver burden explained by pain ratings, depression and anxiety, and cognitive difficulties (as reported by the ICM and the caregiver separately).
Results: Thirty-one ICM-Caregiver Dyads were included in the sample. ICMs self-rated higher cognitive difficulties (M=71, SD=36) compared to their caregivers’ ratings of the ICMs cognitive difficulties (M=39, SD=29). Most ICMs reported that their cognitive difficulties had increased (64%) since their diagnosis with CM and 26% had been diagnosed with cognitive impairment. Levels of caregiver burden were mild-moderate (M=27, SD=14). ICM-reported cognitive difficulties explained a significant portion (15%) of variance in caregiver burden over and above ICM-rated pain, and ICM-rated depression and anxiety, F(1, 24=.8.64, p=.01); results were similar when caregiver reports of cognitive difficulties were used (F(1,24)=5.17, p=.03).
Conclusion: ICMs have moderate levels of cognitive difficulties that significantly impact their caregivers’ report of burden above and beyond ratings of pain, depression, and anxiety. ICMs may benefit from additional support, such as stress reduction, psychotherapy, and cognitive skills training. Caregivers may benefit from additional resources to prevent burden such as individual psychotherapy, stress management resources, and instrumental support.
Authors:
Author - Karlee Patrick,
M.A.,
Kent state university
Co-Author - Emily Rabinowitz,
M.A.,
Kent state university
Co-Author - Grant Ripley,
B.A.,
Syracuse University
Co-Author - Chase Lemek,
Kent State University
Co-Author - Doug Delahanty,
Ph.D.,
Kent State University
E120 - Developing Conversation Cards to Enhance Teens’ Social Connections and Mental Health
Poster Number: E120Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Child and Family Health
Developing Conversation Cards to Enhance Teens’ Social Connections
Youth depression and suicidality is alarmingly high, especially among girls and LGBTQIA+ individuals, though mental health services remain limited. We created conversation cards for adolescents and caregivers to encourage emotional closeness through discussions on relationships, identity, sexuality, mental health, and life experiences. Three levels indicate how sensitive the topic is, so conversation partners can choose their comfort level. We aimed to assess the acceptability of these conversation cards among teens and adults who work with teens.
Methods
Participants were 40 individuals, including youth, school counselors, and staff from a local LGBTQIA+ organization who reviewed 64 conversation cards. Participants rated cards on meaningfulness, interest, and comfort level, and provided open-ended feedback.
Results
Most cards were rated favorably. However, youth rated 16 cards as "Maybe" or "Not Really" meaningful, 6 cards as "Maybe" or "Not Really" interesting, and 13 cards as “Uncomfortable” to discuss. Adults rated all cards as “Probably” or “Definitely” meaningful and interesting, and all except three prompts were “Very Comfortable.”
Based on the feedback, we revised 29 prompts, which were reviewed again. Teens rated all revised prompts as “Probably” or “Definitely” meaningful and interesting and all but two prompts were “Very Comfortable.” As expected, more sensitive prompts were rated as more interesting but less comfortable by both teens and adults.
Conclusion
Our findings suggest that the target population will find the intervention acceptable and valuable. Involving the community in designing the intervention helps rebuild trust in science by providing interventions that the community endorses.
Keywords: Adolescents, Mental healthYouth depression and suicidality is alarmingly high, especially among girls and LGBTQIA+ individuals, though mental health services remain limited. We created conversation cards for adolescents and caregivers to encourage emotional closeness through discussions on relationships, identity, sexuality, mental health, and life experiences. Three levels indicate how sensitive the topic is, so conversation partners can choose their comfort level. We aimed to assess the acceptability of these conversation cards among teens and adults who work with teens.
Methods
Participants were 40 individuals, including youth, school counselors, and staff from a local LGBTQIA+ organization who reviewed 64 conversation cards. Participants rated cards on meaningfulness, interest, and comfort level, and provided open-ended feedback.
Results
Most cards were rated favorably. However, youth rated 16 cards as "Maybe" or "Not Really" meaningful, 6 cards as "Maybe" or "Not Really" interesting, and 13 cards as “Uncomfortable” to discuss. Adults rated all cards as “Probably” or “Definitely” meaningful and interesting, and all except three prompts were “Very Comfortable.”
Based on the feedback, we revised 29 prompts, which were reviewed again. Teens rated all revised prompts as “Probably” or “Definitely” meaningful and interesting and all but two prompts were “Very Comfortable.” As expected, more sensitive prompts were rated as more interesting but less comfortable by both teens and adults.
Conclusion
Our findings suggest that the target population will find the intervention acceptable and valuable. Involving the community in designing the intervention helps rebuild trust in science by providing interventions that the community endorses.
Authors:
Co-Author - Jennifer Wolff,
Dr,
Washington University in St Louis
Co-Author - Matthew Kreuter,
Dr,
Washington University in St Louis
Presenter - Judith Mwobobia,
Washington University in St Louis
E122 - Intervention Preferences of Black Women with Breast Cancer and Their Informal Caregivers: Results from Dyadic Interviews
Poster Number: E122Time: 05:00 PM - 05:50 PM
Topics: Cancer, Social and Environmental Context and Health
Background/Purpose: Dyadic interventions for cancer patients and their informal caregivers hold promise, but they have been rarely integrated into clinical care, and there are few interventions specifically for Black patients. We conducted interviews with Black patients and their female caregivers to inform a dyadic psychosocial intervention.
Methods: Twenty patients and caregivers (10 dyads) participated in semi-structured interviews, first together and then in separate breakout rooms, to describe their experiences with the patient’s cancer and their preferences for intervention. Interviews were transcribed and independently coded by two coders. These analyses summarize findings from descriptive codes related to intervention preferences.
Results: Most patients and caregivers said they preferred an intervention that would work with patients and caregivers both separately and together (Caregiver: “Being able to have that combination would be awesome”). Many participants were receptive to a Zoom intervention; they appreciated the flexibility of video teleconferencing and thought it would allow people experiencing side effects or worried about infection to participate. Some acknowledged that people may not be comfortable with the technology and it might be difficult to build rapport remotely. Participants had mixed views about whether they would prefer an intervention specifically for Black women or one that was open to everyone. Some saw cancer as a potentially unifying experience (Patient: “Cancer is cancer. And we all bleed the same way. We all fight the same way”), whereas others expressed a preference for an intervention focused on Black women in particular (Patient: “I am a Black woman living in a white man's world…. [Y]es, we should have our own [group]”). Several participants suggested creating a celebratory or joyful atmosphere and including food, music, or giveaways.
Conclusions: Black patients and caregivers expressed interest in dyadic interventions, especially those that would address patients and caregivers both as individuals and as a pair.
Keywords: Cancer, Cancer survivorshipMethods: Twenty patients and caregivers (10 dyads) participated in semi-structured interviews, first together and then in separate breakout rooms, to describe their experiences with the patient’s cancer and their preferences for intervention. Interviews were transcribed and independently coded by two coders. These analyses summarize findings from descriptive codes related to intervention preferences.
Results: Most patients and caregivers said they preferred an intervention that would work with patients and caregivers both separately and together (Caregiver: “Being able to have that combination would be awesome”). Many participants were receptive to a Zoom intervention; they appreciated the flexibility of video teleconferencing and thought it would allow people experiencing side effects or worried about infection to participate. Some acknowledged that people may not be comfortable with the technology and it might be difficult to build rapport remotely. Participants had mixed views about whether they would prefer an intervention specifically for Black women or one that was open to everyone. Some saw cancer as a potentially unifying experience (Patient: “Cancer is cancer. And we all bleed the same way. We all fight the same way”), whereas others expressed a preference for an intervention focused on Black women in particular (Patient: “I am a Black woman living in a white man's world…. [Y]es, we should have our own [group]”). Several participants suggested creating a celebratory or joyful atmosphere and including food, music, or giveaways.
Conclusions: Black patients and caregivers expressed interest in dyadic interventions, especially those that would address patients and caregivers both as individuals and as a pair.
Authors:
Author - Tess Thompson,
PhD, MPH,
UNC-Chapel Hill
Co-Author - Emani Sargent,
Washington University in St. Louis
Co-Author - Christi Lero,
Washington University in St. Louis
Author - Judith Mwobobia,
Washington University in St. Louis
Co-Author - Naitra Ramchander,
Washington University in St. Louis
Co-Author - Aimee James, PhD MPH,
PhD MPH,
Washington University in St. Louis
Co-Author - Serena Xiong, PhD, MPH,
PhD, MPH,
University of Minnesota Medical School
Co-Author - LaShaune Johnson,
University of Houston
E123 - WHOOP in the Wild
Poster Number: E123Time: 05:00 PM - 05:50 PM
Topics: Methods and Measurement, Digital Health
In Vermont, 21% of adult primary care patients report recent use of CBD, and nation-wide 14% of the population reports using CBD consistently thus there is a critical need for scientific studies evaluating the physiological effects of CBD at recreationally-relevant doses. We are interested in the effect of chronic CBD use on the cardiovascular system, particularly looking at heart rate variability (HRV) as a biomarker for cardiovascular health. Our cross-sectional study leverages wearable sensors (wrist-worn WHOOP bands) to provide continuous, real-time data, yielding insights into the dynamic and individualized physiology of CBD users and non-users. This is particularly important as it pertains to certain biometrics, such as HRV, whose accuracy is limited to assessment at a time before an individual has performed any movement for the day. Additionally, the ability to remotely collect physiological data is particularly advantageous as researchers are located in Vermont, where access to participants is limited due to small population size. Recruitment strategies employ digital platforms, such as Facebook group advertisements, to ensure nationwide-reaching participation and a representative sample across urban and rural regions. To complement WHOOP-recorded biometric data, the study integrates lifestyle profiling through online surveys, including the ASA24 and ACT24, which provide detailed insights into participants' daily activity, diet, and sleep patterns. The combination of biometric data with additional self-reported measures—International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, Mental Health Continuum Short Form, Global Quality of Life Scale, and PRIMEscreen short food frequency questionnaire —enables a comprehensive assessment of factors influencing HRV. Ultimately, this study aims to explore the potential of wearable technology to provide objective health data and to support more inclusive health interventions, enhancing our understanding of cardiovascular health disparities and the effects of CBD across diverse populations.
Keywords: Methodology, TechnologyAuthors:
Co-Author - Andrea Corcoran,
Vermont State University Castleton
Co-Presenter - Hailey Martinovich,
Vermont State University- Castleton
E124 - Development and Evaluation of a New Self-Report Measure of Engagement with Digital Interventions
Poster Number: E124Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Methods and Measurement
Objective: It is increasingly understood that engagement with digital interventions entails physical, cognitive, and affective components. However, most empirical studies examining engagement with digital interventions focus on physical engagement measured via objective usage metrics. Although self-reported instruments have been developed to measure other components of engagement, they have either shown inadequate psychometric properties or conflated engagement with other related but distinct constructs, such as motivation. To address this gap, the present study developed and evaluated the psychometric properties of a new self-report instrument, the Engagement with Digital Interventions (EDI) scale, designed to more precisely measure physical, cognitive, and affective engagement.
Methods: The EDI scale was tested with a sample of 400 online U.S. participants. These participants completed two digital tasks (a self-monitoring task and a puzzle game) and used the scale to rate their engagement with each task. The factor structure of engagement was assessed using factor analysis. Internal consistency and construct validity were also assessed.
Results: Exploratory factor analysis (conducted on data from one task) revealed a three-factor structure that provided the best fit, accounting for 76.2% of the variance after removing the cross-loading item. Confirmatory factor analysis (CFA) of this factor structure showed a good fit to the data across both tasks (CFIs > .97, TLIs > .96, RMSEAs < .08, SRMR < .06). The instrument showed high internal consistency in both tasks (Cronbach’s alphas > .85). Convergent validity was supported by moderate to high correlations between the engagement components with theoretically related constructs (i.e., motivation and cognitive flow). Discriminant validity was supported by weaker correlations with the Big-5 personality traits. Convergent and discriminant validity were further validated by a CFA of multitrait-multimethod data that included engagement measured using a different method. Concurrent validity was confirmed as higher self-reported engagement with the puzzle game was significantly correlated with completing more levels of the game (beta = .219, SE = .108, p < .001).
Conclusion: The EDI scale demonstrated strong psychometric properties in measuring engagement with digital interventions. It is recommended for use in future digital intervention studies to further validate and refine its application.
Keywords: Assessment, Behavior ChangeMethods: The EDI scale was tested with a sample of 400 online U.S. participants. These participants completed two digital tasks (a self-monitoring task and a puzzle game) and used the scale to rate their engagement with each task. The factor structure of engagement was assessed using factor analysis. Internal consistency and construct validity were also assessed.
Results: Exploratory factor analysis (conducted on data from one task) revealed a three-factor structure that provided the best fit, accounting for 76.2% of the variance after removing the cross-loading item. Confirmatory factor analysis (CFA) of this factor structure showed a good fit to the data across both tasks (CFIs > .97, TLIs > .96, RMSEAs < .08, SRMR < .06). The instrument showed high internal consistency in both tasks (Cronbach’s alphas > .85). Convergent validity was supported by moderate to high correlations between the engagement components with theoretically related constructs (i.e., motivation and cognitive flow). Discriminant validity was supported by weaker correlations with the Big-5 personality traits. Convergent and discriminant validity were further validated by a CFA of multitrait-multimethod data that included engagement measured using a different method. Concurrent validity was confirmed as higher self-reported engagement with the puzzle game was significantly correlated with completing more levels of the game (beta = .219, SE = .108, p < .001).
Conclusion: The EDI scale demonstrated strong psychometric properties in measuring engagement with digital interventions. It is recommended for use in future digital intervention studies to further validate and refine its application.
Authors:
Author - Qinggang Yu,
PhD,
University of Michigan
Co-Author - Pei-Yao Hung,
PhD,
University of Michigan
Co-Author - Carolyn Yoon,
PhD,
University of Michigan
Co-Author - Richard Bagozzi,
PhD,
University of Michigan
Co-Author - Inbal Nahum-Shani,
PhD,
University of Michigan
E125 - The relation between immune cell ratios and quality of life, psychosocial functioning, and pain intensity in a sample of US veterans
Poster Number: E125Time: 05:00 PM - 05:50 PM
Topics: Military and Veterans' Health, Quality of Life
Introduction: Inflammation has been indicated as a key causal factor in pain and health-related quality of life outcomes. The ratio of CD4+ T cells to CD8+ T cells has promise as an immune specific biomarker of chronic inflammation but has not been examined in Veterans or in its relation to pain and functional outcomes. Further, immune markers may particularly matter for US post-9/11 combat veterans, in the context of this population’s high rate of exposure to several environmental contaminants that can cause immune dysregulation. The goal of the present study was therefore to examine the strength of CD4/CD8 ratio as a biological predictor of pain intensity and quality of life outcomes in US post-9/11 combat veterans.
Methods: 59 post-9/11 US combat veterans (mean age = 41.1 years; 69.5% male; 61.4% White American) completed self-report measures at baseline and 2 years following baseline. Blood samples were collected at the baseline time point. We predicted quality of life, perceived disability, and pain intensity at the two-year follow-up time point by CD4/CD8 ratio, age, education, and physical health symptoms (e.g., fatigue, aches) at baseline using Bayesian linear regression. Missing data was handled using multiple imputation with chained equations (MICE). All analyses were conducted using the brms package in R.
Results: Findings demonstrated that immune cell ratios were marginally, positively associated with quality of life (estimate = 0.08, 95% Credible Interval [-0.13, 0.29]) and pain intensity (estimate = 0.05, 95% Credible Interval [-0.07, 0.15]), and had little to no evidence of an association with perceived disability (estimate = 0.02, 95% Credible Interval [-0.08, 0.13]). Physical symptoms were associated with lower quality of life (estimate = -1.00, 95% Credible Interval [-1.70, -0.29]), and greater pain intensity (mean = 0.46, 95% Credible Interval [0.01, 0.94]) and perceived disability (estimate = 1.59, 95% Credible Interval [1.19, 1.98]).
Conclusions: These results indicate that the relation between CD4+/CD8+ T cell ratios and quality of life and pain intensity are modest and uncertain, with no evidence of association with perceived disability, in a sample of post-9/11 US combat veterans. Physical symptoms were more robustly predictive of later quality of life and functioning. Further work examining the potential mediation of the relation between immune biomarkers and functioning by psychological factors may inform these associations.
Keywords: Immune function, Quality of lifeMethods: 59 post-9/11 US combat veterans (mean age = 41.1 years; 69.5% male; 61.4% White American) completed self-report measures at baseline and 2 years following baseline. Blood samples were collected at the baseline time point. We predicted quality of life, perceived disability, and pain intensity at the two-year follow-up time point by CD4/CD8 ratio, age, education, and physical health symptoms (e.g., fatigue, aches) at baseline using Bayesian linear regression. Missing data was handled using multiple imputation with chained equations (MICE). All analyses were conducted using the brms package in R.
Results: Findings demonstrated that immune cell ratios were marginally, positively associated with quality of life (estimate = 0.08, 95% Credible Interval [-0.13, 0.29]) and pain intensity (estimate = 0.05, 95% Credible Interval [-0.07, 0.15]), and had little to no evidence of an association with perceived disability (estimate = 0.02, 95% Credible Interval [-0.08, 0.13]). Physical symptoms were associated with lower quality of life (estimate = -1.00, 95% Credible Interval [-1.70, -0.29]), and greater pain intensity (mean = 0.46, 95% Credible Interval [0.01, 0.94]) and perceived disability (estimate = 1.59, 95% Credible Interval [1.19, 1.98]).
Conclusions: These results indicate that the relation between CD4+/CD8+ T cell ratios and quality of life and pain intensity are modest and uncertain, with no evidence of association with perceived disability, in a sample of post-9/11 US combat veterans. Physical symptoms were more robustly predictive of later quality of life and functioning. Further work examining the potential mediation of the relation between immune biomarkers and functioning by psychological factors may inform these associations.
Authors:
Author - Marcus G. Wild,
PhD,
VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Sarah Parr,
BS,
VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Christina D. Hejl,
BS,
VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Rakeshwar Guleria,
PhD,
VISN 17 Center of Excellence for Research on Returning War Veterans
E127 - US Air Force military training instructors have worse psychological outcomes once they transition into the career field
Poster Number: E127Time: 05:00 PM - 05:50 PM
Topics: Military and Veterans' Health, Social and Environmental Context and Health
Background:
Each year, fewer than 600 military training instructors (MTIs) train more than 40,000 young men and women entering the US Air Force. For this reason, the health of MTIs is of upmost importance to the safety, health, and performance of vulnerable trainees during 7.5 weeks of Basic Military Training. MTIs work long hours under intense time- and performance- pressure and report having limited time for self-care and health behaviors. The current study aims to compare psychological outcomes between MTI students just entering the career field with experienced MTIs to identify targets for preventive intervention during the transition into the career field.
Method:
Air Force personnel (N=488) completed a survey as part of an annual health exam, with about an even split between MTI students in the first six months of technical school (46%) and MTIs with at least 12 months in the job (54%). Questions related to demographics (e.g., race, gender, rank, months in job) and psychological variables, including perceived stress (PSS-10), psychological inflexibility (AAQ-II), emotional social support (PROMIS 4a; 20 vs. <20 based on distribution of responses), and a 2-item adaption of the Maslach Burnout Inventory (summative score >3 is burned out). Linear or logistic regression models adjusting for demographics were conducted for each outcome, with gender included as a potential moderator between each outcome and MTI experience.
Results:
Most MTIs were male (73%), non-Hispanic White (52%), in a relationship (82%), with a rank of either Staff Sergeant or Technical Sergeant (88%). Compared to MTI students, MTIs were more likely to have elevated burnout scores (OR = 2.82, p < .001, 95% CI [1.77, 4.55]), higher levels of perceived stress (B = 1.75, SE = 0.67, p = .009), and higher levels of psychological inflexibility (B = 1.41, SE = 0.53, p = .008). There were no gender differences observed and no between-group differences in emotional support.
Discussion:
Several changes have been implemented to MTI job duties since the 2012 sexual assault scandal, but MTIs still report reduced psychological outcomes as they transition into the career field, including increases in burnout, stress, and psychological inflexibility. These findings suggest the need for an increase in upstream prevention initiatives, even within the first 12 months in the career field, to maintain the psychological health of MTIs as they transition into this demanding career field.
Keywords: Occupational health, StressEach year, fewer than 600 military training instructors (MTIs) train more than 40,000 young men and women entering the US Air Force. For this reason, the health of MTIs is of upmost importance to the safety, health, and performance of vulnerable trainees during 7.5 weeks of Basic Military Training. MTIs work long hours under intense time- and performance- pressure and report having limited time for self-care and health behaviors. The current study aims to compare psychological outcomes between MTI students just entering the career field with experienced MTIs to identify targets for preventive intervention during the transition into the career field.
Method:
Air Force personnel (N=488) completed a survey as part of an annual health exam, with about an even split between MTI students in the first six months of technical school (46%) and MTIs with at least 12 months in the job (54%). Questions related to demographics (e.g., race, gender, rank, months in job) and psychological variables, including perceived stress (PSS-10), psychological inflexibility (AAQ-II), emotional social support (PROMIS 4a; 20 vs. <20 based on distribution of responses), and a 2-item adaption of the Maslach Burnout Inventory (summative score >3 is burned out). Linear or logistic regression models adjusting for demographics were conducted for each outcome, with gender included as a potential moderator between each outcome and MTI experience.
Results:
Most MTIs were male (73%), non-Hispanic White (52%), in a relationship (82%), with a rank of either Staff Sergeant or Technical Sergeant (88%). Compared to MTI students, MTIs were more likely to have elevated burnout scores (OR = 2.82, p < .001, 95% CI [1.77, 4.55]), higher levels of perceived stress (B = 1.75, SE = 0.67, p = .009), and higher levels of psychological inflexibility (B = 1.41, SE = 0.53, p = .008). There were no gender differences observed and no between-group differences in emotional support.
Discussion:
Several changes have been implemented to MTI job duties since the 2012 sexual assault scandal, but MTIs still report reduced psychological outcomes as they transition into the career field, including increases in burnout, stress, and psychological inflexibility. These findings suggest the need for an increase in upstream prevention initiatives, even within the first 12 months in the career field, to maintain the psychological health of MTIs as they transition into this demanding career field.
Authors:
Presenter - Chase A. Aycock, PsyD, ABPP,
United States Air Force
Co-Author - Trevin Glasgow,
University of Virginia
Co-Author - Mario Nicolas,
PhD,
United States Air Force
Co-Author - Carol Copeland,
PhD,
University of Virginia
Co-Author - Breana Hart,
TSgt,
United States Air Force
Co-Author - Jordan M. Ellis, PhD,
United States Air Force
Co-Author - Kara Wiseman,
MPH, PhD,
University of Virginia
E128 - Identifying Early Intervention Targets in Health Behaviors for U.S. Air Force Military Training Instructors
Poster Number: E128Time: 05:00 PM - 05:50 PM
Topics: Military and Veterans' Health, Social and Environmental Context and Health
Background: Safe and effective training of new military recruits depends largely on the health of their instructors. Each year in the US Air Force, 600 military training instructors (MTIs) are tasked with preparing 40,000 young adults for military service. Previous studies suggest that the time pressure and workload associated with being an MTI may be linked to worsened health behaviors. This study compares health behavior outcomes for experienced MTIs (12+ months of experience) and MTI students (<12 months of experience) to identify whether and to what degree health behaviors change as MTIs transition into this demanding role, aiming to identify targets for prevention and early intervention. Method: The sample consists of 488 MTIs who completed surveys as part of a mandatory annual behavioral health visit. Health behaviors included physical activity (IPAQ-SF, high level vs. low/moderate), sleep-related impairment (PROMIS 4a, <T score 50 vs. ≥T score 50), past-year binge drinking (yes vs. no), food choice quality (exceptional/excellent/very good/good vs. fair/poor/very poor), and food portion control quality (exceptional/excellent/very good/good vs. fair/poor/very poor). Regression models assessed the association between MTI status (experienced vs. MTI student) and each health behavior, adjusted for demographics (gender, race/ethnicity, rank, and relationship status). A health behavior composite score was created by summing each health behavior (possible scores 0-5). Results: Just over half of the sample were MTIs (54%). Logistic regression results suggested that, compared to MTI students, MTIs were more likely to report significantly elevated sleep impairment (OR = 1.87, p = .01, 95% CI [1.22, 2.88]). Linear regression results indicated MTIs had lower health behavior composite scores (B = -0.34, SE = 0.12, p = .01) compared to MTI students. There were no differences in physical activity, binge drinking, food choice quality, or food portion control. Discussion: Findings indicate experienced MTIs report greater sleep impairment and fewer total health behaviors than MTI students. Future research should explore reasons for these differences. Preventive efforts in the workplace focused on health behaviors (particularly sleep) during the first year on the job may promote a healthier MTI corps and enhance training delivery for the thousands of young recruits they train each year.
Keywords: Occupational health, Health behaviorsAuthors:
Author - Trevin Glasgow,
PhD,
University of Virginia
Author - Chase A. Aycock, PsyD,
,
United States Air Force
Co-Author - Kara Wiseman,
PhD,
University of Virginia
Co-Author - Carol Copeland,
PhD,
University of Virginia
Co-Author - Danielle Cain, TSgt,
MA,
United States Air Force
Co-Author - Jordan Ellis,
PhD,
United States Air Force
Co-Author - Daniel G. Cassidy, PhD,
,
United States Air Force
E129 - Exploring the Dynamic Associations between Affect, Craving, and Behavioral Coping of Alcohol Use during Treatment: Findings from a Time-Varying Effect Modeling (TVEM) Analysis of 84 Consecutive Days of Daily Diary
Poster Number: E129Time: 05:00 PM - 05:50 PM
Topics: Multiple Health Behavior Change , Substance Misuse
BACKGROUND: Approximately 1 million Americans present for alcohol use disorder (AUD) treatment each year. Factors contributing to alcohol use, abstinence, and reduced drinking during treatment as well as specific mechanisms of behavior change are not yet well understood. More specifically, although negative affect, positive affect, craving, and alcohol coping have each been explored as predictors of alcohol use, the dynamic relationships among these variables remain unclear, limiting our understanding of how predictors work together. Using novel time-varying effect modeling (TVEM), we examined the lagged day-to-day associations among daily affect, behavioral coping skills, and alcohol craving for individuals in AUD treatment.
METHODS: Participants (N = 181, 51% women) were enrolled in a 12-week cognitive-behavioral outpatient treatment for AUD. For 84 consecutive days, participants self-reported on positive affect and negative affect, average levels of alcohol craving, and behavioral alcohol coping strategies.
DATA: Daily ecological momentary assessments were collected via smartphones. During this period, n = 123 participants completed 80% of daily reports (67 or more days); n = 21 completed all 84 days. The SAS macro %TVEM was used to examine the proposed lagged time-varying associations, controlling for baseline psychopathology, biological sex, marital status, SES, and number of treatment sessions attended. Missing data were handled using full-information maximum likelihood.
RESULTS: Higher levels of negative affect on a given day were associated with higher craving the next day. This association was observed across the entire treatment period and changed in a roughly quadratic fashion, with the strongest associations emerging during week 4 of treatment. Similarly, higher levels of positive affect were associated with next-day adaptive behavioral coping across the treatment period; negative affect was associated with higher next-day behavioral coping across weeks 2-7. During weeks 5 to 7, higher craving was associated with lower behavioral coping the next day. No other lagged associations were found.
CONCLUSION: This analysis extends the literature by demonstrating when and how mechanisms of behavior change are active during treatment. Findings can be used to more thoroughly prepare clients for changes to expect during treatment. Future AUD treatment may be improved by focusing on behavioral alcohol coping skills.
Keywords: Alcoholism, CopingMETHODS: Participants (N = 181, 51% women) were enrolled in a 12-week cognitive-behavioral outpatient treatment for AUD. For 84 consecutive days, participants self-reported on positive affect and negative affect, average levels of alcohol craving, and behavioral alcohol coping strategies.
DATA: Daily ecological momentary assessments were collected via smartphones. During this period, n = 123 participants completed 80% of daily reports (67 or more days); n = 21 completed all 84 days. The SAS macro %TVEM was used to examine the proposed lagged time-varying associations, controlling for baseline psychopathology, biological sex, marital status, SES, and number of treatment sessions attended. Missing data were handled using full-information maximum likelihood.
RESULTS: Higher levels of negative affect on a given day were associated with higher craving the next day. This association was observed across the entire treatment period and changed in a roughly quadratic fashion, with the strongest associations emerging during week 4 of treatment. Similarly, higher levels of positive affect were associated with next-day adaptive behavioral coping across the treatment period; negative affect was associated with higher next-day behavioral coping across weeks 2-7. During weeks 5 to 7, higher craving was associated with lower behavioral coping the next day. No other lagged associations were found.
CONCLUSION: This analysis extends the literature by demonstrating when and how mechanisms of behavior change are active during treatment. Findings can be used to more thoroughly prepare clients for changes to expect during treatment. Future AUD treatment may be improved by focusing on behavioral alcohol coping skills.
Authors:
Presenter - Junru Zhao,
The University of Oklahoma Health Sciences Center
Co-Author - clara Bradizza,
The State University of New York at Buffalo
Co-Author - Kyler Knapp,
The State University of New York at Buffalo
Co-Author - Braden Linn,
The Pennsylvania State University
Co-Author - Charles LaBarre,
The State University of New York at Buffalo
Co-Author - Paul Stasiewicz,
The State University of New York at Buffalo
E131 - Expert Consensus on the Delivery of Psychological Follow-Up Post-Bariatric Surgery: A Delphi Study
Poster Number: E131Time: 05:00 PM - 05:50 PM
Topics: Obesity, Mental Health
Background: Recent studies have examined patient and provider perspectives of psychological follow-up care post-bariatric surgery; however, there exists little evidence on the agreement among healthcare providers regarding how to best provide this type of care.
Methods: The current study used the Delphi method to establish expert consensus on psychological follow-up post-bariatric surgery via three rounds of web-based surveys. Survey 1 queried experts’ perspectives of psychological follow-up, Survey 2 asked experts to rate the top five strategies for care delivery, and Survey 3 assessed the acceptability and feasibility of the top strategies. Each survey was developed based on findings from the previous survey. Qualitative data from Survey 1 were analyzed thematically to inform subsequent surveys. Descriptive statistics were used to assess consensus in Surveys 2 and 3. Additionally, Wilcoxon signed-rank tests were employed to examine differences in acceptability and feasibility by provider type.
Results: Participants (N=28) were experts in providing direct follow-up care to bariatric surgery patients in the United States (mean±SD, age=44.0±10.7, 85.2% Women, 89.3% non-Hispanic, 85.7% White). Most were employed at academic medical centers (n=22) and identified as psychologists (n=15). In Survey 1, experts identified 10 topics and 134 subtopics related to psychological follow-up post-bariatric surgery. These topics included: 1) frameworks, 2) delivery modalities, 3) timelines, 4) types of services, 5) approaches, 6) types of providers, 7) concerns to address, 8) patient factors, 9) challenges, and 10) facilitators to care. Survey 2 reached expert consensus on six of these topics; however, consensus was not reached regarding concerns to address during psychological follow-up. In Survey 3, while many strategies achieved consensus on acceptability (n=12), fewer achieved consensus on feasibility (n=5). Results demonstrated significant differences in acceptability ratings for frameworks and approaches, and differences in feasibility ratings of approaches by provider type (ps < .05).
Conclusions: Findings suggest that although psychological follow-up post-bariatric surgery may take various forms, some consensus is present among experts on the most optimal strategies for delivering this care. Future research should evaluate the feasibility of implementing the most acceptable strategies in clinical settings to guide the next steps in care provision.
Keywords: Obesity, Clinical applicationsMethods: The current study used the Delphi method to establish expert consensus on psychological follow-up post-bariatric surgery via three rounds of web-based surveys. Survey 1 queried experts’ perspectives of psychological follow-up, Survey 2 asked experts to rate the top five strategies for care delivery, and Survey 3 assessed the acceptability and feasibility of the top strategies. Each survey was developed based on findings from the previous survey. Qualitative data from Survey 1 were analyzed thematically to inform subsequent surveys. Descriptive statistics were used to assess consensus in Surveys 2 and 3. Additionally, Wilcoxon signed-rank tests were employed to examine differences in acceptability and feasibility by provider type.
Results: Participants (N=28) were experts in providing direct follow-up care to bariatric surgery patients in the United States (mean±SD, age=44.0±10.7, 85.2% Women, 89.3% non-Hispanic, 85.7% White). Most were employed at academic medical centers (n=22) and identified as psychologists (n=15). In Survey 1, experts identified 10 topics and 134 subtopics related to psychological follow-up post-bariatric surgery. These topics included: 1) frameworks, 2) delivery modalities, 3) timelines, 4) types of services, 5) approaches, 6) types of providers, 7) concerns to address, 8) patient factors, 9) challenges, and 10) facilitators to care. Survey 2 reached expert consensus on six of these topics; however, consensus was not reached regarding concerns to address during psychological follow-up. In Survey 3, while many strategies achieved consensus on acceptability (n=12), fewer achieved consensus on feasibility (n=5). Results demonstrated significant differences in acceptability ratings for frameworks and approaches, and differences in feasibility ratings of approaches by provider type (ps < .05).
Conclusions: Findings suggest that although psychological follow-up post-bariatric surgery may take various forms, some consensus is present among experts on the most optimal strategies for delivering this care. Future research should evaluate the feasibility of implementing the most acceptable strategies in clinical settings to guide the next steps in care provision.
Authors:
Co-Author - Taylor N. Swanson, MS,
MS,
University of Florida
Co-Author - Kelsey L. Barrett, BS,
BS,
University of Florida
Co-Author - Armaan Ram Shetty,
BS,
University of Florida
Co-Author - Kate E. Worwag,
MS,
University of Florida
Co-Author - Meena Shankar, MS, RDN, CCRC,
MS, RDN, CCRC,
University of Florida
Co-Author - Kathryn M. Ross, PhD, MPH, FSBM,
PhD, MPH, FSBM,
University of Florida
E132 - The relationship of perceived stress management skills and inflammation in breast cancer patients following primary surgery
Poster Number: E132Time: 05:00 PM - 05:50 PM
Topics: Cancer, Stress
Background: Physical activity (PA) and sleep quality are associated with improved patient outcomes and quality of life in breast cancer (BC) patients. Perceived stress management skills (PSMS) efficacy has been associated with increased PA and better sleep quality, however, the relationship between the individual subscales of PSMS and these health behaviors is unclear. A quantitative modeling analysis was used to test our hypothesis that each subscale of PSMS is associated with increased PA engagement and better sleep quality
Methods: Participants included BC patients stage III or below (n = 240; M age = 50.34) who had surgery for primary breast cancer in the past 8 weeks. PSMSs were measured by the Measure of Current Status (MOCS) part A subscales (relaxation, awareness of tension, assertiveness, cognitive coping skills). PA was measured using 7-day self-reported moderate-vigorous PA (MVPA). Sleep quality was measured by the Pittsburgh Sleep Quality Index global score (higher scores indicates greater sleep disruption). Structural equation modeling was used to assess the association of PSMS and PA/Sleep Quality while controlling for weeks since surgery, age, and income
Results: The final model met criteria for sufficient fit (CFI=1.00, RMSEA=.000, SRMR =.000). Direct paths were observed from assertiveness to MVPA (β = -.18, p = .018), and cognitive coping to MVPA (β = .17, p = .033). Relaxation and awareness of tension were not associated with MVPA. In addition, direct paths were observed from awareness of tension to sleep quality (β = .24, p <.001), and cognitive coping to sleep quality (β = -.23, p = .003). Weeks since surgery, age, and income were not associated with either MVPA or sleep quality (p > .05).
Conclusions: Several PSMS are uniquely associated with lifestyle factors including PA, and sleep quality. Higher levels of assertiveness were associated with lower MVPA and higher awareness of tension was associated greater sleep disruption. In addition, higher cognitive coping efficacy appeared to be associated with both higher levels of MVPA and less sleep disruption. Cognitive coping strategies may be a key factor to target in interventional studies to enhance MVPA and sleep quality in BC patients after surgery. Future research may investigate how changes in PSMSs influence associated lifestyle behavior changes in addition to long term clinical outcomes (i.e., recurrence and mortality) in BC patients throughout treatment, and into survivorship.
Keywords: Stress, Health behavior changeMethods: Participants included BC patients stage III or below (n = 240; M age = 50.34) who had surgery for primary breast cancer in the past 8 weeks. PSMSs were measured by the Measure of Current Status (MOCS) part A subscales (relaxation, awareness of tension, assertiveness, cognitive coping skills). PA was measured using 7-day self-reported moderate-vigorous PA (MVPA). Sleep quality was measured by the Pittsburgh Sleep Quality Index global score (higher scores indicates greater sleep disruption). Structural equation modeling was used to assess the association of PSMS and PA/Sleep Quality while controlling for weeks since surgery, age, and income
Results: The final model met criteria for sufficient fit (CFI=1.00, RMSEA=.000, SRMR =.000). Direct paths were observed from assertiveness to MVPA (β = -.18, p = .018), and cognitive coping to MVPA (β = .17, p = .033). Relaxation and awareness of tension were not associated with MVPA. In addition, direct paths were observed from awareness of tension to sleep quality (β = .24, p <.001), and cognitive coping to sleep quality (β = -.23, p = .003). Weeks since surgery, age, and income were not associated with either MVPA or sleep quality (p > .05).
Conclusions: Several PSMS are uniquely associated with lifestyle factors including PA, and sleep quality. Higher levels of assertiveness were associated with lower MVPA and higher awareness of tension was associated greater sleep disruption. In addition, higher cognitive coping efficacy appeared to be associated with both higher levels of MVPA and less sleep disruption. Cognitive coping strategies may be a key factor to target in interventional studies to enhance MVPA and sleep quality in BC patients after surgery. Future research may investigate how changes in PSMSs influence associated lifestyle behavior changes in addition to long term clinical outcomes (i.e., recurrence and mortality) in BC patients throughout treatment, and into survivorship.
Authors:
Presenter - Ania Murillo,
B.S.,
University of Miami Miller School of Medicine
Co-Author - Mason Krueger,
M.S.,
Department of Psychology, University of Miami
Co-Author - Michael Antoni,
PhD,
Department of Psychology, University of Miami
E133 - Examining acceptability of the “Back on Track” multidisciplinary intervention for suboptimal weight outcomes after metabolic and bariatric surgery
Poster Number: E133Time: 05:00 PM - 05:50 PM
Topics: Obesity, Multiple Health Behavior Change
A significant subset of patients experience suboptimal clinical response or recurrent weight gain following metabolic and bariatric surgery (MBS). These outcomes are multifactorial and have been linked to dietary, physical activity, and medical non-adherence. However, few interventions have been developed to address precipitants to suboptimal weight outcomes after MBS, especially integrative care models that target multiple domains of functioning. We examined the acceptability of a multidisciplinary postoperative intervention—Back on Track (BOT)—targeting suboptimal clinical response and recurrent weight gain after MBS. The BOT program comprises a minimum of three monthly visits each with a doctoral-level health psychologist and registered dietician, and an additional follow-up visit with the referring surgeon. Patients (N = 120) at a metropolitan healthcare system who underwent bariatric surgery between 2002-2019 were referred to BOT between 2017-2020 at routine surgical follow-ups. We conducted retrospective chart reviews for demographic, anthropometric, and BOT program utilization data. Patients were predominately Black (n = 84, 70.0%) women (n = 108, 90.0%) who had undergone sleeve gastrectomy (n = 89, 74.2%). The majority of referred patients did not schedule any appointments (n = 56, 46.7%) while 40.8% (n = 49) attended a median 1-2 visits with health psychology or dietetics without completing BOT. Few patients (n = 15, 12.5%) completed BOT. Program completers and non-completers did not differ in demographic or surgical characteristics. Program completers’ weight change across BOT ranged from -13.60 to 17.60 lbs (M = 5.50, SD = 9.18), with a negative value indicating weight gain, corresponding to BMI change of -2.89 to 3.70 kg/m2 (M = 0.75, SD = 1.60). Weight decreased from program completers’ first to last BOT appointment, t(14) = 2.32, p = .036, 95% CI: 0.42, 10.58, d = 0.60. Corresponding BMI change and total weight loss change were not significant. While weight loss was minimal for program completers, it is possible that BOT supports weight stabilization for some patients, which is an important intervention target in context of recurrent weight gain. However, low attendance and completion rates for BOT suggest a need for future research investigating barriers and facilitators, especially those that may relate to racial/ethnic differences, for utilization of integrative postoperative interventions targeting suboptimal weight outcomes after MBS.
Keywords: Obesity, InterventionAuthors:
Presenter - Matthew Murray,
PhD,
University of Chicago Medicine
Co-Author - Sylvia Herbozo,
PhD,
Rush University Medical Center
Co-Author - Heather Eisele,
PhD,
University of Illinois at Chicago
Co-Author - Alison Newman,
PhD,
University of Illinois at Chicago
Co-Author - Lisa Sanchez-Johnsen,
PhD,
Medical College of Wisconsin
Co-Author - Chandra Hassan,
MD,
University of Illinois at Chicago
E134 - Correlates of interest in and use of alternative medicine for weight loss and GLP-1 medications among adults with obesity
Poster Number: E134Time: 05:00 PM - 05:50 PM
Topics: Obesity, Obesity
Background: “Alternative medicine” weight loss approaches (e.g., dietary supplements, home remedies) with no proven benefits and potential risks are widely used by individuals with obesity. Less widely used are evidence-based FDA-approved pharmacotherapies (e.g., GLP-1 agonists). While access is an essential factor influencing use of these and other weight loss approaches, attitudinal and psychosocial variables may also be influential.
Methods: Health care patients with BMI ≥ 30 kg/m2 from a large academic medical center were invited by email to complete an online cross-sectional survey study. Participants reported their use of and interest in both alternative medicine and GLP-1 medications for obesity. Potential correlates of use and interest were measured using validated instruments or adapted items and included distrust of pharmaceutical corporations; preferences for natural medical products; social norms regarding use of these approaches; expected weight loss if using these approaches; and habitual social media use.
Results: Participants (n=190) were 64.7% women, 63.7% white, and 84.2% non-Latino/Hispanic with a mean age of 51.3 years. Alternative medicine approaches had been used by 16% of patients in the prior year (42% ever), and GLP-1 medications by 8% in prior year (15% ever). Interest ratings for alternative medicine approaches was 2.7 and for GLP-1s was 4.6 on a 1-6 scale, with higher numbers indicating greater interest. After controlling for demographics and other psychosocial variables, interest in alternative approaches was associated with greater social norms related to alternative medicine, greater weight loss expectations with alternative medicine, and identifying as a woman. Use of alternative medicine approaches in the past 12 months was associated with lower pharmaceutical distrust. Interest in GLP-1s was associated with lower preference for natural medicines; greater social norms for GLP-1 use; greater weight loss expectations; and lower education level. Naturalness preference most strongly predicted participants’ relative interest in alternative vs pharmacotherapy approach.
Discussion: Social norms, weight loss expectations, and preference for natural medicine may be targets for decreasing use of potentially dangerous and ineffective alternative medicines and increasing consideration of evidence-based treatments for obesity.
Keywords: Obesity, Weight lossMethods: Health care patients with BMI ≥ 30 kg/m2 from a large academic medical center were invited by email to complete an online cross-sectional survey study. Participants reported their use of and interest in both alternative medicine and GLP-1 medications for obesity. Potential correlates of use and interest were measured using validated instruments or adapted items and included distrust of pharmaceutical corporations; preferences for natural medical products; social norms regarding use of these approaches; expected weight loss if using these approaches; and habitual social media use.
Results: Participants (n=190) were 64.7% women, 63.7% white, and 84.2% non-Latino/Hispanic with a mean age of 51.3 years. Alternative medicine approaches had been used by 16% of patients in the prior year (42% ever), and GLP-1 medications by 8% in prior year (15% ever). Interest ratings for alternative medicine approaches was 2.7 and for GLP-1s was 4.6 on a 1-6 scale, with higher numbers indicating greater interest. After controlling for demographics and other psychosocial variables, interest in alternative approaches was associated with greater social norms related to alternative medicine, greater weight loss expectations with alternative medicine, and identifying as a woman. Use of alternative medicine approaches in the past 12 months was associated with lower pharmaceutical distrust. Interest in GLP-1s was associated with lower preference for natural medicines; greater social norms for GLP-1 use; greater weight loss expectations; and lower education level. Naturalness preference most strongly predicted participants’ relative interest in alternative vs pharmacotherapy approach.
Discussion: Social norms, weight loss expectations, and preference for natural medicine may be targets for decreasing use of potentially dangerous and ineffective alternative medicines and increasing consideration of evidence-based treatments for obesity.
Authors:
Author - Francesca L. Wilkins,
MS, CHES,
University of Florida
Co-Author - Wendy S. Moore, PhD,
University of Florida
Co-Author - Megan A. McVay, PhD,
University of Florida
E135 - Economic Investment and Weight Loss in a Behavioral Weight Management Clinical Trial
Poster Number: E135Time: 05:00 PM - 05:50 PM
Topics: Obesity, Multiple Health Behavior Change
Background: Higher annual household income is associated with improved weight loss outcomes in behavioral weight loss (BWL) programs, but the underlying mechanisms of this association remain unclear. A potential explanation may be increased ability to purchase devices and services that support changes in diet and physical activity.
Methods: This study examined associations between annual household income, spending on weight loss tools (e.g., fitness and cooking equipment, health support), and percent weight loss in 431 adults with obesity (mean ± SD age= 49.5±11.3 years, BMI = 35.7 ± 4.0 kg/m2, 73.5% White, 83.5% Female) enrolled in a 16-week BWL program. At baseline and Month 4 (end of intervention), participants completed weight measurements using study-provided e-scales; income was self-reported (within categorical ranges) at baseline and spending on tools was self-reported at Month 4. Linear regression models tested associations between income, total spending, percent weight loss from baseline to Month 4.
Results: The median range for household incomes was $75,001 – $100,000. Participants lost an average (mean ± SD) of 6.3 ± 4.8% of their baseline weight during the BWL program and reported spending an average of $133.0±216.3 on weight loss tools. Higher income at baseline significantly predicted greater weight loss, p=.002, r =0.15. There were not, however, statistically significant associations between spending and percent weight loss (p = 0.337, r = -0.05) and spending and household income were found (p = 0.920, r = 0.01).
Conclusion: Results suggest that additional spending on program-related costs in a BWL program may not impact weight loss outcomes. It could be that BWL programs may be sufficiently effective for promoting weight loss without supplemental purchases, or that the measure used did not adequately capture spending on weight loss tools. It is also possible that there may be other benefits of higher household income that account for the association between income and weight loss. Future studies should focus on (1) developing and validating a standardized measure of assessing spending on weight loss tools, (2) exploring whether spending on specific items might be related to weight loss outcomes, and (3) examining novel mechanistic pathways that might explain the association between income and weight loss outcomes.
Keywords: Intervention, Weight controlMethods: This study examined associations between annual household income, spending on weight loss tools (e.g., fitness and cooking equipment, health support), and percent weight loss in 431 adults with obesity (mean ± SD age= 49.5±11.3 years, BMI = 35.7 ± 4.0 kg/m2, 73.5% White, 83.5% Female) enrolled in a 16-week BWL program. At baseline and Month 4 (end of intervention), participants completed weight measurements using study-provided e-scales; income was self-reported (within categorical ranges) at baseline and spending on tools was self-reported at Month 4. Linear regression models tested associations between income, total spending, percent weight loss from baseline to Month 4.
Results: The median range for household incomes was $75,001 – $100,000. Participants lost an average (mean ± SD) of 6.3 ± 4.8% of their baseline weight during the BWL program and reported spending an average of $133.0±216.3 on weight loss tools. Higher income at baseline significantly predicted greater weight loss, p=.002, r =0.15. There were not, however, statistically significant associations between spending and percent weight loss (p = 0.337, r = -0.05) and spending and household income were found (p = 0.920, r = 0.01).
Conclusion: Results suggest that additional spending on program-related costs in a BWL program may not impact weight loss outcomes. It could be that BWL programs may be sufficiently effective for promoting weight loss without supplemental purchases, or that the measure used did not adequately capture spending on weight loss tools. It is also possible that there may be other benefits of higher household income that account for the association between income and weight loss. Future studies should focus on (1) developing and validating a standardized measure of assessing spending on weight loss tools, (2) exploring whether spending on specific items might be related to weight loss outcomes, and (3) examining novel mechanistic pathways that might explain the association between income and weight loss outcomes.
Authors:
Co-Author - Kelsey M. Arroyo, MS,
MS,
University of Florida
Co-Author - Taylor N. Swanson, MS,
MS,
University of Florida
Co-Author - Kelsey L. Barrett, BS,
BS,
University of Florida
Co-Author - Kate E. Worwag,
MS,
University of Florida
Co-Author - Meena Shankar, MS, RDN, CCRC,
MS, RDN, CCRC,
University of Florida
Co-Author - Kathryn M. Ross, PhD, MPH, FSBM,
PhD, MPH, FSBM,
University of Florida
E136 - Does network density predict treatment outcomes and physical activity behaviors in an adult behavioral weight loss intervention?
Poster Number: E136Time: 05:00 PM - 05:50 PM
Topics: Obesity, Social and Environmental Context and Health
Background: Individuals tend to exhibit physical and mental health behaviors similar to those with whom they are socially connected. Obesity is associated with numerous negative physical and mental health consequences, and group behavioral weight loss interventions (BWLI) remain the gold standard of treatment. These interventions are often grounded in social cognitive theory, which posits that social relationships formed during these interventions may be a critical pathway for problem-solving and information sharing. Social networks analysis is a methodology that is uniquely poised to investigate how social networks form and evolve in these groups, and whether they can be leveraged to improve and maintain treatment outcomes. Therefore. the present study sought to determine if social networks formed in the context of an adult BWLI can predict intervention outcomes. Methods: Participants recruited for an ancillary network study (n=95, 7 participant groups) were enrolled in an 18-month behavioral weight loss program delivered in a primary care setting. Network and follow-up assessment data were collected every 6 months. Participants were asked to identify individuals in the group 1) with whom they interacted most frequently and 2) to whom they would go to for social support. These responses were used to calculate network density, Participants were also asked to report how many times in the past week they had engaged in physical activity. Data were analyzed and visualized with SPSS and UCINET. Results: Linear regression models indicated that network density was not predictive of weight loss at month 6 (β = -3.11, p= .70) or month 18 (β= 1.39, p= .24), but it was predictive of weight loss at month 12 (β = 11.31, p= .02). Network density was significantly predictive of physical activity times per week (β = 0.16, p= 0.002). and minutes of physical activity per session (β = 0.20, p= 0.005) at the six-month assessment, however, there were no significant relationships between network density and physical activity times per week or minutes per session at 12 or 18 months. Discussion: Taken together, these results suggest that the intervention components that most benefit from increased social network density may differ over time. Future research is needed to determine how social networks may be leveraged most advantageously in BWLIs.
Keywords: Weight loss, Physical activityAuthors:
Presenter - Demetria R. Pizano, MA,
MA,
University of Alabama in Birmingham
Co-Author - Alena C. Borgatti, MA,
MA,
The University of Alabama at Birmingham
Co-Author - Gareth R. Dutton, PhD, FSBM,
PhD, FSBM,
University of Alabama at Birmingham
E137 - Daily Impact: How Movement Behaviors Affect Teen Somatic Symptoms
Poster Number: E137Time: 05:00 PM - 05:50 PM
Topics: Pain, Child and Family Health
Background. Somatic symptoms are prevalent among teens, with estimates ranging from 8-12% (Lieb et al., 2000). These symptoms often co-occur with emotional distress, having significant impacts on development, school attendance and achievement, and daily living (Cerutti et al., 2016). Risk and protective factors for the development of somatic symptoms are poorly understood. Movement behaviours (i.e., physical activity, sleep, and screen time) may influence somatic symptoms. Some research shows a negative association between physical activity and somatic symptoms (Ames et al., 2022; Baceviciene et al., 2019). Poor sleep and sedentary behaviours (i.e., screen time) are associated with increases in reported somatic symptoms (Cerutti et al., 2016; Schlarb et a., 2017). Most research uses cross-sectional design and focuses on single behaviours (e.g., physical activity without consideration of sleep and sedentary behaviours). We ask how daily engagement in movement behaviours are associated with somatic symptoms at the daily and next day level among teens.
Method. Sixty-two teenagers (ages 13-17) participated in a 9-day intensive longitudinal design study. Teens completed start-of-day and end-of day daily diaries assessing experiences of somatic symptoms (e.g., pain, fatigue). Teens also wore Fitbit Charge 3 devices to objectively assess movement behaviours. Multilevel modeling was used to estimate within-person same- and next-day associations between movement behaviours and somatic symptoms.
Results. Within-person sleep negatively predicted next-day pain and pain interference in random intercept models (p<.05). Further, within-person sleep negatively predicted next-day (p<.01) fatigue and next-day (p<.01) fatigue interference in random slope models. Between-person sleep negatively predicted daily fatigue interference in random slope models (p<.05). Additionally, between-person screen time positively predicted daily fatigue in random slope models (p<.05) and number of somatic symptoms (p<.05) in random intercept models. No within-or-between person associations between physical activity and pain, fatigue or somatic symptoms were observed.
Conclusion. Findings add to the existing literature by providing intensive longitudinal evidence of associations between objective sleep and screen time with day-to-day fluctuations in pain and fatigue, respectively. Future research with larger samples is needed to overcome limited statistical power of the present study.
Keywords: Adolescents, FatigueMethod. Sixty-two teenagers (ages 13-17) participated in a 9-day intensive longitudinal design study. Teens completed start-of-day and end-of day daily diaries assessing experiences of somatic symptoms (e.g., pain, fatigue). Teens also wore Fitbit Charge 3 devices to objectively assess movement behaviours. Multilevel modeling was used to estimate within-person same- and next-day associations between movement behaviours and somatic symptoms.
Results. Within-person sleep negatively predicted next-day pain and pain interference in random intercept models (p<.05). Further, within-person sleep negatively predicted next-day (p<.01) fatigue and next-day (p<.01) fatigue interference in random slope models. Between-person sleep negatively predicted daily fatigue interference in random slope models (p<.05). Additionally, between-person screen time positively predicted daily fatigue in random slope models (p<.05) and number of somatic symptoms (p<.05) in random intercept models. No within-or-between person associations between physical activity and pain, fatigue or somatic symptoms were observed.
Conclusion. Findings add to the existing literature by providing intensive longitudinal evidence of associations between objective sleep and screen time with day-to-day fluctuations in pain and fatigue, respectively. Future research with larger samples is needed to overcome limited statistical power of the present study.
Authors:
Presenter - Dr. Megan Ames,
PhD,
University of Victoria
Co-Author - Emmett Sihoe,
University of Victoria
Co-Author - Olivia Gale,
University of Victoria
Co-Author - Elizabeth Jean Buckler,
PhD,
University of Victoria
E138 - Pain intensity and somatic symptoms in emerging adults: the moderating role of hazardous drinking
Poster Number: E138Time: 05:00 PM - 05:50 PM
Topics: Pain, Substance Misuse
Pain and hazardous drinking are highly prevalent and frequently co-occur among emerging adults (EA; 18-24 years). Separate lines of research indicate that people who experience chronic or severe pain, and people who drink heavily, may each be more likely to engage in somatization (i.e., the tendency to experience and report diverse physical symptoms and sensations often associated with psychological distress). Identifying factors associated with somatization is important because it is a transdiagnostic construct that predicts a range of negative medical and psychological outcomes. No research has tested associations between pain, hazardous drinking, and somatic symptoms among EA. Students at a northeastern United States public university (N = 512; Mage = 18.86, SD = 0.90; 73.6% women; 76.2% White) completed measures of pain intensity (Graded Chronic Pain Scale), hazardous drinking (Alcohol Use Disorder Identification Test; AUDIT), and somatic symptoms (Pennebaker Inventory of Limbic Languidness). Separate conditional effects models (PROCESS macro), adjusted for gender and race, tested hazardous drinking variables (AUDIT total; consumption, dependence, and alcohol-related problems subscales) as moderators between pain intensity and somatic symptoms. Greater pain was associated with experiencing a greater number and frequency of somatic symptoms at all levels of hazardous drinking (AUDIT total score), but the association was strongest among those with the highest levels of hazardous drinking (B = 0.10, t = 2.12, p = 0.03). Examination of the AUDIT subscales revealed that only alcohol consumption, and not dependence or alcohol-related problems, moderated the association between pain and somatic symptoms (B = 0.19, t = 2.11, p = 0.04), such that as consumption increased so too did the strength of the relationship between pain and the number and frequency of somatic symptoms. As EA experience more pain, they may report greater somatic symptoms commonly associated with psychological distress. This relation is strongest among EA who engage in higher levels of hazardous drinking, which appears to be driven by greater levels of alcohol consumption. Among EA, co-occurring pain and hazardous drinking may signal a vulnerability to somatization, suggesting this is a group that warrants further individualized attention. Future research may prospectively examine the role of hazardous drinking and pain in somatization and its sequelae.
Keywords: Pain, Substance abuseAuthors:
Co-Author - Elizabeth L. Pinney,
Binghamton University
Co-Author - Jeff Boissoneault, PhD,
PhD,
University of Minnesota
Co-Author - Emily L. Zale, PhD,
PhD,
Binghamton University
E139 - Pain and substance use in adults with chronic low back pain: Examining emotion regulation and interoceptive awareness as moderators
Poster Number: E139Time: 05:00 PM - 05:50 PM
Topics: Pain, Substance Misuse
Cannabis and alcohol use are common among individuals with chronic pain, who often rely on these substances to cope. Less is known about which individuals with pain are at greatest risk for substance use. Emotion regulation (ER) and interoceptive awareness (IA) are potential influences on the relationship between pain and substance use. The aim of this secondary analysis was to explore the potential moderating role of ER and IA on the relationship between pain severity and substance use in individuals with chronic low back pain (CLBP).
Participants were 203 adults (64.9% female; Mage = 43.4 years) enrolled in an RCT testing physical activity interventions for CLBP. Participants completed self-report surveys at baseline to assess pain severity and interference (BPI), past three-month cannabis use (0 = no, 1 = yes), alcohol risk (binary outcome [0 = absence of risk, 1 = presence of risk and continuous severity score among those with any risk]; ASSIST v3.1), emotion regulation (DERS-36), and IA (MAIA-2). ER and four IA subscales (i.e., Not Worrying, Self-Regulation, Trusting, and Noticing) were independently tested as moderators of the relationship between pain and substance use using logistic and negative binomial regression.
Pain severity was negatively associated with presence of alcohol risk (B = -.34, 95% CI [-.55, -.15]). Pain was not associated with cannabis use or alcohol risk severity score (ps > .05). The interaction between pain severity and IA Not Worrying was significantly associated with presence of alcohol risk (B = -.33, 95% CI [-.73, -.04]). At high levels of Not Worrying, increased pain severity was associated with decreased probability of the presence of alcohol risk (B = -.66, 95% CI [-1.26, -.35]). Neither ER nor the IA subscales emerged as significant moderators of relations between pain and cannabis use or alcohol risk severity score (ps > .05).
Among individuals with CLBP, higher pain severity was negatively associated with alcohol risk. The negative association between pain and alcohol risk may reflect reverse causality within a cross-sectional study and is consistent with prior literature demonstrating that alcohol use is associated with decreased likelihood of chronic pain, specifically when use is moderate. The inverse relationship between pain severity and alcohol risk was strongest among individuals who do not experience worry over their pain. Future research is warranted to establish the directionality of these relationships.
Keywords: Pain, Substance abuseParticipants were 203 adults (64.9% female; Mage = 43.4 years) enrolled in an RCT testing physical activity interventions for CLBP. Participants completed self-report surveys at baseline to assess pain severity and interference (BPI), past three-month cannabis use (0 = no, 1 = yes), alcohol risk (binary outcome [0 = absence of risk, 1 = presence of risk and continuous severity score among those with any risk]; ASSIST v3.1), emotion regulation (DERS-36), and IA (MAIA-2). ER and four IA subscales (i.e., Not Worrying, Self-Regulation, Trusting, and Noticing) were independently tested as moderators of the relationship between pain and substance use using logistic and negative binomial regression.
Pain severity was negatively associated with presence of alcohol risk (B = -.34, 95% CI [-.55, -.15]). Pain was not associated with cannabis use or alcohol risk severity score (ps > .05). The interaction between pain severity and IA Not Worrying was significantly associated with presence of alcohol risk (B = -.33, 95% CI [-.73, -.04]). At high levels of Not Worrying, increased pain severity was associated with decreased probability of the presence of alcohol risk (B = -.66, 95% CI [-1.26, -.35]). Neither ER nor the IA subscales emerged as significant moderators of relations between pain and cannabis use or alcohol risk severity score (ps > .05).
Among individuals with CLBP, higher pain severity was negatively associated with alcohol risk. The negative association between pain and alcohol risk may reflect reverse causality within a cross-sectional study and is consistent with prior literature demonstrating that alcohol use is associated with decreased likelihood of chronic pain, specifically when use is moderate. The inverse relationship between pain severity and alcohol risk was strongest among individuals who do not experience worry over their pain. Future research is warranted to establish the directionality of these relationships.
Authors:
Author - Laura E. Laumann, PhD,
PhD,
Brown University
Co-Author - Katherine E. Gnall, MS,
MS,
University of Connecticut
Co-Author - Mariel Emrich,
University of Connecticut
Co-Author - Tania B. Huedo-Medina, PhD,
PhD,
University of Connecticut
Co-Author - Camille L. Garnsey,
University of Connecticut
Co-Author - Erika Osherow, M.Ed., M.A.,
M.Ed., M.A.,
University of Connecticut
Co-Author - Angela R. Starkweather,
PhD,
Rutgers School of Nursing
Co-Author - Crystal L. Park, PhD, FSBM,
PhD, FSBM,
University of Connecticut
E141 - Declining Vigorous Physical Activity Among Adolescent and Young Adult Cancer Survivors: A Longitudinal Comparison with Siblings and Identifying Predictive Factors using the Childhood Cancer Survivor Study
Poster Number: E141Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Cancer
Adolescents and young adults (AYA) surviving cancer face ongoing health concerns that regular physical activity (PA) can help alleviate. Understanding PA participation in AYAs can guide interventions to enhance their quality of life, while identifying sub-groups that could benefit from extra support.
We analyzed longitudinal data from the Childhood Cancer Survivor Study (CCSS) cohort to 1) characterize changes in vigorous physical activity (VPA) over three time points (T1-1999 or 2007, T2-2014, T3-2020 totaling a 13 or 21 year study period) among survivors of early AYA cancers (diagnosed between ages 15-21) and their siblings, and 2) identify demographic and health factors predicting survivors' VPA compared to their siblings.
For Aim 1, we calculated VPA metabolic equivalence tasks (MET) hours/week and the percentage of participants engaging in VPA. For Aim 2, we used mixed-effects linear regression to assess predictors of VPA change over time. A mixed-effect model was used to assess overall effect on VPA change for categorical predictor variables with more than two levels (e.g., age).
The analysis included 1,400 survivors and 1,514 siblings (54% female, 90% White-Non-Hispanic). At T1, survivors had lower VPA participation (53%, p=0.01) than siblings (60%, p=0.01). Both groups experienced declines in VPA over time, with survivors declining more steeply (53% to 45% to 40%) compared to siblings (60% to 55% to 52%) from T1 to T2 to T3. Being female was associated with lower VPA levels across both groups (p<0.001). Among survivors, age predicted lower VPA (p=0.0012), while being in a relationship was associated with higher VPA (p=0.007).
This study highlights a concerning trend of declining VPA participation among both AYA cancer survivors and their siblings, with survivors showing a more significant reduction. Age and marital status emerged as key factors influencing survivors' VPA levels, indicating older survivors and those without partners may need targeted support. The consistent association of lower VPA levels with being female highlights the need for gender-specific interventions. As the AYA survivor population grows, addressing these disparities is essential to promote healthier lifestyles and long-term well-being. Enhanced support systems and resources are crucial to help survivors maintain physical activity and improve their quality of life.
Keywords: Adolescents, CancerWe analyzed longitudinal data from the Childhood Cancer Survivor Study (CCSS) cohort to 1) characterize changes in vigorous physical activity (VPA) over three time points (T1-1999 or 2007, T2-2014, T3-2020 totaling a 13 or 21 year study period) among survivors of early AYA cancers (diagnosed between ages 15-21) and their siblings, and 2) identify demographic and health factors predicting survivors' VPA compared to their siblings.
For Aim 1, we calculated VPA metabolic equivalence tasks (MET) hours/week and the percentage of participants engaging in VPA. For Aim 2, we used mixed-effects linear regression to assess predictors of VPA change over time. A mixed-effect model was used to assess overall effect on VPA change for categorical predictor variables with more than two levels (e.g., age).
The analysis included 1,400 survivors and 1,514 siblings (54% female, 90% White-Non-Hispanic). At T1, survivors had lower VPA participation (53%, p=0.01) than siblings (60%, p=0.01). Both groups experienced declines in VPA over time, with survivors declining more steeply (53% to 45% to 40%) compared to siblings (60% to 55% to 52%) from T1 to T2 to T3. Being female was associated with lower VPA levels across both groups (p<0.001). Among survivors, age predicted lower VPA (p=0.0012), while being in a relationship was associated with higher VPA (p=0.007).
This study highlights a concerning trend of declining VPA participation among both AYA cancer survivors and their siblings, with survivors showing a more significant reduction. Age and marital status emerged as key factors influencing survivors' VPA levels, indicating older survivors and those without partners may need targeted support. The consistent association of lower VPA levels with being female highlights the need for gender-specific interventions. As the AYA survivor population grows, addressing these disparities is essential to promote healthier lifestyles and long-term well-being. Enhanced support systems and resources are crucial to help survivors maintain physical activity and improve their quality of life.
E142 - Exploring Reframing as a Behavior Change Strategy for Increasing Physical Activity in People with Multiple Sclerosis.
Poster Number: E142Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Health of Marginalized Populations
Multiple Sclerosis (MS) is an incurable, chronic, progressive disease that affects cognitive and physical functioning, reducing a person’s quality of life. Physical Activity (PA) may help manage MS, but individuals with MS often remain inactive. Reframing, a coaching strategy to help individuals challenge their negative thoughts, could help a person overcome PA barriers. This early-stage trial aimed to understand how reframing can lead to changes in cognitive and physical behaviours for individuals with MS. The present study represents part of a larger analysis to understand the feasibility and acceptability of reframing for persons with MS. This study used a single arm design. Participants (N=22) met the following inclusion criteria: (a) MS diagnosis for > 1 year, (b) currently exercising <90 mins/week, (c) Patient-determined disability score < 6. Participants received a single ~15-minute reframing session with four surveys (pre-,post-, and 1 and 4 weeks post). Additionally, participants received a follow-up interview at 1-week post-reframing about their cognitive and physical changes during the week following reframing. Reframing included: (1) identifying biases contributing to negative thinking, (2) challenging the accuracy of these thoughts, and (3) reframing their view to be more accurate. The primary outcomes were PA and cognitive biases. An inductive content analysis was used to analyze the interview data, while Repeated Measures ANOVA assessed changes in PA and cognitive errors. Cognitive errors significantly decreased (p=0.16, partial eta=.258) from pre-reframing (M=5.32) to 7 days post reframing (M=4.52). Light PA (p=.029, partial eta=.218) significantly increased from pre-reframing (M=2.26) to 1 week post reframing (M=3.14). While moderate-vigorous PA (p=<0.01, partial eta=.460) significantly increased from pre reframing (M=2.76) to 4 weeks post reframing (M=5.76). Changes to PA at all levels were sustained at the 4-week follow-up. Interview findings triangulated the quantitative data contextualizing the cognitive and behavioural changes following reframing. This study contributes to the growing body of evidence suggesting that reframing can be an effective strategy for physical activity behaviour change. Findings provide preliminary evidence to justify a future randomized pilot trial to with the goal of refining and eventually testing the effectiveness of reframing as a PA promotion strategy for people with MS.
Keywords: Physical activity, Health behavior changeAuthors:
Author - Isabelle F. Hill,
BKin, MSc,
Brock University
Co-Author - Sean Locke,
PhD,
Brock University
E143 - Exploring Pregnant Women’s Perspective on Pre-Pregnancy Physical Activity in Nebraska: A Qualitative Study
Poster Number: E143Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Women's Health
Background: Physical activity is a crucial element of health at every stage of a woman’s life. The pre-pregnancy period is an ideal time to encourage regular physical activity in women, helping to improve health and prevent weight gain, which can carry over into pregnancy. Despite the benefits, many women do not engage in regular physical activity.
Objective: To explore pregnant women’s experiences of pre-pregnancy physical activity and the factors that influence their engagement in physical activity.
Methods: This was a qualitative descriptive study. A convenience sampling method was used to recruit women across Nebraska (n=17). Data were collected between December 2023 and February 2024 via Zoom. A semi-structured interview guide was developed based on the Theory of Planned Behavior (TPB). Data were analyzed using a thematic analysis approach based on TPB constructs. Member checking and an audit trail were performed to ensure the validity and reliability of the data.
Results: Three main themes were created based on the TPB constructs (1) Behavioral attitudes towards physical activity, (2) Subjective norms, and (3) Perceived behavioral control. Within the TPB theme of behavioral attitudes, women expressed positive beliefs about physical activity, emphasizing its physiological and psychological benefits. However, there was a lack of awareness of the specific physical activity guidelines. Within the subjective norms theme, partners, family, and friends were viewed as supportive of physical activity, encouraging women to be active. Within the theme of perceived behavioral control, women discussed barriers to physical activity such as low motivation, time constraints, and the COVID-19 pandemic. Environmental factors (accessibility to resources, neighborhood features, and weather) were viewed as both barriers and enablers of physical activity engagement. Suggestions for other women included listening to their bodies, seeking guidance from healthcare providers, and connecting with community resources.
Conclusion: This study underscores the importance of promoting physical activity to women before pregnancy through education, social support, and tailored evidence-based interventions to improve maternal and infant health outcomes. Addressing barriers and leveraging enablers could help Nebraskan women initiate and maintain an active lifestyle before getting pregnant.
Keywords: Physical activity, Women's healthObjective: To explore pregnant women’s experiences of pre-pregnancy physical activity and the factors that influence their engagement in physical activity.
Methods: This was a qualitative descriptive study. A convenience sampling method was used to recruit women across Nebraska (n=17). Data were collected between December 2023 and February 2024 via Zoom. A semi-structured interview guide was developed based on the Theory of Planned Behavior (TPB). Data were analyzed using a thematic analysis approach based on TPB constructs. Member checking and an audit trail were performed to ensure the validity and reliability of the data.
Results: Three main themes were created based on the TPB constructs (1) Behavioral attitudes towards physical activity, (2) Subjective norms, and (3) Perceived behavioral control. Within the TPB theme of behavioral attitudes, women expressed positive beliefs about physical activity, emphasizing its physiological and psychological benefits. However, there was a lack of awareness of the specific physical activity guidelines. Within the subjective norms theme, partners, family, and friends were viewed as supportive of physical activity, encouraging women to be active. Within the theme of perceived behavioral control, women discussed barriers to physical activity such as low motivation, time constraints, and the COVID-19 pandemic. Environmental factors (accessibility to resources, neighborhood features, and weather) were viewed as both barriers and enablers of physical activity engagement. Suggestions for other women included listening to their bodies, seeking guidance from healthcare providers, and connecting with community resources.
Conclusion: This study underscores the importance of promoting physical activity to women before pregnancy through education, social support, and tailored evidence-based interventions to improve maternal and infant health outcomes. Addressing barriers and leveraging enablers could help Nebraskan women initiate and maintain an active lifestyle before getting pregnant.
Authors:
Presenter - Priyanka Chaudhary,
University of Nebraska Omaha
Co-Author - Kailey Snyder,
University of Nebraska Omaha
Co-Author - Michaela Schenkelberg,
University of Nebraska Omaha
Co-Author - Danae Dinkel,
University of Nebraska Omaha
E144 - Perceived affective benefits of physical activity and physical activity behavior
Poster Number: E144Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Health Communication and Policy
Increasing evidence supports the role of perceived affective benefits of physical activity (PA) as critical predictors of PA behavior. The purposes of the present study were to test the hypothesis that messages touting affective benefits of PA would lead to increased PA intentions and to examine correlates of PA behavior among individuals not meeting recommended PA levels.
U.S. adults (n=321; Mage=37 years; 59.3% female; 83% white) who engaged in <150 minutes a week of moderate-intensity aerobic PA (M= 64.2; SD=40.5) were recruited online through Amazon’s MTurk in 2017 to complete a cross-sectional experiment.
First, participants reported their average weekly number of minutes engaging in moderate-intensity PA and completed measures of affective forecasts and barriers to PA. They were then randomized to read 1 of 6 brief messages which were categorized as espousing either affective (n=225; e.g., more relaxed, more energized), cognitive (n=42; e.g., improved memory), or physical health (n=54; e.g., increased longevity) benefits of PA. Outcomes included anticipated affect (positive affect, negative affect, fatigue, and tranquility), mood outcome expectations, PA self-efficacy, and PA intentions.
Participants who read an affective message expected to experience lower fatigue following PA (M=2.68 out of 5; F(2, 318)=4.26, p=.015) than participants who read about cognitive (M=3.13, p=.010) and physical (M=2.96, p=.076) health benefits. However, contrary to hypotheses, the messages had no effect on any other outcomes (all ps>.195).
Consistent with prior research, the strongest correlates of greater PA behavior were greater self-efficacy (r=.38) and more positive affective forecasts (r=.32), followed by greater PA prioritization (r=.28) and lower PA barriers (r=-.23). Anticipated fatigue (r=.30), positive affect (r=.25), and negative affect (r=.23) were more strongly correlated with PA behavior than tranquility (r=.17).
Age did not moderate any relationships of affective beliefs with PA engagement, but the associations of greater anticipated positive affect (B=11.060, p=.019) and greater anticipated tranquility (B=10.143, p=.035) with greater PA were stronger for women than men.
Results suggest a need for continued efforts to develop PA messaging that reliably increases PA intentions and behavior. This study provides further support for affective beliefs as correlates of PA, with implications for who might be most motivated by affective beliefs.
Keywords: Physical activity, Health communicationU.S. adults (n=321; Mage=37 years; 59.3% female; 83% white) who engaged in <150 minutes a week of moderate-intensity aerobic PA (M= 64.2; SD=40.5) were recruited online through Amazon’s MTurk in 2017 to complete a cross-sectional experiment.
First, participants reported their average weekly number of minutes engaging in moderate-intensity PA and completed measures of affective forecasts and barriers to PA. They were then randomized to read 1 of 6 brief messages which were categorized as espousing either affective (n=225; e.g., more relaxed, more energized), cognitive (n=42; e.g., improved memory), or physical health (n=54; e.g., increased longevity) benefits of PA. Outcomes included anticipated affect (positive affect, negative affect, fatigue, and tranquility), mood outcome expectations, PA self-efficacy, and PA intentions.
Participants who read an affective message expected to experience lower fatigue following PA (M=2.68 out of 5; F(2, 318)=4.26, p=.015) than participants who read about cognitive (M=3.13, p=.010) and physical (M=2.96, p=.076) health benefits. However, contrary to hypotheses, the messages had no effect on any other outcomes (all ps>.195).
Consistent with prior research, the strongest correlates of greater PA behavior were greater self-efficacy (r=.38) and more positive affective forecasts (r=.32), followed by greater PA prioritization (r=.28) and lower PA barriers (r=-.23). Anticipated fatigue (r=.30), positive affect (r=.25), and negative affect (r=.23) were more strongly correlated with PA behavior than tranquility (r=.17).
Age did not moderate any relationships of affective beliefs with PA engagement, but the associations of greater anticipated positive affect (B=11.060, p=.019) and greater anticipated tranquility (B=10.143, p=.035) with greater PA were stronger for women than men.
Results suggest a need for continued efforts to develop PA messaging that reliably increases PA intentions and behavior. This study provides further support for affective beliefs as correlates of PA, with implications for who might be most motivated by affective beliefs.
Authors:
Co-Author - Jennifer M. Taber,
PhD,
Kent State University
Co-Author - Kelsey Curran,
MPH,
Cleveland Clinic
E145 - Perspectives of Rural Primary Care Providers on Implementing Exercise Prescription for Knee Osteoarthritis in Older Patients
Poster Number: E145Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Aging
Introduction: Rural older adults experience a high burden of arthritis and pain. Exercise is a first-line treatment for several painful conditions, including knee osteoarthritis (OA); however, many older rural patients with these conditions face barriers to engaging in exercise. Given the critical role of primary care providers (PCPs) in OA management, we sought to understand their attitudes and experiences counseling older patients about physical activity (PA) for knee OA.
Methods: We conducted semi-structured, in-depth interviews with 11 PCPs serving rural adults. Interviews focused on challenges to increasing PA among their older patients with knee OA, and examined their perspectives on a proposed clinical pathway, which included PCP screening and counseling to refer older adults with OA to a remotely-delivered exercise program. Data were analyzed using thematic analysis with an inductive-deductive coding approach.
Results: PCPs identified opportunities and challenges regarding supporting physical activity among their rural older patients with OA, which occurred across three PCP-led behaviors: 1) routine PA screening of older patients with OA, 2) PA counseling, and 3) referral to exercise program. PCPs typically believed a simple, standardized PA screening tool could facilitate conversations with patients, but anticipated structural barriers (e.g., no fiscal incentive, limited visit time) to complete screenings. When counseling patients on PA, PCPs felt their patient relationships would facilitate collaborative conversations about positive lifestyle changes, generally; however, they reported skepticism about patients’ readiness to increase PA and ambivalence about their role in addressing unreadiness. Lastly, providers thought having an exercise program to refer patients to would be helpful, but that few affordable and accessible options were currently available to rural patients.
Discussion: While rural PCPs generally recognized the value of PA for their older patients with OA and were enthusiastic about a tele-exercise program, there was no consensus on whether or how an exercise prescription pathway could be effectively implemented in their clinics, with most barriers identified occurring outside of PCPs’ control (e.g., structural barriers, patient motivation factors). Alternative approaches addressing multilevel barriers are likely needed to support rural older adults with OA to become more physically active and access tele-exercise programs.
Keywords: Physical activity, Primary careMethods: We conducted semi-structured, in-depth interviews with 11 PCPs serving rural adults. Interviews focused on challenges to increasing PA among their older patients with knee OA, and examined their perspectives on a proposed clinical pathway, which included PCP screening and counseling to refer older adults with OA to a remotely-delivered exercise program. Data were analyzed using thematic analysis with an inductive-deductive coding approach.
Results: PCPs identified opportunities and challenges regarding supporting physical activity among their rural older patients with OA, which occurred across three PCP-led behaviors: 1) routine PA screening of older patients with OA, 2) PA counseling, and 3) referral to exercise program. PCPs typically believed a simple, standardized PA screening tool could facilitate conversations with patients, but anticipated structural barriers (e.g., no fiscal incentive, limited visit time) to complete screenings. When counseling patients on PA, PCPs felt their patient relationships would facilitate collaborative conversations about positive lifestyle changes, generally; however, they reported skepticism about patients’ readiness to increase PA and ambivalence about their role in addressing unreadiness. Lastly, providers thought having an exercise program to refer patients to would be helpful, but that few affordable and accessible options were currently available to rural patients.
Discussion: While rural PCPs generally recognized the value of PA for their older patients with OA and were enthusiastic about a tele-exercise program, there was no consensus on whether or how an exercise prescription pathway could be effectively implemented in their clinics, with most barriers identified occurring outside of PCPs’ control (e.g., structural barriers, patient motivation factors). Alternative approaches addressing multilevel barriers are likely needed to support rural older adults with OA to become more physically active and access tele-exercise programs.
Authors:
Presenter - Kushang V. Patel,
University of Washington
Presenter - Elise V. Hoffman,
University of Washington
Author - Nancy M. Gell,
University of Vermont
Author - Leah M. Adams,
George Mason University
E146 - Physical activity self-regulation supports adults’ long-term physical activity maintenance
Poster Number: E146Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Social and Environmental Context and Health
The current study examined the self-determination theory’s self-regulation constructs in relation to adults’ physical activity maintenance. Adults (28-45 years) were recruited through an alumni organization at a Midwestern university. Participants completed an online survey, reporting their current physical activity levels and self-regulation, as well as their physical activity levels at least 10 years prior. Participants’ MET units for previous and current physical activity were used to categorize participants as either receiving maximal health benefits (≥24 MET units) or not (<24 MET). Based on this categorization of participants’ current and previous physical activity, four sample subgroups were created for analyses: maintainers (previous and current physical activity≥24 MET), improvers (previous activity<24 MET and current activity≥24 MET), decliners (previous activity≥24 MET and current activity<24 units MET), and sedentary (previous and current activity<24 MET). Data were analyzed using IBM SPSS software. ANOVA analyses and post hoc analyses were used to determine differences in self-regulation between physical activity maintenance subgroups. Gender and perceived health were covariates. Participants (N=721) were mostly female (63%) with a mean age of 33.37 (standard deviation (SD)=3.87). Forty-nine percent of participants were overweight or obese. Participants were predominately Caucasian (90%) and educated (38% with a college degree; 58% with an advanced degree). With 5 being excellent, participants reported a mean of 3.83 for perceived health (SD=0.77). No differences in external self-regulation were detected. Introjected self-regulation was higher among maintenance participants versus decliners (p=0.00) and sedentary participants (p=0.00). Maintainers were also higher in identified self-regulation compared to decliners (p=0.00) and sedentary participants (p=0.00). Improvers reported higher identified self-regulation compared to decliners (p=0.00) and sedentary participants (p=0.00). For intrinsic self-regulation, maintainers were significantly higher than decliners p=0.00) and sedentary participants (p=0.00). Improvers were higher in intrinsic self-regulation compared to decliners (p=0.00) and sedentary participants (p=0.00). Results support a strong relationship between self-regulation and physical activity maintenance. Future research is needed to examine self-regulation as a potential strategy to promote sustained regular physical activity.
Keywords: Physical activity, Health behavior changeAuthors:
Presenter - Karly S. Geller, PhD,
PhD,
Miami University
E147 - Exploring the health and behaviors of theological students in North America: A cross-sectional study
Poster Number: E147Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Integrative Health and Spirituality
Research shows clergy are affected by high rates of obesity and chronic disease, likely due to the unique stressors and lifestyle factors associated with their profession. Limited studies on theological students (i.e., clergy-in-training) in the USA suggest they may enter their vocation already experiencing poor health outcomes (e.g., obesity, high blood pressure) and unhealthy lifestyle behaviors. Thus, the purpose of this study was to investigate the health and behaviors of theological students in North America (N=430). Students from approximately 68 accredited theological schools completed questionnaires related to their health and their exercise, diet, and sleep behaviors. Binomial logistic regressions were used to determine the effects of age, gender, and race, physical activity, diet, and sleep on the likelihood that students were obese or reported a diagnosis of a chronic disease. Students were on average 38.9 (SD=13.0) years old, female (61%), and White (71%). Increasing age was associated with an increased likelihood of obesity (OR: 1.03, 95% CI: 1.01, 1.04), cancer (OR: 1.12, 95% CI: 1.07, 1.17), diabetes OR: 1.09, 95% CI: 1.05, 1.12), high cholesterol (OR: 1.06, 95% CI: 1.03, 1.09), and high blood pressure (OR: 1.08, 95% CI: 1.05, 1.11), and a decreased likelihood of anxiety (OR: 0.96, 95% CI: 0.94, 0.98). Females were less likely to report diabetes (OR: 0.32, 95% CI: 0.17, 0.92), high cholesterol (OR: 0.45, 95% CI: 0.22, 0.90), and high blood pressure (OR: 0.38, 95% CI: 0.18, 0.79) than males, but more likely to report anxiety (OR: 1.95, 95% CI: 1.15, 3.32). When compared to White students, Black/African American students were more likely to report high blood pressure (OR: 2.89, 95% CI: 1.17, 7.14) and Asian students were less likely to be obese (OR: 0.20, 95% CI: 0.08, 0.54) and to report anxiety (OR: 0.24, 95% CI: 0.09, 0.65). Being physically active was associated with a decreased likelihood of reporting diabetes (OR: 0.24, 95% CI: 0.94, 0.62) and high blood pressure (OR: 0.37, 95% CI: 0.17, 0.82). We present preliminary evidence on how age, gender, race, and physical activity predict the likelihood of chronic disease among theological students in North America. Our findings highlight the need for longitudinal studies with larger, more diverse samples and objective measures to better understand the temporal relationships between health behaviors and outcomes in this population.
Keywords: Health promotion, Public healthAuthors:
Author - Benjamin L. Webb, PhD,
PhD,
Southern Illinois University Edwardsville
Presenter - Nathan T. West, PhD,
PhD,
University of Alaska Anchorage
E148 - Examining disparities in physical activity enjoyment and self-efficacy by race/ethnicity and sexual orientation in college women
Poster Number: E148Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Women's Health
Background: Establishing physical activity (PA) behaviors during the transitional years of college provides a foundation for healthy habits into adulthood. Starting in adolescence, women are less active than men, putting them at higher risk of inactivity-related physical and mental chronic health problems, with notable disparities by race/ethnicity and sexual orientation. Racial/ethnic minority and sexual minority women are less active than Non-Hispanic White or heterosexual women, creating a need for understanding influences on PA participation. The purpose of this study was to examine disparities in PA influences by race/ethnicity and sexual orientation among college women.
Methods: A volunteer sample of students at a large Northeastern University participated in an online survey (2018-2024) asking about their demographics, PA participation, PA enjoyment (PAE), self-efficacy for exercise (SEE) and physical/mental health outcomes (depression, perceived stress, sleep, perceived health). Only cis-gender women were included in analyses; sexual orientation was dichotomized as heterosexual and sexual minority (all other identities). T-tests and ANOVAs were used to examine differences in PA, PAE, SEE by race/ethnicity and sexual orientation. Logistic regressions determined the likelihood of meeting PA recommendations while controlling for demographics and physical/mental health variables. Results: Participants (n=4419) were predominately Non-Hispanic White (n=3432, 73.1%), heterosexual (n=3903, 84.1%) and meeting PA recommendations (n=3116, 72.7%). Heterosexual women were more active, report less depression and stress, have greater PAE and SEE, better sleep and perceive better health than sexual minority women (p’s <0.001). Non-Hispanic White women reported higher PA, PAE and SEE than several other racial/ethnic groups (p’s <0.001), though trends were not as clear for the physical and mental health outcomes. Generally, logistic regression analyses revealed that PAE and SEE were significant predictors for meeting PA recommendations for most groups when controlling for the physical and mental health outcomes.
Conclusion: These findings indicate a significant disparity in PAE and SEE among women who are at a higher risk for being inactive. Tailored programming for racial/ethnic minority or sexual minority women could be developed to target these constructs to support well-being. Limitations include a volunteer bias, uneven sample sizes, and self-report measures.
Keywords: Ethnic differences, Women's healthMethods: A volunteer sample of students at a large Northeastern University participated in an online survey (2018-2024) asking about their demographics, PA participation, PA enjoyment (PAE), self-efficacy for exercise (SEE) and physical/mental health outcomes (depression, perceived stress, sleep, perceived health). Only cis-gender women were included in analyses; sexual orientation was dichotomized as heterosexual and sexual minority (all other identities). T-tests and ANOVAs were used to examine differences in PA, PAE, SEE by race/ethnicity and sexual orientation. Logistic regressions determined the likelihood of meeting PA recommendations while controlling for demographics and physical/mental health variables. Results: Participants (n=4419) were predominately Non-Hispanic White (n=3432, 73.1%), heterosexual (n=3903, 84.1%) and meeting PA recommendations (n=3116, 72.7%). Heterosexual women were more active, report less depression and stress, have greater PAE and SEE, better sleep and perceive better health than sexual minority women (p’s <0.001). Non-Hispanic White women reported higher PA, PAE and SEE than several other racial/ethnic groups (p’s <0.001), though trends were not as clear for the physical and mental health outcomes. Generally, logistic regression analyses revealed that PAE and SEE were significant predictors for meeting PA recommendations for most groups when controlling for the physical and mental health outcomes.
Conclusion: These findings indicate a significant disparity in PAE and SEE among women who are at a higher risk for being inactive. Tailored programming for racial/ethnic minority or sexual minority women could be developed to target these constructs to support well-being. Limitations include a volunteer bias, uneven sample sizes, and self-report measures.
Authors:
Co-Author - Caellum Impelluso,
MS,
Physical Activity and Public Health Lab at Pennsylvania State University
Co-Author - Michele Duffey,
MS,
Pennsylvania State University
Co-Author - Keegan T. Peterson, MPH,
MPH,
Penn State University
E149 - Can machine learning-driven goal setting increase physical activity? A pre-post quasi-experimental study of 1,249 mHealth app users.
Poster Number: E149Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Digital Health
Background: Mobile health (mHealth) delivered goal setting interventions that include financial incentives (FI) can increase physical activity (PA). It is not clear whether a supervised machine learning [ML] algorithm can be used to set better goals and boost intervention effects.
Objective: To examine whether an mHealth PA intervention with FI is improved with the incorporation of an optional ML-driven goal setting algorithm.
Methods: A 17-week pre-post quasi-experiment was conducted among users of the Sprout app, an mHealth PA intervention with FI targeting North American employees (March-July 2022). The study consisted of a five-week ‘run-in’ (baseline) period, where users (i.e., registered with the app for at least five weeks) could earn FI for meeting static daily step goal (i.e., $0.15 USD each day). A 12-week ‘intervention’ period followed. During this period users were given the option of either (a) continuing with their static goal (control) or (b) opting into ML-driven adaptive goals (intervention). The supervised ML algorithm set new daily step goals at the beginning of each week based on users' recent daily step count patterns and cluster-based comparisons (i.e., portion of standard deviation of cluster to which user belonged added to goal). Independent-samples t-tests examined between-group differences in mean daily step count change from baseline (‘pre’: baseline vs. ‘post’: Week 6, Week 12; p<0.05) controlling for covariates (e.g., age, gender).
Results: A total of 1,249 participants (control: n=447; intervention: n=802) were included (59.4% between 30 and 50 years of age; 42.5% women; BMI: 27.9±9.8 kg/m²; baseline daily step count: 6,366±3,617; days registered on app: 633±497). There were no between-group differences in mean daily step count change from baseline at Week 6 (mean difference [MD] [95% CI]: 49 [-579, 480]; p=0.855) nor Week 12 (MD [95% CI]: 443 [-110, 998]; p=0.116).
Conclusion: Compared to controls, PA did not improve among those opting into the ML-driven adaptive goal setting condition. Future research should test different ML approaches (e.g., reinforcement learning) more likely to set refined, PA promoting goals.
Keywords: Physical activity, Behavior ChangeObjective: To examine whether an mHealth PA intervention with FI is improved with the incorporation of an optional ML-driven goal setting algorithm.
Methods: A 17-week pre-post quasi-experiment was conducted among users of the Sprout app, an mHealth PA intervention with FI targeting North American employees (March-July 2022). The study consisted of a five-week ‘run-in’ (baseline) period, where users (i.e., registered with the app for at least five weeks) could earn FI for meeting static daily step goal (i.e., $0.15 USD each day). A 12-week ‘intervention’ period followed. During this period users were given the option of either (a) continuing with their static goal (control) or (b) opting into ML-driven adaptive goals (intervention). The supervised ML algorithm set new daily step goals at the beginning of each week based on users' recent daily step count patterns and cluster-based comparisons (i.e., portion of standard deviation of cluster to which user belonged added to goal). Independent-samples t-tests examined between-group differences in mean daily step count change from baseline (‘pre’: baseline vs. ‘post’: Week 6, Week 12; p<0.05) controlling for covariates (e.g., age, gender).
Results: A total of 1,249 participants (control: n=447; intervention: n=802) were included (59.4% between 30 and 50 years of age; 42.5% women; BMI: 27.9±9.8 kg/m²; baseline daily step count: 6,366±3,617; days registered on app: 633±497). There were no between-group differences in mean daily step count change from baseline at Week 6 (mean difference [MD] [95% CI]: 49 [-579, 480]; p=0.855) nor Week 12 (MD [95% CI]: 443 [-110, 998]; p=0.116).
Conclusion: Compared to controls, PA did not improve among those opting into the ML-driven adaptive goal setting condition. Future research should test different ML approaches (e.g., reinforcement learning) more likely to set refined, PA promoting goals.
Authors:
Author - Babac Salmani,
PhD Candidate,
Western University
Co-Author - Marc Mitchell,
PhD,
Western University
E150 - Sun, snow, and step counts: Seasonality exerts the largest influence on physical activity levels among middle-aged, working adults
Poster Number: E150Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Multiple Health Behavior Change
Combatting adults’ low levels of moderate-vigorous physical activity (MVPA) is an ongoing public health concern. However, even adults who meet the MVPA guidelines often engage in excessive sedentary time (ST). Full-time working adults are at high risk for leading sedentary, inactive lifestyles due to desk-based jobs and passive commuting. While myriad interventions have been designed to alter their activity levels, these efforts often target only ST or MVPA and neglect to target the full activity profile. The present RCT examined the efficacy of simultaneously increasing MVPA and reducing ST among low-active, middle-aged working adults. N=88 adults (Mage=54.64) were randomized into an intervention group (↑MVPA↓ST) designed to increase MVPA and decrease ST or a control group (↑MVPA) targeting MVPA only. Both groups completed a 12-week period consisting of one weekly 60-min exercise class and guidelines to complete two additional exercise sessions to build up to 150 min/week of MVPA. The ↑MVPA↓ST group also participated in a novel social cognitive theory-based intervention targeting the displacement of ST via increased steps. Participants in both groups wore pedometers throughout the 12 weeks, but only the ↑MVPA↓ST group received guidance on setting goals to increase steps. Changes in mean pedometer-measured steps/day and mean accelerometer-measured min/day of ST, light-intensity physical activity (LPA), and MVPA were examined at baseline and immediately after the 12 weeks. ANCOVA tests examining Time*Activity*Group interaction effects showed insignificant changes for ST, LPA, and MVPA (p=.139). There was a significant Time*Activity*Wave interaction effect. Wave 1 participants (who participated in summer months) increased their MVPA (p=.002), whereas Wave 2 participants (who participated in winter months) increased ST (p<.001) and decreased LPA (p=.027) and MVPA (p=0.043). Time*Group effects for changes in steps were also insignificant (p=.808). We observed similar Time*Wave interaction effects (p<.001) among steps, with Wave 1 participants significantly increasing their daily steps (p<.001) and Wave 2 participants experiencing a nonsignificant decrease (p=0.094). Overall, the seasonal differences between the waves may have exerted the most substantial influence on participants’ activity levels. The present findings shed light on critical design and implementation factors to be considered when targeting middle-aged working adults' physical activity levels.
Keywords: Behavior Change, Physical activityAuthors:
Author - Emily Erlenbach,
PHD, MS, BS,
EXOS
Co-Author - Neha P. Gothe,
PhD,
Northeastern University
E151 - An Examination of Social Ecological Factors Associated with Being a Physical Activity Increaser
Poster Number: E151Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Social and Environmental Context and Health
Individuals who increase their physical activity (PA) over the lifespan are understudied, as PA generally declines with age. The social ecological model provides a way to examine what variables facilitate increases in PA over time. However, the model is broad and further work is needed to identify key variables and their impact on PA . The overall aim of the study was to separately examine individual, social, and environmental factors associated with being a PA increaser over a 10-year period. We hypothesized that individual factors- being male, younger age, more education, greater health locus of control, perceived PA importance, social factors - greater friend and family social support, and the environmental factor- greater perceived neighborhood quality would be associated with the likelihood of being a PA increaser, compared to being a PA decreaser.
Participants were 2,554 25- to 75-year-olds from two waves of the longitudinal National Survey of Midlife Development in the United States (MIDUS). The dependent variable was created by first calculating a PA score consistent with prior research using the MIDUS dataset (Lachman & Agrigoroaei, 2010). Participants were then categorized into five groups (i.e., increaser, decreaser, stable active, stable inactive, stable not regularly active) based on a change in score from one wave to the next. Three separate multinomial logistic regression analyses were conducted to explore three levels of the social ecological model, controlling for BMI, self-evaluated health, and functional restrictions.
Results suggest that age and education impact the likelihood of being a PA increaser. Each one year increase in age was associated with increased odds of being a PA decreaser compared to an increaser (OR=1.018, 95% CI[1.008, 1.028]). An undergraduate education vs receiving a graduate education increases the odds of being a PA decreaser relative to an increaser by 39% (OR=1.394, 95%CI[1.011, 1.968]. Contrary to our hypothesis, gender, health locus of control, perceived PA importance, social support and perceived neighborhood quality did not predict the likelihood of being a PA increaser over a PA decreaser. Results are consistent with other studies finding age and education impact PA engagement. Interventions that target PA may need to prioritize demographics like age over psychosocial factors.
Keywords: Physical activity, Behavior ChangeParticipants were 2,554 25- to 75-year-olds from two waves of the longitudinal National Survey of Midlife Development in the United States (MIDUS). The dependent variable was created by first calculating a PA score consistent with prior research using the MIDUS dataset (Lachman & Agrigoroaei, 2010). Participants were then categorized into five groups (i.e., increaser, decreaser, stable active, stable inactive, stable not regularly active) based on a change in score from one wave to the next. Three separate multinomial logistic regression analyses were conducted to explore three levels of the social ecological model, controlling for BMI, self-evaluated health, and functional restrictions.
Results suggest that age and education impact the likelihood of being a PA increaser. Each one year increase in age was associated with increased odds of being a PA decreaser compared to an increaser (OR=1.018, 95% CI[1.008, 1.028]). An undergraduate education vs receiving a graduate education increases the odds of being a PA decreaser relative to an increaser by 39% (OR=1.394, 95%CI[1.011, 1.968]. Contrary to our hypothesis, gender, health locus of control, perceived PA importance, social support and perceived neighborhood quality did not predict the likelihood of being a PA increaser over a PA decreaser. Results are consistent with other studies finding age and education impact PA engagement. Interventions that target PA may need to prioritize demographics like age over psychosocial factors.
Authors:
Author - Mel McHugh,
M.S.,
Rosalind Franklin University of Medicine & Science
Co-Author - Kristin L. Schneider,
PhD,
Rosalind Franklin University of Medicine & Science
E152 - Affective and Physical-Feeling States as Predictors of Variability in Daily Physical Activity Among Adolescents
Poster Number: E152Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Child and Family Health
Meeting the recommended 60-minutes of moderate-to-vigorous physical activity (MVPA) in adolescence can translate into positive health outcomes, yet many adolescents struggle to maintain regular engagement. Factors influencing physical activity include affect (e.g., positive, negative) and physical-feeling states (e.g., energy, fatigue), both of which are significantly associated with adolescent physical activity engagement. Because physical activity requires regular engagement for maximum benefit, consistent engagement in MVPA is a critical target for clinical interventions. Adolescents who engage in habitual physical activity are more likely to maintain it long-term. Therefore, it is of clinical importance to know what factors increase consistency in MVPA. This study hypothesized that higher positive affect and energy and lower negative affect and fatigue would be associated with less variable (i.e., more consistent) MVPA.
One-hundred adolescents aged 13 – 18 (M = 14.45) took part in an ecological momentary assessment (EMA) study over a 20-day period, completing surveys 4-times a day using a smartphone. Affect was collected using the PANAS-C. Energy and fatigue was collected using the POMS-SF. Physical activity was collected using an Actigraph accelerometer.
Multilevel models assessing the relationship between MVPA and affective and physical-feeling states. Models were analyzed using a two-level time-series analysis with within-person affect and physical-feeling states (level 1) and person-mean affect and physical-feeling states (level 2) predicting MVPA. The final model assessing MVPA and affect showed that adolescents with a higher overall negative affect (β = 0.198, p = 0.033) and positive affect (β = 0.108, p = 0.038) demonstrated higher variability in MVPA. The final models assessing energy and fatigue with MVPA were non-significant.
These analyses show that adolescents that demonstrate high levels of positive and negative affect are associated with more variable engagement in their day-to-day physical activity relative to those with lower affective ratings. While only partially supportive of study hypotheses, these findings provide important mechanistic targets for future studies seeking to increase consistency in adolescent MVPA. Specifically, adolescents with high levels of self-reported affect relative to their peers may be targets for intervention modules that encourage consistent MVPA rather than trainings that target novice exercisers.
Keywords: Adolescents, Physical activityOne-hundred adolescents aged 13 – 18 (M = 14.45) took part in an ecological momentary assessment (EMA) study over a 20-day period, completing surveys 4-times a day using a smartphone. Affect was collected using the PANAS-C. Energy and fatigue was collected using the POMS-SF. Physical activity was collected using an Actigraph accelerometer.
Multilevel models assessing the relationship between MVPA and affective and physical-feeling states. Models were analyzed using a two-level time-series analysis with within-person affect and physical-feeling states (level 1) and person-mean affect and physical-feeling states (level 2) predicting MVPA. The final model assessing MVPA and affect showed that adolescents with a higher overall negative affect (β = 0.198, p = 0.033) and positive affect (β = 0.108, p = 0.038) demonstrated higher variability in MVPA. The final models assessing energy and fatigue with MVPA were non-significant.
These analyses show that adolescents that demonstrate high levels of positive and negative affect are associated with more variable engagement in their day-to-day physical activity relative to those with lower affective ratings. While only partially supportive of study hypotheses, these findings provide important mechanistic targets for future studies seeking to increase consistency in adolescent MVPA. Specifically, adolescents with high levels of self-reported affect relative to their peers may be targets for intervention modules that encourage consistent MVPA rather than trainings that target novice exercisers.
Authors:
Author - Zachary C. Bricken,
University of Kansas
Chair - Christopher C. Cushing, PhD,
PhD,
University of Kansas
E153 - Behavior Change Pathways: Self-Efficacy as a Mediator Linking Intraindividual Variability to Maintenance in MVPA
Poster Number: E153Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Digital Health
Intraindividual variability (IIV) in physical activity is an underexplored phenomenon, particularly its role in influencing long-term maintenance. This substudy of the WalkIT Arizona trial—a factorial randomized clinical trial testing adaptive goals and financial reinforcement to increase walking across neighborhoods with varying walkability—investigated the mediating role of self-efficacy in the relationship between IIV and physical activity maintenance. Two specific domains of IIV were examined: variability in daily moderate-to-vigorous physical activity (MVPA) bout minutes and variability in the timing of MVPA bout initiation. Using structural equation modeling (SEM), we estimated causal mediation effects, ensuring temporal precedence and controlling for confounding by selecting a minimally sufficient set of covariates to block non-causal backdoor paths.
In the daily MVPA model, self-efficacy significantly mediated the relationship between IIV and physical activity maintenance (Mediation Effect = 0.057, p = 0.003), with significant total (Estimate = 0.448, p < 0.001) and direct effects (Estimate = 0.391, p < 0.001). Similarly, in the MVPA timing model, self-efficacy mediated the relationship between IIV and maintenance (Mediation Effect = 4.218, p = 0.048). These findings suggest that greater IIV in both daily MVPA bout minutes and start times is positively associated with self-efficacy, which, in turn, supports sustained physical activity during the follow-up period.
This analysis highlights the dual role of IIV and self-efficacy as empirical mechanisms linking evidence-based behavior change techniques to physical activity maintenance. Variability in physical activity behaviors may reflect adaptive patterns that enhance self-efficacy, facilitating long-term engagement in physical activity. By employing rigorous causal mediation methods—including temporal alignment and covariate adjustment—this study provides robust evidence for these mechanisms of action. Future research should further investigate the interplay between IIV and self-efficacy to optimize behavior change interventions and sustain long-term physical activity outcomes.
Keywords: Health behavior change, Causal pathway modelsIn the daily MVPA model, self-efficacy significantly mediated the relationship between IIV and physical activity maintenance (Mediation Effect = 0.057, p = 0.003), with significant total (Estimate = 0.448, p < 0.001) and direct effects (Estimate = 0.391, p < 0.001). Similarly, in the MVPA timing model, self-efficacy mediated the relationship between IIV and maintenance (Mediation Effect = 4.218, p = 0.048). These findings suggest that greater IIV in both daily MVPA bout minutes and start times is positively associated with self-efficacy, which, in turn, supports sustained physical activity during the follow-up period.
This analysis highlights the dual role of IIV and self-efficacy as empirical mechanisms linking evidence-based behavior change techniques to physical activity maintenance. Variability in physical activity behaviors may reflect adaptive patterns that enhance self-efficacy, facilitating long-term engagement in physical activity. By employing rigorous causal mediation methods—including temporal alignment and covariate adjustment—this study provides robust evidence for these mechanisms of action. Future research should further investigate the interplay between IIV and self-efficacy to optimize behavior change interventions and sustain long-term physical activity outcomes.
Authors:
Co-Author - Vincent Berardi, PhD,
PhD,
Chapman University
Co-Author - Marc Adams,
PhD,
Arizona State University
E154 - Moral injury and professional quality of life among Hong Kong nurses caring for trauma-exposed patients: The serial mediating roles of resilience and job satisfaction
Poster Number: E154Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Mental Health
Background. Frontline nurses at times face with highly distressful work experiences(e.g.,life-and-death situations, clients’ sufferings) needing them to make difficult treatment decisions that might contradict with their beliefs. Those nurses are particularly vulnerable to experiencing moral injury(MI; negative emotions/feelings from one’s engagement in, failure to prevent, witnessing of acts conflicting moral values/beliefs). Western studies have found that MI are associated with nurses’ professional quality of life(ProQoL; indicated by burnout, compassion satisfaction, and secondary traumatic stress) through perceptions of psychosocial resources(e.g., resilience, job satisfaction). However, relevant studies on Asian nurses are limited. This study examined the association between MI and ProQoL, plus the moderating roles of resilience and job satisfaction in such association among Hong Kong nurses.
Methods. Nurses(N=252) with experiences caring for trauma-exposed patients (e.g., accidents, suicide, terminal illnesses, mental health problems) were recruited from nursing associations in Hong Kong completed an online survey measuring the aforementioned variables between February-March, 2024.
Results. Mediation analysis results (SPSS Process model 6) showed the links between MI and the ProQoL indicators were significantly and serially mediated by resilience and job satisfaction. Specifically, those indirect pathways from MI(via resilience to job satisfaction) to burnout(effect=0.02, se=.01, 95%CI=0.01,0.03), secondary traumatic stress(effect=-0.01, se=.003, 95%CI=-0.01,-0.001) and compassion satisfaction(effect=-0.02, se=.01, 95%CI=-0.04,-0.01) were significant. After considering the mediators, the direct effects from MI to higher burnout(effect=0.15, se=.02, 95%CI=0.11,0.20), higher secondary traumatic stress (effect=0.21, se=.03, 95%CI=0.16,0.26), and lower compassion satisfaction(effect=-0.08, se=.03, 95%CI=-0.14,-0.02) were still significant.
Implications. MI was associated with poorer ProQoL among Hong Kong nurses caring for trauma-exposed patients; such associations were also explained by nurses’ perceptions of psychological resources (i.e., resilience and job satisfaction). The findings provided recommendations for services supporting those nurses’ mental health. Providing nurses with workshops that train their skills to cope with MI, to build their resilience, and to facilitate their job satisfaction might be effective in promoting ProQoL.
Keywords: Quality of life, Occupational healthMethods. Nurses(N=252) with experiences caring for trauma-exposed patients (e.g., accidents, suicide, terminal illnesses, mental health problems) were recruited from nursing associations in Hong Kong completed an online survey measuring the aforementioned variables between February-March, 2024.
Results. Mediation analysis results (SPSS Process model 6) showed the links between MI and the ProQoL indicators were significantly and serially mediated by resilience and job satisfaction. Specifically, those indirect pathways from MI(via resilience to job satisfaction) to burnout(effect=0.02, se=.01, 95%CI=0.01,0.03), secondary traumatic stress(effect=-0.01, se=.003, 95%CI=-0.01,-0.001) and compassion satisfaction(effect=-0.02, se=.01, 95%CI=-0.04,-0.01) were significant. After considering the mediators, the direct effects from MI to higher burnout(effect=0.15, se=.02, 95%CI=0.11,0.20), higher secondary traumatic stress (effect=0.21, se=.03, 95%CI=0.16,0.26), and lower compassion satisfaction(effect=-0.08, se=.03, 95%CI=-0.14,-0.02) were still significant.
Implications. MI was associated with poorer ProQoL among Hong Kong nurses caring for trauma-exposed patients; such associations were also explained by nurses’ perceptions of psychological resources (i.e., resilience and job satisfaction). The findings provided recommendations for services supporting those nurses’ mental health. Providing nurses with workshops that train their skills to cope with MI, to build their resilience, and to facilitate their job satisfaction might be effective in promoting ProQoL.
Authors:
Author - Nelson C.Y. Yeung, PhD,
PhD,
The Chinese University of Hong Kong
Author - Jessica Chan,
The Chinese University of Hong Kong
E155 - A feasibility pilot study on social virtual reality for hospitalized older adult trauma patients
Poster Number: E155Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Digital Health
Older adults (65 and above) represent a significant portion of trauma admissions in U.S. hospitals, primarily due to falls and collisions. Managing pain effectively and mitigating social isolation in this population is crucial. Traditional opioid treatments, while common, pose risks such as addiction, delirium, and constipation, leading to extended hospital stays and increased costs. This study explores the feasibility and acceptability of social virtual reality (SVR) as a novel, non-pharmacologic approach to address pain and social isolation among older trauma patients. We report on Phase 1 of an NIH-funded feasibility study, in which we approached 46 eligible patients, recruiting 10, to solicit feedback on their preferences for social virtual environments to interact with friends and loved ones.
The study employs a two-phase design to evaluate SVR’s potential. We describe a user-centered, iterative design approach to enhance SVR’s feasibility, acceptability, and usability in the target population. We presented existing versions of SVR applications, primarily vTimeXR, Spatial, and Engage, to hospitalized older adult trauma patients, interviewing them and making iterative refinements based on their feedback. Phase 2 will examine how social interactions with family members or friends in a VR environment influence the user experience.
Initial results from Phase 1 indicate that older adults are receptive to VR environments, with feedback highlighting both positive engagement and areas for improvement. Out of 46 approached patients, 11 consented. Ten patients completed Phase 1, and one was ruled out due to an undisclosed injury. Of the 35 who did not participate, seven were interested but were discharged too early, 14 reported limited interest in the technology, and eight reported issues with mental state, exhaustion, fatigue, and/or pain. Participants who completed the study indicated environments could serve as effective distractions, facilitate social interaction, and evoke calming emotions. Participants suggested enhancing the realism of nature elements and offering more interactive features, such as tasks, games, or narratively compelling videos.
These early results suggest this is a feasible approach. By addressing both physical and emotional needs through SVR, this research could impact the care of hospitalized older adults, offering a scalable solution to enhance patient outcomes in a clinical setting.
Keywords: Technologies, Quality of lifeThe study employs a two-phase design to evaluate SVR’s potential. We describe a user-centered, iterative design approach to enhance SVR’s feasibility, acceptability, and usability in the target population. We presented existing versions of SVR applications, primarily vTimeXR, Spatial, and Engage, to hospitalized older adult trauma patients, interviewing them and making iterative refinements based on their feedback. Phase 2 will examine how social interactions with family members or friends in a VR environment influence the user experience.
Initial results from Phase 1 indicate that older adults are receptive to VR environments, with feedback highlighting both positive engagement and areas for improvement. Out of 46 approached patients, 11 consented. Ten patients completed Phase 1, and one was ruled out due to an undisclosed injury. Of the 35 who did not participate, seven were interested but were discharged too early, 14 reported limited interest in the technology, and eight reported issues with mental state, exhaustion, fatigue, and/or pain. Participants who completed the study indicated environments could serve as effective distractions, facilitate social interaction, and evoke calming emotions. Participants suggested enhancing the realism of nature elements and offering more interactive features, such as tasks, games, or narratively compelling videos.
These early results suggest this is a feasible approach. By addressing both physical and emotional needs through SVR, this research could impact the care of hospitalized older adults, offering a scalable solution to enhance patient outcomes in a clinical setting.
Authors:
Author - S. Isabelle Mcleod Daphnis,
Cornell University
Presenter - Mariel Emrich,
University of Connecticut
Author - Reece Simpson,
Weill Cornell Medicine
Author - Max Accurso,
Weill Cornell Medicine
Author - Ella Blicker,
Weill Cornell Medicine
Author - Olivia Baryluk,
Weill Cornell Medicine
Author - Robert Winchell,
M.D.,
Weill Cornell Medicine
Author - sara czaja,
Ph.D.,
Weill Cornell Medicine
Author - Carrington Reid,
Ph.D., M.D.,
Weill Cornell Medicine
Author - JoAnn Difede,
Ph.D.,
Weill Cornell Medical College
Author - Andrea Stevenson Won,
Ph.D.,
Cornell University
E156 - A Shared-Management Web-Based Intervention for Sleep Deficiency in School-Age Children with Juvenile Idiopathic Arthritis and their Parents: Feasibility and Acceptability Study
Poster Number: E156Time: 05:00 PM - 05:50 PM
Topics: Sleep, Child and Family Health
Study Objectives: To describe the feasibility, acceptability, and preliminary efficacy of a pilot randomized controlled trial sleep health intervention (SLEEPSMART) for children with juvenile idiopathic arthritis (JIA) and their parents.
Methods: Fifty children, 8-13 years, with JIA and sleep deficiency, and their parents participated in the pilot RCT study. Children and parents were randomized to SLEEPSMART or usual care. The SLEEPSMART intervention was 7-weeks and included weekly educational modules, quizzes, goal setting, and an online sleep coach. Children wore actigraphy and completed sleep diaries and surveys at baseline (T1), immediately post-intervention (T2), and one-month post-intervention (T3). Feasibility was measured by the percentage of eligible, enrolled, and retained dyads, engagement was measured when dyads completed the modules, and usefulness and acceptability were measured with the Treatment Evaluation Inventory and qualitative interviews. Preliminary efficacy on primary outcomes included actigraphy total sleep time, sleep efficiency, self-report PROMIS sleep disturbance, PROMIS sleep-related impairment, and secondary outcomes included self-efficacy in children with JIA and their parents.
Results: Of the 50 child-parent dyads enrolled, 88% completed the baseline assessment. Seventy-five percent of children and 89% of parents reported high acceptance; 89% of parents and 80% of children would recommend SLEEPSMART. Compared to children in the control group, children who received the SLEEPSMART intervention had significant improvements in actigraphy total sleep time, sleep efficiency, and self-report PROMIS sleep disturbance scores immediately post intervention and one-month follow up, and in dysfunctional beliefs and attitudes and sleep efficacy scores one-month post-intervention. Parents in the SLEEPSMART group had significant improvements in PROMIS sleep-related impairment and DBAS scores immediately post-intervention and one-month follow-up, and in self-efficacy scores one-month post intervention in comparison to parents in the control group.
Conclusion: SLEEPSMART was feasible, acceptable, and improved objective and self-report sleep and self-efficacy outcomes in children with JIA and their parents. Sleep is a modifiable behavior and a missing piece in pediatric rheumatology care. This pilot RCT addressed current gaps in the literature and will inform the necessary sample sizes and power of a future larger multisite trial.
Keywords: Autoimmune disease, Self-efficacyMethods: Fifty children, 8-13 years, with JIA and sleep deficiency, and their parents participated in the pilot RCT study. Children and parents were randomized to SLEEPSMART or usual care. The SLEEPSMART intervention was 7-weeks and included weekly educational modules, quizzes, goal setting, and an online sleep coach. Children wore actigraphy and completed sleep diaries and surveys at baseline (T1), immediately post-intervention (T2), and one-month post-intervention (T3). Feasibility was measured by the percentage of eligible, enrolled, and retained dyads, engagement was measured when dyads completed the modules, and usefulness and acceptability were measured with the Treatment Evaluation Inventory and qualitative interviews. Preliminary efficacy on primary outcomes included actigraphy total sleep time, sleep efficiency, self-report PROMIS sleep disturbance, PROMIS sleep-related impairment, and secondary outcomes included self-efficacy in children with JIA and their parents.
Results: Of the 50 child-parent dyads enrolled, 88% completed the baseline assessment. Seventy-five percent of children and 89% of parents reported high acceptance; 89% of parents and 80% of children would recommend SLEEPSMART. Compared to children in the control group, children who received the SLEEPSMART intervention had significant improvements in actigraphy total sleep time, sleep efficiency, and self-report PROMIS sleep disturbance scores immediately post intervention and one-month follow up, and in dysfunctional beliefs and attitudes and sleep efficacy scores one-month post-intervention. Parents in the SLEEPSMART group had significant improvements in PROMIS sleep-related impairment and DBAS scores immediately post-intervention and one-month follow-up, and in self-efficacy scores one-month post intervention in comparison to parents in the control group.
Conclusion: SLEEPSMART was feasible, acceptable, and improved objective and self-report sleep and self-efficacy outcomes in children with JIA and their parents. Sleep is a modifiable behavior and a missing piece in pediatric rheumatology care. This pilot RCT addressed current gaps in the literature and will inform the necessary sample sizes and power of a future larger multisite trial.
Authors:
Author - Shumenghui Zhai,
PhD, MPH,
Pacific Lutheran University
Author - Tonya M. Palermo, PhD,
PhD,
Seattle Children's Research Institute
Author - Susan Shenoi,
MD,MS,
University of Washington, Dept of Pediatrics, School of Medicine
Author - George Demiris, PhD,
PhD,
University of Pennsylvania
Author - Waylon Howard,
PhD,
Center for Child Health, Behavior, & Devleopment, Seattle Childrens Research Institute
Author - Teresa M. Ward, PhD,
PhD,
University of Washington, Dept of Pediatrics, School of Medicine
E157 - Bidirectional Cannabis-Insomnia Interplay Differs by Subjective Social Standing at a Rural University
Poster Number: E157Time: 05:00 PM - 05:50 PM
Topics: Sleep, Social and Environmental Context and Health
Aim: College students face elevated cannabis and insomnia risk, with evidence supporting a feed-forward risk process by which both domains worsen over time. Understanding subjective social status (SSS), or perceptions of relative social standing, may reveal psychosocial risks in rural college students beyond socioeconomic status. This study clarified reciprocal cannabis-insomnia associations, hypothesizing greater vulnerability in lower-SSS students.
Method: One-month prospective online survey data was drawn from 332 college students (Mage=19.03±1.39, range=18-25; 53% female; 84% White) at a four-year university in the northeastern U.S. Of the original 332, 4 were excluded due to missing cannabis data, resulting in a main analytical sample of 328. Health behavior surveys at Wave 1 (W1) and Wave 2 (W2; average interval=34±6.96 days) assessed SSS, cannabis use, and insomnia severity.
Results: In the full sample, 35% surpassed clinical threshold for insomnia symptom severity (≥14; M=8.03±5.86) and 45% reported past-month cannabis use at W1. A fully saturated, multigroup cross-lagged path analysis tested whether reciprocal associations of insomnia symptom severity and past-month cannabis frequency differed by SSS (n=130 low, n=198 high per median split) after controlling for male sex using all available data. While contemporaneous pathways (e.g., W1 cannabis to W2 cannabis) were significant in both subsamples of high and low SSS (β=0.62-0.91, ps<.001), only the low SSS group demonstrated evidence for cross-lagged risk conferral over time. Specifically, W1 insomnia severity was significantly associated with increased W2 cannabis use frequency over one month in the low SSS group only (β=0.04, p<.05); in contrast, the prospective cannabis-sleep association was only marginally significant (β=-0.37, p<.10). Cross-lagged paths were nonsignificant in the high SSS group (ps>.10).
Conclusions: Findings highlight rural college students with lower SSS as a potential risk group for the damaging effects of insomnia symptoms on short-term cannabis risk. By bridging historically distinct literatures and integrating social determinants of health, current findings may support advancement of health equity in rural, socioeconomically disadvantaged college populations. Future research may clarify SSS-affective mechanisms underlying disparate cannabis-insomnia risk, as well as treatment effects of interventions targeting SSS.
Keywords: Health behaviors, Substance abuseMethod: One-month prospective online survey data was drawn from 332 college students (Mage=19.03±1.39, range=18-25; 53% female; 84% White) at a four-year university in the northeastern U.S. Of the original 332, 4 were excluded due to missing cannabis data, resulting in a main analytical sample of 328. Health behavior surveys at Wave 1 (W1) and Wave 2 (W2; average interval=34±6.96 days) assessed SSS, cannabis use, and insomnia severity.
Results: In the full sample, 35% surpassed clinical threshold for insomnia symptom severity (≥14; M=8.03±5.86) and 45% reported past-month cannabis use at W1. A fully saturated, multigroup cross-lagged path analysis tested whether reciprocal associations of insomnia symptom severity and past-month cannabis frequency differed by SSS (n=130 low, n=198 high per median split) after controlling for male sex using all available data. While contemporaneous pathways (e.g., W1 cannabis to W2 cannabis) were significant in both subsamples of high and low SSS (β=0.62-0.91, ps<.001), only the low SSS group demonstrated evidence for cross-lagged risk conferral over time. Specifically, W1 insomnia severity was significantly associated with increased W2 cannabis use frequency over one month in the low SSS group only (β=0.04, p<.05); in contrast, the prospective cannabis-sleep association was only marginally significant (β=-0.37, p<.10). Cross-lagged paths were nonsignificant in the high SSS group (ps>.10).
Conclusions: Findings highlight rural college students with lower SSS as a potential risk group for the damaging effects of insomnia symptoms on short-term cannabis risk. By bridging historically distinct literatures and integrating social determinants of health, current findings may support advancement of health equity in rural, socioeconomically disadvantaged college populations. Future research may clarify SSS-affective mechanisms underlying disparate cannabis-insomnia risk, as well as treatment effects of interventions targeting SSS.
Authors:
Co-Author - Krutika Rathod,
University of Maine
Co-Author - Leah Cingranelli,
University of Maine
Co-Author - Patricia A. Goodhines, PhD,
PhD,
University of Maine
E158 - Chronotypes, discrimination, and health behaviors among college students
Poster Number: E158Time: 05:00 PM - 05:50 PM
Topics: Sleep, Social and Environmental Context and Health
Introduction: Evening chronotype preferences (e.g., delayed sleep schedule) are associated with increased substance use and worse mental health symptoms. College students may be particularly vulnerable given their higher prevalence of this chronotype compared to the general population. Exploring discrimination as a moderator in the associations between chronotype and health behaviors could reveal if sociocultural factors exacerbate these risks. In fact, the role of discrimination in relation to chronotype has not been extensively studied. We hypothesized that having a more evening chronotype preference would be associated with increased alcohol use and worse mental health symptoms, and that these associations would be stronger in the presence of higher levels of discrimination.
Method: In an online cross-sectional study, 704 college students (mean age ± SD = 19.44 ± 1.80 years; 71% female; 43% White) completed the Composite Scale of Morningness (CSM) as a measure of chronotype, Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), Hopkins Symptoms Checklist (HSCL-25) as a measure of mental health, and the Everyday Discrimination Scale (EDS). Discrimination was assessed as a moderator using R version 4.3.1.
Results: The most commonly reported reasons for discrimination were gender (42%), age (42%), and race (36%). Mean chronotype was 31.33 (SD = 6.53), corresponding to an intermediate chronotype preference. Controlling for covariates, discrimination did not significantly modify associations between chronotype and health outcomes (p’s > .181). However, having a more evening chronotype preference was associated with increased alcohol use (β = -0.04, p = .004) and worse mental health (β = -0.01, p = .011). More discrimination was also associated with worse mental health (β = 0.02, p < .001).
Conclusions: Findings suggest that having a more evening chronotype preference is associated with increased alcohol use and worse mental health outcomes among college students. Although discrimination did not significantly moderate the associations between chronotype and these health outcomes, higher levels of discrimination was linked to worse mental health. Universities should prioritize sleep health, particularly for students with evening chronotypes, and consider the broader sociocultural factors, such as discrimination, that may contribute to mental health challenges and poor health behaviors.
Keywords: Abnormal sleep, Health behaviorsMethod: In an online cross-sectional study, 704 college students (mean age ± SD = 19.44 ± 1.80 years; 71% female; 43% White) completed the Composite Scale of Morningness (CSM) as a measure of chronotype, Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), Hopkins Symptoms Checklist (HSCL-25) as a measure of mental health, and the Everyday Discrimination Scale (EDS). Discrimination was assessed as a moderator using R version 4.3.1.
Results: The most commonly reported reasons for discrimination were gender (42%), age (42%), and race (36%). Mean chronotype was 31.33 (SD = 6.53), corresponding to an intermediate chronotype preference. Controlling for covariates, discrimination did not significantly modify associations between chronotype and health outcomes (p’s > .181). However, having a more evening chronotype preference was associated with increased alcohol use (β = -0.04, p = .004) and worse mental health (β = -0.01, p = .011). More discrimination was also associated with worse mental health (β = 0.02, p < .001).
Conclusions: Findings suggest that having a more evening chronotype preference is associated with increased alcohol use and worse mental health outcomes among college students. Although discrimination did not significantly moderate the associations between chronotype and these health outcomes, higher levels of discrimination was linked to worse mental health. Universities should prioritize sleep health, particularly for students with evening chronotypes, and consider the broader sociocultural factors, such as discrimination, that may contribute to mental health challenges and poor health behaviors.
Authors:
Author - Ashley Miller,
M.S.,
Virginia Commonwealth University
Co-Author - Sarah Morton,
M.S.,
Virginia Commonwealth University
Co-Author - Rachel Pitts,
B.S.,
Virginia Commonwealth University
Co-Author - Robin Everhart,
Ph.D.,
Virginia Commonwealth University
E159 - Hemodialysis adherence and emotional distress in end-stage renal disease patients: The effects of the SARS-CoV-2 pandemic
Poster Number: E159Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Aging
Background: End-stage renal disease (ERSD) affects over 800,000 patients in the U.S. Hemodialysis (HD) is a life-sustaining treatment, requiring three four-hour sessions per week. Adherence to HD is critical to prevent serious complications and death. However, many ESRD patients are non-adherent to treatments, leading to increased morbidity and mortality. Causes of non-adherence are varied, including behavioral or psychological factors, medical comorbidities, logistical challenges, and external factors. The COVID-19 pandemic may also have impacted adherence since late 2019.
Methods: Eligible participants were adults aged 18 years or older, English-speaking, (73.5% Black) diagnosed with ESRD, and receiving hemodialysis for at least three months. Participants were recruited between 2022 and 2024. The primary outcomes included assessing non-adherence to hemodialysis and identifying treatment barriers related to the ongoing SARS-CoV-2 pandemic. Secondary outcomes included assessing symptoms of depression, anxiety, and emotional distress.
Results: A total of 49 participants were recruited between 2022 and 2024. Non-adherence to hemodialysis appointments were reported in 55.1% (n=27) of participants, with 24.5% missing more than one HD appointment. Common barriers included experiencing gastrointestinal illness (n=14; 28.6%), chest pain or shortness of breath (n=12; 24.5%), and fever (n=4; 8.2%). Non-adherence to hemodialysis was significantly correlated with greater emotional distress (r (47) = .290, p = .048), indicating that higher levels of distress were associated with greater non-adherence to hemodialysis. Treatment barriers perceived to be related to the COVID-19 pandemic also showed significant correlations with greater session non-adherence (r (44)= .380, p= .009); employment challenges for family members (r (44)= .307, p= .038); fear of virus transmission (r (44) = .343, p= .019), and changes in medical care (r (44) = .340, p=.021). Several COVID-19 barriers were also significantly correlated with increases in emotional distress. These findings suggest that mental health symptoms, and external treatment barriers, such as those related to the pandemic, influence adherence to hemodialysis.
Conclusion: This study highlights the complex factors influencing adherence to hemodialysis in patients with ESRD. These results underscore the importance of addressing both psychological and external barriers to improve ESRD adherence rates.
Keywords: Health, Renal/urologic disordersMethods: Eligible participants were adults aged 18 years or older, English-speaking, (73.5% Black) diagnosed with ESRD, and receiving hemodialysis for at least three months. Participants were recruited between 2022 and 2024. The primary outcomes included assessing non-adherence to hemodialysis and identifying treatment barriers related to the ongoing SARS-CoV-2 pandemic. Secondary outcomes included assessing symptoms of depression, anxiety, and emotional distress.
Results: A total of 49 participants were recruited between 2022 and 2024. Non-adherence to hemodialysis appointments were reported in 55.1% (n=27) of participants, with 24.5% missing more than one HD appointment. Common barriers included experiencing gastrointestinal illness (n=14; 28.6%), chest pain or shortness of breath (n=12; 24.5%), and fever (n=4; 8.2%). Non-adherence to hemodialysis was significantly correlated with greater emotional distress (r (47) = .290, p = .048), indicating that higher levels of distress were associated with greater non-adherence to hemodialysis. Treatment barriers perceived to be related to the COVID-19 pandemic also showed significant correlations with greater session non-adherence (r (44)= .380, p= .009); employment challenges for family members (r (44)= .307, p= .038); fear of virus transmission (r (44) = .343, p= .019), and changes in medical care (r (44) = .340, p=.021). Several COVID-19 barriers were also significantly correlated with increases in emotional distress. These findings suggest that mental health symptoms, and external treatment barriers, such as those related to the pandemic, influence adherence to hemodialysis.
Conclusion: This study highlights the complex factors influencing adherence to hemodialysis in patients with ESRD. These results underscore the importance of addressing both psychological and external barriers to improve ESRD adherence rates.
Authors:
Co-Author - Matthew C. Whited, PhD, FSBM,
PhD, FSBM,
East Carolina University
Co-Author - Alan J. Christensen, PhD, FSBM,
PhD, FSBM,
East Carolina University
Presenter - Taylor L. Stallings, MS,
MS,
East Carolina University
E160 - Impact of Biophilic Design on College Student Perception of Mental Health and Environmental Benefits: A Dose-Response Study
Poster Number: E160Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Mental Health
Objective: We examined a dose-response relationship of plants placed in a university classroom with college students’ self-reported cognitive performance, mental and psychosomatic health, environmental quality perceptions, and objectively measured indoor air quality (IAQ) parameters.
Methods: This quasi-experimental design study involved two university classrooms, a Comparison Classroom (CC) and a Biophilic Classroom (BC). In the BC, but not in the CC, 50 plants were placed in Week 4 (W4), an additional 51 plants in W10, and all plants removed in W14. Surveys were administered at 4 time points (T1: W3 [baseline]; T2: W7; T3: W13, and T4: W16) to assess students’ perceptions and health outcomes, including perceived stress, cognitive performance, nature connectedness, indoor environmental quality, air freshness, odor intensity, productivity, and sleepiness, with scores ranging from 0-40 (stress), 1-7 (sleepiness), or 1-5 (all other variables). IAQ was monitored continuously using TSI AirAssure™ Monitors. A mixed model was used to examine effects of plant placement (CC vs. BC), time (over 4 time points), and their interaction on survey variables controlling for selected covariates.
Results: At Baseline, 257 students completed the survey in the CC and 80 in the BC. Plants in the BC significantly improved student perceived indoor environmental quality (T2: 4.04 vs. 3.51, p<.001; T3: 4.00 vs. 3.52, p<.001), air freshness (T2: 4.07 vs. 3.41, p<.001; T3: 3.91 vs. 3.48, p<.01), and productivity (T2: 3.33 vs. 2.91, p<.01; T3: 3.33 vs. 2.90, p<.01). However, adding more plants did not further improve these perceptions. No significant differences were found in students’ cognitive performance, perceived stress, sleepiness, nature connectedness, or IAQ parameters between CC and BC.
Conclusion: Adding plants to university classrooms significantly enhanced students’ perceptions of indoor environmental quality, air freshness, and productivity, suggesting that biophilic elements improve the classroom experience and create a more appealing, learning-friendly environment. However, adding plants did not cause measurable changes to indoor air quality, indicating that existing ventilation systems were already effective and might not be enhanced by the addition plants. Future studies should investigate the long-term effects and explore additional biophilic design strategies to better understand and maximize the benefits for student learning and well-being.
Keywords: Built environment, Mental healthMethods: This quasi-experimental design study involved two university classrooms, a Comparison Classroom (CC) and a Biophilic Classroom (BC). In the BC, but not in the CC, 50 plants were placed in Week 4 (W4), an additional 51 plants in W10, and all plants removed in W14. Surveys were administered at 4 time points (T1: W3 [baseline]; T2: W7; T3: W13, and T4: W16) to assess students’ perceptions and health outcomes, including perceived stress, cognitive performance, nature connectedness, indoor environmental quality, air freshness, odor intensity, productivity, and sleepiness, with scores ranging from 0-40 (stress), 1-7 (sleepiness), or 1-5 (all other variables). IAQ was monitored continuously using TSI AirAssure™ Monitors. A mixed model was used to examine effects of plant placement (CC vs. BC), time (over 4 time points), and their interaction on survey variables controlling for selected covariates.
Results: At Baseline, 257 students completed the survey in the CC and 80 in the BC. Plants in the BC significantly improved student perceived indoor environmental quality (T2: 4.04 vs. 3.51, p<.001; T3: 4.00 vs. 3.52, p<.001), air freshness (T2: 4.07 vs. 3.41, p<.001; T3: 3.91 vs. 3.48, p<.01), and productivity (T2: 3.33 vs. 2.91, p<.01; T3: 3.33 vs. 2.90, p<.01). However, adding more plants did not further improve these perceptions. No significant differences were found in students’ cognitive performance, perceived stress, sleepiness, nature connectedness, or IAQ parameters between CC and BC.
Conclusion: Adding plants to university classrooms significantly enhanced students’ perceptions of indoor environmental quality, air freshness, and productivity, suggesting that biophilic elements improve the classroom experience and create a more appealing, learning-friendly environment. However, adding plants did not cause measurable changes to indoor air quality, indicating that existing ventilation systems were already effective and might not be enhanced by the addition plants. Future studies should investigate the long-term effects and explore additional biophilic design strategies to better understand and maximize the benefits for student learning and well-being.
Authors:
Presenter - Kaigang Li, PhD,
PhD,
Colorado State University
Co-Author - Ashley Perrault,
Colorado State University
Co-Author - Wendy DeYoung,
Colorado State University
Co-Author - Emma Cameron,
Colorado State University
Co-Author - Chad Miller,
Colorado State University
Co-Author - Alison O’Connor,
Colorado State University
Co-Author - Mengmeng Gu,
Colorado State University
Co-Author - Barry Braun, PhD,
PhD,
Colorado State University
E161 - Beyond Social Class: A mixed methods exploration of the impact of Childhood Socioeconomic Status, Resource Predictability, and Intolerance of Uncertainty on Temporal Discounting.
Poster Number: E161Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Health of Marginalized Populations
Background: Temporal discounting (TD), the preference for smaller, immediate rewards over larger, delayed ones, is higher among people from low socioeconomic status (SES). High TD predicts impulsive choices like substance use, decreased exercise, and poor financial planning; it is therefore critical to understand underlying mechanisms of the SES-TD relationship. Evidence suggests inconsistent resource access leads individuals to prioritize short term needs; given the unpredictable nature of low SES, resource predictability (RP) may explain why low SES is linked to higher TD. The current study explored whether RP and perceptions of unpredictability mediate the SES-TD association. We additionally explored moderating effects of childhood poverty and low uncertainty tolerance (UT).
Methods: 423 adults (Mage=37 yrs; 49% male) reported current and childhood objective/subjective social class, childhood RP, current beliefs about predictability, UT, and TD measured by the Monetary Choice Questionnaire. Linear regressions with interactions tested childhood RP/unpredictability beliefs as mediators, and UT and childhood social class as moderators. Qualitative analyses also explored reflections on subjective social class, to understand individual experiences impacting decision-making.
Results: Lower objective and subjective SES predicted greater TD (βs>-.70, ps<.001). Childhood RP did not mediate the association between SES and TD (βs>.16, ps>.15). UT did not moderate the association between SES and TD (βs<-.00, ps>.29), nor did childhood SES (βs> -.07, ps>.26). The direct effect of perceptions of unpredictability on TD was significant (βs< -.05, ps<.05); however, the SES-TD effect remained significant after these beliefs were added to the model (βs> -.23, ps<.001). Therefore, unpredictability beliefs partially mediated the SES-TD relationship. Qualitative analyses revealed that self-reported exposure to scarcity and RP was higher for individuals with low subjective social class.
Conclusion: Our findings suggest perceptions of unpredictability partially explain the association between SES and TD. Though we only measured childhood RP, we hypothesize that current unpredictability plays a role in impulsive decision-making, particularly if perceptions of unpredictability stem from direct experiences with RP. Future research should examine the role of RP to contextualize decision making for disadvantaged individuals and inform interventions promoting healthier choices.
Keywords: Decision making, SocioeconomicMethods: 423 adults (Mage=37 yrs; 49% male) reported current and childhood objective/subjective social class, childhood RP, current beliefs about predictability, UT, and TD measured by the Monetary Choice Questionnaire. Linear regressions with interactions tested childhood RP/unpredictability beliefs as mediators, and UT and childhood social class as moderators. Qualitative analyses also explored reflections on subjective social class, to understand individual experiences impacting decision-making.
Results: Lower objective and subjective SES predicted greater TD (βs>-.70, ps<.001). Childhood RP did not mediate the association between SES and TD (βs>.16, ps>.15). UT did not moderate the association between SES and TD (βs<-.00, ps>.29), nor did childhood SES (βs> -.07, ps>.26). The direct effect of perceptions of unpredictability on TD was significant (βs< -.05, ps<.05); however, the SES-TD effect remained significant after these beliefs were added to the model (βs> -.23, ps<.001). Therefore, unpredictability beliefs partially mediated the SES-TD relationship. Qualitative analyses revealed that self-reported exposure to scarcity and RP was higher for individuals with low subjective social class.
Conclusion: Our findings suggest perceptions of unpredictability partially explain the association between SES and TD. Though we only measured childhood RP, we hypothesize that current unpredictability plays a role in impulsive decision-making, particularly if perceptions of unpredictability stem from direct experiences with RP. Future research should examine the role of RP to contextualize decision making for disadvantaged individuals and inform interventions promoting healthier choices.
Authors:
Author - Alexandra Mouangue,
Drexel University, Center for Weight, Eating, and Lifestyle Science (WELL Center)
Co-Author - Christen Deveney,
Ph.D.,
Department of Psychological Sciences, Wellesley College
Co-Author - Stephen Chen,
Ph.D,
Wellesley College
E162 - Associations of cannabis marketing exposure with susceptibility to cannabis use among cannabis never-users in Oklahoma
Poster Number: E162Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Decision Making
BACKGROUND Cannabis marketing in areas with thriving sales, like Oklahoma, has proliferated. Cannabis marketing has negative effects on youth, but little research has examined how susceptibility to cannabis use may differ by marketing exposure among adults. The current study examined associations between marketing exposure and susceptibility to cannabis use among cannabis never-users in Oklahoma.
METHODS Adults aged ≥18-years in Oklahoma (N=1,605; 55.5% female; 76.6% non-Hispanic White) who reported never having used cannabis were surveyed about past-month exposure to cannabis marketing (yes/no) from each of four sources (outdoor [billboards, signs], social media, print [magazines], and Internet), susceptibility to cannabis use (measured with 3 items), cannabis harm perceptions (no/a little harm vs some/a lot of harm), and depressive and anxiety symptoms (measured with the Patient Health Questionnaire-4). Crude and adjusted logistic regression models examined associations of number of marketing exposure sources with cannabis use susceptibility. Models controlled for cannabis harm perceptions and mental health (i.e., depressive and anxiety) symptoms, given the strong overlap with cannabis use.
RESULTS Nearly a quarter of cannabis never-users were susceptible to future use (22.3%, n=358). In the crude logistic regression, participants exposed to a greater average number of cannabis marketing sources were more likely to report cannabis use susceptibility (OR=1.09; 95% CI [1.01, 1.19]; p=.025). The association between number of cannabis marketing sources and susceptibility became non-significant (AOR=1.08; 95% CI [.99, 1.17]; p=.075) after controlling for cannabis harm perceptions (AOR=3.05; 95% CI [2.33, 3.98]; p=<.001), depressive symptoms (AOR=1.57; 95% CI [1.08, 2.28]; p=.019), and anxiety symptoms (AOR=1.03; 95% CI [.71, 1.51]; p=.873). Susceptible (vs non-susceptible) never users (OR=3.14; 95% CI [2.41, 4.10]; p=<.001) and adults with anxiety symptoms (vs without; OR=1.44; 95% CI [1.11, 1.87]; p=.006) reported significantly lower cannabis harm perceptions.
CONCLUSION Among adults in Oklahoma, greater cannabis marketing exposure was significantly associated with cannabis use susceptibility. However, the association was no longer significant after adjusting for harm perceptions and mental health symptoms. Cannabis harm perceptions and mental health symptoms may be stronger predictors of susceptibility to cannabis use than marketing exposure.
Keywords: Public health, Risk perceptionMETHODS Adults aged ≥18-years in Oklahoma (N=1,605; 55.5% female; 76.6% non-Hispanic White) who reported never having used cannabis were surveyed about past-month exposure to cannabis marketing (yes/no) from each of four sources (outdoor [billboards, signs], social media, print [magazines], and Internet), susceptibility to cannabis use (measured with 3 items), cannabis harm perceptions (no/a little harm vs some/a lot of harm), and depressive and anxiety symptoms (measured with the Patient Health Questionnaire-4). Crude and adjusted logistic regression models examined associations of number of marketing exposure sources with cannabis use susceptibility. Models controlled for cannabis harm perceptions and mental health (i.e., depressive and anxiety) symptoms, given the strong overlap with cannabis use.
RESULTS Nearly a quarter of cannabis never-users were susceptible to future use (22.3%, n=358). In the crude logistic regression, participants exposed to a greater average number of cannabis marketing sources were more likely to report cannabis use susceptibility (OR=1.09; 95% CI [1.01, 1.19]; p=.025). The association between number of cannabis marketing sources and susceptibility became non-significant (AOR=1.08; 95% CI [.99, 1.17]; p=.075) after controlling for cannabis harm perceptions (AOR=3.05; 95% CI [2.33, 3.98]; p=<.001), depressive symptoms (AOR=1.57; 95% CI [1.08, 2.28]; p=.019), and anxiety symptoms (AOR=1.03; 95% CI [.71, 1.51]; p=.873). Susceptible (vs non-susceptible) never users (OR=3.14; 95% CI [2.41, 4.10]; p=<.001) and adults with anxiety symptoms (vs without; OR=1.44; 95% CI [1.11, 1.87]; p=.006) reported significantly lower cannabis harm perceptions.
CONCLUSION Among adults in Oklahoma, greater cannabis marketing exposure was significantly associated with cannabis use susceptibility. However, the association was no longer significant after adjusting for harm perceptions and mental health symptoms. Cannabis harm perceptions and mental health symptoms may be stronger predictors of susceptibility to cannabis use than marketing exposure.
Authors:
Author - Sarah Joslin,
B.S.,
TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center
Co-Author - Erin Vogel,
PhD,
TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center
Co-Author - Amy Cohn,
PhD,
TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center
E163 - Optimizing Alcohol Interventions in Sororities Using Social Network Analysis
Poster Number: E163Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Substance Misuse
Background: Alcohol use is prevalent among college students in sororities and fraternities (i.e., Greek life) across America, putting them at risk for alcohol-related health concerns. Addressing this public health concern requires optimizing alcohol intervention strategies by understanding the role of social networks on drinking behavior. Sorority and fraternity leaders can be leveraged to disseminate health promotion behaviors. This study investigates a sorority’s drinking buddy network to determine potential network methods for effective interventions. Methods: Social network analysis was used to examine the structure of a drinking buddy network within a sorority at a Midwestern university. Survey data from 99 members (45.21% response rate) were used to assess network centrality, subgroups, and homophily based on year in school and leadership roles. We hypothesized that a member’s year in school and leadership role within the sorority would be significantly related to their ties in the network. Results: Year in school was significantly correlated with drinking ties (r = 0.092, p < 0.001) indicating that members consumed alcohol with those within their cohort. Contrary to expectations, sorority leaders were less central in the drinking network and did not significantly influence alcohol-related social connections (Adj R² = 0.003, p > 0.09). The most central members were not in formal leadership positions, indicating they may be more effectively positioned to lead alcohol use prevention initiatives. Conclusions: These findings challenge the conventional reliance on formal sorority leadership for alcohol risk management intervention delivery. The results suggest shifting focus to central, non-leaders within drinking networks. Enlisting these key network actors could enhance the diffusion and effectiveness of intervention initiatives, aligning intervention points with the actual social structure. Further research should explore the broader applicability of network-based strategies in public health interventions within Greek life.
Keywords: Alcohol, Social network analysisAuthors:
Author - Kristina Miljkovic,
M.S.,
University of Southern California
Co-Author - Thomas Valente, PhD,
PhD,
University of Southern California
Co-Author - Rose Marie Ward, PhD,
PhD,
University of Cincinnati
E164 - Lessons Learned in Implementing a Pragmatic Behavioral Intervention to Prevent Household Spread of COVID-19 in Point-of-Care Settings
Poster Number: E164Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Decision Making
Background: COVID-19 disproportionately affected Latinos during the height of the pandemic in the U.S. We implemented a novel tailored behavioral and clinic-based intervention, the COVID-19 Prevention Program (CPP) designed to reduce household and community transmission of COVID-19 in Latino patients in a FQHC. Purpose: The purpose of this study is to describe lessons learned in implementing CPP (2022-2024). Methods: CPP is a randomized controlled trial where patients are randomized to: 1) a standard-of-care control group that received established clinical care and follow-ups and 2) an enhanced standard-of-care group that received standard-of-care plus tailored, real-time mobile/virtual counseling delivered by promotoras. We collected and analyzed process data guided by the Consolidation Framework for Implementation Research that includes the following domains: a) Innovation: the “thing” being implemented, b) Outer Setting: the setting in which the Inner Setting exists, c) Inner Setting: the setting in which the innovation is implemented, d) Individuals: the roles and characteristics of individuals; & e) Implementation Process: the activities and strategies used to implement the innovation. Results: The emerging themes were: 1) Changes in COVID-19 guidelines and increased accessibility of tests and vaccines reduced patient engagement, which was seen in the 6-week follow-up attrition rate of 48% (Innovation & Outer Setting). 2) Contact frequency from staff and duration of the calls were perceived as high and lengthy by patients (Implementation Process & Inner setting). 3) The utilization of several different applications by the promotoras such as REDCap, Google Voice, spreadsheets, electronic health records, registries, and texting campaigns resulted in technological challenges in the implementation of activities and in the integration of data (inner setting). 4) Limiting the interaction between the data collection staff (blinded to group assignment) and the implementation team (unblinded) created communication barriers when patients were contacted by both teams at the same time point for different activities (Implementation Process & Inner Setting). Conclusion: The dynamics of the pandemic and evolving guidelines resulted in significant challenges. These lessons learned can be applied to inform future studies about the changes of public engagement and response to pandemics over time.
Keywords: Health behavior change, InfectionAuthors:
Author - Carolina Lopez De La Torre,
MPH,
San Diego State University
Co-Author - Noe C. Crespo,
PhD, MPH, MS,
San Diego State University
Co-Author - Naomi Romero Alvarez,
BA,
Family Health Centers of San Diego
Co-Author - Grace Cota,
BS,
Family Health Centers of San Diego
Co-Author - Yukary Bustamante,
BA,
Family Health Centers of San Diego
Co-Author - Kiria G. Fraga,
MPH,
San Diego State University
Co-Author - Job Godino,
PhD,
Family Health Centers of San Diego
Co-Author - John Elder,
MPH, PhD,
San Diego State University
Co-Author - Eyal Oren,
PhD MS,
San Diego State University
Co-Author - C.D. Joey Lin,
PhD,
San Diego State University
Co-Author - Elva Arredondo,
PhD,
San Diego State University
Co-Author - Hala Madanat,
PhD,
San Diego State University
Co-Author - Christian B. Ramers,
MD MPH,
Family Health Centers of San Diego
E167 - Location differences in daily stress for midlife adults with physical impairments: Insights from Ecological Momentary Assessment (EMA)
Poster Number: E167Time: 05:00 PM - 05:50 PM
Topics: Stress, Health of Marginalized Populations
Background: Individuals with physical impairments often experience poor health outcomes as their impairments impact their daily life. While research has shown that they adjust to changes caused by their impairment in their daily life, little research has focused on how location differences impact daily stress in midlife adults (aged 50-64) as their adjustments are primarily utilized in the home. The purpose of this study is to understand differences in daily stress based on location for midlife adults with physical impairments to develop adaptive interventions to reduce health disparities in this population.
Methods: We used a custom-built ecological momentary assessment mobile app to collect data about the types and severity of daily stressors among midlife adults for two weeks. Participants (N = 121) were a diverse sample (36.4% nonwhite). The mean age was 57.50 years (SD = 3.88). Most participants identified as female (85.5%, n = 95), with 21.2% identifying as male (20.7%, n = 25), and one participant identifying as nonbinary (0.8%). All lived in an urban environment in Indiana. We conducted quantitative (ANOVA) analyses to examine impairment differences in self-reported health measures and the location and intensity of daily stress experiences.
Results: Overall, reported health information revealed significant health differences for those with impairments having more poor health days (p < .05), days with pain (p < .05), and days that poor health limited their activities (p < .05). Across all stressors, ANOVAs revealed those with impairments reported higher frequency of stressors at home (M = 10.86, p < .05), and higher severity of stressors when outside the home (M = 4.55, p < .05) . Impairment status was not statistically different for significance in overall frequency of stressors or average stressor intensity.
Conclusions: Individuals with physical impairments experience worse health when compared to those without impairments. This may be due to the significantly higher frequency of stressors at home, and higher stress intensity they experience outside the home. These findings suggest that those with physical impairments may choose to spend more time at home to avoid the increased stress they would experience outside of the home. Our results highlight the need for interventions to increase support and adaptations so that individuals with physical impairments can be better included in their community to help reduce stress.
Keywords: Disability, StressMethods: We used a custom-built ecological momentary assessment mobile app to collect data about the types and severity of daily stressors among midlife adults for two weeks. Participants (N = 121) were a diverse sample (36.4% nonwhite). The mean age was 57.50 years (SD = 3.88). Most participants identified as female (85.5%, n = 95), with 21.2% identifying as male (20.7%, n = 25), and one participant identifying as nonbinary (0.8%). All lived in an urban environment in Indiana. We conducted quantitative (ANOVA) analyses to examine impairment differences in self-reported health measures and the location and intensity of daily stress experiences.
Results: Overall, reported health information revealed significant health differences for those with impairments having more poor health days (p < .05), days with pain (p < .05), and days that poor health limited their activities (p < .05). Across all stressors, ANOVAs revealed those with impairments reported higher frequency of stressors at home (M = 10.86, p < .05), and higher severity of stressors when outside the home (M = 4.55, p < .05) . Impairment status was not statistically different for significance in overall frequency of stressors or average stressor intensity.
Conclusions: Individuals with physical impairments experience worse health when compared to those without impairments. This may be due to the significantly higher frequency of stressors at home, and higher stress intensity they experience outside the home. These findings suggest that those with physical impairments may choose to spend more time at home to avoid the increased stress they would experience outside of the home. Our results highlight the need for interventions to increase support and adaptations so that individuals with physical impairments can be better included in their community to help reduce stress.
Authors:
Author - Jonathan Gerth,
Indiana University
Co-Author - Xing Yao,
Indiana University
Co-Author - Betsey Z. Nuseibeh,
Indiana University
Co-Author - Patrick C. Shih,
PhD,
Indiana University
Co-Author - Erik J. Nelson,
PhD,
Brigham Young University
Co-Author - Aric A. Prather,
PhD,
University of California, San Francisco
Co-Author - Mario Schootman,
PhD,
Saint Louis University
Co-Author - Stephen J. Carter,
PhD,
Indiana University
Co-Author - Evan J. Jordan,
Ph.D.,
Indiana Univeristy
E168 - Integrating Distress Screening and Referral in Glaucoma Care: Qualitative Insights from Patient Attitudes and Perspectives
Poster Number: E168Time: 05:00 PM - 05:50 PM
Topics: Stress, Digital Health
INTRODUCTION: Primary open-angle glaucoma (POAG) is a chronic disorder that can lead to irreversible vision loss if untreated. POAG patients often experience significant psychosocial distress which negatively impacts disease outcomes and accelerates progression; these risk factors are often overlooked. We aimed to understand POAG patients’ attitudes toward psychosocial distress screening/referral to guide the development of a targeted behavioral intervention.
METHODS: We recruited POAG patients (age ≥18 years) from Duke Eye Center glaucoma clinics from September 2022 to August 2023. Participants completed surveys assessing psychosocial risk factors and acceptability of distress screening/referral. Distress was measured with the Hospital Anxiety and Depression Scale (HADS). Purposive sampling, based on race (white, black), sex (male, female), and distress (moderate, high HADS), was used to identify 10 patients to interview. Semi-structured interviews were conducted with an interview guide covering reasons for distress and its impact on glaucoma care, attitudes toward distress screening/referral, and importance of physician involvement. Interviews were recorded, transcribed, and analyzed using rapid analysis.
RESULTS: Our sample (N=10) was split evenly across race and sex with a mean (SD) age of 67.6 years (12.46) and HADS score of 14.2 (5.85). Patients noted that distress was inadequately addressed or invalidated in glaucoma care, agreed that distress screening should be a component of care, were generally receptive to distress screening via self-report survey, and had no concerns about screening burden. Common distress sources were fear of blindness, uncertainty about the future, social isolation, financial stress related to medication and transportation, managing multiple treatments, and loss of independence. While some patients managed their distress effectively, others reported its negative impacts on glaucoma care and medication adherence. There was strong enthusiasm for referrals to behavioral interventions targeting distress with emphasis on provider endorsement as essential.
DISCUSSION: Patients confirmed a need and desire for accessible and comprehensive integration of psychosocial support (i.e. screening, referral, treatment) into routine glaucoma care. Next steps include pilot testing a mobile app based behavioral intervention to assess initial feasibility, acceptability, and preliminary efficacy to reduce distress in POAG patients.
Keywords: Stress, Chronic illnessMETHODS: We recruited POAG patients (age ≥18 years) from Duke Eye Center glaucoma clinics from September 2022 to August 2023. Participants completed surveys assessing psychosocial risk factors and acceptability of distress screening/referral. Distress was measured with the Hospital Anxiety and Depression Scale (HADS). Purposive sampling, based on race (white, black), sex (male, female), and distress (moderate, high HADS), was used to identify 10 patients to interview. Semi-structured interviews were conducted with an interview guide covering reasons for distress and its impact on glaucoma care, attitudes toward distress screening/referral, and importance of physician involvement. Interviews were recorded, transcribed, and analyzed using rapid analysis.
RESULTS: Our sample (N=10) was split evenly across race and sex with a mean (SD) age of 67.6 years (12.46) and HADS score of 14.2 (5.85). Patients noted that distress was inadequately addressed or invalidated in glaucoma care, agreed that distress screening should be a component of care, were generally receptive to distress screening via self-report survey, and had no concerns about screening burden. Common distress sources were fear of blindness, uncertainty about the future, social isolation, financial stress related to medication and transportation, managing multiple treatments, and loss of independence. While some patients managed their distress effectively, others reported its negative impacts on glaucoma care and medication adherence. There was strong enthusiasm for referrals to behavioral interventions targeting distress with emphasis on provider endorsement as essential.
DISCUSSION: Patients confirmed a need and desire for accessible and comprehensive integration of psychosocial support (i.e. screening, referral, treatment) into routine glaucoma care. Next steps include pilot testing a mobile app based behavioral intervention to assess initial feasibility, acceptability, and preliminary efficacy to reduce distress in POAG patients.
Authors:
Presenter - Natalie Chou,
BA,
Duke Psychiatry and Behavioral Sciences
Co-Author - Hannah Fisher,
PhD,
Duke Psychiatry and Behavioral Sciences
Co-Author - Eun Young Choi,
MD,
Duke Ophthalmology
Co-Author - Davina Malek,
MD,
Bascom Palmer Eye Institute
Co-Author - Alessandro Jammal,
MD, PhD,
Bascom Palmer Eye Institute
Co-Author - Felipe Medeiros,
MD, PhD,
Bascom Palmer Eye Institute
Co-Author - Kelly Muir,
MD,
Duke Ophthalmology
Co-Author - Tamara Somers,
PhD,
Duke Psychiatry and Behavioral Sciences
Co-Author - Samuel Berchuck,
PhD,
Duke Biostatistics and Bioinformatics
E169 - Factors associated with tobacco use, risky alcohol consumption, and concurrent tobacco and risky alcohol use among vocational education students
Poster Number: E169Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Health of Marginalized Populations
Background: Little is known about factors associated with tobacco use, risky alcohol consumption, or concurrent use among vocational education students. This study aimed to examine tobacco use, risky alcohol consumption, and concurrent use by type of vocational training and identify the factors associated with tobacco use, risky alcohol consumption, and concurrent use.
Method: A cross-sectional online survey was conducted among 1057 students attending Technical and Further Education campuses in New South Wales, Australia.
Results: Tobacco use (40%) and risky alcohol consumption (68%), were highest among those completing courses relating to craft and related trades work and plant and machine operations. Concurrent use was highest among those completing courses in services and sales (32%). The type of vocational training was not associated with tobacco use, risky alcohol consumption, or concurrent use. Participants who were married/living with a partner, and unemployed had significantly lower odds of tobacco use. Students who identified as Aboriginal or Torres Strait Islander and experienced symptoms of depression had significantly higher odds of tobacco use. Participants who were 25 years or older, female, and unemployed had significantly lower odds of risky alcohol consumption. Unemployed participants had significantly lower odds of concurrent use, while those who experienced symptoms of anxiety had significantly higher odds of concurrent use.
Conclusions: Tobacco and alcohol interventions could target subgroups of vocational education students including employed people and those experiencing anxiety or depression.
Keywords: Tobacco use, AlcoholMethod: A cross-sectional online survey was conducted among 1057 students attending Technical and Further Education campuses in New South Wales, Australia.
Results: Tobacco use (40%) and risky alcohol consumption (68%), were highest among those completing courses relating to craft and related trades work and plant and machine operations. Concurrent use was highest among those completing courses in services and sales (32%). The type of vocational training was not associated with tobacco use, risky alcohol consumption, or concurrent use. Participants who were married/living with a partner, and unemployed had significantly lower odds of tobacco use. Students who identified as Aboriginal or Torres Strait Islander and experienced symptoms of depression had significantly higher odds of tobacco use. Participants who were 25 years or older, female, and unemployed had significantly lower odds of risky alcohol consumption. Unemployed participants had significantly lower odds of concurrent use, while those who experienced symptoms of anxiety had significantly higher odds of concurrent use.
Conclusions: Tobacco and alcohol interventions could target subgroups of vocational education students including employed people and those experiencing anxiety or depression.
Authors:
Co-Author - Christine Paul,
The University of Newcastle
Co-Author - Prince Atorkey,
Australian College of Applied Professions and University of Newcastle
Co-Author - Jason Dizon,
Hunter Medical Research Institute
Co-Author - Lucy Leigh,
Hunter Medical Research Institute
Co-Author - Flora Tzelepis,
The University of Necastle
E170 - Cannabis Vape Product Advertisement Exposure Is Associated with Cannabis Vape Product Use and Perceptions among U.S. Young Adults
Poster Number: E170Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Social and Environmental Context and Health
Introduction
In 2023, the prevalence of past-month and past-year use of cannabis vape products (CVPs) among U.S. young adults (YAs) (ages 19-30) were at all-time highs of 14% (7.3 million) and 22% (11.6 million), respectively. One significant factor contributing to CVP use is exposure to commercial advertisements (ads). This study examined the relationships between CVP ad exposure, frequency of exposure, perceptions of CVPs, and CVP use behaviors among U.S. YAs.
Method
A sample of YAs (ages 18-30 years; n=2024) who either used or did not use CVPs in the past year completed a web-based survey in June 2024. Participants responded to questions about sociodemographic backgrounds, cannabis use-related environment, cannabis-related perceptions (e.g., harm perceptions and outcome expectancies), and cannabis use history and dependence. Multivariable regressions were performed to examine the associations between exposure to CVP ads, frequency of ad exposure, CVP use perceptions, and CVP use in the past year overall and by marketing channels, controlling for covariates.
Results
Overall, 60.0% of participants were exposed to CVP ads, and 49.7% had used CVPs in the past year. YAs exposed to CVP ads were more likely to use CVPs in the past year (aOR=1.60, 95% CI=1.32, 1.94), and more frequent ad exposure was associated with increased CVP use (aOR=1.09, 95% CI=1.05, 1.14). Both ad exposure (β=-0.22, 95% CI= -0.32, -0.11) and higher frequency of exposure (β=-0.08, 95% CI=-0.12, -0.05) were associated with lower perceived addiction of CVP use. More frequent exposure was also associated with more positive outcome expectancies of CVP use (β=0.07, 95% CI=0.03, 0.11). Exposure to ads through various marketing channels was associated with CVP use, including email or text messages (aOR=2.19, 95% CI=1.61, 2.98), cannabis retailers (aOR=2.06, 95% CI=1.63, 2.59), websites (aOR=1.61, 95% CI=1.29, 2.02), and social media (aOR=1.14, 95% CI=1.16, 1.71).
Discussion
The results revealed strong associations between CVP ad exposure and CVP-related perceptions and use among YAs, a vulnerable group increasingly at risk for cannabis commercial targeting. CVP marketing through cannabis retailers and online channels (emails, websites, social media) may be especially influential in prompting CVP use among YAs. Perceived addiction and positive expectancies from CVP use may explain the associations between CVP ad exposure and CVP use.
Keywords: Substance abuse, Population healthIn 2023, the prevalence of past-month and past-year use of cannabis vape products (CVPs) among U.S. young adults (YAs) (ages 19-30) were at all-time highs of 14% (7.3 million) and 22% (11.6 million), respectively. One significant factor contributing to CVP use is exposure to commercial advertisements (ads). This study examined the relationships between CVP ad exposure, frequency of exposure, perceptions of CVPs, and CVP use behaviors among U.S. YAs.
Method
A sample of YAs (ages 18-30 years; n=2024) who either used or did not use CVPs in the past year completed a web-based survey in June 2024. Participants responded to questions about sociodemographic backgrounds, cannabis use-related environment, cannabis-related perceptions (e.g., harm perceptions and outcome expectancies), and cannabis use history and dependence. Multivariable regressions were performed to examine the associations between exposure to CVP ads, frequency of ad exposure, CVP use perceptions, and CVP use in the past year overall and by marketing channels, controlling for covariates.
Results
Overall, 60.0% of participants were exposed to CVP ads, and 49.7% had used CVPs in the past year. YAs exposed to CVP ads were more likely to use CVPs in the past year (aOR=1.60, 95% CI=1.32, 1.94), and more frequent ad exposure was associated with increased CVP use (aOR=1.09, 95% CI=1.05, 1.14). Both ad exposure (β=-0.22, 95% CI= -0.32, -0.11) and higher frequency of exposure (β=-0.08, 95% CI=-0.12, -0.05) were associated with lower perceived addiction of CVP use. More frequent exposure was also associated with more positive outcome expectancies of CVP use (β=0.07, 95% CI=0.03, 0.11). Exposure to ads through various marketing channels was associated with CVP use, including email or text messages (aOR=2.19, 95% CI=1.61, 2.98), cannabis retailers (aOR=2.06, 95% CI=1.63, 2.59), websites (aOR=1.61, 95% CI=1.29, 2.02), and social media (aOR=1.14, 95% CI=1.16, 1.71).
Discussion
The results revealed strong associations between CVP ad exposure and CVP-related perceptions and use among YAs, a vulnerable group increasingly at risk for cannabis commercial targeting. CVP marketing through cannabis retailers and online channels (emails, websites, social media) may be especially influential in prompting CVP use among YAs. Perceived addiction and positive expectancies from CVP use may explain the associations between CVP ad exposure and CVP use.
Authors:
Author - Siyan Meng,
MA,
Rutgers University School of Public Health
Author - Kathryn La Capria,
MPH,
Rutgers University
Author - Julia Chen-Sankey,
PhD, MPP,
Rutgers University School of Public Health
E171 - HEALing Communities Study’s employment of mobile medical units to combat opioid-overdose-related deaths in Ohio.
Poster Number: E171Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Community Engagement
Purpose: In 2022, Ohio had the tenth-highest drug overdose death rate in the country with an estimated 84% of deaths being opioid-related. Medicines to combat overdoses include naloxone, a medication used to reverse overdoses to decrease mortality. Medications for opioid use disorder (MOUD), including methadone and buprenorphine, also reduce the risk of opioid overdose mortality. MOUD treatment barriers disproportionally impact marginalized populations including individuals of low socioeconomic status, people of color, and individuals living in rural areas. Mobile medical units (MMU) connect individuals with resources, medications, brief health counseling, and additional preventative services. Here, we describe the process of implementing MMUs in Ohio communities as part of the HEALing Communities Study (HCS).
Methods: HCS was a parallel-group, cluster-randomized, unblinded, wait-list controlled trial in four states with 19 Ohio counties chosen to participate. Coalitions selected strategies to implement evidence-based practices (EBPs) to reduce opioid overdose mortality including overdose education and naloxone distribution (OEND), expanding MOUD treatment availability, and expanding linkage to MOUD services.
Results: In total, nine MMUs were used across counties ranging from rural to urban communities. Of those, seven were newly purchased for the HCS study and two were existing units supported with HCS funds. Five counties successfully implemented the MOUD linkage strategy via an MMU. All nine MMUs incorporated OEND into their services with standardized education about the signs of overdose and the proper use of naloxone. Overall, the process of integrating MMUs into Ohio communities had its challenges and lessons learned. Notable barriers were overcome in determining ownership, services, staffing, and costs of acquiring and operating the MMU. Service staff noted difficulties with OEND and MOUD treatment referral utilization and acceptance within communities. Local organizations and advocates were critical in addressing prevailing stigma and engaging community members in MMU services.
Conclusion: Consensus on the logistical aspects was essential, with partnerships playing a crucial role in planning EBPs for underserved communities and ensuring the units’ long-term sustainability. MMUs were valuable for delivering EBPs to under-served communities and helping reduce overdoses and overdose-related deaths.
Keywords: Substance abuse, OpioidsMethods: HCS was a parallel-group, cluster-randomized, unblinded, wait-list controlled trial in four states with 19 Ohio counties chosen to participate. Coalitions selected strategies to implement evidence-based practices (EBPs) to reduce opioid overdose mortality including overdose education and naloxone distribution (OEND), expanding MOUD treatment availability, and expanding linkage to MOUD services.
Results: In total, nine MMUs were used across counties ranging from rural to urban communities. Of those, seven were newly purchased for the HCS study and two were existing units supported with HCS funds. Five counties successfully implemented the MOUD linkage strategy via an MMU. All nine MMUs incorporated OEND into their services with standardized education about the signs of overdose and the proper use of naloxone. Overall, the process of integrating MMUs into Ohio communities had its challenges and lessons learned. Notable barriers were overcome in determining ownership, services, staffing, and costs of acquiring and operating the MMU. Service staff noted difficulties with OEND and MOUD treatment referral utilization and acceptance within communities. Local organizations and advocates were critical in addressing prevailing stigma and engaging community members in MMU services.
Conclusion: Consensus on the logistical aspects was essential, with partnerships playing a crucial role in planning EBPs for underserved communities and ensuring the units’ long-term sustainability. MMUs were valuable for delivering EBPs to under-served communities and helping reduce overdoses and overdose-related deaths.
Authors:
Author - Tim Ingram,
MS,
University of Cincinnati-College of Medicine
Author - Jennifer L. Brown,
PhD, FSBM,
Purdue University
Author - Joel Sprunger,
PhD,
University of Cincinnati-College of Medicine
Author - Paul Matherny,
MPH,
The Ohio State University - Department of Internal Medicine
Author - Michael Lyons,
MD, MPH,
The Ohio State University - Department of Emergency Medicine
Author - T. John Winhusen,
PhD,
University of Cincinnati-College of Medicine
E172 - Characteristics of cannabis use among men who have sex with men in Nepal: A respondent-driven cross-sectional survey
Poster Number: E172Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Health of Marginalized Populations
Background
Men who have sex with men (MSM) use cannabis more frequently than heterosexuals. Cannabis use has various adverse psychological and health outcomes. In the pretext of elevated sexual pleasure and stress relieving potential of cannabis, it is used worldwide, including in Nepal. However, there is a lack of research regarding the existing status and factors associated with cannabis use among men who have sex with men (MSM) in Nepal. This study aimed to find out the prevalence and factors associated with cannabis use among MSM in Nepal.
Methods
A cross-sectional survey was conducted among MSM in Nepal (N=250) between October and November 2022. Participants were recruited using respondent-driven sampling (RDS) in Kathmandu Valley, Nepal. We collected socio-demographic characteristics, HIV risk-related behaviors, and questions on recreational drugs such as cannabis, poppers, cocaine, heroin, and drugs associated with chemsex (i.e., crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Using multivariable ordinal logistic analysis, the association of demographics, sexual risk-related behaviors, and health-related behaviors with cannabis use were examined. Overall proportions were weighted in RDS Analyst software, and 95% confidence intervals were calculated.
Results
In a study involving 250 participants, the mean age was 27.6 (SD=8.9) years. We found that 27.3% of participants ever used cannabis in their lifetime, and 15.6% had used it within the past six months. With increasing age, MSM were less likely to use cannabis use in the past six months (aOR: 0.8; 95% CI: 0.7-0.9). Participants who were single (aOR: 21.5; 95% CI: 2.6-175.6), ever being detained by the police (aOR: 11.4; 95% CI: 2.2-58.4), smoking tobacco daily (aOR: 4.6; 95% CI: 1.2-17.9), seen a doctor within the last six months (aOR: 0.2; 95% CI: 0.1-0.6), and having a trusted healthcare provider (aOR: 0.1; 95% CI: 0.01-0.2) were associated with cannabis use in past six months.
Conclusion
This study found that the prevalence of cannabis use among MSM is more common. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to younger, single, and daily smoker MSM in the form of screening, risk stratification, and treatment. Further investigation is warranted to elucidate the underlying mechanisms relating to cannabis use among MSM. Tailored interventions to mitigate drug-related harm in this population should be implemented.
Keywords: Opioids, Tobacco useMen who have sex with men (MSM) use cannabis more frequently than heterosexuals. Cannabis use has various adverse psychological and health outcomes. In the pretext of elevated sexual pleasure and stress relieving potential of cannabis, it is used worldwide, including in Nepal. However, there is a lack of research regarding the existing status and factors associated with cannabis use among men who have sex with men (MSM) in Nepal. This study aimed to find out the prevalence and factors associated with cannabis use among MSM in Nepal.
Methods
A cross-sectional survey was conducted among MSM in Nepal (N=250) between October and November 2022. Participants were recruited using respondent-driven sampling (RDS) in Kathmandu Valley, Nepal. We collected socio-demographic characteristics, HIV risk-related behaviors, and questions on recreational drugs such as cannabis, poppers, cocaine, heroin, and drugs associated with chemsex (i.e., crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Using multivariable ordinal logistic analysis, the association of demographics, sexual risk-related behaviors, and health-related behaviors with cannabis use were examined. Overall proportions were weighted in RDS Analyst software, and 95% confidence intervals were calculated.
Results
In a study involving 250 participants, the mean age was 27.6 (SD=8.9) years. We found that 27.3% of participants ever used cannabis in their lifetime, and 15.6% had used it within the past six months. With increasing age, MSM were less likely to use cannabis use in the past six months (aOR: 0.8; 95% CI: 0.7-0.9). Participants who were single (aOR: 21.5; 95% CI: 2.6-175.6), ever being detained by the police (aOR: 11.4; 95% CI: 2.2-58.4), smoking tobacco daily (aOR: 4.6; 95% CI: 1.2-17.9), seen a doctor within the last six months (aOR: 0.2; 95% CI: 0.1-0.6), and having a trusted healthcare provider (aOR: 0.1; 95% CI: 0.01-0.2) were associated with cannabis use in past six months.
Conclusion
This study found that the prevalence of cannabis use among MSM is more common. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to younger, single, and daily smoker MSM in the form of screening, risk stratification, and treatment. Further investigation is warranted to elucidate the underlying mechanisms relating to cannabis use among MSM. Tailored interventions to mitigate drug-related harm in this population should be implemented.
Authors:
Presenter - Kiran Paudel, BPH,
BPH,
University of Connecticut
Co-Author - Rosanna Mazzeo,
Yale University
Co-Author - Kamal Gautam,
University of Connecticut
Co-Author - Anjila Pandey,
Tribhuwan University
Co-Author - Antoine Khati,
University of Connecticut
Co-Author - Tara Ballav Adhikari,
Nepal Health Frontiers
Co-Author - Jeffrey Wickersham,
Yale School of Medicine
Co-Author - Roman Shrestha, PhD, MPH,
PhD, MPH,
University of Connecticut
E173 - Mode Matters: Exploring How Modes of Cannabis Administration Affect THC Plasma Concentrations and Subjective Effects
Poster Number: E173Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Mental Health
As cannabis products are becoming increasingly accessible and many novel modes of use such as dabbing and vaping grow in popularity among cannabis users, it is essential to understand the extent to which these modes of administration results in different use experiences and abuse liability outcomes. Existing studies primarily utilized laboratory settings with lower-potency or research-grade cannabis, failing to capture common modes of use among users of higher-potency legal market products. Accordingly, this study aimed to investigate how modes of administrations impact objective and subjective effects experienced by users using naturalistic administration of legal market products.
A series of quasi-experimental studies were conducted with 252 participants (46.4% female) using legal market cannabis products. Participants completed a baseline assessment where they reported demographics, substance use, and medical history and an experimental laboratory assessment where they administered their products via their typical preferred mode of administration. Modes of administration were categorized into four general modes of use for analyses: dabbing, vaping, bong-like modes, joint-like modes. Primary outcome measures included plasma THC concentrations as well as subjective drug effects.
Plasma THC concentrations and measures of subjective drug effects varied significantly across modes of administration. Compared with bong- and joint-like modes, dabbing and vaping were on average associated with higher levels plasma THC concentrations and subjective effects, indicating greater THC exposure when using these modes. Interestingly, dabbing and vaping also exhibited more rapid reductions in levels of subjective intoxication over time, suggesting that higher levels of intoxication may not be sustained for these modes.
Modes of administration significantly impacted THC exposure and subjective drug effects of legal market cannabis products among regular users. Across four common modes of administration, significant differences in objective and subjective effects of cannabis were observed. Results demonstrated the need to better characterize and account for modes of administration to inform safe uses in future research.
Keywords: Substance abuse, RiskA series of quasi-experimental studies were conducted with 252 participants (46.4% female) using legal market cannabis products. Participants completed a baseline assessment where they reported demographics, substance use, and medical history and an experimental laboratory assessment where they administered their products via their typical preferred mode of administration. Modes of administration were categorized into four general modes of use for analyses: dabbing, vaping, bong-like modes, joint-like modes. Primary outcome measures included plasma THC concentrations as well as subjective drug effects.
Plasma THC concentrations and measures of subjective drug effects varied significantly across modes of administration. Compared with bong- and joint-like modes, dabbing and vaping were on average associated with higher levels plasma THC concentrations and subjective effects, indicating greater THC exposure when using these modes. Interestingly, dabbing and vaping also exhibited more rapid reductions in levels of subjective intoxication over time, suggesting that higher levels of intoxication may not be sustained for these modes.
Modes of administration significantly impacted THC exposure and subjective drug effects of legal market cannabis products among regular users. Across four common modes of administration, significant differences in objective and subjective effects of cannabis were observed. Results demonstrated the need to better characterize and account for modes of administration to inform safe uses in future research.
Authors:
Presenter - Margy Yumeng Chen,
University of Colorado Boulder
Co-Author - Ashley Brooks-Russell,
PhD,
University of Colorado Anschutz Medical Campus
Co-Author - Angela D. Bryan, PhD, FSBM,
PhD, FSBM,
University of Colorado Boulder
Co-Author - L. Cinnamon Bidwell,
PhD,
University of Colorado Boulder
E175 - Longitudinal correlates of quitting e-cigarettes in the US
Poster Number: E175Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, Health Communication and Policy
Background. E-cigarette use has risen markedly among US youth and adults, despite efforts to curb this trend. To inform future programs and policies, we sought to identify the longitudinal correlates of quitting e-cigarette use.
Methods. A nationally representative sample of 1138 respondents who used e-cigarettes took a baseline online survey between Nov 2022 and Jan 2023. Six months later, 844 of these respondents (74% completion rate) took a follow-up survey. Analyses used weighted bivariate and multivariable logistic regression to identify correlates of quitting e-cigarettes use, defined as not currently vaping at follow-up. The multivariable analysis included only statistically significant correlates from bivariate analyses.
Results. Overall, 15% of respondents had quit e-cigarettes by follow up. In multivariable analysis, gay, lesbian, or bisexual respondents were more likely to quit using e-cigarettes than straight respondents (22% vs. 13%, aOR = 2.20, 95% CI = 1.10-4.38). Quitting was also more common among those who used e-cigarettes occasionally (aOR = 5.93, 95% CI = 3.11-11.30), were not nicotine dependent (aOR = 2.56, 95% CI = 1.38-4.76), and had higher intentions to quit (aOR = 1.49, 95% CI = 1.09-2.04). In bivariate but not multivariable analyses, quitting was more common among respondents who were adolescents, perceived e-cigarettes as harmful, had inaccurate beliefs about the harms of e-cigarette use relative to smoking, and were motivated to reduce their current vaping levels (all p<.05).
Conclusions. Quitting e-cigarettes is relatively common among groups at higher risk for use, including gay, lesbian, and bisexual people. Targeted interventions focused on reducing nicotine dependence and increasing quit intentions, especially among those who vape daily and with low intentions to quit, could be effective in promoting successful e-cigarette cessation.
Keywords: Cessation, Tobacco controlMethods. A nationally representative sample of 1138 respondents who used e-cigarettes took a baseline online survey between Nov 2022 and Jan 2023. Six months later, 844 of these respondents (74% completion rate) took a follow-up survey. Analyses used weighted bivariate and multivariable logistic regression to identify correlates of quitting e-cigarettes use, defined as not currently vaping at follow-up. The multivariable analysis included only statistically significant correlates from bivariate analyses.
Results. Overall, 15% of respondents had quit e-cigarettes by follow up. In multivariable analysis, gay, lesbian, or bisexual respondents were more likely to quit using e-cigarettes than straight respondents (22% vs. 13%, aOR = 2.20, 95% CI = 1.10-4.38). Quitting was also more common among those who used e-cigarettes occasionally (aOR = 5.93, 95% CI = 3.11-11.30), were not nicotine dependent (aOR = 2.56, 95% CI = 1.38-4.76), and had higher intentions to quit (aOR = 1.49, 95% CI = 1.09-2.04). In bivariate but not multivariable analyses, quitting was more common among respondents who were adolescents, perceived e-cigarettes as harmful, had inaccurate beliefs about the harms of e-cigarette use relative to smoking, and were motivated to reduce their current vaping levels (all p<.05).
Conclusions. Quitting e-cigarettes is relatively common among groups at higher risk for use, including gay, lesbian, and bisexual people. Targeted interventions focused on reducing nicotine dependence and increasing quit intentions, especially among those who vape daily and with low intentions to quit, could be effective in promoting successful e-cigarette cessation.
Authors:
Presenter - Mayank Sakhuja,
PhD,
University of North Carolina at Chapel Hill
Co-Author - Shayna Farris,
BS,
University of North Carolina at Chapel Hill
Co-Author - Tara L. Queen,
PhD,
University of North Carolina at Chapel Hill
Co-Author - Marissa G. Hall,
PhD,
University of North Carolina at Chapel Hill
Co-Author - Mohammad Ebrahimi Kalan,
PhD,
University of Maryland, College Park
Co-Author - Paschal Sheeran,
PhD,
University of North Carolina at Chapel Hill
Co-Author - Kurt M. Ribisl,
PhD,
University of North Carolina at Chapel Hill
Co-Author - Jennifer Mendel Sheldon,
MPH,
University of North Carolina at Chapel Hill
Co-Author - Noel T. Brewer,
PhD,
University of North Carolina at Chapel Hill
E176 - Dialectical Behavior Therapy Skills Training as a Brief Intervention for Cigarette Smoking by Patients with Cancer: A Scoping Review and Narrative Synthesis of Related Literature
Poster Number: E176Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, Stress
Patients with cancer who smoke cigarettes experience more treatment failures and complications and are less likely to survive cancer than patients who stop smoking or have never smoked. Although a cancer diagnosis can be a catalyst for addressing smoking, 12.7% of patients with cancer continue to smoke cigarettes, in part because standard tobacco treatment may not effectively address the psychological distress and/or emotion dysregulation that makes quitting smoking difficult for many patients with cancer. Novel behavioral interventions are critically needed. Dialectical Behavior Therapy – Skills Training (DBT-ST) has demonstrated efficacy as a brief intervention for managing emotions and stress across varied populations, but has not been adapted for patients with cancer who smoke. To determine its suitability for this population, we conducted a scoping review of brief DBT-ST with similar populations: people with substance use, breast cancer, or emotion dysregulation. We followed PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Studies were restricted to English-language publications of DBT-ST as a brief intervention of 20 or fewer sessions. We found 26 publications representing 23 research studies, extracted study details, and narratively synthesized the results. The 23 studies included 12 quasi-experimental designs, seven pilot randomized controlled trials (RCTs), and four RCTs. Studies were conducted in Iran (11), the United States (9), Australia (2), and Canada (1). All studies found at least one improvement in a main outcome following DBT-ST intervention, with results maintained at follow-up. Qualitative outcomes indicated high satisfaction with DBT-ST and good retention. Studies recruited diverse participants, with some far exceeding population averages. Over half of studies were single-gender, including only females or males. Study populations were relatively young, with only four studies including people older than 50 years. We found considerable heterogeneity across studies in intervention design, testing, and measurement. Despite concerns regarding generalizability to an older, male population with cancer who smokes, we concluded that DBT-ST as a brief intervention for people with substance use, cancer, or emotion dysregulation demonstrates sufficient positive outcomes to adapt this approach for our target patient population.
Keywords: Smoking, InterventionAuthors:
Author - Marcia McCall,
PhD, MBA, LCMHCA,
Wake Forest University School of Medicine
Co-Author - Charlotte Boyd,
MA, CHES,
Wake Forest University School of Medicine
Co-Author - Nicole Kerr,
MA,
Wake Forest University
Co-Author - Stephanie Daniel,
PhD,
Wake Forest University School of Medicine
Co-Author - Erin Sutfin,
PhD,
Wake Forest University School of Medicine
E177 - Co-creating a Smoking Cessation Support Program for (Expectant) Parents in Vulnerable Situations
Poster Number: E177Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, Child and Family Health
Background: ‘Smoke-free Parents’ (SFP) is a national smoking cessation program offering telephone counseling for (expectant) parents across the Netherlands. To address inequalities in smoking prevalence and access to cessation support, this co-creation study aimed to tailor SFP to better address the specific needs and contexts of (expectant) parents in vulnerable situations, by involving the target group, smoking cessation counselors, and healthcare professionals.
Methods: Five co-creation sessions were held using participatory health research methods to foster equal and empowering engagement. Activities included brainstorming through photo associations, interviewing peers, and creating fictional target group personas. Participants then mapped out the user journey, identifying barriers to accessing the SFP program and brainstorming potential solutions. Ideas were prioritized using a traffic light method. Data collection included field notes, audio recordings, and creative outputs, which were analyzed using qualitative content analysis. Additionally, individual interviews and group discussions were held to evaluate both the process and outcomes.
Results: Nine participants (three mothers, two counselors, two healthcare professionals and two researchers) engaged in the co-creation process. Key attitudes towards smoking cessation were fear of failure, social norms, emotional triggers like stress, and a reliance on smoking for relaxation. Participants highlighted the need for reducing stigma, improving accessibility to cessation support, and involving support networks. Proposed adaptations to SFP included increasing awareness and accessibility among professionals and the target population, offering various forms of coaching (e.g., physical, video call, or group), and involving relatives in the cessation process. Participants rated both the co-creation process and outcomes with an average satisfaction score of 8.25 out of 10.
Conclusion: This study demonstrates the potential of co-creation as a satisfactory method to bridge perspectives across researchers, health care professionals, smoking cessation counselors and the target group, and to incorporate the contextual realities of vulnerable populations into behavioral interventions. Future research will evaluate the implementation of the tailored Smoke-Free Parents program, with the ultimate goal of informing policy and practice aimed at reducing health disparities related to smoking cessation.
Keywords: Participatory research, Tobacco controlMethods: Five co-creation sessions were held using participatory health research methods to foster equal and empowering engagement. Activities included brainstorming through photo associations, interviewing peers, and creating fictional target group personas. Participants then mapped out the user journey, identifying barriers to accessing the SFP program and brainstorming potential solutions. Ideas were prioritized using a traffic light method. Data collection included field notes, audio recordings, and creative outputs, which were analyzed using qualitative content analysis. Additionally, individual interviews and group discussions were held to evaluate both the process and outcomes.
Results: Nine participants (three mothers, two counselors, two healthcare professionals and two researchers) engaged in the co-creation process. Key attitudes towards smoking cessation were fear of failure, social norms, emotional triggers like stress, and a reliance on smoking for relaxation. Participants highlighted the need for reducing stigma, improving accessibility to cessation support, and involving support networks. Proposed adaptations to SFP included increasing awareness and accessibility among professionals and the target population, offering various forms of coaching (e.g., physical, video call, or group), and involving relatives in the cessation process. Participants rated both the co-creation process and outcomes with an average satisfaction score of 8.25 out of 10.
Conclusion: This study demonstrates the potential of co-creation as a satisfactory method to bridge perspectives across researchers, health care professionals, smoking cessation counselors and the target group, and to incorporate the contextual realities of vulnerable populations into behavioral interventions. Future research will evaluate the implementation of the tailored Smoke-Free Parents program, with the ultimate goal of informing policy and practice aimed at reducing health disparities related to smoking cessation.
Authors:
Presenter - Linda Van Der Spek,
Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam; Trimbos Institute
Co-Author - Tessa Scheffers-van Schayck,
Dr.,
Trimbos Institute
Co-Author - Hans van Kippersluis,
Prof. Dr.,
Erasmus School of Economics
Co-Author - Hilmar Bijma,
Dr.,
Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam
Co-Author - Gera Nagelhout,
Prof. Dr.,
Maastricht University; Avans University of Applied Sciences
Co-Author - Jasper V. Been,
Dr.,
Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam
Co-Author - Leonieke J. Breunis,
Dr.,
Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam
E179 - Feasibility outcomes for the Women Exercising, Active, and Learning Together for Health (WEALTH) trial
Poster Number: E179Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Physical Activity
Every year, two million women reach menopause in the United States, and will spend up to 40% of their life in a postmenopausal state. In the years preceding menopause, there is a substantial decline in purposeful physical activity. Effective strategies are needed to promote continued involvement in health-enhancing physical activity in premenopausal women. Our study aimed to determine the feasibility of the Women Exercising, Active, and Learning Together for Health (WEALTH) trial.
The WEALTH trial was a pilot, workplace, dance-fitness intervention for premenopausal women offered during the lunch hour. Women were asked to attend two 30-minute programming sessions per week for six weeks. Feasibility was assessed through five metrics: recruitment capability, retention, compliance, treatment fidelity, and acceptability. We successfully recruited 28 women (39.75 years ± 6.06) who were staff (n = 20) or faculty (n = 8) members from Louisiana State University. This represents a 93% success in recruitment relative to our a priori goal of 30 women. Retention, as assessed by attendance in the final week of class was 50%. Compliance (mean number of classes attended) was 7 classes ± 3, with 3 women attending all sessions offered. Treatment fidelity was 95%, with 19/20 classes offered, one class was canceled due to university closure related to a severe weather event. Lastly, acceptability was rated on a 5-point scale (1 = strongly disagree, 5 = strongly disagree) in a post-intervention survey (n = 23). Participants reported that they enjoyed the program (4.8/5), found the program useful (4.8/5), and were satisfied with the instructor (4.9/5). Women who participated in WEALTH received an average of 1 minute of sedentary time, 2 minutes of light activity, and 27 minutes of moderate activity.
This study provides evidence for the feasibility of a dance-fitness workplace intervention for premenopausal women. Future iterations of the WEALTH intervention will seek to determine larger-scale efficacy, enhance scalability, and offer programming with differing modalities to better understand women's specific movement behavior needs.
Keywords: Women's health, Physical activityThe WEALTH trial was a pilot, workplace, dance-fitness intervention for premenopausal women offered during the lunch hour. Women were asked to attend two 30-minute programming sessions per week for six weeks. Feasibility was assessed through five metrics: recruitment capability, retention, compliance, treatment fidelity, and acceptability. We successfully recruited 28 women (39.75 years ± 6.06) who were staff (n = 20) or faculty (n = 8) members from Louisiana State University. This represents a 93% success in recruitment relative to our a priori goal of 30 women. Retention, as assessed by attendance in the final week of class was 50%. Compliance (mean number of classes attended) was 7 classes ± 3, with 3 women attending all sessions offered. Treatment fidelity was 95%, with 19/20 classes offered, one class was canceled due to university closure related to a severe weather event. Lastly, acceptability was rated on a 5-point scale (1 = strongly disagree, 5 = strongly disagree) in a post-intervention survey (n = 23). Participants reported that they enjoyed the program (4.8/5), found the program useful (4.8/5), and were satisfied with the instructor (4.9/5). Women who participated in WEALTH received an average of 1 minute of sedentary time, 2 minutes of light activity, and 27 minutes of moderate activity.
This study provides evidence for the feasibility of a dance-fitness workplace intervention for premenopausal women. Future iterations of the WEALTH intervention will seek to determine larger-scale efficacy, enhance scalability, and offer programming with differing modalities to better understand women's specific movement behavior needs.
Authors:
Presenter - Ryan Hulteen,
PhD,
Louisiana State University
Author - Heather Allaway,
PhD,
Louisiana State University
Author - Jaclyn Hadfield,
PhD,
Louisiana State University
E180 - Healthy & Happy Mothers First: An Innovative Trauma-Informed Obstetric Care Method
Poster Number: E180Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Mental Health
The infants of individuals with adverse childhood experiences (ACEs) face a two- to five-fold increase in developmental and health risks. Pregnant individuals with trauma histories experience obstetric procedures as invasive, triggering hyperarousal and post-traumatic stress symptoms. The American College of Obstetricians and Gynecologists (ACOG) recommends incorporating Trauma-Informed Care (TIC) practices in treating pregnant patients. However, the lack of a TIC curriculum leaves obstetricians feeling unprepared and uncomfortable treating these patients, highlighting the need for innovative approaches. The Substance Abuse and Mental Health Services Administration provides the four R’s of TIC: The clinician realizes the impact of trauma on experiences of care during pregnancy. Recognizes the manifestations of trauma and its sequelae in clinical encounters. Responds with appropriate language and behaviors that build trust, respect, and is supportive of the patient’s autonomy. Resists re-traumatization through trauma-informed practices.A 3-day training program will teach four obstetricians trauma-informed treatment with three training modules. The first module teaches providers to recognize the effects of trauma and its sequelae in their patient’s clinical encounters. The second module trains providers on verbal and body language skills that respond to trauma and avoid retraumatization. The final module teaches providers to detect and respond to acute post-traumatic stress reactions. These modules aim to teach providers the care needed to improve outcomes for pregnant individuals with trauma histories. The Perinatal RISE lab will implement these trainings at the Ramón Sardá Maternal/Infant Hospital in Argentina and conduct a randomized controlled pilot study to test for maternal and infant health.
Keywords: Advocacy, TraumaAuthors:
Author - Pamela Scorza,
ScD, MPH,
Columbia University at the Vagelos College of Physicians and Surgeons
Co-Presenter - Alexa Castaneda,
Columbia University
Co-Presenter - Daelyn Pena,
Columbia University
Co-Presenter - Ammey Corrales,
Barnard College
E181 - "It's just extremely complicated to talk to someone who doesn't understand" Barriers to accessing healthcare in female farmers in Georgia
Poster Number: E181Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Quality of Life
Background: Farming is consistently ranked as one of the most dangerous occupations in the United States, and research has found that farmers utilize healthcare resources less frequently than their non-farming counterparts. A better understanding of barriers to engaging with healthcare that exist within the farming community is crucial, particularly among female farmers, who represent an increasing proportion of domestic agriculture producers. There is limited research exploring the lived experience of female farmers, and they may face unique barriers to engaging with healthcare resources compared to their male counterparts. A better understanding of the challenges female farmers face when trying to engage with healthcare resources can help researchers and practitioners alike in the development of novel solutions to support the health and wellbeing of female farmers. Methods: Semi-structured qualitative interviews were conducted with farmers living in 18 counties across the state of Georgia (n=32). A combination of inductive and deductive coding was used to conduct thematic analysis on interview transcripts, and responses were compared based on gender. Results: Female respondents consistently identified long distances from resources, time constraints, concerns about the cost of care, feeling disconnected from healthcare providers, and a deficit of specialized care as barriers to engaging with healthcare. Respondents also described poor prior experiences with healthcare providers, stigma, pride, and under prioritization of personal health as significant barriers. Female respondents indicated that male farmers were more likely to face cultural barriers to healthcare engagement, where formal healthcare challenges were more pronounced barriers for female producers. Conclusion: Farmers identified both structural and cultural barriers to engaging with resources to support mental and physical health. Respondents consistently identified telehealth and concierge doctor services as critical touchpoints for healthcare access in rural areas, indicating that these may effectively fill gaps in traditional healthcare delivery models that would otherwise prevent farmers from engaging with care.
Keywords: Women's health, Worksite healthAuthors:
Co-Author - Christina Proctor,
MPH, PhD,
University of Georgia College of Public Health, Department of Health Promotion and Behavior
Co-Author - Chase Reece,
BSHP,
University of Georgia College of Public Health, Department of Health Promotion and Behavior
Co-Author - Lauren Griffeth,
PhD,
University of Georgia Office of Learning and Organizational Development
E182 - Primary Outcomes of a Prospective Pilot RCT of a Remotely Delivered Self-Management Program (TEAM-Red) for Depressed Young Black Women at Risk for Hypertension
Poster Number: E182Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Mental Health
Objective: Few studies have addressed self-management of both cardiovascular and mental health simultaneously in Black women who are at high risk for negative cardiovascular outcomes. This 6-month prospective randomized-controlled trial (RCT) tested TEAM-Red, a 5-session group self-management intervention for young Black women, co-led by a nurse and peer educator, versus an Enhanced waitlist (eWL) control in a cross-over design.
Methods: Depressed Black women ages 18-49 with at least one risk factor for hypertension were included. Assessments were conducted at Screening, Baseline, Weeks 12 and 24. Participants were randomized to TEAM-Red or eWL at baseline and groups crossed over at 12-week such that all participants received TEAM-Red by week 24. Primary outcome was depression measured by the PHQ-9. Behavioral outcomes were diet quality, physical exercise, and alcohol use. Secondary outcomes were quality of life for mental health (SF-12), perceived stress, social support and hypertension knowledge. Group differences were assessed at week 12 (primary) and repeated measures were assessed at week 24 for the entire sample.
Results: Mean sample age (N=49) was 34.80 years (SD= 8.22); 100% (N = 49) female, 100% Black. Mean BMI was 37.6 (SD=6.3); cardiovascular age was 46.2 (SD=8.8); mean systolic blood pressure (SBP) at baseline was 121.4 (14.2). At screen, participants reported moderate levels of discrimination (Mean=25.1; SD=10.6) with 74.2% reporting race as a primary reason for discrimination and moderate levels of stress as measured by the Perceived Stress Scale (PSS-10). Mean total sample PHQ-9 was 15.18 (SD=3.38) at screen. TEAM-Red was associated with a 17.1 higher odds of being not being depressed at week 12 (OR=17.14, 95% CI: 1.78, 164.97; p=0.014). At 12-weeks, TEAM-Red had significantly lower scores than eWL on PHQ-9 (p<.05), nutrition as measured by the DASH-Q (p<.05), and SF-12 mental health (p<.05) but not on physical exercise. At 24 weeks, the sample improved on PHQ-9, hypertension knowledge, perceived stress, social support, SF-12 mental health and alcohol use (p<.05). Engagement was high and attrition rate at week 24 was 22%.
Conclusions: TEAM-Red appears to improve depression, stress levels and diet quality in Black women who acknowledge symptoms of depression and are at risk for hypertension, although long-term maintenance of behavior change may need additional support. Conclusions need to be made cautiously given study limitations
Keywords: Self Management, Mental healthMethods: Depressed Black women ages 18-49 with at least one risk factor for hypertension were included. Assessments were conducted at Screening, Baseline, Weeks 12 and 24. Participants were randomized to TEAM-Red or eWL at baseline and groups crossed over at 12-week such that all participants received TEAM-Red by week 24. Primary outcome was depression measured by the PHQ-9. Behavioral outcomes were diet quality, physical exercise, and alcohol use. Secondary outcomes were quality of life for mental health (SF-12), perceived stress, social support and hypertension knowledge. Group differences were assessed at week 12 (primary) and repeated measures were assessed at week 24 for the entire sample.
Results: Mean sample age (N=49) was 34.80 years (SD= 8.22); 100% (N = 49) female, 100% Black. Mean BMI was 37.6 (SD=6.3); cardiovascular age was 46.2 (SD=8.8); mean systolic blood pressure (SBP) at baseline was 121.4 (14.2). At screen, participants reported moderate levels of discrimination (Mean=25.1; SD=10.6) with 74.2% reporting race as a primary reason for discrimination and moderate levels of stress as measured by the Perceived Stress Scale (PSS-10). Mean total sample PHQ-9 was 15.18 (SD=3.38) at screen. TEAM-Red was associated with a 17.1 higher odds of being not being depressed at week 12 (OR=17.14, 95% CI: 1.78, 164.97; p=0.014). At 12-weeks, TEAM-Red had significantly lower scores than eWL on PHQ-9 (p<.05), nutrition as measured by the DASH-Q (p<.05), and SF-12 mental health (p<.05) but not on physical exercise. At 24 weeks, the sample improved on PHQ-9, hypertension knowledge, perceived stress, social support, SF-12 mental health and alcohol use (p<.05). Engagement was high and attrition rate at week 24 was 22%.
Conclusions: TEAM-Red appears to improve depression, stress levels and diet quality in Black women who acknowledge symptoms of depression and are at risk for hypertension, although long-term maintenance of behavior change may need additional support. Conclusions need to be made cautiously given study limitations
Authors:
Presenter - Jennifer B. Levin, PhD,
PhD,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Erika Kelley,
PhD,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Farren Briggs,
PhD,
University of Miami, Miller School of Medicine
Co-Author - Mahboob Rahman,
MD,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Taylor Maniglia,
MA,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Emma Church,
MA,
University Hospitals of Cleveland Medical Center/CWRU SOM/Cleveland State University
Co-Author - Nicole Fiorelli,
MA,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Carla Conroy,
University Hospitals Cleveland Medical Center/CWRU SOM
Co-Author - Jessica Surdam,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Kathy-Diane Reich,
University Hospitals of Cleveland Medical Center/Cleveland State University
Co-Author - Danette Conklin,
PhD,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Carla Harwell,
MD,
University Hospitals of Cleveland Medical Center/CWRU SOM
Co-Author - Vicki Haywood Doe,
PhD,
Vicki Doe Fitness
Co-Author - Martha Sajatovic, MD,
MD,
Case Western Reserve University/University Hospitals Cleveland Medical Center
E183 - Health promotion implemented specifically for senior centers populations: Sex and ethnic differences
Poster Number: E183Time: 05:00 PM - 05:50 PM
Topics: Aging, Dissemination and Implementation
Introduction: Senior centers are community spaces providing a variety of support services and programs that can be tailored to community location and population accessing the senior center. Over 11,000 senior centers in the United States provide resources and programs to decrease isolation and promote physical and mental health. In Spring 2024, Delaware’s Division of Aging and Adults with Physical Disabilities provided mini grants statewide to 16 different senior centers to implement health promotion programs. The types of health promotion programs were specific to each site and chosen based upon needs of their specific community. Programs varied in length and content (physical activity, nutrition, arts, Spanish language, support group) including evidence-based (e.g., Bingocize, Matter of Balance). The purpose of this study was to examine sex and race differences in outcomes and self-reported program health promotion impacts.
Methods: Using a mixed methods approach, quantitative surveys and focus group data describe outcomes associated with participation in these healthy lifestyle programs in all 16 sites. Descriptives examined participant (N=475) demographics (i.e., living situation, social isolation, age, sex) and outcomes (quality of life, physical activity, and perceived health). Focus groups implemented post program with participants were coded and thematic analyses conducted to examine motivations for participation and impact.
Results: Participants were mostly female (86%), aged 73.51 + 8.9 years, 74.6% white and 21.2% Black, and 40% living alone. General linear modeling revealed significant sex differences in physical activity (p<0.001), race differences in physical health (p<0.001), and time effects on mental health (p<0.001). Chi square (p<0.01) analyses yield significant differences in types of program participation where more whites participated in language and arts and more blacks in nutrition and equal in physical activity. Qualitative analyses determined major themes associated with participation in the health promotion programs were making healthy choices, being socially active, improved physical/ mental health, and improved confidence.
Conclusion: Senior centers have the potential to reach and impact at risk, underserved populations and provide them with community specific programming. Therefore, senior center directors should examine the community needs when considering the implementation of health promotion programs into their centers.
Keywords: Aging, Community interventionMethods: Using a mixed methods approach, quantitative surveys and focus group data describe outcomes associated with participation in these healthy lifestyle programs in all 16 sites. Descriptives examined participant (N=475) demographics (i.e., living situation, social isolation, age, sex) and outcomes (quality of life, physical activity, and perceived health). Focus groups implemented post program with participants were coded and thematic analyses conducted to examine motivations for participation and impact.
Results: Participants were mostly female (86%), aged 73.51 + 8.9 years, 74.6% white and 21.2% Black, and 40% living alone. General linear modeling revealed significant sex differences in physical activity (p<0.001), race differences in physical health (p<0.001), and time effects on mental health (p<0.001). Chi square (p<0.01) analyses yield significant differences in types of program participation where more whites participated in language and arts and more blacks in nutrition and equal in physical activity. Qualitative analyses determined major themes associated with participation in the health promotion programs were making healthy choices, being socially active, improved physical/ mental health, and improved confidence.
Conclusion: Senior centers have the potential to reach and impact at risk, underserved populations and provide them with community specific programming. Therefore, senior center directors should examine the community needs when considering the implementation of health promotion programs into their centers.
Authors:
Presenter - Elizabeth Orsega-Smith,
PhD, FSBM,
University Of Delaware
Co-Author - Julia O'Hanlon,
MPA,
University of Delaware
Co-Author - Serena A. Schade, M.S.,
M.S.,
University of Delaware
Co-Author - Valerie Simmet,
BS,
University of Delaware
Co-Author - Jillian Orellano,
University of Delaware
Co-Author - Mihret Walelgne,
BS,
University of Delaware
Co-Author - Brynna Torpey,
University of Delaware
E184 - AN EXPLORATION OF WHY WOMEN WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES ARE NOT GETTING ROUTINE CERVICAL CANCER SCREENING: AN EXPLORATORY MIXED METHODS DESIGN
Poster Number: E184Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Cancer
Cervical cancer is a serious diagnosis that can lead to significant health consequences, but early detection through screening can reduce risks. However, women with intellectual and developmental disabilities (I/DD) encounter unique barriers to cervical cancer screening (CCS), including limited access to health information, low awareness of CCS importance, and communication gaps between providers and caregivers. Current research on CCS disparities largely addresses demographic factors among women with I/DD who have or have not undergone screening, but it overlooks personal experiences and influences that facilitate or hinder screening. This gap highlights the need for studies that incorporate the voices and experiences of women with I/DD to pinpoint factors that can encourage CCS.
Methods: Using the socio-ecological model (SEM) as a framework, we conducted an electronic survey among women with I/DD (n=31) to capture barriers and facilitators to screening at each SEM level. The survey data provided descriptive insights into facilitators and barriers to screening across each level of the SEM. Following the survey, a subset of participants (n=10) were selected for in-depth interviews to further explore and expand upon the survey findings. A thematic analysis was then conducted in which codes were identified and organized according to each level of the SEM (individual, interpersonal, community, organizational and policy). Data triangulation was then performed for each group by comparing survey and interview findings to identify consistent patterns and validate key themes.
Results: Decisions to pursue CCS were shaped by various socio-ecological factors. Individual influences included healthcare provider recommendations, family history of cancer, and value for preventive healthcare. Interpersonal support primarily came from family members, especially mothers or relatives in healthcare. At the community level, access to sex education and transportation facilitated CCS for some, while logistical challenges hindered others. Organizational factors included the value of accommodating, culturally competent providers, though a lack of disability-informed providers was noted. At the policy level, most women were unaware of relevant policies but recognized insurance coverage as a facilitator to screening. Conclusion: These findings underscore the need for accessible pathways, improved provider training, and patient education to increase CCS among women with I/DD.
Keywords: Cancer, DisabilityMethods: Using the socio-ecological model (SEM) as a framework, we conducted an electronic survey among women with I/DD (n=31) to capture barriers and facilitators to screening at each SEM level. The survey data provided descriptive insights into facilitators and barriers to screening across each level of the SEM. Following the survey, a subset of participants (n=10) were selected for in-depth interviews to further explore and expand upon the survey findings. A thematic analysis was then conducted in which codes were identified and organized according to each level of the SEM (individual, interpersonal, community, organizational and policy). Data triangulation was then performed for each group by comparing survey and interview findings to identify consistent patterns and validate key themes.
Results: Decisions to pursue CCS were shaped by various socio-ecological factors. Individual influences included healthcare provider recommendations, family history of cancer, and value for preventive healthcare. Interpersonal support primarily came from family members, especially mothers or relatives in healthcare. At the community level, access to sex education and transportation facilitated CCS for some, while logistical challenges hindered others. Organizational factors included the value of accommodating, culturally competent providers, though a lack of disability-informed providers was noted. At the policy level, most women were unaware of relevant policies but recognized insurance coverage as a facilitator to screening. Conclusion: These findings underscore the need for accessible pathways, improved provider training, and patient education to increase CCS among women with I/DD.
Authors:
Author - Kailey Snyder,
PhD,
University of Nebraska at Omaha
Co-Author - Anne Woodruff Jameson,
DPT,
University of Nebraska at Omaha
Co-Author - Colby Kelley,
BS,
University of Nebraska at Omaha
E185 - “The cost of caring”: A qualitative analysis on the experience of secondary traumatic stress among healthcare workers caring for trauma-exposed patients in Hong Kong
Poster Number: E185Time: 05:00 PM - 05:50 PM
Topics: Stress, Quality of Life
Background. Caring for trauma-exposed patients could trigger secondary traumatic stress symptoms(STSS; behaviors/ emotions when indirectly exposed to others’ traumatic experiences) among healthcare workers(HCWs). Despite the high prevalence and negative health impacts of STSS found in Western HCWs, their Asian counterparts’ experiences have been underexplored. This study qualitatively explored the experience of STSS among HCWs in Hong Kong.
Methods. 28 HCWs(18 nurses, 10 doctors) with experiences caring for trauma-exposed patients(e.g., accidents, suicide, terminal illnesses, sexual assaults) were recruited from healthcare professional associations in Hong Kong to participate in a qualitative interview in July-August 2024. Guided by Bride’s Secondary Traumatic Stress Symptoms Model, the interview scripts were coded line-by-line and analyzed thematically using ATLAS.ti.
Results. STSS were more common in the nurses than the doctors. Consistent with Bride’s multidimensional model, four major themes in STSS emerged. Results indicated that the HCWs: 1)thought about work with the traumatized patients even off duty(intrusion); 2)wanted to avoid working with some clients(avoidance); 3)had negative thoughts/feelings about themselves/others (negative changes in cognitions/mood); 4)had trouble concentrating/sleeping (hyperarousal). Other culturally-salient STSS were also identified. Some HCWs: 5)frequently reflected on their errors/insufficiencies in patient care after work; 6)wanted to end patients’ sessions earlier; 7)had memories of personal traumas triggered by patient care; 8)had important others noticed their mood swings; 9)were more vigilant about potential dangers in daily life; 10)felt upset for social injustice when caring for socially-disadvantaged patients; and 11)experienced physical symptoms(e.g., headache, stomach-ache, muscle stiffness) after work shifts(somatization).
Implications. STSS was common among Hong Kong HCWs caring for trauma-exposed patients; protocols helping HCWs to cope with work-related trauma exposure should be introduced. Besides the well-documented dimensions of STSS in Western studies, our findings identified some culturally-salient STSS among HCWs in a Chinese cultural context. Future studies should investigate the manifestations of STSS and culturally-tailor instruments of STSS in HCWS from different cultures.
Keywords: Trauma, Mental healthMethods. 28 HCWs(18 nurses, 10 doctors) with experiences caring for trauma-exposed patients(e.g., accidents, suicide, terminal illnesses, sexual assaults) were recruited from healthcare professional associations in Hong Kong to participate in a qualitative interview in July-August 2024. Guided by Bride’s Secondary Traumatic Stress Symptoms Model, the interview scripts were coded line-by-line and analyzed thematically using ATLAS.ti.
Results. STSS were more common in the nurses than the doctors. Consistent with Bride’s multidimensional model, four major themes in STSS emerged. Results indicated that the HCWs: 1)thought about work with the traumatized patients even off duty(intrusion); 2)wanted to avoid working with some clients(avoidance); 3)had negative thoughts/feelings about themselves/others (negative changes in cognitions/mood); 4)had trouble concentrating/sleeping (hyperarousal). Other culturally-salient STSS were also identified. Some HCWs: 5)frequently reflected on their errors/insufficiencies in patient care after work; 6)wanted to end patients’ sessions earlier; 7)had memories of personal traumas triggered by patient care; 8)had important others noticed their mood swings; 9)were more vigilant about potential dangers in daily life; 10)felt upset for social injustice when caring for socially-disadvantaged patients; and 11)experienced physical symptoms(e.g., headache, stomach-ache, muscle stiffness) after work shifts(somatization).
Implications. STSS was common among Hong Kong HCWs caring for trauma-exposed patients; protocols helping HCWs to cope with work-related trauma exposure should be introduced. Besides the well-documented dimensions of STSS in Western studies, our findings identified some culturally-salient STSS among HCWs in a Chinese cultural context. Future studies should investigate the manifestations of STSS and culturally-tailor instruments of STSS in HCWS from different cultures.
Authors:
Author - Nelson C.Y. Yeung, PhD,
PhD,
The Chinese University of Hong Kong
Author - Tsz Yung Stephanie Lau,
The Chinese University of Hong Kong
Co-Author - Eliza L.Y. Wong,
The Chinese University of Hong Kong
Co-Author - Anka A. Vujanovic,
University of Houston
Co-Author - Kevin K. C. Hung,
The Chinese University of Hong Kong
Co-Author - Victor C.W. Tam,
The Chinese University of Hong Kong
Co-Author - Catherine Tang,
Hong Kong Shue Yan University
E186 - Substance use among sexual and gender minority youth: An examination of disparities at the intersection of gender, sexual identity, and race/ethnicity
Poster Number: E186Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Health of Marginalized Populations
Background: Research has documented disparities in substance use among sexual and gender minority youth (SGMY) compared to their peers. The present study sought to identify SGMY with intersecting minoritized social positions (i.e., gender, sexual identity, and race/ethnicity) who may share disproportionate burdens of alcohol use, binge drinking, marijuana use, and use of other recreational drugs.
Methods: Data were drawn from the 2022 LGBTQ National Teen Survey, which included 10,967 SGMY aged 13-18 living in the United States. We applied exhaustive Chi-squared Automatic Interaction Detection (CHAID) analyses to assess the prevalence of past-30-day substance use across combinations of gender, sexual identity, and race/ethnicity. CHAID, a tree-based analytic technique, identifies the most significant predictors of substance use and reveals subgroups at highest risk. This approach provides a quantitative, intersectional understanding of how marginalized identities interact to influence substance use behaviors.
Results: Alcohol use was the most prevalent form of substance use in the sample (19.9%), followed by marijuana use (15.4%), binge drinking (14.2%), and other drug use (2.5%). For both alcohol and marijuana use, sexual identity emerged as the primary factor distinguishing between groups. Alcohol use was highest among queer youth (24.7%), regardless of gender or race/ethnicity, and among pansexual, gay/lesbian, and bisexual cisgender boys and girls who did not identify as Asian (25.1-28.6%). Marijuana use was also most prevalent among queer (21.8%) and pansexual or bisexual youth (17.7%), regardless of gender or race/ethnicity. Among gay/lesbian youth, marijuana use was higher for transgender boys, cisgender boys, and non-binary youth (15.7%) compared to transgender girls, cisgender girls, and questioning youth (10.5%). For binge drinking and other drug use, gender was the only significant differentiator, with cisgender boys having the highest prevalence in both categories (22.8% for binge drinking, 4.0% for other drug use).
Conclusions: These findings emphasize the urgent need for tailored prevention and intervention programs that address the specific substance use risks faced by SGMY, particularly queer-identified youth and cisgender boys. Interventions should also account for the intersecting roles of gender and racial/ethnic identities, as disparities within some sexual identity subgroups suggest that one-size-fits-all approaches may be insufficient.
Keywords: Substance abuse, Minority healthMethods: Data were drawn from the 2022 LGBTQ National Teen Survey, which included 10,967 SGMY aged 13-18 living in the United States. We applied exhaustive Chi-squared Automatic Interaction Detection (CHAID) analyses to assess the prevalence of past-30-day substance use across combinations of gender, sexual identity, and race/ethnicity. CHAID, a tree-based analytic technique, identifies the most significant predictors of substance use and reveals subgroups at highest risk. This approach provides a quantitative, intersectional understanding of how marginalized identities interact to influence substance use behaviors.
Results: Alcohol use was the most prevalent form of substance use in the sample (19.9%), followed by marijuana use (15.4%), binge drinking (14.2%), and other drug use (2.5%). For both alcohol and marijuana use, sexual identity emerged as the primary factor distinguishing between groups. Alcohol use was highest among queer youth (24.7%), regardless of gender or race/ethnicity, and among pansexual, gay/lesbian, and bisexual cisgender boys and girls who did not identify as Asian (25.1-28.6%). Marijuana use was also most prevalent among queer (21.8%) and pansexual or bisexual youth (17.7%), regardless of gender or race/ethnicity. Among gay/lesbian youth, marijuana use was higher for transgender boys, cisgender boys, and non-binary youth (15.7%) compared to transgender girls, cisgender girls, and questioning youth (10.5%). For binge drinking and other drug use, gender was the only significant differentiator, with cisgender boys having the highest prevalence in both categories (22.8% for binge drinking, 4.0% for other drug use).
Conclusions: These findings emphasize the urgent need for tailored prevention and intervention programs that address the specific substance use risks faced by SGMY, particularly queer-identified youth and cisgender boys. Interventions should also account for the intersecting roles of gender and racial/ethnic identities, as disparities within some sexual identity subgroups suggest that one-size-fits-all approaches may be insufficient.
Authors:
Co-Author - Peter McCauley,
University of Connecticut
Co-Author - Lisa Eaton,
PhD,
University of Connecticut
Co-Author - Ryan Watson, PhD,
PhD,
University of Connecticut
E187 - Participation in health-promoting daily activities post-COVID: A latent profile analysis of Minnesota fairgoers
Poster Number: E187Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Social and Environmental Context and Health
Background: Participation in fitness, leisure, and social activities are vital for health. The COVID-19 pandemic response restricted access to community spaces where these activities occur. On May 11, 2023, the COVID-19 Public Health Emergency ended, which was presumed to restore access to these spaces and facilitate return to pre-pandemic activities. This study aimed to explore the general populations’ levels of participation in fitness, leisure, and social activities since the Public Health Emergency ended and to identify sub-groups for whom additional support may be required.
Methods: A cross-sectional survey of adults (age ≥18) who attended the Minnesota State Fair and two rural county fairs in Minnesota during July and August 2023 was conducted. Activity participation (percentage of activities retained in 4 domains) was measured using the Activity Card Sort 3. Health-related quality of life (physical and mental component t-scores) was measured using the PROMIS Global Health-10. Latent profile analysis was used to identify clusters of participants who had common profiles of activity participation. Kruskal-Wallis and Fisher’s exact tests were used to compare clusters’ health-related quality of life and demographic variables.
Results: Fairgoers (n=264) were 52.6 (18.6) years of age, and were predominantly White (89.0%), and female (65.2%). Three activity participation clusters were identified: high participation (n=89, 94.4% [4.9%] total activity retention), moderate participation (n=128, 79.8% [4.2%] total activity retention), low participation (n=65.7% [5.3%] total activity retention). The moderate participation and low participation clusters reported more barriers to activities (p=.001) and lower scores on general health perception (p<.001), social health (p<.001), and mental health (p<.001) than the high participation cluster. The low participation cluster reported some or more difficulty on more disability domains than the moderate and high participation clusters (p=.007).
Discussion: Although many people have returned to their usual activities since the COVID-19 Public Health Emergency was lifted, people with disability and those who encounter multiple participation barriers remain restricted in their return to usual activities. Policies and programs that facilitate access and provide support for re-engagement in fitness, leisure, and social activities may be needed to promote health among at-risk populations.
Keywords: Quality of life, Health promotionMethods: A cross-sectional survey of adults (age ≥18) who attended the Minnesota State Fair and two rural county fairs in Minnesota during July and August 2023 was conducted. Activity participation (percentage of activities retained in 4 domains) was measured using the Activity Card Sort 3. Health-related quality of life (physical and mental component t-scores) was measured using the PROMIS Global Health-10. Latent profile analysis was used to identify clusters of participants who had common profiles of activity participation. Kruskal-Wallis and Fisher’s exact tests were used to compare clusters’ health-related quality of life and demographic variables.
Results: Fairgoers (n=264) were 52.6 (18.6) years of age, and were predominantly White (89.0%), and female (65.2%). Three activity participation clusters were identified: high participation (n=89, 94.4% [4.9%] total activity retention), moderate participation (n=128, 79.8% [4.2%] total activity retention), low participation (n=65.7% [5.3%] total activity retention). The moderate participation and low participation clusters reported more barriers to activities (p=.001) and lower scores on general health perception (p<.001), social health (p<.001), and mental health (p<.001) than the high participation cluster. The low participation cluster reported some or more difficulty on more disability domains than the moderate and high participation clusters (p=.007).
Discussion: Although many people have returned to their usual activities since the COVID-19 Public Health Emergency was lifted, people with disability and those who encounter multiple participation barriers remain restricted in their return to usual activities. Policies and programs that facilitate access and provide support for re-engagement in fitness, leisure, and social activities may be needed to promote health among at-risk populations.
Authors:
Presenter - Emily Kringle,
PhD, OTR/L,
University of Minnesota
Co-Author - Karli Jahnke,
MOT, OTR/L,
University of Minnesota
Co-Author - M. Carolyn Baum,
PhD, OTR/L,
Washington University in St. Louis School of Medicine
E188 - A mixed methods study measuring the impact of a digital weight loss intervention on health-related quality of life
Poster Number: E188Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Obesity
Background: Obesity is associated with reduced psychosocial functioning. While intensive in-person weight loss interventions have been found to improve Health-Related Quality of Life (HRQoL), a gap exists in understanding how HRQoL is impacted within the context of a scalable, digital weight loss intervention.
Methods: This mixed methods study examined the impact of a 10-week digital weight loss intervention among 32 U.S adults with overweight or obesity on HRQoL. Using a 2x2x2x2-factorial design, participants were randomized to either a harder or easier version of four goals: calorie, step, eating window, and Red Zone Food goal. These goals were tracked daily via Fitbit devices and online surveys. We examined whether change in HRQoL over the course of the intervention varied by goal setting intensity (easier vs. harder) using ANOVA, and whether baseline HRQoL predicted weight loss or goal attainment using linear regression. HRQoL was assessed via the validated SF-36 questionnaire at baseline and 10 weeks; a physical health and a mental health summary score were computed, with higher scores indicative of better quality of life. Goal attainment was operationalized as the percentage of days that goals were met. To better explain our quantitative findings, we conducted 14 semi-structured qualitative interviews at the end of the intervention. Interviews were professionally transcribed, then coded by two coders.
Results: Participants were predominantly women (72%) with a mean age of 47.7 (SD = 13.3) years and a mean BMI of 30.5 (SD = 3.8). Improvement in physical health over the 10-week intervention was greater for those receiving the harder (vs. easier) versions of the calorie goal (5.8 vs. -1.9 unit change in HRQoL, respectively) and Red Zone Food goal (6.1 vs. -2.3, respectively). Improvement in mental health was greater for those receiving the easier (vs. harder) version of the Red Zone Food goal (2.6 vs. -4.8, respectively). Neither baseline physical or mental HRQoL was correlated with goal attainment or weight loss. Interviews reflected that harder goals led to health behavior change, indicating complementary findings between the quantitative and qualitative data.
Conclusions: Harder goals related to energy intake (calorie and Red Zone Foods) improved physical health, while an easier Red Zone Food goal improved mental health. These novel findings provide insights into how to create a digital weight loss intervention that improves HRQoL.
Keywords: Quality of life, ObesityMethods: This mixed methods study examined the impact of a 10-week digital weight loss intervention among 32 U.S adults with overweight or obesity on HRQoL. Using a 2x2x2x2-factorial design, participants were randomized to either a harder or easier version of four goals: calorie, step, eating window, and Red Zone Food goal. These goals were tracked daily via Fitbit devices and online surveys. We examined whether change in HRQoL over the course of the intervention varied by goal setting intensity (easier vs. harder) using ANOVA, and whether baseline HRQoL predicted weight loss or goal attainment using linear regression. HRQoL was assessed via the validated SF-36 questionnaire at baseline and 10 weeks; a physical health and a mental health summary score were computed, with higher scores indicative of better quality of life. Goal attainment was operationalized as the percentage of days that goals were met. To better explain our quantitative findings, we conducted 14 semi-structured qualitative interviews at the end of the intervention. Interviews were professionally transcribed, then coded by two coders.
Results: Participants were predominantly women (72%) with a mean age of 47.7 (SD = 13.3) years and a mean BMI of 30.5 (SD = 3.8). Improvement in physical health over the 10-week intervention was greater for those receiving the harder (vs. easier) versions of the calorie goal (5.8 vs. -1.9 unit change in HRQoL, respectively) and Red Zone Food goal (6.1 vs. -2.3, respectively). Improvement in mental health was greater for those receiving the easier (vs. harder) version of the Red Zone Food goal (2.6 vs. -4.8, respectively). Neither baseline physical or mental HRQoL was correlated with goal attainment or weight loss. Interviews reflected that harder goals led to health behavior change, indicating complementary findings between the quantitative and qualitative data.
Conclusions: Harder goals related to energy intake (calorie and Red Zone Foods) improved physical health, while an easier Red Zone Food goal improved mental health. These novel findings provide insights into how to create a digital weight loss intervention that improves HRQoL.
Authors:
Author - Annalisa Lim,
Stanford University
Co-Author - Amanda Zeitlin,
Stanford University
Co-Author - Abby King,
PhD,
Stanford University
Co-Author - Christopher Gardner,
PhD,
Stanford University
Co-Author - Michele Patel,
PhD,
Stanford University
E189 - How Light and Moderate Physical Activity are Classified has Implications for Whether Pregnant Women are Meeting or Not Meeting Activity Guidelines
Poster Number: E189Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Methods and Measurement
Background: Accurately defining light (LPA) and moderate physical activity (MPA) is necessary to appropriately classify people as meeting PA guidelines (150 min MPA/week). While guidelines define MPA as 3-6 metabolic equivalents (METs), some researchers suggest higher thresholds (e.g., 3.6 or 4 to 6 METs) to discern LPA from MPA. Few studies explore how these thresholds impact PA classification, especially in pregnant persons with overweight/obesity (PP-OW/OB), who are more likely to engage in PA potentially classified as LPA and MPA (e.g., yoga, walking). This is of concern in interventions, as misclassifying PA may negatively impact motivation and compliance. Given this literature gap, this study aimed to examine how MPA minutes (min) vary when defined as 3-6, 3.6-6, and 4-6 METs and assess number of min spent between 2-3 and 2.51-3 METs in PP-OW/OB. Methods: PP-OW/OB (N=23; Mage=31±3 years; MBMI=31±7 kg/m²) from the Healthy Mom Zone study wore an ActiGraph 24hr/day up to 9 days. Weekly and daily min were computed using MET ranges of MPA=3-6, 3.6-6, 4-6, and LPA=2-3 and 2.51-3. Mean differences in MPA min for the ranges were analyzed using t-tests and visualized using Bland-Altman and confidence interval plots. Included data had ≥4 days and ≥600 min/day wear time. Results: Women had 171 min/week MPA when defined as 3-6 METs, 20 more than when defined as 3.6-6 METs (151 min/week), p>0.05, and 42 more than 4-6 METs (129 min/week), p=0.06. Further, 22 more min/week were classified as MPA when defined as 3.6-6 (151 min/week) versus 4-6 METs (129 min/week), p’s>0.05. Women had 49 min between 2-3 METs but no min between 2.51-3 METs. Confidence interval plots showed differences between 3-6 and 4-6 METs, but not other ranges. Bland-Altman plots showed little variability. Conclusions: This study was one of the first to explore how MET thresholds impact whether PP-OW/OB are classified as meeting PA guidelines. Notably, women had 19-43 more min/week MPA when the lower MET bound was 3 versus 3.6 and 4 METs. Further, no PA min were between 2.51-3 METS, showing a clear delineation between LPA and MPA. Using 3 METs may appropriately classify PP-OW/OB as meeting PA guidelines and reduce misclassification that can lower motivation and compliance. These findings have implications in interventions using device-based metrics to classify participants as meeting PA guidelines. Research examining how these thresholds impact compliance and intervention outcomes is needed.
Keywords: Physical activity, MeasurementAuthors:
Author - Victoria A. Suhy,
BS,
The Pennsylvania State University
Co-Author - Abigail M. Pauley, PhD,
PhD,
The Pennsylvania State University
Co-Author - Jamie A. Whitney,
MS,
The Pennsylvania State University
Co-Author - Daniel E. Rivera, PhD, FSBM,
PhD, FSBM,
Arizona State University
Co-Author - Owais Khan,
PhD,
The Arizona State University
Co-Author - Amy Moore, PhD, MS, RD,
PhD, RD,
The Pennsylvania State University, Center for Childhood Obesity Research
Co-Author - Sy-Miin Chow,
PhD,
The Pennsylvania State University
Co-Author - Constantino M. Lagoa,
PhD,
The Pennsylvania State University
Co-Author - Young Won Cho,
MA,
The Pennsylvania State University
Co-Author - Danying Shao,
PhD,
The Pennsylvania State University
Co-Author - Krista S. Leonard-Corzo, PhD,
PhD,
Arizona State University
Co-Author - Danielle Symons Downs, PhD,
PhD,
The Pennsylvania State University
E190 - 24-hour movement behaviors profiles and their transition among adolescents before and after a school year: Findings from the Movimente Program
Poster Number: E190Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Multiple Health Behavior Change
Time spent in 24-hour movement behaviors (24-h MB), including physical activity, sedentary behavior, and sleep may have distinct health consequences. We aimed to identify 24h MB profiles in adolescents by applying a person-centered clustering approach and examine how profiles membership changed from the beginning to the end of a school year. Brazilian adolescents from the Movimente Program answered a standardized questionnaire before and after a school year about time practicing sports activities and non-sport activities (≤419min/week and ≥420min/week), watching TV, using computer – PC, cellphone, and playing video game – VG (≤2h/day and >2h/day), sleeping (hours/night) on weekdays and weekends (8-10h/night” and “<8 or >10h/night). Latent Transition Analysis was used to identify 24-hMB profiles and verify membership transition before and after a school year. Profiles were labeled to convey key characteristics. The sample was composed of 610 adolescents (girls: 52.5%, mean age: 13.0(sd:1.0). Five profiles of 24hMB were identified: (1) “Active, high TV/PC, and inadequate night sleep” (n=20 - 3.3%), (2) “Inactive, high all screen time and inadequate night sleep” (n=149 - 24.4%), (3) “Inactive, high PC, inadequate night sleep” (328 - 53.8%), (4) “Active, high TV/VG, adequate week sleep” (n=19 - 3.1%), and (5) “Active high PC, adequate night sleep” (n=94 - 15.4%). Almost one fourth of the sample (24.4%), remained in the profile (2) “Inactive, high screen time and inadequate night sleep”, after one school year. Predominant transitions occurred from profiles (3) “Inactive, high PC, inadequate night sleep” (66%) and (4) “Active, high TV/VG, adequate week sleep” (49%) to profile (1) “Active, high TV/PC, and inadequate night sleep”. Also, from (5) “Active high PC adequate night sleep” (65%) to (4) “Active, high TV/VG, adequate week sleep”, and from (1) “Active, high TV/PC, and inadequate night sleep” (65%) to (2) “Inactive, high all screen time and inadequate night sleep”. After a school year almost 25% of the adolescents stayed in the same 24h MB profiles, while the predominant transition for the remaining adolescents was towards higher PA, higher screen time, and longer sleep duration. These findings can aid development and implementation of public health strategies to promote health targeting more than one behavior at the same time.
Keywords: Physical activity, Health behavior changeAuthors:
Author - Gabrielli De Mello,
PhD,
Texas A&M AgriLife Research
Co-Author - Rafael da Costa,
PhD,
Federal University of Rondônia
Co-Author - Marcus Lopes,
PhD,
Children's Hospital of Eastern Ontario Research Institute
Co-Author - Jacob Szeszulski,
PhD,
Texas A&M AgriLife Research
Co-Author - Kelly Silva,
PhD,
Federal University of Santa Catarina
E191 - Environmental Intervention Associated with Improved Sleep Health of U.S. Air Force Technical Training Students
Poster Number: E191Time: 05:00 PM - 05:50 PM
Topics: Military and Veterans' Health, Sleep
Background: Around half of US Air Force (USAF) personnel in entry-level training report insufficient sleep. USAF students live in dorms, typically on military bases located in the Southern US. Through focus groups and site visits, we identified the need for an intervention which maintains the dorm sleep environment within parameters conducive to optimal sleep. This quasi-experimental study evaluated differences in sleep and academic performance in USAF students after a sleep environment intervention.
Method: Participants were, on average, 22.4 (4.3) year-old USAF personnel in Technical Training, a program immediately after Basic Military Training which develops career-specific job skills. Persons living in the intervention building (n = 28) slept in rooms where temperature was regulated to an average of 68 degrees F, and received cooling mattress toppers, a tower fan, and blackout curtains. Those living in the control building (n = 24) slept in rooms with standard temperature and light regulation. Students completed an anonymous survey at baseline and one-month follow-up, reporting sleep health, sleep-related impairment, sleep disturbance, and their impression of the sleep environment. Academic test scores were also collected. The inverse probability weighted linear regression model assessed differences in each of the sleep outcomes and academic performance between the groups.
Results: At follow-up, the intervention group reported better sleep health compared to control (est. mean difference = 1.25, p = .0078, 95% CI [0.35, 2.16]). The intervention group also reported less subjective negative impact of environmental sleep factors (est. mean difference = -3.80, p = .0199, 95% CI [-6.93, -0.62]), and less sleep-related impairment compared to control (est. mean difference = -3.80, p = .0195, 95% CI [-6.95, -0.64]). There were no differences between the groups on sleep disturbance or academic performance (p > .05).
Discussion: USAF students who received a multi-component environmental intervention for optimizing sleep experienced improved sleep health and reduced sleep-related impairment. While further research using larger samples and random assignment is needed to examine the long-term effects of such interventions on academic, physical, and occupational performance, these preliminary results support military leaders’ advocacy for funding to tune the sleep environment for the benefit of student health and national security-relevant skills acquisition.
Keywords: Environment, Sleep disordersMethod: Participants were, on average, 22.4 (4.3) year-old USAF personnel in Technical Training, a program immediately after Basic Military Training which develops career-specific job skills. Persons living in the intervention building (n = 28) slept in rooms where temperature was regulated to an average of 68 degrees F, and received cooling mattress toppers, a tower fan, and blackout curtains. Those living in the control building (n = 24) slept in rooms with standard temperature and light regulation. Students completed an anonymous survey at baseline and one-month follow-up, reporting sleep health, sleep-related impairment, sleep disturbance, and their impression of the sleep environment. Academic test scores were also collected. The inverse probability weighted linear regression model assessed differences in each of the sleep outcomes and academic performance between the groups.
Results: At follow-up, the intervention group reported better sleep health compared to control (est. mean difference = 1.25, p = .0078, 95% CI [0.35, 2.16]). The intervention group also reported less subjective negative impact of environmental sleep factors (est. mean difference = -3.80, p = .0199, 95% CI [-6.93, -0.62]), and less sleep-related impairment compared to control (est. mean difference = -3.80, p = .0195, 95% CI [-6.95, -0.64]). There were no differences between the groups on sleep disturbance or academic performance (p > .05).
Discussion: USAF students who received a multi-component environmental intervention for optimizing sleep experienced improved sleep health and reduced sleep-related impairment. While further research using larger samples and random assignment is needed to examine the long-term effects of such interventions on academic, physical, and occupational performance, these preliminary results support military leaders’ advocacy for funding to tune the sleep environment for the benefit of student health and national security-relevant skills acquisition.
Authors:
Presenter - Jordan Ellis,
PhD,
United States Air Force
Co-Author - Xin-Qun Wang,
MS,
University of Virginia Public Health Sciences
Co-Author - Faith Luyster,
PhD,
University of Pittsburgh School of Nursing
Co-Author - Chase A. Aycock, PsyD,
PsyD,
United States Air Force
Co-Author - Kara Wiseman,
MPH, PhD,
University of Virginia Public Health Sciences
Co-Author - Debamita Kundu,
PhD,
University of Virginia Public Health Sciences
Co-Author - Trevin Glasgow,
PhD,
University of Virginia Public Health Sciences
Co-Author - Daniel Cassidy,
PhD,
Psychological Health Center of Excellence
Co-Author - Wayne Talcott,
PhD,
University of Virginia Public Health Sciences
E192 - Reductions in Underage Alcohol Use After US Air Force Basic Military Training: Implications for Prevention
Poster Number: E192Time: 05:00 PM - 05:50 PM
Topics: Military and Veterans' Health, Substance Misuse
Background: Hazardous alcohol use can lead to myriad severe health and occupational consequences for young Airmen (an inclusive term used for Air Force personnel). In fact, alcohol use is the leading cause for article 15s in entry-level technical training, resulting in discharge. Anonymous surveillance data of pre-service alcohol use has observed effect measure modification based by legal drinking age (i.e., 21 or older), with underage drinkers endorsing riskier pre-service alcohol use. The current study explores how alcohol use patterns change during the transition period of enlisting in the military and whether these age differences persist after 7.5 weeks of basic military training (BMT).
Method: Participants consist of 103,240 Airmen in entry-level training at one of four military installations between 2016 and 2019. They anonymously completed the Alcohol Use Disorder Identification Test (AUDIT) for two time points: the thirty days prior to enlisting (pre-BMT) and the past 30 days of alcohol use while in technical training, immediately following BMT (i.e., post-BMT). Among those who endorsed any alcohol use, three dichotomized outcomes were compared: risky drinking (total score >8), binge use (item #3 >2), and heavy drinking (AUDIT #2>1). A multilevel generalized linear regression model was performed to compare across time points, stratifying by age category (<21 vs. ≥21) and controlling for installation-level differences.
Results: Among underage drinkers (23%), there was a significant reduction in risky drinking post-BMT as compared to pre-BMT (OR=0.75; 95% CI: 0.59-0.70; p=0.018). Similarly, underage drinkers endorsed reduced binge drinking (OR=0.57; 95% CI: 0.45-0.73; p≤0.001) and heavy drinking (OR=0.65; 95% CI: 0.55-0.76; p≤0.001). There were no significant differences between time points for legal age drinkers (77%).
Discussion: Underage drinkers anonymously reported reduced risky alcohol use, binge drinking, and heavy drinking after BMT compared to pre-service use. These observational findings could indicate that the change of context and identity during the transition into military service could serve as a protective factor for alcohol-related problems among young adults. The negative consequences of underage alcohol use increase after enlisting, which may also reduce underage drinking. Factors inherent to basic military training may be protective against hazardous drinking and could be leveraged for preventative interventions.
Keywords: Population health, AlcoholMethod: Participants consist of 103,240 Airmen in entry-level training at one of four military installations between 2016 and 2019. They anonymously completed the Alcohol Use Disorder Identification Test (AUDIT) for two time points: the thirty days prior to enlisting (pre-BMT) and the past 30 days of alcohol use while in technical training, immediately following BMT (i.e., post-BMT). Among those who endorsed any alcohol use, three dichotomized outcomes were compared: risky drinking (total score >8), binge use (item #3 >2), and heavy drinking (AUDIT #2>1). A multilevel generalized linear regression model was performed to compare across time points, stratifying by age category (<21 vs. ≥21) and controlling for installation-level differences.
Results: Among underage drinkers (23%), there was a significant reduction in risky drinking post-BMT as compared to pre-BMT (OR=0.75; 95% CI: 0.59-0.70; p=0.018). Similarly, underage drinkers endorsed reduced binge drinking (OR=0.57; 95% CI: 0.45-0.73; p≤0.001) and heavy drinking (OR=0.65; 95% CI: 0.55-0.76; p≤0.001). There were no significant differences between time points for legal age drinkers (77%).
Discussion: Underage drinkers anonymously reported reduced risky alcohol use, binge drinking, and heavy drinking after BMT compared to pre-service use. These observational findings could indicate that the change of context and identity during the transition into military service could serve as a protective factor for alcohol-related problems among young adults. The negative consequences of underage alcohol use increase after enlisting, which may also reduce underage drinking. Factors inherent to basic military training may be protective against hazardous drinking and could be leveraged for preventative interventions.
Authors:
Presenter - Chase A. Aycock,
PsyD,
United States Air Force
Co-Author - Sowan Kang,
PhD,
United States Air Force
Co-Author - Debamita Kundu,
PhD,
University of Virginia
Co-Author - Indika Mallawaarachchi,
M.S.,
University of Virginia
Co-Author - G. Wayne Talcott,
PhD,
University of Virginia
E193 - Association between HIV knowledge and stigma among HIV healthcare providers in the Dominican Republic: The role of empathy and social distance
Poster Number: E193Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Dissemination and Implementation
Background: HIV-related stigma and inadequate knowledge about HIV among healthcare providers (HCPs) hinder optimal care for people with HIV (PWH). While research has explored the impact of stigma and knowledge on healthcare outcomes, the mechanisms driving HCPs’ behaviors remain underexplored. In this study, we examine empathy and desire for social distance, critical factors in shaping attitudes and behaviors toward PWH, as mediators of the relationship between HIV knowledge and stigma among HCPs.
Methods: HCP data from two clinics in the Dominican Republic (ClinicalTrials.gov ID: NCT04491539) were evaluated. Inclusion criteria were: age 18+, 4+ weekly hours of PWH care, proficiency in Spanish, and ability to provide informed consent. Data from four time points (N=265) were used, acknowledging the possibility of non-independent observations. We conducted serial mediation models using the SPSS Process macro, where the relationship between HIV knowledge and stigma toward PWH among HCPs is mediated through first empathy and then desire for social distance from PWH.
Results: HCPs had a mean age of 43.29 years (SD=12.09). Most participants (81.5%) identified as non-male; 95.1% identified as heterosexual, and 73.3% as multi-racial. Serial mediation models revealed significant indirect effects, indicating that higher HIV knowledge links to greater empathy toward PWH (B=1.86, SE=.33, p<.001), leading to reduced desire for social distance (B=-.11, SE=.05, p=.031). In turn, social distance is associated with higher worry of contracting HIV (B=.13, SE=.03, p<.001), more infection precaution measures (B=.05, SE=.02, p=.029), more stigmatizing opinions about PWH (B=.12, SE=.04, p=.005), and unwillingness to provide services to marginalized groups, including men who have sex with men, transgender individuals, sex workers, and migrants (B=.19, SE=.06, p=.001).
Conclusions: Tailored interventions that enhance HIV knowledge and increase empathy and thus reduce desire for social distance from PWH in HCPs could effectively reduce HCPs’ HIV stigmatizing attitudes and potentially improve care outcomes for PWH. Interventions should address both cognitive (knowledge) and affective (empathy, social distance) components to improve provider-patient interactions in HIV care.
Keywords: HIV, Public healthMethods: HCP data from two clinics in the Dominican Republic (ClinicalTrials.gov ID: NCT04491539) were evaluated. Inclusion criteria were: age 18+, 4+ weekly hours of PWH care, proficiency in Spanish, and ability to provide informed consent. Data from four time points (N=265) were used, acknowledging the possibility of non-independent observations. We conducted serial mediation models using the SPSS Process macro, where the relationship between HIV knowledge and stigma toward PWH among HCPs is mediated through first empathy and then desire for social distance from PWH.
Results: HCPs had a mean age of 43.29 years (SD=12.09). Most participants (81.5%) identified as non-male; 95.1% identified as heterosexual, and 73.3% as multi-racial. Serial mediation models revealed significant indirect effects, indicating that higher HIV knowledge links to greater empathy toward PWH (B=1.86, SE=.33, p<.001), leading to reduced desire for social distance (B=-.11, SE=.05, p=.031). In turn, social distance is associated with higher worry of contracting HIV (B=.13, SE=.03, p<.001), more infection precaution measures (B=.05, SE=.02, p=.029), more stigmatizing opinions about PWH (B=.12, SE=.04, p=.005), and unwillingness to provide services to marginalized groups, including men who have sex with men, transgender individuals, sex workers, and migrants (B=.19, SE=.06, p=.001).
Conclusions: Tailored interventions that enhance HIV knowledge and increase empathy and thus reduce desire for social distance from PWH in HCPs could effectively reduce HCPs’ HIV stigmatizing attitudes and potentially improve care outcomes for PWH. Interventions should address both cognitive (knowledge) and affective (empathy, social distance) components to improve provider-patient interactions in HIV care.
Authors:
Presenter - Ibrahim Yigit,
Florida State University
Co-Author - Robert Paulino-Ramírez,
Universidad Iberoamericana (UNIBE)
Co-Author - John Waters,
Caribbean Vulnerable Communities Coalition (CVC)
Co-Author - Dustin M. Long,
Wake Forest University, School of Medicine, Biostatistics and Data Science
Co-Author - Janet M. Turan, PhD,
PhD,
University of Alabama at Birmingham
Co-Author - Henna Budhwani, PhD, MPH,
PhD, MPH,
Florida State University
E194 - Barriers and Bridges: A Qualitative Analysis of PrEP Use Among Heterosexual Men within Kenya’s Fishing Communities
Poster Number: E194Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Social and Environmental Context and Health
Kenya’s fishing communities bear a disproportionate burden of the new HIV cases compared to the rest of the country. As a result, targeted interventions have been formulated to increase access to HIV prevention within fishing communities located in this region and mobile fishermen residing in these communities are a priority population. We conducted a qualitative analysis to examine barriers and facilitators to PrEP use among mobile fishermen residing in high HIV prevalence fishing communities in Western Kenya.
A qualitative study was conducted within the Owete trial, a RCT of a social network-based intervention to promote HIV testing and linkage to HIV services. Investigators conducted in-depth interviews (IDIs) with fishermen residing in 3 fishing communities in Siaya County, Kenya. Fishermen were interviewed at 3 time points: baseline (n=64), 3-mo (n=64), 6-mo (n=62). A 9-person team developed and applied inductive codes to transcript data and used a framework analysis approach for derivation of major themes. Additionally, a thematic analysis of experiences with PrEP use at 6-month follow-up was conducted using close data review, memoing, and synthesis of emergent themes.
Of 62 IDI participants, 15 reported current use of PrEP at 6-mo follow-up. Several factors emerged as highly influential for continued PrEP use: peer support and seeing other respected men in the community discuss and use PrEP helped to motivate and normalize PrEP use. Anticipated relationship conflict was a barrier to PrEP use: men reported fears that their romantic partners would assume infidelity or confuse PrEP medication with ART, leading some men to feel it was necessary to hide daily medication. Men felt that heavy alcohol use was an obstacle to regularly taking PrEP, as it contributed to forgetting to take medication and being unable to pick up medication. The mobile nature of work in fishing meant that fishermen had inconsistent access to home clinics to fill prescriptions. Finally, fishermen described their experiences with economic vulnerability and food insecurity, which made it difficult for them to prioritize HIV prevention, including PrEP use.
Factors such as social support, anticipated relationship conflict, economic vulnerability, mobility, and alcohol use appeared to impact PrEP use among Kenyan fishermen. These fishermen-specific barriers and facilitators can inform targeted interventions for PrEP use in this high-priority population.
Keywords: Prevention, Health behaviorsA qualitative study was conducted within the Owete trial, a RCT of a social network-based intervention to promote HIV testing and linkage to HIV services. Investigators conducted in-depth interviews (IDIs) with fishermen residing in 3 fishing communities in Siaya County, Kenya. Fishermen were interviewed at 3 time points: baseline (n=64), 3-mo (n=64), 6-mo (n=62). A 9-person team developed and applied inductive codes to transcript data and used a framework analysis approach for derivation of major themes. Additionally, a thematic analysis of experiences with PrEP use at 6-month follow-up was conducted using close data review, memoing, and synthesis of emergent themes.
Of 62 IDI participants, 15 reported current use of PrEP at 6-mo follow-up. Several factors emerged as highly influential for continued PrEP use: peer support and seeing other respected men in the community discuss and use PrEP helped to motivate and normalize PrEP use. Anticipated relationship conflict was a barrier to PrEP use: men reported fears that their romantic partners would assume infidelity or confuse PrEP medication with ART, leading some men to feel it was necessary to hide daily medication. Men felt that heavy alcohol use was an obstacle to regularly taking PrEP, as it contributed to forgetting to take medication and being unable to pick up medication. The mobile nature of work in fishing meant that fishermen had inconsistent access to home clinics to fill prescriptions. Finally, fishermen described their experiences with economic vulnerability and food insecurity, which made it difficult for them to prioritize HIV prevention, including PrEP use.
Factors such as social support, anticipated relationship conflict, economic vulnerability, mobility, and alcohol use appeared to impact PrEP use among Kenyan fishermen. These fishermen-specific barriers and facilitators can inform targeted interventions for PrEP use in this high-priority population.
Authors:
Author - Swetha Mukalel,
University of California San Francisco
Author - Holly Nishimura,
PhD, MPH,
University of California San Francisco
Author - Sarah Gutin,
PhD,
University of California San Francisco
Author - Phoebe Olugo,
Impact Research and Development Organisation
Author - Jayne Lewis-Kulzer,
MPH,
University of California San Francisco
Author - Zachary Kwena,
PhD, MA,
Kenya Medical Research Institute
Author - Marguerite Thorpe,
MD,
University of California Los Angeles
Author - Carol Camlin,
PhD, MPH (Co-Senior Author),
University of California San Francisco
Author - Kawango Agot,
PhD (Co-Senior Author),
Impact Research and Development Organisation
E195 - Willingness to use Long-Acting Injectable Pre-Exposure Prophylaxis (LAI-PrEP) by Delivery Modality among Hispanic/Latino Sexual Minority Men
Poster Number: E195Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Health of Marginalized Populations
Background: There is limited understanding of the preferences and demand for long-acting injectable pre-exposure prophylaxis (LAI-PrEP) among Hispanic/Latino sexual minority men (HLSMM), a group with unwavering HIV incidence rates over the past 13 years. This study investigates how preferences for LAI-PrEP injection settings and providers cluster and how these preferences relate to willingness to use LAI-PrEP among HLSMM.
Methods: Data were obtained from a longitudinal observational cohort study of cisgender sexual minority men ages 18-45 who were in romantic or sexual relationships with other cisgender men and resided in the US Ending the HIV Epidemic priority jurisdictions. Secondary data analysis focused on baseline data of a subsample of 115 HLSMM, using principal component analysis (PCA) to identify how preferences for LAI-PrEP injection settings and providers group together. Hierarchical regression, adjusting for sociodemographic variables, assessed how these preference clusters relate to overall willingness to use LAI-PrEP.
Results: PCA identified two main factors: (1) a preference for LAI-PrEP in traditional medical settings with medical professionals, termed “Professional and Clinical” contexts, and (2) a preference for LAI-PrEP in non-traditional settings with paraprofessionals or nonprofessionals, termed “Non-Professional and Non-Clinical” contexts. Regression analysis indicated that a preference to receive LAI-PrEP by Non-Professional and Non-Clinical settings was associated with greater willingness to use LAI-PrEP, whereas preferences for Professional and Clinical settings did not show a significant association.
Conclusion: Offering LAI-PrEP in non-traditional settings may be crucial for improving uptake and retention among HLSMM. These findings highlight the importance of providing LAI-PrEP through diverse venues to better address the needs of HLSMM and enhance their access to HIV prevention.
Keywords: HIV, PreventionMethods: Data were obtained from a longitudinal observational cohort study of cisgender sexual minority men ages 18-45 who were in romantic or sexual relationships with other cisgender men and resided in the US Ending the HIV Epidemic priority jurisdictions. Secondary data analysis focused on baseline data of a subsample of 115 HLSMM, using principal component analysis (PCA) to identify how preferences for LAI-PrEP injection settings and providers group together. Hierarchical regression, adjusting for sociodemographic variables, assessed how these preference clusters relate to overall willingness to use LAI-PrEP.
Results: PCA identified two main factors: (1) a preference for LAI-PrEP in traditional medical settings with medical professionals, termed “Professional and Clinical” contexts, and (2) a preference for LAI-PrEP in non-traditional settings with paraprofessionals or nonprofessionals, termed “Non-Professional and Non-Clinical” contexts. Regression analysis indicated that a preference to receive LAI-PrEP by Non-Professional and Non-Clinical settings was associated with greater willingness to use LAI-PrEP, whereas preferences for Professional and Clinical settings did not show a significant association.
Conclusion: Offering LAI-PrEP in non-traditional settings may be crucial for improving uptake and retention among HLSMM. These findings highlight the importance of providing LAI-PrEP through diverse venues to better address the needs of HLSMM and enhance their access to HIV prevention.
Authors:
Presenter - Stephen Ramos,
PhD,
University of California, San Bernardino
Co-Author - Glenn Wagner,
PhD,
RAND
Co-Author - Daniel Siconolfi,
PhD,
RAND
Co-Author - Keith Horvath,
PhD,
San Diego State University
Co-Author - Erik Storholm,
PhD,
San Diego State Univeristy
E196 - Identifying Inclusive Terms for Primary Care Team Members
Poster Number: E196Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Decision Making
Introduction. Efforts to increase vaccine uptake through approaches such as standing orders, patient communication training, and use of vaccine champions involve the whole primary care team. To support these whole-team approaches, we sought to identify inclusive terms for primary care team members involved in vaccination.
Methods. Participants were a national sample of 2,527 US primary care professionals who: 1) had a role in human papillomavirus (HPV) vaccination for children ages 9-12 years; 2) were a physician, physician assistant (PA), advanced practice nurse (APN), including clinical nursing specialist and nurse practitioner, registered nurse (RN), licensed practical/vocational nurse (LPN/LVN), medical assistant (MA), or certified nursing assistant (CNA); 3) specialized in pediatrics, family medicine, or general medicine or worked in a clinic with one of those specialties. We randomized participants to one of nine terms describing clinical roles (e.g., “provider”, “clinician”, “clinical staff”, “nursing staff”). The survey assessed the applicability of terms and preference for terms. Applicability refers to the general endorsement of terms to describe different roles in vaccination (e.g., “provider”, “clinician”) for different trainings (e.g., physician, PA, APN). Preference reflects personal choice for terms based on individual training.
Results. No single term adequately represented all clinical roles, but “provider” and “nursing staff” performed well together. Most participants endorsed “provider” (99%), “clinician” (98%), and “vaccine prescribers” (96%) for physicians. “Provider” (86%) and “advanced practitioner” (86%) were the most common terms for PAs or APNs. For their own roles, “provider” was the most preferred term among physicians (87%), and second most preferred among PAs or APNs (68%). Most respondents endorsed “nursing staff” for nurses (91%). Similarly, to describe themselves, most nurses preferred “nursing staff” (97%).
Conclusion. Quality improvement efforts engaging the entire primary care team may benefit from using “providers” and “nursing staff.” Simplifying references to primary care professionals involved in vaccine delivery may improve training, make educational materials more user-friendly, and support work in interprofessional education, ultimately improving vaccine delivery. Our findings support “provider” as preferred and endorsed term, contrasting with a view discouraging its use.
Keywords: Health promotion, Public healthMethods. Participants were a national sample of 2,527 US primary care professionals who: 1) had a role in human papillomavirus (HPV) vaccination for children ages 9-12 years; 2) were a physician, physician assistant (PA), advanced practice nurse (APN), including clinical nursing specialist and nurse practitioner, registered nurse (RN), licensed practical/vocational nurse (LPN/LVN), medical assistant (MA), or certified nursing assistant (CNA); 3) specialized in pediatrics, family medicine, or general medicine or worked in a clinic with one of those specialties. We randomized participants to one of nine terms describing clinical roles (e.g., “provider”, “clinician”, “clinical staff”, “nursing staff”). The survey assessed the applicability of terms and preference for terms. Applicability refers to the general endorsement of terms to describe different roles in vaccination (e.g., “provider”, “clinician”) for different trainings (e.g., physician, PA, APN). Preference reflects personal choice for terms based on individual training.
Results. No single term adequately represented all clinical roles, but “provider” and “nursing staff” performed well together. Most participants endorsed “provider” (99%), “clinician” (98%), and “vaccine prescribers” (96%) for physicians. “Provider” (86%) and “advanced practitioner” (86%) were the most common terms for PAs or APNs. For their own roles, “provider” was the most preferred term among physicians (87%), and second most preferred among PAs or APNs (68%). Most respondents endorsed “nursing staff” for nurses (91%). Similarly, to describe themselves, most nurses preferred “nursing staff” (97%).
Conclusion. Quality improvement efforts engaging the entire primary care team may benefit from using “providers” and “nursing staff.” Simplifying references to primary care professionals involved in vaccine delivery may improve training, make educational materials more user-friendly, and support work in interprofessional education, ultimately improving vaccine delivery. Our findings support “provider” as preferred and endorsed term, contrasting with a view discouraging its use.
Authors:
Author - Aditi Tomar,
Univeristy of North Carolina
Co-Author - Benjamin Z. Kahn,
Univeristy of North Carolina
Co-Author - Melissa B. Gilkey, PhD,
PhD,
Univeristy of North Carolina
Co-Author - William A. Calo, PhD, JD,
PhD, JD,
Penn State College of Medicine
Co-Author - Katherine I. Kritikos,
University of North Carolina
Co-Author - Noel T. Brewer, PhD,
PhD,
University of North Carolina
E197 - Cervical Cancer Screening and HPV Vaccination Barriers in the Caribbean: A Qualitative Study
Poster Number: E197Time: 05:00 PM - 05:50 PM
Topics: Cancer, Women's Health
Significance: Cervical cancer (CCA) is the second most common and deadly cancer, among women in regions of the Americas; namely the Caribbean, having some of the greatest burden. Despite being highly preventable through HPV vaccination and screening, these preventive practices lack adequate uptake due to multilevel factors including stigma. Stigma is highly prevalent especially in the Caribbean region and may affect preventative behaviors such as screening and vaccination. The study’s aim was to understand cervical cancer stigma and barriers to screening and vaccination in Grenada and Trinidad and Tobago.
Methods: A qualitative study was conducted utilizing focus groups. Six focus groups were conducted with clinicians and women using a semi-structured guide assessing barriers to screening and HPV vaccination. The focus groups were audio-recorded and transcribed verbatim using MAXQDA. Thematic analysis was used to analyze the data.
Results: The study revealed several key barriers to HPV vaccination including misinformation and a lack of knowledge about the vaccine’s safety and efficacy. Parents felt that the vaccine was unnecessary if their daughters were not sexually active. Additionally, parents were unaware that the vaccine was available for male adolescents. Barriers to CCA screening included uncomfortable and painful Pap smears. Women reported delays in obtaining the results of the Pap smears. Many of the women felt that information on breast cancer were more readily available than CCA. Women believed that the stigma surrounding cervical stigma was still prevalent. The stigma resulted from the beliefs that CCA was caused by being promiscuous and having multiple partners. Many participants had limited knowledge of the role of HPV vaccination in preventing CCA.
Discussion: These findings reveal persistent stigma associated with CCA. Consequently, behavioral medicine strategies to combat CCA ought to incorporate stigma-focused interventions. It is essential to emphasize that CCA is common yet highly treatable and even curable when detected at the precancerous or early stages. Importantly, interventions must tackle both stigma and misinformation. Addressing the root causes of vaccine hesitancy, such as access to accurate information is crucial to improving vaccination rates. Furthermore, these results underscore the urgent need for prioritizing HPV vaccination and screening, while reducing stigma, to reduce premature deaths among Caribbean populations.
Keywords: Women's health, Cancer screeningMethods: A qualitative study was conducted utilizing focus groups. Six focus groups were conducted with clinicians and women using a semi-structured guide assessing barriers to screening and HPV vaccination. The focus groups were audio-recorded and transcribed verbatim using MAXQDA. Thematic analysis was used to analyze the data.
Results: The study revealed several key barriers to HPV vaccination including misinformation and a lack of knowledge about the vaccine’s safety and efficacy. Parents felt that the vaccine was unnecessary if their daughters were not sexually active. Additionally, parents were unaware that the vaccine was available for male adolescents. Barriers to CCA screening included uncomfortable and painful Pap smears. Women reported delays in obtaining the results of the Pap smears. Many of the women felt that information on breast cancer were more readily available than CCA. Women believed that the stigma surrounding cervical stigma was still prevalent. The stigma resulted from the beliefs that CCA was caused by being promiscuous and having multiple partners. Many participants had limited knowledge of the role of HPV vaccination in preventing CCA.
Discussion: These findings reveal persistent stigma associated with CCA. Consequently, behavioral medicine strategies to combat CCA ought to incorporate stigma-focused interventions. It is essential to emphasize that CCA is common yet highly treatable and even curable when detected at the precancerous or early stages. Importantly, interventions must tackle both stigma and misinformation. Addressing the root causes of vaccine hesitancy, such as access to accurate information is crucial to improving vaccination rates. Furthermore, these results underscore the urgent need for prioritizing HPV vaccination and screening, while reducing stigma, to reduce premature deaths among Caribbean populations.
Authors:
Presenter - Kimlin Tam Ashing, PhD,
PhD,
City of Hope
Co-Author - Kamilah Thomas-Purcell,
PhD,
Nova Southeastern University
Co-Author - Gaole Song, DrPH,
DrPH,
Beckman Research Institute, City of Hope Comprehensive Cancer Center
Co-Author - Diadrey-Anne Sealy,
PhD,
Loma Linda
E198 - MindfulT1D: A pilot and feasibility study of a compassion-based virtual group program for adults with type 1 diabetes (T1D)
Poster Number: E198Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Quality of Life
Background: The burden of T1D management coupled with constant data and alerts from diabetes devices (e.g., continuous glucose monitors, or CGM) can exacerbate diabetes distress (DD) in people living with T1D. Increasing self-compassion, which encompasses self-kindness, mindfulness, and common humanity, may reduce DD; however, few studies have applied compassion-based approaches to address DD in adults with T1D. The goals of this pilot study were to determine feasibility, acceptability, and preliminary impact of a brief compassion-based group intervention diabetes and psychosocial outcomes among adults with T1D.
Methods: Adult (18+ years) CGM users with T1D and elevated DD were invited to attend 3 weekly 75-minute virtual group classes via a HIPAA-compliant program. Data collection included pre- and post-intervention CGM data downloads and self-report surveys (T1-Diabetes Distress Assessment System; Diabetes Self-Compassion Scale; satisfaction survey) and post-intervention focus groups. Data were analyzed using Wilcoxon signed-rank tests. Focus group data were analyzed using thematic analysis.
Results: Twenty-four adults participated (age 42.4±15 years; diabetes duration 27.3±13 years; 67% female; 58% White, 21% Asian, 8% Hispanic, 4% Black; 83% insulin pump use, 79% closed loop system use; time between 70-180 mg/dL 72.2±.11%). MindfulT1D demonstrated acceptability and a high rate of retention with 83% attending all classes and 96% attending 2 classes. Moderate-to-large effect sizes were found for reduced core diabetes distress (p=.017, r=-.49), management difficulties (p=.03, r=-.44), technology challenges (p=.002, r=-.62), and increased diabetes self-compassion (p=.045, r=.41). Participants said they valued the T1D-centered approach to self-compassion, having a group facilitator who also lived with T1D, and the group format. Suggestions for improvement included having >3 classes with shorter duration (<60 minutes) to reinforce practices. Several wanted their diabetes care providers to incorporate compassion-based practices into clinical care. Most (92%) said they would recommend the program to others.
Conclusions: Findings show evidence of feasibility, acceptability, and preliminary efficacy of MindfulT1D for reducing DD in adults with T1D who use CGM. Further research is needed on MindfulT1D in a larger, more heterogenous sample, including those on multiple daily injections and with less time in glucose target range, over a longer period.
Keywords: Diabetes, MindfulnessMethods: Adult (18+ years) CGM users with T1D and elevated DD were invited to attend 3 weekly 75-minute virtual group classes via a HIPAA-compliant program. Data collection included pre- and post-intervention CGM data downloads and self-report surveys (T1-Diabetes Distress Assessment System; Diabetes Self-Compassion Scale; satisfaction survey) and post-intervention focus groups. Data were analyzed using Wilcoxon signed-rank tests. Focus group data were analyzed using thematic analysis.
Results: Twenty-four adults participated (age 42.4±15 years; diabetes duration 27.3±13 years; 67% female; 58% White, 21% Asian, 8% Hispanic, 4% Black; 83% insulin pump use, 79% closed loop system use; time between 70-180 mg/dL 72.2±.11%). MindfulT1D demonstrated acceptability and a high rate of retention with 83% attending all classes and 96% attending 2 classes. Moderate-to-large effect sizes were found for reduced core diabetes distress (p=.017, r=-.49), management difficulties (p=.03, r=-.44), technology challenges (p=.002, r=-.62), and increased diabetes self-compassion (p=.045, r=.41). Participants said they valued the T1D-centered approach to self-compassion, having a group facilitator who also lived with T1D, and the group format. Suggestions for improvement included having >3 classes with shorter duration (<60 minutes) to reinforce practices. Several wanted their diabetes care providers to incorporate compassion-based practices into clinical care. Most (92%) said they would recommend the program to others.
Conclusions: Findings show evidence of feasibility, acceptability, and preliminary efficacy of MindfulT1D for reducing DD in adults with T1D who use CGM. Further research is needed on MindfulT1D in a larger, more heterogenous sample, including those on multiple daily injections and with less time in glucose target range, over a longer period.
Authors:
Presenter - Molly Tanenbaum,
Stanford University School of Medicine
Co-Author - Brooke Cassoff,
DiabetesSangha
Co-Author - Mabelle Pasmooij,
Stanford University School of Medicine
Co-Author - Chloe Kaelberer,
University of North Dakota School of Medicine & Health Sciences
Co-Author - Kathleen Judge,
ACNS-BC, CDCES,
Stanford Medicine
Co-Author - Sarah Hanes,
Stanford University School of Medicine
Co-Author - Himani Darji,
Stanford University School of Medicine
Co-Author - Modupe Osikomaiya,
Stanford University School of Medicine
Co-Author - Marina Basina,
MD,
Stanford University School of Medicine
E199 - Diabetes-Related Family Conflict and Glycemic Outcomes in the Context of Adolescents’ Behavior Problems
Poster Number: E199Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Child and Family Health
Introduction
Previous research on children and adolescents with T1D has shown important connections between child behavior and glycemic outcomes. Specifically, attention problems and externalizing behaviors have been linked to lower levels of diabetes self-management and higher HbA1c. It is unknown if these behaviors also lead to increased diabetes-related family conflict, which negatively impacts outcomes in adolescents with T1D. The current study aimed to understand the associations between these factors and how they may affect diabetes management and glycemic outcomes.
Methods
151 adolescents with T1D ages 11-17 (55% female, age 14.0±2.0 years, 83% non-Hispanic white, mean HbA1c=9.1%±2.1) and their female caregivers were enrolled in a randomized clinical trial of an intervention for distressed caregivers. At baseline, caregivers completed the Child Behavior Checklist (CBCL), which assessed externalizing problems and attention problems, and the Diabetes Family Conflict Scale (DFCS), which assessed familial conflict related to diabetes care. Adolescents' HbA1c values were extracted from medical records.
Results
Adolescents with borderline-clinical and clinically significant T-scores in attention problems and externalizing problems on the CBCL (>64) comprised 25% and 16% of our sample, respectively, despite only 7% of the national population scoring in this range. Higher levels of attention problems (r=.26, p=.002) and externalizing problems (r=.45, p<.001) were significantly associated with greater family conflict. After adjusting for adolescent age, sex, and caregivers’ marital status, multivariable linear regressions indicated that attention problems (B=.27, p=.001) and externalizing problems (B=.46, p<.001) were significant predictors of DFCS scores. Further, DFCS was a significant predictor of HbA1c (B=.38, p<.001).
Conclusion
Behavior problems can play an important role in the context of how families manage their child's diabetes, especially in samples such as ours, where caregivers reported distress and most adolescents were not meeting glycemic targets. Our findings suggest that adolescents with significant attention and externalizing behavior problems may be at increased risk for diabetes-related family conflict, which can significantly affect their HbA1c. This analysis demonstrates the importance of understanding adolescents’ diabetes management and glycemic outcomes in the context of behavioral challenges and their impact on the family.
Keywords: Adolescents, FamilyPrevious research on children and adolescents with T1D has shown important connections between child behavior and glycemic outcomes. Specifically, attention problems and externalizing behaviors have been linked to lower levels of diabetes self-management and higher HbA1c. It is unknown if these behaviors also lead to increased diabetes-related family conflict, which negatively impacts outcomes in adolescents with T1D. The current study aimed to understand the associations between these factors and how they may affect diabetes management and glycemic outcomes.
Methods
151 adolescents with T1D ages 11-17 (55% female, age 14.0±2.0 years, 83% non-Hispanic white, mean HbA1c=9.1%±2.1) and their female caregivers were enrolled in a randomized clinical trial of an intervention for distressed caregivers. At baseline, caregivers completed the Child Behavior Checklist (CBCL), which assessed externalizing problems and attention problems, and the Diabetes Family Conflict Scale (DFCS), which assessed familial conflict related to diabetes care. Adolescents' HbA1c values were extracted from medical records.
Results
Adolescents with borderline-clinical and clinically significant T-scores in attention problems and externalizing problems on the CBCL (>64) comprised 25% and 16% of our sample, respectively, despite only 7% of the national population scoring in this range. Higher levels of attention problems (r=.26, p=.002) and externalizing problems (r=.45, p<.001) were significantly associated with greater family conflict. After adjusting for adolescent age, sex, and caregivers’ marital status, multivariable linear regressions indicated that attention problems (B=.27, p=.001) and externalizing problems (B=.46, p<.001) were significant predictors of DFCS scores. Further, DFCS was a significant predictor of HbA1c (B=.38, p<.001).
Conclusion
Behavior problems can play an important role in the context of how families manage their child's diabetes, especially in samples such as ours, where caregivers reported distress and most adolescents were not meeting glycemic targets. Our findings suggest that adolescents with significant attention and externalizing behavior problems may be at increased risk for diabetes-related family conflict, which can significantly affect their HbA1c. This analysis demonstrates the importance of understanding adolescents’ diabetes management and glycemic outcomes in the context of behavioral challenges and their impact on the family.
Authors:
Author - Charity Davis,
B.A.,
Vanderbilt University Medical Center
Co-Author - Tabitha McCarty,
B.S.,
Vanderbilt University Medical Center
Co-Author - Sarah S. Jaser,
PhD,
Vanderbilt University Medical Center
E200 - Sleep characteristics, subjective cognitive complaints, and hemoglobin A1c among U.S. adults with diabetes
Poster Number: E200Time: 05:00 PM - 05:50 PM
Topics: Sleep, Diabetes
Background: Suboptimal sleep and cognitive dysfunction are independently associated with poorer glycemic management in adults with diabetes. No research has examined whether their co-occurrence further undermines an individual’s ability to engage in the complex behaviors required to manage diabetes. Thus, our aim was to examine whether the association of suboptimal sleep and hemoglobin A1c (HbA1c) differs by cognitive status in this population.
Methods: We included 2,177 adults with self-reported diabetes and complete data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 cycles. Primary sleep exposures were self-reported sleep duration (SD) on week/work-days (categorized as: <5, 5-to-<7, 7-to-<9, and ≥9 hours) and trouble sleeping (yes/no; ever reported trouble sleeping to doctor). Subjective cognitive complaints (yes/no; feeling limited by difficulty remembering or experiencing periods of confusion) were used as a proxy for cognitive dysfunction. Separate multivariable linear regression models with progressive adjustment were used to examine associations of each sleep exposure (SD or trouble sleeping) with HbA1c, and to examine potential interactions between each sleep exposure x cognitive complaints (M1: demographics; M2: M1 + depressive symptoms, body mass index, and diabetes medication; M3: M2 + alcohol and carbohydrate intake; M4: M3 + interaction term).
Results: Among respondents (mean age 62 years, 47% female, 65% non-white), 47%, 5%, 29%, and 19% had SDs <5, 5-to-<7, 7-to-<9, and ≥9, respectively, 41% had trouble sleeping, and 15% had cognitive complaints. SD was not associated with HbA1 in M1 (ps≥.1432). However, SD<5 was marginally associated with higher HbA1c (M3: b=.424, SE=.237, p=.078) and SD≥9 was significantly associated with lower HbA1c (M3: b=-.196, SE=.087, p=.028) compared to SD 7-to-<9 in M2-M3. Trouble sleeping was significantly associated with lower HbA1c in M1-M3 (M3: b=-.256, SE=.105, p=.018) compared to no trouble sleeping. When adding the interaction term to M4, no evidence of effect measure modification was observed for SD x cognitive complaints (p=.463) or trouble sleeping x cognitive complaints (p=.728).
Conclusion: Among adults with diabetes, very short sleep duration was marginally associated with higher HbA1c while long sleep duration and trouble sleeping were unexpectedly associated with lower HbA1c. Results did not differ between those with and without subjective cognitive complaints.
Keywords: Abnormal sleep, DiabetesMethods: We included 2,177 adults with self-reported diabetes and complete data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 cycles. Primary sleep exposures were self-reported sleep duration (SD) on week/work-days (categorized as: <5, 5-to-<7, 7-to-<9, and ≥9 hours) and trouble sleeping (yes/no; ever reported trouble sleeping to doctor). Subjective cognitive complaints (yes/no; feeling limited by difficulty remembering or experiencing periods of confusion) were used as a proxy for cognitive dysfunction. Separate multivariable linear regression models with progressive adjustment were used to examine associations of each sleep exposure (SD or trouble sleeping) with HbA1c, and to examine potential interactions between each sleep exposure x cognitive complaints (M1: demographics; M2: M1 + depressive symptoms, body mass index, and diabetes medication; M3: M2 + alcohol and carbohydrate intake; M4: M3 + interaction term).
Results: Among respondents (mean age 62 years, 47% female, 65% non-white), 47%, 5%, 29%, and 19% had SDs <5, 5-to-<7, 7-to-<9, and ≥9, respectively, 41% had trouble sleeping, and 15% had cognitive complaints. SD was not associated with HbA1 in M1 (ps≥.1432). However, SD<5 was marginally associated with higher HbA1c (M3: b=.424, SE=.237, p=.078) and SD≥9 was significantly associated with lower HbA1c (M3: b=-.196, SE=.087, p=.028) compared to SD 7-to-<9 in M2-M3. Trouble sleeping was significantly associated with lower HbA1c in M1-M3 (M3: b=-.256, SE=.105, p=.018) compared to no trouble sleeping. When adding the interaction term to M4, no evidence of effect measure modification was observed for SD x cognitive complaints (p=.463) or trouble sleeping x cognitive complaints (p=.728).
Conclusion: Among adults with diabetes, very short sleep duration was marginally associated with higher HbA1c while long sleep duration and trouble sleeping were unexpectedly associated with lower HbA1c. Results did not differ between those with and without subjective cognitive complaints.
Authors:
Author - Brittanny M Polanka,
PhD,
Univeristy of Alabama at Birmingham School of Medicine
Co-Author - Loretta Hsueh,
PhD,
University of Illinois at Chicago
Co-Author - Tiwaloluwa A Ajibewa,
PhD,
Northwestern University Feinberg School of Medicine
Co-Author - Kristen Allen-Watts,
PhD, MPH,
University of Alabama at Birmingham School of Medicine
Co-Author - Amber W Kinsey,
PhD,
University of Alabama at Birmingham School of Medicine
Co-Author - Andrea L Cherrington,
MD,
University of Alabama at Birmingham School of Medicine
Co-Author - S Justin Thomas,
PhD,
University of Alabama at Birmingham School of Medicine
E201 - Stigmatized Grief: How Families of People Who Died from Accidental Overdose Experience Loss
Poster Number: E201Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Substance Misuse
Introduction: Nearly 75,000 people died from an accidental opioid overdose in the U.S. in 2023. Grieving the loss of a loved one can result in an array of emotions, including sadness, anger, and hopelessness. However, family members grieving a socially stigmatized death of a loved one, like an accidental overdose, may experience grief differently. The current study examines experiences of stigmatized grief in family members who lost a loved one to an accidental opioid overdose.
Methods: Between January and June 2024, 29 family members of people who died from an accidental opioid overdose were interviewed. Interviews were conducted in the context of a statewide substance use disorder stigma reduction campaign in Pennsylvania. Qualitative analysis was conducted with NVivo. The analysis utilized inductive and deductive coding approaches, exploring both implicit and explicit content.
Results: The majority of participants identified as female (n=26) and White, non-Hispanic (n=25). Most participants were parents (n=21), four were siblings, three were children, and one was a cousin. Over half (n=16) represented urban counties. Like those who experience non-stigmatized grief, participants described emotional (e.g., anger, anxiety) and physical (e.g., insomnia, weight fluctuations) reactions to grief. Participants further described experiencing judgment, shame, and blame when openly grieving their loved ones. During interactions with first responders, healthcare providers, and friends and family, participants were told their loved ones’ deaths were not a priority or were blamed outright for their loved ones’ deaths. Participants internalized stigmatizing experiences and blamed themselves for their loved ones’ deaths. Coping strategies included employing secrecy about their loved one’s death and socially isolating as they grieved. Participants also discussed the use of stigmatizing language when referring to accidental overdose and advocated for change (i.e., replacing overdose with poisoning).
Conclusions: Results suggest that family members experienced stigmatized grief when they lost a loved one to an accidental overdose. Experiences of stigma prolonged the grief process for participants and resulted in additional pain and shame specific to how their loved ones died. There is an urgent need to address the barriers to seeking help (e.g., stigma, financial burden, lack of knowledge) and increase support for families at the individual and community levels.
Keywords: Substance abuse, FamilyMethods: Between January and June 2024, 29 family members of people who died from an accidental opioid overdose were interviewed. Interviews were conducted in the context of a statewide substance use disorder stigma reduction campaign in Pennsylvania. Qualitative analysis was conducted with NVivo. The analysis utilized inductive and deductive coding approaches, exploring both implicit and explicit content.
Results: The majority of participants identified as female (n=26) and White, non-Hispanic (n=25). Most participants were parents (n=21), four were siblings, three were children, and one was a cousin. Over half (n=16) represented urban counties. Like those who experience non-stigmatized grief, participants described emotional (e.g., anger, anxiety) and physical (e.g., insomnia, weight fluctuations) reactions to grief. Participants further described experiencing judgment, shame, and blame when openly grieving their loved ones. During interactions with first responders, healthcare providers, and friends and family, participants were told their loved ones’ deaths were not a priority or were blamed outright for their loved ones’ deaths. Participants internalized stigmatizing experiences and blamed themselves for their loved ones’ deaths. Coping strategies included employing secrecy about their loved one’s death and socially isolating as they grieved. Participants also discussed the use of stigmatizing language when referring to accidental overdose and advocated for change (i.e., replacing overdose with poisoning).
Conclusions: Results suggest that family members experienced stigmatized grief when they lost a loved one to an accidental overdose. Experiences of stigma prolonged the grief process for participants and resulted in additional pain and shame specific to how their loved ones died. There is an urgent need to address the barriers to seeking help (e.g., stigma, financial burden, lack of knowledge) and increase support for families at the individual and community levels.
Authors:
Presenter - Övgü Kaynak, PhD,
PhD,
Penn State Harrisburg
Co-Author - Nicole Sturges,
Penn State Harrisburg
Co-Author - Christopher Whipple,
PhD,
Penn State Harrisburg
Co-Author - Erica Saylor,
MPH,
Penn State Harrisburg
Co-Author - Weston Kensinger,
PhD,
Penn State Harrisburg
E202 - Sociodemographic Factors Influencing Parental Vaccine Barriers in Tennessee
Poster Number: E202Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Health of Marginalized Populations
Background: Routine Immunization is a critical public health intervention; however, various barriers prevent optimal vaccine uptake among children. In response, the University of Tennessee launched the Community Registered Nurse Navigator (CRNN) project to remove these barriers and increase vaccination uptake. This study investigates data from the CRNN project to examine the prevalence and characteristics of vaccine barriers among parents in Tennessee, with a focus on sociodemographic disparities.
Methods: This cross-sectional study analyzed data (N = 9,333) from the CRNN project, which includes community assessments of childhood vaccine-related barriers in Tennessee. Surveys were distributed to parents/caretaker of children under 18 years by 16 CRNNs at community events, with data collected between July 2022 and May 2024. The survey employed the validated Search for Hardships and Obstacles to Shots (SHOTS) survey. Descriptive statistics and logistic regression were used to examine the association between these barriers and up-to-date vaccination status, adjusting for potential confounders.
Results: The majority of participants were White (84.6%) and high school graduates (39.7%). The analysis revealed that racial/ethnic minority groups, particularly identified as "Other," reported the highest barrier scores across all categories (access, concern, and importance) with a total barrier score of 16.80 ± 20.18. Conversely, higher-income families and college graduates reported the lowest barrier scores of 8.85 ± 13.63 and 9.26 ± 13.31, respectively. Logistic regression revealed that the total concern barrier score of immunization (B = -0.085, OR = 0.918, 95% CI [0.907, 0.930], p < 0.001) and the total access barrier score of immunization (B = -0.011, OR = 0.989, 95% CI [0.978, 0.999], p < 0.05) were significantly associated with parental-reported up-to-date immunization status.
Conclusion: The study reveals significant sociodemographic disparities in vaccine barriers, with minority groups and lower-income families facing the highest challenges. Addressing immunization concern-related barriers and focusing on access-related interventions are crucial for improving vaccine coverage in Tennessee, particularly among vulnerable populations.
Keywords: Children's health, Health disparitiesMethods: This cross-sectional study analyzed data (N = 9,333) from the CRNN project, which includes community assessments of childhood vaccine-related barriers in Tennessee. Surveys were distributed to parents/caretaker of children under 18 years by 16 CRNNs at community events, with data collected between July 2022 and May 2024. The survey employed the validated Search for Hardships and Obstacles to Shots (SHOTS) survey. Descriptive statistics and logistic regression were used to examine the association between these barriers and up-to-date vaccination status, adjusting for potential confounders.
Results: The majority of participants were White (84.6%) and high school graduates (39.7%). The analysis revealed that racial/ethnic minority groups, particularly identified as "Other," reported the highest barrier scores across all categories (access, concern, and importance) with a total barrier score of 16.80 ± 20.18. Conversely, higher-income families and college graduates reported the lowest barrier scores of 8.85 ± 13.63 and 9.26 ± 13.31, respectively. Logistic regression revealed that the total concern barrier score of immunization (B = -0.085, OR = 0.918, 95% CI [0.907, 0.930], p < 0.001) and the total access barrier score of immunization (B = -0.011, OR = 0.989, 95% CI [0.978, 0.999], p < 0.05) were significantly associated with parental-reported up-to-date immunization status.
Conclusion: The study reveals significant sociodemographic disparities in vaccine barriers, with minority groups and lower-income families facing the highest challenges. Addressing immunization concern-related barriers and focusing on access-related interventions are crucial for improving vaccine coverage in Tennessee, particularly among vulnerable populations.
Authors:
Presenter - SANJAYA REGMI,
PhD, MPH,
University of Tennessee
Co-Author - Elizabeth Sowell,
University of Tennessee
Co-Author - Chenoa Allen,
PhD, MPH,
University of Tennessee Knoxville
Co-Author - Ben Jones,
University of Tennessee Knoxville
Co-Author - Nan M Gaylord,
University of Tennessee Knoxville
Co-Author - Victoria Niederhauser,
University of Tennessee Knoxville
E203 - Pregnancy inflammation mediates the relationship between paternal resilience resources and gestational length in married couples
Poster Number: E203Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Women's Health
Adverse birth outcomes including preterm birth and low birthweight can engender long-term developmental consequences for the health and wellbeing of infants. High inflammation among mothers during gestation is known to raise the risks for adverse birth outcomes and developmental adversities. However, research has rarely investigated whether psychological protective factors might decrease inflammation in pregnancy, and thereby indirectly reduce the risk of birth outcomes. In this study, we tested whether maternal and paternal protective factors conceptualized as resilience resources (social support, self-esteem, mastery, optimism) predict longer gestational length and higher birthweight through lower maternal C-Reactive Protein (CRP), and whether these effects varied by parental relationship status. Using a sample of 217 dyads from the Community Child Health Network study (CCHN), we tested a two-stage latent moderated-mediation model followed by a multigroup structural equation model. For married parental dyads, we found that paternal resilience resources predicted lower prenatal maternal CRP levels, which then predicted a longer gestational length. No significant relationships were found in the unmarried dyads whether they were cohabitating or not. This research suggests that resilience resources of fathers in married relationships may be protective for maternal-child health with many implications.
Keywords: Resilience resources, protective factors, preterm birth, paternal, relationship status
Keywords: Immune function, PregnancyKeywords: Resilience resources, protective factors, preterm birth, paternal, relationship status
Authors:
Presenter - Kavya Swaminathan,
MA,
University of California Merced
Co-Author - Christine Guardino,
PhD,
Stony Brook University
Co-Author - Christine Dunkel Schetter,
PhD,
University of California, Los Angeles
Co-Author - Haiyan Liu,
PhD,
University of California, Merced
Co-Author - Jennifer Hahn-Holbrook,
PhD,
University of California, Merced
E204 - Effects of Parenting Practices and Parent Perceived Stress on Adolescent Waist Circumference and Family Mealtime among African American Adolescents
Poster Number: E204Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Obesity
Family mealtime is a protective factor for adolescent health outcomes (e.g. well-being, diet quality); however, parent stress may diminish the frequency and quality of family meals and increase obesity risk through physiological (e.g., allostatic load) and behavioral (e.g., decreased physical activity (PA), obesogenic diet) pathways. Parenting factors, like responsive parenting (e.g., providing support for adolescent healthy eating) and feeding practices (e.g., parental monitoring - tracking adolescent diet), may mitigate the effects of parent stress by promoting adolescent behaviors (e.g., nutritious eating, increased PA) that are linked with healthier weight outcomes; however, few studies have examined this in African American (AA) families. Therefore, this study assesses the moderating effects of parenting factors on the relationship between parent stress and AA adolescent health outcomes (adolescent waist circumference, frequency and quality of family mealtime). Baseline data was used from 144 AA parent-adolescent dyads who participated in a weight-loss trial (Adolescent: Mage=12.9 years, SD=1.8; 63% female; MBMI%=96.7, SD=3.9). Adolescent waist circumference was measured using validated national guidelines for the “natural waist.” Adolescent-reported family mealtime frequency (meals per week) and quality (climate at meals), adolescent-reported parenting factors (e.g., responsiveness, monitoring, pressure-to-eat), and parent-reported parent perceived stress were assessed with scales validated in AAs. Hierarchical linear regressions revealed several main effects, such that higher parental responsiveness was associated with lower adolescent waist circumference (β =-4.99, SE=1.52, p<.05), while higher parental monitoring was associated with higher adolescent waist circumference (β=4.65, SE=1.55, p<.01). Furthermore, higher parental pressure-to-eat was associated with lower frequency of mealtime (β=-0.47, SE=0.21, p=.028). Results also showed that higher parental responsiveness was associated with higher quality of family mealtime (β=0.36, SE=0.08, p<.001). No main effects of stress or two-way interactions were significant. Although parenting factors did not moderate the effect of stress on adolescent health outcomes, these findings suggest that responsive parenting is associated with beneficial family mealtime and adolescent weight outcomes, and that future family health interventions with AA adolescents should consider targeting parenting practices.
Keywords: Adolescents, HealthAuthors:
Presenter - Taylor White,
BS,
University of South Carolina
Co-Author - Dawn K. Wilson, PhD, FSBM,
University of South Carolina
Co-Author - Allison Sweeney,
PhD,
University of South Carolina
Co-Author - M. Lee Van Horn,
PhD,
University of New Mexico
Poster Session E
Description
Date: 3/28/2025
Start: 5:00 PM
End: 5:50 PM
Location: Grand Ballroom A-B