Browsing by Author "Sharifi, Mona"

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    Characteristics of achieving clinically important weight loss in two paediatric weight management interventions
    (Wiley, 2021) Fiechtner, Lauren; Castro, Ines; Cheng, Erika R.; Sharifi, Mona; Gerber, Monica W.; Luo, Man; Goldmann, Don; Sandel, Megan; Block, Jason; Orav, E. John; Taveras, Elsie M.; Pediatrics, School of Medicine
    Objective: To examine characteristics and lifestyle behaviours associated with achieving clinically important weight loss (CIWL) in two paediatric weight management interventions (PWMIs). Methods: We examined 1010 children enrolled in the STAR and Connect for Health trials. We defined achieving CIWL as any participant who had decreased their BMI z-score by ≥0.2 units over 1 year. Using log-binomial regression we examined associations of child and household characteristics and lifestyle behaviours with achieving CIWL. Results: In multivariable analyses, children with severe obesity had a lower likelihood of achieving CIWL compared to children without severe obesity (RR: 0.68 [95% CI: 0.49, 0.95]). Children who were ≥10 years were less likely to achieve CIWL (RR: 0.56 [95% CI: 0.42, 0.74]) vs those 2-6 years of age. Children who consumed <1 sugary beverage per day at the end of the intervention were more likely to achieve CIWL vs those who did not meet the goal (RR: 1.36 [95% CI 1.09-1.70]). Conclusion: In this analysis of children enrolled in PWMIs, achieving CIWL was associated with younger age, not having severe obesity and consuming fewer sugary beverages at the end of the intervention. Focusing on intervening earlier in life, when a child is at a lower BMI, and reducing sugary beverages could allow for more effective PWMI's.
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    Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity
    (American Public Health Association, 2016-03) Fiechtner, Lauren; Kleinman, Ken; Melly, Steven J.; Sharifi, Mona; Marshall, Richard; Block, Jason; Cheng, Erika R.; Taveras, Elsie M.; Department of Pediatrics, IU School of Medicine
    OBJECTIVES: To determine whether proximity to a supermarket modified the effects of an obesity intervention. METHODS: We examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included computerized clinician decision support plus family self-guided behavior change or health coaching. Outcomes were 1-year change in BMI z-score, sugar-sweetened beverage intake, and fruit and vegetable intake. We examined distance to the closest supermarket as an effect modifier. RESULTS: Distance to supermarkets was an effect modifier of 1-year change in BMI z-score and fruit and vegetable intake but not sugar-sweetened beverage intake. With each 1-mile shorter distance to a supermarket, intervention participants increased their fruit and vegetable intake by 0.29 servings per day and decreased their BMI z-score by -0.04 units relative to controls. CONCLUSIONS: Living closer to a supermarket is associated with greater improvements in fruit and vegetable intake and weight status in an obesity intervention.
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    Multilevel Correlates of Healthy BMI Maintenance and Return to a Healthy BMI among Children in Massachusetts
    (Mary Ann Liebert, 2017-04) Fiechtner, Lauren; Cheng, Erika R.; Lopez, Gabriel; Sharifi, Mona; Taveras, Elsie M.; Pediatrics, School of Medicine
    OBJECTIVES: To examine predictors of healthy BMI maintenance (HBM) or return to a healthy BMI (RHB) among children. METHODS: We studied 33,272 children in Massachusetts between 2008 and 2012. We used multinomial logistic regression to examine associations of individual- and neighborhood-level factors with the odds of: (1) HBM: maintenance of a healthy BMI ≥5th to <85th percentile and (2) RHB: transition to a healthy BMI range from an initial BMI ≥85th percentile between two clinic visits spanning an average of 3.5 years. RESULTS: Racial/ethnic minorities had lower odds of HBM and RHB than non-Hispanic white children. Higher neighborhood educational attainment was associated with an increased odds of HBM and RHB. Higher neighborhood median household income, proximity to a supermarket, and access to more open recreational space were associated with a higher odds of HBM. Children of ages 2-5 years at baseline had higher odds of RHB and HBM than children 13 years and older. CONCLUSIONS: Early childhood interventions and efforts to create health-promoting neighborhoods including improving access to supermarkets and open recreational space could have important effects on obesity prevention and management.
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    User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies
    (JMIR, 2024-05-21) Ray, Jessica; Benjamin Finn, Emily; Tyrrell, Hollyce; Aloe, Carlin F.; Perrin, Eliana M.; Wood, Charles T.; Miner, Dean S.; Grout, Randall; Michel, Jeremy J.; Damschroder, Laura J.; Sharifi, Mona; Pediatrics, School of Medicine
    Background: Electronic health record-based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. Objective: This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. Methods: In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. Results: We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. Conclusions: UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies.