2025
Factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 in primary healthcare settings in Nepal: a cross-sectional study
Timalsena D, Nakarmi C, Mali S, Dhakal A, Bharati A, Bishwokarma A, Adhikari A, Poudel B, Kulung B, Baral P, Bhattarai S, Dixit L, Pokharel Y, Rhodes E, Xu D, Spiegelman D, Shrestha A. Factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 in primary healthcare settings in Nepal: a cross-sectional study. BMJ Open 2025, 15: e090923. PMID: 40935428, DOI: 10.1136/bmjopen-2024-090923.Peer-Reviewed Original ResearchConceptsWHO packageNon-communicable diseasesPrimary healthcareBody mass indexCardiovascular disease risk-prediction chartsHealthcare workersCardiovascular diseaseRisk prediction chartsPrimary healthcare settingsPrimary healthcare facilitiesPrimary healthcare centresBlood glucose screeningCardiovascular disease riskLow-resource settingsCross-sectional studyAssociated with accessBMI assessmentHealthcare settingsSystemic barriersProvider motivationBlood pressure measurementsAvailability of metforminRisk chartsPrediction chartsHealthcare facilitiesNonparametric Estimation of the Potential Impact Fraction and the Population Attributable Fraction With Individual‐Level and Aggregated Data
Chan C, Zepeda‐Tello R, Camacho‐García‐Formentí D, Cudhea F, Meza R, Rodrigues E, Spiegelman D, Barrientos‐Gutierrez T, Zhou X. Nonparametric Estimation of the Potential Impact Fraction and the Population Attributable Fraction With Individual‐Level and Aggregated Data. Statistics In Medicine 2025, 44: e70214. PMID: 40798868, DOI: 10.1002/sim.70214.Peer-Reviewed Original ResearchConceptsDistributional assumptionsFinite sample performanceImpact of distributional assumptionsPotential impact fractionNonparametric estimationSample performanceDistributional violationsPopulation attributable fractionImpact fractionNonparametric methodsSimulation studyContinuous exposure dataPopulation impact fractionsAttributable fractionSugar-sweetened beverage consumptionIncidence of type 2 diabetesAssumptionsExposure distributionEstimationAggregate dataBeverage consumptionNonparametricType 2 diabetesIndividual-levelTarget populationImplementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda)
Longenecker C, Kiggundu J, Ayebare F, Muddu M, Kayima J, Mutungi G, Ssinabulya I, Schwartz J, Spiegelman D, Tong G, Nugent R, Aifah A, Kagoya F, Cameron D, Hutchinson B, Kamya M, Katahoire A, Semitala F. Implementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda). BMC Health Services Research 2025, 25: 1060. PMID: 40790739, PMCID: PMC12341278, DOI: 10.1186/s12913-025-13281-9.Peer-Reviewed Original ResearchConceptsCluster randomized trialHypertension careHIV clinicHealth workersWakiso districtStepped-wedge cluster randomized trialRates of HIV viral suppressionImplementation strategiesQuality HIV careClinical health workersBaseline hypertension prevalenceResource intensive strategyFacility-based costsLife expectancy gainsHIV viral suppressionBP controlPatient BP controlHTN careHuman-centered design approachRandomized trialsHIV careImplementation outcomesHypertension prevalencePre-implementationNon-AIDS comorbiditiesExposure Measurement Error Correction in Longitudinal Studies With Discrete Outcomes
Yang C, Zhang N, Li J, Mehta U, Hart J, Spiegelman D, Wang M. Exposure Measurement Error Correction in Longitudinal Studies With Discrete Outcomes. Statistics In Medicine 2025, 44: e70191. PMID: 40680786, PMCID: PMC12274082, DOI: 10.1002/sim.70191.Peer-Reviewed Original ResearchConceptsNurses' Health Study IIError-prone exposureDiscrete outcomesLongitudinal studyMeasurement error correctionEnvironmental epidemiologistsHealth outcomesTime-varying functionCoverage probability improvementStudy designOccurrence of anxiety disordersStudy IIExposure measurementsEstimation procedureSimulation studyBias reductionAnxiety disordersExposure effectsHistory functionOutcomesChronic exposure effectsExposure historyNursesError correctionEpidemiologistsEarly findings from the integration of hypertension care into differentiated service delivery models for HIV in Uganda: a mixed‐method study
Kiggundu J, Semitala F, Lipoto C, Giibwa L, Twine R, Mwaka S, Ayebare F, Kiwala C, Magambo E, Mutungi G, Ssinabulya I, Spiegelman D, Kayima J, Muddu M, Schwartz J, Katahoire A, Longenecker C. Early findings from the integration of hypertension care into differentiated service delivery models for HIV in Uganda: a mixed‐method study. Journal Of The International AIDS Society 2025, 28: e26499. PMID: 40622382, PMCID: PMC12232483, DOI: 10.1002/jia2.26499.Peer-Reviewed Original ResearchConceptsHypertension careHealthcare providersExperiences of healthcare providersDSD modelCluster randomised trialRoutine medical recordsInductive thematic analysisGeneralised estimating equationsTime interaction effectsService delivery modelsMixed-methods studyIntegrated careHypertension visitsImplementation researchThematic analysisDelivery modelsPLHIVWakiso districtHypertension managementConsolidation frameworkNational guidelinesQuantitative outcome variablesUganda national guidelinesCareClient educationSt. Louis enhancing engagement and retention (STEER) in HIV/AIDS care: a participatory intersectional needs assessment for intervention and implementation planning
Humphries D, Marotta P, Hu Y, Wang V, Gross G, Rucker D, Jones J, Alam F, Brown T, Spiegelman D, Carter C. St. Louis enhancing engagement and retention (STEER) in HIV/AIDS care: a participatory intersectional needs assessment for intervention and implementation planning. Frontiers In Public Health 2025, 13: 1589671. PMID: 40567982, PMCID: PMC12187841, DOI: 10.3389/fpubh.2025.1589671.Peer-Reviewed Original ResearchConceptsCommunity health workersNeeds assessmentHealth workersIntegration of community health workersFocus groupsFront-line health workersLack of social supportParticipatory needs assessmentHIV Epidemic initiativeImprove HIV outcomesCommunity engagement principlesContext of HIVDrivers of inequalityPeer specialistsHealth coachingProvider turnoverClinical leadersHealth inequalitiesCare teamHIV/AIDS careHIV outcomesSocial supportCommunity partnersHistory of structural racismOutreach workersBarriers and facilitators to a combined strategy of HPV vaccination and cervical cancer screening among Mexican women
León-Maldonado L, Cabral A, Pages G, Brown B, Allen-Leigh B, Lazcano-Ponce E, Bosch F, Spiegelman D, Torres-Ibarra L, Hernández-Ramírez R, Egger E, Rivera-Paredez B, Salmerón J. Barriers and facilitators to a combined strategy of HPV vaccination and cervical cancer screening among Mexican women. Human Vaccines & Immunotherapeutics 2025, 21: 2483018. PMID: 40172917, PMCID: PMC11970787, DOI: 10.1080/21645515.2025.2483018.Peer-Reviewed Original ResearchConceptsInterpersonal-level barriersHigh-quality careFacilitators to participationExperiences of stigmaCervical cancer screeningLack of timeCommunity-level facilitatorsConstant comparative methodPublic health interventionsHealth center personnelInstitutional-level barriersSeverity of cervical cancerHPV-based screeningSemi-structured interviewsCancer screeningHealth interventionsPerceived severity of cervical cancerHealth centersPhone remindersSocioecological modelIntrapersonal levelInconvenient hoursFamily encouragementPerceived severityHPV vaccinationLearn-As-you-GO (LAGO) trials: optimizing treatments and preventing trial failure through ongoing learning
Bing A, Spiegelman D, Nevo D, Lok J. Learn-As-you-GO (LAGO) trials: optimizing treatments and preventing trial failure through ongoing learning. Biometrics 2025, 81: ujaf061. PMID: 40407021, PMCID: PMC12099308, DOI: 10.1093/biomtc/ujaf061.Peer-Reviewed Original ResearchConceptsIntervention packageBinary outcomesIntervention effectsConditional mean modelsOptimal intervention packagesOverall intervention effectContinuous outcomesComplex intervention packagesConfidence bandsInterval estimationImplementation trialLarge-scale intervention trialsMean modelIntervention trialsHypothesis testingInterventionStandard statistical methodsOutcomesTrialsConfidenceTheoryPower and Sample Size Calculations for Cluster Randomized Hybrid Type 2 Effectiveness‐Implementation Studies
Owen M, Curran G, Smith J, Tedla Y, Cheng C, Spiegelman D. Power and Sample Size Calculations for Cluster Randomized Hybrid Type 2 Effectiveness‐Implementation Studies. Statistics In Medicine 2025, 44: e70015. PMID: 39930740, DOI: 10.1002/sim.70015.Peer-Reviewed Original ResearchConceptsHybrid type 2 effectiveness-implementation studySample size calculationCluster randomized trialCluster randomized designSize calculationImplementation research outcomesReduce cardiovascular diseaseIssue of multiple testingEffective outcomesImplementation outcomesCommunity interventionsControl blood pressureBinary outcomesOutcomes approachLiterature searchMultiple testingCardiovascular diseaseInterventionRandomized trialsStandard statistical methodsBlood pressureOutcomesType 2 studies
2024
Estimation and inference for causal spillover effects in egocentric-network randomized trials in the presence of network membership misclassification
Chao A, Spiegelman D, Buchanan A, Forastiere L. Estimation and inference for causal spillover effects in egocentric-network randomized trials in the presence of network membership misclassification. Biostatistics 2024, 26: kxaf009. PMID: 40159413, PMCID: PMC11955068, DOI: 10.1093/biostatistics/kxaf009.Peer-Reviewed Original ResearchConceptsHIV Prevention Trials NetworkBehavioral changesImpact of interventionsPopulation behavior changePeer-based strategiesRandomized trialsIntervention effectsBehavioral interventionsStudy designSpillover effectsInterventionTrials NetworkInvestigate finite sample propertiesAverage spillover effectFinite sample propertiesBehavioral trainingParticipantsLeverage peer influenceMisclassificationDisseminate informationInterference settingOutcomesPeer influenceSurrogate networksSample propertiesSocio-economic factors associated with cancer stigma among apparently healthy women in two selected municipalities Nepal
Paneru B, Karmacharya A, Makaju S, Kafle D, Poudel L, Mali S, Timsina P, Shrestha N, Timalsena D, Chaudhary K, Bhandari N, Rai P, Shakya S, Spiegelman D, Sheth S, Stangl A, Eastment M, Shrestha A. Socio-economic factors associated with cancer stigma among apparently healthy women in two selected municipalities Nepal. PLOS ONE 2024, 19: e0301059. PMID: 39680514, PMCID: PMC11649127, DOI: 10.1371/journal.pone.0301059.Peer-Reviewed Original ResearchConceptsCancer Stigma ScaleCancer stigmaMean stigma scoreGeneralized Estimating EquationsStigma scoresDomains of stigmaPublic health researchSocio-demographic factorsCross-sectional studyStigma ScaleMultivariate linear regressionHealthy womenLower educationHealth researchMarital statusCause of deathStigmaLow overall prevalenceEstimating EquationsFemale populationLikert scalePrimary cause of deathOverall prevalenceOlder ageScoresBarriers to and facilitators of improving physical activity and nutrition behaviors during chemotherapy for breast cancer: a sequential mixed methods study
Puklin L, Irwin M, Sanft T, Ferrucci L, Harrigan M, McGowan C, Cartmel B, Zupa M, Winer E, Deyling M, Ligibel J, Basen-Engquist K, Spiegelman D, Sharifi M. Barriers to and facilitators of improving physical activity and nutrition behaviors during chemotherapy for breast cancer: a sequential mixed methods study. Supportive Care In Cancer 2024, 32: 590. PMID: 39141176, DOI: 10.1007/s00520-024-08789-5.Peer-Reviewed Original ResearchConceptsPhysical activityLifestyle interventionSelf-reported PA questionnaireSelf-reported diet qualityBreast cancerHealthy Eating Index-2015Stage I-III breast cancerBenefits of PASequential mixed methods studyI-III breast cancerChemotherapy-related symptomsMixed methods studyThematic content analysisBehavioral goalsSense of controlBody mass indexPA questionnaireSemi-structured interviewsMean body mass indexTranscribed verbatimIntervention armTailored educationDiet qualityNutritional behaviorMental benefitsDemonstrating service delivery models for effective initiation and retention on pre-exposure prophylaxis (PrEP) among female bar workers in Dar es Salaam, Tanzania: A double randomized intervention study protocol
Chebet J, Akyoo W, Goymann H, Harling G, Barnhart D, Mosha I, Kamori D, Gandhi M, Mbunda T, Kipeleka J, Sando D, Spiegelman D, Mpembeni R, Bärnighausen T. Demonstrating service delivery models for effective initiation and retention on pre-exposure prophylaxis (PrEP) among female bar workers in Dar es Salaam, Tanzania: A double randomized intervention study protocol. PLOS ONE 2024, 19: e0304077. PMID: 38935796, PMCID: PMC11210872, DOI: 10.1371/journal.pone.0304077.Peer-Reviewed Original ResearchConceptsFemale bar workersPre-exposure prophylaxisIntention-to-treatBar workersPrimary outcomeRisk of HIV infectionAdherence to PrEPRisk of HIV acquisitionImprove PrEP adherenceGerman Clinical Trials RegisterPublic sector clinicsService delivery modelsRandomized trial designHIV negative womenPrevent HIV InfectionHIV infectionPrEP provisionClinical Trials RegisterHIV testingPrEP initiationHealth facilitiesPromote PrEPPrEP adherenceDelivery modelsReduce barriersNavigating grey areas in HIV and mental health implementation science
Harkness A, Giusto A, Hamilton A, Hernandez‐Ramirez R, Spiegelman D, Weiner B, Beidas R, Larson M, Lippman S, Wainberg M, Smith J. Navigating grey areas in HIV and mental health implementation science. Journal Of The International AIDS Society 2024, 27: e26271. PMID: 38923301, PMCID: PMC11197965, DOI: 10.1002/jia2.26271.Peer-Reviewed Original ResearchConceptsImplementation scienceNational Institute of Mental HealthImplementation researchMental healthImplementation strategiesImpact of implementation strategiesHIV Epidemic goalsInstitute of Mental HealthUNAIDS targetsFederal fundersResearch workforceHIV transmissionEvidence-basedGlobal HIVUnited StatesHIVCapacity buildingRecipient's perspectiveNational InstituteHealthExpert guidanceInterventionHigh-impact scienceControl groupOvercome challengesEffects of a dietary intervention on cardiometabolic risk and food consumption in a workplace
Shrestha A, Tamrakar D, Ghinanju B, Shrestha D, Khadka P, Adhikari B, Shrestha J, Waiwa S, Pyakurel P, Bhandari N, Karmacharya B, Shrestha A, Shrestha R, Bhatta R, Malik V, Mattei J, Spiegelman D. Effects of a dietary intervention on cardiometabolic risk and food consumption in a workplace. PLOS ONE 2024, 19: e0301826. PMID: 38656951, PMCID: PMC11042715, DOI: 10.1371/journal.pone.0301826.Peer-Reviewed Original ResearchConceptsConsumption of whole grainsHealthy foodPre-post intervention studyWhole grainsMedian consumptionCardiovascular risk factor profileRisk factor profileBlood pressureWorksite settingWorksite interventionsUnhealthy foodsHealth programsMeasured blood pressurePre-hypertensionCardiometabolic riskDiastolic blood pressureIntervention studiesFactors dietPaired-t testFactor profileFasting glucose levelsDhulikhel HospitalHospital premisesEmployee healthHospital employeesCausal Selection of Covariates in Regression Calibration for Mismeasured Continuous Exposure
Tang W, Spiegelman D, Liao X, Wang M. Causal Selection of Covariates in Regression Calibration for Mismeasured Continuous Exposure. Epidemiology 2024, 35: 320-328. PMID: 38630507, PMCID: PMC12337126, DOI: 10.1097/ede.0000000000001706.Peer-Reviewed Original ResearchConceptsMismeasured exposureOutcome modelRegression calibrationMeasurement error modelSelection of covariatesNonparametric settingEffect modificationCovariate adjustmentFiber intakeMeasurement errorCardiovascular diseaseEffects of fiber intakeStudy datasetOutcomesCovariatesComprehensive guidanceError modelRegressionHealthEfficiency lossErrorRosnerWillettExposureAdjustment
2023
Reasons for using traditional and complementary care by people living with HIV on antiretroviral therapy and association with interrupted care: a mixed methods study in Eswatini
Molemans M, Reis R, Shabalala F, Dlamini N, Masilela N, Simelane N, Pell C, Chao A, Spiegelman D, Vernooij E, van Leth F. Reasons for using traditional and complementary care by people living with HIV on antiretroviral therapy and association with interrupted care: a mixed methods study in Eswatini. BMC Complementary Medicine And Therapies 2023, 23: 350. PMID: 37794359, PMCID: PMC10548651, DOI: 10.1186/s12906-023-04184-5.Peer-Reviewed Original ResearchConceptsInterrupted careAntiretroviral therapyType of illnessCurrent usersTCAM providersTCAM usersHIV diagnosisHIV continuumClinic recordsMultivariable analysisComplementary careVisit dateHealth facilitiesAlternative medicineTCAM useBiomedical careCareAdditional careMixed-methods studyHIVTherapyQualitative content analysisOpen-ended questionsMethods studyContextual factorsTrusted residents and housing assistance to decrease violence exposure in New Haven (TRUE HAVEN): a strengths-based and community-driven stepped-wedge intervention to reduce gun violence
Tong G, Spell V, Horton N, Thornhill T, Keene D, Montgomery C, Spiegelman D, Wang E, Roy B. Trusted residents and housing assistance to decrease violence exposure in New Haven (TRUE HAVEN): a strengths-based and community-driven stepped-wedge intervention to reduce gun violence. BMC Public Health 2023, 23: 1545. PMID: 37580653, PMCID: PMC10426138, DOI: 10.1186/s12889-023-15997-x.Peer-Reviewed Original ResearchConceptsGun violenceHousing assistanceStructural racismHousing stabilityViolence exposureMulti-level interventionsCommunity gun violenceMulti-stakeholder coalitionsRental assistance programsCommunity-based organizationsHousing supportPolicy changesFinancial educationStable housingBeing of individualsViolenceTarget neighborhoodsCommunity membersNew HavenNeighborhood ratesAssistance programsOrganization leadersRacismHavenNeighborhoodCorrecting for Bias Due to Mismeasured Exposure History in Longitudinal Studies with Continuous Outcomes
Cai J, Zhang N, Zhou X, Spiegelman D, Wang M. Correcting for Bias Due to Mismeasured Exposure History in Longitudinal Studies with Continuous Outcomes. Biometrics 2023, 79: 3739-3751. PMID: 37222518, PMCID: PMC11214728, DOI: 10.1111/biom.13877.Peer-Reviewed Original ResearchAssociation between cancer stigma and cervical cancer screening uptake among women of Dhulikhel and Banepa, Nepal
Paneru B, Karmacharya A, Bharati A, Makaju S, Adhikari B, Kafle D, Shakya S, Spiegelman D, Seth S, Stangl A, Shrestha A, Shrestha A. Association between cancer stigma and cervical cancer screening uptake among women of Dhulikhel and Banepa, Nepal. PLOS ONE 2023, 18: e0285771. PMID: 37200234, PMCID: PMC10194964, DOI: 10.1371/journal.pone.0285771.Peer-Reviewed Original ResearchConceptsCervical cancer screening uptakeCancer screening uptakeScreening uptakeMultivariable logistic regressionCancer Stigma ScaleCancer stigmaCervical cancerAge of menarcheFirst sexual intercourseLogistic regressionNepalese womenSexual intercourseReproductive health variablesCervical cancer screeningEffective screening programsSemi-urban areasCross-sectional studyPercent of womenMean total scoreFamily planning usersScreening servicesCancer screeningCommon cancerDisease burdenScreening program
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