Ziya Gizlice

University of North Carolina at Chapel Hill, North Carolina, United States

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Publications (54)112.89 Total impact

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    ABSTRACT: Background: Inequity in cancer care continues to be a problem for African Americans who are often diagnosed at later stages and are less likely to complete recommended treatments. Accountability for Cancer Care through Undoing Racism and Equity is an NCI-funded systems change intervention trial to increase racial equity in quality and completion of treatment for early stage breast and lung cancer patients at two cancer centers. Methods: Embedded within this study is a randomized control trial of newly diagnosed Caucasians and African Americans with stage 1 and 2 breast and lung cancers. Individuals are randomly assigned to a specially trained patient navigator or to usual care. Since most health systems do not have methods of tracking “real time” clinical performance, a real time registry has been developed. This registry provides “Monthly Clinical Performance Reports” that are delivered by a physician champion to the cancer center care providers. Results: The registry provides the navigator with daily information regarding treatment and appointment adherence for all trial participants. This information allows the navigator, physician champion, and healthcare team to intervene with patients to identify and remove barriers to care, and minimize or eliminate interruptions to the cancer treatments. The monthly reports provide each provider with status reports on their patients regarding adherence to treatment. Interim analysis has shown an increase in treatment completion at both cancer centers. Conclusions: The combination of the patient navigator and physician champion with real time information appears to have a positive effect on patient treatment completion.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) is a systems change intervention addressing disparities in treatment initiation and completion that result in poorer health outcomes for African American breast and lung cancer patients compared to White. Using an Undoing Racism™ framework, which emphasizes institutional transparency and accountability, ACCURE implemented a “power analysis” of the cancer treatment system as a mechanism for patients to describe “pressure point encounters” that facilitated or hindered their treatment. Methods: We conducted eight focus groups, four with African American and four with White breast and lung cancer survivors, at our two partner cancer centers. A community-based participatory research (CBPR) approach was used to develop focus group guides, train coders, and conduct qualitative data analysis. Transcripts were coded and analyzed by a racially diverse community-academic team. Findings were used to inform the development of Healthcare Equity Trainings (HET), conducted with providers and staff at each cancer center. Results: Findings revealed overall satisfaction with cancer care with subtle distinctions in how African American and White lung and breast cancer patients experience treatment, including difficulties with communication regarding appointments, side effects and pain, and coordination of care in the emergency room. Incorporating findings into HET engaged cancer center staff and providers in recognizing pressure points in the cancer system and generating systems-level solutions. Conclusion: Power analysis is a useful diagnostic tool to map patients’ interactions with cancer systems and a catalyst for ACCURE’s efforts to reduce inequities in quality and completion of lung and breast cancer care.
    11/2014
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    ABSTRACT: Background: Community-Based Participatory Research partnerships are powerful mechanisms needed to address race-based health disparities while utilizing systems science methodologies. The Greensboro Health Disparities Collaborative (GHDC), an 11-year community-academic partnership, created the foundation for the interdisciplinary steering committee of the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) study. ACCURE is an NCI-funded 5-year systems-intervention project, using CBPR and principles of Undoing Racism™ to optimize transparency and accountability for racial equity in health outcomes for African American and Caucasian early stage breast and lung cancer patients. Methods: The ACCURE Steering Committee includes the co-principal investigators from each partnership organization and leadership representatives from: (1) two medical centers, (2) an anti-racism non-profit, (3) a university prevention research center, (4) and stakeholders from the Greensboro, NC community. The GHDC strengthened the capacity of the ACCURE Steering Committee through co-learning using principles of anti-racism and research ethics. The Steering Committee developed trust and methods of bi-directional learning through weekly facilitated communications, shared work files, and consistent organization. Results: Using capacity-building methods, the ACCURE Steering Committee organized the planning and management of research participant recruitment, and development of multiple systems-interventions; including an electronic medical record analysis tool for nurse navigators and anti-racism professional development training for medical staff. Conclusion: The Steering Committee of the ACCURE research study is a model partnership that emerged from the foundation and methods used by the GHDC. Communication channels and sub-committee structures expanded opportunities for continued collaborative work to facilitate community-medical-academic partnerships in addressing cancer disparities through innovative research activities.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Despite federal guidelines for training providers in Cultural Competent Care, African American cancer patients continue to experience worse outcomes. Persistent inequity after cancer diagnosis demands a diligent and bold response to address implicit bias embedded within healthcare systems. We will describe and discuss the HealthCare Equity Training (HET), being tested by a CBPR partnership, as part of an NCI-funded systems change intervention trial to increase racial equity in quality and completion of treatment for early stage breast and lung cancer patients at two cancer centers. Methods: HET is a 2-year process informed by an anti-racism framework and methods, beginning with a 2-hour workshop, followed by quarterly booster sessions. Facilitators engage care providers and staff in: (a) adopting a common vocabulary and understanding of racial equity, both in their organization and communities; (b) recognizing multiple levels of structural racism; (c) analyzing “pressure point encounters” during treatment that undermine quality and completion of cancer care; and (d) reviewing race-specific EHR data regarding standards of care. Results: Process evaluation findings are showing participants changing their thinking about their clinical/professional care, the power associated with their role and responsibilities, and how specific procedures and protocol systems can enhance their interactions with patients and colleagues. Conclusion: The partnership of 2 cancer centers, an anti-racism training organization, a cancer survivor support group, and 2 universities has been essential for conceptualizing and launching HET. Wanting to understand and address racial equity, as a team and proactively, is an important incentive for recruiting, scheduling, and sustaining participation.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: We examined cross-sectional associations among neighborhood- and individual-level factors related to a healthful lifestyle and dietary intake, physical activity (PA), and support for obesity prevention polices in rural eastern North Carolina adults. We examined perceived neighborhood barriers to a healthful lifestyle, and associations between neighborhood barriers to healthy eating and PA, participants' support for seven obesity prevention policies, and dependent variables of self-reported dietary and PA behaviors, and measured body mass index (BMI) (n = 366 study participants). We then used participants' residential addresses and Geographic Information Systems (GIS) software to assess neighborhood-level factors related to access to healthy food and PA opportunities. Correlational analyses and adjusted linear regression models were used to examine associations between neighborhood-level factors related to a healthful lifestyle and dietary and PA behaviors, BMI, and obesity prevention policy support. The most commonly reported neighborhood barriers (from a list of 18 potential barriers) perceived by participants included: not enough bicycle lanes and sidewalks, not enough affordable exercise places, too much crime, and no place to buy a quick, healthy meal to go. Higher diet quality was inversely related to perceived and GIS-assessed neighborhood nutrition barriers. There were no significant associations between neighborhood barriers and PA. More perceived neighborhood barriers were positively associated with BMI. Support for obesity prevention policy change was positively associated with perceptions of more neighborhood barriers. Neighborhood factors that promote a healthful lifestyle were associated with higher diet quality and lower BMI. Individuals who perceived more neighborhood-level barriers to healthy eating and PA usually supported policies to address those barriers. Future studies should examine mechanisms to garner such support for health-promoting neighborhood changes.
    Journal of community health. 08/2014;
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    ABSTRACT: IMPORTANCE Most primary care clinicians lack the skills and resources to offer effective lifestyle and medication (L&M) counseling to reduce coronary heart disease (CHD) risk. Thus, effective and feasible CHD prevention programs are needed for typical practice settings. OBJECTIVE To assess the effectiveness, acceptability, and cost-effectiveness of a combined L&M intervention to reduce CHD risk offered in counselor-delivered and web-based formats. DESIGN, SETTING, AND PARTICIPANTS A comparative effectiveness trial in 5 diverse family medicine practices in North Carolina. Participants were established patients, aged 35 to 79 years, with no known cardiovascular disease, and at moderate to high risk for CHD (10-year Framingham Risk Score [FRS], ≥10%). INTERVENTIONS Participants were randomized to counselor-delivered or web-based format, each including 4 intensive and 3 maintenance sessions. After randomization, both formats used a web-based decision aid showing potential CHD risk reduction associated with L&M risk-reducing strategies. Participants chose the risk-reducing strategies they wished to follow. MAIN OUTCOMES AND MEASURES The primary outcome was within-group change in FRS at 4-month follow-up. Other measures included standardized assessments of blood pressure, blood lipid levels, lifestyle behaviors, and medication adherence. Acceptability and cost-effectiveness were also assessed. Outcomes were assessed at 4 and 12 months. RESULTS Of 2274 screened patients, 385 were randomized (192 counselor; 193 web): mean age, 62 years; 24% African American; and mean FRS, 16.9%. Follow-up at 4 and 12 months included 91% and 87% of the randomized participants, respectively. There was a sustained reduction in FRS at both 4 months (primary outcome) and 12 months for both counselor-based (-2.3% [95% CI, -3.0% to -1.6%] and -1.9% [95% CI, -2.8% to -1.1%], respectively) and web-based groups (-1.5% [95% CI, -2.2% to -0.9%] and -1.7% [95% CI, -2.6% to -0.8%] respectively). At 4 months, the adjusted difference in FRS between groups was -1.0% (95% CI, -1.8% to -0.1%) (P = .03), and at 12 months, it was -0.6% (95% CI, -1.7% to 0.5%) (P = .30). The 12-month costs from the payer perspective were $207 and $110 per person for the counselor- and web-based interventions, respectively. CONCLUSIONS AND RELEVANCE Both intervention formats reduced CHD risk through 12-month follow-up. The web format was less expensive. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01245686.
    JAMA Internal Medicine 05/2014; · 13.25 Impact Factor
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    ABSTRACT: Promoting daily routine physical activities, such as active travel to school, may have important health implications. Practitioners and policy makers must understand the variety of factors that influence whether or not a child uses active school travel. Several reviews have identified both inhibitors and promoters of active school travel, but few studies have combined these putative characteristics in one analysis. The purpose of this study is to examine associations between elementary school children's active school travel and variables hypothesized as correlates (demographics, physical environment, perceived barriers and norms).
    International Journal of Behavioral Nutrition and Physical Activity 05/2014; 11(1):61. · 3.58 Impact Factor
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    ABSTRACT: Early preventive dental visits are essential in improving children's oral health, especially young children at high risk for dental caries. However, there is scant information on how these children enter the dental care system. Our objectives were as follows: (1) to describe how a population-based cohort of young Medicaid-enrolled children entered dental care; and (2) to investigate the influence of caregiver characteristics on their children's dental care-seeking patterns. We relied on Medicaid claims and interview data of caregiver-child dyads who were enrolled in the Carolina Oral Health Literacy study during 2007-2008. The analytical cohort comprised 1000 children who had no dental visits before enrollment. Additional information was collected on sociodemographic characteristics, oral health status, health literacy, dental neglect, and access to care barriers. Our analyses relied on descriptive, bivariate, and multivariate methods. During the 25-month median follow-up period, 39% of the children (mean baseline age: 16 months) entered the dental care system, and 13% of their first encounters were for emergency care. Caregivers' dental neglect emerged as a significant predictor of nonentrance. Children with reported oral health problems at baseline were more likely to enter the dental care system compared with children with better oral health, but they were also more likely to require emergency care. Caregivers have a pivotal role in children's oral health and care. Interventions aimed at improving children's oral health should involve community outreach to engage caregivers in a culturally appropriate manner when their children are infants or toddlers.
    PEDIATRICS 04/2014; · 4.47 Impact Factor
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    ABSTRACT: Decision aids offer promise as a practical solution to improve patient decision making about coronary heart disease (CHD) prevention medications and help patients choose medications to which they are likely to adhere. However, little data is available on decision aids designed to promote adherence. In this paper, we report on secondary analyses of a randomized trial of a CHD adherence intervention (second generation decision aid plus tailored messages) versus usual care in an effort to understand how the decision aid facilitates adherence. We focus on data collected from the primary study visit, when intervention participants presented 45 minutes early to a previously scheduled provider visit; viewed the decision aid, indicating their intent for CHD risk reduction after each decision aid component (individualized risk assessment and education, values clarification, and coaching); and filled out a post-decision aid survey assessing their knowledge, perceived risk, decisional conflict, and intent for CHD risk reduction. Control participants did not present early and received usual care from their provider. Following the provider visit, participants in both groups completed post-visit surveys assessing the number and quality of CHD discussions with their provider, their intent for CHD risk reduction, and their feelings about the decision aid. We enrolled 160 patients into our study (81 intervention, 79 control). Within the decision aid group, the decision aid significantly increased knowledge of effective CHD prevention strategies (+21 percentage points; adjusted p<.0001) and the accuracy of perceived CHD risk (+33 percentage points; adjusted p<.0001), and significantly decreased decisional conflict (-0.63; adjusted p<.0001). Comparing between study groups, the decision aid also significantly increased CHD prevention discussions with providers (+31 percentage points; adjusted p<.0001) and improved perceptions of some features of patient-provider interactions. Further, it increased participants' intentions for any effective CHD risk reducing strategies (+21 percentage points; 95% CI 5 to 37 percentage points), with a majority of the effect from the educational component of the decision aid. Ninety-nine percent of participants found the decision aid easy to understand and 93% felt it easy to use. Decision aids can play an important role in improving decisions about CHD prevention and increasing patient-provider discussions and intent to reduce CHD risk.
    BMC Medical Informatics and Decision Making 02/2014; 14(1):14. · 1.60 Impact Factor
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    ABSTRACT: Recent evidence supports a link between caregivers' health literacy and their children's health and use of health services. Disruptions in children's health insurance coverage have been linked to poor health care and outcomes. We examined young children's Medicaid enrollment patterns in a well-characterized cohort of child/caregivers dyads and investigated the association of caregivers' low health literacy with the incidence of enrollment gaps.
    PLoS ONE 01/2014; 9(10):e110178. · 3.53 Impact Factor
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    ABSTRACT: Background: Rural US residents are at higher risk of chronic disease compared to urban residents. This disparity may be partly due to limited opportunities for healthy food choices and physical activity in rural environments. Objectives: Among eastern NC residents, examine racial differences between (1) perceptions of neighborhood barriers and supports for a healthy diet and physical activity and (2) personal support for policy changes to facilitate healthier food and physical activity environments. Methods: As part of the Heart Healthy Lenoir (HHL) Project, a community-based, participatory initiative to reduce cardiovascular disease risk, we recruited Lenoir County residents to participate in a lifestyle intervention to reduce CVD risk. In 2010, the population of Lenoir County was 59,495, with 23.2% of residents living in poverty. Participants completed an 18-item questionnaire to assess perceived neighborhood barriers to a healthy diet and physical activity. Participants were also asked to indicate their level of support for seven obesity prevention policy strategies. Examples of policy strategies included Communities should provide incentives to food stores to locate in rural or low-income areas; and Communities should improve sidewalks to support walking. To better understand disparities in CVD risk and opportunities to decrease them, we present results by self-described race. Results: Of the 339 participants, 215 (63%) were African American, 115 (34%) white, and 8 (2%) other. Compared to whites, African Americans were more likely to report the following as a big problem in their neighborhood: (1) too many fast food places (18.6% African American versus 7.8% whites, p = 0.029); (2) too much crime (27.7% versus 13.8%, p = 0.0019); (3) unattended dogs (22.4% versus 9.5%, p = 0.0038); (4) verbal abuse from people on the streets (7.0% versus 1.7%, p = 0.0001); and (5) bad air from cars and factories (18.6% versus 13.8%, p < 0.0001). African Americans indicated higher support for policy change strategies than did whites (p = 0.0026). Conclusions: In this sample, African Americans reported a more challenging built environment in which to consume a healthful diet and be active and expressed greater support for policy changes to improve the environment when compared to whites. To reduce chronic disease risk and risk disparities, identified disparities in the places and spaces where individuals live and work should be addressed.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: The Accountability for Cancer Care through Undoing Racism and Equity study is a partnership between communities and health systems to optimize transparency and accountability to achieve racial equity in cancer treatment among patients with early stage breast and lung cancer. Given national emphasis on electronic health records and meaningful use (MU), we are leveraging EHRs for race specific quality reports and development of a real time registry that identifies patients who have missed appointments or have not met expected milestones in timely cancer care. We developed an automated system to perform a retrospective chart review in 2 disparate and complex healthcare systems. The data obtained serves as a baseline for our population based interrupted, time-series analysis and will be used as the substrate for initial race-specific feedback sessions for providers to begin the quality improvement methodology in the study. Transparent data and provider feedback are part of a multi-faceted intervention to narrow gaps in both treatment initiation and completion between White and African-American patients. The programming involved in collecting the retrospective data will be transferable to prospective data acquisitions so changes in care can instantly be assessed over time. The real time electronic registry is the key to the patient-centered tracking process. Imbedded warnings from this system will serve as triggers for discussions and services provided by a navigator trained to identify adherence barriers related to implicit system bias. We will present early results and discuss overcoming MU deficits and using EHRs for improving transparency and care.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Although lifestyle and medications are effective for coronary heart disease (CHD) risk reduction, few studies have examined the comparative effectiveness of various strategies for delivering high quality CHD risk reduction. In this paper, we report on the design and baseline characteristics of participants for just such a trial. We conducted a randomized trial of the same lifestyle and medication intervention delivered in two alternate formats: counselor-delivered or web-based. The trial was conducted at 5 diverse practices in a family medicine research network and included men and women age 35-79 who were at high risk of CHD events based on 10-year predicted Framingham risk of ≥10% or a known history of cardiovascular disease. After individual-level randomization, participants in both arms received a decision aid plus four intensive intervention visits and 3 maintenance visits over 12 months. The primary outcome was change in 10-year predicted CHD risk among patients without prior cardiovascular disease. Secondary outcomes, measured among all participants, included changes in CHD risk factors, cost-effectiveness, and acceptability at 4 and 12-month follow-up. We randomized 489 eligible patients: 389 without and 100 with a known history of cardiovascular disease. Mean age was 62.3. 75% were white, 25% African American. 45% had a college education. 88% had health insurance. Mean 10-year predicted CHD risk was 16.9%. We have successfully recruited a diverse sample of practices and patients that will provide a rich sample in which to test the comparative effectiveness of two strategies to implement high quality CHD prevention.
    Contemporary clinical trials 08/2013; · 1.51 Impact Factor
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    ABSTRACT: Despite high obesity prevalence rates, few low-income midlife women participate in weight loss maintenance trials. This pilot study aims to assess the effectiveness of two weight loss maintenance interventions in this under-represented population. Low-income midlife women who completed a 16-week weight loss intervention and lost >= 8 lbs (3.6 kg) were eligible to enroll in one of two 12-month maintenance programs. The programs were similar in content and had the same number of total contacts, but were different in the contact modality (Phone + Face-to-Face vs. Face-to-Face Only). Two criteria were used to assess successful weight loss maintenance at 12 months: (1) retaining a loss of >= 5% of body weight from the start of the weight loss phase and (2) a change in body weight of < 3%, from the start to the end of the maintenance program. Outcome measures of changes in physiologic and psychosocial factors, and evaluations of process measures and program acceptability (measured at 12 months) are also reported. For categorical variables, likelihood ratio or Fisher's Exact (for small samples) tests were used to evaluate statistically significant relationships; for continuous variables, t-tests or their equivalents were used to assess differences between means and also to identify correlates of weight loss maintenance. Overall, during the 12-month maintenance period, 41% (24/58) of participants maintained a loss of >= 5% of initial weight and 43% (25/58) had a <3% change in weight. None of the comparisons between the two maintenance programs were statistically significant. However, improvements in blood pressure and dietary behaviors remained significant at the end of the 12-month maintenance period for participants in both programs. Participant attendance and acceptability were high for both programs. The effectiveness of two pilot 12-month maintenance interventions provides support for further research in weight loss maintenance among high-risk, low-income women.Trial registrationClinicalTrials.gov Identifier: NCT00288301.
    BMC Public Health 07/2013; 13(1):653. · 2.08 Impact Factor
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    ABSTRACT: Caregivers' health literacy has emerged as an important determinant of young children's health care and outcomes. We examined the hypothesis that caregivers' health literacy influences children's oral-health-care-related expenditures. This was a prospective cohort study of 1,132 child/caregiver dyads (children's mean age = 19 months), participating in the Carolina Oral Health Literacy Project. Health literacy was measured by the REALD-30 (word recognition based) and NVS (comprehension based) instruments. Follow-up data included child Medicaid claims for CY2008-10. We quantified expenditures using annualized 2010 fee-adjusted Medicaid-paid dollars for oral-health-related visits involving preventive, restorative, and emergency care. We used descriptive, bivariate, and multivariate statistical methods based on generalized gamma models. Mean oral-health-related annual expenditures totaled $203: preventive-$81, restorative-$99, and emergency care-$22. Among children who received services, mean expenditures were: emergency hospital-based-$1282, preventive-$106, and restorative care-$343. Caregivers' low literacy in the oral health context was associated with a statistically non-significant increase in total expenditures (average annual difference = $40; 95% confidence interval, -32, 111). Nevertheless, with both instruments, emergency dental care expenditures were consistently elevated among children of low-literacy caregivers. These findings provide initial support for health literacy as an important determinant of the meaningful use and cost of oral health care.
    Journal of dental research 05/2013; · 3.46 Impact Factor
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    ABSTRACT: OBJECTIVE: To translate a behavioral weight loss intervention for mid-life, low-income women in real world settings. DESIGN AND METHODS: In this pragmatic clinical trial, we randomly selected 6 North Carolina county health departments and trained their current staff to deliver a 16-session evidence-based behavioral weight loss intervention (special intervention, SI). SI weight loss outcomes were compared to a delayed intervention (DI) control group. RESULTS: Of 432 women expressing interest, 189 completed baseline measures and were randomized within health departments to SI (N =126) or DI (N = 63). At baseline, average age was 51 years, 53% were African American, mean weight was 100 kg, and BMI averaged 37 kg/m(2) . A total of 96 (76%) SI and 55 (87%) DI participants returned for 5-month follow-up measures. The crude weight change was -3.1 kg in the SI and -0.4 kg in the DI group, for a difference of 2.8 kg (95% CI 1.4 to 4.1, p = .0001). Diet quality and physical activity improved significantly more in the SI group, and estimated intervention costs were $327 per participant. CONCLUSIONS: This pragmatic short-term weight loss intervention targeted to low-income mid-life women yielded meaningful weight loss when translated to the county health department setting.
    Obesity 02/2013; · 3.92 Impact Factor
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    ABSTRACT: OBJECTIVE: To develop a brief questionnaire to assess dietary fat quality, the Dietary Fat Quality Assessment (DFQA), for use in dietary counseling to reduce heart disease risk. METHODS: A subsample of 120 underserved, midlife women enrolled in a randomized, controlled weight loss trial completed baseline and follow-up telephone surveys. Main outcome measures included dietary fat components (total fat, saturated fat, polyunsaturated fat, monounsaturated fat, omega-3 fatty acids, and cholesterol). RESULTS: Assessments of major dietary fat components using the DFQA and a food frequency questionnaire were significantly correlated, with correlation coefficients of 0.54-0.66 (P < .001). Intra-class correlation coefficients to assess reliability ranged from 0.48 to 0.59 for each of the fat components studied. CONCLUSIONS AND IMPLICATIONS: The DFQA provides a reasonable assessment of dietary fat quality associated with coronary heart disease risk and may prove useful as a brief assessment tool to guide dietary counseling given to reduce heart disease risk.
    Journal of nutrition education and behavior. 01/2013;
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    ABSTRACT: BACKGROUND: Most studies on the local food environment have used secondary sources to describe the food environment, such as government food registries or commercial listings (e.g., Reference USA). Most of the studies exploring evidence for validity of secondary retail food data have used on-site verification and have not conducted analysis by data source (e.g., sensitivity of Reference USA) or by food outlet type (e.g., sensitivity of Reference USA for convenience stores). Few studies have explored the food environment in American Indian communities. To advance the science on measuring the food environment, we conducted direct, on-site observations of a wide range of food outlets in multiple American Indian communities, without a list guiding the field observations, and then compared our findings to several types of secondary data. METHODS: Food outlets located within seven State Designated Tribal Statistical Areas in North Carolina (NC) were gathered from online Yellow Pages, Reference USA, Dun & Bradstreet, local health departments, and the NC Department of Agriculture and Consumer Services. All TIGER/Line 2009 roads (>1,500 miles) were driven in six of the more rural tribal areas and, for the largest tribe, all roads in two of its cities were driven. Sensitivity, positive predictive value, concordance, and kappa statistics were calculated to compare secondary data sources to primary data. RESULTS: 699 food outlets were identified during primary data collection. Match rate for primary data and secondary data differed by type of food outlet observed, with the highest match rates found for grocery stores (97%), general merchandise stores (96%), and restaurants (91%). Reference USA exhibited almost perfect sensitivity (0.89). Local health department data had substantial sensitivity (0.66) and was almost perfect when focusing only on restaurants (0.91). Positive predictive value was substantial for Reference USA (0.67) and moderate for local health department data (0.49). Evidence for validity was comparatively lower for Dun & Bradstreet, online Yellow Pages, and the NC Department of Agriculture. CONCLUSIONS: Secondary data sources both over- and under-represented the food environment; they were particularly problematic for identifying convenience stores and specialty markets. More attention is needed to improve the validity of existing data sources, especially for rural local food environments.
    International Journal of Behavioral Nutrition and Physical Activity 11/2012; 9(1):137. · 3.58 Impact Factor
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    ABSTRACT: Physical activity (PA) is low among African American women despite awareness of its positive impact on health. Learning and Developing Individual Exercise Skills for a Better Life (L.A.D.I.E.S.) compares three strategies for increasing PA among African American women using a cluster randomized, controlled trial. Underactive adult women from 30 churches (n=15 participants/church) were recruited. Churches were randomized to a faith-based intervention, a non-faith based intervention, or an information only control group. Intervention groups will meet 25 times in group sessions with other women from their church over a 10-month period. Control group participants will receive standard educational material promoting PA. All participants will be followed for an additional 12months to assess PA maintenance. Data will be collected at baseline, 10, and 22months. The primary outcome is PA (steps/day, daily moderate-to-vigorous PA). We expect treatment effects indicating that assignment to either of the active interventions is associated with greater magnitude of change in PA compared to the control group. In exploratory analyses, we will test whether changes in the faith-based intervention group are greater than changes in the non-faith-based intervention group. L.A.D.I.E.S. focuses on a significant issue-increasing PA levels-in a segment of the population most in need of successful strategies for improving health. If successful, L.A.D.I.E.S. will advance the field by providing an approach that is successful for initiating and sustaining change in physical activity, which has been shown to be a primary risk factor for a variety of health outcomes, using churches as the point of delivery.
    Contemporary clinical trials 08/2012; 33(6):1159-71. · 1.51 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate whether the evidence-based Body & Soul program, when disseminated and implemented without researcher or agency involvement and support, would achieve results similar to those of earlier efficacy and effectiveness trials. DESIGN: Prospective group randomized trial. SETTING: Churches with predominantly African American membership. PARTICIPANTS: A total of 1,033 members from the 15 churches completed baseline surveys. Of these participants, 562 (54.4%) completed the follow-up survey 6 months later. INTERVENTION: Church-based nutrition program for African Americans that included pastoral involvement, educational activities, church environmental changes, and peer counseling. MAIN OUTCOME MEASURE: Daily fruit and vegetable (FV) intake was assessed at pre- and posttest. ANALYSIS: Mixed-effects linear models. RESULTS: At posttest, there was no statistically significant difference in daily servings of FVs between the early intervention group participants compared to control group participants (4.7 vs 4.4, P = .38). Process evaluation suggested that added resources such as technical assistance could improve program implementation. CONCLUSIONS AND IMPLICATIONS: The disseminated program may not produce improvements in FV intake equal to those in the earlier efficacy and effectiveness trials, primarily because of a lack of program implementation. Program dissemination may not achieve public health impact unless support systems are strengthened for adequate implementation at the church level.
    Journal of nutrition education and behavior 03/2012; · 1.36 Impact Factor

Publication Stats

596 Citations
112.89 Total Impact Points

Institutions

  • 2007–2014
    • University of North Carolina at Chapel Hill
      • • Center for Health Promotion and Disease Prevention
      • • Department of Nutrition
      • • Department of Medicine
      North Carolina, United States
  • 2013
    • Penn State Hershey Medical Center and Penn State College of Medicine
      Hershey, Pennsylvania, United States
  • 2012
    • Gramercy Research Group
      Winston-Salem, North Carolina, United States
  • 2008
    • Rhode Island College
      Providence, Rhode Island, United States
  • 2005
    • North Carolina Department of Health and Human Services
      Raleigh, North Carolina, United States