Heather Kitzman Ph.D.

Law, L. H., D. K. Wilson, S. M. St George, H. Kitzman and C. J. Kipp (2019). “Families Improving Together (FIT) for weight loss: a resource for translation of a positive climate-based intervention into community settings.” Transl Behav Med. Jun 5. [Epub ahead of print].

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Climate-based weight loss interventions, or those that foster a nurturing family environment, address important ecological influences typically ignored by the traditional biomedical treatments. Promoting a climate characterized by positive communication, autonomy support, and parental warmth supports adolescents in making healthy behavioral changes. In addition, encouraging these skills within the family may have additional benefits of improved family functioning and other mental and physical health outcomes. Although several programs have identified essential elements and established the evidence base for the efficacy of these interventions, few have offered resources for the translation of these constructs from theoretical concepts to tangible practice. This paper provides strategies and resources utilized in the Families Improving Together (FIT) for weight loss randomized controlled trial to create a warm, supportive climate characterized by positive communication within the parent-child relationship. Detailed descriptions of how Project FIT emphasized these constructs through facilitator training, intervention curriculum, and process evaluation are provided as a resource for clinical and community interventions. Researchers are encouraged to provide resources to promote translation of evidence-based interventions for programs aiming to utilize a positive climate-based family approach for lifestyle modification.

Tan, M., A. Mamun, H. Kitzman and L. Dodgen (2019). “Longitudinal Changes in Allostatic Load during a Randomized Church-based, Lifestyle Intervention in African American Women.” Ethn Dis 29(2): 297-308.

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Introduction: African American (AA) women have disproportionately higher risk of cardiovascular disease than White women, which may be explained by the uniquely higher allostatic load (AL) found in AA women. No studies have tested the effect of lifestyle interventions on AL in AA women. Our objectives were to assess the change in allostatic load following a lifestyle intervention and explore the roles of lifestyle behaviors and socioeconomic factors on allostatic load change. Methods: Participants were non-diabetic (mean age and SD: 48.8+/-11.2 y) AA women (n=221) enrolled in a church-based, cluster randomized trial testing a standard diabetes prevention program (DPP) and a faith-enhanced DPP with 4-months of follow-up. We assessed the relationships of changes in diet, physical activity, neighborhood disadvantage, individual socioeconomic factors, and other lifestyle variables to changes in AL at 4-months using a multilevel multinomial logistic regression model. Results: Average AL decreased (-.13+/-.99, P=.02) from baseline to 4-months. After adjusting for other variables, a high school education or less (OR:.1, CI:.02-.49) and alcohol use (OR: .31, CI: .09-.99) contributed to increased AL. Living in a disadvantaged neighborhood was responsible for increased AL, though it was not statistically significant. There were no statistically significant associations between AL and other health behavior changes. Conclusions: Lower education levels may dampen the benefits of lifestyle interventions in reducing AL. Although a significant reduction in AL was found after participation in a lifestyle intervention, more research is needed to determine how lifestyle behaviors and socioeconomic factors influence AL in AA women.

Wesson, D. and H. Kitzman (2018). “In Reply to Palmer et al.” Acad Med 93(9): 1264.

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We thank Palmer and colleagues for their comments regarding our article. They describe important and more traditional components of community-engaged work that we greatly support. Our work, however, transcends the traditional community-engaged strategies employed in community–academic partnerships that focus primarily on engagement with individuals in communities. This more traditional approach includes collaborative learning, health screening, lay health promoters, and education for both entities as described by Palmer and colleagues. Often, these strategies are voluntary in nature and not integrated into the daily operations of the health care system. Our approach aims to achieve this integration first by being grounded in engagement with community-based entities (in our case, churches, Dallas Park and Recreation) and second, by becoming institutionalized as a standard practice within the health care system. Specifically, our approach employs the concept of equal partnerships described in community based participatory research methods as essential to building trust and identifying trusted agents. We propose that involving the leadership of community entities, not just individuals independent of these important community institutions, as equal partners in the development of innovations improves efficacy and dissemination. Our Invited Commentary describes numerous ways to operationalize and institutionalize community entities within the health care system that we feel should be taught in medical education programs to promote use in the health care system. We commend Palmer and colleagues for their important community engaged work while emphasizing that our approaches extend beyond traditional methods of community engagement in academic medicine. (Text of reply to Palmer et al. concerning authors’ article, Wesson DE, Kitzman HE. How academic health systems can achieve population health in vulnerable populations through value-based care: The critical importance of establishing trusted agency. Acad Med. 2018; 93: 839–842.)

Wesson, D. E. and H. E. Kitzman (2018). “How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency.” Acad Med 93(6): 839-842.

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Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served and are willing to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.

Wesson, D., H. Kitzman, K. H. Halloran and K. Tecson (2018). “Innovative Population Health Model Associated With Reduced Emergency Department Use And Inpatient Hospitalizations.” Health Aff (Millwood) 37(4): 543-550.

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Population health strategies that improve access to health care and address social determinants of health may reduce the use of costly emergency services. Here we describe a strategy adopted by Baylor Scott & White Health to reduce rising rates of emergency department use and inpatient hospitalizations in an underserved Dallas community that is home to many people with low socioeconomic status. Baylor Scott & White partnered with the Dallas Park and Recreation Department to create a level-three primary care clinic integrating wellness and prevention programs in a city recreational center. The clinic, known as the Baylor Scott & White Health and Wellness Center, exemplifies the integration of social determinants of health within a population health strategy. Emergency department (ED) and inpatient care use was examined over twelve months after initiation of services at the center. People who used the center’s services showed a reduction in ED use of 21.4 percent and a reduction in inpatient care use of 36.7 percent, with an average cost decrease of 34.5 percent and 54.4 percent, respectively. These data support the use of population health strategies to reduce the use of emergency services.