Kelly Palmer

Interests

Research

Health Promotion; Community-Engaged Research; Settings-Based Interventions; Chronic Disease Prevention; Health Equity; Qualitative Research Methods; Mixed Methods; Implementation Science

Courses

Scholarly Contributions

Journals/Publications

• Palmer, K., Crocker, R. M., Marrero, D. G., & Tan, T. (2023).

  A vicious cycle: employment challenges associated with diabetes foot ulcers in an economically marginalized Southwest US sample

  . Frontiers in Clinical Diabetes and Healthcare. doi:10.3389/fcdhc.2023.1027578
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  To describe patients' reported employment challenges associated with diabetic foot ulcers (DFUs).Fifteen patients from under-resourced communities in Southern Arizona, with a history of DFUs and/or amputations, were recruited from a tertiary referral center from June 2020 to February 2021. Participants consented to an audio-recorded semi-structured phone interview. Interviews were transcribed and thematically analyzed using the Dedoose data analysis platform.Participants shared a common theme around the cyclic challenges of DFU prevention/management and employment. Those employed in manual labor-intensive jobs or jobs requiring them to be on their feet for long durations of time believed working conditions contributed to the development of their DFUs. Patients reported work incapacity due to declines in mobility and the need to offload for DFU management. Many expressed frustration and emotional distress related to these challenges noting that DFUs resulted in lower remuneration as medical expenses increased. Consequently, loss of income and/or medical insurance often hindered participants' ability to manage DFUs and subsequent complications.These data illuminate the vicious cycle of DFU and employment challenges that must be addressed through patient-centered prevention strategies. Healthcare providers should consider a person's contextual factors such as employment type to tailor treatment approaches. Employers should establish inclusive policies that support patients with DFUs returning to work through flexible working hours and adapted work tasks as needed. Policymakers can also mitigate employment challenges by implementing social programs that provide resources for employees who are unable to return to work in their former capacity.
• Rivers, P., Palmer, K. N., Okechukwu, A., McClelland, D. J., Garcia, D. O., Sun, X., Pogreba-Brown, K., Carvajal, S. C., & Marrero, D. G. (2023).

  Immigration Status and Chronic Disease Outcomes – a Scoping Review

  . Europe PMC. doi:10.21203/rs.3.rs-3143647/v1
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  Abstract Background Undocumented immigrants face significant barriers to accessing regular medical care in the U.S. This is a concern especially for individuals with chronic conditions. This scoping review provides an overview of the current knowledge on chronic health outcomes for undocumented immigrants compared to documented immigrants or US-born citizens. Methods The review process was conducted in accordance with the PRISMA-ScR guidelines, and the selection of studies was based on pre-defined criteria. Results Nine articles were included. Key information such as population details, and study details, outcomes, and limitations are presented. There was conflicting evidence as to whether undocumented immigrants have poorer health outcomes, with undocumented immigrants faring better on nine (43%) measures, faring worse on nine (43%), and with no difference found on three (14%) measures when compared to documented immigrants or US-born citizens. Conclusion Undocumented individuals face significant barriers to accessing the same level of health care for their chronic conditions, but it is unclear if this translates to poorer health outcomes. Future, rigorous studies are recommended to address this gap and better understand the health of this vulnerable population.
• Garcia, D. O., Thomson, C. A., Marrero, D. G., Hatcher, J., Kram, N. A., Palmer, K. N., Okechukwu, A., Mantina, N. M., & Melton, F. L. (2022). Hair Stylists as Lay Health Workers: Perspectives of Black Women on Salon-Based Health Promotion. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 59, 004695802210931. doi:10.1177/00469580221093183
• Marrero, D. G., Armstrong, D. G., Palmer, K. N., Crocker, R. M., Tan, T., & Gomez, C. (2022). A Qualitative Study of Barriers to Care-Seeking for Diabetic Foot Ulceration Across Multiple Levels of the Healthcare System. Journal of Foot and Ankle Research. doi:10.21203/rs.3.rs-1689888/v1
• Marrero, D. G., Palmer, K. N., Crocker, R. M., & Tan, T. (2022). The patient's perspective of diabetic foot ulceration: A phenomenological exploration of causes, detection and care seeking. Journal of Advanced Nursing, 78(8), 2482-2494. doi:10.1111/jan.15192
• Melton, F., Palmer, K., Solola, S., Luy, L., Herrera-Theut, K., Zabala, L., Knapp, S. M., Yee, R., Yee, E., & Calhoun, E. (2022). Race and Gender-Based Perceptions of Older Septuagenarian Adults. Women's Health Reports, 3(1), 944-956.
• Palmer, K., Okechukwu, A., Mantina, N. M., Melton, F., Kram, D. N., Hatcher, J., Marrero, D. G., Thomson, C. A., & Garcia, D. O. (2022).

  Stylists' and Clients’ perspectives of the black salon-a qualitative study guided by the settings approach theory

  . SSM - Qualitative Research in Health. doi:10.1016/j.ssmqr.2021.100029
• Smalls, B. L., Adegboyega, A., Palmer, K. N., & Hatcher, J. (2022). Evaluating Social Support and T2D Risk Factors Among Members of Rural-Dwelling Grandparent-Headed Households. Journal of Appalachian Health, 4(2).
• Tan, T., Crocker, R. M., Palmer, K., Gomez, C., Armstrong, D. G., & Marrero, D. G. (2022).

  A qualitative study of barriers to care-seeking for diabetic foot ulceration across multiple levels of the healthcare system

  . Journal of Foot and Ankle Research. doi:10.1186/s13047-022-00561-4
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  Abstract Introduction The mechanisms for the observed disparities in diabetes-related amputation are poorly understood and could be related to access for diabetic foot ulceration (DFU) care. This qualitative study aimed to understand patients’ personal experiences navigating the healthcare system and the barriers they faced. Methods Fifteen semi-structured interviews were conducted over the phone between June 2020 to February 2021. Participants with DFUs were recruited from a tertiary referral center in Southern Arizona. The interviews were audio-recorded and analyzed according to the NIMHD Research Framework, focusing on the health care system domain. Results Among the 15 participants included in the study, the mean age was 52.4 years (66.7% male), 66.7% was from minority racial groups, and 73.3% was Medicaid or Indian Health Service beneficiaries. Participants frequently reported barriers at various levels of the healthcare system. On the individual level, themes that arose included health literacy and inadequate insurance coverage resulting in financial strain. On the interpersonal level, participants complained of fragmented relationships with providers and experienced challenges in making follow-up appointments. On the community level, participants reported struggles with medical equipment. On the societal level, participants also noted insufficient preventative foot care and education before DFU onset, and many respondents experienced initial misdiagnoses and delays in receiving care. Conclusions Patients with DFUs face significant barriers in accessing medical care at many levels in the healthcare system and beyond. These data highlight opportunities to address the effects of diabetic foot complications and the inequitable burden of inadequately managed diabetic foot care.
• Crocker, R. M., Palmer, K., Marrero, D. G., & Tan, T. (2021).

  Patient perspectives on the physical, psycho-social, and financial impacts of diabetic foot ulceration and amputation

  . Journal of Diabetes and its Complications. doi:10.1016/j.jdiacomp.2021.107960
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  Diabetic foot ulcers (DFUs) and ulceration are complex and lifelong problems for patients with diabetes which dramatically increase mortality rates. This qualitative study sought to capture detailed personal accounts and insights from patients with a clinical history of DFUs and amputations to better understand patient experiences.Fifteen patients from a tertiary referral center that treats diabetic foot problems were approached for participation. Inclusion criteria included having at least one DFU and being of white, Native American, or Hispanic background. Interviews were conducted by telephone by study staff trained in qualitative data gathering and audio recorded.The main themes that emerged around impacts included the heavy burden of managing care, significant loss of ambulatory function, economic stress due to medical care costs and job loss, and emotional suffering tied to these stressors.These data illuminate common social and personal impacts of diabetic foot problems across an ethnically and racially diverse and predominantly low-income US sample that expand our understanding of related declines in well-being. Our results indicate a need for proactive mental health assessment post DFUs diagnosis and the diversification of hospital and community-based support systems.
• Kram, N., Yesufu, V., Lott, B. E., Palmer, K., Balogun, M., & Ehiri, J. E. (2021).

  ‘Making the most of our situation’: a qualitative study reporting health providers’ perspectives on the challenges of implementing the prevention of mother-to-child transmission of HIV services in Lagos, Nigeria

  . BMJ Open. doi:10.1136/bmjopen-2020-046263
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  Objectives To investigate the challenges of, and opportunities for, effective delivery of prevention of mother-to-child transmission (PMTCT) services from the perspectives of primary healthcare providers in Lagos, Nigeria. Design This qualitative study consisted of nine focus groups with 59 health providers, analysed thematically. Setting Thirty-eight primary health facilities in central and western districts of Lagos, Nigeria. Participants Participants included nurses, nursing assistants, community health workers, laboratory workers, pharmacists, pharmacy technicians, monitoring and evaluation staff and medical records personnel. Results Health providers’ challenges included frustration with the healthcare system where unmet training needs, lack of basic amenities for effective and safe treatment practices, low wages and inefficient workflow were discussed. Providers discussed patient-level challenges, which included the practice of giving fake contact information for fear of HIV-related stigmatisation, and refusal to accept HIV-positive results and to enrol in care. Providers’ suggestions for addressing PMTCT service delivery challenges included the provision of adequate supplies and training of healthcare workers. To mitigate stigmatisation, participants suggested home-based care, working with traditional birth attendants and religious institutions and designating a HIV health educator for each neighbourhood. Conclusions Findings illustrate the complex nature of PMTCT service delivery and illuminate issues at the patient and health system levels. These results may be used to inform strategies for addressing identified barriers and to improve the provision of PMTCT services, thus ensuring better outcomes for women and families.
• Marrero, D. G., Blew, R. M., Palmer, K., James, K., Roe, D. J., & Hingle, M. (2021).

  Rationale and design of a type 2 diabetes prevention intervention for at-risk mothers and children at a Federally Qualified Healthcare Center: EPIC El Rio Families Study Protocol

  . BMC Public Health. doi:10.1186/s12889-021-10392-w
• Marrero, D., Roe, D. J., Palmer, K. N., Hingle, M., Blew, R., James, K., Mockbee, J., Saboda, K., Shaibi, G. Q., & Whitlatch, S. (2021). Feasibility and Acceptability of a Type 2 Diabetes Prevention Intervention for Mothers and Children at a Federally Qualified Healthcare Center. Journal of Primary Care and Community Health, 12, 215013272110576. doi:10.1177/21501327211057643
• Palmer, K., Rivers, P., Melton, F., McClelland, D. J., Hatcher, J., Marrero, D. G., Thomson, C. A., & Garcia, D. O. (2021).

  Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review

  . BMC Public Health. doi:10.1186/s12889-021-11584-0
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  African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical.A PRISMA-guided systematic review was conducted to identify and critically evaluate health promotion interventions for African Americans delivered in barbershops and hair salons. Subject headings and keywords used to search for synonyms of 'barbershops,' 'hair salons,' and 'African Americans' identified all relevant articles (from inception onwards) from six databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index). Experimental and quasi-experimental studies for adult (> 18 years) African Americans delivered in barbershops and hair salons that evaluated interventions focused on risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer, and type 2 diabetes were included. Analyses were conducted in 2020.Fourteen studies met criteria for inclusion. Ten studies hosted interventions in a barbershop setting while four took place in hair salons. There was substantial variability among interventions and outcomes with cancer the most commonly studied disease state (n = 7; 50%), followed by hypertension (n = 5; 35.7%). Most reported outcomes were focused on behavior change (n = 10) with only four studies reporting clinical outcomes.Health promotion interventions delivered in barbershops/hair salons show promise for meeting cancer screening recommendations and managing hypertension in African Americans. More studies are needed that focus on diabetes and obesity and utilize the hair salon as a site for intervention delivery.PROSPERO CRD42020159050 .
• Adegboyega, A., Aleshire, M. E., Wiggins, A., Palmer, K., & Hatcher, J. (2020).

  A Motivational Interviewing Intervention to Promote CRC Screening

  . Cancer Nursing. doi:10.1097/ncc.0000000000000905
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  Appalachian Kentuckians suffer a disproportionate incidence and mortality from colorectal cancer (CRC) and are screened at lower rates (35%) compared with 47% of Kentuckians.The aim of this study was to evaluate the efficacy of a motivational interviewing intervention delivered by trained Lay Health Advisors on CRC screening.Eligible participants recruited from an emergency department (ED) completed a baseline survey and were randomized to either the control or the motivational interviewing intervention provided by Lay Health Advisors. Follow-up surveys were administered 3 and 6 months after baseline. To evaluate potential differences in treatment and control groups, t tests, χ2, and Mann-Whitney U tests were used.At either the 3- or 6-month assessment, there was no difference in the CRC screening by group (χ2 = 0.13, P = .72). There was a significant main effect for the study group in the susceptibility to CRC model; regardless of time, those in the intervention group reported approximately 1-point higher perceived susceptibility to CRC, compared with controls (est. b = 0.68, P = .038). Age and financial adequacy had a significant effect related to CRC screening. Older participants (est. b = 0.09, P = .014) and those who reported financial inadequacy (est. b = 2.34, P = .002) reported more screening barriers.This pilot study elucidated important factors influencing the uptake of CRC for an ED transient population and this may be useful in the design of future interventions using motivational interviewing in EDs.Nurses can provide information about CRC screening guidelines and provide referrals to appropriate screening resources in the community.
• Adegboyega, A., Contreras, O. E., Hatcher, J., Palmer, K. N., & Smalls, B. L. (2020).

  Assessing Diabetes Risk Factors in Rural Dwelling Grandparent Caregivers

  . Gerontology and Geriatric Medicine. doi:10.1177/2333721420924986
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  Objective: The purpose of this study is to assess type 2 diabetes mellitus (T2DM) risk factors in grandparent caregivers living in a rural environment. Methods: Clinical measures (hemoglobin A1c [HbA1c], blood pressure, and lipids) and self-reported data on social environment factors were attained. Data were analyzed via Pearson’s correlation and regression models. Results: By clinical definition of diabetes (HbA1c ≥ 6.5%), 21% were prediabetic and 28% had undiagnosed T2DM. There was an association between the number of individuals in the home and triglycerides ( r = −.25), high-density lipoproteins (HDL; r = .43), and body mass index (BMI; r = .39). Guardianship status had a significant association with BMI ( r = −.38). There was a significant association between low-density lipoprotein (LDL; r = −.32) and access to community shared resources. In the adjusted linear model, the number of grandchildren in the home had a significant relationship with HDL (β = .012, p = .021) whereas the number of individuals living in the home had a statistically significant relationship with HDL (β = .026, p < .000) and BMI (β = .046, p = .02). In addition, 15% of participants reported being food insecure. Discussion: Efforts are needed to identify and screen at-risk populations living in geographically isolated areas. Considerations should be given to leveraging existing community resources for grandparent caregivers via schools, health systems, and government agencies to optimize health and well-being.
• Palmer, K., Barry, V. E., Marrero, D. G., McKinney, B. M., Graves, A. N., Winters, C. K., & Hannon, T. S. (2020).

  Intervention Delivery Matters: What Mothers at High Risk for Type 2 Diabetes Want in a Diabetes Prevention Program—Results from a Comparative Effectiveness Trial

  . Diabetes Therapy. doi:10.1007/s13300-020-00891-1
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  Participants in the ENCOURAGE Healthy Families Study, a family-focused, modified Diabetes Prevention Program, reported challenges to and preferences for engaging in a diabetes prevention program. Challenges with flexible intervention delivery, accessibility, the traditional group-based format, and Coronavirus Disease 2019 (COVID-19) exposure risk can be mitigated by participant preferences for one-on-one, virtual/online intervention delivery.Trial Registration: ClinicalTrials.gov identifier, NCT01823367.
• Palmer, K., Rivers, P., Melton, F., McClelland, J., Hatcher, J., Marrero, D. G., Thomson, C. A., & Garcia, D. O. (2020).

  Protocol for a systematic review of health promotion interventions for African Americans delivered in US barbershops and hair salons

  . BMJ Open. doi:10.1136/bmjopen-2019-035940
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  Introduction African American adults are disproportionately burdened by chronic diseases, particularly at younger ages. Developing culturally appropriate interventions is paramount to closing the gap in these health inequities. The purpose of this systematic review is to critically evaluate health promotion interventions for African Americans delivered in two environments that are frequented by this population: barbershops and hair salons. Characteristics of effective interventions will be identified and evidence for the effectiveness of these interventions will be provided. Results of this review will inform future health promotion efforts for African Americans particularly focused on the leading health inequities in obesity-related chronic diseases: cardiovascular disease, cancer and type 2 diabetes. Methods and analysis Subject headings and keywords will be used to search for synonyms of ‘barbershops,’ ‘hair salons’ and ‘African Americans’ to identify all relevant articles (from inception onwards) in the following databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature, Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index) and ProQuest Dissertations. Experimental and quasi-experimental studies for adult ( > 18 years) African Americans delivered in barbershops and hair salons will be included. Eligible interventions will include risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer and type 2 diabetes. Two reviewers will independently screen, select and extract data and a third will mediate disagreements. The methodological quality (or risk of bias) of individual studies will be appraised using the Effective Public Health Practice Project Quality Assessment Tool. Quality and content of the evidence will be narratively synthesised. Ethics and dissemination Since this is a protocol for a systematic review, ethical approval is not required. Findings from the review will be widely disseminated through conference presentations, peer-reviewed publications and traditional and social media outlets.
• Marrero, D. G., Palmer, K. N., Hannon, T. S., Saha, C. K., Carroll, A. E., & O'Kelly Phillips, E. (2018). The ENCOURAGE healthy families study: A comparative effectiveness trial to reduce risk for type 2 diabetes in mothers and children. Pediatric Diabetes, 19(6), 1041-1049. doi:10.1111/pedi.12692
• Palmer, K., Saha, C., Phillips, E. O., Krishnan, A., Foster, G. D., Finkelstein, E. A., Wojtanowski, A. C., & Marrero, D. G. (2018).

  The Two-Year Outcomes and Cost Effectiveness of a Commercial Weight Loss Program for the Prevention of Type 2 Diabetes among People with Prediabetes

  . Rivera Open. doi:10.31532/endocrinoldiabetesobes.1.1.005
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  Objectives. There is solid evidence that risk for developing type 2 diabetes can be prevented by lifestyle interventions. However, there are few diabetes prevention programs available. Given the increasing prevalence of prediabetes, we sought to investigate if a commercial weight loss program with significant capacity could address this need. This study, conducted in Indianapolis, Indiana in 2014–16, investigated if (Weight Watchers- WW) could cost effectively achieve and sustain sufficient weight loss in persons with prediabetes to reduce diabetes risk for 24 months.
• Palmer, K., Saha, C., Phillips, E. O., Krishnan, A., Foster, G. D., Finkelstein, E. A., Wojtanowski, A. C., & Marrero, D. G. (2018). The Two-Year Outcomes and Cost Effectiveness of a Commercial Weight Loss Program for the Prevention of Type 2 Diabetes among People with Prediabetes. Endocrinology, Diabetes and Obesity. doi:10.31532/endocrinoldiabetesobes.1.1.005
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  Objectives: There is solid evidence that risk for developing type 2 diabetes can be prevented by lifestyle interventions.However, there are few diabetes prevention programs available.Given the increasing prevalence of prediabetes, we sought to investigate if a commercial weight loss program with significant capacity could address this need.This study, conducted in Indianapolis, Indiana in 2014-16, investigated if (Weight Watchers-WW) could cost effectively achieve and sustain sufficient weight loss in persons with prediabetes to reduce diabetes risk for 24 months.Methods: A previous, randomized controlled trial evaluated the effectiveness of the WW program in 225 persons with prediabetes as determined by an HbA1c value ≥5.7% and ≤6.4% or a self-reported history of gestational diabetes with an HbA1c
• Marrero, D. G., Palmer, K., Phillips, E. O., Miller‐Kovach, K., Foster, G. D., & Saha, C. (2016).

  Comparison of Commercial and Self-Initiated Weight Loss Programs in People With Prediabetes: A Randomized Control Trial

  . American Journal of Public Health. doi:10.2105/ajph.2015.303035
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  Objectives. To determine if a widely available weight-management program (Weight Watchers) could achieve sufficient weight loss in persons with prediabetes compared with a Diabetes Prevention Program–based individual counseling program supported by National Diabetes Education Program materials. Methods. We conducted an individual, randomized intervention trial in Indianapolis, Indiana, in 2013 to 2014, in 225 persons with prediabetes. We compared the Weight Watchers weight-management program (n = 112) with Your Game Plan to Prevent Type 2 Diabetes, a program developed by the National Diabetes Education Program. Outcomes were weight and metabolic markers measured at baseline, 6 months, and 12 months. Results. Intervention participants lost significantly more weight than controls at 6 months (5.5% vs 0.8%) and 12 months (5.5% vs 0.2%; both P < .001). The intervention group also had significantly greater improvements in hemoglobin A1c and high-density lipoprotein cholesterol level than did controls. Conclusions. A large weight-management program is effective for achieving lifestyle changes associated with diabetes prevention. Such programs could significantly increase the availability of diabetes prevention programs worldwide making an immediate and significant public health impact.
• Hannon, T. S., Carroll, A. E., Palmer, K., Saha, C., Childers, W. K., & Marrero, D. G. (2015).

  Rationale and design of a comparative effectiveness trial to prevent type 2 diabetes in mothers and children: The ENCOURAGE healthy families study

  . Contemporary Clinical Trials. doi:10.1016/j.cct.2014.11.016
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  The number of youth with type 2 diabetes (T2D) is expected to quadruple over 4 decades. Gestational diabetes mellitus (GDM) is also increasing and is linked with development of T2D in women, and greater risk for T2D in adolescents exposed to GDM. Despite the increasing prevalence of T2D, approaches to prevent diabetes in high-risk youth and families are rare. To address this, we are conducting the Encourage Health Families Study (ENCOURAGE). This is a randomized trial evaluating the comparative effectiveness and costs of an adaptation of the Diabetes Prevention Program (DPP) directed at mothers who had GDM or prediabetes and their children. The intervention is a group-based lifestyle program which we developed and implemented in partnership with the YMCA. We are comparing the ENCOURAGE intervention targeted to 1) mothers who have had GDM or prediabetes, and 2) mothers who have had GDM or prediabetes along with their school-aged children. This manuscript provides 1) the rationale for a targeted approach to preventing T2D and the interventions, 2) description of the translation of the DPP curriculum, and 3) the study design and methodology. The primary aims are to determine if participation leads to 1) weight loss in high-risk mothers, and 2) youth having healthier weights and lifestyle habits. We will also evaluate costs associated with each approach. These data are essential to build a translation model of T2D prevention that is both realistic and feasible to address this growing problem in both youth and adults.

Proceedings Publications

• Smalls, B. L., Palmer, K., Contreras, O. A., & Hatcher, J. (2020).

  1595-P: Evaluating Social Support and T2D Risk Factors among Members of Rural-Dwelling Grandparent-Headed Households

  . In American Diabetes Association Scientific Sessions.
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  Objective: The purpose of this paper is to elucidate factors impacting the health, development and management of chronic illnesses, particularly type 2 diabetes of rural grandparent-headed households (GHH). Research Design and Methods: Prospective data were collected from rural-dwelling members of GHHs living in Appalachia Kentucky with no known diagnosis of T2D. Data collected on family characteristics, T2D clinical risk factors, and social support were assessed using the Medical Outcomes Survey (MOS) Social Support and the Child and Adolescent Social Support Scale (CASSS). Results: Sixty-six grandparents and 72 grandchildren participated in the study. The average age and HbA1Cs were 59.4 years and 6.2% ± 1.4 for grandparents and 11.8 years and 4.9% ± 0.6 for grandchildren. The majority of grandparents were found to have prediabetes (31%) or undiagnosed diabetes (28%). The number of people living in GHHs were associated with grandparents’ triglycerides, HDL, and BMI whereas custody status was associated with BMI. Average social support scores among grandparents suggested moderately high perceived social support (79 ± 3.4). For grandchildren, social support provided by grandparents had no association with T2D risk factors, whereas support from teachers, classmates, and close friends was associated with HbA1C, BMI, and blood pressure in grandchildren. Conclusion: This study shows that rural-dwelling grandparent caregivers are at an increased risk for T2D. In addition, increased responsibility may provide a determinant of health due to the potential stress of caregiving for grandchildren. Social support between grandparents and grandchildren has no effect on T2D risk factors. However, social support provided by peers, teachers, and close friends were associated with T2D risk factors in grandchildren. These findings support the use of peer support and school settings as mechanisms for interventions to reduce T2D in adolescents, particularly those of GHHs. Disclosure B.L. Smalls: None. K.N. Palmer: None. O.A. Contreras: None. J. Hatcher: None. Funding National Institute for Diabetes and Digestive and Kidney Diseases (R03DK101705 to J.H.)
• Wilson, S., Palmer, K., Marrero, D. G., McKinney, B. M., & Stupiansky, N. W. (2018).

  Type-1 Diabetes Management and Alcohol Use: A Qualitative Analysis of Lived Experiences and Strategies of College Students

  . In Society for Adolescent Health and Medicine.
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  Purpose: Type-1 diabetics transitioning from high school to college often struggle to maintain control of their diabetes. Many factors contribute to poor glycemic control. Without parental influence and a controlled home environment, blood glucose levels become less optimal, leading to a rocky transition. The main goal of this study was to identify barriers and facilitators to managing type-1 diabetes (T1D) in college, and to explore strategies employed during the transition from home to college. Researchers were particularly interested in how type-1 diabetics managed glycemic control while engaging in potentially risky behaviors such as alcohol use.
• Wessel, J., O'Kelly-Phillips, E., Palmer, K., Saha, C., Hannon, T. S., Carroll, A. E., & Marrero, D. G. (2015).

  Abstract P121: Comparative Effectiveness Study of the Diabetes Prevention Program in Families: Preliminary Results

  . In American Heart Association.
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  The prevalence of gestational diabetes (GDM) is increasing substantially and currently affects up to 14% of pregnancies. As many as 70% of women with GDM will develop type 2 diabetes (T2D) in the next 10 years. Moreover as many as 40% of children exposed to in-utero diabetes will develop obesity and T2D. The Diabetes Prevention Program (DPP) is an evidence-based lifestyle intervention that has been shown to lower T2D risk by 58% in high-risk adults. Family based lifestyle interventions that target either children, parents or both have reported mixed results. We modified the DPP curriculum to use with families (DPPF) and recruited mothers with a history of GDM and their children 8-15 years old. We randomized n=130 families to test which method of delivering the DPPF (mothers only (M) or mothers and their children (M+C)) is more effective at lowering families T2D risk. Baseline characteristics of women were similar among each intervention group (n=65 M and n=65 M+C, respectively): age (38±8 vs 39±11, P=0.5), ethnicity (Black 55% vs 55%, White 20% vs 17%, Latino 20% vs 27%, other 5% vs 2%, P=0.6), body mass index (BMI, 37±8 vs 38±7, P=0.24), systolic blood pressure (SBP, 121±11 vs 122±13, P=0.8), diastolic blood pressure (DBP, 103±26 vs 105±21, P=0.6), HbA1c (5.6±0.4 vs 5.7±0.3, p=0.2). The majority of women self-reported low levels of physical activity (PA): moderate PA (2 days or less per week, 42% vs 26%, P=0.06) or vigorous PA (2 days or less per week, 38% vs 25%, P=0.1), and high levels of sedentary activities (3 or more hours per day, 49% vs 58%, P=0.2). For diet related obesogenic behaviors women self-reported high levels of eating meals while watching TV (3 days or more per week, 58% vs 74%, P=.06) and eating at restaurants (3 days or more per week, 28% vs 41%, P=0.1). Follow-up is ongoing and currently n=32 families have completed the 3-month follow-up. Preliminary analyses of mothers show decreases in HbA1c (-.01±.3 vs -.1±.2), SBP (-9.7±30 vs -3.1±8), DBP (-8±19 vs -1±9) but not BMI (0.07±1.6 vs 0.04±1.2); however results were not significantly different by intervention group.
• Khan, A. K., Palmer, K., & Marrero, D. G. (2014).

  Analytical Comparison of the Effectiveness of the Diabetes Prevention Program and Weight Watchers as media to prevent Type II Diabetes via Weight Loss in Different Age Categories

  . In Indiana University Annual Research Symposium.