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Maas VYF, Poels M, Ista E, Menge LF, Vanden Auweele KLHE, de Bie RWA, de Smit DJ, van Vliet-Lachotzki EH, Franx A, Koster MPH. The effect of a locally tailored intervention on the uptake of preconception care in the Netherlands: a stepped-wedge cluster randomized trial (APROPOS-II study). BMC Public Health 2022; 22:1997. [PMID: 36319990 PMCID: PMC9623982 DOI: 10.1186/s12889-022-14343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The preconception period provides a window of opportunity for interventions aiming to reduce unhealthy lifestyle behaviours and their negative effect on pregnancy outcomes. This study aimed to assess the effectiveness of a locally tailored preconception care (PCC) intervention in a hybrid-II effectiveness implementation design. METHODS A stepped-wedge cluster randomized controlled trial was performed in four Dutch municipalities. The intervention contained a social marketing strategy aiming to improve the uptake (prospective parents) and the provision (healthcare providers) of PCC. Prospective parents participated by administering a questionnaire in early pregnancy recalling their preconceptional behaviours. Experiences of healthcare providers were also evaluated through questionnaires. The composite primary outcome was adherence to at least three out of four preconceptional lifestyle recommendations (early initiation of folic acid supplements, healthy nutrition, no smoking or alcohol use). Secondary outcomes were preconceptional lifestyle behaviour change, (online) reach of the intervention and improved knowledge among healthcare providers. RESULTS A total of 850 women and 154 men participated in the control phase and 213 women and 39 men in the intervention phase. The composite primary outcome significantly improved among women participating in the municipality where the reach of the intervention was highest (Relative Risk (RR) 1.57 (95% Confidence Interval (CI) 1.11-2.22). Among women, vegetable intake had significantly improved in the intervention phase (RR 1.82 (95%CI 1.14-2.91)). The aimed online reach- and engagement rate of the intervention was achieved most of the time. Also, after the intervention, more healthcare providers were aware of PCC-risk factors (54.5% vs. 47.7%; p = 0.040) and more healthcare providers considered it easier to start a conversation about PCC (75.0% vs. 47.9%; p = 0.030). CONCLUSION The intervention showed some tentative positive effects on lifestyle behaviours among prospective parents. Primarily on vegetable intake and the knowledge and competence of healthcare providers. The results of this study contribute to the evidence regarding successfully implementing PCC-interventions to optimize the health of prospective parents and future generations. TRIAL REGISTRATION Dutch Trial Register: NL7784 (Registered 06/06/2019).
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Affiliation(s)
- V. Y. F. Maas
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - M. Poels
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ,House of Women, Niasstraat 7, 1095 TS Amsterdam, The Netherlands
| | - E. Ista
- grid.5645.2000000040459992XDepartment of Internal Medicine - Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ,grid.416135.40000 0004 0649 0805Department of Paediatric Surgery, Paediatric intensive care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - L. F. Menge
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - R. W. A. de Bie
- grid.425719.c0000 0001 2232 838XDutch Ministry of Health, Welfare and Sports, Parnassusplein 5, 2511 VX The Hague, The Netherlands ,grid.413681.90000 0004 0631 9258Department of Obstetrics, Diakonessenhuis Hospital, Bosboomstraat 1, Utrecht, 3582 KE The Netherlands
| | - D. J. de Smit
- MediClara Projects, Prinses Beatrixstraat 7, 1396 KD Baambrugge, The Netherlands
| | - E. H. van Vliet-Lachotzki
- grid.426579.b0000 0004 9129 9166Dutch Genetic Alliance, VSOP, Koninginnelaan 23, 3762 DA Soest, The Netherlands
| | - A. Franx
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - M. P. H. Koster
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Weeks R, White S, Hartner AM, Littlepage S, Wolf J, Masten K, Tingey L. COVID-19 Messaging on Social Media for American Indian and Alaska Native Communities: Thematic Analysis of Audience Reach and Web Behavior. JMIR INFODEMIOLOGY 2022; 2:e38441. [PMID: 36471705 PMCID: PMC9709694 DOI: 10.2196/38441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/30/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, tribal and health organizations used social media to rapidly disseminate public health guidance highlighting protective behaviors such as masking and vaccination to mitigate the pandemic's disproportionate burden on American Indian and Alaska Native (AI/AN) communities. OBJECTIVE Seeking to provide guidance for future communication campaigns prioritizing AI/AN audiences, this study aimed to identify Twitter post characteristics associated with higher performance, measured by audience reach (impressions) and web behavior (engagement rate). METHODS We analyzed Twitter posts published by a campaign by the Johns Hopkins Center for Indigenous Health from July 2020 to June 2021. Qualitative analysis was informed by in-depth interviews with members of a Tribal Advisory Board and thematically organized according to the Health Belief Model. A general linearized model was used to analyze associations between Twitter post themes, impressions, and engagement rates. RESULTS The campaign published 162 Twitter messages, which organically generated 425,834 impressions and 6016 engagements. Iterative analysis of these Twitter posts identified 10 unique themes under theory- and culture-related categories of framing knowledge, cultural messaging, normalizing mitigation strategies, and interactive opportunities, which were corroborated by interviews with Tribal Advisory Board members. Statistical analysis of Twitter impressions and engagement rate by theme demonstrated that posts featuring culturally resonant community role models (P=.02), promoting web-based events (P=.002), and with messaging as part of Twitter Chats (P<.001) were likely to generate higher impressions. In the adjusted analysis controlling for the date of posting, only the promotion of web-based events (P=.003) and Twitter Chat messaging (P=.01) remained significant. Visual, explanatory posts promoting self-efficacy (P=.01; P=.01) and humorous posts (P=.02; P=.01) were the most likely to generate high-engagement rates in both the adjusted and unadjusted analysis. CONCLUSIONS Results from the 1-year Twitter campaign provide lessons to inform organizations designing social media messages to reach and engage AI/AN social media audiences. The use of interactive events, instructional graphics, and Indigenous humor are promising practices to engage community members, potentially opening audiences to receiving important and time-sensitive guidance.
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Affiliation(s)
- Rose Weeks
- Center for Indigenous Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States
| | - Sydney White
- Center for Indigenous Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States
| | - Anna-Maria Hartner
- Center for Indigenous Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States
| | - Shea Littlepage
- Center for Indigenous Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States
| | | | - Kristin Masten
- Center for Indigenous Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States
| | - Lauren Tingey
- Center for Indigenous Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States
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Ozga JE, Romm KF, Turiano NA, Douglas A, Dino G, Alexander L, Blank MD. Cumulative disadvantage as a framework for understanding rural tobacco use disparities. Exp Clin Psychopharmacol 2021; 29:429-439. [PMID: 34014742 PMCID: PMC9752977 DOI: 10.1037/pha0000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditional tobacco product (cigarettes and smokeless tobacco) and polytobacco use rates are significantly higher among rural adolescents and adults compared to their nonrural counterparts. Such disparities are due to several factors that promote tobacco use initiation and continuation, including individual-level psychopharmacological factors and structural-level factors such as fewer tobacco control efforts (e.g., fewer smoke-free policies and lower tobacco excise taxes), targeted tobacco marketing, less access to health-relevant resources, and more positive cultural norms surrounding tobacco use in rural communities. In this review, we use cumulative disadvantage theory as a framework for understanding how psychopharmacological and structural-level factors serve as drivers of tobacco use in rural areas. We start by describing how structural-level differences between rural-nonrural communities impact psychopharmacological influences and, when available, how these factors influence tobacco use. We conclude by discussing the interplay between factors, providing suggestions for ways to assess our application of cumulative disadvantage theory empirically and making recommendations for research and policy implementation in rural areas. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jenny E. Ozga
- Department of Behavioral Medicine and Psychiatry, West Virginia University
| | - Katelyn F. Romm
- Milken Institute School of Public Health, George Washington University
| | - Nicholas A. Turiano
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | | | - Geri Dino
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
| | - Linda Alexander
- Department of Social and Behavioral Sciences, Clinical and Translational Sciences Institute, West Virginia University
| | - Melissa D. Blank
- Department of Psychology, West Virginia University
- West Virginia Prevention Research Center, West Virginia University
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Patten CA, Lando HA, Desnoyers CA, Bock MJ, Alexie L, Decker PA, Hughes CA, Resnicow K, Burhansstipanov L, Boyer R, Klejka J. Healthy Pregnancies Project: Cluster Randomized Controlled Trial of a Community Intervention to Reduce Tobacco Use among Alaska Native Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9302. [PMID: 33322686 PMCID: PMC7764642 DOI: 10.3390/ijerph17249302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022]
Abstract
Substantial gaps remain in the evidence base for prenatal tobacco use interventions among Indigenous women. Using a cluster randomized controlled trial (RCT), the Healthy Pregnancies Project evaluated a community-level intervention for Alaska Native (AN) women in rural western Alaska. Sixteen villages were randomly assigned to usual care (control, n = 8 villages) or usual care plus a community-level intervention delivered by local AN "Native Sisters" (n = 8 villages). Outcomes were tobacco use rate at delivery and at 2 and 6 months postpartum, with biochemical confirmation obtained at 6 months. The program had high reach, enrolling 73% of all eligible women screened. Of the 352 participants, 67% used tobacco at baseline. No significant differences emerged between study groups on follow-up in tobacco use rates. More intervention than control participants made a quit attempt at 2 months postpartum (70% vs. 51%, respectively, p = 0.012). Participants in both study groups reported the program helped to raise awareness of healthy pregnancies in the study villages. This trial supports the reach of a community-level intervention, but not its efficacy for reducing tobacco use during pregnancy or postpartum. Efforts to sustain early quit attempts appear warranted. The community involvement, and reported impact on raising awareness of the importance of healthy pregnancies, supports the value of the research program in this community.
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Affiliation(s)
- Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA; (M.J.B.); (C.A.H.)
| | - Harry A. Lando
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, 1300 2nd St, Ste 200, Minneapolis, MN 55454, USA;
| | - Chris A. Desnoyers
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA; (C.A.D.); (L.A.); (R.B.); (J.K.)
| | - Martha J. Bock
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA; (M.J.B.); (C.A.H.)
| | - Lucinda Alexie
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA; (C.A.D.); (L.A.); (R.B.); (J.K.)
| | - Paul A. Decker
- Department of Health Sciences Research, Mayo Clinic, Harwick 7, 200 First Street SW, Rochester, MN 55905, USA;
| | - Christine A. Hughes
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA; (M.J.B.); (C.A.H.)
| | - Kenneth Resnicow
- School of Public Health, University of Michigan, 109 S. Observatory, 3867 SPH1, Ann Arbor, MI 48109, USA;
| | - Linda Burhansstipanov
- Native American Cancer Initiatives, Inc., 3022 South Nova Road, Pine, CO 80470, USA;
| | - Rahnia Boyer
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA; (C.A.D.); (L.A.); (R.B.); (J.K.)
| | - Joseph Klejka
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA; (C.A.D.); (L.A.); (R.B.); (J.K.)
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Lefebvre RC, Chandler RK, Helme DW, Kerner R, Mann S, Stein MD, Reynolds J, Slater MD, Anakaraonye AR, Beard D, Burrus O, Frkovich J, Hedrick H, Lewis N, Rodgers E. Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing communities study. Drug Alcohol Depend 2020; 217:108338. [PMID: 33152673 PMCID: PMC7534788 DOI: 10.1016/j.drugalcdep.2020.108338] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The HEALing Communities Study (HCS) is testing whether the Communities that Heal (CTH) intervention can decrease opioid overdose deaths through the implementation of evidence-based practices (EBPs) in highly impacted communities. One of the CTH intervention components is a series of communications campaigns to promote the implementation of EBPs, increase demand for naloxone and medications for opioid use disorder (MOUD), and decrease stigma toward people with opioid use disorder and the use of EBPs, especially MOUD. This paper describes the approach to developing and executing these campaigns. METHODS The HCS communication campaigns are developed and implemented through a collaboration between communication experts, research site staff, and community coalitions using a three-stage process. The Prepare phase identifies priority groups to receive campaign messages, develops content for those messages, and identifies a "call to action" that asks people to engage in a specific behavior. In the Plan phase, campaign resources are produced, and community coalitions develop plans to distribute campaign materials. During the Implement stage, these distribution plans guide delivery of content to priority groups. Fidelity measures assess how community coalitions follow their distribution plan as well as barriers and facilitators to implementation. An evaluation of the communication campaigns is planned. CONCLUSIONS If successful, the Prepare-Plan-Implement process, and the campaign materials, could be adapted and used by other communities to address the opioid crisis. The campaign evaluation will extend the evidence base for how communication campaigns can be developed and implemented through a community-engaged process to effectively address public health crises.
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Affiliation(s)
- R. Craig Lefebvre
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA,Corresponding author
| | - Redonna K. Chandler
- National Institute on Drug Abuse, 3WFN RM 09D02, 301 North Stonestreet Ave, Bethesda, MD, 20892, USA
| | - Donald W. Helme
- Department of Communication, University of Kentucky, 271 Blazer Dining, Lexington, KY, 40506-0042, USA
| | - Robin Kerner
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, Suite 810, New York, NY, 10027, USA.
| | - Sarah Mann
- Center for Clinical and Translational Science, College of Medicine, The Ohio State University, 376 W 10th Avenue, Columbus, OH, 43210, USA.
| | - Michael D. Stein
- School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Jennifer Reynolds
- Health Communications and Marketing, Oak Ridge Institute for Science and Education (ORAU), 100 ORAU Way, Oak Ridge, TN, 37830, USA.
| | - Michael D. Slater
- School of Communication, The Ohio State University, 3016 Derby Hall, Columbus, OH, 43210, USA
| | - Amarachi R. Anakaraonye
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Dacia Beard
- School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA.
| | - Olivia Burrus
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Jenna Frkovich
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Haley Hedrick
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Nicky Lewis
- Department of Communication, University of Kentucky, 363 S. Martin Luther King Blvd., Lexington, KY 40526, USA.
| | - Emma Rodgers
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, Suite 810, New York, NY, 10027, USA.
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Patten CA, Lando HA, Desnoyers CA, Klejka J, Decker PA, Bock MJ, Hughes CA, Alexie L, Boyer R, Resnicow K, Burhansstipanov L. Association of Tobacco Use During Pregnancy, Perceived Stress, and Depression Among Alaska Native Women Participants in the Healthy Pregnancies Project. Nicotine Tob Res 2020; 22:2104-2108. [PMID: 31566239 PMCID: PMC7593352 DOI: 10.1093/ntr/ntz189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/27/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In general population samples, higher levels of stress and depression have been associated with increased prevalence of smoking in pregnancy. Little is known about the association of prenatal tobacco use, stress, and depression among American Indian or Alaska Native (AI/AN) women. METHODS The Healthy Pregnancies Project is a cluster-randomized controlled trial, evaluating a community-level intervention compared with usual care, for reducing tobacco use during pregnancy and postpartum among AN women in 16 villages in western Alaska. This cross-sectional study analyzed baseline data from enrolled pregnant women. Baseline measures included the self-reported, 7-day, point-prevalence current use of any tobacco, Perceived Stress Scale (PSS), and the Center for Epidemiological Studies-Depression (CES-D). Generalized estimating equations (GEE) analyses adjusted for village, participant age, and gestational age. RESULTS Participants (N = 352) were on average (SD) 25.8 (5.0) years of age and at 26.8 (9.8) weeks gestation. 66.5% were current tobacco users, of which 77% used Iqmik, a homemade form of smokeless tobacco. Compared with nonusers, tobacco users reported lower PSS score (p = .020) and less clinical levels of depression (CES-D ≥ 16) (18.1% vs. 9.3%, p = .21). Findings were not accounted for by nicotine dependence severity or self-reported tobacco use before pregnancy. CONCLUSIONS In this sample of pregnant AN women, tobacco users report less stress and clinical levels of depression than nonusers. A potential challenge with tobacco treatment for pregnant AN women is to provide alternative ways of deescalating stress and affect management instead of using tobacco. IMPLICATIONS This study contributes novel information on the association of tobacco use, perceived stress, and depression among Alaska Native women enrolled in a clinical trial to promote healthy pregnancies. Most prior studies addressing this topic were conducted among general population samples of pregnant women who smoked cigarettes. Little is known about these associations with prenatal smokeless tobacco, or among American Indian or Alaska Native women. The results are contrary to findings reported previously, because current tobacco use was associated with less stress and depression than nonuse. The study findings have implications for cessation treatment for this tobacco-use disparity group.
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Affiliation(s)
- Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | | | | | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Martha J Bock
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Developing a Messaging Graphic for Storage Times of Refrigerated Ready to Eat (RTE) Foods for a Consumer Food Safety Health Campaign. Eur J Investig Health Psychol Educ 2020; 10:859-875. [PMID: 34542516 PMCID: PMC8314301 DOI: 10.3390/ejihpe10030062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022] Open
Abstract
This study developed and evaluated risk communication messages for ready to eat (RTE) foods targeted towards consumer storage practices in a food safety health campaign. Concepts were determined from a fractional factorial design of five categories of attributes potentially present in health promotion: title, message, graphic, slogan, and icon. Consumers viewed a subset of concepts and scored how useful the concept was in remembering to throw away RTE foods that were stored too long. Regression analysis determined which combinations of message attributes were most likely to result in using the information to throw out foods, which could help prevent foodborne illness. Findings showed that for this type of information, a graphic is a critical element for the printed schematic. The slogan (i.e., a short statement similar to a jingle or tag-line in a commercial) may be important to consumers, but the icon was not important.
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Sinicrope PS, Koller KR, Prochaska JJ, Hughes CA, Bock MJ, Decker PA, Flanagan CA, Merritt ZT, Meade CD, Willetto AL, Resnicow K, Thomas TK, Patten CA. Social Media Intervention to Promote Smoking Treatment Utilization and Cessation Among Alaska Native People Who Smoke: Protocol for the Connecting Alaska Native People to Quit Smoking (CAN Quit) Pilot Study. JMIR Res Protoc 2019; 8:e15155. [PMID: 31755867 PMCID: PMC6898890 DOI: 10.2196/15155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/05/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the high prevalence of tobacco use among Alaska Native (AN) people, tobacco cessation interventions developed specifically for this group are lacking. Social media hold promise as a scalable intervention strategy to promote smoking treatment utilization and cessation, given the barriers to treatment delivery (ie, geographic remoteness, limited funding, climate, and travel costs) in the state of Alaska (AK). Building on a longstanding tobacco control research partnership with the AK Tribal Health System, in this study, we are developing and pilot-testing a culturally relevant, Facebook (FB)-delivered intervention that incorporates a digital storytelling approach adapted from the effective Centers for Disease Control Tips from Former Smokers campaign. OBJECTIVE This study aims to promote evidence-based smoking treatment (eg, state quitline and Tribal cessation programs) uptake and cessation among AN people. METHODS This study fulfills the objectives for stage 1 of the National Institute on Drug Abuse behavioral integrative treatment development program. In stage 1a, we will use a mixed method approach to develop the FB intervention. Cultural variance and surface/deep structure frameworks will address the influence of culture in designing health messages. These developmental activities will include qualitative and quantitative assessments, followed by beta testing of proposed intervention content. In stage 1b, we will conduct a randomized pilot trial enrolling 60 AN adults who smoke. We will evaluate the feasibility, uptake, consumer response, and potential efficacy of the FB intervention compared with a control condition (quitline/treatment referral only). Primary outcome measures include feasibility and biochemically verified smoking abstinence at 1-, 3-, and 6-month follow-ups. Secondary outcomes will include self-reported smoking cessation treatment utilization and abstinence from tobacco/nicotine products. We will also explore interdependence (relationship orientation and collaborative efforts in lifestyle change) as a culturally relevant mediator of intervention efficacy. RESULTS The study enrolled 40 participants for phase 1, with data saturation being achieved at 30 AN people who smoke and 10 stakeholders. For phase 2, we enrolled 40 participants. Qualitative assessment of proposed intervention content was completed with 30 AN smokers and 10 stakeholders. We are currently analyzing data from the quantitative assessment with 40 participants in preparation for the beta testing, followed by the randomized pilot trial. CONCLUSIONS The project is innovative for its use of social media communication tools that are culturally relevant in a behavioral intervention designed to reach AN people statewide to promote smoking treatment utilization and cessation. The study will further advance tobacco cessation research in an underserved disparity group. If the pilot intervention is successful, we will have a blueprint to conduct a large randomized controlled efficacy trial. Our approach could be considered for other remote AN communities to enhance the reach of evidence-based tobacco cessation treatments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15155.
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Affiliation(s)
- Pamela S Sinicrope
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, United States
| | - Kathryn R Koller
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Christine A Hughes
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, United States
| | - Martha J Bock
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, United States
| | - Paul A Decker
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Christie A Flanagan
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Zoe T Merritt
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Crystal D Meade
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Abbie L Willetto
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Timothy K Thomas
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, United States
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Patten CA, Koller KR, Flanagan CA, Hiratsuka V, Merritt ZT, Sapp F, Meade CD, Hughes CA, Decker PA, Murphy N, Thomas TK. Postpartum Tobacco Use and Perceived Stress among Alaska Native Women: MAW Phase 4 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3024. [PMID: 31438550 PMCID: PMC6747207 DOI: 10.3390/ijerph16173024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 01/29/2023]
Abstract
Prior research explored reasons for tobacco use among pregnant Alaska Native (AN) women but did not address the postpartum period. This study followed up with AN women one to three years postpartum who had participated in a prenatal smoking cessation intervention study (Motivate Alaska Women (MAW) Phase 3) and had consented to be re-contacted for future studies. Of 47 eligible women, 32 (68%) participated. A semi-structured phone interview was conducted a mean of 2.0 years after delivery (range 1.6-2.8). Measures assessed self-reported tobacco use status in the 12 months after delivery, at 12 months postpartum, and at the time of the interview; reasons for maintaining abstinence, continued use, or relapse; and included the Perceived Stress Scale (PSS) and Negative Affect (NA) scale. Content analysis was used to generate themes from open-ended response items. Tobacco use was reported by 23 women (72%) at delivery, 30 (94%) within the 12 months after delivery, 27 (84%) at 12 months postpartum, and 29 (91%) at the time of the interview. Among nine women not using tobacco at delivery, seven (78%) relapsed during the 12 months after delivery. Of the 29 current tobacco users, 28 (97%) smoked cigarettes. Twenty-seven participants (84%) reported stress and 15 (52%) indicated addiction as reasons for continuing, starting, or resuming tobacco use. Types of stressors were related to parenting and traumatic experiences. Among current tobacco users, mean NA score (18.7) was significantly higher (p = 0.01) than the normative mean (14.8), but no differences were detected for PSS score. In this sample of AN women, postpartum tobacco use was highly prevalent, and stress was a primary reason that women endorsed for using tobacco. These preliminary results have several practice and research implications for exploring ways to support non-tobacco use among postpartum AN women.
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Affiliation(s)
- Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Kathryn R Koller
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Christie A Flanagan
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Vanessa Hiratsuka
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK 99508, USA
| | - Zoe T Merritt
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Flora Sapp
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Crystal D Meade
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Christine A Hughes
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Neil Murphy
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK 99508, USA
| | - Timothy K Thomas
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
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Patten CA, Lando HA, Desnoyers CA, Barrows Y, Klejka J, Decker PA, Hughes CA, Bock MJ, Boyer R, Resnicow K, Burhansstipanov L. The Healthy Pregnancies Project: Study protocol and baseline characteristics for a cluster-randomized controlled trial of a community intervention to reduce tobacco use among Alaska Native pregnant women. Contemp Clin Trials 2019; 78:116-125. [PMID: 30703523 PMCID: PMC6407629 DOI: 10.1016/j.cct.2019.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tobacco use prevalence is high among pregnant Alaska Native (AN) women but few interventions have been evaluated for this group. The Healthy Pregnancies Project aims to evaluate a multicomponent intervention for reducing tobacco use during pregnancy and the postpartum period among AN women. This report describes the study protocol and participant baseline characteristics. DESIGN Cluster-randomized controlled trial with village as the unit of assignment. Sixteen villages in rural southwest Alaska were stratified on village size and randomized to a multicomponent intervention (n = 8 villages) or usual care (n = 8 villages). METHODS Pregnant AN women from the study villages were enrolled. All participants receive the usual care provided to pregnant women in this region. Participants from intervention villages additionally receive individual phone counseling on healthy pregnancies plus a social marketing campaign targeting the entire community delivered by local AN "Native Sisters." Baseline measurements for all enrolled pregnant women have been completed. Follow-up assessments are ongoing at delivery, and at 2 and 6 months postpartum. The primary outcome is biochemically verified tobacco use status at 6 months postpartum. RESULTS Recruitment was feasible with 73% of eligible women screened enrolled. The program reached more than half (56%) of AN pregnant women from the study villages during the recruitment period. Participants are N = 352 pregnant AN women, 188 enrolled from intervention villages and 164 from control villages. At baseline, participants' mean (SD) age was 25.8 (5.0) years, they were at 26.8 (9.8) weeks gestation, and 66.5% were current tobacco users. DISCUSSION Processes and products from this project may have relevance to other Native American populations aiming to focus on healthy pregnancies in their communities.
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Affiliation(s)
- Christi A Patten
- Mayo Clinic, Department of Psychiatry and Psychology, BioBusiness Bldg 5-26, 200 First Street SW, Rochester, MN 55905, USA.
| | - Harry A Lando
- University of Minnesota, 1300 2(nd) St, Ste 200, Minneapolis, MN 55454, USA.
| | - Chris A Desnoyers
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Yvette Barrows
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Joseph Klejka
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Paul A Decker
- Mayo Clinic, Department of Health Sciences Research, Harwick 7, 200 First Street SW, Rochester, MN 55905, USA.
| | - Christine A Hughes
- Mayo Clinic, Department of Psychiatry and Psychology, BioBusiness Bldg 5-26, 200 First Street SW, Rochester, MN 55905, USA.
| | - Martha J Bock
- Mayo Clinic, Department of Psychiatry and Psychology, BioBusiness Bldg 5-26, 200 First Street SW, Rochester, MN 55905, USA.
| | - Rahnia Boyer
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Kenneth Resnicow
- University of Michigan, 109 S. Observatory, 3867 SPH1, Ann Arbor, MI 48109, USA.
| | - Linda Burhansstipanov
- Native American Cancer Initiatives, Inc., 3022 South Nova Road, Pine, CO 80470, USA.
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