Jessie Wong

All Publications

• Diabetes Device Satisfaction Among Adolescents Living With Type 1 Diabetes and Their Parents. Journal of diabetes science and technology Wong, J. J., Alamarie, S. A., Hanes, S. J., Flores, H., Ngo, J., Schneider-Utaka, A. K., Hood, K. K. 2024: 19322968241296135

  Abstract

  Diabetes technologies are valuable tools to reduce burden and enhance glycemic control, especially during adolescence. The current study sought to understand the factors associated with parent and adolescent diabetes device satisfaction.This study used cross-sectional data from 175 adolescents living with type 1 diabetes and 176 parents. Adolescent ages ranged from 12 to 19 (Mage=14.7, SD=1.89) and were balanced by gender (48% male). Kendall's W examined concordance between parent and adolescent satisfaction and bivariate correlations and paired t-tests identified correlates of satisfaction.There was low concordance (Kendall's W = 0.13) between parent and adolescent device satisfaction. Automated insulin delivery (AID) use (vs non-use) was related to higher satisfaction for adolescents (4.52 [0.71] vs 4.20 [0.87], P = .008) and parents (4.25 [0.82] vs 3.71 [0.90], P < .001). Pump use was not significantly related. Parent satisfaction was correlated with hemoglobin A1c (HbA1c; R = -0.301, P < .001), percent time-in-range (R = 0.214, P = .007), and percent time-above-range (R = -0.193, P = .015). Adolescent satisfaction was unrelated to glycemic measures. Adolescent and parent satisfaction were both related to better psychosocial functioning. Significant associations between AID use, psychosocial functioning, and glycemic control and device satisfaction remained after accounting for one another. Demographic correlates were non-significant.Adolescents and their parents have discrepant levels of satisfaction with devices. Although both adolescent and parent satisfaction are linked to use of automated technology and better psychosocial functioning, only parent satisfaction is associated with glycemia. This pattern suggests adolescents and parents hold varying priorities when it comes to device use. Acknowledging and addressing these differences may enhance the uptake and continued use of devices.

  View details for DOI 10.1177/19322968241296135

  View details for PubMedID 39529259

• Satisfaction with diabetes involvement: Exploring parent and adolescent perspectives. Diabetic medicine : a journal of the British Diabetic Association Wong, J. J., Hanes, S. J., Flores, H., Ngo, J., Hood, K. K. 2023: e15254

  Abstract

  Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management.Cross-sectional baseline data from 157 parent-adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage  = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t-tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations.Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time-in-range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non-Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = -2.783, p = 0.003). Both percent time-in-range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress.Both adolescent and parents' satisfaction with adolescents' involvement in self-management are indicators of both glycaemic control and psychosocial well-being, whereas parents' self-evaluations are more closely tied to diabetes-specific distress.

  View details for DOI 10.1111/dme.15254

  View details for PubMedID 38010056

• Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine. Nature medicine Tobias, D. K., Merino, J., Ahmad, A., Aiken, C., Benham, J. L., Bodhini, D., Clark, A. L., Colclough, K., Corcoy, R., Cromer, S. J., Duan, D., Felton, J. L., Francis, E. C., Gillard, P., Gingras, V., Gaillard, R., Haider, E., Hughes, A., Ikle, J. M., Jacobsen, L. M., Kahkoska, A. R., Kettunen, J. L., Kreienkamp, R. J., Lim, L. L., Männistö, J. M., Massey, R., Mclennan, N. M., Miller, R. G., Morieri, M. L., Most, J., Naylor, R. N., Ozkan, B., Patel, K. A., Pilla, S. J., Prystupa, K., Raghavan, S., Rooney, M. R., Schön, M., Semnani-Azad, Z., Sevilla-Gonzalez, M., Svalastoga, P., Takele, W. W., Tam, C. H., Thuesen, A. C., Tosur, M., Wallace, A. S., Wang, C. C., Wong, J. J., Yamamoto, J. M., Young, K., Amouyal, C., Andersen, M. K., Bonham, M. P., Chen, M., Cheng, F., Chikowore, T., Chivers, S. C., Clemmensen, C., Dabelea, D., Dawed, A. Y., Deutsch, A. J., Dickens, L. T., DiMeglio, L. A., Dudenhöffer-Pfeifer, M., Evans-Molina, C., Fernández-Balsells, M. M., Fitipaldi, H., Fitzpatrick, S. L., Gitelman, S. E., Goodarzi, M. O., Grieger, J. A., Guasch-Ferré, M., Habibi, N., Hansen, T., Huang, C., Harris-Kawano, A., Ismail, H. M., Hoag, B., Johnson, R. K., Jones, A. G., Koivula, R. W., Leong, A., Leung, G. K., Libman, I. M., Liu, K., Long, S. A., Lowe, W. L., Morton, R. W., Motala, A. A., Onengut-Gumuscu, S., Pankow, J. S., Pathirana, M., Pazmino, S., Perez, D., Petrie, J. R., Powe, C. E., Quinteros, A., Jain, R., Ray, D., Ried-Larsen, M., Saeed, Z., Santhakumar, V., Kanbour, S., Sarkar, S., Monaco, G. S., Scholtens, D. M., Selvin, E., Sheu, W. H., Speake, C., Stanislawski, M. A., Steenackers, N., Steck, A. K., Stefan, N., Støy, J., Taylor, R., Tye, S. C., Ukke, G. G., Urazbayeva, M., Van der Schueren, B., Vatier, C., Wentworth, J. M., Hannah, W., White, S. L., Yu, G., Zhang, Y., Zhou, S. J., Beltrand, J., Polak, M., Aukrust, I., de Franco, E., Flanagan, S. E., Maloney, K. A., McGovern, A., Molnes, J., Nakabuye, M., Njølstad, P. R., Pomares-Millan, H., Provenzano, M., Saint-Martin, C., Zhang, C., Zhu, Y., Auh, S., de Souza, R., Fawcett, A. J., Gruber, C., Mekonnen, E. G., Mixter, E., Sherifali, D., Eckel, R. H., Nolan, J. J., Philipson, L. H., Brown, R. J., Billings, L. K., Boyle, K., Costacou, T., Dennis, J. M., Florez, J. C., Gloyn, A. L., Gomez, M. F., Gottlieb, P. A., Greeley, S. A., Griffin, K., Hattersley, A. T., Hirsch, I. B., Hivert, M. F., Hood, K. K., Josefson, J. L., Kwak, S. H., Laffel, L. M., Lim, S. S., Loos, R. J., Ma, R. C., Mathieu, C., Mathioudakis, N., Meigs, J. B., Misra, S., Mohan, V., Murphy, R., Oram, R., Owen, K. R., Ozanne, S. E., Pearson, E. R., Perng, W., Pollin, T. I., Pop-Busui, R., Pratley, R. E., Redman, L. M., Redondo, M. J., Reynolds, R. M., Semple, R. K., Sherr, J. L., Sims, E. K., Sweeting, A., Tuomi, T., Udler, M. S., Vesco, K. K., Vilsbøll, T., Wagner, R., Rich, S. S., Franks, P. W. 2023

  Abstract

  Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.

  View details for DOI 10.1038/s41591-023-02502-5

  View details for PubMedID 37794253

  View details for PubMedCentralID 8563635

• Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review. Communications medicine Jacobsen, L. M., Sherr, J. L., Considine, E., Chen, A., Peeling, S. M., Hulsmans, M., Charleer, S., Urazbayeva, M., Tosur, M., Alamarie, S., Redondo, M. J., Hood, K. K., Gottlieb, P. A., Gillard, P., Wong, J. J., Hirsch, I. B., Pratley, R. E., Laffel, L. M., Mathieu, C. 2023; 3 (1): 132

  Abstract

  The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care.Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years).We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact.Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes.

  View details for DOI 10.1038/s43856-023-00358-x

  View details for PubMedID 37794113

  View details for PubMedCentralID 8481000

• DiabetesWise: An innovative approach to promoting diabetes device awareness. Journal of diabetes Wong, J. J., Addala, A., Hanes, S. J., Krugman, S., Naranjo, D., Nelmes, S., Rose, K. J., Tanenbaum, M. L., Hood, K. K. 2023

  Abstract

  DiabetesWise is an unbranded, data-driven online resource that tailors device recommendations based on preferences and priorities of people with insulin-requiring diabetes. The objective of this study is to examine whether DiabetesWise increases uptake of diabetes devices, which are empirically supported to improve glycemic and psychosocial outcomes.The sample included 458 participants (Mage  = 37.1, SD = 9.73; 66% female; 81% type 1 diabetes) with insulin-requiring diabetes and minimal diabetes device use at enrollment. Participants used DiabetesWise and completed online surveys. Chi-square and t tests evaluated requests for a device prescription, receiving a prescription, and starting a new device at 1 and 3 months post use. Baseline predictors of these variables and past use of continuous glucose monitors (CGMs) and changes in diabetes distress post use were also examined.Within the first month of interacting with DiabetesWise 19% of participants asked for a prescription for a diabetes device. This rate rose to 31% in the first 3 months. These requests resulted in 16% of the sample starting a new device within the first 3 months. Whereas several factors were associated with prior CGM use, receiving a prescription, and starting a new device, more diabetes distress (t(343) = -3.13, p = .002) was the only factor associated with asking for a prescription. Diabetes distress decreased after interacting with DiabetesWise within 1 month (t(193) = 3.51, p < .001) and 3 months (t(180) = 5.23, p < .001).Within 3 months of interacting with DiabetesWise, one in three participants had requested a prescription for a new diabetes device and average distress levels were reduced, indicating benefit from this low-intensity online platform.

  View details for DOI 10.1111/1753-0407.13401

  View details for PubMedID 37139842

• Psychosocial Effects of the Loop Open-Source Automated Insulin Delivery System. Journal of diabetes science and technology Wong, J. J., Hood, K. K., Hanes, S. J., Lal, R. A., Naranjo, D. 2022: 19322968221105288

  Abstract

  This study examined the psychosocial impact of Loop, an open-source automated insulin dosing system that has emerged from the diabetes technology "Do-It-Yourself" (DIY) movement.Subsamples of 239 adults, 115 children, and 243 parents completed data collection at the time of Loop initiation and 3 and 6 months later. Surveys collected demographic and clinical information, percent time-in-range, HbA1c, and validated psychosocial measures. Analyses included paired t tests and McNemar's tests to compare psychosocial functioning at 3 and 6 months and regression models to assess baseline predictors of psychosocial outcomes at 6 months.Adults reported significant improvements in diabetes distress (t = -7.20 P < .001; t = -8.01, P < .001), sleep quality (t = 6.81, P < .001; t = 2.98, P = .003), fear of hypoglycemia (t = -4.42, P < .001; t = -4.97, P < .001), and hypoglycemia confidence (t = 8.68, P < .001; t = 7.96 P < .001) from baseline to 3 months and 6 months, respectively. Significant improvements in parents' and children's sleep quality and parents' fear of hypoglycemia were also observed. Several baseline characteristics were associated with psychosocial outcomes at 6 months.The current findings support the broad and sustained benefits of Loop across multiple aspects of psychosocial well-being. Advancement and dissemination of such technologies has the potential to improve mental and physiological health among people living with type 1 diabetes.

  View details for DOI 10.1177/19322968221105288

  View details for PubMedID 35771004

• Telehealth for people with diabetes: poised for a new approach. The lancet. Diabetes & endocrinology Hood, K. K., Wong, J. J. 2021

  View details for DOI 10.1016/S2213-8587(21)00312-0

  View details for PubMedID 34838158

• Discontinued Use of the Loop Insulin Dosing System: A Mixed-Methods Investigation. Diabetes technology & therapeutics Wong, J., Suttiratana, S., Lal, R. A., Lum, J., Lanning, M. S., Dunlap, A., Arbiter, B., Hanes, S., Bailey, R., Hood, K., Naranjo, D. 2021

  Abstract

  Loop is an open-source automated insulin dosing system that allows users unrivaled control over system settings that effect future glucose prediction. Thousands use Loop, but little is known about those who discontinue.In a large observational study, 874 Loop participants completed surveys and provided glycemic data, 46 (5.3%) of those self-identified as discontinuing Loop during the observation window, 45 completed a discontinued use survey, 22 provided system settings data, and 19 participated in semi-structured interviews about their discontinuation. Qualitative data were transcribed, coded, and analyzed.Older age and not trusting Loop were associated with discontinued use, though no other demographic or clinical characteristics were significant correlates. The most endorsed reasons were "I decided to try something else" (27.8%) followed by "It just didn't help as much as I thought it would" (22.2%). Qualitative analyses revealed prominent themes centered upon mental and emotional burden and adjusting settings. Other reasons for discontinued use included: fear of disapproval of Loop use from diabetes provider, barriers to acquiring component devices, a desire to try new/different technologies, concerns that Loop could not accommodate specific exercise or low insulin dose regimens, and worry about Loop use during pregnancy. It was noted that burdens might be alleviated by enhanced technical assistance and expert guidance.While the majority of individuals in the Loop observational study continued use, those who discontinued reported similar challenges. Technical support and education specific to setting calculations could expand Loop benefits, alleviate burden, and support sustained use among new Loop users.

  View details for DOI 10.1089/dia.2021.0362

  View details for PubMedID 34780283

• Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability. Journal of pediatric psychology Wong, J. J., Hanes, S., Iturralde, E., Lanning, M. S., Naranjo, D., Tanenbaum, M., Hood, K. K. 2020

  Abstract

  AIMS: Psychosocial screenings are recommended and increasingly common in pediatric subspecialty clinics, though little is known about their acceptability. This study seeks to uncover profiles of acceptability and assess demographic and clinical correlates among adolescents with diabetes.METHODS: A sample of 124 adolescents (57.7% female) ages 12-21years (M=16.2±2.3) completed screenings during routine diabetes appointments. K-means clustering of responses to acceptability items derived profiles; Analysis of Variance (ANOVA) and Chi-square tests assessed correlates.RESULTS: Adolescents with the most common profile (72.6%) placed high importance on medical providers' awareness of their emotions and reported no difficulties/discomfort with the screener. These youth had moderate depressive symptoms, low diabetes distress, and low A1c. Those who fit a less common profile (18.5%) were uncomfortable with the screener and had the highest depressive symptoms and lowest A1c. Youth who fit a smaller profile (6.5%) endorsed technical difficulties and had high depressive symptoms and lowest diabetes distress. The smallest profile (2.4%, N=3) had difficulty understanding and experienced discomfort with the screening and had the lowest depressive symptoms and the highest diabetes distress and A1c. These differences in depressive symptoms (F=3.54, p=.017), A1c values (F=4.03, p=.009), and diabetes distress (F=3.27, p=.036) were significant though differences in age, gender, and diabetes duration were not.CONCLUSIONS: Most youth responded favorably to in-clinic psychosocial screenings. Youth who were less satisfied were at increased risk for psychosocial and medical complications. Findings highlight areas of need, such as enhanced support with and an emphasized rationale for screenings, which may improve patient experience in subspecialty care.

  View details for DOI 10.1093/jpepsy/jsaa112

  View details for PubMedID 33316061

• Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use. Diabetes technology & therapeutics Wong, J., Barley, R., Hanes, S., Tanenbaum, M., Lanning, M. S., Naranjo, D., Hood, K. 2020

  Abstract

  BACKGROUND: Despite the demonstrated benefits of diabetes device use, uptake of insulin pumps and continuous glucose monitors (CGMs) remains quite low. The current study aimed to identify profiles of parents of youth with type 1 diabetes based on their attitudes toward diabetes-specific technology and barriers to diabetes technology uptake.METHODS: Online survey data were collected from 471 parents in the T1D Exchange Clinic Network (child's age=12.0±3.2 years; diabetes duration=7.0±2.9 years; A1c=8.4%±1.3; 75% using insulin pump; 27% using CGM).RESULTS: K-means cluster analyses revealed 5 parent profiles: Embracers (50.7%), Burdened (15.7%), Hopeful but Hassled (14.2%), Distrusting (12.7%), and Data Minimalists (6.6%). ANOVAs and Chi-square tests identified differences between groups based on diabetes distress, worry over hypoglycemia, device use, and demographic characteristics.CONCLUSIONS: Providers encouraging device uptake may benefit from tailoring their approaches based on these distinct groups and their corresponding concerns and needs.

  View details for DOI 10.1089/dia.2019.0492

  View details for PubMedID 31971451

• Depression and family arguments: disentangling reciprocal effects for women and men. Family practice Wong, J. J., Frost, N. D., Timko, C. n., Heinz, A. J., Cronkite, R. n. 2020; 37 (1): 49–55

  Abstract

  Depression is a debilitating condition that affects the individual and the family.This study sought to identify potential reciprocal influences between family arguments and depressive symptoms among clinically depressed patients over a 23-year span.The present study employed a longitudinal, observational design with 424 depressed patients. Separate cross-lagged path models examined longitudinal associations for women and men over 23 years while adjusting for age, income, and marital and parental status.Among depressed men, more severe baseline depressive symptoms predicted more family arguments 10 years later. Among depressed women, more severe baseline depressive symptoms predicted fewer family arguments 1 year later, while more severe depressive symptoms at 10-year follow-up predicted more family arguments at 23-year follow-up. More family arguments predicted more severe depressive symptoms among women and men, with some variation in the time intervals of these associations.These findings suggest that while depressive symptoms may temporarily diminish family arguments among women, such symptoms were associated with more family arguments over longer time intervals. Moreover, family arguments put depressed men and women at risk for more severe depressive symptoms. These results support the use of screening for family arguments and interventions to help depressed individuals develop skills to manage interpersonal conflict.

  View details for DOI 10.1093/fampra/cmz048

  View details for PubMedID 32076721

• Monetary reinforcement for self-monitoring of blood glucose among young people with type 1 diabetes: evaluating effects on psychosocial functioning DIABETIC MEDICINE Wong, J. J., Addala, A., Naranjo, D., Hood, K. K., Cengiz, E., Ginley, M. K., Feinn, R. S., Wagner, J. A. 2019

  Abstract

  To explore the auxiliary psychosocial effects of a monetary reinforcement intervention targeting self-monitoring of blood glucose among young people with Type 1 diabetes.Sixty young people with Type 1 diabetes, HbA1c concentrations between 58 and 119 mmol/mol (7.5-13.0%), and average self-monitoring of blood glucose <4 times per day were randomized to either enhanced usual care or a 24-week intervention of monetary rewards for self-monitoring of blood glucose and associated behaviours (e.g. uploading glucose meters). Data were collected from the young people and their parents at baseline, during the intervention (6, 12 and 24 weeks) and after the intervention (36 weeks).Linear mixed models were used to evaluate the intervention effects on psychosocial outcomes, adjusting for corresponding baseline levels and potential moderation by baseline level. The intervention reduced diabetes distress at week 6 among young people who had average and high baseline distress. It also reduced diabetes distress at weeks 12 and 24 among those with low baseline distress. The intervention also reduced young person-reported diabetes-related family conflict and diabetes-related interference among those with high baseline scores in these areas; however, the intervention worsened young person-reported diabetes interference among those with low baseline interference. Effects were medium-sized and time-limited.Findings indicate predominantly positive impacts of monetary reinforcement interventions on psychosocial outcomes, although effects varied by outcome and time point. Whereas early improvements in diabetes distress were observed for all who received the intervention, improvements in other areas varied according to the level of psychosocial challenge at baseline. Incorporating psychosocial interventions may bolster and maintain effects over time.

  View details for DOI 10.1111/dme.14174

  View details for Web of Science ID 000497174800001

  View details for PubMedID 31701566

• Correlates of health care use among White and minority men and women with diabetes: An NHANES study. Diabetes research and clinical practice Wong, J. J., Hood, K. K., Breland, J. Y. 2019

  Abstract

  AIMS: The current study sought to identify patient-level factors related to health care use among White and minority men and women with diabetes.METHODS: A sample of 447 of non-pregnant individuals with diabetes, ages 18-64, was drawn from the 2015-2016 National Health and Nutrition Examination Surveys dataset. Poisson regression models tested associations between health care use and self-rated health, depression, medical comorbidities, body mass index, marital status, number of children, income, insurance coverage, and age, stratified by gender and racial/ethnic minority status.RESULTS: Poorer self-rated health was the only significant correlate of increased health care use among White men with diabetes whereas income and insurance were significant correlates of increased use among minority men. Among White and minority women, higher levels of depression and being single were correlated with greater health care use. Comorbid medical conditions and insurance coverage were also related to use among minority women.CONCLUSIONS: Among individuals with diabetes, health care use among White men appeared to be driven by subjective health whereas financial factors were critical among minority men. Family structure and mental health were instrumentally associated with health care use among all women. These factors can be targeted to promote equitable access to care.

  View details for PubMedID 30844470

• Depression in Context: Important Considerations for Youth with Type 1 vs Type 2 Diabetes. Pediatric diabetes Wong, J. J., Addala, A. n., Abujaradeh, H. n., Adams, R. N., Barley, R. C., Hanes, S. J., Iturralde, E. n., Lanning, M. S., Naranjo, D. n., Tanenbaum, M. L., Hood, K. K. 2019

  Abstract

  Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type.Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes.A sample of 149 youth ages 12-21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type.Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = 0.025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -0.98, P < 0.001) than type 1 (β = -0.48, P < 0.001). Further probing revealed that among youth with better global health, adolescents with type 1 had more depressive symptoms than those with type 2 diabetes (β = 0.33, P = 0.035). Diabetes duration and depressive symptoms were positively associated among individuals with type 2 (β = 0.86, P = 0.043), but not type 1 diabetes. No gender differences were detected.These findings suggest that correlates of depressive symptoms in youth with diabetes differ by diabetes type. Global health appears to be an important correlate among youth with both types, whereas diabetes duration was only a significant factor among those with type 2 diabetes. The current findings can inform future psychosocial intervention efforts within both these populations. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/pedi.12939

  View details for PubMedID 31644828

• Depression and Healthcare Utilization in Patients with Inflammatory Bowel Disease. Journal of Crohn's & colitis Wong, J. J., Sceats, L., Dehghan, M., Wren, A. A., Sellers, Z. M., Limketkai, B. N., Bensen, R., Kin, C., Park, K. T. 2018

  Abstract

  Background: Depression frequently co-occurs in patients with inflammatory bowel disease (IBD) and is a driver in health care costs and utilization.Aim: This study examined the associations between depression and total health care costs, emergency department (ED) visits, computed tomography (CT) scans during ED/inpatient visits, and IBD-related surgery among IBD patients.Methods: Our sample included 331,772 IBD patients from a national administrative claims database (Truven Health MarketScan Database). Gamma and Poisson regression analyses assessed differences related to depression controlling for key variables.Results: Approximately 16% of the IBD cohort was classified as having depression. Depression was associated with a $17,706 (95% CI [$16,892, 18,521]) increase in mean annual IBD-related health care costs and an increased incidence of ED visits (aIRR of 1.5; 95% CI [1.5, 1.6]). Among patients who had ≥1 ED/inpatient visits, depression was associated with an increased probability of receiving repeated CT scans (1-4 CT scans aOR of 1.6; 95% CI [1.5, 1.7]; ≥5 CT scans aOR 4.6; 95% CI [2.9, 7.3]) and increased odds of undergoing an IBD-related surgery (aOR of 1.2; 95% CI [1.1, 1.2]). Secondary analysis with a pediatric subsample revealed approximately 12% of this cohort was classified as having depression, and depression was associated with increased costs and incidence rates of ED visits and CT scans, but not IBD-related surgery.Conclusion: Quantifiable differences in healthcare costs and patterns of utilization exist among patients with IBD and depression. Integration of mental health services within IBD care may improve overall health outcomes and costs of care.

  View details for PubMedID 30256923

• Effect of Middle School Interventions on Alcohol Misuse and Abuse in Mexican American High School Adolescents Five-Year Follow-up of a Randomized Clinical Trial JAMA PSYCHIATRY Gonzales, N. A., Jensen, M., Tein, J., Wong, J. J., Dumka, L. E., Mauricio, A. 2018; 75 (5): 429–37

  Abstract

  Substance abuse preventive interventions frequently target middle school students and demonstrate efficacy to prevent early onset and use of alcohol and illicit drugs. However, evidence of sustained results to prevent later patterns of alcohol misuse and more serious alcohol abuse disorders has been lacking, particularly for US Latino populations.To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation with a Mexican American sample.A previous randomized clinical trial was conducted with 516 Mexican American 7th graders and at least 1 parent who identified as having Mexican origin. Three annual cohorts of families were recruited from rosters of 4 middle schools and randomized to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003-2004, 2004-2005, and 2005-2006. Data acquisition for the follow-up assessments of late-adolescent alcohol misuse and abuse, which were not included in the initial randomized clinical trial, was conducted from September 2009 to September 2014; analysis was conducted between August 2016 and July 2017. In this assessment, 420 children (81.4%) of the sample were included, when the majority were in their final year of high school.The 9-session Bridges/Puentes intervention integrated youth, parent, and family intervention sessions that were delivered in the spring semester at each school, with separate groups for English-dominant vs Spanish-dominant families. The control workshop was offered during the same semester at each school, also in English and Spanish.Primary outcomes were diagnostic assessment of lifetime alcohol use disorder in the 12th grade, 5 years after the intervention, based on the Diagnostic Interview Schedule for Children and past-year frequency of alcohol use, binge drinking, and drunkenness based on the 2001 Youth Risk Behavior Survey.Of the 420 participants, 215 (51.2%) were girls (mean [SD] age, 17.9 [0.62] years). The intervention reduced the likelihood of having an alcohol use disorder (β = -.93; SE, 0.47; P = .047; odds ratio, 0.39). Intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness were moderated by baseline substance use. The intervention reduced the frequency of alcohol use (β = -.51; SE, 0.24; P = .04; Cohen d = 0.43) and drunkenness (β = -.51; SE, 0.26; P = .049; Cohen d = 0.41) among youth who reported any previous substance use at baseline (T1 initiators) but not among those who had not initiated any substance use (T1 abstainers) at baseline. For past-year binge drinking, the intervention finding did not reach statistical significance among T1 initiators (β = -.40; SE, 0.23; P = .09) or T1 abstainers (β = .23; SE, 0.14; P = .11).Study results support an association between a universal middle school intervention and alcohol misuse and alcohol use disorders among Mexican American high school students and implementation of universal middle school interventions to reach Latino communities.

  View details for PubMedID 29562080

  View details for PubMedCentralID PMC5875338

• Mental Health Service Needs in Children and Adolescents With Inflammatory Bowel Disease and Other Chronic Gastrointestinal Disorders. Journal of pediatric gastroenterology and nutrition Wong, J. J., Maddux, M. n., Park, K. T. 2018

  View details for PubMedID 29509635

• Project ECHO Diabetes Trial Improves Outcomes for Medically Underserved People. Diabetes care Walker, A. F., Haller, M. J., Addala, A., Filipp, S. L., Lal, R. A., Gurka, M. J., Figg, L. E., Hechavarria, M., Zaharieva, D. P., Malden, K. G., Hood, K. K., Westen, S. C., Wong, J. J., Donahoo, W. T., Basina, M., Bernier, A. V., Maahs, D. M. 2024

  Abstract

  The Project Extension for Community Healthcare Outcomes (ECHO) model is used in 180 countries to address chronic disease care through a provider empowerment, tele-education approach. Few studies have rigorously evaluated the impact of the program on patient outcomes using randomized designs.Implementation of an ECHO Diabetes program was evaluated using a stepped-wedge design with recruitment of 20 federally qualified health centers (FQHCs) across California and Florida with randomized, phased-in intervention entry. Participating FQHCs (referred to as "spokes") provided aggregate data, including the Healthcare Effectiveness Data and Information Set (HEDIS) and diabetes technology use. Patients were recruited from spokes, and data collection involved historical and prospective HbA1c measures, HEDIS markers, and pre/post surveys. Linear mixed models were used to generate patient-level monthly HbA1c estimates and evaluate change over time; Poisson regression was used to model clinic-level technology use.The spoke-level cohort included 32,796 people with type 1 diabetes (T1D; 3.4%) and type 2 diabetes (T2D; 96.6%), of whom 72.7% were publicly insured or uninsured. The patient-level cohort included 582 adults with diabetes (33.0% with T1D, 67.0% with T2D). Their mean age was 51.1 years, 80.7% were publicly insured or uninsured, 43.7% were non-Hispanic White, 31.6% were Hispanic, 7.9% were non-Hispanic Black, and 16.8% were in other race/ethnicity categories. At the spoke level, there were statistically significant reductions before and after the intervention in the proportion of people with HbA1c >9% (range 31.7% to 26.7%; P = 0.033). At the patient level, there were statistically significant increases in those using continuous glucose monitoring (range 25.1% to 36.8%; P < 0.0001) and pump use (range 15.3% to 18.3%; P < 0.001) before and after the intervention.The ECHO model demonstrates promise for reducing health disparities in diabetes and contributes to our understanding of program benefits beyond the provider level.

  View details for DOI 10.2337/dc24-2100

  View details for PubMedID 39688288

• Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts. BMJ open diabetes research & care Walker, A. F., Haller, M. J., Addala, A., Filipp, S. L., Lal, R., Gurka, M. J., Figg, L. E., Hechavarria, M., Zaharieva, D. P., Malden, K. G., Hood, K. K., Westen, S. C., Wong, J. J., Donahoo, W. T., Basina, M., Bernier, A. V., Duncan, P., Maahs, D. M. 2024; 12 (4)

  Abstract

  Diabetes disparities exist based on socioeconomic status, race, and ethnicity. The aim of this study is to compare two cohorts with diabetes from California and Florida to better elucidate how health outcomes are stratified within underserved communities according to state location, race, and ethnicity.Two cohorts were recruited for comparison from 20 Federally Qualified Health Centers as part of a larger ECHO Diabetes program. Participant-level data included surveys and HbA1c collection. Center-level data included Healthcare Effectiveness Data and Information Set metrics. Demographic characteristics were summarized overall and stratified by state (frequencies, percentages, means (95% CIs)). Generalized linear mixed models were used to compute and compare model-estimated rates and means.Participant-level cohort: 582 adults with diabetes were recruited (33.0% type 1 diabetes (T1D), 67.0% type 2 diabetes (T2D)). Mean age was 51.1 years (95% CI 49.5, 52.6); 80.7% publicly insured or uninsured; 43.7% non-Hispanic white (NHW), 31.6% Hispanic, 7.9% non-Hispanic black (NHB) and 16.8% other. Center-level cohort: 32 796 adults with diabetes were represented (3.4% with T1D, 96.6% with T2D; 72.7% publicly insured or uninsured). Florida had higher rates of uninsured (p<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386).Characteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida's lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.

  View details for DOI 10.1136/bmjdrc-2024-004229

  View details for PubMedID 39242122

• 'We're taught green is good': Perspectives on time in range and time in tight range from youth with type 1 diabetes, and parents of youth with type 1 diabetes. Diabetic medicine : a journal of the British Diabetic Association Tanenbaum, M. L., Pang, E., Tam, R., Bishop, F. K., Prahalad, P., Zaharieva, D. P., Addala, A., Wong, J. J., Naranjo, D., Hood, K. K., Maahs, D. M. 2024: e15423

  Abstract

  Continuous glucose monitoring (CGM) systems are standard of care for youth with type 1 diabetes with the goal of spending >70% time in range (TIR; 70-180 mg/dL, 3.9-10 mmol/L). We aimed to understand paediatric CGM user experiences with TIR metrics considering recent discussion of shifting to time in tight range (TITR; >50% time between 70 and 140 mg/dL, 3.9 and 7.8 mmol/L).Semi-structured interviews and focus groups with adolescents with type 1 diabetes and parents of youth with type 1 diabetes focused on experiences with TIR goals and reactions to TITR. Groups and interviews were audio-recorded, transcribed and analysed using content analysis.Thirty participants (N = 19 parents: age 43.6 ± 5.3 years, 79% female, 47% non-Hispanic White, 20 ± 5 months since child's diagnosis; N = 11 adolescents: age 15.3 ± 2 years, 55% female, 55% non-Hispanic White, 16 ± 3 months since diagnosis) attended. Participants had varying levels of understanding of TIR. Some developed personally preferred glucose ranges. Parents often aimed to surpass 70% TIR. Many described feelings of stress and disappointment when they did not meet a TIR goal. Concerns about TITR included increased stress and burden; risk of hypoglycaemia; and family conflict. Some participants said TITR would not change their daily lives; others said it would improve their diabetes management. Families requested care team support and a clear scientific rationale for TITR.The wealth of CGM data creates frequent opportunities for assessing diabetes management and carries implications for management burden. Input from people with type 1 diabetes and their families will be critical in considering a shift in glycaemic goals and targets.

  View details for DOI 10.1111/dme.15423

  View details for PubMedID 39118381

• Islet autoantibodies as precision diagnostic tools to characterize heterogeneity in type 1 diabetes: a systematic review COMMUNICATIONS MEDICINE Felton, J. L., Redondo, M. J., Oram, R. A., Speake, C., Long, S., Onengut-Gumuscu, S., Rich, S. S., Monaco, G. F., Harris-Kawano, A., Perez, D., Saeed, Z., Hoag, B., Jain, R., Evans-Molina, C., DiMeglio, L. A., Ismail, H. M., Dabelea, D., Johnson, R. K., Urazbayeva, M., Wentworth, J. M., Grif, K. J., Sims, E. K., Tobias, D. K., Merino, J., Ahmad, A., Aiken, C., Benham, J. L., Bodhini, D., Clark, A. L., Colclough, K., Corcoy, R., Cromer, S. J., Duan, D., Felton, J. L., Francis, E. C., Gillard, P., Gingras, V., Gaillard, R., Haider, E., Hughes, A., Ikle, J. M., Jacobsen, L. M., Kahkoska, A. R., Kettunen, J. T., Kreienkamp, R. J., Lim, L., Mannisto, J. E., Massey, R., Mclennan, N., Miller, R. G., Morieri, M., Most, J., Naylor, R. N., Ozkan, B., Patel, K., Pilla, S. J., Prystupa, K., Raghavan, S., Rooney, M. R., Schoen, M., Semnani-Azad, Z., Sevilla-Gonzalez, M., Svalastoga, P., Takele, W., Tam, C., Thuesen, A. B., Tosur, M., Wallace, A. S., Wang, C. C., Wong, J. J., Yamamoto, J. M., Young, K., Amouyal, C., Andersen, M. K., Bonham, M. P., Chen, M., Cheng, F., Chikowore, T., Chivers, S. C., Clemmensen, C., Dabelea, D., Dawed, A. Y., Deutsch, A. J., Dickens, L. T., DiMeglio, L. A., Dudenhoffer-Pfeifer, M., Evans-Molina, C., Fernandez-Balsells, M., Fitipaldi, H., Fitzpatrick, S. L., Gitelman, S. E., Goodarzi, M. O., Grieger, J. A., Guasch-Ferre, M., Habibi, N., Hansen, T., Huang, C., Harris-Kawano, A., Ismail, H. M., Hoag, B., Johnson, R. K., Jones, A. G., Koivula, R. W., Leong, A., Leung, G. W., Libman, I. M., Liu, K., Long, S., Lowe, W. L., Morton, R. W., Motala, A. A., Onengut-Gumuscu, S., Pankow, J. S., Pathirana, M., Pazmino, S., Perez, D., Petrie, J. R., Powe, C. E., Quinteros, A., Jain, R., Ray, D., Ried-Larsen, M., Saeed, Z., Santhakumar, V., Kanbour, S., Sarkar, S., Monaco, G. F., Scholtens, D. M., Selvin, E., Sheu, W., Speake, C., Stanislawski, M. A., Steenackers, N., Steck, A. K., Stefan, N., Stoy, J., Taylor, R., Tye, S., Ukke, G., Urazbayeva, M., Van der Schueren, B., Vatier, C., Wentworth, J. M., Hannah, W., White, S. L., Yu, G., Zhang, Y., Zhou, S. J., Beltrand, J., Polak, M., Aukrust, I., de Franco, E., Flanagan, S. E., Maloney, K. A., McGovern, A., Molnes, J., Nakabuye, M., Njolstad, P., Pomares-Millan, H., Provenzano, M., Saint-Martin, C., Zhang, C., Zhu, Y., Auh, S., de Souza, R., Fawcett, A. J., Gruber, C., Mekonnen, E., Mixter, E., Sherifali, D., Eckel, R. H., Nolan, J. J., Philipson, L. H., Brown, R. J., Billings, L. K., Boyle, K., Costacou, T., Dennis, J. M., Florez, J. C., Gloyn, A. L., Gomez, M. F., Gottlieb, P. A., Greeley, S. W., Griffin, K., Hattersley, A. T., Hirsch, I. B., Hivert, M., Hood, K. K., Josefson, J. L., Kwak, S., Laffel, L. M., Lim, S. S., Loos, R. F., Ma, R. W., Mathieu, C., Mathioudakis, N., Meigs, J. B., Misra, S., Mohan, V., Murphy, R., Oram, R., Owen, K. R., Ozanne, S. E., Pearson, E. R., Perng, W., Pollin, T. I., Pop-Busui, R., Pratley, R. E., Redman, L. M., Redondo, M. J., Reynolds, R. M., Semple, R. K., Sherr, J. L., Sims, E. K., Sweeting, A., Tuomi, T., Udler, M. S., Vesco, K. K., Vilsboll, T., Wagner, R., Rich, S. S., Franks, P. W., ADA EASD PMDI 2024; 4 (1): 66

  Abstract

  Islet autoantibodies form the foundation for type 1 diabetes (T1D) diagnosis and staging, but heterogeneity exists in T1D development and presentation. We hypothesized that autoantibodies can identify heterogeneity before, at, and after T1D diagnosis, and in response to disease-modifying therapies.We systematically reviewed PubMed and EMBASE databases (6/14/2022) assessing 10 years of original research examining relationships between autoantibodies and heterogeneity before, at, after diagnosis, and in response to disease-modifying therapies in individuals at-risk or within 1 year of T1D diagnosis. A critical appraisal checklist tool for cohort studies was modified and used for risk of bias assessment.Here we show that 152 studies that met extraction criteria most commonly characterized heterogeneity before diagnosis (91/152). Autoantibody type/target was most frequently examined, followed by autoantibody number. Recurring themes included correlations of autoantibody number, type, and titers with progression, differing phenotypes based on order of autoantibody seroconversion, and interactions with age and genetics. Only 44% specifically described autoantibody assay standardization program participation.Current evidence most strongly supports the application of autoantibody features to more precisely define T1D before diagnosis. Our findings support continued use of pre-clinical staging paradigms based on autoantibody number and suggest that additional autoantibody features, particularly in relation to age and genetic risk, could offer more precise stratification. To improve reproducibility and applicability of autoantibody-based precision medicine in T1D, we propose a methods checklist for islet autoantibody-based manuscripts which includes use of precision medicine MeSH terms and participation in autoantibody standardization workshops.

  View details for DOI 10.1038/s43856-024-00478-y

  View details for Web of Science ID 001198030600001

  View details for PubMedID 38582818

  View details for PubMedCentralID PMC10998887

• Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations. Journal of diabetes and its complications Addala, A., Wong, J. J., Penaranda, R. M., Hanes, S. J., Abujaradeh, H., Adams, R. N., Barley, R. C., Iturralde, E., Lanning, M. S., Tanenbaum, M. L., Naranjo, D., Hood, K. K. 2023; 37 (7): 108514

  Abstract

  Youth from lower socioeconomic status (SES) have suboptimal type 1 diabetes (T1D) outcomes. Patient reported outcomes (PROs) measure psychosocial states and are associated with T1D outcomes, however are understudied in low SES youth. We aimed to evaluate associations between PROs and public insurance status, a proxy for low SES.We analyzed survey data from 129 youth with T1D (age 15.7 ± 2.3 years, 33 % publicly insured) screened with PROMIS Global Health (PGH, measuring global health) and Patient Health Questionnaire (PHQ-9, measuring depressive symptoms) during diabetes appointments. Correlation and regression analyses evaluated differences in PGH and PHQ-9 by insurance status.For youth with public insurance, lower global health correlated with lower self-monitoring blood glucose (SMBG; r = 0.38,p = 0.033) and older age (r = -0.45,p = 0.005). In youth with private insurance, lower global health correlated with lower SMBG (r = 0.27,p = 0.018) and female sex (rho = 0.26,p = 0.015). For youth with private insurance, higher depressive symptoms correlated with higher body mass index (r = 0.22,p = 0.03) and fewer SMBG (r = -0.35,p = 0.04). In multivariate regression analyses, public insurance was inversely associated with global health (p = 0.027).PGH is a particularly salient PRO in youth with public insurance. Global health may be an important psychosocial factor to assess in youth with T1D from low SES backgrounds.

  View details for DOI 10.1016/j.jdiacomp.2023.108514

  View details for PubMedID 37263033

• Sharing the Blues: Longitudinal Influences of Depression within Couples CONTEMPORARY FAMILY THERAPY Wong, J. J., Timko, C., Heinz, A. J., Cronkite, R. 2023

  View details for DOI 10.1007/s10591-023-09664-x

  View details for Web of Science ID 000967386500002

• Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings. Diabetes therapy : research, treatment and education of diabetes and related disorders Lewit, E. M., Figg, L. E., Addala, A., Filipp, S. L., Lal, R., Gurka, M. J., Herndon, J. B., Haller, M. J., Maahs, D. M., Walker, A. F. 2023

  Abstract

  Project ECHO Diabetes is a tele-education learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert "hub" teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and "spokes" consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients. We sought to estimate the costs of operating a Project ECHO Diabetes hub, inclusive of diabetes support coach costs.Data from Project ECHO Diabetes from June 2021 to June 2022 and wages from national databases were used to estimate hub and diabetes support coach costs to operate a 6-month, 24-session Project ECHO Diabetes program at hubs (University of Florida and Stanford University) and spokes (PCP clinic sites in Florida and California).Hub costs for delivering a 6-month Project ECHO Diabetes program to five spoke clinics were $96,873. Personnel costs were the principal driver. Mean cost was $19,673 per spoke clinic and $11.37 per spoke clinic patient. Diabetes support coach costs were estimated per spoke clinic and considered scalable in that they would increase proportionately with the number of spoke clinics in a Project ECHO Diabetes cohort. Mean diabetes support coach costs were $6,506 per spoke clinic and $3.72 per patient. Total program costs per hub were $129,404. Mean cost per clinic was $25,881. Mean cost per patient was $15.03.Herein, we document real-world costs to operate a Project ECHO Diabetes hub and diabetes support coaches. Future analysis of Project ECHO Diabetes will include estimates of spoke participation costs and changes in health care costs and savings. As state agencies, insurers, and philanthropies consider the replication of Project ECHO Diabetes, this analysis provides important initial information regarding primary operating costs.

  View details for DOI 10.1007/s13300-022-01364-3

  View details for PubMedID 36680682

• Post-Traumatic Stress Disorder in pediatric Implantable Cardioverter Defibrillator patients and their parents. Heart rhythm Schneider, L. M., Wong, J. J., Adams, R., Bates, B., Chen, S., Ceresnak, S. R., Danovsky, M., Hanisch, D., Motonaga, K. S., Restrepo, M., Shaw, R. J., Sears, S. F., Trela, A., Dubin, A. M., Hood, K. K. 2022

  Abstract

  An ICD in the pediatric patient (and the precipitating events that led to ICD placement) can be traumatic for patients and their families and may lead to PTSD.This study aimed to estimate the prevalence of PTSD in pediatric ICD patients and their parents and identify the factors associated with PTSD incidence.Pediatric participants with an ICD ages 8-21 years and parents of youth ages 0-21 years completed surveys that included demographics and PTSD measures. Pediatric participants completed additional psychosocial measures, such as anxiety and depression self-report questionnaires.Fifty youth (30% female) and 43 parents (70% female) completed the measures. Six youth (12%) met the screening criteria for a likely PTSD diagnosis, while 20 parents (47%) met the cutoff for PTSD on the screening measure. Children with PTSD were more likely to have had a secondary prevention ICD (83% vs 17%, p=0.021), meet the clinical cutoff for depression (67% vs 16%, p=.005), and had higher shock anxiety (31.7 vs 17.9, p=0.003) than children without PTSD. Female gender (57% vs 23%, p=0.043) and patient depression (31% vs 5%, p=.042) were associated with PTSD among parents.Parents were found to be more likely to meet the criteria for PTSD than youth. Among youth, PTSD was associated with medical and psychosocial factors whereas PTSD among parents was associated with being female and child depression. Clinic based screenings and management planning of emotional functioning are warranted to address psychological distress in patients and parents.

  View details for DOI 10.1016/j.hrthm.2022.06.025

  View details for PubMedID 35772698

• Qualitative Study of User Experiences with Loop, an Open-Source Automated Insulin Delivery (AID) System. Diabetes technology & therapeutics Suttiratana, S., Wong, J., Lanning, M. S., Dunlap, A. R., Hanes, S., Hood, K., Lal, R. A., Naranjo, D. 1800

  Abstract

  BACKGROUND: Loop is an open-source automated insulin delivery (AID) system, used by more than 9,000 people with Type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation.METHODS: Focus groups revealed 72 new and existing users' perspectives on Loop uptake, use and persistence. A subsample of participants from a mixed methods observational cohort study shared first-hand accounts of their experiences using Loop. Participants were predominately white (95%), male (50%), privately insured (94%), reported annual household income ≥ $100K (73%) and education exceeding a bachelor's degree (87%) with a mean HbA1c of 6.6±0.8%. Data were analyzed and synthesized by a multidisciplinary team.RESULTS: Participants detailed their experiences with a) Loop technical support and troubleshooting, b) decreased mental/behavioral burden, c) technical issues with parts of the system, d) glycemic control, e) personalizing settings, and f) providers while using Loop. Decreased burden was the most endorsed benefit defined by less worry, stress, and cognitive effort and less time spent on diabetes management tasks. Participants highlighted the benefits of Loop overnight and their introduction to "Loop communities" during use. The most discussed challenges involved technical issues. A range of provider attitudes and knowledge about Loop complicated users' clinical experiences and disclosure.CONCLUSIONS: This sample of new and experienced Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components, customizing the system to suit one's lifestyle and habits, and adjusting system settings. Challenges related to system set up and calibrating settings are remediable and, if addressed, may better serve Loop users. Users reported feeling empowered by the customizability of and the educational effects facilitated by the open source AID system. Loop helped users learn more about their chronic illness and physiology in an acceptable format.

  View details for DOI 10.1089/dia.2021.0485

  View details for PubMedID 35099278

• Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes. Frontiers in endocrinology Addala, A., Filipp, S. L., Figg, L. E., Anez-Zabala, C., Lal, R. A., Gurka, M. J., Haller, M. J., Maahs, D. M., Walker, A. F., Project ECHO Diabetes Research Team, Haller, M., Sheehan, E., Bernier, A., Westen, S., Stahmer, H., Donahoo, W. T., Roque, X., Malden, G., Hechavarria, M., Maahs, D., Lal, R., Addala, A., Figg, L., Yabut, K., Alramahi, N., Cortes, A., Zaharieva, D., Basina, M., Judge, K., Wilke, L., Hood, K., Wong, J., Wang, J., Bhatia, S., Lewit, E. 2022; 13: 1066521

  Abstract

  Introduction: In the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.Methods: PCPs (n=116) who participated in Project ECHO Diabetes and completed pre- and post-intervention surveys were included in this analysis. The survey was administered in California and Florida to participating PCPs via REDCap and paper surveys. This survey aimed to evaluate practice demographics, protocols with adult and pediatric T1D management, challenges, resources, and provider knowledge and confidence in diabetes management. Differences and statistical significance in pre- and post-intervention responses were evaluated via McNemar's tests.Results: PCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.Discussion: PCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.

  View details for DOI 10.3389/fendo.2022.1066521

  View details for PubMedID 36589850

• Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D. BMJ open diabetes research & care Walker, A. F., Cuttriss, N., Haller, M. J., Hood, K. K., Gurka, M. J., Filipp, S. L., Anez-Zabala, C., Yabut, K., Roque, X., Wong, J. J., Baer, L., Figg, L., Bernier, A., Westen, S., Lewit, E., Sheehan, E., Basina, M., Lal, R., Maizel, J., Maahs, D. M. 2021; 9 (1)

  Abstract

  INTRODUCTION: Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs' abilities to manage patients with T1D.RESEARCH DESIGN AND METHODS: Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences.RESULTS: In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01).CONCLUSIONS: The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.

  View details for DOI 10.1136/bmjdrc-2021-002262

  View details for PubMedID 34244218

• Cost considerations for adoption of diabetes technology are pervasive: a qualitative study of persons living with type 1 diabetes and their families. Diabetic medicine : a journal of the British Diabetic Association Addala, A., Suttiratana, S. C., Wong, J. J., Lanning, M. S., Barnard, K. D., Weissberg-Benchell, J., Laffel, L. M., Hood, K. K., Naranjo, D. 2021: e14575

  Abstract

  BACKGROUND: Cost is a major consideration in the uptake and continued use of diabetes technology. With increasing use of automated insulin delivery systems, it is important to understand the specific cost-related barriers to technology adoption. In this qualitative analysis, we were interested in understanding and examining the decision-making process around cost and diabetes technology use.MATERIALS AND METHODS: Four raters coded transcripts of four stakeholder groups using inductive coding for each stakeholder group to establish relevant themes/nodes. We applied the Social Ecological Model in the interpretation of five thematic levels of cost.RESULTS: We identified five thematic levels of cost: policy, organizational, insurance, interpersonal, and individual. Equitable diabetes technology access was an important policy-level theme. The insurance-level theme had multiple sub-themes which predominantly carried a negative valence. Participants also emphasized the psychosocial burden of cost specifically identifying diabetes costs to their families, the guilt of diabetes related costs, and frustration in the time and involvement required to ensure insurance coverage.CONCLUSION: We found broad consensus in how cost is experienced by stakeholder groups. Cost considerations for diabetes technology uptake extended beyond finances to include time, cost to society, morality, and interpersonal relationships. Cost also reflected an important moral principle tied to the shared desire for equitable access to diabetes technology. Knowledge of these considerations can help clinicians and researchers promote equitable device uptake while anticipating barriers for all persons living with type 1 diabetes and their families.

  View details for DOI 10.1111/dme.14575

  View details for PubMedID 33794006

• Barriers to Continuous Glucose Monitoring in People With Type 1 Diabetes: Clinician Perspectives. Diabetes spectrum : a publication of the American Diabetes Association Lanning, M. S., Tanenbaum, M. L., Wong, J. J., Hood, K. K. 2020; 33 (4): 324–30

  Abstract

  The purpose of this study was to determine clinician attitudes about the distinct barriers to uptake of continuous glucose monitoring (CGM) among people with diabetes. Survey data were collected measuring individual barriers, prerequisites to CGM, confidence in addressing barriers, and clinic staff resources. Results show that clinicians commonly report barriers to using CGM among people with diabetes in their clinic. Furthermore, clinicians who report a high number of barriers do not feel confident in overcoming the barriers to CGM. Interventions that attempt to empower clinicians to address concerns about CGM among people with diabetes may be warranted because low uptake does not appear to be directly related to available resources or prerequisites to starting CGM.

  View details for DOI 10.2337/ds19-0039

  View details for PubMedID 33223770

• Are Common Sense Model constructs and self-efficacy simultaneously correlated with self-management behaviors and health outcomes: A systematic review. Health psychology open Breland, J. Y., Wong, J. J., McAndrew, L. M. 2020; 7 (1): 2055102919898846

  Abstract

  This systematic review answered two questions among adults with chronic conditions: When included in the same statistical model, are Common Sense Model constructs and self-efficacy both associated with (1) self-management behaviors and (2) health outcomes? We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included 29 articles. When included in the same statistical model, Common Sense Model constructs and self-efficacy were both correlated with outcomes. Self-efficacy was more consistently associated with self-management behaviors, and Common Sense Model constructs were more consistently associated with health outcomes. Findings support the continued inclusion and integration of both frameworks to understand and/or improve chronic illness self-management and outcomes.

  View details for DOI 10.1177/2055102919898846

  View details for PubMedID 32030192

  View details for PubMedCentralID PMC6978827

• Cost, Hassle, and On-Body Experience: Barriers to Diabetes Device Use in Adolescents and Potential Intervention Targets. Diabetes technology & therapeutics Messer, L. H., Tanenbaum, M. n., Cook, P. F., Wong, J. n., Hanes, S. n., Driscoll, K. A., Hood, K. n. 2020

  Abstract

  Adolescents with diabetes have the highest A1cs of all age group. Diabetes devices (insulin pumps and continuous glucose monitors [CGM]) can improve glycemic outcomes, and though uptake of devices have increased, they remain underutilized in this population. This study characterizes adolescent-reported barriers to diabetes device use to determine targets for clinician intervention.We surveyed 411 adolescents with type 1 diabetes (mean age 16.302.25 years) on barriers to diabetes device use, technology use attitudes (general and diabetes-specific), benefits and burdens of CGM, self-efficacy for diabetes care, diabetes distress, family conflict, and depression. We characterize barriers to device uptake; assess demographic and psychosocial differences in device users, discontinuers, and non-users; and determine differences in device use by gender and age.The majority of adolescents used an insulin pump (n=307, 75%) and more than half used CGM (n=225, 55%). Cost/insurance-related concerns were the most commonly endorsed barrier category (61%) followed by wear-related issues (58.6%) which includes hassle of wearing the device (38%), and dislike of device on body (33%). Adolescents who endorsed more barriers also reported more diabetes distress (p=0.003), family conflict (p=0.003), and depressive symptoms (p=0.014). Pump and CGM discontinuers both endorsed more barriers and more negative perceptions of technology than current users, but reported no difference from device users in diabetes distress, family conflict, or depression. Gender was not related to perceptions of devices.Clinicians can proactively assess attitudes toward diabetes technology and perceptions of benefits/burdens to encourage device uptake and potentially prevent device discontinuation among adolescents.

  View details for DOI 10.1089/dia.2019.0509

  View details for PubMedID 32163719

• The role of depression course on life functioning and coping outcomes from baseline through 23-year follow-up. Journal of mental health (Abingdon, England) Woodhead, E. n., Cronkite, R. n., Finlay, A. n., Wong, J. n., Haverfield, M. n., Timko, C. n. 2020: 1–9

  Abstract

  Although studies have examined how depressed patients' baseline characteristics predict depression course, still needed are studies of how depression course is associated with modifiable long-term outcomes.This study examined six outcomes of three groups representing distinct depression courses (low baseline severity, rapid decline; moderate baseline severity, rapid decline; and high baseline severity, slow decline): medical functioning, coping patterns, family functioning, social functioning, employment, and work functioning.Adults with depression at baseline (N = 382; 56% women) were followed for 23 years on self-reported outcomes (79% response rate). Data from the baseline assessment and follow-ups (1, 4, 10, and 23 years) were used in a longitudinal analysis to examine associations between depression course and outcomes.All depression course groups declined on medical and social functioning and employment over follow-up. The high- and moderate-severity depression course groups reported poorer coping patterns than the low-severity group. The high-severity depression course group reported poorer family functioning than the moderate-severity group, and had the poorest work functioning outcome, followed by the moderate-severity and then the low-severity groups.Patients with a high- or moderate-severity depression course may benefit from treatment that manages coping patterns and improves family and work functioning.

  View details for DOI 10.1080/09638237.2020.1793127

  View details for PubMedID 32667276

• Diabetes-Specific Self-Compassion: A New Measure for Parents of Youth With Type 1 Diabetes. Journal of pediatric psychology Tanenbaum, M. L., Adams, R. N., Wong, J. J., Hood, K. K. 2020

  Abstract

  Given the high daily demands of managing type 1 diabetes (T1D), parents of youth with T1D can experience high levels of emotional distress, burden, and self-criticism, with implications for parent and child well-being and parent self-efficacy for managing diabetes. Diabetes-specific self-compassion (SC), or being kind to oneself when facing challenges related to managing diabetes, may serve as protective for parents. This study aimed to create and assess the psychometric properties of a new tool, the diabetes-specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D.We adapted a parent diabetes-specific SC measure; surveyed parents (N = 198; parent: 88% female; 95% non-Hispanic White; M age = 44 ± 8.9; child: 46% female; M age = 13 ± 3.4, range 2-18 years; 83% insulin pump users; 40% continuous glucose monitor (CGM) users; HbA1c from clinic data available for 76 participants: M HbA1c = 8.1 ± 1.3%) and conducted confirmatory factor analysis, and reliability and construct validity analyses. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and HbA1c.A bifactor structure provided the best fit, with one general factor and two wording-related group factors (positively and negatively worded items). The final 19-item SCS-Dp demonstrated excellent internal consistency (α =.94; range of item-total correlations: .52-.81) and good construct validity. As predicted, greater SC was associated with lower distress (r = -.68, p < .001) and greater empowerment (r = .43, p < .001) and was not associated with diabetes numeracy (p = .61). Diabetes-specific Self-Compassion Scale was not associated with HbA1c (p = .28).Results provide initial evidence of good reliability and validity of the SCS-Dp to assess diabetes-specific SC in parents.

  View details for DOI 10.1093/jpepsy/jsaa011

  View details for PubMedID 32196093

• An exploratory assessment of pediatric patient and parent needs after implantable cardioverter defibrillator implant. Pacing and clinical electrophysiology : PACE Schneider, L. M., Wong, J. J., Trela, A. n., Hanisch, D. n., Shaw, R. J., Sears, S. F., Motonaga, K. S., Ceresnak, S. R., Hood, K. K., Dubin, A. M. 2020

  Abstract

  Placement of an ICD is often accompanied by psychological adjustment issues in pediatric patients and their parents. While anxiety, depression, and lowered QOL have been seen in these patients, no studies have investigated patient or parent reported needs. This exploratory study describes the needs of pediatric ICD patients and parents and assesses whether patient factors of age, gender, depression, and anxiety are associated with specific needs.ICD patients ages 8-21 and their parents completed a needs analysis survey assessing various domains of functioning. Patients also completed self-reported measures of depression and anxiety.Thirty-two patients (28% female) and their parents (72% mothers) completed the survey. Patients' most frequently endorsed needs involved educational issues: understanding their cardiac event/diagnosis (34%), medications (34%), and how the ICD would change their lifestyle (31%). Parents' most frequently endorsed needs involved family issues; almost half of parents (47%) were concerned about their children's frustration with their overprotectiveness and 28% were concerned with their child feeling depressed or anxious. Patients who reported feeling overprotected (12.1 ± 3.4 vs 17.4 ± 3.5 years, p = .001) were significantly younger than those who did not. Experiencing peer issues was more frequently endorsed by females than males (33% of females vs 4% of males, p = .026).ICD patients and parents endorsed markedly different needs. Patients focused on understanding their ICD, while parents were more focused on their children's emotional needs. Novel ways of educating patients about their device and clinic based screenings of emotional functioning may serve to meet these needs. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/pace.13876

  View details for PubMedID 31971265

• Weight Perceptions and Weight Loss Attempts: Military Service Matters. Military medicine Breland, J. Y., Patel, M. L., Wong, J. J., Hoggatt, K. J. 2019

  Abstract

  INTRODUCTION: People who do not perceive themselves as overweight or obese are less likely to use weight loss treatments. However, little is known about weight perceptions and their association with weight loss attempts among people who have served in the military. They represent a special population with regard to weight perceptions as military personnel must meet strict weight standards to remain in military service.MATERIALS AND METHODS: Using data from the U.S.-based 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys, we fit logistic regression models to determine whether people with overweight or obesity were: (1) more or less likely to underestimate their weight if they reported military service and (2) less likely to attempt weight loss if they underestimated their weight (stratifying by military status). Estimates were adjusted for sociodemographic factors, including objective weight class, gender, age, race/ethnicity, income ratio, comorbidities, and education. This work received exempt status from the Stanford University institutional review board.RESULTS: Among 6,776 participants, those reporting military service had higher odds of underestimating their weight compared to those not reporting military service [OR (odds ratio): 1.44; 95% confidence interval (CI): 1.15, 1.79]. Underestimating weight was associated with lower odds of attempting weight loss among those reporting military service (OR: 0.20; CI: 0.11, 0.36) and those not reporting military service (OR: 0.27; CI: 0.22, 0.34).CONCLUSIONS: This study offers the new finding that underestimating weight is more likely among people reporting military service compared to those not reporting military service. Findings are consistent with past work demonstrating that underestimating weight is associated with a lower likelihood of pursuing weight loss. To combat weight misperceptions, clinicians may need to spend additional time discussing weight-related perceptions and beliefs with patients. The present findings suggest such conversations may be especially important for people reporting military service. Future research should be designed to understand the effects of correcting weight misperceptions. This work would advance the science of weight management and offer ways to increase weight loss treatment engagement, prevent chronic conditions, and improve health outcomes, especially among people reporting military service.

  View details for DOI 10.1093/milmed/usz413

  View details for PubMedID 31822913

• Correlates of health care use among White and minority men and women with diabetes: An NHANES study DIABETES RESEARCH AND CLINICAL PRACTICE Wong, J. J., Hood, K. K., Breland, J. Y. 2019; 150: 122–28

  View details for DOI 10.1016/j.diabres.2019.03.001

  View details for Web of Science ID 000467689500014

• Depression and Health Care Use in Patients With Inflammatory Bowel Disease JOURNAL OF CROHNS & COLITIS Wong, J. J., Sceats, L., Dehghan, M., Wren, A. A., Sellers, Z. M., Limketkai, B. N., Bensen, R., Kin, C., Park, K. T. 2019; 13 (1): 19–26

  View details for DOI 10.1093/ecco-jcc/jjy145

  View details for Web of Science ID 000459355900004

• Receipt of Pharmacotherapy for Alcohol Use Disorder by Male Justice-Involved U.S. Veterans Health Administration Patients. Criminal justice policy review Finlay, A. K., Binswanger, I., Timko, C., Rosenthal, J., Clark, S., Blue-Howells, J., McGuire, J., Hagedorn, H., Wong, J., Van Campen, J., Harris, A. H. 2018; 29 (9): 875-890

  Abstract

  This study examined whether, among Veterans Health Administration (VHA) patients, veterans with recent or current justice involvement have equal receipt of pharmacotherapy for alcohol use disorder compared to veterans with no justice involvement. Using national VHA records, we calculated the overall and facility rates of receipt as the number of patients who received pharmacotherapy for alcohol use disorder divided by the number of patients diagnosed with an alcohol use disorder. Using a mixed-effects logistic regression model, we tested whether justice involvement was associated with pharmacotherapy receipt. Male veterans with jail/court involvement had significantly higher odds of receiving pharmacotherapy for alcohol use disorder compared to other male veterans. Justice-involved veterans had equal or better receipt of pharmacotherapy for alcohol use disorder compared to veterans with no justice involvement. Pharmacotherapy rates are low overall, suggesting that more work can be done to connect veterans to these medications.

  View details for DOI 10.1177/0887403416644011

  View details for PubMedID 30393426

  View details for PubMedCentralID PMC4852381

• Receipt of Pharmacotherapy for Alcohol Use Disorder by Male Justice-Involved U.S. Veterans Health Administration Patients Criminal justice policy review Finlay, A. K., Binswanger, I., Timko, C., Rosenthal, J., Clark, S., Blue-Howells, J., McGuire, J., Hagedorn, H., Wong, J., Van Campen, J., Harris, A. H. 2018; 29 (9): 875–90

  View details for DOI 10.1177/0887403416644011

  View details for PubMedID 30395420

• Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Finlay, A. K., Wong, J. J., Ellerbe, L. S., Rubinsky, A., Gupta, S., Bowe, T. R., Schmidt, E. M., Timko, C., Burden, J. L., Harris, A. S. 2018; 79 (6): 909–17

  View details for DOI 10.15288/jsad.2018.79.909

  View details for Web of Science ID 000454777200012

• Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs. Journal of studies on alcohol and drugs Finlay, A. K., Wong, J. J., Ellerbe, L. S., Rubinsky, A., Gupta, S., Bowe, T. R., Schmidt, E. M., Timko, C., Burden, J. L., Harris, A. H. 2018; 79 (6): 909–17

  Abstract

  OBJECTIVE: Despite evidence of effectiveness, pharmacotherapy-methadone, buprenorphine, or naltrexone-is prescribed to less than 35% of Veterans Health Administration (VHA) patients diagnosed with opioid use disorder (OUD). Among veterans whose OUD treatment is provided in VHA residential programs, factors influencing pharmacotherapy implementation are unknown. We examined barriers to and facilitators of pharmacotherapy for OUD among patients diagnosed with OUD in VHA residential programs to inform the development of implementation strategies to improve medication receipt.METHOD: VHA electronic health records and program survey data were used to describe pharmacotherapy provided to a national cohort of VHA patients with OUD in residential treatment programs (N = 4,323, 6% female). Staff members (N = 63, 57% women) from 44 residential programs (response rate = 32%) participated in interviews. Barriers to and facilitators of pharmacotherapy for OUD were identified from transcripts using thematic analysis.RESULTS: Across all 97 residential treatment programs, the average rate of pharmacotherapy for OUD was 21% (range: 0%-67%). Reported barriers included provider or program philosophy against pharmacotherapy, a lack of care coordination with nonresidential treatment settings, and provider perceptions of low patient interest or need. Facilitators included having a prescriber on staff, education and training for patients and staff, and support from leadership.CONCLUSIONS: Contrary to our hypothesis, barriers to and facilitators of pharmacotherapy for OUD in VHA residential treatment programs were consistent with prior research in outpatient settings. Intensive educational programs, such as academic detailing, and policy changes such as mandating buprenorphine waiver training for VHA providers, may help improve receipt of pharmacotherapy for OUD.

  View details for PubMedID 30573022

• Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015 INFLAMMATORY BOWEL DISEASES Wren, A. A., Bensen, R., Sceats, L., Dehghan, M., Yu, H., Wong, J. J., Maclsaac, D., Sellers, Z. M., Kin, C., Park, K. T. 2018; 24 (10): 2093–2103

  View details for DOI 10.1093/ibd/izy222

  View details for Web of Science ID 000449182600001

• Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007-2014 GASTROENTEROLOGY Sellers, Z. M., MacIsaac, D., Yu, H., Dehghan, M., Zhang, K., Bensen, R., Wong, J. J., Kin, C., Park, K. T. 2018; 155 (2): 469-+

  View details for DOI 10.1053/j.gastro.2018.04.013

  View details for Web of Science ID 000440023400042

• Exclusion criteria and generalizability in bipolar disorder treatment trials CONTEMPORARY CLINICAL TRIALS COMMUNICATIONS Wong, J. J., Jones, N., Timko, C., Humphreys, K. 2018; 9: 130–34

  Abstract

  The current paper reviews the English-language research on exclusion criteria in bipolar disorder treatment trials and discusses how study samples compare to the general bipolar patient population.& Results: Across 8 identified studies of exclusion criteria and their impact, between 55% and 96% of people with bipolar disorder would be excluded from treatment research. The number of exclusion criteria varies across bipolar disorder treatment research, with one study estimate of a median of 7 criteria used across studies. The criteria that excluded the greatest number of potential participants were comorbid substance use disorder, suicidal risk, and comorbid medical conditions. Both studies that compared treatment responses among participants who met and did not meet exclusion criteria found no statistically significant differences.Most potential participants are excluded from outcome research, which creates challenges for recruitment and limits generalizability of study findings. Common exclusionary practices lead to unrepresentative samples that limit generalizability and reduce the confidence of clinicians that findings can be translated to front-line practice with bipolar disorder patients.

  View details for PubMedID 29696235

• Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007-2014. Gastroenterology Sellers, Z. M., MacIsaac, D. n., Yu, H. n., Dehghan, M. n., Zhang, K. Y., Bensen, R. n., Wong, J. J., Kin, C. n., Park, K. T. 2018

  Abstract

  Epidemiologic analyses of acute and chronic pancreatitis (AP and CP) provide insight into causes and strategies for prevention, and affect allocation of resources to its study and treatment. We sought to determine current and accurate incidences of AP and CP, along with the prevalence of CP, in children and adults in the United States.We collected data from the Truven MarketScan Research Databases of commercial inpatient and outpatient insurance claims in the United States from 2007 through 2014 (patients 0-64 years old). We calculated the incidences of AP and CP, and prevalence of CP, based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Children were defined as 18 years or younger and adults as 19 to 64 years old.The incidence of pediatric AP was stable from 2007 through 2014, remaining at 12.3/100,000 persons in 2014. Meanwhile the incidence for adult AP decreased from 123.7/100,000 persons in 2007 to 111.2/100,000 persons in 2014. The incidence of CP decreased over time in children (2.2/100,000 persons in 2007 to 1.9/100,000 persons in 2014) and adults (31.7/100,000 persons in 2007 to 24.7/100,000 persons in 2014). The prevalence of pediatric and adult CP was 5.8/100,000 persons and 91.9/100,000 persons, respectively in 2014. Incidences of AP and CP increased with age; we found little change in incidence during the first decade of life, but linear increases starting in the second decade.We performed a comprehensive epidemiologic analysis of privately insured non-elderly adults and children with AP and CP in the United States. Changes in gallstone formation, smoking, and alcohol consumption, along with advances in pancreatitis management, may be responsible for the stabilization and even decrease in the incidences of AP and CP.

  View details for PubMedID 29660323

• Predicting Substance Use Patterns Among Rural Adults: The Roles of Mothers, Fathers, and Parenthood. Family process Wong, J. J., Cucciare, M. A., Booth, B. M., Timko, C. n. 2018

  Abstract

  This study examined the role of parenthood and parental influences on substance use patterns for 710 stimulant users age 18-61 living in the rural Midwest and Mid-south U.S. Longitudinal growth analyses showed that a maternal history of drug use was associated with increased baseline drug use severity, lesser declines in severity, and greater plateau of drug use severity over time. Parental conflict was associated with lesser declines in drug use severity, and drug use severity declined more steeply for participants who were themselves parents. Participants with two parents having a history of alcohol use had a greater baseline severity of alcohol use, with paternal history of drug use associated with lower baseline alcohol use severity. These findings demonstrate the importance of identifying parental influences in evaluating adult substance use, and point to the inclusion of parents in efforts to prevent and treat substance use disorders.

  View details for PubMedID 29663337

• Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015. Inflammatory bowel diseases Wren, A. A., Bensen, R. n., Sceats, L. n., Dehghan, M. n., Yu, H. n., Wong, J. J., MacIsaac, D. n., Sellers, Z. M., Kin, C. n., Park, K. T. 2018

  Abstract

  Opioids are commonly prescribed for relief in inflammatory bowel disease (IBD). Emerging evidence suggests that adolescents and young adults are a vulnerable population at particular risk of becoming chronic opioid users and experiencing adverse effects.This study evaluates trends in the prevalence and persistence of chronic opioid therapy in adolescents and young adults with IBD in the United States.A longitudinal retrospective cohort analysis was conducted with the Truven MarketScan Database from 2007 to 2015. Study subjects were 15-29 years old with ≥2 IBD diagnoses (Crohn's: 555/K50; ulcerative colitis: 556/K51). Opioid therapy was identified with prescription claims within the Truven therapeutic class 60: opioid agonists. Persistence of opioid use was evaluated by survival analysis for patients who remained in the database for at least 3 years following index chronic opioid therapy use.In a cohort containing 93,668 patients, 18.2% received chronic opioid therapy. The annual prevalence of chronic opioid therapy increased from 9.3% in 2007 to 10.8% in 2015 (P < 0.01), peaking at 12.2% in 2011. Opioid prescriptions per patient per year were stable (approximately 5). Post hoc Poisson regression analyses demonstrated that the number of opioid pills dispensed per year increased with age and was higher among males. Among the 2503 patients receiving chronic opioid therapy and followed longitudinally, 30.5% were maintained on chronic opioid therapy for 2 years, and 5.3% for all 4 years.Sustained chronic opioid use in adolescents and young adults with IBD is increasingly common, underscoring the need for screening and intervention for this vulnerable population.

  View details for PubMedID 29986015

• Barriers to and facilitators of pharmacotherapy for alcohol use disorder in VA residential treatment programs. Journal of substance abuse treatment Finlay, A. K., Ellerbe, L. S., Wong, J. J., Timko, C., Rubinsky, A. D., Gupta, S., Bowe, T. R., Burden, J. L., Harris, A. H. 2017; 77: 38-43

  Abstract

  Among US military veterans, alcohol use disorder (AUD) is prevalent and in severe cases patients need intensive AUD treatment beyond outpatient care. The Department of Veterans Affairs (VA) delivers intensive, highly structured addiction and psychosocial treatment through residential programs. Despite the evidence supporting pharmacotherapy among the effective treatments for AUD, receipt of these medications (e.g., naltrexone, acamprosate) among patients in residential treatment programs varies widely. In order to better understand this variation, the current study examined barriers and facilitators to use of pharmacotherapy for AUD among patients in VA residential treatment programs. Semi-structured qualitative interviews with residential program management and staff were conducted and the Consolidated Framework for Implementation Research was used to guide coding and analysis of interview transcripts. Barriers to use of pharmacotherapy for AUD included cultural norms or philosophy against prescribing, lack of access to willing prescribers, lack of interest from leadership, and perceived lack of patient interest or need. Facilitators included cultural norms of openness or active promotion of pharmacotherapy; education for patients, program staff and prescribers; having prescribers on staff, and care coordination within residential treatment and with other clinic settings in and outside VA. Developing and testing improvement strategies to increase care coordination and consistent support from leadership may also yield increases in the use of pharmacotherapy for AUD among residential patients.

  View details for DOI 10.1016/j.jsat.2017.03.005

  View details for PubMedID 28476269

• FIVE-YEAR DIABETES COMPLICATION PROGRESSION LESS SEVERE IN VETERANS WITH MENTAL HEALTH CONDITIONS Schmidt, E., Chen, C., Barnes, J., Wong, J., Harris, A. SPRINGER. 2017: S824

  View details for Web of Science ID 000398947201082

• Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users. Rural mental health Timko, C. n., Booth, B. M., Han, X. n., Schultz, N. R., Blonigen, D. M., Wong, J. J., Cucciare, M. A. 2017; 41 (2): 110–22

  Abstract

  There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.

  View details for PubMedID 29051795

  View details for PubMedCentralID PMC5642975

• Parenting Intervention Effects on Parental Depressive Symptoms: Examining the Role of Parenting and Child Behavior JOURNAL OF FAMILY PSYCHOLOGY Wong, J. J., Gonzales, N. A., Montano, Z., Dumka, L., Millsap, R. E. 2014; 28 (3): 267–77

  Abstract

  Parental depression is a major risk factor in child development. Growing research suggests parenting programs can positively impact parental depressive symptoms, although the specific mechanisms that explain these effects are unknown. The current study examined parenting mediated effects of a parenting program on mothers' and fathers' depressive symptoms, as well as the role of child behavior in linking parenting to reductions in depressive symptoms. The study samples included 494 mothers and 288 fathers of Mexican origin adolescents who participated in a randomized trial of the Bridges to High School Program/Proyecto Puentes a la Secundaria, a universal prevention and promotion intervention that included parent training but did not directly target parental depressive symptoms. Parenting mediator models tested program effects on parental depressive symptoms through changes in harsh and supportive parenting. Results showed a significant indirect intervention effect on maternal depressive symptoms through changes in mothers' harsh parenting. Next, child behavior models revealed a partial mediation effect of harsh parenting and a full mediation effect of supportive parenting on maternal depressive symptoms through mothers' reports of child externalizing symptoms. Indirect effects of fathers' harsh and supportive parenting on paternal depressive symptoms were also found through fathers' reports of child behavior.

  View details for DOI 10.1037/a0036622

  View details for Web of Science ID 000349170500001

  View details for PubMedID 24798817

• Father Enrollment and Participation in a Parenting Intervention: Personal and Contextual Predictors FAMILY PROCESS Wong, J. J., Roubinov, D. S., Gonzales, N. A., Dumka, L. E., Millsap, R. E. 2013; 52 (3): 440–54

  Abstract

  Fathers are an important, though often underrepresented, population in family interventions. Notably, the inclusion of ethnic minority fathers is particularly scarce. An understanding of factors that promote and hinder father participation may suggest strategies by which to increase fathers' presence in studies designed to engage the family unit. The current research examined Mexican origin (MO) fathers' involvement in a family-focused intervention study. Participants included 495 fathers from eligible two-parent MO families with an adolescent child. Individual, familial, and culturally relevant predictors based on father, mother, and/or child report data were collected through pretest interviews and included in two separate logistic regression analyses that predicted the following: (1) father enrollment in the study and (2) father participation in the intervention. Results indicated that higher levels of maternal education and lower levels of economic stress and interparental conflict were associated with increased father enrollment in the study. Rates of father participation in the intervention were higher among families characterized by lower levels of interparental conflict, economic stress, and Spanish language use. Results highlight the relevancy of the familial and environmental context to MO fathers' research participation decisions. These findings as well as their implications for future research and practice are discussed.

  View details for DOI 10.1111/famp.12024

  View details for Web of Science ID 000324411300008

  View details for PubMedID 24033241

  View details for PubMedCentralID PMC5889082