Live Research Spotlight 4: Health of Marginalized Populations

The role affective states play in disordered eating is often studied to evaluate emotion regulation models of eating disorders. Despite evidence disordered eating is common among young sexual minority women, no studies have used ecological momentary assessment to assess affect preceding and following disordered eating among this vulnerable population. The present study addresses this gap by assessing negative affect (NA), positive affect (PA) and disordered eating (overeating, loss of control eating, emotional eating, dietary restraint, skipping meals for weight/shape) 5 times per day for 2 weeks among 145 sexual minority and 151 heterosexual cisgender women who binge eat (Mage=25.3, MBMI=29.3, 58% White). Concurrent and time-lagged multilevel models of affect-disordered eating associations were conducted with sexual orientation as a moderator. Analyses examining affect preceding eating showed for all women, higher NA was associated with a greater likelihood of emotional eating and skipping meals the next several hours. Higher PA was associated with a lower likelihood of subsequent overeating and emotional eating for all women, and lower likelihood of loss of control eating and dietary restraint for heterosexual women only. Analyses of affect following eating behaviors showed NA was higher following overeating, emotional eating, and skipping meals for all women, and higher following loss of control eating for heterosexual women only. PA was higher for all women following times when they did not engage in emotional eating. In sum, sexual minority and heterosexual women generally showed similar affect-disordered eating patterns, but several critical differences were found. Experiencing higher PA reduced subsequent loss of control eating and dietary restraint for heterosexual women only, suggesting sexual minority women may not experience the same protective benefits of PA. Heterosexual (but not sexual minority) women also experienced higher NA following loss of control eating, suggesting differential community norms may influence affective responses to disordered eating. Findings highlight a need to better understand disordered eating in daily life among sexual minority women. Future research considering how unique sociocultural pressures (e.g., heterosexist discrimination, community norms) impact sexual minority women could improve understanding of their disordered eating, and inform culturally tailored interventions for this at-risk and understudied group.

Presenter - Kristin Heron, Ph.D.,
Old Dominion University

Co-Author - Jennifer Shipley, Ph.D.,
Old Dominion University

Co-Author - Cassidy Sandoval, Ph.D.,
Appalachian State University

Co-Author - Emily Panza, PhD, Ph.D.,
Brown University

Co-Author - Meredith Turner, M.S.,
Virginia Consortium Program in Clinical Psychology

Co-Author - Sage Hawn, Ph.D.,
Old Dominion University

Co-Author - Abby Braitman, Ph.D.,
Old Dominion University

Background: The Tough Talks COVID (TT-C) study was a randomized controlled trial of a digital health intervention (DHI) designed to empower Black young adults (YA) in the US South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines. We aimed to identify subgroups of Black YA for whom the TT-C DHI was most impactful.

Methods: Black YA aged 18-29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on baseline general vaccine attitudes including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic and linear regression were used to examine the associations between latent profiles and vaccine uptake as well as modification of the DHI’s effects on vaccine attitudes three months post-randomization.

Results: Three profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (p<0.05). The TT-C DHI had a stronger effect, though not statistically significant, on vaccine uptake among those who were vaccine-resistant [OR: 1.81 (0.41, 7.90)] compared to those who were vaccine-receptive at baseline [OR: 1.32 (0.35, 5.04)]. Similarly, the DHI had the strongest effect – with statistically significant (p<0.05) measures of association and interaction p-values – among the vaccine-resistant and vaccine-neutral subgroups for vaccine hesitancy, confidence, knowledge, and conspiracy beliefs [vaccine-resistant diff: -0.40 (-0.76, -0.37), 0.39 (0.02, 0.75), 0.90 (0.27, 1.53), and -0.47 (-0.86, -0.09); vaccine neutral diff: -0.36 (-0.52, -0.19), 0.35 (0.18, 0.51), 0.81 (0.41, 1.20), and -0.24 (-0.44, -0.03)]. The DHI had no effects on these outcomes among the vaccine-receptive subgroup.

Conclusions: Our findings revealed subgroups of Black YA in the US South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black YA who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations for resource efficiency and to drive the biggest improvements in vaccine outcomes.

Presenter - Noah Mancuso,
Research Triangle Institute (RTI) International, Women's Global Health Imperative, Berkeley, United States

Co-Author - Jenna Michaels,
Research Triangle Institute (RTI) International, Women's Global Health Imperative, Berkeley, United States

Co-Author - Erica Browne,
Research Triangle Institute (RTI) International, Women's Global Health Imperative, Berkeley, United States

Co-Author - Marie C.D. Stoner,
Research Triangle Institute (RTI) International, Women's Global Health Imperative, Berkeley, United States

Co-Author - Allysha C. Maragh-Bass, PhD, MPH, PhD, MPH,
FHI 360

Co-Author - Jacob B. Stocks,
Institute on Digital Health and Innovation, College of Nursing, Florida State University (FSU), Tallahassee, FL

Co-Author - Zachary R. Soberano,
Institute on Digital Health and Innovation, College of Nursing, Florida State University (FSU), Tallahassee, FL

Co-Author - C. Lily Bond,
Institute on Digital Health and Innovation, College of Nursing, Florida State University (FSU), Tallahassee, FL

Co-Author - Ibrahim Yigit,
Institute on Digital Health and Innovation, College of Nursing, Florida State University (FSU), Tallahassee, FL

Co-Author - Maria Leonora G. Comello,
University of North Carolina, Chapel Hill, NC

Co-Author - Margo Adams Larsen,
University of North Carolina, Chapel Hill, NC

Co-Author - Kathryn E. Muessig, PhD, PhD,
Institute on Digital Health and Innovation, College of Nursing, Florida State University (FSU), Tallahassee, FL

Co-Author - Audrey E. Pettifor,
University of North Carolina, Chapel Hill, NC

Co-Author - Lisa B. Hightow-Weidman,
Institute on Digital Health and Innovation, College of Nursing, Florida State University (FSU), Tallahassee, FL

Co-Author - Henna Budhwani, PhD, MPH,
Institute on Digital Health and Innovation, College of Nursing, Florida State University (FSU), Tallahassee, FL

Background: Despite growing associations between food insecurity (FI) and binge eating, eating disorder interventions have not been adapted and implemented among individuals with FI. Our prior co-design research showed that these individuals are interested in binge eating intervention, but would need financial support to implement behavior changes. Thus, we implemented a $10 weekly stipend as an adaptation to a 16-week digital binge eating intervention delivered in a pilot study. In determining the stipend amount, we balanced providing sufficient support against staying below tax documentation thresholds (e.g., to avoid compromising governmental benefits). This abstract presents users’ feedback post-intervention on their use of the stipend and perspectives on future stipend adaptations, and is the first such assessment relative to eating disorders. Methods: Adults (N=31, 74% self-identified as female; 16% Hispanic; 29% non-Hispanic Black, 13% non-Hispanic other, 42% non-Hispanic White) with recurrent binge eating, FI, and type 2 diabetes mellitus enrolled in the pilot trial. Results present findings among those who have completed the intervention to date (n=16); the last participant ends November 2024, so the full sample will be presented at the meeting. Results: Most participants reported using their stipend to buy food for themselves (75%), as well as food for others (31%), transportation (25%), cooking supplies (19%), and medication (19%). The majority (56%) said the stipend enabled them to buy things they would not otherwise have purchased. Nearly all (88%) said the stipend was helpful for making behavior changes. When asked if $10 was sufficient, 50% said no and suggested $15-50 stipends. Yet most (69%) also preferred not to give their social security number for payment purposes, endorsing concerns of taxes, benefits eligibility, and privacy. All participants preferred the weekly distribution over other frequencies (e.g., monthly). Discussion: Overall, stipends were perceived as valuable, and may be a critical intervention adaptation for this population. We gave a smaller stipend to minimize potential burdens on users (e.g., taxes, providing W-9s), yet the optimal amount remains unknown, as does its impact on behavior change outcomes. Future administration must continue prioritizing equity considerations when selecting a stipend amount. Findings have healthcare policy implications that may inform future sustainable stipend implementation strategies.

Author - Isabel R. Rooper,
Northwestern University Feinberg School of Medicine

Co-Author - Rebecca L. Flynn,
Northwestern University Feinberg School of Medicine

Co-Author - Chidiebere Azubuike, MS,
Northwestern University Feinberg School of Medicine

Co-Author - Graham Miller,
Northwestern University Feinberg School of Medicine

Co-Author - Adrian Ortega, PhD, PhD,
Northwestern University Feinberg School of Medicine

Co-Author - Leah M. Parsons,
Northwestern University Feinberg School of Medicine

Co-Author - Jennifer Wildes, PhD, PhD,
Department of Psychiatry & Behavioral Neuroscience, University of Chicago

Co-Author - Andrea K. Graham, PhD, PhD,
Northwestern University Feinberg School of Medicine

Transgender and gender diverse (TGD) individuals are defined as individuals whose gender identity differs from their sex assigned at birth. TGD individuals face significant mental and physical health disparities, including experiences of bias and discrimination, heightened levels of psychological distress, and increased suicidality. These disparities are exacerbated by recent legislation banning or restricting access to gender-affirming care in many states. As prior research demonstrates that gender-affirming care is associated with decreased psychological distress among TGD individuals, restricting access to gender-affirming care presents a substantial public health concern. One potential method of delivering gender-affirming care to TGD individuals living in locations in which in-person gender-affirming services are unavailable is telehealth, which enables patients to receive care in a safe, comfortable environment and seek out healthcare providers with experience delivering gender-affirming care. The present research used a qualitative approach to explore TGD individuals’ perspectives of telehealth in the context of gender-affirming care. Fifty-seven TGD individuals were recruited via Prolific between March 22, 2024 and April 24, 2024. Participants responded to seven open-ended questions assessing prior experiences using telehealth for gender-affirming care, pros and cons of telehealth, contexts in which telehealth is more or less appropriate, and recommendations for improving access to gender-affirming care via telehealth. Responses were coded and analyzed by a team of four researchers using reflexive thematic analysis. The following themes were generated: 1) telehealth promotes greater access to gender-affirming care, 2) telehealth enables patients to choose a healthcare experience that best suits their needs, 3) many gender-affirming services can be delivered effectively through telehealth, 4) telehealth is most beneficial in combination with in-person care, and 5) it is necessary to improve the availability and cost of gender-affirming telehealth services. These findings suggest that telehealth has promising potential to expand access to gender-affirming care, particularly among individuals who live in locations in which in-person gender-affirming care is not available, individuals with disabilities, and individuals with mental health diagnoses.

Co-Author - Conor Duffy, MS,
Virginia Commonwealth University

Co-Author - Steph L. Cull, M.S. Psychology,
Virginia Commonwealth University

Co-Author - Jackline A. Otieno,
Virginia Commonwealth University

Co-Author - Dex Schult,
Virginia Commonwealth University

Co-Author - Catherine Wall, MS,
Virginia Commonwealth University

Co-Author - Eric G. Benotsch, PhD, PhD,
Virginia Commonwealth University

AIM: Patient portals (PPs, eg, MyChart) improve diabetes outcomes, but disparities persist in PP access and use. The purpose of this single-arm prospective study was to evaluate the feasibility, acceptability, and preliminary efficacy of a multi-level intervention (MAP) to increase PP use among 22 adults with type 2 diabetes (T2D) who accessed healthcare at two community health centers (NCT05180721). METHODS: In this 6-month intervention, participants were provided an Android tablet and unlimited data service, training on how to use the tablet and the PP, and referral for social determinants of health needs by a community-health worker (CHW). Clinic nurses assessed diabetes self-management (DSM) behaviors, co-created a DSM plan and sent individualized portal messages to participants twice/week (week 1-12) then once/week (week 13-24). Assessments at baseline, 3 months (3M) and 6 months (6M) included PP logins, technology attitude/confidence, and diabetes and psychosocial outcomes. This study was IRB approved; informed consent was obtained. RESULTS: Participants were 73% women, 45% white, 77% Hispanic, 59% <high school education, 46% low health literacy, 55% uninsured, 68% reported financial difficulties. Age was mean(±SD) 56.3(±10.9), years, T2D duration 11.8(±9.1) years, A1C 8.3%(±1.5). N=1 was lost to follow-up. Mean PP logins per week were 0 at baseline, 3.2±1.6 at weeks 1-12, 1.5±0.9 at weeks 13-24, and 2.1±1.1) over 6 months. At 3M, 77% reported at least 1 challenge in using the PP (eg, technology, literacy). There was a significant improvement in technology confidence, diabetes self-efficacy, and diabetes distress, with a trend toward increased digital health literacy. There was no significant change in technology attitudes (perceived ease of use/usefulness of PP), DSM behaviors, or A1C. Fidelity to CHW protocol was 85%. Fidelity to the nurse protocol was 84% at 3M and 52% at 6M. Acceptability of the intervention was high (therapeutic alliance with nurse, satisfaction with the intervention). All participants reported that the PP was helpful for diabetes care, they would continue to use the PP, and would recommend MAP to a friend. CONCLUSION: Logins per week increased at 3M and slowly decreased over 6M, remaining >=1/week. Technology support was essential. Preliminary data suggest good indices of feasibility, acceptability, and efficacy. Findings suggest improvements for a larger trial to improve health equity in PP use for adults with T2D.

Co-Author - Julie Wagner, PhD,
UConn Health

Presenter - Samuel Akyirem,
Yale University

Co-Author - Sangchoon Jeon, PhD,
Yale School of Nursing

Co-Author - Helen Chen, PhD,
Indiana University

Co-Author - Joanna Lipson, MPH,
Yale School of Nursing

Co-Author - Maritza Minchala, MPH,
Yale University

Co-Author - Robin Whittemore, PhD, PhD,
Yale School of Nursing