Christine E. Spadola

Review of family-based approaches to improve postoperative outcomes among bariatric surgery patients

BACKGROUND Bariatric surgery must be partnered with postoperative lifestyle modifications for enduring weight loss and related health effects to be fully appreciated. Little is known about how these lifestyle modifications may be affected by the involvement of other family members living in the household; therefore, this review describes current family-based approaches to improving postoperative outcomes in bariatric surgery patients and their families. METHODS A MEDLINE search of publications from 1999 to 2014 was conducted in January 2014. Retrieved titles and abstracts were assessed by 2 authors to determine relevance to the topic surrounding family-based approaches to improve postbariatric surgery outcomes. All study designs except case studies were considered if they included some aspect of family as a predictor in relation to improved health outcomes after surgery. RESULTS Initial searches yielded 650 publications (bariatric surgery+family, n = 193; bariatric surgery+child, n = 338; bariatric surgery+spouse, n = 4; bariatric surgery+social support, n = 115). Two studies met criteria for a family-based approach to improving metabolic outcomes in bariatric patients. Seven studies discussed the impact of bariatric surgery on families. All other studies were excluded for not discussing family-based approaches. CONCLUSION Despite limited documentation of family-based approaches on improving health outcomes in patients who underwent bariatric surgery, evidence suggests that such an approach may be advantageous if planned a priori to occur before, during, and after bariatric surgery. Future studies could test the combination of bariatric surgery and a family-based approach for improved metabolic outcomes in both the patient and involved family member(s).

Postoperative marijuana use and disordered eating among bariatric surgery patients

BACKGROUND Current literature is scarce in documenting marijuana use after bariatric weight loss surgery (WLS). OBJECTIVES The objective of this study was to explore the association among marijuana use patterns, disordered eating, and food addiction behaviors in patients 2 years after WLS. SETTING A university hospital in the United States. METHODS Participants (N = 50, mean age 28 y, standard deviation = 5.8) were administered a structured assessment that included the Addiction Severity Index, Yale Food Addiction Scale, Eating Disorder Examination Questionnaire, and Disordered Eating Questionnaire. Marijuana use was defined based on the Addiction Severity Index as current use (within 30 d), recent use (use in last year), and increased use (increased use since surgery). Data were analyzed using Fishers exact tests and linear regression methods adjusting for age, gender, race/ethnicity, time since surgery, and change in body mass index. RESULTS The majority of the sample was female (76%) and underwent Roux-en-Y gastric bypass (62%). Eighteen percent (18%) of the sample reported current marijuana use; 38% reported recent use; and 21.4% reported increased use post-WLS. A loss of controlled food intake was associated with current (P = .02) and increased post-WLS use (P = .01). Increased use and/or regular marijuana use predicted higher scores on eating disorder subscales compared with respective counterparts (P<.05). Current use did not significantly predict higher scores on the Yale Food Addiction Scale. CONCLUSIONS Findings indicated marijuana use in post-WLS patients despite recommendations against use. A subgroup of WLS patients may be at risk for disordered eating post-WLS, particularly those who used marijuana before surgery, and should be closely monitored for several years post-WLS.

Recruiting and Assessing Recent Young Adult Latina Immigrants in Health Disparities Research

The authors interviewed 4 researchers to identify facilitators in recruiting and assessing Latina immigrants. The 4 researchers recruited 530 recent Latina immigrants (ages 18-23 years) for a study of social and cultural determinants of health. Consensual qualitative research methods revealed that respondent-driven sampling was an effective recruitment method. Fear of deportation was a barrier. Stigma about sensitive topics (e.g., sex, drug use) did not affect participation. Findings can help counselors conduct health disparities research.

A Qualitative Examination of Increased Alcohol Use after Bariatric Surgery among Racially/Ethnically Diverse Young Adults

IntroductionMounting evidence suggests that bariatric surgery, or weight loss surgery (WLS), patients might be vulnerable to developing post-operative alcohol use problems. While the majority of published research offers information concerning the prevalence of problematic alcohol use post-WLS, the literature lacks comprehensive, qualitative explorations examining why alcohol misuse might emerge after WLS. Such data-driven hypotheses are needed to effectively target this emerging concern. Additionally, young adults and racial/ethnic minorities are both increasingly undergoing WLS and are at heightened risk for problems related to alcohol use. To date, these groups have been under-represented in study samples.MethodsTo address these important gaps in the literature, racially/ethnically diverse, young adult WLS patients who indicated a post-WLS increase in alcohol use (n = 12) participated in an individual, semi-structured qualitative interview. Data were analyzed through two coding cycles; an external audit of the emerging themes was also conducted to further ensure the trustworthiness of the data.ResultsInterviews revealed four major themes prompting an increase in alcohol use after WLS: (1) increased sensitivity to alcohol intoxication, (2) utilizing alcohol as a replacement self-soothing mechanism for food, (3) increase in socialization, and (4) utilizing alcohol as a coping mechanism.ConclusionsBy understanding the drivers of increases in alcohol use after WLS, precision-targeted pre- and post-surgical counseling interventions can be developed to address this emerging concern.

Factor structure of a standards-based inventory of competencies in social work with groups

ABSTRACT Purposes: This study extends previous findings on a measure of competencies based on Standards for Social Work Practice with Groups. The Inventory of Competencies in Social Work with Groups (ICSWG) measures confidence in performing the Standards. This study examines the latent structure of the Inventory, while illuminating the underlying structure of the Standards. Methods: A multinational sample of 586 persons completed the ICSWG. Exploratory factor analysis (EFA), reliability estimates, standard error of measurement estimates, and a range of validity tests were conducted. Results: The EFA yielded a six-factor solution consisting of core values, mutuality/connectivity, collaboration, and three phases of group development (planning, beginnings/middles, endings). The alphas were .98 for the scale and ranged from .85 to .95 for the subscales. Correlations between the subscales and validators supported evidence of construct validity. Discussion: The findings suggest key group work domains that should be taught and practiced in social work with groups.

Enhancing yoga participation: A qualitative investigation of barriers and facilitators to yoga among predominantly racial/ethnic minority, low-income adults

Yoga is underutilized among racial/ethnic minorities and low-income populations. To enhance participation among these demographic groups and to inform a future clinical trial, we conducted a qualitative formative investigation, informed by the Social Contextual Model of health behavior change, to identify barriers and facilitators to yoga that could impact study participation. We recruited twenty-four racially/ethnically diverse adults, with and without prior yoga experience, from a low-income, urban housing community to participate in either an individual interview or focus group. A thematic data analysis approach was employed. Barriers to yoga engagement included the perception that yoga lacks physicality and weight loss benefits, fear of injury, lack of ability/self-efficacy to perform the practices, preference for other physical activities, and scheduling difficulties. Facilitators of yoga engagement included a quality yoga instructor who provides individualized instruction, beginner level classes, and promotional messaging that highlights the potential benefits of yoga, such as stress reduction.