General Public Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30812
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Browsing General Public Health by Author "Kade, Laura"
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Item Effectively recruiting for Family-central "E-health" research: Lessons from the Lifestyle Medicine Health Education and Intervention Program Study at a Pediatric Mobile Clinic(2022) Trammell, Benjamin Lewis III; Robinson, Christina; Kade, LauraAbstract: Background: Childhood obesity is a growing global epidemic with significant racial, ethnic, and socioeconomic disparities. While current efforts to stem the tide of the obesity epidemic have focused on public policy and individual level behaviors, little research has been done on community and family-based health interventions. In this study, a novel design of personalized text messages allowed flexible participation while relaying key lifestyle information on six major contributing factors to obesity. The patient population served by the Pediatric Mobile Clinic has been known to be difficult to reach in part because of their diverse range of cultures and languages, lack of access to affordable healthcare, housing instability, phone service capabilities, and access to individualized health related information. The purpose of this sub-analysis was to identify the most efficient and effective recruitment methods to reach a broader subset of underserved patient populations. Methods: Literature review and research study personnel experience informed the design and implementation of 6 recruitment styles to help increase participant engagement. These styles included a tracking sheet, in-person discussions, phone call tree, text messages, email prompts and an Electronic Medical Record review, all of which led to a pre-screen questionnaire that determined eligibility for enrollment. Results: 377 potential patients were pre-screened resulting in 19 participants being enrolled into the study, which is a 5% enrollment rate. 39 of them were screened in person whereas the remaining 338 were screened via phone call tree. Telephone calls produced more people enrolled per month; however, telephone call recruitment required a greater volume of participants screened to produce one enrolled subject in comparison to in-person screening. In person recruitment was most effective overall with 11 of the enrolled having been recruited in person vs 8 enrolled via telephone calls. Phone calling results in greater volume but may not be as efficient. The largest prescreen failure group was due to the inability of being able to contact potential participants followed by English not being a patient's primary language. Conclusions: Enrolling people in-person may be beneficial because you are able to make a human connection which could result in a greater conversion of prospective patients to consented participants. Contacting patients multiple times via different forms of communication (Text message; email; voicemail) helped increase recruitment numbers. Recruiting patients via multiple and diverse methods may be beneficial for enrollment, particularly with underserved patients who live busy lives and may not be as accessible during clinic or traditional 9-5 hours. Future studies should consider expanding their recruitment base by applying for IRB approval of materials in multiple languages. The recruitment methodology and findings from this unique and underserved patient population could potentially inform and shape future community and family-based e-health studies.Item Not So Easy Sleeping: A Canary in The Coal Mine for Adolescent Asthma?(2022) Kade, Laura; Thompson, ErikaPurpose: Sleep is an important biologic process and deficits in sleep can lead to poor physical and mental health outcomes. Proper sleep is important for all ages; however, younger individuals need more sleep to maintain a healthy lifestyle. Currently, U.S. adolescents do not sleep enough, which is a concerning warning sign for negative downstream health effects. In adolescents, a lack of sleep has been linked to poor performance in school, drug and alcohol use, sports injuries, car crashes, and even suicide. A recent study has also found that adolescents who have disrupted sleep timing (i.e., going to bed late and waking up late) are more likely to have asthma and allergies - about three times higher - than other adolescents who went to bed earlier. Asthma usually gets worse at night and poor sleep can lead to worse asthma symptoms, but the impact of sleep as a risk factor on the development of asthma is not well known. Given the increasing prevalence of asthma and poor sleep among adolescents, more research is needed in order to isolate appropriate interventions. The purpose of this study was to assess the proportion of high school students who were sleep deficient and if sleep was associated with the health outcome, asthma. Methods: The 2019 Youth Risk Behavior Surveillance System (YRBSS) was used to conduct an independent analysis of all Fort Worth high school student's (n=1,992) sleep and asthma status, stratified by demographic variables. A linear trend analysis from 2015 to 2019 of sleep and asthma, respectively, at the national and high school level was done using logistic regression models controlling for sex, race, and ethnicity. Additionally, a bivariate analysis was conducted using the YRBSS Analysis tool to assess for any associations between poor sleep and asthma. Results: A predominant portion of Fort Worth high school students do not get enough sleep (74.5%, CI [72.1, 76.8]), with 11th (76.9%, CI [72.6, 80.8], p value= 0.01) and 12th graders (82.4%, CI [78.1,86.0], p value=0.00) getting the least sleep in comparison with 9th graders (68.8%, CI [64.7,72.7]). While sleep has been on the decline (p value< 0.05) since 2015, asthma has been increasing (p value< 0.05) since 2015; however, individuals who identified as Hispanic were less likely to have asthma than individuals who identified as White (p value=0.01). The bivariate analysis found that adolescents who get less sleep have a 1.62 times higher likelihood of having asthma (p value< 0.00). Conclusion: Poor sleep is a persistent and significant issue among adolescents that can lead to increased anxiety, depression, and difficulty concentrating in the short-term, and a higher risk for health issues later in life, such as excess weight gain, dyslipidemia, and metabolic and cardiovascular diseases. Sleep must be reprioritized to reduce the propensity for long-term consequences, with a particular focus on 11th and 12th graders. Further research is warranted in regard to the association between sleep status and asthma but better sleep will lead to improved adolescent and lifelong health outcomes.