Kimberly R . Middleton | University of Maryland, College Park (original) (raw)

Papers by Kimberly R . Middleton

BMC Medical Research Methodology

Background Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic ... more Background Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic is vital. The current paper describes the changes in methods and processes conducted within a CBPR mixed-methods study to a virtual setting during the novel coronavirus (COVID-19) pandemic. Method The DC Community Organizing for Optimal Culinary Knowledge study with Heart (DC COOKS with Heart) was designed to assess the feasibility of a dietary behavior intervention among African-American adults that are at risk for cardiovascular disease (CVD). The study is under the umbrella of an ongoing CBPR study and community advisory board that facilitates community involvement in study design and promotes ongoing engagement with community members and leaders. The study population for D.C. COOKS with Heart consists of adult African-American individuals who live in two low-resource neighborhoods in Washington, D.C., which were impacted disproportionately by COVID. Eligible study participants who pr...

PubMed, Dec 14, 2005

Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs... more Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are shown on selected hospital, clinic, patient, and visit characteristics, as well as selected trends in OPD visits since 1993. The report highlights variation in use across the major types of OPD clinics surveyed. Methods: The data shown in this report were collected from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results: During 2003, an estimated 94.6 million visits were made to hospital OPDs in the United States, about 33.1 visits per 100 persons. This rate represents a 35-percent increase since 1993, although rates have been stable since 1999. Infants under 12 months of age had a visit rate of 88.7 visits per 100 persons, a rate that increased by 23 percent since 1993. Increasing trends in OPD visit rates were found for persons 50-64 years of age (up by 30 percent), 13-21 years of age (up by 32 percent), 22-49 years of age (up by 34 percent), and 1-12 years of age (up by 71 percent). Females had higher OPD visit rates than males (39.6 compared with 26.4 visits per 100 persons), and black or African American persons had higher OPD visit rates than white persons (59.7 compared with 29.9 visits per 100 persons). Medicaid and State Children's Health Insurance Program patients used OPDs for preventive care services more frequently than private pay patients. The preventive care visit rate by Hispanic and Latino patients was twice the rate by non-Hispanic patients. Diphtheria, tetanus, and acellular pertussis (DTaP) was the most frequently provided vaccine to children under age 18 years. Between 1993-94 and 2003, the proportion of visits involving only mid-level providers increased from 5.9 to 12.6 percent of visits.

PubMed, Aug 5, 2003

Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs... more Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. The report highlights new items on continuity of care of OPD visits, including: whether the visit was the first or a followup for a problem, number of visits to the clinic during the past 12 months for established patients, and whether other physicians shared care for the patient's problem. The report also highlights variation in utilization across the major types of OPD clinics surveyed. Methods: The data presented in this report were collected from the 2001 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results: During 2001, about 83.7 million visits were made to hospital OPDs in the United States. The 2001 rate (29.9 per 100 persons) represents a 33 percent increase since 1992. Females had higher OPD visit rates than males (35.2 versus 24.3 visits per 100 persons) and black or African-American persons had higher OPD visit rates than white persons (48.8 versus 27.9 visits per 100 persons). The majority of visits to hospital OPDs were made by patients with previous visits to the clinic (84.2 percent); 70.0 percent had visited the clinic one or more times during the past 12 months. Preventive care visits comprised 15.5 percent of all OPD visits; nearly three out of four preventive care visits were made by females (72.8 percent). Diagnostic and screening services were ordered or provided at 85.0 percent of visits, therapeutic and preventive services were ordered or provided at 45.6 percent of visits, and medications were prescribed at 64.6 percent of visits. Most patients were given an appointment to return to the clinic (60.1 percent).

PubMed, Jun 23, 2006

Objectives: This report describes ambulatory care visits to hospital OPDs in the United States. S... more Objectives: This report describes ambulatory care visits to hospital OPDs in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1994 through 2004 are also presented. Methods: The data presented in this report were collected in the 2004 NHAMCS, a national probability sample survey of visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Selected comparisons are also made with data from the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Results: During 2004, an estimated 85.0 million visits were made to hospital OPDs in the United States, about 29.5 visits per 100 persons. Females (35.1 per 100 persons) had higher OPD visit rates than males (23.6 per 100 persons), and black or African American persons (50.3 per 100 persons) had higher OPD visit rates than white persons (27.0 visits per 100 persons). The overwhelming majority of visits to hospital OPDs were made by established patients (85.4 percent). Females made 75.5 percent of preventive care visits. The preventive care visit rate by Hispanic or Latino patients was twice the rate of non-Hispanic patients. Diagnostic and screening services were ordered at 90.3 percent of visits, therapeutic and preventive services were ordered at 50.0 percent of visits, and medications were ordered at 67.4 percent of visits. The proportion of visits involving only midlevel providers increased from 5.9 in 1993-94 to 11.4 percent of visits in 2003-04.

PubMed, Jun 29, 2007

Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs... more Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1995 to 2005 are also presented. Methods: The data presented in this report were collected in the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to emergency and OPDs of nonfederal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results: During 2005, an estimated 90.4 million visits were made to hospital OPDs in the United States, about 31.0 visits per 100 persons. Females (37.2 per 100 persons) had higher OPD visit rates than males (24.7 visits per 100 persons), and black or African-American persons (56.8 visits per 100 persons) had higher OPD visit rates than white persons (28.3 visits per 100 persons). Visit rates to OPD clinics for preventive care were highest for children under 1 year of age (43.1 per 100 persons). Almost one-half of OPD visits (46.1 percent) were made by patients with one or more chronic conditions. Hypertension was the most frequent chronic condition listed (19.7 percent). Visits with asthma declined with increasing age. From 1995 to 2005, the following visit characteristics changed: The visit rate for children under 15 years of age increased by 38%, the percentage of visits made by adults 18 years and over with depression indicated on the medical record increased by 48%; visits by adults with obesity, diabetes, and hypertension increased by 24%, 34%, and 43%, respectively; visits with counseling for tobacco use increased from 2.7 to 3.8 percent; visits with counseling for diet and nutrition increased from 9.4 to 15.7 percent; and visits with 6 or more medications prescribed or provided more than doubled, from 4.9 to 11.2 percent.

Frontiers in Nutrition

Disparities in diet-related diseases persist among African-Americans despite advances in risk fac... more Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent’s interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved Afri...

Annals of Emergency Medicine, 2009

Objectives-This report describes ambulatory care visits to hospital outpatient departments (OPDs)... more Objectives-This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics, as well as selected trends in OPD visits since 1992. Methods-The data presented in this report were collected from the 2002 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results-During 2002, an estimated 83.3 million visits were made to hospital OPDs in the United States, or about 29.4 visits per 100 persons. This 2002 rate represents a 31 percent increase since 1992, although rates have been stable since 1999. Females had higher OPD visit rates than males, and black or African American persons had higher OPD visit rates than white persons. The overwhelming majority of visits to hospital OPDs were made by established patients (82.8 percent); 23.8 percent of visits had six or more visits to the clinic within the past year. Private insurance was the most frequent expected payment source (37.3 percent), followed by Medicaid or State Children's Health Insurance Program (SCHIP) (27.3 percent). Since 1999, the percentage of children under 18 years of age relying on Medicaid/SCHIP increased by 23.4 percent. Preventive care visits comprised 18.0 percent of all OPD visits. Medicaid/SCHIP patients used OPDs for preventive care services more frequently than private pay patients. Diagnostic and screening services were ordered or provided at 88.3 percent of visits, therapeutic and preventive services were ordered or provided at 42.8 percent of visits, and medications were prescribed at 65.1 percent of visits. Most patients were given an appointment to return to the clinic (63.3 percent). The percentage of visits where any physician was seen decreased by 10.4 percent between 1992 and 2002, driven largely by a 50 percent decrease in visits to residents or interns. The percentage of visits in which either a physician assistant or nurse practitioner (midlevel providers) was seen increased by 47.0 percent between 1992 and 2002.

Additional file 1. SPIRIT 2013 Checklist: recommended items to address in a clinical trial protoc... more Additional file 1. SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents.

Translational Behavioral Medicine, 2021

A call to action for behavioral scientists to utilize the field’s collective set of knowledge and... more A call to action for behavioral scientists to utilize the field’s collective set of knowledge and skills to conduct and support research to prevent racism and combat the effects of racism on health outcomes

Advance data, 2006

OBJECTIVES This report describes ambulatory care visits to hospital OPDs in the United States. St... more OBJECTIVES This report describes ambulatory care visits to hospital OPDs in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1994 through 2004 are also presented. METHODS The data presented in this report were collected in the 2004 NHAMCS, a national probability sample survey of visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Selected comparisons are also made with data from the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. RESULTS During 2004, an estimated 85.0 million visits were made to hospital OPDs in the United States, about 29.5 visits per 100 persons. Females (35.1 per 100 persons) had higher OPD visit rates than males (23.6 per 100 persons), and blac...

BMJ Health & Care Informatics, 2020

IntroductionA mixed-method, co-design approach to studying the adoption of mobile health (mHealth... more IntroductionA mixed-method, co-design approach to studying the adoption of mobile health (mHealth) technology among African-American (AA) women has not been fully explored. Qualitative data may contextualise existing knowledge surrounding perceptions of mHealth among AA women as part of formative work for designing a physical activity application (app).MethodsA convenience sample of 16 AA women completed an informatics survey prior to participating in focus groups exploring their use of mobile technology and health apps. Survey responses provided frequency data, while iterative transcript analysis of focus groups identified themes.ResultsThe majority of participants (mean age=62.1 years, SD=6.6) felt comfortable using a tablet/smartphone (75.0%). Most (68.8%) reported using health-related apps, primarily focused on physical activity and nutrition. Focus groups revealed four overarching concepts, including (1) user attachment, (2) technology adoption, (3) potential facilitators and (...

BACKGROUND Community-based participatory research is an effective tool for improving health outco... more BACKGROUND Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. OBJECTIVE This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. METHODS We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participan...

Complementary Therapies in Medicine, 2018

Systemic lupus erythematosus (SLE) is an autoimmune disease associated with widespread inflammati... more Systemic lupus erythematosus (SLE) is an autoimmune disease associated with widespread inflammation and tissue damage. It is more common and severe among Blacks, Hispanics, and Asians; with higher incidence in women. While the goals of medical treatment are to prevent flares and reduce organ damage, up to 50% of patients perceive their health to be suboptimal with unaddressed needs including fatigue and pain. Recent SLE treatment guidelines focus on improving quality of life. Yoga has shown improvements in quality-of-life and fatigue in various diagnoses. While there is growing evidence that yoga therapy may help osteoarthritis and rheumatoid arthritis symptoms, there is only one reference in the literature related to SLE.

Pilot and feasibility studies, 2018

While there is a growing interest in the therapeutic benefits of yoga, minority populations with ... more While there is a growing interest in the therapeutic benefits of yoga, minority populations with arthritis tend to be under-represented in the research. Additionally, there is an absence of guidance in the literature regarding the use of multicultural teams and sociocultural health beliefs, when designing yoga studies for a racially diverse population with arthritis. This pilot study examined the feasibility of offering yoga as a self-care modality to an urban, bilingual, minority population with osteoarthritis (OA) or rheumatoid arthritis (RA), in the Washington, DC area. The primary objective of the study was to assess the feasibility of offering an 8-week, bilingual yoga intervention adapted for arthritis to a convenience sample of primarily Hispanic and Black/African-American adults. A racially diverse interdisciplinary research team was assembled to design a study to facilitate recruitment and retention. The second objective identified outcome measures to operationalize potenti...

Complementary Therapies in Medicine, 2017

Objectives-To examine the acceptability of yoga research tailored to recruit and retain a minorit... more Objectives-To examine the acceptability of yoga research tailored to recruit and retain a minority population (both English and Spanish speaking) with arthritis. Yoga research for arthritis often underrepresents minorities and acceptability for this population has not previously been investigated. Design-Acceptability was evaluated using retention, adherence, journals, and semi-structured exit interviews from twelve participants with osteoarthritis or rheumatoid arthritis undergoing an 8-week yoga intervention. Journal quotes were analyzed using content analysis techniques. NVivo software was used to organize transcripts and assemble themes. Two methods of triangulation (data and investigator) were used to overcome potential bias from a single-perspective interpretation. Exit interview comments were content analyzed using a card sort method. The study was designed with a cultural infrastructure including a multicultural research team, translators, and bilingual materials and classes, to facilitate trust and acceptability for primarily Hispanic and Black/African-American adults. Setting-Washington, D.C. metropolitan area, USA. Results-On average participants attended 10 of 16 classes, with home practice 2-3 days a week. All who completed were still practicing yoga three-months later. Qualitative narrative analysis identified major themes related to facilitating factors and barriers for yoga practice, self

Health and Quality of Life Outcomes, 2013

Arthritis Research & Therapy, 2011

International Journal of Yoga Therapy, 2015

There is growing evidence that yoga can be beneficial as an aspect of self-care for people with a... more There is growing evidence that yoga can be beneficial as an aspect of self-care for people with arthritis. However, yoga may be less acceptable to those from different cultures, socioeconomic backgrounds, and racial/ethnic identities. While implementing a feasibility/acceptability pilot study of yoga as self-care in minority communities, the subject of spirituality surfaced. This commentary shares the experience of the researchers and yoga teachers collaborating on the study and the larger conversation that ensued following the withdrawal of one of the study participants. It is an attempt to start a relevant and needed dialogue around yoga research as an integrative health modality, and why the underlying body-mind-spirit approach to yoga may sometimes serve as a barrier to participation for diverse populations suffering from arthritis.

Sickle cell disease (SCD) is characterized by recurrent painful vasoocclusive crises. Current evi... more Sickle cell disease (SCD) is characterized by recurrent painful vasoocclusive crises. Current evidence focuses on the frequency of acute pain crises resulting in emergency department use and nonplanned inpatient hospital admissions; yet few studies focus on pain sequelae outside the healthcare system or how individuals self-manage their chronic SCD-related pain. This study investigated the feasibility of a biobehavioral intervention as an adjunct nonpharmacological therapy to assist in the self-management of chronic pain. A randomized, controlled clinical trial of hypnosis was conducted in outpatients with SCD (n = 31). Patient-reported outcomes (PROs) administered at baseline, five, and twelve weeks from both groups included pain frequency, intensity, and quality (Pain Impact Scale (PIQ) and Numerical Rating Scales); anxiety (State-Trait Anxiety Inventory), coping strategies (Coping Strategies Scale), sleep (Pittsburgh Sleep Quality Index (PSQI)), and depression (Beck Depression In...

BMC Medical Research Methodology

Background Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic ... more Background Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic is vital. The current paper describes the changes in methods and processes conducted within a CBPR mixed-methods study to a virtual setting during the novel coronavirus (COVID-19) pandemic. Method The DC Community Organizing for Optimal Culinary Knowledge study with Heart (DC COOKS with Heart) was designed to assess the feasibility of a dietary behavior intervention among African-American adults that are at risk for cardiovascular disease (CVD). The study is under the umbrella of an ongoing CBPR study and community advisory board that facilitates community involvement in study design and promotes ongoing engagement with community members and leaders. The study population for D.C. COOKS with Heart consists of adult African-American individuals who live in two low-resource neighborhoods in Washington, D.C., which were impacted disproportionately by COVID. Eligible study participants who pr...

PubMed, Dec 14, 2005

Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs... more Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are shown on selected hospital, clinic, patient, and visit characteristics, as well as selected trends in OPD visits since 1993. The report highlights variation in use across the major types of OPD clinics surveyed. Methods: The data shown in this report were collected from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results: During 2003, an estimated 94.6 million visits were made to hospital OPDs in the United States, about 33.1 visits per 100 persons. This rate represents a 35-percent increase since 1993, although rates have been stable since 1999. Infants under 12 months of age had a visit rate of 88.7 visits per 100 persons, a rate that increased by 23 percent since 1993. Increasing trends in OPD visit rates were found for persons 50-64 years of age (up by 30 percent), 13-21 years of age (up by 32 percent), 22-49 years of age (up by 34 percent), and 1-12 years of age (up by 71 percent). Females had higher OPD visit rates than males (39.6 compared with 26.4 visits per 100 persons), and black or African American persons had higher OPD visit rates than white persons (59.7 compared with 29.9 visits per 100 persons). Medicaid and State Children's Health Insurance Program patients used OPDs for preventive care services more frequently than private pay patients. The preventive care visit rate by Hispanic and Latino patients was twice the rate by non-Hispanic patients. Diphtheria, tetanus, and acellular pertussis (DTaP) was the most frequently provided vaccine to children under age 18 years. Between 1993-94 and 2003, the proportion of visits involving only mid-level providers increased from 5.9 to 12.6 percent of visits.

PubMed, Aug 5, 2003

Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs... more Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. The report highlights new items on continuity of care of OPD visits, including: whether the visit was the first or a followup for a problem, number of visits to the clinic during the past 12 months for established patients, and whether other physicians shared care for the patient's problem. The report also highlights variation in utilization across the major types of OPD clinics surveyed. Methods: The data presented in this report were collected from the 2001 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results: During 2001, about 83.7 million visits were made to hospital OPDs in the United States. The 2001 rate (29.9 per 100 persons) represents a 33 percent increase since 1992. Females had higher OPD visit rates than males (35.2 versus 24.3 visits per 100 persons) and black or African-American persons had higher OPD visit rates than white persons (48.8 versus 27.9 visits per 100 persons). The majority of visits to hospital OPDs were made by patients with previous visits to the clinic (84.2 percent); 70.0 percent had visited the clinic one or more times during the past 12 months. Preventive care visits comprised 15.5 percent of all OPD visits; nearly three out of four preventive care visits were made by females (72.8 percent). Diagnostic and screening services were ordered or provided at 85.0 percent of visits, therapeutic and preventive services were ordered or provided at 45.6 percent of visits, and medications were prescribed at 64.6 percent of visits. Most patients were given an appointment to return to the clinic (60.1 percent).

PubMed, Jun 23, 2006

Objectives: This report describes ambulatory care visits to hospital OPDs in the United States. S... more Objectives: This report describes ambulatory care visits to hospital OPDs in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1994 through 2004 are also presented. Methods: The data presented in this report were collected in the 2004 NHAMCS, a national probability sample survey of visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Selected comparisons are also made with data from the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Results: During 2004, an estimated 85.0 million visits were made to hospital OPDs in the United States, about 29.5 visits per 100 persons. Females (35.1 per 100 persons) had higher OPD visit rates than males (23.6 per 100 persons), and black or African American persons (50.3 per 100 persons) had higher OPD visit rates than white persons (27.0 visits per 100 persons). The overwhelming majority of visits to hospital OPDs were made by established patients (85.4 percent). Females made 75.5 percent of preventive care visits. The preventive care visit rate by Hispanic or Latino patients was twice the rate of non-Hispanic patients. Diagnostic and screening services were ordered at 90.3 percent of visits, therapeutic and preventive services were ordered at 50.0 percent of visits, and medications were ordered at 67.4 percent of visits. The proportion of visits involving only midlevel providers increased from 5.9 in 1993-94 to 11.4 percent of visits in 2003-04.

PubMed, Jun 29, 2007

Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs... more Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1995 to 2005 are also presented. Methods: The data presented in this report were collected in the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to emergency and OPDs of nonfederal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results: During 2005, an estimated 90.4 million visits were made to hospital OPDs in the United States, about 31.0 visits per 100 persons. Females (37.2 per 100 persons) had higher OPD visit rates than males (24.7 visits per 100 persons), and black or African-American persons (56.8 visits per 100 persons) had higher OPD visit rates than white persons (28.3 visits per 100 persons). Visit rates to OPD clinics for preventive care were highest for children under 1 year of age (43.1 per 100 persons). Almost one-half of OPD visits (46.1 percent) were made by patients with one or more chronic conditions. Hypertension was the most frequent chronic condition listed (19.7 percent). Visits with asthma declined with increasing age. From 1995 to 2005, the following visit characteristics changed: The visit rate for children under 15 years of age increased by 38%, the percentage of visits made by adults 18 years and over with depression indicated on the medical record increased by 48%; visits by adults with obesity, diabetes, and hypertension increased by 24%, 34%, and 43%, respectively; visits with counseling for tobacco use increased from 2.7 to 3.8 percent; visits with counseling for diet and nutrition increased from 9.4 to 15.7 percent; and visits with 6 or more medications prescribed or provided more than doubled, from 4.9 to 11.2 percent.

Frontiers in Nutrition

Disparities in diet-related diseases persist among African-Americans despite advances in risk fac... more Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent’s interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved Afri...

Annals of Emergency Medicine, 2009

Objectives-This report describes ambulatory care visits to hospital outpatient departments (OPDs)... more Objectives-This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics, as well as selected trends in OPD visits since 1992. Methods-The data presented in this report were collected from the 2002 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Results-During 2002, an estimated 83.3 million visits were made to hospital OPDs in the United States, or about 29.4 visits per 100 persons. This 2002 rate represents a 31 percent increase since 1992, although rates have been stable since 1999. Females had higher OPD visit rates than males, and black or African American persons had higher OPD visit rates than white persons. The overwhelming majority of visits to hospital OPDs were made by established patients (82.8 percent); 23.8 percent of visits had six or more visits to the clinic within the past year. Private insurance was the most frequent expected payment source (37.3 percent), followed by Medicaid or State Children's Health Insurance Program (SCHIP) (27.3 percent). Since 1999, the percentage of children under 18 years of age relying on Medicaid/SCHIP increased by 23.4 percent. Preventive care visits comprised 18.0 percent of all OPD visits. Medicaid/SCHIP patients used OPDs for preventive care services more frequently than private pay patients. Diagnostic and screening services were ordered or provided at 88.3 percent of visits, therapeutic and preventive services were ordered or provided at 42.8 percent of visits, and medications were prescribed at 65.1 percent of visits. Most patients were given an appointment to return to the clinic (63.3 percent). The percentage of visits where any physician was seen decreased by 10.4 percent between 1992 and 2002, driven largely by a 50 percent decrease in visits to residents or interns. The percentage of visits in which either a physician assistant or nurse practitioner (midlevel providers) was seen increased by 47.0 percent between 1992 and 2002.

Additional file 1. SPIRIT 2013 Checklist: recommended items to address in a clinical trial protoc... more Additional file 1. SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents.

Translational Behavioral Medicine, 2021

A call to action for behavioral scientists to utilize the field’s collective set of knowledge and... more A call to action for behavioral scientists to utilize the field’s collective set of knowledge and skills to conduct and support research to prevent racism and combat the effects of racism on health outcomes

Advance data, 2006

OBJECTIVES This report describes ambulatory care visits to hospital OPDs in the United States. St... more OBJECTIVES This report describes ambulatory care visits to hospital OPDs in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1994 through 2004 are also presented. METHODS The data presented in this report were collected in the 2004 NHAMCS, a national probability sample survey of visits to emergency and outpatient departments of nonfederal, short-stay, and general hospitals in the United States. Selected comparisons are also made with data from the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. RESULTS During 2004, an estimated 85.0 million visits were made to hospital OPDs in the United States, about 29.5 visits per 100 persons. Females (35.1 per 100 persons) had higher OPD visit rates than males (23.6 per 100 persons), and blac...

BMJ Health & Care Informatics, 2020

IntroductionA mixed-method, co-design approach to studying the adoption of mobile health (mHealth... more IntroductionA mixed-method, co-design approach to studying the adoption of mobile health (mHealth) technology among African-American (AA) women has not been fully explored. Qualitative data may contextualise existing knowledge surrounding perceptions of mHealth among AA women as part of formative work for designing a physical activity application (app).MethodsA convenience sample of 16 AA women completed an informatics survey prior to participating in focus groups exploring their use of mobile technology and health apps. Survey responses provided frequency data, while iterative transcript analysis of focus groups identified themes.ResultsThe majority of participants (mean age=62.1 years, SD=6.6) felt comfortable using a tablet/smartphone (75.0%). Most (68.8%) reported using health-related apps, primarily focused on physical activity and nutrition. Focus groups revealed four overarching concepts, including (1) user attachment, (2) technology adoption, (3) potential facilitators and (...

BACKGROUND Community-based participatory research is an effective tool for improving health outco... more BACKGROUND Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. OBJECTIVE This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. METHODS We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participan...

Complementary Therapies in Medicine, 2018

Systemic lupus erythematosus (SLE) is an autoimmune disease associated with widespread inflammati... more Systemic lupus erythematosus (SLE) is an autoimmune disease associated with widespread inflammation and tissue damage. It is more common and severe among Blacks, Hispanics, and Asians; with higher incidence in women. While the goals of medical treatment are to prevent flares and reduce organ damage, up to 50% of patients perceive their health to be suboptimal with unaddressed needs including fatigue and pain. Recent SLE treatment guidelines focus on improving quality of life. Yoga has shown improvements in quality-of-life and fatigue in various diagnoses. While there is growing evidence that yoga therapy may help osteoarthritis and rheumatoid arthritis symptoms, there is only one reference in the literature related to SLE.

Pilot and feasibility studies, 2018

While there is a growing interest in the therapeutic benefits of yoga, minority populations with ... more While there is a growing interest in the therapeutic benefits of yoga, minority populations with arthritis tend to be under-represented in the research. Additionally, there is an absence of guidance in the literature regarding the use of multicultural teams and sociocultural health beliefs, when designing yoga studies for a racially diverse population with arthritis. This pilot study examined the feasibility of offering yoga as a self-care modality to an urban, bilingual, minority population with osteoarthritis (OA) or rheumatoid arthritis (RA), in the Washington, DC area. The primary objective of the study was to assess the feasibility of offering an 8-week, bilingual yoga intervention adapted for arthritis to a convenience sample of primarily Hispanic and Black/African-American adults. A racially diverse interdisciplinary research team was assembled to design a study to facilitate recruitment and retention. The second objective identified outcome measures to operationalize potenti...

Complementary Therapies in Medicine, 2017

Objectives-To examine the acceptability of yoga research tailored to recruit and retain a minorit... more Objectives-To examine the acceptability of yoga research tailored to recruit and retain a minority population (both English and Spanish speaking) with arthritis. Yoga research for arthritis often underrepresents minorities and acceptability for this population has not previously been investigated. Design-Acceptability was evaluated using retention, adherence, journals, and semi-structured exit interviews from twelve participants with osteoarthritis or rheumatoid arthritis undergoing an 8-week yoga intervention. Journal quotes were analyzed using content analysis techniques. NVivo software was used to organize transcripts and assemble themes. Two methods of triangulation (data and investigator) were used to overcome potential bias from a single-perspective interpretation. Exit interview comments were content analyzed using a card sort method. The study was designed with a cultural infrastructure including a multicultural research team, translators, and bilingual materials and classes, to facilitate trust and acceptability for primarily Hispanic and Black/African-American adults. Setting-Washington, D.C. metropolitan area, USA. Results-On average participants attended 10 of 16 classes, with home practice 2-3 days a week. All who completed were still practicing yoga three-months later. Qualitative narrative analysis identified major themes related to facilitating factors and barriers for yoga practice, self

Health and Quality of Life Outcomes, 2013

Arthritis Research & Therapy, 2011

International Journal of Yoga Therapy, 2015

There is growing evidence that yoga can be beneficial as an aspect of self-care for people with a... more There is growing evidence that yoga can be beneficial as an aspect of self-care for people with arthritis. However, yoga may be less acceptable to those from different cultures, socioeconomic backgrounds, and racial/ethnic identities. While implementing a feasibility/acceptability pilot study of yoga as self-care in minority communities, the subject of spirituality surfaced. This commentary shares the experience of the researchers and yoga teachers collaborating on the study and the larger conversation that ensued following the withdrawal of one of the study participants. It is an attempt to start a relevant and needed dialogue around yoga research as an integrative health modality, and why the underlying body-mind-spirit approach to yoga may sometimes serve as a barrier to participation for diverse populations suffering from arthritis.

Sickle cell disease (SCD) is characterized by recurrent painful vasoocclusive crises. Current evi... more Sickle cell disease (SCD) is characterized by recurrent painful vasoocclusive crises. Current evidence focuses on the frequency of acute pain crises resulting in emergency department use and nonplanned inpatient hospital admissions; yet few studies focus on pain sequelae outside the healthcare system or how individuals self-manage their chronic SCD-related pain. This study investigated the feasibility of a biobehavioral intervention as an adjunct nonpharmacological therapy to assist in the self-management of chronic pain. A randomized, controlled clinical trial of hypnosis was conducted in outpatients with SCD (n = 31). Patient-reported outcomes (PROs) administered at baseline, five, and twelve weeks from both groups included pain frequency, intensity, and quality (Pain Impact Scale (PIQ) and Numerical Rating Scales); anxiety (State-Trait Anxiety Inventory), coping strategies (Coping Strategies Scale), sleep (Pittsburgh Sleep Quality Index (PSQI)), and depression (Beck Depression In...