Activities and support provided by family caregivers of persons with type 2 diabetes

Indiana University-Purdue University Indianapolis (IUPUI)Type 2 diabetes, a chronic condition affecting millions, continues to rise in epidemic proportions. Type 2 diabetes, managed through lifestyle changes, affects the entire family. Family caregivers provide vital support to these individuals; however, little research has been conducted surrounding the perceived difficulty or ease of caregiver activity and supportive behaviors. The purpose of this dissertation was to develop and psychometrically test a scale that measures this difficulty or ease of activities and behaviors. This was accomplished through the compilation of three distinct manuscripts. First, an integrative review was conducted to identify what is known regarding needs and concerns of family caregivers of persons with type 2 diabetes; findings revealed a need for more research. Then, based on these recommendations, a qualitative study was conducted that explored the needs and concerns identified by 33 American Indian, African American, and White family caregivers. All these caregivers had similar concerns related to needing general diabetes information, providing support to the family member, and taking care of their own health. Study themes were used to develop items for a new instrument, the Diabetes Caregiver Activity and Support Scale (D-CASS) that was psychometrically tested with 101 American Indian, African American, and White family caregivers of persons with type 2 diabetes. This study used a cross-sectional, descriptive-correlational design and provided evidence of internal consistency reliability (α = .82) and two-week test-retest reliability (intraclass correlation coefficient = .70) for the D-CASS. Criterion-related validity was established using a single-item criterion measuring overall how easy or difficult it was for caregivers to provide care for their loved ones (r = .65, p < .01). Unidimensionality was supported by factor analysis, with loadings ranging from .45 to .70, with 32% of the variance explained by the first factor (eigenvalue = 4.02). Model testing through a series of three hierarchical multiple regressions guided by a conceptual model provided further evidence of construct validity for the D-CASS. This dissertation provided better understanding of needs and concerns of family caregivers of persons with type 2 diabetes and led to the development of a psychometrically sound diabetes-specific instrument for future research

Comparing treatment fidelity between study arms of a randomized controlled clinical trial for stroke family caregivers

OBJECTIVE: To compare treatment fidelity among treatment arms in the Telephone Assessment and Skill-Building Kit study for stroke caregivers (TASK II) with respect to: 1) protocol adherence; 2) intervention dosage and 3) nurse intervener perspectives. DESIGN: A randomized controlled clinical trial design. SETTING: Urban, community, midwestern United States. SUBJECTS: A total of 254 stroke caregivers (mean ±SD age, 54.4 ±11.8 years), 55 (22.0%) males and 199 (78.4%) females) randomized to the TASK II intervention (n=123) or an Information, Support, and Referral comparison group (n=131). INTERVENTIONS: TASK II participants received the TASK II Resource Guide; Information, Support, and Referral participants received a standard caregiver brochure. At approximately 8 weeks after discharge, both groups received 8 weekly calls from a nurse, with a booster call 4 weeks later. MEASURES: Protocol adherence was evaluated with the TASK II Checklist for Monitoring Adherence. Intervention dosage was measured by the number of minutes caregivers spent reading materials and talking with the nurse. Nurse intervener perspectives were obtained through focus groups. RESULTS: Protocol adherence was 80% for the TASK II and 92% for the Information, Support, and Referral. As expected, intervention dosage differed between TASK II and Information, Support, and Referral with respect to caregiver time spent reading materials (t=-6.49; P<.001) and talking with the nurse (t=-7.38; P<.001). Focus groups with nurses yielded further evidence for treatment fidelity and recommendations for future trials. CONCLUSIONS: These findings substantiate treatment fidelity in both study arms of the TASK II stroke caregiver intervention trial (NIH R01NR010388; ClinicalTrials.govNCT01275495)

Canopy functional trait variation across Earth’s tropical forests

Tropical forest canopies are the biosphere’s most concentrated atmospheric interface for carbon, water and energy1,2. However, in most Earth System Models, the diverse and heterogeneous tropical forest biome is represented as a largely uniform ecosystem with either a singular or a small number of fixed canopy ecophysiological properties3. This situation arises, in part, from a lack of understanding about how and why the functional properties of tropical forest canopies vary geographically4. Here, by combining field-collected data from more than 1,800 vegetation plots and tree traits with satellite remote-sensing, terrain, climate and soil data, we predict variation across 13 morphological, structural and chemical functional traits of trees, and use this to compute and map the functional diversity of tropical forests. Our findings reveal that the tropical Americas, Africa and Asia tend to occupy different portions of the total functional trait space available across tropical forests. Tropical American forests are predicted to have 40% greater functional richness than tropical African and Asian forests. Meanwhile, African forests have the highest functional divergence—32% and 7% higher than that of tropical American and Asian forests, respectively. An uncertainty analysis highlights priority regions for further data collection, which would refine and improve these maps. Our predictions represent a ground-based and remotely enabled global analysis of how and why the functional traits of tropical forest canopies vary across space

Emotional and Behavioral Aspects of Diabetes in American Indians/Alaska Natives

American Indians and Alaska Natives (AI/ANs) bear a disproportionate burden of diabetes and associated long-term complications. Behavioral interventions play a vital role in promoting diabetes medical and psychological outcomes, yet the development of interventions for AI/AN communities has been limited. A systematic review was conducted of studies focused on the psychosocial and behavioral aspects of diagnosed diabetes among AI/ANs. Ovid and PubMed databases and published reference lists were searched for articles published between 1987 and 2014 that related to the psychosocial and behavioral aspects of type 1 or type 2 diabetes in the AI/AN population. Twenty studies were identified that met the inclusion criteria. Nineteen studies were observational and one study was intervention based. Two of the studies used community-based participatory research methodology. Of the 20 studies, 2 discussed cultural influences associated with diabetes self-management and 10 identified the specific tribes that participated in the study. Tribal affiliations among the studies were broad with the number of AI/AN participants in each study ranging from 30 to 23,529 participants. Emotional and behavioral topics found in the literature were adherence ( n = 2), depression ( n = 9), physical activity ( n = 3), psychosocial barriers ( n = 1), social support ( n = 3), and stress ( n = 2). Relatively few studies were identified using AI/AN populations over a 27-year period. This is in stark contrast to what is known about the prevalence and burden that type 1 and type 2 diabetes mellitus place on AI/AN communities. Future research should promote community engagement through the use of community-based participatory research methodologies, seek to further understand and describe the emotional and behavioral context for diabetes self-management in this population, and develop and test innovative interventions to promote the best possible diabetes outcomes. </jats:p

Group Social Support Facilitates Adoption of Healthier Behaviors Among Black Women in a Community-Initiated National Diabetes Prevention Program

The aim of this study was to better understand facilitators and barriers of the early adoption of healthy eating and physical activity behaviors among Black women participating in a community-based, community-initiated diabetes education program. We held focus groups with participants ( N = 14) ages 24 to 90 years. Participants were recruited from a multisite, community-based diabetes prevention program in the Southeastern United States. Data were collected in March and June of 2017. Barriers and facilitators of change were categorized using the socioecological model with interpersonal, intrapersonal, community, and environmental factors serving as the foundation for thematic content. Participants reported the adoption of several behavioral changes resulting in positive health outcomes. They also identified several facilitators and few barriers to initial behavior change on participating in the diabetes prevention program. The greatest facilitator was interpersonal, while the greatest barriers were community and/or environmental. Understanding the factors that improve or impede the successful adoption of health behaviors among Black women participating in a behavioral lifestyle program will allow us to develop stronger, more tailored interventions that provide the greatest impact to assist in improving weight loss outcomes and reducing the burden of diabetes among Black women. </jats:p

School Health Infrastructure and Students’ Elevated Body Mass Index

School-age children with overweight or obesity continue to be problematic in the United States, and are associated with many health, social, and financial problems. Schools provide an excellent venue in which to promote healthy weight in students, and school nurses are well-positioned to play an essential role in controlling obesity. The number of studies reporting relationships among school health infrastructure and prevalence of elevated Body Mass Index (BMI) is limited. The present study explored associations between three components of school health infrastructure (staff, services, budget) and the proportion overweight or obese 1st, 3rd, and 6th grade students, after controlling for selected factors (race, county education level, county poverty level, rurality). Study results supported an independent association between elevated BMI and school health staff. Additionally, independent associations between elevated BMI and the following covariates were supported: household income, race, and parents’ educational level. There is an ultimate need for well-designed studies addressing these associations. </jats:p

Food Insecurity Is Associated with Mental&ndash;Physical Comorbidities among U.S. Adults: NHANES 2013 to 2016

The co-occurrence of mental and physical conditions has increased significantly during the last decade. However, research examining the influence of social factors such as food insecurity is limited. The purpose of this study was to examine the association between food insecurity and mental&ndash;physical comorbidity status among U.S. adults. Data for this analysis were drawn from the National Health and Nutrition Examination Survey (NHANES) for the years 2013&ndash;2016. Respondents ages 18 and older who reported at least one of three chronic conditions (i.e., type 2 diabetes mellitus, hypertension, and hyperlipidemia) and responded to a nine-item depression scale were included in the analytic sample. The prevalence of food insecurity among those with depression and a cardiometabolic condition was 34% compared to 13% among those with a cardiometabolic condition only. Findings from multinomial logistic regression models indicated that food insecurity was associated with higher risk of mental&ndash;physical comorbidity (OR: 3.6, 95% CI: 2.26&ndash;5.76). Respondents reporting poor diet and poor self-reported health had higher odds of comorbid depression and cardiometabolic conditions. Female respondents had increased odds of comorbid depression and cardiometabolic conditions. Food insecurity is associated with co-occurring depression and cardiometabolic disease and may have implications for disease management

Food Insecurity Is Associated with Mental–Physical Comorbidities among U.S. Adults: NHANES 2013 to 2016

The co-occurrence of mental and physical conditions has increased significantly during the last decade. However, research examining the influence of social factors such as food insecurity is limited. The purpose of this study was to examine the association between food insecurity and mental–physical comorbidity status among U.S. adults. Data for this analysis were drawn from the National Health and Nutrition Examination Survey (NHANES) for the years 2013–2016. Respondents ages 18 and older who reported at least one of three chronic conditions (i.e., type 2 diabetes mellitus, hypertension, and hyperlipidemia) and responded to a nine-item depression scale were included in the analytic sample. The prevalence of food insecurity among those with depression and a cardiometabolic condition was 34% compared to 13% among those with a cardiometabolic condition only. Findings from multinomial logistic regression models indicated that food insecurity was associated with higher risk of mental–physical comorbidity (OR: 3.6, 95% CI: 2.26–5.76). Respondents reporting poor diet and poor self-reported health had higher odds of comorbid depression and cardiometabolic conditions. Female respondents had increased odds of comorbid depression and cardiometabolic conditions. Food insecurity is associated with co-occurring depression and cardiometabolic disease and may have implications for disease management.</jats:p

Abstract A027: Evaluation of psychotropic medication usage patterns in patients with pancreatic cancer by race/ethnicity

Abstract Background: Pancreatic cancer (PC) has been associated with detrimental impacts on psychological wellbeing. Reported PC-related depression and anxiety rates are higher than in other types of cancer. A substantial component to improve psychological well-being in patients with PC is the use of drug therapy to provide symptomatic relief. The presence of racial disparities in the utilization of psychotropic medication has been reported in some cancer types. However, despite these known racial disparities and the increased psychiatric symptoms in patients with PC, there has not been an evaluation of racial disparities in psychotropic medication use among patients with PC. The purpose of this study was to describe usage patterns of psychotropic medications by race among patients diagnosed with PC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a PC diagnosis and an active outpatient prescription claim for psychotropic medications from 2009-2018. Prescription claims were specific to patients diagnosed with PC and stratified by self-identified race/ethnicity. Patients who were on psychotropic medications before PC diagnosis, or unspecified race/ethnicity were excluded from the analysis. Psychotropic pharmacological agents consisted of anxiolytics, antidepressants, and anti-delirium/antipsychotic medications. Results: 71,700 participants were included in the analysis. Racial/ethnic participant breakdown included 80% White, 12% African American/Black, 4.5% Asian/Pacific Islander, 3% Hispanic, and 0.25% Native American. Results are presented as an unadjusted relative risk (RR) and 95% Confidence Interval (CI). As compared to White patients, African American/Black (RR 0.60; 95% CI 0.57-0.64), Asian/Pacific Islander (RR 0.52; 95% CI 0.48-0.58), and Hispanic (RR 0.61; 95% CI 0.55-0.67) patients had lower utilization of anxiolytics. For antidepressant medications, African American/Black (RR 0.74; 95% CI 0.71-0.77), Asian/Pacific Islander (RR 0.61; 95% CI 0.58-0.66), and Hispanic (RR 0.87; 95% CI 0.82-0.92) patients had less utilization compared to White patients. For anti-delirium/antipsychotic agents, African American/Black (RR 1.09; 95% CI 1.01-1.17) had a higher risk of utilization while Asian/Pacific Islander (RR 0.83; 95% CI 0.73-0.95) had less utilization when compared to White patients. No other differences were noted in psychotropic medication use by race/ethnicity. Conclusion: The study showed that utilization patterns of psychotropic agents in patients with PC varied by race/ethnicity. Racial/ethnic minorities had lower utilization rates for most of the drug classes except anti-delirium/antipsychotic agents in which African American/Black had higher utilization rates when compared to White patients. Further research needs to be carried out to examine social and clinical factors causing this phenomenon. Citation Format: MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana Wilkie, John Allen. Evaluation of psychotropic medication usage patterns in patients with pancreatic cancer by race/ethnicity [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A027.</jats:p