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Puschel K, Thompson B, Rioseco A, Leon A, Goic C, Fuentes I, Vescovi Z. Cancer advocacy in residency education: From principles to competencies. J Cancer Policy 2024; 40:100470. [PMID: 38479645 DOI: 10.1016/j.jcpo.2024.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020-2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians. METHODS Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model's main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education. RESULTS Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways. Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain. Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill. POLICY SUMMARY The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.
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Affiliation(s)
- Klaus Puschel
- Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile.
| | - Beti Thompson
- Public Health Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Andrea Rioseco
- Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Augusto Leon
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile; Department of Surgical Oncology, School of Medicine, Universidad Católica de Chile, Chile
| | - Carolina Goic
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Isabella Fuentes
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Zdenka Vescovi
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
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Jackson H, Dunphy C, Grist MB, Jiang X, Xu L, Guy GP, Salvant-Valentine S. Weathering the Storm: Syringe Services Program Laws and Human Immunodeficiency Virus During the COVID-19 Pandemic. J Acquir Immune Defic Syndr 2023; 94:395-402. [PMID: 37949442 PMCID: PMC11299426 DOI: 10.1097/qai.0000000000003293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Syringe services programs (SSPs) are community-based prevention programs that provide a range of harm reduction services to persons who inject drugs. Despite their benefits, SSP laws vary across the United States. Little is known regarding how legislation surrounding SSPs may have influenced HIV transmission over the COVID-19 pandemic, a period in which drug use increased. This study examined associations between state SSP laws and HIV transmission among the Medicaid population before and after the COVID-19 pandemic. METHODS State-by-month counts of new HIV diagnoses among the Medicaid population were produced using administrative claims data from the Transformed Medicaid Statistical Information System from 2019 to 2020. Data on SSP laws were collected from the Prescription Drug Abuse Policy System. Associations between state SSP laws and HIV transmission before and after the start of the COVID-19 pandemic were evaluated using an event study design, controlling for the implementation of COVID-19 nonpharmaceutical interventions and state and time fixed effects. RESULTS State laws allowing the operation of SSPs were associated with 0.54 (P = 0.044) to 1.18 (P = 0.001) fewer new monthly HIV diagnoses per 100,000 Medicaid enrollees relative to states without such laws in place during the 9 months after the start of the COVID-19 pandemic. The largest effects manifested for population subgroups disproportionately affected by HIV, such as male and non-Hispanic Black Medicaid enrollees. CONCLUSION Less restrictive laws on SSPs may have helped mitigate HIV transmission among the Medicaid population throughout the COVID-19 pandemic. Policymakers can consider implementing less restrictive SSP laws to mitigate HIV transmission resulting from future increases in injection drug use. DISCLAIMER The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Affiliation(s)
- Hannah Jackson
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christopher Dunphy
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary Blain Grist
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN; and
| | - Xinyi Jiang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Likang Xu
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gery P Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sheila Salvant-Valentine
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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Baker C, Benayoun BA. Menopause Is More Than Just Loss of Fertility. THE PUBLIC POLICY AND AGING REPORT 2023; 33:113-119. [PMID: 38155935 PMCID: PMC10751372 DOI: 10.1093/ppar/prad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Clayton Baker
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Molecular and Computational Biology Department, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Bérénice A Benayoun
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Molecular and Computational Biology Department, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
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Rousseau A, Riggan KA, Halyard M, James SE, Kelly M, Phillips D, Allyse MA. Cancer Screening Experiences of Black Breast and Ovarian Cancer Patients and Family Members. J Community Health 2023; 48:882-888. [PMID: 37219788 PMCID: PMC10203662 DOI: 10.1007/s10900-023-01233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 05/24/2023]
Abstract
Black women experience disproportionate rates of advanced breast cancer diagnoses and mortality. Mammography is a proven and effective tool in early breast cancer detection and impacts patient outcomes. We interviewed Black women with a personal or family history of breast and/or ovarian cancer to understand their screening experiences and views. N = 61 individuals completed an interview. Interview transcripts were qualitatively analyzed for themes regarding clinical experiences, guideline adherence, and family sharing specific to Black women and their families. Most participants were college educated with active health insurance. Women in this cohort were knowledgeable about the benefits of mammography and described few barriers to adhering to annual mammogram guidelines. Some with first-degree family history were frustrated at insurance barriers to mammography before the age of 40. Participants were generally comfortable encouraging family and friends to receive mammograms and expressed a desire for a similar screening tool for ovarian cancer. However, they expressed concern that factors such as screening awareness and education, lack of insurance coverage, and other systematic barriers might prevent other Black women from receiving regular screening. Black women in this cohort reported high adherence to mammography guidelines, but expressed concern about cultural and financial barriers that may impact cancer screening access in the population more generally and contribute to disparities. Participants noted the importance of frank and open discussions of breast cancer screening in their families and community as a means of improving awareness.
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Affiliation(s)
- Abigail Rousseau
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Michele Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Sarah E James
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
| | - Marion Kelly
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- Department of Community Engagement, Mayo Clinic, Scottsdale, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Daphne Phillips
- Department of Speech Pathology, Mayo Clinic, Phoenix, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Korn AR, Walsh-Bailey C, Correa-Mendez M, DelNero P, Pilar M, Sandler B, Brownson RC, Emmons KM, Oh AY. Social determinants of health and US cancer screening interventions: A systematic review. CA Cancer J Clin 2023; 73:461-479. [PMID: 37329257 PMCID: PMC10529377 DOI: 10.3322/caac.21801] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.
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Affiliation(s)
- Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Behavioral and Policy Sciences Department, RAND Corporation, Boston, MA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Margarita Correa-Mendez
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - April Y. Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Young MJ, Bodien YG, Freeman HJ, Fecchio M, Edlow BL. Toward Uniform Insurer Coverage for Functional MRI Following Severe Brain Injury. J Head Trauma Rehabil 2023; 38:351-357. [PMID: 36854104 PMCID: PMC10329974 DOI: 10.1097/htr.0000000000000864] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Functional magnetic resonance imaging (fMRI) now promises to improve diagnostic and prognostic accuracy for patients with disorders of consciousness, and accordingly has been endorsed by professional society guidelines, including those of the American Academy of Neurology, American College of Rehabilitation Medicine, National Institute on Disability, Independent Living, and Rehabilitation Research, and the European Academy of Neurology. Despite multiple professional society endorsements of fMRI in evaluating patients with disorders of consciousness following severe brain injury, insurers have yet to issue clear guidance regarding coverage of fMRI for this indication. Lack of insurer coverage may be a rate-limiting barrier to accessing this technique, which could uncover essential diagnostic and prognostic information for patients and their families. The emerging clinical and ethical case for harmonized insurer recognition and reimbursement of fMRI for vulnerable persons following severe brain injury with disorders of consciousness is explained and critically evaluated.
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Affiliation(s)
- Michael J Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
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Falk D, Cubbin C, Salsman JM, Winkfield KM, Foley KL, Noel L, Jones B. Navigating Financial Barriers to Papanicolaou Tests and Mammograms for Young Adult Women Residing in Rural and Border Areas of Texas. J Adolesc Young Adult Oncol 2023; 12:159-167. [PMID: 35475705 PMCID: PMC10124170 DOI: 10.1089/jayao.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Costs of Papanicolaou (Pap) tests and mammograms are a primary barrier for women aged 18-39 seeking screening and diagnostic services. Race/ethnicity and rural/border resident status compound their risks for delayed diagnosis, possibly resulting in higher mortality. Methods: We analyzed cross-sectional data from young adult (YA) women (aged 18-39) from a cancer education and patient navigation (PN) program in rural and border Texas from 2012 to 2016. Descriptive statistics, Chi-square tests, and logistic regressions summarized sociodemographic variables and receipt of PN, Pap tests, and mammograms. Results: The sample consisted of 1181 women aged 31.8 years (standard deviation 5.5) on average. A total of 795 (67.3%) received PN, 494 (41.8%) received a Pap test, and 121 (10.3%) received a mammogram. The YA women attending the program due to cost (odds ratio [OR]: 7.24; confidence interval [CI]: 4.74-11.05) and reporting 1 (OR: 3.84; CI: 2.40-6.14) or 2+ barriers (OR: 6.00; CI: 3.61-9.99) had higher odds of being navigated than those not concerned about cost and not identifying a barrier. The YA women attending due to cost (OR: 2.22, CI: 1.61-3.05) and receiving navigation (OR: 1.92; CI: 1.29-2.84) had higher odds of receiving a Pap test than their counterparts. The majority receiving a mammogram were worried about cost (85.1%); 40.5% had a family history of breast cancer, and a doctor or nurse recommended a mammogram for 15.7%. Conclusion: Detection of cervical and breast cancer in YA women residing in rural and border Texas may be improved with PN to assist with financial barriers to care and service coordination.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Karen M. Winkfield
- Meharry-Vanderbilt Alliance, Nashville, Tennessee, USA
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristie L. Foley
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
- Departments of Health Social Work, Oncology, Population Health, and Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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Kowalski AE. Behaviour within a Clinical Trial and Implications for Mammography Guidelines. THE REVIEW OF ECONOMIC STUDIES 2023; 90:432-462. [PMID: 36798741 PMCID: PMC9928190 DOI: 10.1093/restud/rdac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Mammography guidelines have weakened in response to evidence that mammograms diagnose breast cancers that would never eventually cause symptoms, a phenomenon called "overdiagnosis." Given concerns about overdiagnosis, instead of recommending mammograms, US guidelines encourage women aged 40-49 to get them as they see fit. To assess whether these guidelines target women effectively, I propose an approach that examines mammography behavior within an influential clinical trial that followed participants long enough to find overdiagnosis. I find that women who are more likely to receive mammograms are healthier and have higher socioeconomic status. More importantly, I find that the 20-year level of overdiagnosis is at least 3.5 times higher among women who are most likely to receive mammograms. At least 36% of their cancers are overdiagnosed. These findings imply that US guidelines encourage mammograms among healthier women who are more likely to be overdiagnosed by them. Guidelines in other countries do not.
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O’Sullivan K, O’Donovan A. Factors associated with breast cancer mammography screening and breast self-examination in Irish women: results from the Irish Longitudinal Study on Ageing (TILDA). Acta Oncol 2022; 61:1301-1308. [DOI: 10.1080/0284186x.2022.2143277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- K. O’Sullivan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A. O’Donovan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Quigley L. Whom Do Incentive Program Physicians Serve? New Measures for Assessing Program Reach. J Ambul Care Manage 2022; 45:266-278. [PMID: 36006385 DOI: 10.1097/jac.0000000000000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One approach to ameliorating health workforce maldistribution is incentivizing health professionals, including physicians, to locate in underserved areas. However, eligibility for programs typically relies on large geographic areas whereas it is subpopulations within underserved areas who are typically at risk. New measures introduced in this article capture data on the patients actually served by incentive program physicians. A pilot study of one state's J-1 Visa Waiver and loan repayment programs validated the new measures of medical need, low income, rural location, and population-to-provider ratios of provider location, providing a nuanced picture of the groups actually served by incentive program physicians.
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Affiliation(s)
- Leo Quigley
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia and Office of Health Affairs, West Virginia University, Morgantown, West Virginia
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Nguyen HV, Mital S. Effects of e-cigarette use on mental health among youths: quasi-experimental evidence from Canada. Addiction 2022; 117:2673-2682. [PMID: 35545859 DOI: 10.1111/add.15943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Existing research on mental health comorbidities of youth e-cigarette use is subject to confounding bias and reverse causality. This study aimed to measure the effects of e-cigarette use on youth mental health, using e-cigarette minimum legal age (MLA) law in Canada as a natural experiment. DESIGN We used difference-in-differences (DD), difference-in-differences-in-differences (DDD) and two-sample instrumental variables (TSIV) methods. SETTING Data were from nationally representative Canadian Community Health Surveys 2008-2019 and Canadian Student Tobacco Alcohol and Drugs Surveys 2008-2019. PARTICIPANTS The study sample comprised of respondents aged 15 to 18 (in DD analysis; n = 33 858) and aged 15 to 24 (in DDD analysis; n = 78 689). MEASUREMENTS Primary outcomes were self-reported mood disorders and anxiety disorders. Secondary outcomes were cannabis use, illicit drug use, cigarette use and strength of peer relationships at schools. FINDINGS After the e-cigarette MLA laws, risks of mood disorders declined by 1.9 percentage points (95% CI, 0.0-3.8; P = 0.05) in the DD analysis and by 2.6 percentage points (95% CI, 0.2-5.0; P = 0.03) in the DDD analysis. For anxiety disorders, while the DD estimate was negative but imprecisely estimated, the MLA law reduced risks of anxiety disorder by 3.6 percentage points (95% CI, 0.9-6.2; P = 0.01) in the DDD analysis. Youths in provinces with MLA laws were also less likely to report cannabis use and illicit drug use and more likely to feel being part of schools. TSIV analysis indicates that youth e-cigarette use increased the likelihood of mood and anxiety disorders by 44% and 37%, respectively. CONCLUSION AND RELEVANCE In Canada, the e-cigarette minimum legal age law appears to have reduced risks of mood and anxiety disorders, lowered substance use and improved peer relationships at schools. Combined with previous evidence of lower e-cigarette use following the minimum legal age law, our findings indicate that youth e-cigarette use increases risks of mood and anxiety disorders.
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Affiliation(s)
- Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
| | - Shweta Mital
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
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Dunphy C, Miller GF, Rice K, Vo L, Sunshine G, McCord R, Howard-Williams M, Coronado F. The Impact of Covid-19 State Closure Orders on Consumer Spending, Employment, and Business Revenue. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:43-49. [PMID: 34016904 PMCID: PMC8589864 DOI: 10.1097/phh.0000000000001376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT In response to the COVID-19 pandemic, states across the United States implemented various strategies to mitigate transmission of SARS-CoV-2 (the virus that causes COVID-19). OBJECTIVE To examine the effect of COVID-19-related state closures on consumer spending, business revenue, and employment, while controlling for changes in COVID-19 incidence and death. DESIGN The analysis estimated a difference-in-difference model, utilizing temporal and geographic variation in state closure orders to analyze their impact on the economy, while controlling for COVID-19 incidence and death. PARTICIPANTS State-level data on economic outcomes from the Opportunity Insights data tracker and COVID-19 cases and death data from usafacts.org. INTERVENTIONS The mitigation strategy analyzed within this study was COVID-19-related state closure orders. Data on these orders were obtained from state government Web sites containing executive or administrative orders. MAIN OUTCOME MEASURES Outcomes include state-level estimates of consumer spending, business revenue, and employment levels. RESULTS Analyses showed that although state closures led to a decrease in consumer spending, business revenue, and employment, they accounted for only a small portion of the observed decreases in these outcomes over the first wave of COVID-19. CONCLUSIONS The impact of COVID-19 on economic activity likely reflects a combination of factors, in addition to state closures, such as individuals' perceptions of risk related to COVID-19 incidence, which may play significant roles in impacting economic activity.
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Affiliation(s)
- Christopher Dunphy
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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Stampini M, Oliveri ML, Ibarrarán P, Flores C. Who Works Less When a Parent Needs Long-Term Care? Gender Disparities in Labor Market Effects in Mexico. JOURNAL OF LONG-TERM CARE 2022; 2022:130-141. [PMID: 35983104 PMCID: PMC9380844 DOI: 10.31389/jltc.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
We use longitudinal data from the Mexican Health and Aging Study to analyze the effect of having a parent in need of long-term care on labor supply of men and women aged 50-64 in Mexico. After accounting for both individual and time fixed effects, we find that parents' need of long-term care is associated with both a significant drop in the likelihood of working (by 2.42 percentage points), and a reduction in the number of hours worked (by 7.3%) among women who remain employed. In contrast, we find no effect on the labor supply of men. In a context of rapid population aging, the increase in the need of long-term care risks to hinder the efforts to reduce gender imbalances in the labor market.
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Eibich P, Goldzahl L. Does retirement affect secondary preventive care use? Evidence from breast cancer screening. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101061. [PMID: 34555616 PMCID: PMC8683749 DOI: 10.1016/j.ehb.2021.101061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
This paper examines the causal impact of retirement on preventive care use by focusing on breast cancer screening. It contributes to a better understanding of the puzzling results in the literature reporting mixed effects on health care consumption at retirement. We use five waves of data from the Eurobarometer surveys conducted between 1996 and 2006, covering 25 different European countries. We address the endogeneity of retirement by using age thresholds for pension eligibility as instrumental variables in a bivariate probit model. We find that retirement reduces mammography use and other secondary preventive care use. Our results suggest that health status, income, and knowledge on cancer prevention and treatment contribute little to our understanding of the effects of retirement. Instead, our evidence suggests important effect heterogeneity based on the generosity of the social health insurance system and organized screening programs.
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Affiliation(s)
- Peter Eibich
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057 Rostock, Germany; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK.
| | - Léontine Goldzahl
- EDHEC Business School, 24 Avenue Gustave Delory, CS 50411, 59057 Roubaix Cedex 1, France.
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15
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Ertem Z, Schechter-Perkins EM, Oster E, van den Berg P, Epshtein I, Chaiyakunapruk N, Wilson FA, Perencevich E, Pettey WBP, Branch-Elliman W, Nelson RE. The impact of school opening model on SARS-CoV-2 community incidence and mortality. Nat Med 2021; 27:2120-2126. [PMID: 34707317 DOI: 10.1038/s41591-021-01563-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022]
Abstract
The role that traditional and hybrid in-person schooling modes contribute to the community incidence of SARS-CoV-2 infections relative to fully remote schooling is unknown. We conducted an event study using a retrospective nationwide cohort evaluating the effect of school mode on SARS-CoV-2 cases during the 12 weeks after school opening (July-September 2020, before the Delta variant was predominant), stratified by US Census region. After controlling for case rate trends before school start, state-level mitigation measures and community activity level, SARS-CoV-2 incidence rates were not statistically different in counties with in-person learning versus remote school modes in most regions of the United States. In the South, there was a significant and sustained increase in cases per week among counties that opened in a hybrid or traditional mode versus remote, with weekly effects ranging from 9.8 (95% confidence interval (CI) = 2.7-16.1) to 21.3 (95% CI = 9.9-32.7) additional cases per 100,000 persons, driven by increasing cases among 0-9 year olds and adults. Schools can reopen for in-person learning without substantially increasing community case rates of SARS-CoV-2; however, the impacts are variable. Additional studies are needed to elucidate the underlying reasons for the observed regional differences more fully.
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Affiliation(s)
- Zeynep Ertem
- Systems Science and Industrial Engineering Department, Binghamton University, State University of New York, New York, NY, USA
| | - Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Emily Oster
- Brown University Watson Institute for International and Public Affairs, Providence, RI, USA
| | - Polly van den Berg
- Beth Israel Deaconess Medical Center, Department of Medicine, Section of Infectious Diseases, Boston, MA, USA
| | - Isabella Epshtein
- VA Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Eli Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA.,Carver College of Medicine, Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Warren B P Pettey
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.,IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Westyn Branch-Elliman
- VA Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA. .,VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Richard E Nelson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA.,IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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16
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Lyu W, Wanchek T, Wehby GL. The effects of state facial surgery mandates on timeliness of primary cleft repair surgery in the United States. Oral Dis 2021; 28:1620-1627. [PMID: 33586311 DOI: 10.1111/odi.13801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/29/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examines the effects of state facial surgery mandates on the timeliness of primary cleft repair surgery for privately insured children with oral clefts in the United States. MATERIALS AND METHODS Using IBM Health MarketScan® Database from 2001 to 2017, we estimate regression models separately for age at cleft lip repair and cleft palate repair by having a mandate while considering child-level factors and other state differences. The sample includes 1,451 children who had primary cleft lip repair by age 12 months, and 1,402 children who had primary cleft palate repair by age 18 months. RESULTS A mandate was associated with earlier cleft lip repair by 13 days (95% CI, -21.5 to -4.7 days) when controlling for state differences, regardless if the child had other birth defects. For children needing cleft palate repair, a mandate was associated with earlier surgery by 87 days (95% CI, -136.1 to -38.4 days) only when no other birth defects were present. CONCLUSIONS State facial surgery mandates were associated with earlier cleft lip repair for children with or without other birth defects, and earlier cleft palate repair for children without other birth defects (besides oral clefts). Findings suggest benefits to privately insured children with oral clefts from state mandates to cover needed services.
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Affiliation(s)
- Wei Lyu
- Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN, USA.,Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Tanya Wanchek
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.,Department of Economics, Tippie College of Business, University of Iowa, Iowa City, IA, USA.,Department of Preventive & Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA.,Public Policy Center, University of Iowa, Iowa City, IA, USA.,National Bureau of Economic Research, Cambridge, MA, USA
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17
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Kowalski AE. Mammograms and Mortality: How Has the Evidence Evolved? THE JOURNAL OF ECONOMIC PERSPECTIVES : A JOURNAL OF THE AMERICAN ECONOMIC ASSOCIATION 2021; 35:119-140. [PMID: 34421215 PMCID: PMC8371936 DOI: 10.1257/jep.35.2.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Decades of evidence reveal a complicated relationship between mammograms and mortality. Mammograms may detect deadly cancers early, but they may also lead to the diagnosis and potentially fatal treatment of cancers that would never progress to cause symptoms. I provide a brief history of the evidence on mammograms and mortality, focusing on evidence from clinical trials, and I discuss how this evidence informs mammography guidelines. I then explore the evolution of all-cause mortality relative to breast cancer mortality within an influential clinical trial. I conclude with some responses to the evolving evidence.
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Affiliation(s)
- Amanda E Kowalski
- Applied Economics and Public Policy, University of Michigan, Ann Arbor, Michigan
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18
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Einav L, Finkelstein A, Oostrom T, Ostriker A, Williams H. Screening and Selection: The Case of Mammograms. THE AMERICAN ECONOMIC REVIEW 2020; 110:3836-3870. [PMID: 34305149 PMCID: PMC8300583 DOI: 10.1257/aer.20191191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this selection is quantitatively important: shifting the recommendation from age 40 to 45 results in three times as many deaths if compliers were randomly selected than under the estimated patterns of selection. The results highlight the importance of considering characteristics of compliers when making and designing recommendations.
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Affiliation(s)
- Liran Einav
- Department of Economics, Stanford University, and the National Bureau of Economic Research
| | - Amy Finkelstein
- Department of Economics, Massachusetts Institute of Technology, and the National Bureau of Economic Research
| | | | | | - Heidi Williams
- Department of Economics, Stanford University, and the National Bureau of Economic Research
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19
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The Behavioral Risk Factor Surveillance System: Information, Relationships, and Influence. Am J Prev Med 2020; 59:773-775. [PMID: 33220750 PMCID: PMC7852027 DOI: 10.1016/j.amepre.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
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20
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Price S, Zhang X, Spencer A. Measuring the impact of national guidelines: What methods can be used to uncover time-varying effects for healthcare evaluations? Soc Sci Med 2020; 258:113021. [PMID: 32502834 DOI: 10.1016/j.socscimed.2020.113021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
We examine the suitability of three methods using patient-level data to evaluate the time-varying impacts of national healthcare guidelines. Such guidelines often codify progressive change and are implemented gradually; for example, National Institute for Health and Care Excellence (NICE) suspected-cancer referral guidelines. These were revised on June 23, 2015, to include more cancer symptoms and test results ("features"), partly reflecting changing practice. We explore the time-varying impact of guideline revision on time to colorectal cancer diagnosis, which is linked to improved outcomes in decision-analytic models. We included 11,842 patients diagnosed in 01/01/2006-31/12/2017 in the Clinical Practice Research Datalink with England cancer registry data linkage. Patients were classified by whether their first pre-diagnostic cancer feature was in the original guidelines (NICE-2005) or was added during the revision (NICE-2015-only). Outcome was diagnostic interval: time from first cancer feature to diagnosis. All analyses adjusted for age and sex. Two difference-in-differences analyses used either a Pre (01/08/2012-31/12/2014, n = 2243) and Post (01/08/2015-31/12/2017, n = 1017) design, or event-study cohorts (2006-2017 vs 2015) to estimate change in diagnostic interval attributable to official implementation of the revised guidelines. A semiparametric varying-coefficient model analysed the difference in diagnostic interval between the NICE groups over time. After model estimation, primary and broader treatment effects of guideline content and implementation were measured. The event-study difference-in-differences and the semiparametric varying-coefficient methods showed that shorter diagnostic intervals were attributable to official implementation of the revised guidelines. This impact was only detectable by pre-to-post difference-in-differences when the pre/post periods were selected according to the estimation results from the varying-coefficient model. Formal tests of the parametric models, which are special cases of the semiparametric model, suggest that they are misspecified. We conclude that the semiparametric method is well suited to explore the time-varying impacts of guidelines codifying progressive change.
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Affiliation(s)
- Sarah Price
- Cancer Diagnosis (DISCO) Group, College of Medicine and Health, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK.
| | - Xiaohui Zhang
- Department of Economics, Exeter Business School, University of Exeter, Rennes Drives, Exeter, Devon, EX4 4PU, UK
| | - Anne Spencer
- Health Economics Group, College of Medicine and Health, St Luke's Campus, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
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21
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Abstract
Background Evidence-based Clinical Decision Support Systems (CDSSs) usually obtain clinical evidences from randomized controlled trials based on coarse-grained groups. Individuals who are beyond the scope of the original trials cannot be accurately and objectively supported. Also, patients’ opinions and preferences towards the health care delivered to them have rarely been considered. In this regards, we propose to use clinical experience data as an evidence to support patient-oriented decision-making. Methods The experience data of similar patients from social networks as subjective evidence and the argumentation rules derived from clinical guidelines as objective evidence are combined to support decision making together. They are integrated into a comprehensive decision support architecture. The patient reviews are crawled from social networks and sentimentally analyzed to become structured data which are mapped to the Clinical Sentiment Ontology (CSO). This is used to build a Patient Experience Knowledge Base (PEKB) that can complement the original clinical guidelines. An Experience Inference Engine (EIE) is developed to match similar experience cases from both patient preference features and patient conditions and ultimately, comprehensive clinical recommendations are generated. Results A prototype system is designed and implemented to show the feasibility of the decision support architecture. The system allows patients and domain experts to easily explore various choices and trade-offs via modifying attribute values to select the most appropriate decisions. Conclusions The integrated decision support architecture built is generic to solving a wide range of clinical problems. This will lead to better-informed clinical decisions and ultimately improved patient care.
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22
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Aminawung JA, Hoag JR, Kyanko KA, Xu X, Richman IB, Busch SH, Gross CP. Breast cancer supplemental screening: Women's knowledge and utilization in the era of dense breast legislation. Cancer Med 2020; 9:5662-5671. [PMID: 32537899 PMCID: PMC7402830 DOI: 10.1002/cam4.3218] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/07/2020] [Accepted: 05/24/2020] [Indexed: 01/24/2023] Open
Abstract
Background Given the growth in dense breast notification (DBN) legislation in the United States, we examined the association between different types of DBN laws and supplemental screening behaviors among women. Methods We surveyed in March–April 2018 a nationally representative sample of women aged 40‐59 years who received a routine screening mammogram in the past 18 months. Survey items included the following topics regarding supplemental screening: discussing risks or benefits with a provider, knowledge about the risk of false positives, and utilization. We grouped women by state DBN into non‐DBN, generic DBN (mentions breast density but not supplemental screening), DBN that mentions supplemental screening (DBN‐SS), and DBN with mandated insurance coverage for supplemental screening (DBN‐coverage), and estimated adjusted predicted probabilities for supplemental screening behaviors. Results Of 1641 women surveyed, 21.3% resided in non‐DBN, 41.2% in generic DBN, 25.8% in DBN‐SS, and 12.5% in DBN‐coverage states. Overall, 23.0% of respondents had discussed supplemental screening with a provider, 11.3% of whom discussed the risks, and 49.5% discussed the benefits. In adjusted analysis, women living in DBN‐coverage states were more likely to discuss supplemental screening (27.5%) than women in non‐DBN states (13.6%); pairwise contrast 13.8% (95% CI, 2.1% to 25.6%; P = .01). They were also more likely to have received supplemental screening for increased breast density (19.3%) compared to women living in non‐DBN (9.9%); contrast 9.4% (95% CI, 1.6% to 17.3%; P = .01), Generic DBN (7.3%); difference 12.0% (95% CI, 4.6% to 19.4%; P =< .001), and DBN‐SS (8.8%); contrast 10.5% (95% CI, 2.6% to 18.5%; P < .01) states. Conclusions Women in DBN‐coverage states were more likely to discuss supplemental screening with their providers, and to undergo supplemental screening, compared to women in states with other types of DBN laws, or without DBN laws.
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Affiliation(s)
- Jenerius A Aminawung
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica R Hoag
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Kelly A Kyanko
- Department of Population Health, New York University School of Medicine, New York City, NY, USA
| | - Xiao Xu
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Ilana B Richman
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Susan H Busch
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.,Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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23
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Park HG, Kim YI, Huh WK, Bae S. The association between social media use for health related information and compliance with breast and cervical cancer screenings. RESEARCH REPORTS (MONTGOMERY) 2020; 4:e1-e14. [PMID: 34278179 PMCID: PMC8281882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a need to investigate the impact of social media use on patient compliance with important health screenings due to the inconsistency of research findings on the effect of using social media on cervical cancer screenings. This study assessed associations between social media use and adherence in women at risk for breast and cervical cancer to mammograms and Pap smear screenings. A total of 6695 respondents from the Health Information National Trends Survey (HINTS) 5 Cycle 1 and 2 datasets were used for data analysis. Chi-square tests were used to explore social network activities and cancer screening compliance, and multivariate logistic regressions were used to identify factors associated with cancer screening compliance. Among respondents, 68% of women and 84% of women complied with mammograms and Pap smears, respectively. Women who used the Internet during last 12 months to visit a social networking site, participate in a forum support group for medical issue, or watch a health-related video on YouTube complied with Pap smears more significantly than women who did not use the Internet (p <.05, p <.0001, and p <.001, respectively). Variables associated with mammogram and Pap smear screening compliance were age, health insurance, regular provider, marital status, and internet use. There was no significant association between social network activities and compliance with mammogram screenings. It is critical to use the same and up-to-date guidelines when reporting cancer screening rates to effectively promote adherence to cancer prevention programs and make valid and reliable comparisons across studies.
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Affiliation(s)
- HyounKyoung G. Park
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
| | - Warner K. Huh
- Division of Gyn Oncology, University of Alabama at Birmingham, 1201 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
| | - Sejong Bae
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave. South, Birmingham, Alabama 35205, United States
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 Univ. Blvd, Birmingham, Alabama 35205, United States
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24
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Breast cancer diagnosis using thermography and convolutional neural networks. Med Hypotheses 2020; 137:109542. [DOI: 10.1016/j.mehy.2019.109542] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
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25
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Nguyen HV. Association of Canada's Provincial Bans on Electronic Cigarette Sales to Minors With Electronic Cigarette Use Among Youths. JAMA Pediatr 2020; 174:e193912. [PMID: 31682725 PMCID: PMC7017978 DOI: 10.1001/jamapediatrics.2019.3912] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Banning electronic cigarette (e-cigarette) sales to minors has been a key policy to protect children from e-cigarettes in the United States and Canada, but to date little is known about the outcome of such a ban. OBJECTIVES To investigate the association of banning e-cigarette sales to minors in Canada with e-cigarette use among youths and the mechanisms through which a ban might be associated with their e-cigarette use. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental difference-in-differences and triple-differences study used data from the nationally representative Canadian Tobacco, Alcohol and Drugs Survey (2013-2017) and Canadian Student Tobacco, Alcohol and Drugs Survey (2014-2017). Study samples consisted of respondents aged 15 to 18 years (in difference-in-differences analysis; n = 8212) and aged 15 to 25 years (in triple-differences analysis; n = 20 934) in the Canadian Tobacco, Alcohol and Drugs Survey, and students in grades 6 to 12 (in difference-in-differences analysis; n = 78 650) in the Canadian Student Tobacco, Alcohol and Drugs Survey. INTERVENTIONS Canada's provincial bans on e-cigarette sales to youths younger than 18 or 19 years (depending on province) implemented between 2015 and 2017. MAIN OUTCOMES AND MEASURES The primary outcome was past 30-day e-cigarette use among youths. Secondary outcomes were difficulty of access to e-cigarettes, perception of e-cigarette harm, and use of social sources of e-cigarettes. RESULTS After the bans, e-cigarette use among youths increased in all provinces, but the increase was 3.1 percentage points (95% CI, 0.2-6.0; P = .04), or 79%, lower in provinces with a ban than in provinces without a ban. Youths in provinces with a ban were 2.6 percentage points (95% CI, 1.5-3.7; P = .001), or 18%, less likely to believe that regular e-cigarette use poses no harm and 6.2 percentage points (95% CI, 1.1-11.4; P = .02), or 16%, more likely to self-report greater difficulty in obtaining e-cigarettes. Among youths who reported using e-cigarettes, the likelihood of obtaining e-cigarettes from social sources was 17.3 percentage points (95% CI, 5.2 -29.4; P = .01), or 29%, higher in provinces with a ban. These findings were robust to several sensitivity analyses. CONCLUSIONS AND RELEVANCE Banning e-cigarette sales to minors was associated with a significant reduction in the rate of increase in e-cigarette use by youths, but this policy alone could not reverse the overall increase in e-cigarette use. The findings from this study suggest that this policy should be supplemented with other measures that can reduce young people's desire to obtain e-cigarettes through social sources, such as a ban on e-cigarettes with flavors that appeal to youths and children.
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Affiliation(s)
- Hai V. Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St John’s, Newfoundland and Labrador, Canada
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26
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Taheri M, Tavakol M, Akbari ME, Anoshirvani AA, Aghabozorgi R, Almasi-Hashiani A, Abbasi M. Socioeconomic inequalities in metastasis, recurrence, stage and grade of breast cancer: a hospital-based retrospective cohort study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E262-E269. [PMID: 31650064 PMCID: PMC6797882 DOI: 10.15167/2421-4248/jpmh2019.60.3.1162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/17/2019] [Indexed: 01/04/2023]
Abstract
Introduction This study aims to estimate the Socio-Economic Status (SES) inequality on the metastasis, recurrence, stage and grade in Breast Cancer (BC). Methods This retrospective cohort study conducted on 411 BC patients in Arak, Iran. Asset-based questionnaire used to estimate the household SES. For calculate of SES inequality was used from Concentration Index (C). Moreover for investigate the association between recurrence and metastasis with other variables were used from multilevel logistic regression and analysis of variance were used to investigate the relationship between SES and other variables. The data were analyzed with Stata (v.13) software. Results Results of analysis of variance showed statistical significant relationship between SES with, insurance, surgery, grade, stage, recurrence and metastasis (p-value < 0.05). Moreover the Odds Ratio (OR) were significant of recurrence with age, academic level of education, supplementary insurance history of BC in first-degree relatives, stage and grade, also, metastasis with age of > 80 years, insurance, supplementary insurance, history of BC in first-degree relatives, chemotherapy, radiotherapy, stage and grade four. The total C index obtained 0.015 (0.002, 0.026), 0.011 (0.003, 0.031), – 0.014 (– 0.034, – 0.001) and – 0.042 (– 0.061, – 0.002) for metastasis, recurrence, stage and grade of BC respectively. Conclusions Our results showed evidence of inequality in the metastasis, recurrence, stage and grade in BC patients.
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Affiliation(s)
- M Taheri
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Tavakol
- Sociology Department, School of Social Sciences, University of Tehran, Tehran, Iran
| | - M E Akbari
- Cancer Research Center (CRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A A Anoshirvani
- Department of Hematology and Medical Oncology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - R Aghabozorgi
- Department of Hematology and Medical Oncology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - A Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - M Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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27
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Tran L, Tran P. US urban-rural disparities in breast cancer-screening practices at the national, regional, and state level, 2012-2016. Cancer Causes Control 2019; 30:1045-1055. [PMID: 31428890 DOI: 10.1007/s10552-019-01217-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies suggesting that rural US women may be less likely to have a recent mammogram than urban women are limited in either scope or granularity. This study explored urban-rural disparities in US breast cancer-screening practices at the national, regional, and state levels. METHODS We used data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance Systems surveys. Logistic models were utilized to examine the impact of living in an urban/rural area on mammogram screening at three geographic levels while adjusting for covariates. We then calculated average adjusted predictions (AAPs) and average marginal effects (AMEs) to isolate the association between breast cancer screening and the urban/rural factor. RESULTS At all geographic levels, AAPs of breast cancer screening were similar among urban, suburban, and rural residents. Regarding "ever having a mammogram" and "having a recent mammogram," urban women had small but significantly higher adjusted probabilities (AAP: 94.6%, 81.1%) compared to rural women (AAP: 93.5%, 80.2%). CONCLUSIONS While urban-rural differences in breast cancer screening are small, they can translate into tens of thousands of rural women not receiving mammograms. Hence, there is a need to continue screening initiatives in these areas to reduce the number of breast cancer deaths.
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Affiliation(s)
- Lam Tran
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Phoebe Tran
- Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, USA
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28
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Busch SH, Hoag JR, Aminawung JA, Xu X, Richman IB, Soulos PR, Kyanko KA, Gross CP. Association of State Dense Breast Notification Laws With Supplemental Testing and Cancer Detection After Screening Mammography. Am J Public Health 2019; 109:762-767. [PMID: 30896987 DOI: 10.2105/ajph.2019.304967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the association of state dense breast notification (DBN) laws with use of supplemental tests and cancer diagnosis after screening mammography. METHODS We examined screening mammograms (n = 1 441 544) performed in 2014 and 2015 among privately insured women aged 40 to 59 years living in 9 US states that enacted DBN laws in 2014 to 2015 and 25 US states with no DBN law in effect. DBN status at screening mammography was categorized as no DBN, generic DBN, and DBN that mandates notification of possible benefits of supplemental screening (DBN+SS). We used logistic regression to examine the change in rate of supplemental ultrasound, magnetic resonance imaging, breast biopsy, and breast cancer detection. RESULTS DBN+SS laws were associated with 10.5 more ultrasounds per 1000 mammograms (95% CI = 3.0, 17.6 per 1000; P = .006) and 0.37 more breast cancers detected per 1000 mammograms (95% CI = 0.05, 0.69 per 1000; P = .02) compared with no DBN law. No significant differences were found for generic DBN laws in either ultrasound or cancer detection. CONCLUSIONS DBN legislation is associated with increased use of ultrasound and cancer detection after implementation only when notification of the possible benefits of supplemental screening is required.
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Affiliation(s)
- Susan H Busch
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Jessica R Hoag
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Jenerius A Aminawung
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Xiao Xu
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Ilana B Richman
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Pamela R Soulos
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Kelly A Kyanko
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Cary P Gross
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
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Buchmueller TC, Goldzahl L. The effect of organized breast cancer screening on mammography use: Evidence from France. HEALTH ECONOMICS 2018; 27:1963-1980. [PMID: 30084221 DOI: 10.1002/hec.3813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/07/2018] [Accepted: 07/01/2018] [Indexed: 06/08/2023]
Abstract
In 2004, France introduced a national program of organized breast cancer screening. The national program built on preexisting local programs in some, but not all, départements. Using data from multiple waves of a nationally representative biennial survey of the French population, we estimate the effect of organized screening on the percentage of women obtaining a mammogram. The analysis uses difference-in-differences methods to exploit the fact that the program was targeted at women in a specific age group: 50 to 74 years old. We find that organized screening significantly raised mammography rates among women in the target age range. Just above the lower age threshold, the percentage of women reporting that they had a mammogram in the past 2 years increased by over 10 percentage points after the national program went into effect. Mammography rates increased even more among women in their 60s. Estimated effects are particularly large for women with less education and lower incomes, suggesting that France's organized screening program has reduced socioeconomic disparities in access to mammography.
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Affiliation(s)
- Thomas C Buchmueller
- Ross School of Business, University of Michigan, Ann Arbor, Michigan
- NBER, Cambridge, Massachusetts
| | - Léontine Goldzahl
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
- EDHEC Business School, Roubaix, France
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Wing C, Simon K, Bello-Gomez RA. Designing Difference in Difference Studies: Best Practices for Public Health Policy Research. Annu Rev Public Health 2018; 39:453-469. [DOI: 10.1146/annurev-publhealth-040617-013507] [Citation(s) in RCA: 553] [Impact Index Per Article: 92.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Coady Wing
- School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana 47405, USA;,
| | - Kosali Simon
- School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana 47405, USA, and National Bureau of Economic Research
| | - Ricardo A. Bello-Gomez
- School of Public and Environmental Affairs, Indiana University, Bloomington, Indiana 47405, USA;,
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Jacobson M, Kadiyala S. When Guidelines Conflict: A Case Study of Mammography Screening Initiation in the 1990s. Womens Health Issues 2017; 27:692-699. [PMID: 28935360 PMCID: PMC5694381 DOI: 10.1016/j.whi.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cancer screening guidelines communicate important information to patients and physicians regarding the costs and benefits of screening. Currently, guideline recommendations from major organizations conflict regarding the age of mammography screening initiation. To understand current and future U.S. mammography screening patterns we study age-mammography patterns from the 1990s, another period of conflicting guideline recommendations. METHODS We examine mammography use rates by single year of age to understand compliance with guideline-recommended initiation ages in the 1990s. Mammography test use data was taken primarily from the 1991 to 2001 Behavioral Risk Factor Surveillance System. The analytic sample included all women 35 to 54 years of age. RESULTS We found a discrete 8.7-percentage point increase in mammography use precisely at age 40 and a much smaller 1.6-percentage point increase in mammography use at age 50. These findings varied by insurance status, with the insured experiencing a large, discrete increase primarily at age 40 and the uninsured experiencing notable discrete increases at ages 40 and 50. CONCLUSION Physicians and patients converged primarily on the age 40 mammography screening threshold during the 1990s. Prices, along with guidelines, were key determinants of the age of screening initiation, with the insured responding to age 40 coverage and cost-sharing reductions and the uninsured affected by guidelines and public funding tied to the age 50 threshold. The policy factors underlying these results, recent ACA coverage increases, and ACA cost-sharing requirements imply that a substantial number of women will continue to receive mammography screening in their 40s.
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Affiliation(s)
- Mireille Jacobson
- University of California Irvine, Paul Merage School of Business, and National Bureau of Economic Research, California
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32
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Kim HB, Lee SM. When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program. JOURNAL OF HEALTH ECONOMICS 2017; 53:100-116. [PMID: 28340393 DOI: 10.1016/j.jhealeco.2017.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 06/06/2023]
Abstract
This study investigates the impact of and behavioral responses to cost sharing in Korea's National Cancer Screening Program, which provides free stomach and breast cancer screenings to those with an income below a certain cutoff. Free cancer screening substantially increases the screening take up rate, yielding more cancer detections. However, the increase in cancer detection is quickly crowded out by cancer detection through other channels such as diagnostic testing and private cancer screening. Further, compliers are much less likely to have cancer than never takers. Crowd-out and selection help explain why the program has been unable to reduce cancer mortality.
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Affiliation(s)
- Hyuncheol Bryant Kim
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY 14853, United States.
| | - Sun-Mi Lee
- National Health Insurance System (NHIS), Seoul, Republic of Korea.
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33
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Bitler MP, Carpenter CS. Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates. Health Serv Res 2016; 52:156-175. [PMID: 26989837 DOI: 10.1111/1475-6773.12477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women. DATA SOURCES Individual-level data on 600,000 women age 19-64 from the CDC's Behavioral Risk Factor Surveillance System. STUDY DESIGN Twenty-four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference-in-differences analysis comparing within-state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate. PRINCIPAL FINDINGS Difference-in-differences estimates indicated that the Pap test mandates significantly increased past 2-year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non-Hispanic white women. These effects are plausibly concentrated among insured women. CONCLUSIONS Mandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.
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Affiliation(s)
| | - Christopher S Carpenter
- Department of Economics, Vanderbilt University, Nashville, TN.,Department of Health Policy, Vanderbilt University, Nashville, TN.,Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN
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34
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Dehkordy SF, Hall KS, Roach AL, Rothman ED, Dalton VK, Carlos RC. Trends in Breast Cancer Screening: Impact of U.S. Preventive Services Task Force Recommendations. Am J Prev Med 2015; 49:419-22. [PMID: 25841980 PMCID: PMC4546897 DOI: 10.1016/j.amepre.2015.02.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/12/2015] [Accepted: 02/24/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although there is general agreement among various guidelines on benefits of routine screening mammography, the age of screening initiation and the optimal frequency of the test remain controversial. In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended against routine breast cancer screening in women aged younger than 50 years. In this study, screening mammography guideline adherence among U.S. women is explored by examining patterns in rates of mammography age of initiation and utilization in years prior to and following the 2009 USPSTF guideline implementation. METHODS U.S. population-based data from the 2007, 2008, 2010, and 2012 Behavioral Risk Factor Surveillance System surveys were used to measure the overall proportion and rate of change in the proportion of women who underwent screening mammography within the last year, by age and survey year. Data were accessed and analyzed in July 2014. RESULTS Rates of mammography screening were lower in 2010 and 2012 compared with 2007 and 2008 (p<0.0001). The rate of screening initiation at age 40 years increased over time and was the highest in the years following USPSTF guideline changes (p=0.012). CONCLUSIONS These data support no perceptible change in U.S. women's patterns of screening mammography age at initiation within 3 years of the USPSTF guideline revision. Whether this finding reflects a delayed effect of guideline revision in population trends or rather health provider practice and patient preference for more frequent screening is unclear and requires further investigation.
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Affiliation(s)
| | - Kelli S Hall
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine; Institute for Social Research, Population Studies Center
| | - Allison L Roach
- Department of Statistics ,University of Michigan, Ann Arbor, Michigan
| | - Edward D Rothman
- Department of Statistics ,University of Michigan, Ann Arbor, Michigan
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine; University of Michigan Institute for Healthcare Policy and Innovation
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine; University of Michigan Institute for Healthcare Policy and Innovation; University of Michigan Program for Imaging Comparative Effectiveness and Health Services Research
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