Randall Stafford

Stanford University | SU

Evidence of whether behavioral weight-loss interventions reduce depressive symptoms among Latino immigrants is limited. The effect of a behavioral weight-loss intervention on depressive symptoms was assessed using data from a clinical trial among Latino immigrants. Participants were randomized to a usual care (UC) control (n = 41), case management...

Diabetes is highly prevalent, affecting over 25 million adults in the US, yet it can be effectively prevented through lifestyle interventions, including the well-tested Diabetes Prevention Program (DPP). American Indian/Alaska Native (AIAN) adults, the majority of whom live in urban settings, are more than twice as likely to develop diabetes as non...

Importance Whether sustained physical activity prevents cardiovascular disease (CVD) events in older adults is uncertain. Objective To test the hypothesis that cardiovascular morbidity and mortality would be reduced in participants in a long-term physical activity program. Design, Setting, and Participants The Lifestyle Interventions and Independ...

Background: HMG-CoA reductase inhibitors (statins) are among the most commonly prescribed classes of medications. Although their cardiovascular benefits and myalgia risks are well documented, their effects on older adults initiating an exercise training program are less understood. Methods: 1,635 sedentary men and women aged 70-89 years with Sho...

Objectives To evaluate the effect of structured physical activity on respiratory outcomes in community-dwelling elderly adults with mobility limitations. DesignMulticenter, randomized trial of physical activity vs health education, with respiratory variables prespecified as tertiary outcomes over an intervention period of 24-42months. Physical acti...

Background: This subgroup analysis of the Lifestyle Intervention and Independence for Elders trial evaluates the impact of a long-term physical activity (PA) intervention on rates of major mobility disability (MMD) among older adults according to their antihypertensive medication use. Methods: Lifestyle Intervention and Independence for Elders s...

The use of aspirin in patients without cardiovascular disease remains controversial. Patients' understanding of the risks and benefits of aspirin likely contribute to the decision of whether or not to use aspirin regularly. The purpose of this study is to assess patients' knowledge of aspirin and identify factors contributing to regular use. A surv...

Hypertension is common and costly. Over the past decade, new antihypertensive therapies have been developed, several have lost patent protection and additional evidence regarding the safety and effectiveness of these agents has accrued. To examine trends in the use of antihypertensive therapies in the United States between 1997 and 2012. We used na...

Objectives C-terminal Agrin Fragment (CAF) has been proposed as a potential circulating biomarker for predicting changes in physical function among older adults. To determine the effect of a one-year PA intervention on changes in CAF concentrations and to evaluate baseline and longitudinal associations between CAF concentrations and indices of phys...

Latino immigrants have high rates of obesity and face barriers to weight loss. To evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss. This was a 2-year, randomized controlled trial comparing two interventions with each other and with usual care (UC). Eligible participan...

Objectives Because they are potentially modifiable and may coexist, we evaluated the combined occurrence of a reduced forced expiratory volume in 1 second (FEV1) and peripheral artery disease (PAD), including its association with exertional symptoms, physical inactivity, and impaired mobility, in sedentary elders with functional limitations. Desig...

We examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. Data were extracted from electronic health records (EHR) for active patients ≥35 years in a multispecialty, multiclinic ambulatory care organization with 1000 providers. New onset type 2 diabetes and subsequent treatment wer...

Importance Describing the relationship between the availability of free prescription drug samples and dermatologists’ prescribing patterns on a national scale can help inform policy guidelines on the use of free samples in a physician’s office.Objectives To investigate the relationships between free drug samples and dermatologists’ local and nati...

Objective To examine weight loss patterns and predictors among participants in a primary care-based translation study of the Diabetes Prevention Program lifestyle intervention. Design and Methods Cluster analysis identified short-term (12-week) weight loss patterns among 72 intervention participants. Analysis of variance assessed cluster differenc...

Background Type 2 diabetes is increasingly common and associated with substantial morbidity and mortality.Methods We conducted descriptive analyses of cross-sectional data using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory physician practices in the US. We focused on visits for diabetes amon...

Low-socioeconomic-status (SES) Latinos are disproportionately represented among the 78 million obese Americans. Tailored behavioral weight-loss interventions show promise, but there is limited adaptation to lower-SES Latino immigrants. This study provides guidance for tailoring obesity-reduction strategies for this population by evaluating food sec...

Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of nonmalignant pain. The aim of the study was to characterize the diagnosis and management of nonmalignant pain in ambulatory, office-based settings in the United States between 2000 and 2010. Serial cross-sectional and multivaria...

In June, 2013, 23 experts from nine countries met at the International Agency for Research on Cancer (IARC), Lyon, France, to assess the carcinogenicity of 14 drugs and herbal products (table). Some agents are discussed in more detail because of data complexity or the extent of human exposure. These assessments will be published as volume 108 of th...

As a result of the rising national obesity rates, public health researchers and advocates have initiated a number of obesity prevention interventions to reduce the rates of overweight and obesity along with their related medical conditions and costs. Policymakers have also initiated a wide range of environmental and policies to support healthy eati...

A 1-A 2 9 8 was discontinued early; only safety results from this group are presented. For the armodafinil 150 mg group compared with placebo, there was a significantly greater decrease in LS mean (SEM) IDS-C30 total score (−21.7 [1.11] vs −17.9 [1.10]; P=0.0097) at week 8 and the percentage of IDS-C30 responders (≥50% decrease from baseline) was s...

Patients with coronary artery disease (CAD) are at high risk of recurrent adverse cardiac events. Such risk can be diminished through a guideline-recommend optimal medical therapy (OMT), defined as adherence to appropriate antiplatelet therapy, lipid-lowering agents, beta-blockers and angio.tensin-converting enzyme inhibitors, blood pressure < 140/...

The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluated the feasibility and potential effectiveness of translating an evidence-based lifestyle intervention for the management of obesity and related risk factors in a primary care setting. Delivered by allied health care providers, the...

Objectives To compare the 1-year survival for different age strata of intensive care unit (ICU) patients after receipt of packed red blood cell (PRBC) transfusions. Background Despite guidelines documenting risks of PRBC transfusion and data showing that increasing age is associated with ICU mortality, little data exist on whether age alters the tr...

Background The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care. Methods We evaluated 2 adapted DPP lifestyle interventions among overweight or obe...

Background: Although the Diabetes Prevention Program (DPP) lifestyle intervention reduced type 2 diabetes incidence by 58% among high-risk adults at academic centers, it requires translation into typical primary care settings. Using baseline data from the Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care...

Obesity and its clinical consequences, such as diabetes, are more prevalent among socially disadvantaged groups in the US, including low-income Latinos and American Indians. Latinos and American Indians are more than twice as likely as non-Hispanic whites to have diabetes. In 2011, with institutional support from the Stanford Office of Community He...

Obesity affects approximately 40% of Latino adults in the United States. Low-income Latino immigrant communities appear to be particularly affected. While intensive lifestyle counseling has been shown to promote weight loss and prevent future obesity-related disease, there has been limited evaluation of such strategies among low-income Latino immig...

Background: Latinos, especially those of low socioeconomic status (SES), are disproportionately represented among the 60 million Americans classified as obese. While intensive behavioral interventions have been effective for weight loss, few have been evaluated for low-SES Latinos. Evidence of behavioral predictors of obesigenic behavior in this po...

Flexner's acute care model remains securely embedded in the U.S. health care system. But given our chronic-disease epidemics, unsustainable costs, poor outcomes, frequent medical errors, and worsening health disparities, we must replace it with a prevention model.

Background: Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States. Methods and results: We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based provider...

Suboptimal aspirin use can result in unnecessary and preventable cardiovascular events. Empowering consumers to approach physicians may provide an effective strategy to overcome barriers to optimal aspirin use. We developed an online aspirin advice tool that provided individually tailored recommendations based on current use and clinical cardiovasc...

The 2010 Affordable Care Act relies on Federally Qualified Health Centers (FQHCs) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and efficiency. To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory ca...

Adult and childhood obesity and related adverse outcomes are most common among racial/ethnic minorities and socio-economically disadvantaged populations in the United States . Research approaches to obesity developed in mainstream populations and deploying new information technologies may exacerbate existing disparities in obesity. Current obesity...

To assess the association between angiotensin converting enzyme inhibitors (ACEis) and improvements in the physical function of older adults in response to chronic exercise training. Secondary analysis of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study, a multisite randomized clinical trial to evaluate the effects of ch...

"Off-label use" occurs when the use of a medication or device deviates from what is mentioned in its US Food and Drug Administration (FDA) product label. Off-label use is common, legal, and an important source of innovation; however, it can be costly, and strong evidence of the efficacy and safety of such use may be lacking.(1) Given the contradict...

Obesity-related increases in multiple inflammatory markers may contribute to the persistent subclinical inflammation common with advancing age. However, it is unclear if a specific combination of markers reflects the underlying inflammatory state. We used factor analysis to identify inflammatory factor(s) and examine their associations with adiposi...

Hypertension is highly prevalent and contributes to cardiovascular morbidity and mortality. Appropriate identification of hypertension is fundamental for its management. The rates of appropriate hypertension diagnosis in outpatient settings using an electronic health record (EHR) have not been well studied. We sought to identify prevalent and incid...

The 2004 Surgeon General's Bone Health Report calls for innovative interventions to reduce osteoporotic fracture. We developed an Internet-based risk- and stage-tailored intervention to promote self-management of fracture risk. We randomized 121 women to receive 18 personalized Internet-based tutorials with behavior modification strategies for nutr...

Photovoice is a methodology of participatory photography often used within marginalized communities. It promotes reflection and dialogue regarding community strengths, challenges, and needs, and empowers community members for social action. We introduced Photovoice to a sub-group of participants within a community-based randomized controlled trial...

There is a lack of information on whether exercise training alone can reduce the prevalence of metabolic syndrome (MetS) in elderly men and women. This study was an ancillary to the Lifestyle Interventions and Independence for Elders Pilot Study, a four-site, single-blind, randomized controlled clinical trial comparing a 12-month physical activity...

Electronic health records (EHRs) are touted as a key strategy for reducing costs and improving quality in our health care system, which are both urgent goals. The shortcomings of our current system are perhaps most apparent in the provision of preventive services. Contrasted with treatment services focused on addressing symptomatic disease, prevent...

Despite reductions in morbidity and mortality and changes in guidelines, little is known regarding changes in asthma treatment patterns. To examine national trends in the office-based treatment of asthma between 1997 and 2009. We used the National Ambulatory Care Survey (NAMCS) and the National Disease and Therapeutic Index™ (NDTI), nationally repr...

The adoption and use of a new drug would ideally be guided by its innovation and cost-effectiveness. However, information about the relative efficacy and safety of a drug is typically incomplete even well after market entry, and various other forces create a marketplace in which most new drugs are little better than their older counterparts. Five p...

The Kingdom of Saudi Arabia (KSA), similar to other countries in the Eastern Mediterranean, has been experiencing a recent rapid increase in the prevalence of chronic diseases and associated risk factors. To begin to take advantage of the chronic disease prevention and health promotion (CDPHP) knowledge available from other nations, researchers at...

Electronic health records (EHRs) are increasingly used by US outpatient physicians. They could improve clinical care via clinical decision support (CDS) and electronic guideline-based reminders and alerts. Using nationally representative data, we tested the hypothesis that a higher quality of care would be associated with EHRs and CDS. We analyzed...

Recombinant factor VIIa (rFVIIa) is approved for treatment of bleeding in patients who have hemophilia with inhibitors but has been applied to a wide range of off-label indications. To estimate patterns of off-label rFVIIa use in U.S. hospitals. Retrospective database analysis. Data were extracted from the Premier Perspectives database (Premier, Ch...

Recombinant factor VIIa (rFVIIa), a hemostatic agent approved for hemophilia, is increasingly used for off-label indications. To evaluate the benefits and harms of rFVIIa use for 5 off-label, in-hospital indications: intracranial hemorrhage, cardiac surgery, trauma, liver transplantation, and prostatectomy. Ten databases (including PubMed, EMBASE,...

Requiring indications for inpatient medication orders may improve the quality of prescribing and allow for easier placement of diagnoses on the problem list. Indications for inpatient medication orders are also required by some regulators. This study assessed a clinical decision support (CDS) system designed to obtain indications and document probl...

Obesity exerts an enormous health impact through its effect on coronary heart disease and its risk factors. Primary care-based and community-based intensive lifestyle counseling may effectively promote weight loss. There has been limited implementation and evaluation of these strategies, particularly the added benefit of community-based interventio...

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Str...

To evaluate patterns of antipsychotic use. DESIGN, SETTING, AND MEASUREMENTS: We used nationally representative data from the IMS Health National Disease and Therapeutic Index to describe outpatient antipsychotic use. The primary outcome was the volume of visits where antipsychotics were used for specific indications (treatment visits). We also qua...

Background: The use of recombinant activated factor VII (rFVIIa) on an off-label basis to treat life-threatening bleeding has been associated with a perceived increased risk of thromboembolic complications. However, data from placebo-controlled trials are needed to properly assess the thromboembolic risk. To address this issue, we evaluated the rat...

To examine obesity diagnosis, obesity-related counseling, and laboratory testing rates among obese pediatric patients seen in US preventive outpatient visits and to determine patient, provider, and practice-level factors that are associated with obesity diagnosis. By using 2005-2007 National Ambulatory Medical Care Survey and National Hospital Ambu...

The aim of this study was to evaluate recent trends and the adoption of practice recommendations for menopausal hormone therapy (MHT) use from 2001 to 2009 by formulation, dose, woman's age, and characteristics of physicians reporting MHT visits. The IMS Health (Plymouth Meeting PA) National Disease and Therapeutic Index physician survey data from...

Background Although modifiable cardiovascular disease risk factors are common, some patients eschew conventional drug treatments in favor of natural alternatives. Pine bark extract, a dietary supplement source of antioxidant oligomeric proanthocyanidin complexes, has multiple putative cardiovascular benefits. Studies published to date about the su...

Congestive heart failure (CHF) continues to account for 3% of admissions to hospitals in the United States, and the diagnosis carries a mortality rate of 20% at one year and 80% at eight years.1,2 There have been numerous advances in the chronic medical management of CHF, including angiotensin antagonists, beta blockers, and aldosterone antagonists...

Strategies are needed to improve the translation of clinical trial results into practice. We assessed the impact of the ALLHAT/JNC7 Dissemination Project's academic detailing component on thiazide-type diuretic prescribing (ALLHAT indicates Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; JNC7 indicates the Seventh Repor...

Each year, the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke St...

Each year, the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke St...

Background: Mexican American adults, whose numbers are growing, have low rates of hypertension treatment and control, placing them at high risk for cardiovascular disease morbidity and mortality. Objectives. In a national sample of Mexican American adults, we examined: 1) 10-year changes in hypertension prevalence, treatment and control among subgr...

The burden of hypertension and related health care needs among Mexican Americans will likely increase substantially in the near future. In a nationally representative sample of U.S. Mexican American adults we examined: 1) the full range of blood pressure categories, from normal to severe; 2) predictors of hypertension awareness, treatment and contr...

Efficacy research has shown that intensive individual lifestyle intervention lowers the risk for developing type 2 diabetes mellitus and the metabolic syndrome. Translational research is needed to test real-world models of lifestyle interventions in primary care settings. E-LITE is a three-arm randomized controlled clinical trial aimed at testing t...

Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations. We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk fact...

Purpose: To characterize patterns of off-label rFVIIa use in ICH and evaluate its comparative safety and effectiveness versus usual care. Methods: Patterns of Use: We analyzed rFVIIa use for ICH using the 2000-08 Premier Prospectives administrative database, a representative sample of 615 US hospitals. Systematic Review: We sought English-languag...

Purpose: To characterize patterns of rFVIIa use in adult cardiac surgery and evaluate its comparative safety and effectiveness versus usual care. Methods: Patterns of Use: We evaluated the use of rFVIIa for cardiac surgery from the 2000-8 Premier Prospectives administrative database, a representative sample of 615 US hospitals. Systematic Review:...

The FDA does not currently require label statements regarding a product's comparative effectiveness. Dr. Randall Stafford, Todd Wagner, and Philip Lavori propose an expanded labeling requirement that would provide explicit information about proven comparative benefits or lack thereof.

A common form of validation study compares alternative methods for collecting data. The Bland-Altman plot pairs observations across methods and plots their mean values vs. their difference. This method provides only limited information, however, when the range of observed values is small relative to the number of observations. This brief report sho...

Researchers, policy makers, insurers, and other stakeholders have voiced enthusiasm about the value of comparative effectiveness research that rigorously evaluates 2 or more drugs or devices. The most recent boost for these efforts has been the US congressional financial stimulus package that contains provisions for $1.1 billion to be devoted to th...

We examined the rates of obesity screening and diagnosis in a nationally representative sample of visits by patients 18 years and older to private physician offices and hospital outpatient departments across the United States. Data were obtained from the 2005 National Ambulatory Medical Care Surveys conducted by the National Center for Health Stati...

Nationally representative data on the quality of care for obese patients in US-ambulatory care settings are limited. We conducted a cross-sectional analysis of the 2005 and 2006 National Ambulatory Medical Care Survey (NAMCS). We examined obesity screening, diagnosis, and counseling during adult visits and associations with patient and provider cha...

To develop a prioritized list of individual drugs for which future research regarding off-label uses is warranted. Retrospective, cross-sectional study. Commercial database that provides ongoing estimates of drug prescribing practices of office-based physicians in the United States and an Internet database of comprehensive evidence-based drug infor...

Diabetes mellitus is common, costly, and increasingly prevalent. Despite innovations in therapy, little is known about patterns and costs of drug treatment. We used the National Disease and Therapeutic Index to analyze medications prescribed between 1994 and 2007 for all US office visits among patients 35 years and older with type 2 diabetes. We us...