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Acharya H, Sykes KJ, Neira TM, Scott A, Pacheco CM, Sanner M, Ablah E, Oyowe K, Ellerbeck EF, Greiner KA, Corriveau EA, Finocchario-Kessler S. A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study. JMIR Form Res 2024; 8:e52920. [PMID: 38557671 PMCID: PMC11019415 DOI: 10.2196/52920] [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: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. OBJECTIVE We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. METHODS The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. RESULTS At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act-compliant record system, improved client engagement, enrollment processes, and identification of resources. CONCLUSIONS Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings.
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Affiliation(s)
- Harshdeep Acharya
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, United States
| | - Kevin J Sykes
- Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, United States
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ton Mirás Neira
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Angela Scott
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Christina M Pacheco
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Matthew Sanner
- Sanner Software Solutions, Kansas City, KS, United States
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Erin A Corriveau
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah Finocchario-Kessler
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
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Hejjaji V, Ellerbeck EF, Jones PG, Pacheco CM, Malik AO, Chan PS, Spertus JA, Arnold SV. Association Between Cardiovascular Event Type and Smoking Cessation Rates Among Outpatients With Atherosclerotic Cardiovascular Disease: Insights From the NCDR PINNACLE Registry. Circ Cardiovasc Qual Outcomes 2024; 17:e009960. [PMID: 38318702 DOI: 10.1161/circoutcomes.122.009960] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND It is unclear how the type of an atherosclerotic cardiovascular disease (ASCVD) event potentially influences patients' likelihood of smoking cessation. METHODS Using 2013 to 2018 data from the US based National Cardiovascular Data Registry Practice Innovation and Clinical Excellence outpatient cardiac registry, we identified patients who were current smokers at a clinic visit and followed them over time for a subsequent ASCVD event. Self-reported smoking status was assessed at each consecutive visit and used to determine smoking cessation after each interim ASCVD event (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke/transient ischemic attack, peripheral artery disease). We constructed separate multivariable Cox models with nonproportional hazards to examine the association of each interim ASCVD event with smoking cessation, compared with not having an interim ASCVD event. We estimated the relative association of ASCVD event type with smoking cessation using contrast tests. Analyses were stratified by presence versus absence of ASCVD at baseline. RESULTS Across 530 cardiology practices, we identified 1 933 283 current smokers (mean age 62±15, male 54%, ASCVD at baseline 50%). Among the 322 743 patients who had an interim ASCVD event and were still smoking, 41 336 (12.8%) quit smoking by their first subsequent clinic visit, which was higher among those with baseline ASCVD (13.4%) as compared with those without baseline ASCVD (11.5%). Each type of ASCVD event was associated with an increased likelihood of smoking. Patients who had an myocardial infarction, underwent coronary artery bypass graft (hazard ratio, 1.60 [95% CI, 1.55-1.65]), or had a stroke or transient ischemic attack were more likely to quit smoking as compared with those who underwent elective percutaneous coronary intervention or had a new diagnosis of peripheral artery disease (hazard ratio, 1.20 [95% CI, 1.17-1.22]). CONCLUSIONS Only 13% of patients reported smoking cessation after an ASCVD event, with the type of event being associated with the likelihood of smoking cessation, prompting the need for patient-centered interventions.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas School of Medicine, KS (E.F.E.)
| | - Philip G Jones
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Christina M Pacheco
- Department of Population Health, University of Kansas Medical Center, KS (C.M.P.)
| | - Ali O Malik
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Paul S Chan
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - John A Spertus
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Suzanne V Arnold
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
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Bridges KM, LeMaster JW, Parente DJ, Pacheco CM, Schultz C, Morrow E, Corriveau E, Miras Neira T, Greiner KA, Woodward J, Anders- Rumsey J, Cirotski D, Finocchario-Kessler S, Ellerbeck EF. Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers. J Prim Care Community Health 2023; 14:21501319231214513. [PMID: 38041409 PMCID: PMC10693805 DOI: 10.1177/21501319231214513] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Rural and under-resourced urban communities face unique challenges in addressing patients' social determinants of health needs (SDoH). Community health workers (CHWs) can support patients experiencing social needs, yet little is known about how rural and under-resourced primary care clinics are screening for SDoH or utilizing CHWs. METHODS Interviews were conducted with primary care clinic providers and managers across a geographically large and predominately rural state to assess screening practices for SDoH and related community resources, and perspectives on using CHWs to address SDoH. Interviews were conducted by phone, recorded, and transcribed. Data were analyzed using thematic analysis. We completed interviews with 27 respondents (12 providers and 15 clinic managers) at 26 clinics. RESULTS Twelve (46.1%) clinics had a standardized process for capturing SDoH, but this was primarily limited to Medicare wellness visits. Staffing and time were identified as barriers to proper SDoH screening. Lack of transportation and affordable medication were the most cited SDoH. While respondents were all aware of CHWs, only 8 (30.8%) included a CHW on their care team. Perceived barriers to engaging CHWs included cost, space, and availability of qualified CHWs. Perceived benefits of engaging CHWs in their practice were: assisting patients with navigating resources and programs, relieving clinical staff of non-medical tasks, and bridging language barriers. CONCLUSIONS Rural and under-resourced primary care clinics need help in identifying and addressing SDoH. CHWs could play an important part in addressing social needs and promoting preventive care if financial constraints could be addressed and local CHWs could be trained.
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Affiliation(s)
| | | | | | | | | | - Emily Morrow
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Corriveau
- University of Kansas Medical Center, Kansas City, KS, USA
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Scierka LE, Mena-Hurtado C, Shishehbor MH, Spertus JA, Nagpal S, Babrowski T, Bunte MC, Politano A, Humphries M, Chung J, Kirksey L, Alabi O, Soukas P, Parikh S, Faizer R, Fitridge R, Provance J, Romain G, McMillan N, Stone N, Scott K, Fuss C, Pacheco CM, Gosch K, Harper-Brooks A, Smolderen KG. The shifting care and outcomes for patients with endangered limbs - Critical limb ischemia (SCOPE-CLI) registry overview of study design and rationale. Int J Cardiol Heart Vasc 2022; 39:100971. [PMID: 35198727 PMCID: PMC8850321 DOI: 10.1016/j.ijcha.2022.100971] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Critical limb ischemia (CLI), the most severe form of peripheral artery disease, is associated with pain, poor wound healing, high rates of amputation, and mortality (>20% at 1 year). Little is known about the processes of care, patients' preferences, or outcomes, as seen from patients' perspectives. The SCOPE-CLI study was co-designed with patients to holistically document patient characteristics, treatment preferences, patterns of care, and patient-centered outcomes for CLI. METHODS This 11-center prospective observational registry will enroll and interview 816 patients from multispecialty, interdisciplinary vascular centers in the United States and Australia. Patients will be followed up at 1, 2, 6, and 12 months regarding their psychosocial factors and health status. Hospitalizations, interventions, and outcomes will be captured for 12 months with vital status extending to 5 years. Pilot data were collected between January and July of 2021 from 3 centers. RESULTS A total of 70 patients have been enrolled. The mean age was 68.4 ± 11.3 years, 31.4% were female, and 20.0% were African American. CONCLUSIONS SCOPE-CLI is uniquely co-designed with patients who have CLI to capture the care experiences, treatment preferences, and health status outcomes of this vulnerable population and will provide much needed information to understand and address gaps in the quality of CLI care and outcomes.ClinicalTrials.gov identifier (NCT Number): NCT04710563 https://clinicaltrials.gov/ct2/show/NCT04710563.
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Affiliation(s)
- Lindsey E. Scierka
- Yale University, Department of Internal Medicine, Vascular Medicine Outcomes Program (VAMOS), New Haven, CT, United States
| | - Carlos Mena-Hurtado
- Yale University, Department of Internal Medicine, Vascular Medicine Outcomes Program (VAMOS), New Haven, CT, United States
| | - Mehdi H. Shishehbor
- Case Western University School of Medicine/Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO, United States
| | - Sameer Nagpal
- Yale University, Department of Internal Medicine, Vascular Medicine Outcomes Program (VAMOS), New Haven, CT, United States
| | | | - Matthew C. Bunte
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO, United States
| | - Amani Politano
- Oregon Health & Science University, Portland, OR, United States
| | | | - Jayer Chung
- Baylor College of Medicine, Houston, TX, United States
| | - Lee Kirksey
- Cleveland Clinic, Cleveland, OH, United States
| | | | | | - Sahil Parikh
- Columbia University – Presbyterian, New York, NY, United States
| | - Rumi Faizer
- University of Minnesota, Minneapolis, MN, United States
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Jeremy Provance
- Yale University, Department of Internal Medicine, Vascular Medicine Outcomes Program (VAMOS), New Haven, CT, United States
| | - Gaëlle Romain
- Yale University, Department of Internal Medicine, Vascular Medicine Outcomes Program (VAMOS), New Haven, CT, United States
| | - Neil McMillan
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Nancy Stone
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO, United States
| | - Kate Scott
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO, United States
| | - Christine Fuss
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO, United States
| | - Christina M. Pacheco
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO, United States
| | - Kensey Gosch
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, MO, United States
| | - Avis Harper-Brooks
- Yale University, Department of Internal Medicine, Vascular Medicine Outcomes Program (VAMOS), New Haven, CT, United States
| | - Kim G. Smolderen
- Yale University, Department of Internal Medicine, Vascular Medicine Outcomes Program (VAMOS), New Haven, CT, United States
- Yale University, Department of Psychiatry, New Haven, CT, United States
- Corresponding author at: 789 Howard Avenue, New Haven, CT 06519, United States.
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Patel KK, Decker C, Pacheco CM, Fuss C, Boda I, Gosch KL, McGhie AI, Thompson RC, Sperry BW, Bateman TM, Spertus JA. Development and Piloting of a Patient-Centered Report Design for Stress Myocardial Perfusion Imaging Results. JAMA Netw Open 2021; 4:e2121011. [PMID: 34415313 PMCID: PMC8379654 DOI: 10.1001/jamanetworkopen.2021.21011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE The management of coronary disease epitomizes the call to better engage patients in shared medical decision-making. Myocardial perfusion imaging (MPI) is the foundation of diagnosis, risk stratification, and subsequent therapy; however, MPI reports are currently interpretable by specialists but not patients. OBJECTIVE To design and test a patient-centered report for stress MPI test results. DESIGN, SETTING, AND PARTICIPANTS This qualitative study of outpatients who underwent an MPI stress test and clinicians used a mixed methods approach. Phase 1 (December 2018 to July 2019) used qualitative methods to design a patient-centered reporting tool, with 5 focus groups with 36 patients and 2 focus groups with 27 clinicians. Phase 2 (June to September 2019) consisted of pilot testing the reporting tool with feedback from a structured survey given to patients who received MPI reports before and after implementing the tool. MAIN OUTCOMES AND MEASURES Key themes around patient experiences with the current MPI reporting and their desire for a more useful report were identified, which led to a sample reporting tool after serial iterations with feedback. Differences in patient knowledge and engagement were assessed between patients before and after implementation of the new reporting tool using χ2 tests. RESULTS From patient focus groups (26 patients; mean [SD] age, 66.3 [9.6] years, 9 [35%] women), 3 themes on the inadequacies of current MPI reporting were identified: (1) inconsistent delivery of results, (2) use of medical jargon, and (3) unclear posttest course. We identified 5 themes for a more patient-centered MPI report: desire for written information, discussion of the report with medical personnel, presentation of results in simple language with use of visual graphics, comparisons with normal results, and personalized risk estimates. In a pilot survey with 123 patients split into a pre-implementation group (69 patients; mean [SD] age, 68.2 [8.5] years; 27 [51%] women) and a postimplementation group (54 patients; mean [SD] age, 66.4 [8.7] years; 30 [56%] women), the patient-centered report led to more patients reading the entire report (45 [83%] vs 46 [67%]; P = .04) and improved knowledge of future risk of cardiac events (41 [76%] vs 20 [29%]; P < .001). There was also a numerically higher percentage of patients who found the report easy to read (45 [83%] vs 44 [68%]; P = .05) and understand (42 [78%] vs 43 [66%]; P = .16), although these results were not statistically significant. CONCLUSIONS AND RELEVANCE This study identified key elements of a patient-centered report design for stress MPI test results, which improved patient engagement and knowledge. These preliminary data support further implementation and study of a more patient-centered MPI report.
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Affiliation(s)
- Krishna K. Patel
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
| | - Carole Decker
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | - Christine Fuss
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Illham Boda
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Kensey L. Gosch
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Arthur I. McGhie
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
| | - Randall C. Thompson
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
| | - Brett W. Sperry
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
| | - Timothy M. Bateman
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
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Patel KK, Jones PG, Ellerbeck EF, Buchanan DM, Chan PS, Pacheco CM, Moneta G, Spertus JA, Smolderen KG. Underutilization of Evidence-Based Smoking Cessation Support Strategies Despite High Smoking Addiction Burden in Peripheral Artery Disease Specialty Care: Insights from the International PORTRAIT Registry. J Am Heart Assoc 2019; 7:e010076. [PMID: 30371269 PMCID: PMC6474973 DOI: 10.1161/jaha.118.010076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Smoking is the most important risk factor for peripheral artery disease (PAD). Smoking cessation is key in PAD management. We aimed to examine smoking rates and smoking cessation interventions offered to patients with PAD consulting a vascular specialty clinic; and assess changes in smoking behavior over the year following initial visit. Methods and Results A total of 1272 patients with PAD and new or worsening claudication were enrolled at 16 vascular specialty clinics (2011–2015, PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry). Interviews collected smoking status and cessation interventions at baseline, 3, 6, and 12 months. Among smokers, transition state models analyzed smoking transitions at each time point and identified factors associated with quitting and relapse. On presentation, 474 (37.3%) patients were active, 660 (51.9%) former, and 138 (10.8%) never smokers. Among active smokers, only 16% were referred to cessation counseling and 11% were prescribed pharmacologic treatment. At 3 months, the probability of quitting smoking was 21%; among those continuing to smoke at 3 months, the probability of quitting during the next 9 months varied between 11% and 12% (P<0.001). The probability of relapse among initial quitters was 36%. At 12 months, 72% of all smokers continued to smoke. Conclusions More than one third of patients with claudication consulting a PAD provider are active smokers and few received evidence‐based cessation interventions. Patients appear to be most likely to quit early in their treatment course, but many quickly relapse and 72% of all patients smoking at baseline are still smoking at 12 months. Better strategies are needed to provide continuous cessation support. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.
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Affiliation(s)
- Krishna K. Patel
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Philip G. Jones
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | - Donna M. Buchanan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Paul S. Chan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | | | - John A. Spertus
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Kim G. Smolderen
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
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Lumpkins CY, Filippi MK, Nazir N, Pacheco CM, Hester CM, Daley SM, Choi WS, Daley CM. It's not just about recruitment: An exploratory look at tobacco education sessions to increase participation into smoking cessation programs among American Indians. ACTA ACUST UNITED AC 2018; 3:1-4. [PMID: 34095515 PMCID: PMC8174104 DOI: 10.15761/hec.1000137] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
American Indians (AI) have the highest smoking rates and lowest quit rates of any racial/ethnic group in the U.S. Researchers and community members from the American Indian Health Research and Education Alliance (AIHREA) created and evaluated a culturally-tailored smoking cessation program, All Nations Breath of Life (ANBL) as a recruitment tool for smoking cessation programs among AI. To increase enrollment in ANBL, AI smokers were approached at cultural events and asked to attend a 30-minute educational session (in-person, n= 179; tele-video, n=97). Tele-video (30%) and in-person (9%) session participants were recruited into ANBL. Pre- and post-tests showed participants in both sessions demonstrated increased motivation and confidence to quit smoking but significant differences were present in both sessions (p < 0.0001). Results indicate that theoretically guided and culturally tailored education sessions are viable approaches to educate and recruit underserved populations into programs that promote smoking cessation.
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Affiliation(s)
- C Y Lumpkins
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | | | - N Nazir
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | | | - C M Hester
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - S M Daley
- Center for American Indian Studies, Johnson County Community College, Kansas City, KS, 66210, USA
| | - W S Choi
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - C M Daley
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.,Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
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Daley CM, Daley SM, Pacheco CM, Smith TE, Talawyma M, McCloskey C, Choi WS, Nazir N, Filippi MK, McKinney D, Gunville J, Greiner KA. Feasibility of Implementing the All Nations Breath of Life Culturally Tailored Smoking Cessation Program for American Indians in Multi-Tribal Urban Communities. Nicotine Tob Res 2018; 20:552-560. [PMID: 28177511 DOI: 10.1093/ntr/ntx030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 01/30/2017] [Indexed: 11/14/2022]
Abstract
Introduction Prevalence of cigarette smoking is highest among American Indians, yet few culturally appropriate smoking cessation programs have yet been developed and tested for multi-tribal American Indian adult populations. This study examined implementation of the All Nations Breath of Life culturally tailored smoking cessation program in multi-tribal urban and suburban American Indian communities in seven locations across five states (N = 312). Methods This single-arm study used community-based participatory research to conduct a 12-week intervention whose primary purpose was to curb commercial tobacco use among American Indians. Participants were followed through month 6 in person and month 12 via telephone. The primary outcome was continuous abstinence from recreational cigarette smoking at 6 months post-baseline, verified through voluntary provision of salivary cotinine levels. Results At program completion (12 weeks post-baseline), 53.3% of program completers remained abstinent; labeling those lost to follow-up as smokers resulted in a 41.4% quit rate. At 6 months post-baseline (primary endpoint), 31.1% of retained participants quit smoking (p < .0001 compared to the highest quit rates among multi-tribal populations reported in the literature, 7%); final quit rate was 22.1% labeling those lost to follow-up as smokers (p = .002). Retention rate at endpoint was 71.2%. 12-month follow-up was attempted with all participants and had a retention rate of 49.0%. Of those participants reached, 34.0% were smoke-free. Conclusions All Nations Breath of Life shows promise as a smoking cessation program for multi-tribal urban American Indian communities. It can be successfully implemented in a variety of urban settings. Implications This is the first large feasibility study of a culturally tailored smoking cessation program for American Indians with good cessation and retention rates in a multi-tribal urban American Indian population. It shows that All Nations Breath of Life can be implemented in multiple urban settings across five states. To our knowledge, this is the first program of its kind to be implemented across multiple heterogeneous urban locations and to include salivary cotinine testing for verification of self-report data across these locations.
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Affiliation(s)
- Christine Makosky Daley
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Sean M Daley
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - Christina M Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - T Edward Smith
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - Myrietta Talawyma
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | | | - Won S Choi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Melissa K Filippi
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Dona McKinney
- Department of Defense Programs Office, Lincoln University, Jefferson City, MO
| | - Jordyn Gunville
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
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Pacheco CM, Wellever A, Nazir N, Pacheco J, Berryhil K, Faseru B, Barnes C, Daley CM, Choi WS. Clearing the air: American Indian tribal college students' exposure to second hand smoke & attitudes towards smoke free campus policies. J Am Coll Health 2018; 66:133-140. [PMID: 29111947 PMCID: PMC5931395 DOI: 10.1080/07448481.2017.1399893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this study was to examine knowledge, awareness, and support for campus smoke-free policies. PARTICIPANTS 1,256 American Indian tribal college students from three tribal colleges in the Midwest and Northern Plains. METHODS Data are from an observational cross-sectional study of American Indian tribal college students, collected through a web-based survey. RESULTS Only 40% of tribal college students reported not being exposed to second hand smoke in the past 7 days. A majority of nonsmokers (66%) agreed or strongly agreed with having a smoke-free campus, while 34.2% of smokers also agreed or strongly agreed. Overall, more than a third (36.6%) of tribal college students were not aware of their campus smoking policies. CONCLUSIONS Tribal campuses serving American Indian students have been much slower in adopting smoke-free campus policies. Our findings show that tribal college students would support a smoke-free campus policy.
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Affiliation(s)
| | - Anthony Wellever
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Niaman Nazir
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Pacheco
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelly Berryhil
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Babalola Faseru
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Charles Barnes
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Allergy & Immunology Research Laboratory, Children’s Mercy Hospital, Kansas City, Missouri, USA
- Department of Pathology and Laboratory Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Christine M. Daley
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Won S. Choi
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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Abstract
Balanced two-arm designs are more powerful than unbalanced designs and, consequently, Bayesian adaptive designs (BADs) are less powerful. However, when considering other subject- or community-focused design characteristics, fixed two-arm designs can be suboptimal. We use a novel approach to identify the best two-arm study design, taking into consideration both the statistical perspective and the community's perception. Data envelopment analysis (DEA) was used to estimate the relative performance of competing designs in the presence of multiple optimality criteria. The two-arm fixed design has enough deficiencies in subject- and community-specific benefit to make it the least favorable study design.
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Affiliation(s)
- Jo Wick
- a Department of Biostatistics , The University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Scott M Berry
- a Department of Biostatistics , The University of Kansas Medical Center , Kansas City , Kansas , USA.,b Berry Consultants , Austin , Texas , USA
| | - Hung-Wen Yeh
- a Department of Biostatistics , The University of Kansas Medical Center , Kansas City , Kansas , USA.,c Center for American Indian Community Health , The University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Won Choi
- c Center for American Indian Community Health , The University of Kansas Medical Center , Kansas City , Kansas , USA.,d Department of Preventative Medicine and Public Health , The University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Christina M Pacheco
- c Center for American Indian Community Health , The University of Kansas Medical Center , Kansas City , Kansas , USA.,e Department of Family Medicine , The University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Christine Daley
- c Center for American Indian Community Health , The University of Kansas Medical Center , Kansas City , Kansas , USA.,d Department of Preventative Medicine and Public Health , The University of Kansas Medical Center , Kansas City , Kansas , USA.,e Department of Family Medicine , The University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Byron J Gajewski
- a Department of Biostatistics , The University of Kansas Medical Center , Kansas City , Kansas , USA.,c Center for American Indian Community Health , The University of Kansas Medical Center , Kansas City , Kansas , USA.,e Department of Family Medicine , The University of Kansas Medical Center , Kansas City , Kansas , USA.,f School of Nursing , The University of Kansas Medical Center , Kansas City , Kansas , USA
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Choi WS, Nazir N, Pacheco CM, Filippi MK, Pacheco J, White Bull J, Nance C, Faseru B, Greiner KA, Daley CM. Recruitment and Baseline Characteristics of American Indian Tribal College Students Participating in a Tribal College Tobacco and Behavioral Survey. Nicotine Tob Res 2015; 18:1488-93. [PMID: 26438647 DOI: 10.1093/ntr/ntv226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/28/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION American Indians (AIs) have the highest cigarette smoking rates of any racial/ethnic group in the United States. Although the overall smoking prevalence in the United States for nonminority populations has decreased over the past several decades, the same pattern is not observed among AIs. The purpose of this observational study was to collect cigarette smoking and related information from American Indian tribal college students to inform tailored interventions. METHODS We conducted a repeated cross-sectional survey of American Indian tribal college students, Tribal College Tobacco and Behavior Survey (TCTABS), with a focus on recruiting all incoming freshman at three participating tribal colleges in the Midwest and Northern Plains regions. A total of 1256 students participated in the baseline surveys between April 2011 and October 2014. RESULTS The overall smoking prevalence of this sample was 34.7%, with differences by region (Northern Plains-44.0% and Midwest-28%). The majority, 87.5% of current smokers reported smoking 10 or less cigarettes per day, 41% reported smoking menthol cigarettes, 52% smoked Marlboro brand, and the mean age of their first cigarette was 14 years. The majority, 62% had made at least one quit attempt in the past year. The overwhelming majority of respondents, regardless of their smoking status, thought that the current smoking prevalence on campus was greater than 41% and approximately one-third believed that it was as high as 61%. CONCLUSIONS Very few studies of smoking have been conducted in this population and results from our study confirm the need for effective interventions. IMPLICATIONS AIs have the highest cigarette smoking rates compared to other racial/ethnic groups in the United States. Furthermore, limited studies have examined the epidemiology of cigarette smoking among tribal college students. This study addresses health disparities related to smoking among college students by examining the demographic, cultural, and environmental characteristics of smoking and quitting. Results from this study could lead to the development of a culturally-tailored smoking cessation and prevention program for American Indian tribal college students.
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Affiliation(s)
- Won S Choi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS;
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Christina M Pacheco
- American Indian Health Research and Education Alliance, Inc, Kansas City, KS; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS; Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Melissa K Filippi
- American Indian Health Research and Education Alliance, Inc, Kansas City, KS; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS; Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Joseph Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS; Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Julia White Bull
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Christi Nance
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Babalola Faseru
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS; Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - K Allen Greiner
- American Indian Health Research and Education Alliance, Inc, Kansas City, KS; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS; Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Christine Makosky Daley
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS; American Indian Health Research and Education Alliance, Inc, Kansas City, KS; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS; Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
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Pacheco JA, Pacheco CM, Lewis C, Williams C, Barnes C, Rosenwasser L, Choi WS, Daley CM. Ensuring healthy American Indian generations for tomorrow through safe and healthy indoor environments. Int J Environ Res Public Health 2015; 12:2810-22. [PMID: 25749318 PMCID: PMC4377934 DOI: 10.3390/ijerph120302810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 12/18/2022]
Abstract
American Indians (AI) have the highest rate of severe physical housing problems in the U.S. (3.9%). Little information exists about the environmental hazards in AI homes. The purposes of this paper are to discuss challenges that were encountered when recruiting AI for a home-and employment-based environmental health assessments, highlight major successes, and propose recommendations for future indoor environmental health studies. The Center for American Indian Community Health (CAICH) and Children's Mercy Hospital's Center for Environmental Health and Allergy and Immunology Research Lab collaborated to provide educational sessions and healthy home assessments for AI. Through educational trainings, more than 240 AI were trained on the primary causes of health problems in homes. A total of 72 homes and places of employment were assessed by AI environmental health specialists. The top three categories with the most concerns observed in the homes/places of employment were allergens/dust (98%), safety/injury (89%) and chemical exposure (82%). While some information on smoking inside the home was collected, these numbers may have been underreported due to stigma. This was CAICH's first endeavor in environmental health and although challenges arose, many more successes were achieved.
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Affiliation(s)
- Joseph A Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Christina M Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Charley Lewis
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Chandler Williams
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Charles Barnes
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1008, Kansas City, KS 66103, USA.
- Department of Allergy, Asthma, and Immunology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd., Kansas City, MO 64108, USA.
| | - Lanny Rosenwasser
- Department of Allergy, Asthma, and Immunology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd., Kansas City, MO 64108, USA.
| | - Won S Choi
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1008, Kansas City, KS 66103, USA.
| | - Christine M Daley
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1008, Kansas City, KS 66103, USA.
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Pacheco CM, Ciaccio CE, Nazir N, Daley CM, DiDonna A, Choi WS, Barnes CS, Rosenwasser LJ. Homes of low-income minority families with asthmatic children have increased condition issues. Allergy Asthma Proc 2014; 35:467-74. [PMID: 25584914 DOI: 10.2500/aap.2014.35.3792] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The home is increasingly associated with asthma. It acts both as a reservoir of asthma triggers and as a refuge from seasonal outdoor allergen exposure. Racial/ethnic minority families with low incomes tend to reside in neighborhoods with low housing quality. These families also have higher rates of asthma. This study explores the hypothesis that black and Latino urban households with asthmatic children experienced more home mechanical, structural condition-related areas of concern than white households with asthmatic children. Participant families (n = 140) took part in the Kansas City Safe and Healthy Homes Program, had at least one asthmatic child, and met income qualifications of no more than 80% of local median income; many were below 50%. Families self-identified their race. Homes were assessed by environmental health professionals using a standard set of criteria and a specific set of on-site and laboratory sampling and analyses. Homes were given a score for areas of concern between 0 (best) and 53 (worst). The study population self-identified as black (46%), non-Latino white (26%), Latino (14.3%), and other (12.9%). Mean number of areas of concern were 18.7 in Latino homes, 17.8 in black homes, 13.3 in other homes, and 13.2 in white homes. Latino and black homes had significantly more areas of concern. White families were also more likely to be in the upper portion of the income. In this set of 140 low-income homes with an asthmatic child, households of minority individuals had more areas of condition concerns and generally lower income than other families.
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Affiliation(s)
- Christina M. Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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Nazir N, Bevil B, Pacheco CM, Faseru B, McCloskey C, Greiner KA, Choi WS, Daley CM. Characteristics of American Indian light smokers. Addict Behav 2014; 39:358-61. [PMID: 24157425 PMCID: PMC3883561 DOI: 10.1016/j.addbeh.2013.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Received: 07/25/2013] [Accepted: 10/01/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION American Indians (AI) have the highest smoking rates of any racial/ethnic group in the U.S. and have more difficulty quitting smoking. Little is known about the smoking characteristics of AI smokers. The present study compared the demographic and smoking characteristics of light (≤10 cigarettes per day; N=206) and moderate/heavy (11+ cigarettes per day; N=86) AI smokers participating in a cross-sectional survey about smoking and health. METHODS Multiple methods were used to recruit participants in attendance at powwows, health and career fairs, and conferences. A total of 998 AI (76% cooperation rate) completed a survey assessing general health, sociodemographics, traditional and commercial tobacco use, knowledge and attitudes related to cancer, source of health information and care and other health-related behaviors. RESULTS AI light smokers were younger and less likely to be married or living with a partner compared to moderate/heavy smokers. AI light smokers were less dependent on smoking and more likely to have home smoking restrictions. There were no differences with respect to number of quit attempts in the past year or the average length of their most recent quit attempt by light vs. moderate/heavy smoking. In addition, a similar proportion of light and heavy smokers reported using tobacco for traditional purposes such as ceremonial, spiritual and prayer. CONCLUSIONS These findings highlight important differences between AI light and heavier smokers. Differences related to smoking characteristics such as level of dependence and home smoking restrictions have important implications for the treatment of AI smokers.
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Affiliation(s)
- Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1080, Kansas City, KS 66160, USA; Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1030, Kansas City, KS 66160, USA.
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Filippi MK, Pacheco CM, McCloskey C, Crosthwait RJ, Begaye J, Kinlacheeny J, Choi WS, Greiner KA, Daley CM. Internet Use for Health Information among American Indians: Facilitators and Inhibitors. J Health Dispar Res Pract 2014; 7:4. [PMID: 25419491 PMCID: PMC4237015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pacheco CM, Daley SM, Brown T, Filippi M, Greiner KA, Daley CM. Moving forward: breaking the cycle of mistrust between American Indians and researchers. Am J Public Health 2013; 103:2152-9. [PMID: 24134368 DOI: 10.2105/ajph.2013.301480] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
American Indians (AIs) have some of the poorest documented health outcomes of any racial/ethnic group. Research plays a vital role in addressing these health disparities. Historical and recent instances of unethical research, specifically the Havasupai diabetes project, have generated mistrust in AI communities. To address the concerns about unethical research held by some AIs in the Heartland (Midwest), the Center for American Indian Community Health (CAICH) has launched a series of efforts to inform AIs about research participants' rights. CAICH educates health researchers about the importance of learning and respecting a community's history, culture, values, and wishes when engaging in research with that community. Through community-based participatory research, CAICH is also empowering AIs to assert their rights as research participants.
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Affiliation(s)
- Christina M Pacheco
- Christina M. Pacheco, Travis Brown, Melissa Filippi, K. Allen Greiner, and Christine M. Daley are with the Center for American Indian Community Health, University of Kansas Medical Center, Kansas City. Sean M. Daley is with the Center for American Indian Studies, Johnson County Community College, Overland Park, KS
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James AS, Filippi MK, Pacheco CM, Cully L, Perdue D, Choi WS, Greiner KA, Daley CM. Barriers to colorectal cancer screening among American Indian men aged 50 or older, Kansas and Missouri, 2006-2008. Prev Chronic Dis 2013; 10:E170. [PMID: 24135394 PMCID: PMC3804015 DOI: 10.5888/pcd10.130067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
American Indian (AI) men have some of the highest rates of colorectal cancer (CRC) in the United States but among the lowest screening rates. Our goal was to better understand awareness and discourse about colorectal cancer in a heterogeneous group of AI men in the Midwestern United States. Focus groups were conducted with AI men (N = 29); data were analyzed using a community-participatory approach to qualitative text analysis. Several themes were identified regarding knowledge, knowledge sources, and barriers to and facilitators of screening. Men in the study felt that awareness about colorectal cancer was low, and people were interested in learning more. Education strategies need to be culturally relevant and specific.
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Affiliation(s)
- Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, 660 So. Euclid Ave, Box 8100, St Louis, MO 63110. E-mail:
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Berg CJ, Daley CM, Nazir N, Cully A, Pacheco CM, Buchanan T, Ahluwalia JS, Greiner KA, Choi WS. Smoke-Free Policies in the Workplace and in the Home among American Indians. J Health Dispar Res Pract 2012; 5:81-91. [PMID: 23795333 PMCID: PMC3689312] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES American Indians are more likely to smoke, less likely to have smoke-free homes, and potentially less likely to have worksite smoke-free policies. We examined correlates of smoke-free policies at home and work among a community-based sample of American Indians in the Midwest. METHODS We examined correlates of smoke-free policies at home and work in a sample of American Indians in the Midwest using a community-based participatory research approach. RESULTS 66.7% were nonsmokers, 15.6% smoked on some days, and 17.6% smoked every day. The majority (72.4%) had complete smoke-free home policies, 13.1% had partial restrictions, and 14.5% had no rules. Moreover, 62.7% had complete smoke-free worksite policies, 27.9% had partial policies, and 9.4% had no worksite smoke-free policies. Factors associated with having a complete smoke-free home policy included being a college graduate (p=.005) and a nonsmoker versus a nondaily (p=.006) or a daily smoker (p<.001). Correlates of having a complete smoke-free worksite policy included being female (p=.005) and a nonsmoker versus a nondaily (p=.03) or a daily smoker (p<.001). Having complete worksite policies was associated with having smoke-free homes (p<.001). CONCLUSIONS Having complete worksite policies was related to having smoke-free home policies; both were associated with being a nonsmoker.
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Affiliation(s)
- Carla J. Berg
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA
| | - Christine Makosky Daley
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Angel Cully
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Christina M. Pacheco
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Taneisha Buchanan
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
- Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN
| | - Jasjit S. Ahluwalia
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
- Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN
| | - K. Allen Greiner
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Won S. Choi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
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Berg CJ, Daley CM, Nazir N, Cully A, Pacheco CM, Buchanan T, Ahuwalia JS, Greiner KA, Choi WS. Smoke-Free Policies in the Workplace and in the Home among American Indians. J Health Dispar Res Pract 2012; 5:7. [PMID: 24286021 PMCID: PMC3839958] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES American Indians are more likely to smoke, less likely to have smoke-free homes, and potentially less likely to have worksite smoke-free policies. We examined correlates of smoke-free policies at home and work among a community-based sample of American Indians in the Midwest. METHODS We examined correlates of smoke-free policies at home and work in a sample of American Indians in the Midwest using a community-based participatory research approach. RESULTS 66.7% were nonsmokers, 15.6% smoked on some days, and 17.6% smoked every day. The majority (72.4%) had complete smoke-free home policies, 13.1% had partial restrictions, and 14.5% had no rules. Moreover, 62.7% had complete smoke-free worksite policies, 27.9% had partial policies, and 9.4% had no worksite smoke-free policies. Factors associated with having a complete smoke-free home policy included being a college graduate (p=.005) and a nonsmoker versus a nondaily (p=.006) or a daily smoker (p<.001). Correlates of having a complete smoke-free worksite policy included being female (p=.005) and a nonsmoker versus a nondaily (p=.03) or a daily smoker (p<.001). Having complete worksite policies was associated with having smoke-free homes (p<.001). CONCLUSIONS Having complete worksite policies was related to having smoke-free home policies; both were associated with being a nonsmoker.
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Faseru B, Daley CM, Gajewski B, Pacheco CM, Choi WS. A longitudinal study of tobacco use among American Indian and Alaska Native tribal college students. BMC Public Health 2010; 10:617. [PMID: 20955575 PMCID: PMC2964633 DOI: 10.1186/1471-2458-10-617] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 10/18/2010] [Indexed: 11/29/2022] Open
Abstract
Background American Indians (AI) have the highest smoking rates of any ethnic group in the US (40.8%), followed most closely by African Americans (24.3%) and European Americans (23.6%). AI smokers also have more difficulty quitting smoking compared to other ethnic groups, evidenced by their significantly lower quit ratios, and are among the least successful in maintaining long term abstinence. While health disparities like these have existed for years among AI, the epidemiology of smoking and nicotine dependence has not been optimally described among this underserved population. Our overarching hypothesis is that the susceptibility of AI to cigarette smoking and nicotine dependence and its consequences has both an underlying nicotine metabolism component as well as psychosocial, cultural, and environment causes. We are well-positioned to explore this issue for the first time in this population. Our objective is to establish a cohort of AI tribal college/university students to determine the predictors of smoking initiation (non-use to experimentation), progression (experimentation to established use), and cessation (established use to cessation). Much of what is known about the process of smoking initiation and progression comes from quantitative studies with non-Native populations. Information related to smoking use among AI tribal college/university (TCU) students is entirely unknown and critically needs further investigation. This study will be the first of its kind among AI college students who are at the highest risk among all ethnic groups for tobacco dependence. Methods/design First year students at Haskell Indian Nations University in Kansas will be recruited over four consecutive years and will be surveyed annually and repeatedly through year 5 of the study. We will use both longitudinal quantitative surveys and qualitative focus group methods to examine key measures and determinants of initiation and use among this high risk group.
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Affiliation(s)
- Babalola Faseru
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA
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Pacheco CM, Tavares CA, Coelho PM, Rocha OA, Santos JM, Prado FR, Francischi JN. Pharmacological evidence supporting a role for IL-1, IL-2 and serotonin in the inflammation induced by Schistosoma mansoni soluble egg antigen (SEA) in rat paws. Mediators Inflamm 1998; 7:261-7. [PMID: 9792336 PMCID: PMC1781856 DOI: 10.1080/09629359890947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
THIS study intended to characterize pharmacologically the mediator(s) released in the inflammation induced by Soluble Egg Antigen (SEA), the main antigen released from eggs of Schistosoma mansoni, in rat hindpaws. A single intraplantar injection of 0.1-100 microg SEA at day zero induced a dose-dependent increase in the volume of rat hindpaws characterizing an oedema of quick onset (within 15 min) and 4h-duration, which was confirmed by histopathological analysis of the paws. A second injection of SEA in the same paw (1-10 microg) 28 days later induced an increased dose-dependent oedematogenic response. The early oedematogenic response following SEA sensitization was derived from serotonin release and interleukin-1 (IL-1), since treatment with either pizotifen or an antibody against IL-1, reduced the response by 60% and 48%, respectively. The increased oedematogenic response derived from SEA-challenge (10 microg) of rat paws derived from a local rather than systemic reaction, since it was not observed if the sensitization was in the contralateral paw or the peritoneal cavity of the animals. Chronic treatment with inhibitors of IL-2 synthesis/release such as cyclosporin or dexamethasone during the sensitization phase reduced the oedematogenic response due to SEA challenge by 51% and 55%, respectively. These data suggested that SEA-challenge was immune-derived and dependent of IL-2 release. It is discussed the association between cytokine release and the resistance of rats to S. mansoni infection.
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Affiliation(s)
- C M Pacheco
- Department of Pharmacology, Institute of Federal University of Minas Gerais, Belo Horizonte, Brazil
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Francischi JN, Dias MF, Rocha OA, de Abreu Castro MS, Kiyomi Funayama Tatsuo MA, Farinelli P, Pacheco CM, Ferreira-Alves DL, Sirois P. Pharmacological characterization of Sephadex-induced oedema in rat paws: predominant role of serotonin and platelet-activating factor. Int Arch Allergy Immunol 1996; 109:398-406. [PMID: 8634526 DOI: 10.1159/000237269] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
An intravenous injection of Sephadex beads has been used to induce lung inflammation and bronchial hyperreactivity in small animals. In the present study, we injected Sephadex beads (0.3-5.5 mg/paw) into rat paws and followed the resulting inflammation plethysmometrically. Our results show that Sephadex beads induced a significant and dose-dependent increase in the hindpaw volume at 5 min; it was maximal at 30-60 min and declined at 4 h. However, the paw volume remained significantly increased for up to 21 days. The initial 4-hour-oedema was confirmed by histopathology of the paw tissues, but the persistent increase in paw volume was related to a chronic inflammatory (granulomatous) response. The Sephadex-induced oedema was predominantly due to serotonin (5-HT) release since specific antagonists such as methysergide (1 mg/kg) and pizotifen (0.1-2 mg/kg) administered both systemically and locally were able to inhibit the oedema (10-100 microgram/paw) as could pretreatment with compound 48/80. In addition, platelet-activating factor (PAF) was also shown to be involved, since systemic pretreatment using the specific PAF antagonist BN 52021 (1 mg/kg) was able to inhibit the increase in paw volume induced by Sephadex. Effective doses of indomethacin (2 mg/kg), L-NAME (1 mg/kg), pyrilamine (1-2 mg/kg), ondansetron (1 mg/kg) and HOE 140 (1 mg/kg) did not affect the Sephadex-induced oedema, thus ruling out the participation of prostaglandins, nitric oxide, histamine, 5-HT3 receptors and bradykinin in its development. Since the late increases in paw volume induced by Sephadex were reduced by pretreatment of the animals with the immunosuppressive drugs rapamycin and dexamethasone but not cyclosporin, our results also suggested that distinct immunological pathways may be involved in the modulation of the chronic phase of inflammation induced by Sephadex beads in rat paws.
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Affiliation(s)
- J N Francischi
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
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Affiliation(s)
- J A Gagliardi
- Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii 96859-5000, USA
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