Tiffany L. Carson

Dietary interventions and quality of life: a systematic review of the literature.

OBJECTIVE To systematically review the literature to examine whether there has been adequate assessment of the effects of dietary intervention on quality of life (QOL) independent of weight loss, assess which instruments are being used to measure nutrition-related QOL, identify gaps in the literature, and suggest future directions. DESIGN Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. RESULTS A total of 24 studies were eligible for inclusion. The Short Form-36 Health Survey was the most widely used instrument to assess QOL. Other disease-specific instruments were used. Several different dietary approaches (eg, low carbohydrate, low calorie, low fat, combinations) were recommended. Across studies, QOL generally improved after participating in behavioral weight loss interventions, but findings revealed a lack of evidence to definitively determine whether reported changes in QOL were a result of weight loss or independent of it. CONCLUSIONS AND IMPLICATIONS It is important to consider how making broad dietary recommendations for all individuals might affect overall QOL in both positive and negative directions when considering factors other than weight loss and health improvement. If dietary interventions are adversely affecting QOL in other domains (eg, social, economic) and this relationship is not being detected or reported by current research practices, barriers for successful and sustainable dietary changes may not be fully understood.

Assessing environmental support for better health: Active living opportunity audits in rural communities in the southern United States

OBJECTIVE Leisure-time physical activity in the United States is lower rural areas and the South and has been linked to socioeconomic and environmental aspects of where people live. The purpose of this study is to assess the built environment and policies for physical activity in rural communities. METHODS Eight rural communities in Alabama and Mississippi were assessed in 2011 using the Rural Active Living Assessment (RALA) street segment (SSA), town-wide (TWA), and town program and policies (PPA) assessment tools. Community Health Advisors Trained as Research Partners (CHARPS) and local staff conducted the assessments. The TWA and PPA were scored by domain and total scores. Data were analyzed using descriptive and nonparametric statistics. RESULTS 117 segments were assessed in 22 towns in 8 counties. Built environmental barriers existed in all communities. Sidewalks were available in only 10-40% of the segments. TWA identified parks and playgrounds as the most available community feature. PPA scores indicated few policies for physical activity outside of school settings with mean scores higher in Mississippi compared to Alabama (61 vs. 49, respectively). CONCLUSIONS Multiple components of rural communities can be successfully assessed by CHARPs using RALA tools, providing information about resources and barriers for physical activity.

Relationship Between Social Support and Body Mass Index Among Overweight and Obese African American Women in the Rural Deep South, 2011–2013

Introduction African American women in the Deep South of the United States are disproportionately obese, a condition strongly influenced by their social environment. The objective of this study was to characterize the prevalence of social support from family and friends for healthy eating and exercise in rural communities. Methods This study is an analysis of a subgroup (N = 195) of overweight and obese African American women from a larger ongoing weight loss trial (N = 409) in rural communities of the Alabama Black Belt and Mississippi Delta. The Social Support and Eating Habits Survey and Social Support and Exercise Survey were used to measure support from family and friends for healthy eating and exercise, respectively. Linear regression was conducted to determine the association between social support factors and body mass index (BMI). Results Concurrently prevalent in our sample were encouraging support for healthy eating (family, median,14.0; range, 5.0–25.0; friends, median, 13.0; range 5.0–25.0) and discouraging support for healthy eating (family, median, 12.0; range, 5.0–25.0; friends, median, 11.0; range, 5.0–25.0). Median scores for support for exercise received in the form of participation from family and friends were 24.0 (range 10.0–48.0) and 24.0 (range 10.0–50.0), respectively. The median score for support for exercise in the form of rewards and punishment from family was 3.0 (range, 3.0–11.0). Social support factors were not associated with BMI. Conclusion Overweight and obese African American women in the rural Deep South experience minimal social support from family and friends for healthy eating and exercise. Given the evidence that social support promotes healthy behaviors, additional research on ways to increase support from family and friends is warranted.

Association of Run‐In Periods with Weight Loss in Obesity Randomized Controlled Trials

Study‐level design characteristics that inform the optimal design of obesity randomized controlled trials (RCTs) have been examined in few studies. A pre‐randomization run‐in period is one such design element that may influence weight loss. We examined 311 obesity RCTs published between 1 January 2007 and 1 July 2009 that examine d weight loss or weight gain prevention as a primary or secondary end‐point. Variables included run‐in period, pre‐post intervention weight loss, study duration (time), intervention type, percent female and degree of obesity. Linear regression was used to estimate weight loss as a function of (i) run‐in (yes/no) and (ii) run‐in, time, percent female, body mass index and intervention type. Interaction terms were also examined. Approximately 19% (18.6%) of the studies included a run‐in period, with pharmaceutical studies having the highest frequency. Although all intervention types were associated with weight loss (Mean = 2.80 kg, SD = 3.52), the inclusion of a pre‐randomization run‐in was associated with less weight loss (P = 0.0017) compared with studies that did not include a run‐in period. However, this association was not consistent across intervention types. Our results imply that in trials primarily targeting weight loss in adults, run‐in periods may not be beneficial for improving weight loss outcomes in interventions.

A Study of the Relationship between Food Group Recommendations and Perceived Stress: Findings from Black Women in the Deep South

Black women in the Deep South experience excess morbidity/mortality from obesity-related diseases, which may be partially attributable to poor diet. One reason for poor dietary intake may be high stress, which has been associated with unhealthy diets in other groups. Limited data are available regarding dietary patterns of black women in the Deep South and to our knowledge no studies have been published exploring relationships between stress and dietary patterns among this group. This cross-sectional study explored the relationship between stress and adherence to food group recommendations among black women in the Deep South. Participants (n = 355) provided demographic, anthropometric, stress (PSS-10), and dietary (NCI ASA-24 hour recall) data. Participants were obese (BMI = 36.5 kg/m2) and reported moderate stress (PSS-10 score = 16) and minimal adherence to Dietary Guidelines for Americans food group recommendations (1/3 did not meet recommendations for any food group). Participants reporting higher stress had higher BMIs than those reporting lower stress. There was no observed relationship between stress and dietary intake in this sample. Based on these study findings, which are limited by potential misreporting of dietary intake and limited variability in stress measure outcomes, there is insufficient evidence to support a relationship between stress and dietary intake.

Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial

Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities.

Body image and dissatisfaction among rural Deep South African American women in a weight loss intervention

Body image perception may impact health-promoting behaviors as well as knowledge regarding health risks associated with obesity. Our cross-sectional analysis evaluated body image and its association with body mass index among overweight and obese treatment-seeking African American women (N = 409). Differences between current and desired body image were captured using the Pulvers scale. Results indicated the presence of body image dissatisfaction among participants (median = 2.00, interquartile range: 2.00–3.00), with greater dissatisfaction observed at higher categories of body mass index. Additionally, receiver operating curves demonstrated the ability of the Pulvers scale to correctly identify participants classified by body mass index. Further research is needed to identify factors that influence body image perception.

Assessment of the nutrition environment in rural counties in the Deep South

The nutrition environment, including food store type, may influence dietary choices, which in turn can affect risk of obesity and related chronic diseases such as CHD, diabetes and cancer. The objective of the present study was to elucidate the extent to which healthy foods are available and affordable in various rural food outlets. A subset of the nutrition environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S). The NEMS-S instrument assessed the availability and price of healthy foods (e.g. low-fat/non-fat milk, lean meats and reduced-fat dinner entrées) compared with less healthy counterparts (e.g. whole milk, non-lean meats and regular dinner entrées). The NEMS-S also assessed the quality of fresh fruits and vegetables. Availability, prices and quality of healthy foods were compared between grocery stores (n 24) and convenience stores (n 67) in nine rural counties in Alabama. Mean availability subscale score (possible range 0 to 30; higher score indicates a greater number of healthier foods were available) for grocery stores was 22·6 (sd 8·1), compared with 6·6 (sd 5·2) in convenience stores (P < 0·0001); and mean price subscale score (possible range −9 to 18; higher score indicates that healthier options were less expensive than the less healthy options) for grocery stores was 2·4 (sd 2·7), compared with 0·7 (sd 1·2) in convenience stores (P = 0·0080). Mean total NEMS-S score (possible range −9 to 54) in grocery stores was 29·8 (sd 10·9) compared with 7·3 (sd 7·1) in convenience stores (P < 0·0001). Both grocery and convenience stores could be strategic points of intervention to improve the nutrition environment in the counties that were surveyed.

Abstract A59: Racial comparisons of the gut microbiota of generally healthy black and white women for insights into colorectal cancer disparities

Racial health disparities persist among black and white women for colorectal cancer (CRC). Since the gut microbiota has been linked to CRC, understanding racial differences in the gut microbiota may yield new insight into unexplained disparities in CRC incidence. Generally healthy non-Hispanic black or white females who were at least 19 years old provided survey data, anthropometrics, and stool samples. Fecal DNA was collected and isolated from a wipe. PCR was used to amplify the V4 region of the 16SrRNA gene and 250 bases were sequenced using the MiSeq platform. Microbiome data were analyzed using the QIIME package. OTU data were log transformed and normalized. Linear models in R Package “limma” were used to test statistical significance differences. Fecal samples were analyzed for 80 females (47 black, 33 white). Mean age and BMI were 39.9 years and 30.1 kg/m 2 , respectively. Blacks had a higher average BMI than whites (33.3 vs. 27.5 kg/m 2 ; p Faecalibacterium (p=0.03) and Bacteroides (p=0.04). The association between race and Bacteroides (logFC=1.72; 0=0.02) persisted in fully adjusted models. Black race was associated with a higher abundance of Bacteroides , which has been linked to CRC. Other racial differences in the gut microbiota were also observed. Efforts to cultivate an “ideal” gut microbiota may help reduce CRC risk and health disparities. Citation Format: Tiffany L. Carson, Fuchenchu Wang, Xiangqin Cui, Bradford E. Jackson, Liam Van Der Pol, Elliot J. Lefkowitz, Casey Morrow, Monica Baskin. Racial comparisons of the gut microbiota of generally healthy black and white women for insights into colorectal cancer disparities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A59.

Abstract B18: Exploring the lived experience of young African American breast cancer survivorship: Early results toward informing a psychoeducational intervention

Background/Purpose Recent data indicate that 11% of the 230,000 women diagnosed with breast cancer each year are young (18-44). Though the five-year survival rates of these young women are improving, there are large health disparities in breast cancer survivorship among young African American women in the United States (e.g. higher breast cancer incidence and mortality when compared with young Caucasians). Further, young African American breast cancer survivors (YAABCS) report poorer quality of life than young Caucasians. Despite recommendations to provide evidence-based and tailored survivorship care for cancer survivors, there are about 23,000 YAABCS between the ages of 20-49 living in a southern tri-state area (Alabama- AL, Louisiana- LA, and Mississippi- MS) for whom a comprehensive breast cancer survivorship education/support intervention does not exist. As few studies have examined YAABCS9s survivorship experiences and/or tested intervention efficacy among this group, further study of their survivorship is warranted to inform the adaptation of an age- and culturally-specific survivorship psychoeducational intervention for YAABCS. As part of an ongoing dissertation study, a Research Tested Intervention Program called the Breast Cancer Education Intervention (BCEi) is being adapted into Y-AMBIENT (the BCEi for YAABCS). The purpose of this abstract is to describe early results of the lived experience of young African American breast cancer survivorship, which will be used to inform the adaptation of Y-AMBIENT. Methods A transcendental phenomenological study design guided by the conceptual framework of the BCEi (Quality of Life Model Applied to Breast Cancer [QOL-BC]) was used. A purposive and snowball sample of YAABCS was recruited from AL, LA, and MS. The study recruitment flyer was disseminated online and via email through breast cancer-affiliated organizations and support groups. Word-of mouth dissemination was also encouraged. Data collected included two semi-structured interviews, a sociodemographic survey, volunteered personal effects from YAABCS, and field/reflective notes. Data were analyzed using NVivo11 Software (qualitative data) and IBM SPSS Software v. 23 (quantitative data), then validated among participating YAABCS. Early Results Early results of the ongoing dissertation study were informed by 7 of 15 YAABCS (mean age= 32 years; mean survivorship= 4 years). These YAABCS perceived survivorship as a labile, new normal. Feeling as though survivorship was a burden, YAABCS described the need to be “strong” for themselves and others. These women actively structured their lives to manage changes to their physical, psychological, social, and spiritual selves. While YAABCS reported successful survivorship management to co-survivors and others, they acknowledged that survivorship was an ongoing “struggle” in which spirituality and survivorship education were key. Discussion/Conclusion Early results indicated a fluid and complex experience of survivorship among YAABCS. While most reported an intensive need for spiritual connection, all reported a need for more comprehensive survivorship education. Thus, a tailored survivorship education intervention may be needed for YAABCS. Future Directions The ongoing dissertation study to adapt Y-AMBIENT will be informed by the lived experience of young African American breast cancer survivorship. Future research examining YAABCS9s perceptions of the BCEi and the inter-relation of QOL-BC constructs may inform this and future interventions that aim to decrease quality of life health disparities among YAABCS. Acknowledgements This research is funded by an American Cancer Society Doctoral Degree Scholarship in Cancer Nursing (DSCN-15-073-01), Susan G. Komen Graduate Traineeship in Disparities Research, Jonas Nurse Leaders Scholarship, and Gladys Farmer Colvin Doctoral Fellowship. Citation Format: Timiya S. Nolan, Tiffany L. Carson, Susan Davies, Comfort Enah, Nataliya Ivankova, Karen Meneses. Exploring the lived experience of young African American breast cancer survivorship: Early results toward informing a psychoeducational intervention. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B18.