Ken P Kleinman

Ken P Kleinman
University of Massachusetts Amherst | UMass Amherst · Department of Biostatistics and Epidemiology

ScD

About

362
Publications
54,935
Reads
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26,747
Citations
Citations since 2017
18 Research Items
10096 Citations
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201720182019202020212022202305001,0001,500
Additional affiliations
September 2015 - present
University of Massachusetts Amherst
Position
  • Professor (Associate)
Description
  • Teaching and Research
January 2000 - August 2015
Harvard Medical School
Position
  • Professor (Associate)
Description
  • 100% Grant-funded Researcher
January 1998 - December 2000

Publications

Publications (362)
Article
Full-text available
OBJECTIVE: To provide an updated birth weight–for–gestational age (BW-for-GA) reference in the United States by using the most recent, nationally representative birth data with obstetric estimates of gestational age (GA). METHODS: We abstracted 3 285 552 singleton births between 22 and 42 weeks’ gestation with nonmissing race and/or ethnicity, inf...
Article
Full-text available
Importance Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are ubiquitous synthetic chemicals that are suspected endocrine disruptors. Objectives To determine the extent to which PFASs are associated with increases in weight and body size and evaluate whether a lifestyle intervention modifies this association. Design, Setting, and Participa...
Article
Full-text available
Objective: To assess associations of pre-, perinatal, and parental factors with age and magnitude at body mass index (BMI) peak and rebound. Study design: Among 1681 children with BMI data from birth to mid-childhood in Project Viva, we fitted individual BMI trajectories using mixed-effect models with natural cubic spline functions and estimated a...
Article
Cesarean delivery rates remain high and variable across hospitals, regions, and countries.¹,2 Cesarean delivery may be a risk factor for childhood obesity,¹,2 possibly because delivery route can influence the intestinal microbiomes,³ which may influence energy regulation.
Article
Background Hospital-specific surgical site infection (SSI) performance following colon surgery and abdominal hysterectomies can impact hospitals’ relative rankings around quality metrics used to determine financial penalties. Current SSI surveillance largely focuses on SSI detected at the operative hospital. Methods Retrospective cohort study to a...
Article
Background: Rates of invasive pneumococcal disease have declined since widespread introduction of pneumococcal conjugate vaccines (PCVs) in the United States. We evaluated the impact of immunization status and recent antibiotic use on an individual child's risk of colonization. Methods: This study extends previously reported data from children <...
Article
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Background MDROs can spread between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) via shared patients. SHIELD OC is a regional decolonization collaborative involving 38 of 104 countywide adult facilities identified by their high degree of direct and indirect patient sharing with one another. We report baseline MDRO prev...
Article
Full-text available
Background Universal decolonization with daily chlorhexidine (CHG) bathing with and without nasal decolonization has significantly reduced positive MRSA clinical cultures and bloodstream infections in adult ICUs in several clinical trials. We evaluated whether decolonization was similarly effective in a lower risk hospitalized population. Methods...
Article
Full-text available
Background: Several per- and polyfluoroalkyl substances (PFAS) are ubiquitous anthropogenic pollutants almost universally detected in humans. Experimental evidence indicates that PFAS alter glucose metabolism and insulin secretion. However, epidemiological studies have yielded inconsistent results. Objective: We sought to examine associations be...
Article
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Background The majority of healthcare-associated infections due to MDROs occur in the post-discharge setting. Understanding MDRO spread and containment in NHs can help identify infection prevention activities needed to care for vulnerable patients in a medical home setting. Methods We conducted a baseline point prevalence study of MDRO colonizatio...
Article
Purpose: Prepregnancy obesity and weight changes accompanying pregnancy (gestational weight gain and postpartum weight retention) may be associated with risk of maternal depressive symptoms during pregnancy and in the postpartum. The few studies that have examined these relationships report conflicting findings. Methods: We studied pregnant (n =...
Article
Objectives: To examine associations of sugar sweetened beverages (SSBs) and other beverage intake during pregnancy with adiposity in midchildhood (median age of 7.7 years). Methods: We studied 1078 mother-child pairs in Project Viva, a prospective prebirth cohort study. Exposures were sugary and nonsugary beverage intake assessed in the first an...
Article
Full-text available
Background Symptomatic vitamin D deficiency is associated with slowed growth in children. It is unknown whether vitamin D repletion in children with asymptomatic serum vitamin D deficiency can restore normal growth. Objective We tested the impact of vitamin D-supplementation on serum concentrations of 25-hydroxyvitamin D [25(OH)D] and short-term g...
Data
CONSORT-2010-Checklist-MS-Word_PlosOne.doc. (DOC)
Data
Supplementation Study and Fortification Study protocol.docx. (DOCX)
Article
Nursing home residents are at risk for acquiring and transmitting MDROs. A serial point-prevalence study of 605 residents in 3 facilities using random sampling found MDRO colonization in 45% of residents: methicillin-resistant Staphylococcus aureus (MRSA, 26%); extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL, 17%); vancomycin-resis...
Article
Background: Observational and experimental evidence demonstrates that protein intake in infancy programs linear growth. To our knowledge, few studies have examined prenatal maternal protein intake. Objective: Our objective was to examine associations of maternal protein intake during pregnancy with offspring linear growth. Design: We analyzed...
Article
Whether targeted or universal decolonization strategies for control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE MRSA trial provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of screening and isolation without decolon...
Article
Full-text available
Background: Surgical site infection (SSI) rates are publicly reported as quality metrics and increasingly used to determine financial reimbursement. Objective: To evaluate the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. Rese...
Article
Importance: Ventilator bundles, including head-of-bed elevation, sedative infusion interruptions, spontaneous breathing trials, thromboprophylaxis, stress ulcer prophylaxis, and oral care with chlorhexidine gluconate, are ubiquitous, but the absolute and relative value of each bundle component is unclear. Objective: To evaluate associations betw...
Article
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Background Little is known about how factors within the general family environment are associated with weight and related behaviors among adolescents/young adults. Methods We studied 3768 females and 2614 males, 14–24 years old in 2011, participating in the Growing Up Today Study 2. We used generalized mixed models to examine cross-sectional assoc...
Article
Background: The obesity epidemic has spared no age group, even young infants. Most childhood obesity is incident by the age of 5 years, making prevention in preschool years a priority. Objective: To examine 2-year changes in age- and sex-specific BMI z-scores and obesity-related behaviours among 441 of the 475 originally recruited participants i...
Article
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Background: Challenges exist in implementing evidence-based strategies, reaching high compliance, and achieving desired outcomes. The rapid adoption of a publicly available toolkit featuring routine universal decolonization of intensive care unit (ICU) patients may affect catheter-related blood stream infections. Methods: Implementation of unive...
Article
Full-text available
Background Despite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations. We report on the construction of the Linked CENTURY database, incorporating CENTURY (Collecting Electronic Nutrition Trajectory Data Using Records of Youth) Study data with b...
Article
Background: Controversy persists about whether certain antidepressants reduce tamoxifen's effectiveness on lowering breast cancer recurrence. We investigated whether taking tamoxifen and antidepressants (in particular, paroxetine) concomitantly is associated with an increased risk of recurrence or contralateral breast cancer. Methods: We examine...
Article
Full-text available
Eating meals, particularly dinner, with family members has been found to be associated with improved dietary intake, lower prevalence of disordered eating behaviors, lower levels of substance abuse, and improved academic outcomes among adolescents. Limited research has examined how the frequency of family meals has changed over time. The objective...
Article
Objectives: To determine whether proximity to a supermarket modified the effects of an obesity intervention. Methods: We examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included a computerized...
Article
Objective: The authors aim was to examine associations of breastfeeding duration and exclusivity in infancy with executive function, behavior, and social-emotional development in mid-childhood. Methods: The authors studied 1037 participants in Project Viva, a prebirth cohort that enrolled pregnant mothers from 1999 to 2002 and followed children...
Article
Objective: To assess the extent to which an obesity prevention intervention that embeds obesity-related messages within a parenting program, compared with controls who received weekly mailings, resulted in a smaller increase in children's BMI (primary outcome) and improvements in weight-related behaviors from baseline to 9-month follow-up. Method...
Article
Objectives: To identify a pediatric ventilator-associated condition definition for use in neonates and children by exploring whether potential ventilator-associated condition definitions identify patients with worse outcomes. Design: Retrospective cohort study and a matched cohort analysis. Setting: Pediatric, cardiac, and neonatal ICUs in fiv...
Article
Background: Urinary tract infections (UTIs) are common health-care-associated infections. Bacteriuria commonly precedes UTI and is often treated with antibiotics, particularly in hospital intensive care units (ICUs). In 2013, a cluster-randomised trial (REDUCE MRSA Trial [Randomized Evaluation of Decolonization vs Universal Clearance to Eradicate...
Article
Background: Current sedation guidelines recommend avoiding benzodiazepines but express no preference for propofol versus dexmedetomidine. In addition, there are limited data on how well randomized controlled trials on sedatives generalize to routine practice where conditions tend to be more varied and complex. Methods: We gathered daily sedative...
Article
Differences in antibiotic knowledge and attitudes between parents of Medicaid-insured and commercially insured children have been previously reported. It is unknown whether understanding has improved and whether previously identified differences persist. A total of 1500 Massachusetts parents with a child <6 years old insured by a Medicaid managed c...
Article
To evaluate the association between employer-mandated enrollment into high-deductible health plans (HDHPs) and contraception and birth rates among reproductive-age women. Using data from 2002 to 2008, we examined 1,559 women continuously enrolled in a Massachusetts health plan for 1 year before and after an employer-mandated switch from an HMO to a...
Article
Glucose dysregulation in pregnancy may affect maternal depressive symptoms during the prenatal and postpartum periods via both physiologic and psychological pathways. During mid-pregnancy, a combination of 50-g 1-h non-fasting glucose challenge test (GCT) and 100-g 3-h fasting oral glucose tolerance test was used to determine pregnancy glycaemic st...
Article
Background/Aims: Employers increasingly offer financial incentives to employees for participation in wellness activities. Whether these incentives are effective is unclear. In a nonprofit health plan, we examined the impact of monetary incentives on completion of a health risk assessment (HRA). Methods: Harvard Pilgrim Health Care, a nonprofit HMO...
Article
Full-text available
Evidence of effective treatment of childhood obesity in primary care settings is limited. To examine the extent to which computerized clinical decision support (CDS) delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved body mass index (BMI; calculated as weight in kilogra...
Article
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The frequency of cluster-randomized trials (CRTs) in peer-reviewed literature has increased exponentially over the past two decades. CRTs are a valuable tool for studying interventions that cannot be effectively implemented or randomized at the individual level. However, some aspects of the design and analysis of data from CRTs are more complex tha...
Book
Improve Your Analytical Skills Incorporating the latest R packages as well as new case studies and applications, Using R and RStudio for Data Management, Statistical Analysis, and Graphics, Second Edition covers the aspects of R most often used by statistical analysts. New users of R will find the book’s simple approach easy to understand while mor...
Article
BACKGROUND Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals. OBJECTIVE To determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infectio...
Article
Objectives To examine the tracking and significance of beverage consumption in infancy and childhood.Methods Among 1163 children in Project Viva, we examined associations of fruit juice and water intake at 1 year (0 oz, 1-7 oz [small], 8-15 oz [medium], and ≥16 oz [large]) with juice and sugar-sweetened beverage (SSB) intake and BMI z-score during...
Article
Full-text available
Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. We...
Article
Our objective was to examine the associations of total and trimester-specific gestational weight gain (GWG) rate with postpartum maternal weight and cardiometabolic risk. We hypothesized the first-trimester GWG would be most strongly associated with long-term maternal health. We studied 801 women enrolled during the first trimester of pregnancy in...
Article
Rationale: The CDC introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs. Objectives: To assess the preventability of VAEs. Methods: We nested a multice...
Article
Full-text available
Background A key requirement for a useful power calculation is that the calculation mimic the data analysis that will be performed on the actual data, once that data is observed. Close approximations may be difficult to achieve using analytic solutions, however, and thus Monte Carlo approaches, including both simulation and bootstrap resampling, ar...
Conference Paper
Background: We conducted a 3 arm cluster randomized trial of three MRSA prevention strategies in 74 ICUs at 43 hospitals which demonstrated universal decolonization with chlorhexidine and mupirocin in adult ICUs resulted in a 44% reduction in risk of bloodstream infection due to all pathogens.(N Engl J Med 2013; 368:2255-2268) Implementing novel ev...
Conference Paper
Background: Bacteriuria commonly precedes UTI, and is often treated with antibiotics, especially in ICU patients. The impact of body surface decolonization on bacteriuria and candiduria is unknown. Methods: Secondary analysis of a 3 arm cluster randomized trial of 43 hospitals (74 adult ICUs). Arms included 1) MRSA screening and isolation, 2) tar...
Conference Paper
Background: The degree to which targeted or universal decolonization strategies for control of MRSA select for resistance to decolonizing agents is unresolved. Methods: MRSA isolates were collected during baseline and intervention periods from 74 ICUs in a 43 hospital, 3-arm, cluster-randomized trial of screening and isolation (arm 1), targeted d...
Article
Full-text available
Background. HIV/hepatitis C virus (HCV) coinfection is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. However, the structural underpinnings for the skeletal fragility in coinfected women have not been characterized. We used peripheral quantitative computed tomography (pQCT) and whole-body dua...
Article
Full-text available
Objective To determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization. Design Pragmatic cluster-randomized trial. Setting Forty-three hospitals with 74 ICUs; 42 of 43 were community hospitals. Patients Pati...
Article
Background: Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States cari...
Article
Background: Surgical site infections (SSIs) following vascular surgery have high morbidity and costs, and are increasingly tracked as hospital quality measures. Objective: To assess the ability of Medicare claims to identify US hospitals with high SSI rates after vascular surgery. Research design: Using claims from fee-for-service Medicare enr...
Article
Full-text available
The objective of our study was to compare the fit of four growth models for weight and height in contemporary US children between birth and 9 years. In Project Viva, we collected weight and height growth data between birth and 9 years. We compared the Jenss model, the adapted Jenss model that adds a quadratic term, and the Reed 1st and 2nd order mo...
Article
We implemented six confounding adjustment methods: (1) covariate-adjusted regression, (2) propensity score (PS) regression, (3) PS stratification, (4) PS matching with two calipers, (5) inverse probability weighting and (6) doubly robust estimation to examine the associations between the body mass index (BMI) z-score at 3 years and two separate dic...
Article
Full-text available
Background Observational studies rarely account for confounding by indication, whereby empiric antibiotics initiated for signs and symptoms of infection prior to the diagnosis of infection are then viewed as risk factors for infection. We evaluated whether confounding by indication impacts antimicrobial risk factors for methicillin-resistant Staphy...
Article
Purpose Several studies have reported increased risk of preeclampsia when 25-hyrdoxyvitamin D (25[OH]D) levels are low. The extent to which 25(OH)D may lower risk for hypertensive disorder during pregnancy remains unclear. Methods Among women enrolled in the Project Viva prenatal cohort in Massachusetts, we examined associations of 25(OH)D levels...
Article
Objective: The Centers for Disease Control and Prevention implemented new surveillance definitions for ventilator-associated events (VAEs) in January 2013. We describe the epidemiology, attributable morbidity, and attributable mortality of VAEs. Design: Retrospective cohort study. Setting: Academic tertiary care center. Patients: All patient...
Article
Television and insufficient sleep are associated with poor mental and physical health. This study assessed associations of TV viewing and bedroom TV with sleep duration from infancy to midchildhood. We studied 1864 children in Project Viva. Parents reported children's average daily TV viewing and sleep (at 6 months and annually from 1-7 years) and...
Article
We established Project Viva to examine prenatal diet and other factors in relation to maternal and child health. We recruited pregnant women at their initial prenatal visit in eastern Massachusetts between 1999 and 2002. Exclusion criteria included multiple gestation, inability to answer questions in English, gestational age 22 weeks at recruitment...
Article
Full-text available
In April 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 for use in the United States. We evaluated rates of pneumococcal colonization, by serotype and antibiotic resistance, in Massachusetts communities where serial cross-sectional surveillance has been conducted for the past decade. Nasopharyngeal swabs were obtained from c...
Article
Guidelines recommend screening for osteoporosis with bone mineral density (BMD) testing in menopausal women, particularly those with additional risk factors for fracture. Many eligible women remain unscreened. This randomized study demonstrates that a single outreach interactive voice response phone call improves rates of BMD screening among high-r...
Article
Full-text available
Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization predicts later infection, with both host and pathogen determinants of invasive disease. Methods: This nested case-control study evaluates predictors of MRSA bacteremia in an 8-intensive care unit (ICU) prospective adult cohort from 1 September 2003 through 30 April 2005...
Article
The goal of this study was to determine changes in antibiotic-dispensing rates among children in 3 health plans located in New England [A], the Mountain West [B], and the Midwest [C] regions of the United States. Pharmacy and outpatient claims from September 2000 to August 2010 were used to calculate rates of antibiotic dispensing per person-year f...
Article
Background: The Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery. Objective: To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Netwo...
Article
Objective: To examine the extent to which an intervention using electronic decision support delivered to pediatricians at the point-of-care of obese children, with or without direct-to-parent outreach, improved health care quality measures for child obesity. Design and methods: Process outcomes from a three-arm, cluster-randomized trial from 14...
Article
In children being taller is associated with higher blood pressure (BP), but few studies have divided height into its components: trunk and leg length. We examined the associations of total height, trunk length and leg length with systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP) at early childhood and mid-childhood visits, as well as ch...
Article
Background: Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: We conducted a pragmatic, cluster-randomized trial. Hospitals were random...
Conference Paper
Full-text available
The cluster-randomized trial (CRT) is a common study design in public health research. In situations where dividing a group of individuals into treatment and controls is unethical or impossible, a CRT design maintains the strengths of a randomized study design. By comparing the outcomes of small populations (clusters), we can observe the impacts of...
Article
Importance Breastfeeding may benefit child cognitive development, but few studies have quantified breastfeeding duration or exclusivity, nor has any study to date examined the role of maternal diet during lactation on child cognition.Objectives To examine relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7...