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Daniel CL, Fillingim S, James J, Bassler J, Lee A. Long COVID prevalence and associated characteristics among a South Alabama population. Public Health 2023; 221:135-141. [PMID: 37451202 DOI: 10.1016/j.puhe.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Long COVID can significantly impact a patient's quality of life. Defined as persistence or emergence of symptoms 4+ weeks after initial COVID-19 diagnosis, long COVID can result in functional impairments, pulmonary issues, and neuropsychiatric conditions, among others. This study aims to identify long COVID risk factors and prevalence in a south Alabama (US) patient population. STUDY DESIGN This was a longitudinal cohort study. METHODS Postdiagnosis standardized phone interviews (baseline, 6 months, and 12 months) from April 2020 to July 2021 with patients testing positive through a large healthcare system. Interviews gathered data on sociodemographics, comorbidities, acute illness, and long COVID. Relationships between 1+ ongoing symptoms and variables of interest were assessed using a generalized estimating equation to conduct multivariate analysis. RESULTS Of the 516 participants, most were female (65%) and African American (57%, n = 293), with a median (interquartile range) age of 41.1 (25.3-54.6) years. Retention was 70% (n = 359) at 6 months and 58% (n = 301) at 12 months. Participants reporting 1+ persistent symptoms were 20% and 17% at 6 and 12 months, respectively. Illness severity (P < 0.0001) and COVID-related emergency room visit with hospital admission at the time of diagnosis (P = 0.0018) were significantly associated with increased long COVID risk. CONCLUSIONS This study found substantial rates of long COVID within our population, with stable rates at 6 and 12 months, indicating illness persistence. Our findings support growing concern for long COVID as a persistent issue within the medical community, with potential to impact patient health for years. Larger, more uniform studies are required to further characterize disease risk factors and clinical course to inform the disease management.
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Affiliation(s)
- C L Daniel
- University of South Alabama, College of Medicine at Mobile, AL, USA.
| | - S Fillingim
- University of South Alabama, College of Medicine at Mobile, AL, USA
| | - J James
- University of South Alabama, College of Medicine at Mobile, AL, USA
| | - J Bassler
- University of Alabama at Birmingham, AL, USA
| | - A Lee
- University of South Alabama, College of Medicine at Mobile, AL, USA
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Lee HY, Daniel CL, Wang K, McLendon L, Coyne-Beasley T. HPV Vaccination among College Students in the South: The Role of HPV Knowledge on Vaccine Initiation and Completion. Asian Pac J Cancer Prev 2023; 24:2149-2156. [PMID: 37378947 PMCID: PMC10505885 DOI: 10.31557/apjcp.2023.24.6.2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine factors related to HPV vaccination initiation and completion, especially the role of health knowledge, among college students in a southern state. METHODS College students ages 17-45 (n=1,708) were analyzed in this study. Primary outcomes were HPV vaccine series initiation and completion; binary logistic regressions were performed to identify associated factors. RESULTS Among total participants, students who were aware that HPV could be transmitted even without symptoms were less likely to initiate HPV vaccination. However, among students who have initiated the vaccine series, those who were aware that HPV could be transmitted without symptoms and that men should receive the HPV vaccine were more likely to complete the vaccine series. Other significant variables included age, gender, race, and international student status. CONCLUSION Future studies are needed to investigate students' concerns regarding initiating HPV vaccination and how to effectively motivate students to initiate and complete the HPV vaccine series.
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Affiliation(s)
- Hee Y. Lee
- School of Social Work, Associate Dean for Research, Endowed Academic Chair on Social Work and Health, The University of Alabama, Tuscaloosa, AL 35487, United States.
| | - Casey L. Daniel
- USA Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, United States.
| | - Kun Wang
- Department of Social Work, Binghamton University, Binghamton, NY, 13905, United States.
| | - Lane McLendon
- USA Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, United States.
| | - Tamera Coyne-Beasley
- USA Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, United States.
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Geller AC, Coroiu A, Keske RR, Haneuse S, Davine JA, Emmons KM, Daniel CL, Gibson TM, McDonald AJ, Robison LL, Mertens AC, Elkin EB, Marghoob A, Armstrong GT. Advancing Survivors Knowledge (ASK Study) of Skin Cancer Surveillance After Childhood Cancer: A Randomized Controlled Trial in the Childhood Cancer Survivor Study. J Clin Oncol 2023; 41:2269-2280. [PMID: 36623247 PMCID: PMC10448942 DOI: 10.1200/jco.22.00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To improve skin cancer screening among survivors of childhood cancer treated with radiotherapy where skin cancers make up 58% of all subsequent neoplasms. Less than 30% of survivors currently complete recommended skin cancer screening. PATIENTS AND METHODS This randomized controlled comparative effectiveness trial evaluated patient and provider activation (PAE + MD) and patient and provider activation with teledermoscopy (PAE + MD + TD) compared with patient activation alone (PAE), which included print materials, text messaging, and a website on skin cancer risk factors and screening behaviors. Seven hundred twenty-eight participants from the Childhood Cancer Survivor Study (median age at baseline 44 years), age > 18 years, treated with radiotherapy as children, and without previous history of skin cancer were randomly assigned (1:1:1). Primary outcomes included receiving a physician skin examination at 12 months and conducting a skin self-examination at 18 months after intervention. RESULTS Rates of physician skin examinations increased significantly from baseline to 12 months in all three intervention groups: PAE, 24%-39%, relative risk [RR], 1.65, 95% CI, 1.32 to 2.08; PAE + MD, 24% to 39%, RR, 1.56, 95% CI, 1.25 to 1.97; PAE + MD + TD, 24% to 46%, RR, 1.89, 95% CI, 1.51 to 2.37. The increase in rates did not differ between groups (P = .49). Similarly, rates of skin self-examinations increased significantly from baseline to 18 months in all three groups: PAE, 29% to 50%, RR, 1.75, 95% CI, 1.42 to 2.16; PAE + MD, 31% to 58%, RR, 1.85, 95% CI, 1.52 to 2.26; PAE + MD + TD, 29% to 58%, RR, 1.95, 95% CI, 1.59 to 2.40, but the increase in rates did not differ between groups (P = .43). CONCLUSION Although skin cancer screening rates increased more than 1.5-fold in each of the intervention groups, there were no differences between groups. Any of these interventions, if implemented, could improve skin cancer prevention behaviors among childhood cancer survivors.
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Affiliation(s)
- Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Robyn R. Keske
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica A. Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Casey L. Daniel
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Todd M. Gibson
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, MD
| | - Aaron J. McDonald
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Ann C. Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Elena B. Elkin
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY
| | - Ashfaq Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
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Koskan AM, Teeter BS, Daniel CL, LoCoco IE, Jensen UT, Ayers SL. U.S. adults' reasons for changing their degree of willingness to vaccinate against COVID-19. Z Gesundh Wiss 2023:1-13. [PMID: 36694558 PMCID: PMC9852802 DOI: 10.1007/s10389-023-01819-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
Introduction COVID-19 vaccines significantly reduce the risk of complications and hospitalizations due to this virus. When COVID-19 vaccines first became commercially available, roughly 30% of U.S. adults reported being hesitant to receive these newly developed vaccines, and 15% said they would not receive the vaccine. However, by May 2021, 19% of adults were vaccine-hesitant, and 13% refused to vaccinate against COVID-19. It is critical to understand why adults' degree of willingness to vaccinate against COVID-19 changed over time to plan for future pandemics and vaccination campaigns. Methods We conducted two waves of survey research over five months (January and May 2021) with a panel of 890 U.S. adults. One survey question assessed willingness to vaccinate against COVID-19. The response option included a slider scale ranging from 0 (signifying complete unwillingness) to 10 (complete willingness). We asked participants whose willingness score changed by more than one point to report their rationale for their change in perceptions. We conducted a conventional content analysis on all qualitative responses. Results We analyzed qualitative responses for 289 participants, 54.7% of whom had not been vaccinated against COVID-19 by May 2021. Among those who remained unvaccinated, 36.1% reported increased willingness to vaccinate. The most commonly cited reasons for becoming more willing to receive the vaccine include believing that COVID-19 vaccines are safe and effective, protecting against the pandemic, and desiring to return to pre-pandemic life. Reasons for increased COVID-19 vaccine hesitancy include vaccine safety concerns, the low perceived need for the vaccine, distrust in how COVID-19 vaccines are made and of larger institutions such as the government and pharmaceutical companies, and concerns about vaccine effectiveness. Conclusion Findings illuminate the rationale behind individuals' changes in their degree of willingness to vaccinate against COVID-19. It is critical to incorporate these considerations in future vaccine rollout initiatives to increase the public's vaccine confidence.
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Affiliation(s)
- Alexis M. Koskan
- College of Health Solutions, Arizona State University, 425 N. 5th Street, Phoenix, AZ USA
| | - Benjamin S. Teeter
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR USA
| | - Casey L. Daniel
- Department of Family Medicine, University of South Alabama Health Whiddon College of Medicine, 5795 USA North Drive, Mobile, AL USA
| | - Iris E. LoCoco
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ USA
| | - Ulrich T. Jensen
- School of Public Affairs, Arizona State University, 411 N Central Ave Suite 400, Phoenix, AZ USA
| | - Stephanie L. Ayers
- School of Public Affairs, Arizona State University, 411 N Central Ave Suite 400, Phoenix, AZ USA
- Southwest Interdisciplinary Research Center (SIRC), Arizona State University, 400 E Van Buren St, Phoenix, AZ USA
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Koskan AM, LoCoco IE, Daniel CL, Teeter BS. Rural Americans' COVID-19 Vaccine Perceptions and Willingness to Vaccinate against COVID-19 with Their Community Pharmacists: An Exploratory Study. Vaccines (Basel) 2023; 11:vaccines11010171. [PMID: 36680016 PMCID: PMC9864964 DOI: 10.3390/vaccines11010171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
In early 2022 in the U.S., rural adults were the least likely to vaccinate against COVID-19 due to vaccine hesitancy and reduced healthcare access. This study explored the factors influencing rural adults' COVID-19 vaccine perceptions and their acceptance of pharmacist-administered vaccination. We utilized phone-based semi-structured interviews with 30 adults living in rural regions of one southwestern state and analyzed the data using a team-based thematic analysis approach. Vaccine-willing participants described knowing other people affected by the virus and their desired protection from the virus. They reported trusting scientific institutions and the government to provide safe vaccines. Vaccine-hesitant populations, however, feared that the COVID-19 vaccine development process had been rushed, compromising the safety of these newer vaccines. Although they differed in the news sources they preferred for receiving COVID-19 vaccine information, both vaccine-willing and vaccine-hesitant participants described trusting local authorities, such as healthcare providers and county government officials, to provide accurate COVID-19 vaccine information. Regarding the acceptability of pharmacist-administered COVID-19 vaccinations, all but one participant described their acceptance of this healthcare delivery approach. Future outreach should leverage rural adults' trust in local sources, including community pharmacists, deemed more convenient access points to healthcare, when addressing vaccine hesitancy.
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Affiliation(s)
- Alexis M. Koskan
- College of Health Solutions, Arizona State University, 425 N 5th Street, Phoenix, AZ 85004, USA
- Correspondence:
| | - Iris E. LoCoco
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 550 E Van Buren Street, Phoenix, AZ 85006, USA
| | - Casey L. Daniel
- Department of Family Medicine, Whiddon College of Medicine, University of South Alabama, 5795 USA North Drive, Mobile, AL 36608, USA
| | - Benjamin S. Teeter
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W Markham St., Little Rock, AR 72205, USA
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Rocque GB, Dent DN, Ingram SA, Caston NE, Thigpen HB, Lalor FR, Jamy OH, Giri S, Azuero A, Young Pierce J, McGowen CL, Daniel CL, Andrews CJ, Huang CHS, Dionne-Odom JN, Weiner BJ, Howell D, Jackson BE, Basch EM, Stover AM. Adaptation of Remote Symptom Monitoring Using Electronic Patient-Reported Outcomes for Implementation in Real-World Settings. JCO Oncol Pract 2022; 18:e1943-e1952. [PMID: 36306496 PMCID: PMC9750550 DOI: 10.1200/op.22.00360] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. METHODS This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semistructured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. RESULTS Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. CONCLUSION Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.
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Affiliation(s)
- Gabrielle B. Rocque
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - D’Ambra N. Dent
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Stacey A. Ingram
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Nicole E. Caston
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Haley B. Thigpen
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Fallon R. Lalor
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Omer H. Jamy
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - Smith Giri
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
| | | | | | - Casey L. Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Courtney J. Andrews
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, AL
| | - Chao-Hui Sylvia Huang
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
| | - J. Nicholas Dionne-Odom
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
| | - Bryan J. Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bradford E. Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela M. Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- University of North Carolina at Chapel Hill Department of Health Policy and Management, Chapel Hill, NC
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Dent D, Ingram SA, Caston NE, Thigpen H, Lalor F, Jamy O, Giri S, Azuero A, Young Pierce J, McGowen CL, Daniel CL, Andrews CJ, Huang CH, Dionne-Odom JN, Weiner BJ, Howell D, Jackson BE, Stover AM, Rocque GB. Adaptation of remote symptom monitoring using electronic patient-reported outcomes for implementation in real-world settings. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
272 Background: Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. Methods: This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman’s Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (Phase I) and workflow (Phase II and III) using electronic health data; qualitative evaluation with semi-structured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. Results: Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real-time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. Conclusions: Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.
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Affiliation(s)
| | | | | | | | - Fallon Lalor
- University of Alabama at Birmingham, Birmingham, AL
| | - Omer Jamy
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Smith Giri
- University of Alabama at Birmingham, Alabama, AL
| | | | | | | | - Casey L. Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | | | | | | | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Rocque GB, Dionne-Odom JN, Stover AM, Daniel CL, Azuero A, Huang CHS, Ingram SA, Franks JA, Caston NE, Dent DAN, Basch EM, Jackson BE, Howell D, Weiner BJ, Pierce JY. Evaluating the implementation and impact of navigator-supported remote symptom monitoring and management: a protocol for a hybrid type 2 clinical trial. BMC Health Serv Res 2022; 22:538. [PMID: 35459238 PMCID: PMC9027833 DOI: 10.1186/s12913-022-07914-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms in patients with advanced cancer are often inadequately captured during encounters with the healthcare team. Emerging evidence demonstrates that weekly electronic home-based patient-reported symptom monitoring with automated alerts to clinicians reduces healthcare utilization, improves health-related quality of life, and lengthens survival. However, oncology practices have lagged in adopting remote symptom monitoring into routine practice, where specific patient populations may have unique barriers. One approach to overcoming barriers is utilizing resources from value-based payment models, such as patient navigators who are ideally positioned to assume a leadership role in remote symptom monitoring implementation. This implementation approach has not been tested in standard of care, and thus optimal implementation strategies are needed for large-scale roll-out. Methods This hybrid type 2 study design evaluates the implementation and effectiveness of remote symptom monitoring for all patients and for diverse populations in two Southern academic medical centers from 2021 to 2026. This study will utilize a pragmatic approach, evaluating real-world data collected during routine care for quantitative implementation and patient outcomes. The Consolidated Framework for Implementation Research (CFIR) will be used to conduct a qualitative evaluation at key time points to assess barriers and facilitators, implementation strategies, fidelity to implementation strategies, and perceived utility of these strategies. We will use a mixed-methods approach for data interpretation to finalize a formal implementation blueprint. Discussion This pragmatic evaluation of real-world implementation of remote symptom monitoring will generate a blueprint for future efforts to scale interventions across health systems with diverse patient populations within value-based healthcare models. Trial registration NCT04809740; date of registration 3/22/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07914-6.
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Affiliation(s)
- Gabrielle B Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA. .,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
| | - J Nicholas Dionne-Odom
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Angela M Stover
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Casey L Daniel
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Chao-Hui Sylvia Huang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Jeffrey A Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Nicole E Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - D' Ambra N Dent
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bryan J Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Brandt HM, Kepka D, Kirchhoff AC, Daniel CL, Bhatt NS. Human papillomavirus (HPV) vaccination is cancer prevention for childhood cancer survivors. Cancer 2022; 128:237-239. [PMID: 34606629 PMCID: PMC8738104 DOI: 10.1002/cncr.33920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/17/2023]
Abstract
Childhood cancer survivors are at high risk for developing human papillomavirus (HPV)-associated subsequent neoplasms. Henderson et al., 2021 identified risk factors for subsequent HPV-associated malignant neoplasms among enrollees in the Childhood Cancer Survivor Study. The exacerbated risk of subsequent HPV cancers found in the study underscores the need for more stringent surveillance and tracking to inform intervention approaches to ensure maximal protection. In addition, HPV vaccination must be prioritized as part of transitional care and survivorship planning. Limited sources of data on survivor practices and outcomes results in limited information to develop guidelines and provide childhood cancer survivors with information on preventing subsequent HPV cancers. Improved efforts are needed to increase HPV vaccination and HPV-related surveillance among childhood cancer survivors to prevent subsequent neoplasms. Childhood cancer survivors are at increased risk of developing a subsequent cancer caused by human papillomavirus or HPV. HPV is a very common and usually benign sexually transmitted infection. HPV vaccination and screening can prevent most HPV cancers. However, childhood cancer survivors have lower HPV vaccination rates than individuals without a cancer history. To help prevent subsequent HPV cancers among childhood cancer survivors, we must gather better information and work to improve HPV vaccination recommendations and acceptance. Childhood cancer survivors are at high risk for developing subsequent human papillomavirus (HPV)-associated cancers; Henderson et al., 2021, examined risk factors for subsequent malignant neoplasms associated with HPV among enrollees in the Childhood Cancer Survivor Study. Improved, targeted efforts to increase HPV vaccination and HPV-related surveillance among childhood cancer survivors are needed.
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Affiliation(s)
- Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105
| | - Deanna Kepka
- University of Utah College of Nursing, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
| | - Anne C. Kirchhoff
- University of Utah Department of Pediatrics, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
| | - Casey L. Daniel
- University of South Alabama College of Medicine, 1660 Springhill Avenue, Mobile, AL, 36604
| | - Neel S. Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-390, Seattle, WA, 98109
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Daniel CL, Williams J, Legg R, McGowen C, Stutzman J. Factors associated with COVID-19 vaccination intentions among adults in the deep South. Vaccine 2022; 40:841-853. [PMID: 35034834 PMCID: PMC8744449 DOI: 10.1016/j.vaccine.2021.12.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 12/14/2021] [Accepted: 12/26/2021] [Indexed: 11/30/2022]
Abstract
The recent approval of several COVID-19 vaccines signals progress toward controlling the pandemic. Although social distancing and masking have been effective, vaccines are an important additional measure of protection to reduce COVID-19 spread. Adequate uptake is essential to reach herd immunity, estimated to be approximately 67%. However, vaccine hesitancy, the fast-tracked nature of the COVID-19 vaccines, and misinformation circulating through various forms of media have contributed to lower vaccination intention than desired. The current research study developed an online survey conducted via Facebook to explore the attitudes and perceptions of adult Alabama residents about COVID-19 and the COVID-19 vaccines. Of the 3,781 respondents, only 44.3% reported intent to receive a vaccine, with a large proportion reporting they were unsure (28.1%). Lack of intention to vaccinate was associated with low educational attainment, low COVID-19 knowledge levels, low income, and African American race. The current survey also explored participants’ influenza vaccine behavior as this information can also be used to inform successful COVID-19 vaccine distribution. Of the respondents, 56% report receiving the yearly influenza vaccine and the majority receive it at a pharmacy or healthcare provider office. This informs likely successful locations for COVID-19 vaccine distribution. Appropriate education targeted to populations most likely to refuse COVID-19 vaccination is essential to promote uptake. The information collected from the current study should be utilized to inform effective and efficient vaccine distribution strategies.
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Affiliation(s)
- Casey L Daniel
- University of South Alabama College of Medicine, Mobile, AL 36604, United States; University of South Alabama Mitchell Cancer Institute, Mobile, AL 36604, United States.
| | - Jacob Williams
- University of South Alabama College of Medicine, Mobile, AL 36604, United States
| | - Rachel Legg
- University of South Alabama College of Medicine, Mobile, AL 36604, United States
| | - Chelsea McGowen
- University of South Alabama Mitchell Cancer Institute, Mobile, AL 36604, United States
| | - Jesse Stutzman
- University of South Alabama College of Medicine, Mobile, AL 36604, United States
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11
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Daniel CL, Atkins A. HPV vaccination disparities and strategies to prevent oropharyngeal cancer in males. Prev Med Rep 2021; 24:101521. [PMID: 34466373 PMCID: PMC8383099 DOI: 10.1016/j.pmedr.2021.101521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Casey L Daniel
- University of South Alabama College of Medicine, Mobile, AL, USA
| | - Amanda Atkins
- University of South Alabama College of Medicine, Mobile, AL, USA
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12
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Daniel CL, Lawson F, Vickers M, Green C, Wright A, Coyne-Beasley T, Lee HY, Turberville S. Enrolling a rural community pharmacy as a Vaccines for Children provider to increase HPV vaccination: a feasibility study. BMC Public Health 2021; 21:1266. [PMID: 34187438 PMCID: PMC8240772 DOI: 10.1186/s12889-021-11304-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. with over 80 million infected individuals. High-risk strains are associated with 6 different cancers. Although infection is preventable, U.S. vaccination rates remain suboptimal and there are noted disparities between urban and rural communities due to economic barriers, lack of access, and low awareness and education. Methods The current pilot study sought to overcome these barriers through an interprofessional collaborative enrolling a community pharmacy in a rural, medically underserved Alabama county as a Vaccines for Children (VFC) provider to provide free vaccines to eligible adolescents. Program evaluation was conducted to determine the intervention’s feasibility. Potential efficacy was assessed by analyzing county-level HPV vaccination uptake and completion rates using state immunization registry data. Results Over the 8-month study, 166 total vaccines were administered to 89 adolescents ages 10–18, including 55 doses of HPV vaccine, 53 doses of Tdap vaccine, 45 doses of meningococcal vaccine, and 13 doses of influenza vaccine. Among these adolescents, mean age was 12.6 years old, and 64 (71.9%) were VFC patients. The pharmacy recorded an increase in total vaccine administration of 158.8%, an increase in prescription revenue of 34.8%, and an increase in total revenue by 24.4% during the course of the study, compared to the previous year. Conclusions Findings from the current work demonstrate the potential of this strategy and can serve as a blueprint for statewide and national dissemination and implementation to ultimately increase access to vaccination services, increase vaccination rates, and reduce urban-rural vaccine disparities.
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Affiliation(s)
- Casey L Daniel
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA.
| | - Frances Lawson
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Macy Vickers
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Chelsea Green
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Anna Wright
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hee Y Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Stacie Turberville
- Division of Cancer Control and Prevention, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604, USA
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13
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McLendon L, Puckett J, Green C, James J, Head KJ, Yun Lee H, Young Pierce J, Beasley M, Daniel CL. Factors associated with HPV vaccination initiation among United States college students. Hum Vaccin Immunother 2021; 17:1033-1043. [PMID: 33325794 DOI: 10.1080/21645515.2020.1847583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Human papillomavirus (HPV) remains the most common sexually transmitted infection (STI) in the U.S. despite widespread availability of a safe, effective vaccine. Although young adults are at greatest risk of HPV infection, extensive vaccine promotion and intervention efforts has been directed toward 11-12-year-olds. College students represent an ideal audience for HPV vaccine "catch-up;" however, research indicates inconsistent HPV vaccination rates within this demographic. An online survey assessing HPV and HPV vaccine knowledge and behaviors was distributed to all undergraduate college students at a large, public university in the Deep South region of the U.S. The primary outcome was receipt of HPV vaccination (binary response options of Yes/No). Logistic regression analyses were performed to determine predictors of HPV vaccination. Of the 1,725 who completed the survey, 47.0% reported having received at least one dose of HPV vaccine; overall series completion (series = 3 doses for this population) was 17.4%. The primary outcome was HPV initiation among college students, defined as having received at least one dose of the HPV vaccine. Results indicated substantial gaps in participants' knowledge of their vaccination status. Provider and parental recommendations as well as social influences were shown to significantly impact student vaccination status, emphasizing the importance of incorporating these elements in future interventions, potentially as multi-level strategies. Future college interventions should address HPV and vaccination knowledge and the importance of provider and parental recommendations.
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Affiliation(s)
- Lane McLendon
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jesse Puckett
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Chelsea Green
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jenna James
- Division of Cancer Control and Prevention, University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Jennifer Young Pierce
- Division of Cancer Control and Prevention, University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Mark Beasley
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Casey L Daniel
- Department of Family Medicine, University of South Alabama College of Medicine, Mobile, AL, USA
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14
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Brooks HE, McLendon LA, Daniel CL. The impact of COVID-19 on pediatric vaccination rates in Alabama. Prev Med Rep 2021; 22:101320. [PMID: 33564619 PMCID: PMC7862025 DOI: 10.1016/j.pmedr.2021.101320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 12/02/2022] Open
Abstract
COVID-19 has caused a drastic shift in healthcare delivery, including vaccination. Pediatric vaccination rates in Alabama decreased between 50.8% and 59.2% in 2020. Pediatric vaccination is vital to sustained public health. Alternative ways to increase pediatric vaccination rates must be considered. Routine vaccination cannot be deprioritized throughout the battle against COVID-19.
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Key Words
- ACIP, Advisory Committee on Immunization Practices
- ADPH, Alabama Department of Public Health
- CDC, Centers for Disease Control and Prevention
- COVID-19, coronavirus disease 2019
- ImmPRINT, Immunization Patient Resources with Integrated Technology
- MMR, measles, mumps, and rubella
- Tdap, tetanus, diphtheria, and pertussis
- U.S., United States
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Affiliation(s)
- Hannah E Brooks
- University of South Alabama College of Medicine, 307 North University Bouelvard, Mobile, AL 36688, United States
| | - Lane A McLendon
- University of South Alabama College of Medicine, 307 North University Bouelvard, Mobile, AL 36688, United States
| | - Casey L Daniel
- University of South Alabama College of Medicine, 307 North University Bouelvard, Mobile, AL 36688, United States
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15
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Aly S, Daniel CL, Bae S, Scarinci IC, Hardy CM, Fouad MN, Baskin ML, Hoenemeyer T, Acemgil A, Demark-Wahnefried W. Cancer-related Beliefs and Preventive Health Practices among Residents of Rural versus Urban Counties in Alabama. Cancer Prev Res (Phila) 2021; 14:593-602. [PMID: 33526429 DOI: 10.1158/1940-6207.capr-20-0458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/11/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
Higher prevalence of cancer-related risk factors, for example, tobacco use, obesity, poor diet, and physical inactivity, is observed in the U.S. Deep South and likely contributes to its increased cancer burden. While this region is largely rural, it is unknown whether cancer-related beliefs and lifestyle practices differ by rural-urban status or are more influenced by other factors. We contacted 5,633 Alabamians to complete a cross-sectional survey to discern cancer-related beliefs and lifestyle practices, and compared data from respondents residing in rural- versus urban-designated counties. Findings were summarized using descriptive statistics; rural-urban subgroups were compared using two-tailed, χ 2 and t tests. Multivariable logistic regression models were used to explore associations by rural-urban status and other sociodemographic factors. Surveys were completed by 671 rural- and 183 urban-county respondents (15.2% response rate). Overall, the prevalence for overweight and obesity (77.8%) and sugar-sweetened beverage intake (273-364 calories/day) was higher than national levels. Most respondents (58%) endorsed raising the state tobacco tax. Respondents from rural- versus urban-designated counties were significantly more likely to be racial/ethnic minority, have lower education, employment, income, food security, and internet access, and endorse fatalistic cancer-related beliefs (<0.05; although regression models suggested that cancer belief differences are more strongly associated with education than counties of residence). Lifestyle practices were similar among rural-urban subgroups. Few rural-urban differences in cancer-related beliefs and lifestyle practices were found among survey respondents, although the high overall prevalence of fatalistic health beliefs and suboptimal lifestyle behaviors suggests a need for statewide cancer prevention campaigns and policies, including increased tobacco taxation.Prevention Relevance: Cancer incidence and mortality are higher in the U.S. Deep South, likely due to increased tobacco-use, obesity, poor diet, and physical inactivity. This study explores whether cancer-related beliefs and lifestyle practices differ by rural-urban status or other sociodemographic factors in a random sample of 855 residents across Alabama.
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Affiliation(s)
- Salma Aly
- Department of Medicine, Alexandria University, Alexandria, Egypt
| | - Casey L Daniel
- University of South Alabama College of Medicine, Mobile, Alabama
| | - Sejong Bae
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Isabel C Scarinci
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Claudia M Hardy
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Mona N Fouad
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Monica L Baskin
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Teri Hoenemeyer
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Aras Acemgil
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama.
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16
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Daniel CL, McLendon L, Green CL, Anderson KJ, Pierce JY, Perkins A, Beasley M. HPV and HPV Vaccination Knowledge and Attitudes Among Medical Students in Alabama. J Cancer Educ 2021; 36:168-177. [PMID: 31502236 DOI: 10.1007/s13187-019-01613-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In addition to being the most common sexually transmitted infection, the human papillomavirus (HPV) is associated with six types of cancer in men and women. The HPV vaccine provides long-lasting, effective protection from high-risk HPV infection, thus serving as a means of cancer prevention. An effective healthcare provider recommendation is well-established as the most significant influence on HPV vaccine uptake, and, as emerging providers, it is critical that medical students receive comprehensive training in this area. However, the type and extent of such training for current medical students in the USA is unclear. An online survey assessing HPV and HPV vaccine knowledge, attitudes, and vaccine status was distributed to all medical students at an Alabama university. Scales were developed to assess composite HPV and HPV knowledge scores and HPV vaccination intentions. Of those age-eligible, 32.1% reported completion of the HPV vaccine series while 15.2% reported partial completion. Knowledge of both HPV and HPV vaccination significantly increased with program year (p < 0.0001 and p = 0.0069, respectively); however, there were knowledge gaps across all years regarding HPV-associated cancers. Attitudes and intentions showed a similar association, with more advanced students demonstrating more positive attitudes toward HPV vaccination (p = 0.0003). There is a need within the current curriculum to include more education and training on HPV, HPV vaccination, and counseling-particularly for students in the first 2 years of their program. Implementation of a classroom module or interactive workshop would likely improve knowledge and attitudes, better preparing students for their future role as potential immunizers.
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Affiliation(s)
- Casey L Daniel
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA.
| | - Lane McLendon
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA
| | - Chelsea L Green
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA
| | - Katie J Anderson
- University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Jennifer Y Pierce
- University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Allen Perkins
- University of South Alabama College of Medicine, 307 North University Boulevard, Mobile, AL, 36688, USA
| | - Mark Beasley
- University of Alabama at Birmingham Ryals School of Public Health, 1665 University Boulevard, Birmingham, AL, 35223, USA
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17
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Williams CP, Gallagher KD, Deehr K, Aswani MS, Azuero A, Daniel CL, Ford EW, Ingram SA, Balch AJ, Rocque GB. Quantifying treatment preferences and their association with financial toxicity in women with breast cancer. Cancer 2020; 127:449-457. [PMID: 33108023 DOI: 10.1002/cncr.33287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of the current study was to understand treatment preferences and their association with financial toxicity in Patient Advocate Foundation clients with breast cancer. METHODS This choice-based conjoint analysis used data from a nationwide sample of women with breast cancer who received assistance from the Patient Advocate Foundation. Choice sets created from 13 attributes of 3 levels each elicited patient preferences and trade-offs. Latent class analysis segmented respondents into distinct preference archetypes. The Comprehensive Score for Financial Toxicity (COST) tool captured financial toxicity. Adjusted generalized linear models estimated COST score differences by preference archetype. RESULTS Of 220 respondents (for a response rate of 10%), the median age was 58 years (interquartile range, 49-66 years); 28% of respondents were Black, indigenous, or people of color; and approximately 60% had household incomes <$40,000. The majority of respondents were diagnosed with early-stage cancer (91%), 38% had recurrent disease, and 61% were receiving treatment. Treatment choice was most affected by preferences related to affordability and impact on activities of daily living. Two distinct treatment preference archetypes emerged. The "cost-prioritizing group" (75% of respondents) was most concerned about affordability, impact on activities of daily living, and burdening care partners. The "functional independence-prioritizing group" (25% of respondents) was most concerned about their ability to work, physical side effects, and interference with life events. COST scores were found to be similar between the archetypes in adjusted models (cost-prioritizing group COST score, 12 [95% confidence interval, 9-14]; and functional independence-prioritizing COST score, 11 [95% confidence interval, 9-13]). CONCLUSIONS Patients with breast cancer prioritized affordability or maintaining functional independence when making treatment decisions. Because of this variability, preference evaluation during treatment decision making could optimize patients' treatment experiences.
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Affiliation(s)
- Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Katie Deehr
- Patient Advocate Foundation, Hampton, Virginia
| | - Monica S Aswani
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andres Azuero
- Department of Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Casey L Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, Alabama
| | - Eric W Ford
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stacey A Ingram
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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18
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Williams C, Gallagher KD, Deehr K, Aswani MS, Azuero A, Daniel CL, Ford EW, Ingram SA, Balch AJ, Rocque GB. Quantifying treatment preferences and their association with financial toxicity in women with breast cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
141 Background: This study sought to understand treatment preferences and their association with financial toxicity in breast cancer patients served by Patient Advocate Foundation (PAF). Methods: This cross-sectional study used survey data from a nationwide sample of women with breast cancer who received assistance from PAF. Choice-based conjoint analysis elicited patient preferences and trade-offs. Latent class analysis segmented respondents into distinct preference groups. The Comprehensive Score for Financial Toxicity (COST) tool captured financial toxicity (range 0-44, lower scores indicate worse financial toxicity). Cramer’s V determined magnitude of relationships in bivariate associations. COST score differences by preference archetype was estimated by least square means and naïve 95% confidence intervals (CI) from adjusted generalized linear models. Results: Of 220 respondents (65% response rate), median age was 58 years (interquartile range [IQR] 49-66) and 60% had household incomes < $40,000. Most respondents were diagnosed with early stage cancer (91%), with 41% diagnosed within the past 2 years; 38% had recurred. Almost two-thirds (61%) were on active treatment. Treatment choice was most affected by preferences related to affordability and impact on activities of daily living (ADLs). Two distinct treatment preference archetypes emerged. The “Cost-Prioritizing Group” (75% of respondents) was most concerned about affordability, impact on ADLs, and burdening care partners. The “Functional Independence-Prioritizing Group” (25% of respondents) was most concerned about ability to work, physical side effects, and interference with important life events. Cost- vs. functional independence-prioritizing respondents were more often diagnosed with an early stage cancer (88% vs. 78%; V = .22), white (78% vs. 56%; V = .21), or privately insured (45% vs. 36%; V = .12). Functional independence- vs. cost-prioritizing respondents more often had household incomes < $40,000 (76% vs. 54%; V = .20), identified as Hispanic/Latino (20% vs. 9%; V = .15), or had Medicaid (15% vs. 7%; V = .12). COST scores were similar between archetypes in adjusted models (Cost-Prioritizing COST = 12, 95% CI 9-14; Functional Independence-Prioritizing COST = 11, 95% CI 9-13). Conclusions: Patients with breast cancer prioritized affordability or maintaining functional independence when making treatment decisions. Because of this variability, preference evaluation during treatment decision-making could optimize patients’ treatment experiences.
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Affiliation(s)
| | | | | | | | | | - Casey L. Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Eric W Ford
- University of Alabama at Birmingham, Birmingham, AL
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19
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Affiliation(s)
- Casey L Daniel
- Department of Family Medicine, University of South Alabama, Mobile, Alabama
| | - Anna R Wright
- Department of Family Medicine, University of South Alabama, Mobile, Alabama
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20
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Desmond RA, Venkatesh R, Padilla LA, Daniel CL, Litton AG, Heimburger DC, Michael Brooks C, Waterbor JW. Twenty-five-Year Follow-up of Short-term Cancer Research Trainees at the University of Alabama at Birmingham: a Brief Report. J Cancer Educ 2019; 34:1010-1013. [PMID: 30043388 DOI: 10.1007/s13187-018-1404-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Long-term follow-up is needed to evaluate the impact of short-term cancer research programs on the career trajectories of medical and graduate students. Participation in these programs may be crucial in fostering the next generation of cancer research scientists. This report presents the career outcomes and research productivity of 77 medical and public health students with 25 years of tracking data following their participation in a summer cancer research training program at the University of Alabama at Birmingham (UAB) in 1990-1998. Of 64 summer trainees with contact information, complete survey responses were received from 55 (86.0%) individuals. Over half reported clinical care of cancer patients and 18.2% stated that they were engaged in cancer research. Literature searches confirmed that 23.4% (18/77) of trainees have published cancer research papers. Future studies should explore the optimal timing of short-term post-baccalaureate academic cancer training experiences to identify participant characteristics and institutional factors that influence career choices and determine research productivity.
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Affiliation(s)
- Renee A Desmond
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raam Venkatesh
- Department of Anesthesiology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Luz A Padilla
- Department of Epidemiology, University of Alabama at Birmingham, RHPB 220, 1530 3rd Avenue South, Birmingham, AL, 35294-0022, USA
| | - Casey L Daniel
- USA Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Allison G Litton
- Department of Epidemiology, University of Alabama at Birmingham, RHPB 220, 1530 3rd Avenue South, Birmingham, AL, 35294-0022, USA
| | | | - C Michael Brooks
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John W Waterbor
- Department of Epidemiology, University of Alabama at Birmingham, RHPB 220, 1530 3rd Avenue South, Birmingham, AL, 35294-0022, USA.
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Affiliation(s)
- Casey L Daniel
- Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA.
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Affiliation(s)
- Casey L Daniel
- University of South Alabama, Mitchell Cancer Institute, United States
| | - Natalie R Gassman
- University of South Alabama, Mitchell Cancer Institute, United States.
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23
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Daniel CL, Gassman NR, Fernandez AM, Bae S, Tan MCB. Intentional tanning behaviors among undergraduates on the United States' Gulf Coast. BMC Public Health 2018; 18:441. [PMID: 29615031 PMCID: PMC5883533 DOI: 10.1186/s12889-018-5345-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 03/21/2018] [Indexed: 12/03/2022] Open
Abstract
Background Rates of melanoma have dramatically increased among adolescents and young adults in recent years, particularly among young women. Exposure to ultraviolet radiation from intentional tanning practices is likely a major contributor to this epidemic. Southern and coastal regions have higher melanoma mortality rates among non-Hispanic whites in other parts of the U.S., yet little is known about tanning practices of adolescents and young adults in these regions. This study determines the prevalence and methods of intentional tanning utilized by an undergraduate population located on the United States’ Gulf Coast. Methods Undergraduate students enrolled at a university on the Gulf Coast completed an online survey from March–April 2016, self-reporting their engagement, knowledge, and attitudes regarding outdoor tanning (OT), indoor tanning (IT) and spray tanning (ST). Univariate and multivariate analyses were performed to identify factors associated with tanning behaviors. Results 2668 undergraduates completed the survey. Of these, 64.9% reported OT tanning, 50.7% reported ever IT, and 21.2% reported ever ST. Conclusions In the largest study to date of intentional tanning behaviors of adolescents and young adults from coastal regions, we found high rates of intentional tanning behaviors. There was also significant engagement in spray tanning by this population, not previously reported for adolescents and young adults in a sample of this size. We also identified a high association between different tanning methods, indicating this population engages in multiple tanning behaviors, a phenomenon whose health consequences are not yet known.
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Affiliation(s)
- Casey L Daniel
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA.
| | - Natalie R Gassman
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Alyssa M Fernandez
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Sejong Bae
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL, 35205, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcus C B Tan
- Department of Surgery, University of South Alabama College of Medicine, 2451 Fillingim Street, Mobile, AL, 36617, USA
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Smith KR, Granberry M, Tan MC, Daniel CL, Gassman NR. Dihydroxyacetone induces G2/M arrest and apoptotic cell death in A375P melanoma cells. Environ Toxicol 2018; 33:333-342. [PMID: 29193605 PMCID: PMC5809210 DOI: 10.1002/tox.22520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/22/2017] [Accepted: 11/17/2017] [Indexed: 05/10/2023]
Abstract
The active ingredient in sunless tanning products (STPs) is a simple sugar, dihydroxyacetone (DHA). Several studies have demonstrated that DHA is absorbed within the viable layers of skin and not fully contained within the stratum corneum. Additionally, spray tanning and other aerosolized application methods have increased the risk of internal exposure through mucous membranes and inhalation. Beyond its presence in STPs, DHA also occurs as an endogenous by-product of fructose metabolism, and an excess of DHA in cells can induce advanced glycation end (AGE) products and oxidative stress. Therefore, exogenous and endogenous exposures to DHA may be harmful to cells, and it has already been demonstrated that exogenous exposure to DHA is cytotoxic in immortalized keratinocytes. Still, little is known about the exogenous DHA exposure effects on other skin components. In this study, we explore the effects of exogenous DHA exposure in a human melanoma cell line, A375P. Melanoma cells were sensitive to DHA and displayed a transient burst of reactive oxygen species within an hour of exposure. Cell cycle arrest at G2/M was observed within 24 h of exposure, and apoptosis, monitored by the cleavage of PARP-1 and Caspase-3, was detected within 72 h of exposure to DHA. Together, these demonstrate that exogenous exposure to DHA has cytotoxic effects in our selected cell model and indicates the need to further investigate the exogenous exposure effects of DHA in other relevant exposure models.
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Affiliation(s)
- Kelly R. Smith
- Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Ave, Mobile, Alabama, 36604-1405 United States of America
| | - Molley Granberry
- Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Ave, Mobile, Alabama, 36604-1405 United States of America
- Auburn University Harrison School of Pharmacy, University of South Alabama, 650 Clinic Dr, Mobile, Alabama, 36608 United States of America
| | - Marcus C.B. Tan
- Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Ave, Mobile, Alabama, 36604-1405 United States of America
| | - Casey L. Daniel
- Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Ave, Mobile, Alabama, 36604-1405 United States of America
| | - Natalie R. Gassman
- Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Ave, Mobile, Alabama, 36604-1405 United States of America
- corresponding author. Natalie R. Gassman, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Ave, Mobile, Alabama, 36604-1405, United States of America, Phone: 251-445-8430, Fax: 251-460-6994,
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Gambla WC, Fernandez AM, Gassman NR, Tan MCB, Daniel CL. College tanning behaviors, attitudes, beliefs, and intentions: A systematic review of the literature. Prev Med 2017; 105:77-87. [PMID: 28867504 DOI: 10.1016/j.ypmed.2017.08.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/18/2017] [Accepted: 08/27/2017] [Indexed: 01/30/2023]
Abstract
Despite well-established links between exposure to ultraviolet radiation (UVR) and skin cancer, UVR-based tanning behaviors persist among college students. Understanding tanning motivations, perceptions, barriers, and demographic characteristics of this population is critical to modifying these behaviors, but is limited by variability in study design, sample size, and outcomes measured in the current literature. To help clarify the tanning behaviors of this population and provide a concise reference for future studies, this review examines existing reports to determine the comparability of tanning behaviors across multiple U.S. college populations. A systematic review of the literature was performed in July 2016 to identify studies investigating tanning behaviors among U.S. college students. Twenty-three studies met inclusion criteria. High rates of indoor tanning (IT) and outdoor tanning (OT) were found among college students. Key motivators included appearance, emotion, health perceptions, and the influence of parents, peers, and the media. Misconceptions regarding skin protection, low rates of sun protective behaviors, and tanning dependence were barriers against safe UVR exposure. Understudied demographic factors may account for variance in observed tanning behaviors, emphasizing the need for standardization efforts to consistently identify trends associated with geographical region, age, year in college, and sex. The findings presented in this review reaffirm that college students are at high risk for tanning-associated skin cancer, emphasizing the critical need for effective, targeted interventions. Improved interventions will reduce the burden of skin cancer within this group, ultimately contributing to longer, healthier lives.
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Affiliation(s)
- William C Gambla
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Alyssa M Fernandez
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States
| | - Natalie R Gassman
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States
| | - Marcus C B Tan
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Casey L Daniel
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States.
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Daniel CL, Keyes D, Gilreath K. The subjective decision of cessation of colorectal cancer screening. Lancet Gastroenterol Hepatol 2017; 2:698-699. [PMID: 28895544 DOI: 10.1016/s2468-1253(17)30254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Casey L Daniel
- Mitchell Cancer Institute, University of South Alabama, Mobile 36604, AL, USA.
| | - Danielle Keyes
- College of Medicine, University of South Alabama, Mobile 36604, AL, USA
| | - Kelly Gilreath
- College of Medicine, University of South Alabama, Mobile 36604, AL, USA
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Joseph RP, Daniel CL, Thind H, Benitez TJ, Pekmezi D. Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors. Am J Lifestyle Med 2016; 10:356-368. [PMID: 28217036 PMCID: PMC5313056 DOI: 10.1177/1559827614554594] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/11/2014] [Accepted: 07/01/2014] [Indexed: 11/17/2022] Open
Abstract
Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.
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Affiliation(s)
- Rodney P. Joseph
- Rodney P. Joseph, PhD, College of Nursing and Health Innovation, Arizona State University, 500 North Third Street, Phoenix, AZ 85004; e-mail:
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Desmond RA, Padilla LA, Daniel CL, Prickett CT, Venkatesh R, Brooks CM, Waterbor JW. Career Outcomes of Graduates of R25E Short-Term Cancer Research Training Programs. J Cancer Educ 2016; 31:93-100. [PMID: 25604064 PMCID: PMC4511721 DOI: 10.1007/s13187-014-0786-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The efficacy of short-term cancer research educational programs in meeting its immediate goals and long-term cancer research career objectives has not been well studied. The purpose of this report is to describe the immediate impact on, and the long-term career outcomes of, 499 medical students and graduate students who completed the Cancer Research Experiences for Students (CaRES) program at the University of Alabama at Birmingham (UAB) from 1999 to 2013. In summer 2014, all 499 program alumni were located and 96.4 % (481 of 499) agreed to complete a longitudinal tracking survey. About 23 % of CaRES alumni (110 of 499) have published at least one cancer-related paper. Overall 238 cancer-related papers have been published by CaRES alumni, one third of this number being first-authored publications. Nearly 15 % (71 of 481 respondents) reported that their current professional activities include cancer research, primarily clinical research and outcomes research. Of these 71 individuals, 27 (38 %) have completed their training and 44 (62 %) remain in training. Of all respondents, 58 % reported that they administered care to cancer patients and 30 % reported other cancer-related professional responsibilities such as working with a health department or community group on cancer control activities. Of the 410 respondents not currently engaged in cancer research, 118 (29 %) stated intentions to conduct cancer research in the next few years. Nearly all respondents (99.6 %) recommended CaRES to today's students. Challenging short-term educational cancer research programs for medical students and graduate health professional students can help them refine and solidify their career plans, with many program alumni choosing cancer research careers.
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Affiliation(s)
- Renee A Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luz A Padilla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Casey L Daniel
- Department of Social and Behavioral Sciences, School of Public Health, Harvard University, Boston, MA, USA
| | - Charles T Prickett
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Raam Venkatesh
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Michael Brooks
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John W Waterbor
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA.
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Padilla LA, Venkatesh R, Daniel CL, Desmond RA, Brooks CM, Waterbor JW. An Evaluation Methodology for Longitudinal Studies of Short-Term Cancer Research Training Programs. J Cancer Educ 2016; 31:84-92. [PMID: 25412722 PMCID: PMC4441613 DOI: 10.1007/s13187-014-0758-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The need to familiarize medical students and graduate health professional students with research training opportunities that cultivate the appeal of research careers is vital to the future of research. Comprehensive evaluation of a cancer research training program can be achieved through longitudinal tracking of program alumni to assess the program's impact on each participant's career path and professional achievements. With advances in technology and smarter means of communication, effective ways to track alumni have changed. In order to collect data on the career outcomes and achievements of nearly 500 short-term cancer research training program alumni from 1999-2013, we sought to contact each alumnus to request completion of a survey instrument online, or by means of a telephone interview. The effectiveness of each contact method that we used was quantified according to ease of use and time required. The most reliable source of contact information for tracking alumni from the early years of the program was previous tracking results, and for alumni from the later years, the most important source of contact information was university alumni records that provided email addresses and telephone numbers. Personal contacts with former preceptors were sometimes helpful, as were generic search engines and people search engines. Social networking was of little value for most searches. Using information from two or more sources in combination was most effective in tracking alumni. These results provide insights and tools for other research training programs that wish to track their alumni for long-term program evaluation.
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Affiliation(s)
- Luz A Padilla
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Raam Venkatesh
- School of Medicine, University of Alabama, Birmingham, USA
| | - Casey L Daniel
- School of Public Health, Harvard University, Boston, USA
| | - Renee A Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - C Michael Brooks
- School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
| | - John W Waterbor
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA.
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Daniel CL, Emmons KM, Fasciano K, Fuemmeler BF, Demark-Wahnefried W. Needs and Lifestyle Challenges of Adolescents and Young Adults With Cancer: Summary of an Institute of Medicine and Livestrong Foundation Workshop. Clin J Oncol Nurs 2015; 19:675-81. [PMID: 26583632 PMCID: PMC4795831 DOI: 10.1188/15.cjon.19-06ap] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Among adolescents and young adults (AYAs) in the United States, cancer is the leading cause of disease-related death. AYA survivors face numerous short- and long-term health and psychosocial issues, as well as increased risk for behavioral and lifestyle challenges, including poor diet, low physical activity (PA), and substance abuse. Many of these behaviors are modifiable, but gaps in care serve as barriers for AYA survivors. OBJECTIVES The purpose of this article is to (a) raise awareness of AYAs' increased risk for poor diet, low PA, and substance abuse; (b) examine previous interventions addressing these issues; and (c) provide recommendations for future directions. METHODS This article summarizes a workshop coordinated by the Institute of Medicine and the Livestrong Foundation to address AYA survivors' needs and ways to enhance their quality of care. FINDINGS Oncology nurses can promote the inclusion of lifestyle behaviors in survivorship care plans of AYA patients and serve as a valuable resource in improving AYA care on a larger scale. In addition, oncology nurse researchers may offer greater understanding of AYA patients' and survivors' needs and best practices by conducting much-needed research with this understudied population.
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Daniel CL, Armstrong GT, Keske RR, Davine JA, McDonald AJ, Sprunck-Harrild KM, Coleman C, Haneuse SJ, Mertens AC, Emmons KM, Marghoob AA, Elkin EB, Dusza SW, Robison LL, Geller AC. Advancing Survivors' Knowledge (ASK) about skin cancer study: study protocol for a randomized controlled trial. Trials 2015; 16:109. [PMID: 25873142 PMCID: PMC4392639 DOI: 10.1186/s13063-015-0637-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background Advances in treatment have increased childhood cancer 5-year survival rates to greater than 80%. However, children previously treated with radiation are at significantly increased risk of developing subsequent neoplasms, the most common of which are skin cancers. The National Cancer Institute and Children’s Oncology Group have issued recommendations for survivors treated with radiation to perform monthly skin self-examinations and receive a physician skin examination at least annually, as early detection has demonstrated markedly improved outcomes in the diagnosis and treatment of skin cancers. The goal of the present study is to increase rates of skin self-examinations and clinical skin examinations among adult survivors of childhood cancer treated with radiation. Methods/Design This randomized controlled trial uses a 3-group comparative effectiveness design comparing: (1) Patient Activation and Education (PAE) including text messaging, print and web-based tutorials over 12 months; (2) PAE plus physician activation (PAE + MD) adding physician activation/educational materials about survivors’ increased skin cancer risk and conducting full-body skin exams; and (3) PAE plus physician activation, plus teledermoscopy (PAE + MD + TD) adding participant receipt of a dermatoscope intended to empower them to photograph suspect moles or lesions for review by the study dermatologist. Discussion The current study addresses barriers to screening in this population by providing educational and motivational information for both survivors and physicians regarding the value of periodic skin examinations. It also utilizes innovative mobile health technology to encourage and motivate (that is activate) survivors to conduct skin self-examinations, request physician exams, and obtain treatment when worrisome lesions are found. Finally, as a comparative effectiveness trial, this study isolates the effects of adding specific components to the patient activation intervention to test the most effective intervention for enhancing skin examination vigilance among this high-risk group. Trial registration Clinicaltrials.gov: NCT02046811; Registration date: 22 January 2014.
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Affiliation(s)
- Casey L Daniel
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA.
| | - Robyn R Keske
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
| | - Aaron J McDonald
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA.
| | - Kim M Sprunck-Harrild
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, LW601, 02215-5450, Boston, MA, USA.
| | - Catherine Coleman
- Department of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, 02215-5450, Boston, MA, USA.
| | - Sebastien J Haneuse
- Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Bldg 2, Rm 451, 02115-6009, Boston, MA, USA.
| | - Ann C Mertens
- Department of Pediatrics, Emory University, Emory Children's Center, 2015 Uppergate Drive, 4th floor, 30322-1014, Atlanta, GA, USA.
| | - Karen M Emmons
- Kaiser Permanente, 1800 Harrison Street, 16th Floor, #161R03, 94612-3463, Oakland, CA, USA.
| | - Ashfaq A Marghoob
- Memorial-Sloan Kettering Cancer Center, 1275 York Ave, 10065-6007, New York, NY, USA.
| | - Elena B Elkin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 44, 10065-6007, New York, NY, USA.
| | - Stephen W Dusza
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 160 East 53rd St, 2nd Floor, 10022-5243, New York, NY, USA.
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA.
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
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Daniel CL, Kohler CL, Stratton KL, Oeffinger KC, Leisenring WM, Waterbor JW, Whelan KF, Armstrong GT, Henderson TO, Krull KR, Robison LL, Nathan PC. Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study. Cancer 2015; 121:1856-63. [PMID: 25649858 DOI: 10.1002/cncr.29265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/22/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation-induced colorectal cancer (CRC). The Children's Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at-risk survivors. METHODS Analyses included 702 five-year survivors (Childhood Cancer Survivor Study) aged ≥36 years who received ≥30 gray of abdominal, pelvic, or spinal radiotherapy. Multivariate generalized linear models were used to calculate relative risks (RR) with 95% confidence intervals (95% CI) for adherence to the Children's Oncology Group's CRC surveillance recommendations. RESULTS With a median age of 43 years (range, 36-58 years), 29.5% of the survivors (207 of 702 survivors) met surveillance recommendations. In multivariate analyses, age ≥50 years versus age 36 to 49 years (RR, 2.6; 95% CI, 2.0-3.4), reporting a routine cancer follow-up visit within 1 year before the study (RR, 1.5; 95% CI, 1.0-2.2), reporting ≥10 physician visits within the past year versus 0 to 9 visits (RR, 1.4; 95% CI, 1.1-1.7), and discussing future cancer risk with a physician at the time of the most recent follow-up visit (RR, 1.4; 95% CI, 1.1-1.7) were found to be associated with adherence to CRC surveillance recommendations. CONCLUSIONS Greater than 70% of survivors at an increased risk of CRC were not screened as recommended. Regular physician contact and discussion of screening were associated with a 60% increase in CRC surveillance. Educational interventions targeted at survivors and their primary care physicians are needed to heighten knowledge of CRC risk after radiotherapy and the importance of appropriate surveillance.
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Affiliation(s)
- Casey L Daniel
- Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts
| | - Connie L Kohler
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kayla L Stratton
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Wendy M Leisenring
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John W Waterbor
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly F Whelan
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Daniel CL, Michael Brooks C, Waterbor JW. Approaches for longitudinally tracking graduates of NCI-funded short-term cancer research training programs. J Cancer Educ 2011; 26:58-63. [PMID: 21210271 PMCID: PMC3930441 DOI: 10.1007/s13187-010-0190-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Short-term cancer research programs for health professions students typically state goals of encouraging and fostering interest in pursuing cancer research-based careers. Evaluating career choices and professional achievements of these trainees has been problematic. Well-designed program evaluation is a key element in determining successful training experiences, and program-specific outcome measures are typically used to assess the effectiveness of each short-term cancer research experience. We describe evaluation approaches for longitudinal tracking of participants of our National Cancer Institute-sponsored Cancer Research Experiences for Students program at the University of Alabama at Birmingham, emphasizing those approaches that demonstrated greatest effectiveness. We also evaluate the various methods we used in terms of cost, efficiency, and effectiveness. Recommendations are provided to assist comparable training programs facing the challenges of longitudinal tracking and program evaluation.
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Affiliation(s)
- Casey L Daniel
- Department of Health Behavior, Cancer Prevention and Control Training Program, University of Alabama at Birmingham, CH19, Room 302, 933 19th Street, South Birmingham, 35294 AL, USA.
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Abstract
The relationship between peritrochanteric heterotopic ossification and the strength of hip abduction after closed intramedullary nailing for femoral shaft fractures was investigated in 25 patients after a mean follow-up of 2 years (range 9 months to 4 years). The power of hip abduction was assessed and compared with the normal hip. Of the 21 patients with heterotopic ossification, 16 had measurable weakness of hip abduction. Grade III heterotopic ossification resulted in 8-20 per cent weakness of hip abduction, but this was not associated with any disability or symptoms. Clinically important abductor weakness is more likely to be due to ipsilateral fractures or a long nail rather than heterotopic ossification.
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Affiliation(s)
- A Biyani
- Department of Orthopaedics, Morriston Hospital, Swansea, UK
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