Joanna Buscemi

Technology-based interventions for weight management: current randomized controlled trial evidence and future directions.

Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs. In the present paper, a summary of the most current literature is provided along with potential solutions to methodological challenges (e.g., high attrition, minimal participant racial/ethnic diversity, heterogeneity of technology delivery modes). Dissemination and policy implications will be highlighted as future directions for the field of eHealth weight management.

Links between the organization of the family home environment and child obesity: a systematic review

Due to increasingly high rates of child overweight and obesity, it is important to identify risk and protective factors that may inform more effective prevention and intervention. The degree of organization in the family home environment is a studied, but not well‐specified, factor that may impact child weight. Prior research on household organization has examined an array of constructs, including family routines, limit setting, household chaos, crowding and the broad home environment. This study systematically reviews literature on organization within the family home environment and weight among children ages 2–12. Six hundred thirty‐seven studies were reviewed by four coders for eligibility, and 32 studies were included in the final synthesis. Overall, 84% of studies provided evidence for relations between at least one indicator of organization within the family home environment and child weight. Studies provided compelling evidence across several constructs, suggesting that the relevance of household organization to child weight extends beyond a single indicator. Directions for future work include (i) examining the mediating role of health behaviours, (ii) examining the moderating role of socioeconomic factors, (iii) broadening this evidence base across cultures and nationalities and (iv) integrating constructs to develop a comprehensive model of organization within the home environment.

Study design and protocol for My Guide: An e-health intervention to improve patient-centered outcomes among Hispanic breast cancer survivors

Breast cancer is the most commonly diagnosed non-skin cancer in women and the leading cause of death among Hispanic women living in the United States. Relative to non-Hispanic white women, Hispanic women report poorer health related quality of life (HRQoL) after treatment. Although eHealth interventions delivered via Smartphones are a viable approach to addressing supportive care accessibility issues while also integrating multidisciplinary approaches for improving HRQoL, few eHealth interventions have been developed that specifically target Hispanic breast cancer survivors (BCS). This manuscript describes the methodology of a multi-site, randomized controlled behavioral trial investigating the feasibility and preliminary efficacy of a Smartphone application aimed at improving HRQoL and cancer-specific distress among Hispanic BCS. Participants will be randomized to receive the intervention application, My Guide (psychoeducation & self-management program), or the health education control condition application, My Health (health education), for six weeks. All participants will also receive weekly telecoaching to enhance adherence to both control and intervention conditions. We will measure the studys primary outcomes, general and disease-specific HRQoL and cancer-specific distress, at three time points: prior to, immediately after the intervention, and eight weeks after initial application use. My Guide may have the potential to improve HRQoL, and to address issues of limited access to supportive care among Hispanic women recovering from breast cancer treatment.

Rationale and design of Mi-CARE: The mile square colorectal cancer screening, awareness and referral and education project

Although colorectal cancer (CRC) is largely preventable through identification of pre-cancerous polyps through various screening modalities, morbidity and mortality rates remain a challenge, especially in African-American, Latino, low-income and uninsured/underinsured patients. Barriers to screening include cost, access to health care facilities, lack of recommendation to screen, and psychosocial factors such as embarrassment, fear of the test, anxiety about testing preparation and fear of a cancer diagnosis. Various intervention approaches to improve CRC screening rates have been developed. However, comparative effectiveness research (CER) to investigate the relative performance of different approaches has been understudied, especially across different real-life practice settings. Assessment of differential efficacy across diverse vulnerable populations is also lacking. The current paper describes the rationale and design for the Mile Square Colorectal Cancer Screening, Awareness and Referral and Education Project (Mi-CARE), which aims to increase CRC screening rates in 3 clinics of a large Federally Qualified Health Center (FQHC) by reducing prominent barriers to screening for low-income, minority and underserved patients. Patients attending these clinics will receive one of three interventions to increase screening uptake: lay patient navigator (LPN)-based navigation, provider level navigation, or mailed birthday CRC screening reminders. The design of our program allows for comparison of the effectiveness of the tailored interventions across sites and patient populations. Data from Mi-CARE may help to inform the dissemination of tailored interventions across FQHCs to reduce health disparities in CRC.

Society of Behavioral Medicine position statement: increase funding for fruits and vegetables production in The Farm Bill reauthorization

The Society of Behavioral Medicine (SBM) recommends that Congress increase funding for fruit and vegetable production and intake in The Farm Bill reauthorization. Analysis of the U.S. Department of Agricultures databases indicates that the availability of fruits and vegetables in the food supply is at half or less than half of what is needed to meet federal dietary recommendations for Americans. Based on the extant literature, SBM supports including funding allocations for fruit and vegetable production, including fruits and vegetables in commodity programs, providing additional insurance subsidies for producing fruits and vegetables, and maintaining or increasing funding for initiatives that promote fruit and vegetable intake. To avoid some of the unintended consequences of increasing support for fruit and vegetable production, new insurance products should be developed in collaboration with groups representing fruit and vegetable producers.

Society of Behavioral Medicine position statement: Society of Behavioral Medicine supports oral cancer early detection by all healthcare providers

In response to the increasing incidence of certain oral and oropharyngeal cancers, the Society of Behavioral Medicine (SBM) calls on healthcare providers and legislators to expand awareness of oral and oropharyngeal cancer risk factors, increase early detection, and support policies that increase utilization of dental services. SBM supports the American Dental Associations 2017 guideline for evaluating potentially malignant oral cavity disorders and makes the following recommendations to healthcare providers and legislators. We encourage healthcare providers and healthcare systems to treat oral exams as a routine part of patient examination; communicate to patients about oral/oropharyngeal cancers and risk factors; encourage HPV vaccination for appropriate patients based on recommendations from the Advisory Committee on Immunization Practices; support avoidance of tobacco use and reduction of alcohol consumption; and follow the current recommendations for evaluating potentially malignant oral cavity lesions. Because greater evidence is needed to inform practice guidelines in the primary care setting, we call for more research in collaborative health and dental services. We encourage legislators to support policies that expand Medicaid to cover adult dental services, increase Medicaid reimbursement for dental services, and require dental care under any modification of, or replacement of, the Affordable Care Act.

Society of Behavioral Medicine position statement: retain school meal standards and healthy school lunches

In 2010, the Healthy, Hunger-Free Kids Act (HHFKA) altered nutrition standards in the U.S. National School Lunch Program in an attempt to promote healthy eating and improve childrens overall health. However, it was reported that these nutrition standard changes were leading to lower consumption of meals and an increase in plate waste. Initial research was unable to validate these reports. Despite these unsubstantiated claims, the U.S. Department of Agriculture released a proposal to roll back some of the nutritional standards implemented by the HHFKA in 2017. An exploration of the current literature uncovered several new studies that further support the updated meal standards outlined in the HHFKA. Identifying and reviewing these studies was the aim of the current brief. Several new studies found that the implementation of the HHFKA standards led to healthier meals, increased fruit consumption, lower plate waste, and reductions in sodium and calories from saturated fats, to name a few. Given the continued evidence that the HHFKA standards improve dietary quality of school meals, policymakers, schools, and stakeholders are urged to continue to support the retention of the new meal standards.

Associations between fiber intake and Body Mass Index (BMI) among African-American women participating in a randomized weight loss and maintenance trial

INTRODUCTION African-American women are at increased risk for obesity, and therefore it is important to identify dietary factors that have the potential to prevent weight gain within this population. The purpose of the current study was to examine associations between daily fiber intake and Body Mass Index (BMI) over the course of an 18-month weight loss intervention for African-American women. METHODS Anthropometric measures and the Block Food Frequency Questionnaire were administered at baseline, 6-month, and 18-month follow-up between 2008 and 2010. A mixed-effects linear regression model with random intercept and time slope was used to model associations between fiber consumption and BMI controlling for time trend. RESULTS Associations between fiber consumption and BMI were significantly different over time (β̂Fiber∗Time=-0.07,p-value=0.003). There was no association between fiber intake and BMI at baseline; however, there was a significant inverse relation between fiber consumption and BMI at 6 months, and the association was even stronger at 18 months. CONCLUSIONS Results from this study suggest that dietary fiber consumption may be particularly important within weight loss interventions tailored for African-American women.

Designing an mHealth application to bridge health disparities in Latina breast cancer survivors: a community-supported design approach

ABSTRACT Latina breast cancer patients in the USA report significantly worse cancer-related symptom burden and health-related quality of life than non-Hispanic whites. However, health literacy (e.g. knowledge about cancer, coping skills and communication) has been found to improve quality of life. In this paper, we present a case study of the methodology used to design Mi Guía (My Guide), a mobile application that aims to improve symptom burden and health-related quality of life among Hispanic women who have completed active treatment for breast cancer by increasing their health literacy. We developed a community-supported approach to building the application, which involved: (1) eliciting feedback from community leaders such as support group organizers and facilitators who are bilingual in Spanish and English, prioritize patients’ preferences and best interests and have a unique knowledge of the women and their needs; (2) conducting a formal evaluation of design principles based on previous interaction design research and user responses; (3) incorporating feedback from potential future users. In this paper, we discuss our methodology, and the challenges and benefits of this approach. We believe that future studies that aim to develop mobile technologies for underserved populations may benefit from a community-supported approach to design.

Society of Behavioral Medicine (SBM) position statement: SBM supports curbing summertime weight gain among America’s youth

The Society of Behavioral Medicine recommends adoption of policies at the district, state, and federal levels that minimize weight gain among youth over the summertime, particularly among low-income, minority school-age youth who appear to be at greater risk. Policies that facilitate (1) partnerships between school districts and community organizations to provide affordable summertime programming, (2) strategic efforts by schools and communities to encourage families to enroll and attend summertime programming via the creation of community-wide summertime offerings offices, (3) adoption of joint-use/shared use agreements in communities to promote use of indoor and outdoor school facilities to provide affordable programming during the summer months, and (4) implementation of strategies that help summer programs achieve the Healthy Eating and Physical Activity (HEPA) standards which have been endorsed by the Healthy Out-of-School Time (HOST) coalition. Research is needed to elucidate key mechanisms by which involvement in structured programming may reduce weight gain over the summer months.