An Evaluation of Primary Care Clinician Referrals for Behavioral Weight Loss Counseling.

Introduction/objectives: In the context of enrolling patients from primary care practices into a weight loss research study, this study describes the percentage of patients primary care clinicians (PCCs) considered appropriate for referral and study participation rates among those referred.

Methods: An electronic health record review identified 5322 patients aged 18 to 75 years with BMI ≥ 30 kg/m as eligible for review by community, attending, and resident PCCs for referral to a weight loss study. Referrals and patient interest in participating in the study are reported overall and by PCC type.

Associations of role, area deprivation index, and race with health behaviors and body mass index among localized prostate cancer patients and their partners.

Purpose: To examine the associations of role (localized prostate cancer (PCa) patient vs. their intimate partner), area deprivation index (ADI-higher scores indicating higher neighborhood deprivation levels), and race (Black/African American (AA) vs. White) with health behaviors and body mass index (BMI) among PCa patients and partners.

Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics.

Purpose: To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity.

Design: Cross-sectional study.

Setting: Rural Southeastern United States.

Role, race, and place: Prostate cancer disparities in Patients' and Partners' health outcomes and psychosocial factors.

Purpose: This study aimed to examine the effects of participant role (patient vs. partner), race (white vs. non-white), and place (less vs.

Medically tailored meals for food insecurity and type 2 diabetes: Protocol for the Food as Medicine for Diabetes (FAME-D) trial.

Background: Food insecurity is associated with worse glycemic management for individuals with type 2 diabetes mellitus (T2DM), but whether medically tailored meals (MTM), a food insecurity intervention, can improve glycemic management is unclear.

Objective: To describe the protocol for a trial assessing whether an MTM plus lifestyle intervention improves hemoglobin A1c (HbA1c) and participant-reported outcomes, relative to a food subsidy (money that can be spent on foods participants choose), for adults with both T2DM and food insecurity.

Methods: The Food as Medicine for Diabetes (FAME-D) randomized clinical trial (goal n = 200) is a pragmatic trial with an active comparator.

Health behaviors, obesity, and marital status among cancer survivors: a MEPS study.

Purpose: Promoting positive health behaviors helps improve cancer survivors' health outcomes during survivorship; however, little is known about whether health behaviors differ by marital status. The purpose is to examine whether health behaviors and obesity among cancer survivors vary by marital status and whether the type of cancer and sociodemographic factors influence the relationship.

Methods: We examined smoking, physical activity, and body mass index (BMI) among 1880 individuals diagnosed with prostate, breast, or colon cancer who were identified from the 2011-2017 Medical Expenditure Panel Survey (MEPS).

Testing the efficacy of a couple-focused, tailored eHealth intervention for symptom self-management among men with prostate cancer and their partners: the study protocol.

Background: Men with localized prostate cancer often experience urinary, sexual, bowel, and hormonal symptoms; general distress; pain; fatigue; and sleep disturbance. For men in an intimate relationship, these symptoms disrupt couples' relationships and intimacy. The symptoms also reduce quality of life for both men and their partners, who are often their primary caregivers.

A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.

Objective: To assess the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices.

Study Setting: A total of 219 small primary care practices (≤10 clinicians per site) across North Carolina with primary data collection from electronic health records (EHRs) from the fourth quarter of 2015 through the second quarter of 2018.

Study Design: We performed a stepped-wedge, stratified, cluster randomized trial of a one-year intervention consisting of practice facilitation utilizing quality improvement techniques coupled with a cardiovascular dashboard that included lists of risk-stratified adults, aged 40-79 years and their unmet treatment opportunities.

Projections of incident atherosclerotic cardiovascular disease and incident type 2 diabetes across evolving statin treatment guidelines and recommendations: A modelling study.

Background: Experimental and observational research has suggested the potential for increased type 2 diabetes (T2D) risk among populations taking statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, few studies have directly compared statin-associated benefits and harms or examined heterogeneity by population subgroups or assumed treatment effect. Thus, we compared ASCVD risk reduction and T2D incidence increases across 3 statin treatment guidelines or recommendations among adults without a history of ASCVD or T2D who were eligible for statin treatment initiation.

Cardiovascular disease, risk factors, and health behaviors among cancer survivors and spouses: A MEPS Study.

Purpose: The purpose of this study was to examine the prevalences of CVD, CVD risk factors. and health behaviors among cancer survivor-spouse dyads, assess how these prevalences differ by role (survivor vs spouse) and gender, and report congruences in health behaviors between survivors and their spouses.

Methods: We identified 1026 survivor-spouse dyads from the 2010-2015 Medical Expenditure Panel Survey.

Validity and Reliability of a Brief Dietary Assessment Questionnaire in a Cardiac Rehabilitation Program.

Purpose: Dietary assessment is vital to inform individualized nutrition care and to evaluate the success of interventions aimed at improving diet for participants in cardiac rehabilitation (CR) programs. The purpose of this study was to assess the validity and reliability of an instrument developed to reflect current evidence-informed dietary recommendations advocated to reduce cardiovascular risk.

Methods: This study was conducted at a single CR program at the University of North Carolina, Chapel Hill.

Prevalence of cardiovascular disease and risk factors, quality of life, and health behaviors of cancer survivors and their spouses: findings from MEPS.

Purpose: Few population-based studies have examined the prevalence of cardiovascular disease (CVD) and risk factors, quality of life (QOL), and health behaviors of cancer survivors and their spouses. This case-control study aimed to fill this gap using the data from a set of large-scale surveys of individuals and families across the USA.

Methods: Data were obtained from the 2010-2015 Medical Expenditure Panel Survey (MEPS).

Diet quality trends among adults with diabetes by socioeconomic status in the U.S.: 1999-2014.

Background: The diet quality of adults living in the United States has improved overtime. We aim to determine whether diet quality among adults with diabetes mellitus has changed over time, and to examine trends in socioeconomic disparities in diet quality.

Methods: Repeated cross-sectional analysis of eight National Health and Nutrition Examination Survey (NHANES) cycles (1999-2000 through 2013-2014).

Evidence of heterogeneity in statin-associated type 2 diabetes mellitus risk: A meta-analysis of randomized controlled trials and observational studies.

Aims: To conduct a meta-analysis of statin-associated type 2 diabetes mellitus (T2D) risk among randomized controlled trials (RCTs) and observational studies (OBSs), excluding studies conducted among secondary prevention populations.

Methods: Studies were identified by searching PubMed (1994-present) and EMBASE (1994-present). Articles had to meet the following criteria: (1) follow-up >one year; (2) >50% of participants free of clinically diagnosed ASCVD; (3) adult participants ≥30 years old; (4) reported statin-associated T2D effect estimates; and (5) quantified precision using 95% confidence interval.

Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations.

As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: (i) to determine if single nucleotide polymorphisms (SNPs) that associate with blood pressure variation, identified in large studies, are applicable to blood pressure control in subjects from a rural population; (ii) to measure the association of these SNPs with subjects' responsiveness to the hypertension intervention; and (iii) to identify other SNPs that may help understand patient-specific responses to an intervention. We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP) or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA) and Caucasian Americans (CAU).

Predisposition to Bitter Taste Associated with Differential Changes in Vegetable Intake in Response to a Community-Based Dietary Intervention.

Although vegetable consumption associates with decreased risk for a variety of diseases, few Americans meet dietary recommendations for vegetable intake. encodes a taste receptor that confers bitter taste sensing from chemicals found in some vegetables. Common polymorphisms in lead to coding substitutions that alter receptor function and result in the loss of bitter taste perception.

Incidence of Heart Failure Observed in Emergency Departments, Ambulatory Clinics, and Hospitals.

Reports on the burden of heart failure (HF) have largely omitted HF diagnosed in outpatient settings. We quantified annual incidence rates ([IR] per 1,000 person years) of HF identified in ambulatory clinics, emergency departments (EDs), and during hospital stays in a national probability sample of Medicare beneficiaries from 2008 to 2014, by age and race/ethnicity. A 20% random sample of Medicare beneficiaries ages ≥65 years with continuous Medicare Parts A, B, and D coverage was used to estimate annual IRs of HF identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes.

Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items.

Background: As Americans commonly consume restaurant foods with poor dietary quality, effective interventions are needed to improve food choices at restaurants.

Purpose: To design and evaluate a restaurant-based intervention to help customers select and restaurants promote heart healthy menu items with healthful fats and high quality carbohydrates.

Methods: The intervention included table tents outlining 10 heart healthy eating tips, coupons promoting healthy menu items, an information brochure, and link to study website.

Accuracy of Self-Reported Heart Failure. The Atherosclerosis Risk in Communities (ARIC) Study.

Objective: The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment.

Methods And Results: ARIC cohort members (60-83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status.

Feasibility and acceptability of a Mediterranean-style diet intervention to reduce cardiovascular risk for low income Hispanic American women.

Objective: Evidence for the cardioprotective effects of a Mediterranean-style (Med-style) diet is strong, however few Med-style dietary interventions have been developed for and tested among Hispanic Americans (HAs), especially younger HAs of reproductive age whose dietary habits may strongly influence dietary intake for all family members.

Design: We adapted a previously tested and evidence-informed lifestyle intervention to reduce CVD risk and evaluated its feasibility, acceptability, and effects on self-reported lifestyle behaviors in this study enrolling low-income HA women attending a Title X family planning clinic in eastern North Carolina. The 3-month long intervention, given to all participants, promoted a Med-style dietary pattern with a focus on increasing consumption of foods commonly consumed by HA that have high quality dietary fats (polyunsaturated and monounsaturated fats primarily from plant sources and fish) and carbohydrates (fruits, vegetables, and whole grains).

Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults.

Background: Few studies have been conducted in rural areas assessing the influence of community-level environmental factors on residents' success improving lifestyle behaviors.

Objective: Our aim was to examine whether 6-month changes in diet, physical activity, and weight were moderated by the food and physical activity environment in a rural adult population receiving an intervention designed to improve diet and physical activity.

Design: We examined associations between self-reported and objectively measured changes in diet, physical activity, and weight, and perceived and objectively measured food and physical activity environments.

Feasibility and Acceptability of a Clinic-based Mediterranean-style Diet Intervention to Reduce Cardiovascular Risk for Hispanic Americans With Type 2 Diabetes.

Purpose The purpose of the study was to modify a previously tested Spanish language version of a Mediterranean (Med)-style dietary intervention so that the dietary recommendations align with the cultural and social needs of Hispanic Americans (HAs) with type 2 diabetes (T2D) and evaluate the modified intervention's feasibility and acceptability. Methods In phase I (formative), semi-structured interviews and focus groups were used to refine the intervention content and format for delivery to HAs with T2D receiving care at a large primary care practice. In phase II (clinical pilot), the 2-month intervention that promoted a Med-style dietary pattern was given to all participants via 2 face-to-face counseling sessions and 2 telephone counseling sessions.