Engaging Rural and Urban Appalachians in Research using a Community-Based Participatory Research Approach

Appalachians are particularly vulnerable to chronic diseases as documented by recent national studies that have identified disproportionally higher rates of cancer, diabetes, heart disease and premature mortality for this population. Evidence-based interventions to reduce rates of diabetes and obesity among adults and children have been ineffective among Appalachians where multiple factors including poor living conditions, limited health information, lifestyle behaviors, and lack of access to health care interact to increase the prevalence of these problems. However, there is growing evidence that Community-Based Participatory Research (CBPR) conducted through community-academic partnerships can lead to significant health and social impact in communities faced with seemingly intractable health disparities. Framed in the guiding principles of the CBPR approach, this paper describes the development of two academic-community partnerships that took root in Appalachian communities, one urban and one rural. Both partnerships aimed to identify community health needs, develop a community-led intervention to promote positive health outcomes, and evaluate that work iteratively. Although the initial focus for each community was to address obesity and diabetes risk, adherence to the CBPR approach led to different community identified prioritized needs and different pilot projects. The CBPR approach resulted in strong partnerships, each with improved capacity to address Appalachian health disparities in their communities

The association between adult attained height and sitting height with mortality in the European prospective investigation into cancer and nutrition (EPIC)

Adult height and sitting height may reflect genetic and environmental factors, including early life nutrition, physical and social environments. Previous studies have reported divergent associations for height and chronic disease mortality, with positive associations observed for cancer mortality but inverse associations for circulatory disease mortality. Sitting height might be more strongly associated with insulin resistance; however, data on sitting height and mortality is sparse. Using the European Prospective Investigation into Cancer and Nutrition study, a prospective cohort of 409,748 individuals, we examined adult height and sitting height in relation to all-cause and cause-specific mortality. Height was measured in the majority of participants; sitting height was measured in ~253,000 participants. During an average of 12.5 years of follow-up, 29,810 deaths (11,931 from cancer and 7,346 from circulatory disease) were identified. Hazard ratios (HR) with 95% confidence intervals (CI) for death were calculated using multivariable Cox regression within quintiles of height. Height was positively associated with cancer mortality (men: HRQ5 vs. Q1=1.11, 95%CI=1.00-1.24; women: HRQ5 vs. Q1=1.17, 95%CI=1.07-1.28). In contrast, height was inversely associated with circulatory disease mortality (men: HRQ5 vs. Q1=0.63, 95%CI=0.56-0.71; women: HRQ5 vs. Q1=0.81, 95%CI=0.70-0.93). Although sitting height was not associated with cancer mortality, it was inversely associated with circulatory disease (men: HRQ5 vs. Q1=0.64, 95%CI=0.55-0.75; women: HRQ5 vs. Q1=0.60, 95%CI=0.49-0.74) and respiratory disease mortality (men: HRQ5 vs. Q1=0.45, 95%CI=0.28-0.71; women: HRQ5 vs. Q1=0.60, 95%CI=0.40-0.89). We observed opposing effects of height on cancer and circulatory disease mortality. Sitting height was inversely associated with circulatory disease and respiratory disease mortality

The Human Phenotype Ontology in 2017.

Deep phenotyping has been defined as the precise and comprehensive analysis of phenotypic abnormalities in which the individual components of the phenotype are observed and described. The three components of the Human Phenotype Ontology (HPO; www.human-phenotype-ontology.org) project are the phenotype vocabulary, disease-phenotype annotations and the algorithms that operate on these. These components are being used for computational deep phenotyping and precision medicine as well as integration of clinical data into translational research. The HPO is being increasingly adopted as a standard for phenotypic abnormalities by diverse groups such as international rare disease organizations, registries, clinical labs, biomedical resources, and clinical software tools and will thereby contribute toward nascent efforts at global data exchange for identifying disease etiologies. This update article reviews the progress of the HPO project since the debut Nucleic Acids Research database article in 2014, including specific areas of expansion such as common (complex) disease, new algorithms for phenotype driven genomic discovery and diagnostics, integration of cross-species mapping efforts with the Mammalian Phenotype Ontology, an improved quality control pipeline, and the addition of patient-friendly terminology

Studying Adolescent Male Sexuality: Where Are We?

This article critically reviews the literature about adolescent males’ sexuality in order to describe the state of the science and to identify promising concepts and research designs that have the potential to guide the next generation of research. A critique was conducted on 94 peer-reviewed studies of sexual behaviors that included a sample of adolescent males; 11 scholarly texts and 2 dissertations. Most studies lacked a theoretical foundation and had cross-sectional designs. For those studies with a theoretical base, 3 perspectives were most often used to guide research: cognitive, biological, or social-environmental. Studies frequently relied on older adolescents or young adult males to report behaviors during early adolescence. Male-only samples were infrequent. Findings include (a) the measurement of sexual activity is frequently limited to coitus and does not explore other forms of “sex”; (b) cognitive factors have been limited to knowledge, attitudes, and intent; (c) little is known about younger males based on their own self-reports; (d) little is known about the normative sexuality development of gay adolescent males; and (e) longitudinal studies did not take into account the complexities of biological, social, and emotional development in interaction with other influences. Research on adolescent sexuality generally is about sexual activity, with little research that includes cognitive competency or young males’ sense of self as a sexual being. The purpose of the paper is to critically review the literature about male sexuality in order to describe the state of the science as well as to identify potential directions to guide the next generation of adolescent male sexual being research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45299/1/10964_2005_Article_5762.pd

Peer mentor versus teacher delivery of a physical activity program on the effects of BMI and daily activity: protocol of a school-based group randomized controlled trial in Appalachia

Abstract Background Rural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations. Appalachians are the most sedentary U.S. population and teens are particularly sedentary. Obesity prevention through improving physical activity is a top priority in Rural Healthy People 2020. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has consistently been greater than 26%. Organized sports has not been effective at improving daily physical activity or health outcomes for Appalachian teens. The purpose of this study is to test the efficacy of a 10-week school-based intervention in promoting self-regulation of physical activity among adolescents not participating in organized sports. By using accelerometers, our study will measure both sedentary time and planned exercise during waking hours. Methods The design for this four-year study is a group-randomized controlled trial (G-RCT). We will recruit high schools in 3 waves, with 4 in Wave 1, 8 in Wave 2, and 8 in Wave 3, for a total of 20 schools. For each wave of schools, we will randomly assign half of the schools to each condition--intervention (peer-to-peer mentoring [MBA]) and comparison (teacher-led [PBA])--for a total of 10 schools in each of the two conditions by study’s end. We will collect data at baseline (T1), 3 months post intervention (T2), and 6 months post intervention (T3). Linear Mixed Models (LMMs) and Generalized Linear Mixed Models (GLMMs) will be used to test the main hypotheses. Power for this study was based the primary analysis comparing BMI outcomes at T2 between the groups, adjusting for baseline BMI values. Discussion This study provides age-appropriate lifestyle education and skill building. Peer-to-peer mentoring by local high school students and school-based tailored support strengthens sustainable behavioral change. Focusing on unique healthy-lifestyle challenges prevalent in low-resource areas such as Appalachia such as overcoming environmental, social, and psychological barriers may improve adherence to physical activity. Serving as role models, peer mentors may improve their own lifestyle behaviors, providing a dual intervention. Trial registration NCT02329262

Comparing the Effects of Teen Mentors to Adult Teachers on Child Lifestyle Behaviors and Health Outcomes in Appalachia

Abstract Childhood obesity prevalence rates in the United States are the highest in the rural Appalachian areas. Teens mentoring younger children to reverse obesity health risks are an understudied approach. This randomized-controlled trial compared the effects of two curriculum delivery methods and assessed the mediating effects of the number of sessions attended on the outcomes. The control group received the 8-week Just for Kids! curriculum via an adult teacher in a classroom and the experimental group received the same curriculum via individual teen mentoring. Data collected at baseline and postintervention were analyzed using multilevel linear models. Each of the outcomes (e.g., body mass index, blood pressure, current lifestyle behaviors) were modeled separately. Only the mentored children demonstrated improved current lifestyle behaviors (e.g., physical activity and dietary patterns) and health outcomes. Teen mentoring was an effective and efficacious approach to impact the lifestyle patterns and health outcomes of children in a school setting