Stephenie C Lemon

• University of Massachusetts Chan Medical School

Purpose Depression and anxiety disorders are prevalent in the perinatal period and disproportionately impact individuals who experience economic marginalization. <15% of at-risk individuals are referred for recommended preventative counseling interventions. Little is known about the attitudes of care professionals and perinatal individuals towards...

Climate change poses profound threats to human safety, health, and well-being. Public health agencies, especially state, territorial, local, and Tribal health departments, can play an essential role in climate change adaptation and mitigation. Public health climate action can protect health, promote health equity, and increase climate change resili...

Background Multimorbidity among parents, guardians, and caregivers may increase the risk of household food insecurity, which would negatively impact both parents and children. However, limited research has been done to evaluate this relationship among this population. To fill this gap, we examined the association between multimorbidity and food ins...

Active transportation such as walking, bicycling, scootering, or using a wheelchair has direct physical and mental health benefits. Electric bicycles (e-bikes) have great potential as a form of active transportation. The Massachusetts Clean Energy Center partnered with the Massachusetts Bicycle Coalition (MassBike) to develop and pilot test of a pr...

Background/Objectives: Pediatric hypertension is an important and impactful condition. The 2017 American Academy of Pediatrics clinical practice guidelines provide recommendations for identifying and managing this condition within primary care. However, the perspectives and self-described practices of physicians are largely absent in the current ev...

Background Patient navigation is an evidence‐based intervention for reducing delays in cancer care for underserved populations. There are limited economic evaluations of patient navigation in the US health care system and few have considered costs at various phases along the implementation spectrum. Having economic data, including costs and cost sa...

Despite rising prevalence of high blood pressure among youth, literature on school nurses’ practices related to youth blood pressure is limited. We aimed to describe school nurses’ current practices related to blood pressure screening and identification and monitoring of high blood pressures. We conducted a web-based national survey of currently pr...

Objectives Digital interventions are increasingly in demand to address mental health concerns, with significant potential to reach populations that disproportionately face barriers to accessing mental health care. Challenges with user engagement, however, persist. The goal of this study was to develop user personas to inform the development of a di...

Purpose The purpose of the study was to describe the development and feasibility of implementing the DM-BOOST program in support of an established diabetes self-management education and support (DSMES) program. Methods A patient panel of 4 adults with type 2 diabetes (T2DM) codesigned DM-BOOST. DM-BOOST is a patient-focused program that includes p...

Background Despite numerous calls for standardized collection of sexual orientation and gender identity (SOGI) data in clinical settings, uptake of this practice still lags. Objectives This study conducted a preimplementation assessment of staff attitudes toward SOGI data collection within an adult primary care practice in an urban academic medica...

Objective Lifestyle interventions are effective, but those delivered via in-person group meetings have poor scalability and reach. Research is needed to establish if remotely delivered lifestyle interventions are non-inferior to in-person delivered lifestyle interventions. Methods We conducted a randomized non-inferiority trial (N = 329) to compar...

Background/objective Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality in the US. Improved diagnosis and treatment of HDP may be achieved through home blood pressure monitoring (HBPM). However, there are challenges to effective HBPM during pregnancy. This qualitative study was conducted to explore patie...

Background Social needs inhibit receipt of timely medical care. Social needs screening is a vital part of comprehensive cancer care, and patient navigators are well-positioned to screen for and address social needs. This mixed methods project describes social needs screening implementation in a prospective pragmatic patient navigation intervention...

Background Understanding changes in diagnostic performance after symptom onset and SARS-CoV-2 exposure within different populations is crucial to guide the use of diagnostics for SARS-CoV-2. Methods The Test Us at Home study was a longitudinal cohort study that enrolled individuals across the United States between October 2021 and February 2022. P...

Background: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality in the US, contributing to over 30% of maternal deaths. Improved diagnosis, treatment, and outcomes of HDP may be achieved through home blood pressure monitoring (HBPM). However, there are many challenges to effective HBPM during pregnancy. W...

We explored patterns of COVID-19 vaccination across pediatric visit types using electronic health record data from 7/1/2021 through 7/25/2022 in a pediatric safety-net clinic. We generated frequencies and descriptive statistics for patient demographic and vaccine administration variables. Analyses were stratified into age subgroups of 5-to-11-year-...

Introduction Integrating equity considerations into bicycle infrastructure, planning, and programming is essential to increase bicycling and reduce physical inactivity–related health disparities. However, little is known about communities’ experiences with activities that promote equity considerations in bicycle infrastructure, planning, and progra...

Adolescence is a critical period for establishing habits and engaging in health behaviors to prevent future cancers. Rural areas tend to have higher rates of cancer-related morbidity and mortality as well as higher rates of cancer-risk factors among adolescents. Rural primary care clinicians are well-positioned to address these risk factors. Our go...

Objective: Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis. Method: We conducted a comprehensive lite...

Public health departments have important roles to play in addressing the local health impacts of climate change, yet are often not well prepared to do so. The Climate and Health Program (CHP) at the Centers for Disease Control and Prevention (CDC) created the Building Resilience Against Climate Effects (BRACE) framework in 2012 as a five-step plann...

Background: The performance of rapid antigen tests (Ag-RDTs) for screening asymptomatic and symptomatic persons for SARS-CoV-2 is not well established. Objective: To evaluate the performance of Ag-RDTs for detection of SARS-CoV-2 among symptomatic and asymptomatic participants. Design: This prospective cohort study enrolled participants betwee...

Objective: To describe the prevalence of blood pressure (BP) screening according to the 2017 American Academy of Pediatrics (AAP) guidelines and differences according to social vulnerability indicators. Study design: We extracted electronic health record data from January 1, 2018, through December 31, 2018 from the largest healthcare system in C...

Objectives: To describe adherence to the American Academy of Pediatrics' (AAP) 2017 clinical practice guidelines for follow-up after high blood pressure (BP) screening by pediatric and family medicine providers in a Massachusetts healthcare system and to assess differences in receipt of follow-up according to child- and clinic-level factors. Meth...

Rises in parental vaccine hesitancy, observed during the COVID−19 pandemic, threaten public health. This is especially concerning for vaccines not typically required for school-entry, such as the vaccines for COVID−19 and human papillomavirus (HPV), both of which also have much lower rates of completion compared to other adolescent vaccines. Pediat...

Introduction: The DM-BOOST intervention was developed to enhance engagement with diabetes self-management training (DSMT). Participants received peer-written text message tips with nudges to reply with personal preferences. They then completed a video call with the DM-BOOST team to confirm patient portal access, review key functions, and set a diab...

Provider physical activity referrals are recommended for cancer survivors, though barriers exist to clinical system integration. To develop and test ActivityChoice, an electronic referral (eReferral) clinic implementation program referring cancer survivors to physical activity programs of their choice. In Phase 1, we conducted semi-structured inter...

Despite the availability of COVID-19 vaccines for youth since 2021, vaccine hesitancy has resulted in suboptimal uptake. Public health campaigns that empower local youth ambassadors as trusted messengers who share their personal narratives related to getting vaccinated hold promise for promoting COVID-19 vaccination. We used a seven-step approach t...

Background Rapid antigen detection tests (Ag-RDT) for SARS-CoV-2 with emergency use authorization generally include a condition of authorization to evaluate the test’s performance in asymptomatic individuals when used serially. We aim to describe a novel study design that was used to generate regulatory-quality data to evaluate the serial use of Ag...

Background: "Storytelling" interventions influence knowledge, attitudes and behavior to promote chronic disease management. We aimed to describe the development of a video "storytelling" intervention to increase gout knowledge and promote adherence to medications and follow-up care after an acute gout flare visit in the emergency department. Meth...

Introduction: Heart-healthy diets are important in preventing hypertension (HTN) and hypertensive disorders of pregnancy (HDP), leading causes of preventable maternal mortality. However, perspectives of pregnant people with these conditions on barriers and facilitators of healthy eating are not well established. This study explored these experience...

Background Hypertension is an important modifiable risk factor of serious maternal morbidity and mortality. Social determinants of health (SDoH) influence hypertension outcomes and may contribute to racial and ethnic differences in hypertension control. Our objective was to assess SDoH and blood pressure (BP) control by race and ethnicity in US wom...

Background: The performance of rapid antigen tests for SARS-CoV-2 (Ag-RDT) in temporal relation to symptom onset or exposure is unknown, as is the impact of vaccination on this relationship. Objective: To evaluate the performance of Ag-RDT compared with RT-PCR based on day after symptom onset or exposure in order to decide on when to test. Design,...

Background: The current study aimed to understand how people with mental health conditions who currently smoke or recently quit engaged with family members or peers when quitting and assessed interest in involving family or peers in cessation interventions. Methods: Adults with mental health conditions who smoke or had quit within the past 5 years...

Background Discrimination has been posited as a contributor of sleep disparities for Latinxs. The strategy used to cope with discrimination may reduce or exacerbate its effects on sleep. This study examined whether different types of discrimination (everyday and major lifetime discrimination) were associated with sleep indices (quality, disturbance...

Socioeconomically disadvantaged children experience a high burden of obesity but few interventions address obesity prevention in this population subgroup. The Healthy Kids & Families study tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were child-parent...

Introduction: Cardiovascular disease (CVD) is the leading cause of maternal morbidity and mortality. The American Heart Association’s “Life’s Simple 7” (LS7) highlights seven modifiable factors for promoting cardiovascular health - managing blood pressure (BP), controlling cholesterol, reducing blood sugar, getting active, eating better, maintainin...

Objective : Innovative strategies are needed to improve pediatric COVID-19 vaccination rates. We describe the process for developing a clinic-based intervention, CONFIDENCE, to improve pediatric COVID-19 vaccine uptake and present results of our beta-test for feasibility and acceptability. Methods : CONFIDENCE included communication training with...

Active transportation by walking or biking can improve health and quality of life. Public health official participation in transportation and land use policy-related decision-making is recommended to improve opportunities for active transportation. However, United States local health department (LHD) engagement in activities that support this decis...

Background and Aim Patients with lung cancer experience high rates of psychosocial distress. They are also more likely to have unresolved, unmet social needs which may contribute to psychosocial distress. Despite this, neighborhood‐level social determinants of health (SDOH) in relation to psychosocial distress have not been adequately investigated...

Introduction Heart healthy diets are important in the prevention and treatment of hypertension (HTN), including among pregnant women. Yet, the barriers, facilitators, and beliefs/preferences regarding healthy eating are not well-described in this population. Objective To identify barriers and facilitators to healthy diet, examine the prevalence of...

Vaccine hesitancy is a long-standing public health issue. The present work describes parental perceptions of COVID-19 vaccination for 5- to 11-year-old children, to aid in vaccination efforts. Parents of 5- to 11-year-old children residing in Worcester, Massachusetts, were recruited through community partner outreach to participate in semi-structur...

Introduction: Community fears of gentrification have created concerns about building active living infrastructure in neighborhoods with low-income populations. However, little empirical research exists related to these concerns. This work describes characteristics of residents who reported 1) concerns about increased cost of living caused by neigh...

We explored perspectives of clinicians in central and western Massachusetts about efforts to vaccinate pediatric patients against COVID-19 as well as best practices and challenges for vaccine delivery. We conducted semi-structured qualitative interviews (n=16) with family practice and pediatric clinicians between late October and early December, 20...

Objectives To identify frequency and correlates of hypertension in a low income, ethnically diverse, sample of children as well as to assess parental awareness of hypertension.Methods This cross-sectional study included parent-child dyads (n = 228), from which physical measurements of the child, and parent reported survey measures were collected. C...

Background Negative emotional eating (EE) is associated with unfavorable behavioral and health outcomes. Understanding its association with positive factors, such as optimism, may shed light into novel interventions. We examined the association between optimism and negative EE in US Caribbean Latinx adults, a population disproportionately exposed t...

Background Supportive family or peer behaviors positively impact smoking cessation in people with mental health problems who smoke. However, the limited understanding of the pathways through which family or peer factors impact quitting limits the development of effective support interventions. This study examined pathways through which family or pe...

Background Performance of rapid antigen tests for SARS-CoV-2 (Ag-RDT) varies over the course of an infection, and their performance in screening for SARS-CoV-2 is not well established. We aimed to evaluate performance of Ag-RDT for detection of SARS-CoV-2 for symptomatic and asymptomatic participants. Methods Participants >2 years old across the U...

Background Rapid antigen tests (Ag-RDT) for SARS-CoV-2 with Emergency Use Authorization generally include a condition of authorization to evaluate the test’s performance in asymptomatic individuals when used serially. Objective To describe a novel study design to generate regulatory-quality data to evaluate serial use of Ag-RDT in detecting SARS-C...

Background Due to underrepresentation of racial/ethnic minority and low-income groups in clinical studies, there is a call to improve the recruitment and retention of these populations in research. Pilot studies can test recruitment and retention practices for better inclusion of medically underserved children and families in subsequent clinical tr...

Adults with mental health problems have a higher prevalence of cigarette smoking. We examined the association of family or peer views towards tobacco use on past 30-day cessation among adult smokers reporting mental health conditions. We used nationally representative data from the Population Assessment of Tobacco and Health Study 2016-2018. We inc...

Background: School-supervised asthma therapy improves asthma outcomes for children, yet this strategy is not widely utilized. School nurses play a vital role in this intervention, yet their perspectives on school-supervised asthma therapy have not been thoroughly examined. Objectives: To examine the perspectives of school nurses participating in sc...

Background Hypertension (HTN) is a leading cause of maternal mortality, and HTN guidelines recommend home blood pressure monitoring (HBPM) to help achieve blood pressure (BP) control. Evidence suggests that HBPM be coupled with a care team to maximize its effectiveness. HBPM use and the prevalence of provider counseling in child-bearing age women w...

Introduction: Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities. Objective: To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions....

Background Implementation science frameworks advise the engagement of multi-level partners (at the patient, provider, and systems level) to adapt and increase the uptake of evidence-based practices (EBPs). However, there is little guidance to ensure that systems-level adaptations reflect the voices of providers who deliver and patients/caregivers w...

BACKGROUND Serial testing for SARS-CoV-2 is recommended to reduce spread of the virus; however, little is known about adherence to recommended testing schedules and reporting practices to health departments. OBJECTIVE Self-Testing for Our Protection from COVID-19 (STOP COVID-19) aims to examine adherence to a risk-based COVID-19 testing strategy u...

Background: Serial testing for SARS-CoV-2 is recommended to reduce spread of the virus; however, little is known about adherence to recommended testing schedules and reporting practices to health departments. Objective: Self-Testing for Our Protection from COVID-19 (STOP COVID-19) aims to examine adherence to a risk-based COVID-19 testing strate...

INTRODUCTION Under-representation in health-related research is one of a multitude of factors that contribute to cancer disparities experienced by African American and Latinx communities. Barriers to research participation stem from historical social injustices, are multi-faceted and include factors specific to the research process, research team m...

BACKGROUND Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether the use of patient portals may improve perceived PCC or which mechanisms might mediate this relationship has not...

Background: Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might medi...

Introduction The American Academy of Pediatrics (AAP) updated its blood pressure (BP) screening guidelines in 2017 to emphasize body weight as a risk factor. We provide contemporary, nationally representative estimates of prevalence of elevated and hypertensive BP among US children and examine sociodemographic prevalence differences, accounting for...

Background Reducing sugar-sweetened beverage (SSB) consumption is a promising dietary target for childhood obesity prevention. This paper describes the design and methods of a cluster randomized trial of H 2 GO!, a youth empowerment intervention to prevent childhood obesity through reducing SSB consumption among a low-income, ethnically diverse sam...

Introduction: Hypertension (HTN) is the most important modifiable risk factor of serious maternal mortality and morbidity. Social determinants, including economic stability and access to healthcare, influence HTN outcomes and are critical to understanding and addressing racial and ethnic differences in HTN control. Objective: To assess social deter...

Introduction Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barrier...

The National Institutes of Health (NIH) launched the Rapid Acceleration of Diagnostics (RADx <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">SM</sup> ) Tech initiative to support the development and commercialization of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) point-of-care te...

Background Physical activity rates in cancer survivors continue to be low despite the known benefits and availability of evidence-based programs. LIVESTRONG at the Y is a national community-based physical activity program offered cost-free to cancer survivors, though is underutilized. We explored perceptions and experiences of staff and participati...

Background US Latinos report high levels of emotional distress. Having positive familial and friend social support buffers emotional distress among US Latinos, but thus far no research has been done on social support and ataque de nervios in that population, or on social strain and emotional distress. Methods This paper assesses social support and...

Background: Policy, systems, and environmental (PSE) approaches can sustainably improve healthy eating (HE) and physical activity (PA) but are challenging to implement. Community health improvement plans (CHIPs) represent a strategic opportunity to advance PSEs but have not been adequately researched. The objective of this study was to describe typ...

Background Physical activity rates in cancer survivors continue to be low despite the known benefits and availability of evidence-based programs. LIVESTRONG at the Y is a national community-based physical activity program offered cost-free to cancer survivors, though is underutilized. We explored perceptions and experiences of staff and participati...

BACKGROUND COVID-19 has had significant health and behavioral impacts on populations worldwide. Cancer survivors are at particular risk of changes in behavioral patterns, as they were encouraged to be more vigilant and observe stricter social distancing guidelines. OBJECTIVE We explored 1) changes in physical activity/sedentary behaviors since COV...

Background: COVID-19 has had significant health and behavioral impacts on populations worldwide. Cancer survivors are at particular risk of changes in behavioral patterns, as they were encouraged to be more vigilant and observe stricter social distancing guidelines. Objective: We explored 1) changes in physical activity/sedentary behaviors since...

BACKGROUND Patients with poorly-controlled type 2 diabetes experience increased morbidity, mortality and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices...

Background Patients with poorly controlled type 2 diabetes (T2D) experience increased morbidity, increased mortality, and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-...

Objective To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in Latina women. Design A secondary analysis of a cross-sectional study. Participants Women (n = 297) were recruited from a community health center in Lawrence, MA. Variables measured The 6-item US Department of Agricultur...

Ataque de nervios is a Latina/o idiom of distress that may occur as a culturally sanctioned response to acute stressful experiences, particularly relating to grief, threat, family conflict, and a breakdown in social networks. The contextual factors associated with ataque de nervios have received little attention in research. This study examined the...

Purpose: Increased physical activity (PA) levels in cancer survivors are associated with decreased risk of recurrence and mortality as well as additional positive health outcomes. PA interventions have shown to be efficacious, though many lack translation to and sustainability in community settings. We used dimensions of the RE-AIM framework to ev...

Objectives To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in U.S. Latina women. Methods This study had a cross-sectional design. Participants were Latina women (n = 297) recruited from a community health center serving a large portion of the Latino population in Lawrence, Massachu...

Objectives To document the level of dysfunctional eating behaviors, specifically emotional eating (EE), uncontrolled eating (UE) and cognitive restraint (CR), among adults in Puerto Rico (PR), and explore the association between each behavior and dietary intake (i.e., percentage of calories from fats, saturated fats and servings of fruits and veget...

Introduction The updated common rule, for human subjects research, requires that consents “begin with a ‘concise and focused’ presentation of the key information that will most likely help someone make a decision about whether to participate in a study” (Menikoff, Kaneshiro, Pritchard. The New England Journal of Medicine . 2017; 376 (7): 613–615.)....

BACKGROUND PERSPeCT is a machine learning recommender system with a database of messages to motivate smoking cessation. PERSPeCT uses collective intelligence of users (i.e., preferences and feedback), demographic and smoking profiles to select motivating messages. PERSPeCT may be more beneficial for tailoring content to minority groups influenced b...

Background The Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT) is a machine learning recommender system with a database of messages to motivate smoking cessation. PERSPeCT uses the collective intelligence of users (ie, preferences and feedback) and demographic and smoking profiles to select motivating message...

Purpose: Increased physical activity (PA) levels in cancer survivors are associated with decreased risk of recurrence and mortality as well as additional positive health outcomes. PA interventions have shown to be efficacious, though many lack translation to and sustainability in community settings. We used dimensions of the RE-AIM framework to eva...

Purpose: Increased physical activity (PA) levels in cancer survivors are associated with decreased risk of recurrence and mortality as well as additional positive health outcomes. PA interventions have shown to be efficacious, though many lack translation to and sustainability in community settings. We used dimensions of the RE-AIM framework to eva...

Background: School-supervised inhaled corticosteroid (ICS) therapy improves pediatric asthma medication adherence, outcomes, and morbidity. However, school-supervised ICS therapy has not been widely adopted into practice. We developed Asthma Link™ as a sustainable, low-cost model of school-supervised asthma therapy, designed for real-world adoptio...

Context: Policies (eg, regulations, taxes, and zoning ordinances) can increase opportunities for healthy eating. Community Health Improvement Plans (CHIP) may foster collaboration and local health department (LHD) engagement in policy decision making to improve local food environments. Limited research describes what policies supportive of healthy...

Objective To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress. Design Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; an...

Objective: The purpose of this study was to present the design, model, and data analysis of an interrupted time series (ITS) model applied to evaluate the impact of health policy, systems, or environmental interventions using count outcomes. Simulation methods were used to conduct power and sample size calculations for these studies. Methods: We...

Objective: To discuss the study design and data analysis for three-phase interrupted time series (ITS) studies to evaluate the impact of health policy, systems, or environmental interventions. Simulation methods are used to conduct power and sample size calculation for these studies. Methods: We consider the design and analysis of three-phase IT...