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Peters SE, Gundersen DA, Neidlinger SM, Ritchie-Dunham J, Wagner GR. Thriving from work questionnaire: Spanish translation and validation. BMC Public Health 2024; 24:1187. [PMID: 38678202 PMCID: PMC11055305 DOI: 10.1186/s12889-024-18173-x] [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: 10/16/2023] [Accepted: 02/21/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Thriving from Work is a construct that has been highlighted as an important integrative positive worker well-being indicator that can be used in both research and practice. Recent public discourse emphasizes the important contributions that work should have on workers' lives in positive and meaningful ways and the importance of valid and reliable instruments to measure worker well-being. The Thriving from Work Questionnaire measures how workers' experiences of their work and conditions of work contributes in positive ways to their thriving both at and outside of work. METHODS The purpose of this study was to translate the Thriving from Work Questionnaire from English to Spanish, and then validate the translated questionnaire in a sample of 8,795 finance workers in Peru and Mexico. We used item response theory models replicating methods that were used for the original validation studies. We conducted a differential item functioning analysis to evaluate any differences in the performance of models between Peru and Mexico. We evaluated criterion validity with organizational leadership, flourishing, vitality, community well-being, and worker's home location socio-economic position. RESULTS The current study demonstrates that the Spanish (Peru/Mexico) questionnaire was found to be a reliable and valid measure of workers' thriving from work. One item was dropped from the long-form version of the original U.S. questionnaire. Both the long and short form versions of the questionnaire had similar psychometric properties. Empirical reliability was high. Criterion validity was established as hypothesized relationships between constructs was supported. There were no differences in the performance of the model between countries suggesting utility across Latin American countries. CONCLUSIONS The current study demonstrated that the Spanish (Peru and Mexico) version of the questionnaire is both a reliable and valid measure of worker well-being in Latin America. Specific recommendations are made for the adaptation of the questionnaire and directions of future research.
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Affiliation(s)
- Susan E Peters
- Center for Work, Health, and Well-being, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Daniel A Gundersen
- Center for Work, Health, and Well-being, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Survey and Qualitative Methods Core, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stephanie M Neidlinger
- Center for Work, Health, and Well-being, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Work, Organizational, and Business Psychology, Helmut-Schmidt University, Hamburg, Germany
| | - Jim Ritchie-Dunham
- Center for Work, Health, and Well-being, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Strategic Clarity, Belchertown, MA, USA
| | - Gregory R Wagner
- Center for Work, Health, and Well-being, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Liu J, Hanby E, Kingsley M, Winickoff JP, Gundersen DA, Tan ASL. Dual-Vaping of Nicotine and Cannabis among Adults who Currently Use Tobacco Products in Five New England States. Nicotine Tob Res 2024:ntae062. [PMID: 38502116 DOI: 10.1093/ntr/ntae062] [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] [Received: 10/15/2023] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Current measures of vaping behaviors do not distinguish what substances participants are vaping and to what extent they are dual-vaping nicotine and cannabis. This study describes the use of new survey questions that more specifically ask whether participants who vape are vaping nicotine, cannabis, CBD, or another substance. METHODS Adults, who reported any past-30-day tobacco use, from five New England states participated in an online survey from April 2021 to July 2022. Participants who vaped were asked, "Have you used any of the following vape substances in the past 30 days?" with the possible responses of nicotine, cannabis, CBD, other, and "don't know." Dual-use of both nicotine and cannabis was defined as the vaping of both nicotine and cannabis and/or CBD in the past-30-days, operationalized as a dichotomous outcome. Data were collected in monthly, repeated cross-sectional waves. Multinomial logistic regression was used to examine correlates of dual-vaping. RESULTS The analytic sample included 1547 adults who reported past-30-day tobacco use (mean age 42.9 years, 62.8% female, 85.4% White, 48.5% income of less than $50,000). Over one-quarter (26.1%) reported dual-vaping in the past-30-days. Identifying as male (p=0.002) and self-rated anxiety (p=0.043) were associated with a higher odds of dual-vaping. CONCLUSIONS Our findings show that a sizable proportion of a sample of New England adults who have used tobacco in the past-30-days are dual-vaping nicotine and cannabis. Adequate survey measures for assessing the vaping of multiple substances can help in better screening and characterization of health behaviors around dual-use. IMPLICATIONS This study addresses a key gap in adequate survey measures for assessing vaping of multiple substances. We found that among adults with past 30-day tobacco use, dual-vaping was prevalent and associated with different correlates, such as self-reported anxiety and education level, compared to sole-vaping of nicotine or cannabis. Our findings may help in characterizing and targeting future population-level surveillance and intervention efforts for multiple substance use behaviors.
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Affiliation(s)
- Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA
| | - Elaine Hanby
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA
| | - Melody Kingsley
- Massachusetts Tobacco Cessation and Prevention Program (MTCP), Massachusetts Department of Public Health, Boston, MA
| | - Jonathan P Winickoff
- MassGeneral Hospital Division of General Academic Pediatrics, Boston, MA
- MGH Tobacco Research and Treatment Center, Boston, MA
- American Academy of Pediatrics Julius B. Richmond Center, Itasca, IL
| | - Daniel A Gundersen
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, Division of General Internal Medicine, New Brunswick, NJ
| | - Andy S L Tan
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA
- University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA
- Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, PA, USA
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Kruse GR, Percac-Lima S, Barber-Dubois M, Davies ME, Gundersen DA, Ho O, Mascioli L, Munshi M, Perry S, Singh D, Thomas A, Emmons KM, Haas JS. Bundling Colorectal Cancer Screening Outreach with Screening for Social Risk in Federally Qualified Health Centers: A Stepped-Wedge Implementation-Effectiveness Study. J Gen Intern Med 2024:10.1007/s11606-024-08654-5. [PMID: 38332440 DOI: 10.1007/s11606-024-08654-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Bundling is combining individual interventions to meet quality metrics. Bundling offers of cancer screening with screening for social determinants of health (SDOH) may enable health centers to assist patients with social risks and yield efficiencies. OBJECTIVE To measure effects of bundling fecal immunochemical testing (FIT) and SDOH screening in federally qualified health centers (FQHCs). DESIGN Clustered stepped-wedge trial. PARTICIPANTS Four Massachusetts FQHCs randomized to implement bundled FIT-SDOH over 8-week "steps." INTERVENTION Outreach to 50-75-year-olds overdue for CRC screening to offer FIT with SDOH screening. The implementation strategy used facilitation and training for data monitoring and reporting. MAIN MEASURES Implementation process descriptions, data from facilitation meetings, and CRC and SDOH screening rates. Rates were compared between implementation and control FQHCs in each "step" by fitting generalized linear mixed-effects models with random intercepts for FQHCs, patients, and "step" by FQHC. KEY RESULTS FQHCs tailored implementation processes to their infrastructure, workflows, and staffing and prioritized different groups for outreach. Two FQHCs used population health outreach, and two integrated FIT-SDOH within established programs, such as pre-visit planning. Of 34,588 patients overdue for CRC screening, 54% were female; 20% Black, 11% Latino, 10% Asian, and 47% white; 32% had Medicaid, 16% Medicare, 32% private insurance, and 11% uninsured. Odds of CRC screening completion in implementation "steps" compared to controls were higher overall and among groups prioritized for outreach (overall: adjusted odds ratio (aOR) 2.41, p = 0.005; prioritized: aOR 2.88, p = 0.002). Odds of SDOH screening did not differ across "steps." CONCLUSIONS As healthcare systems are required to conduct more screenings, it is notable that outreach for a long-standing cancer screening requirement increased screening, even when bundled with a newer screening requirement. This outreach was feasible in a real-world safety-net clinical population and may conserve resources, especially compared to more complex or intensive outreach strategies. CLINICAL TRIALS REGISTRATION NCT04585919.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Madeline E Davies
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana Farber Cancer Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Oanh Ho
- Harbor Health Services, Inc., Mattapan, MA, USA
| | - Lynette Mascioli
- Massachusetts League of Community Health Centers, Boston, MA, USA
| | - Mehezbin Munshi
- Massachusetts League of Community Health Centers, Boston, MA, USA
| | - Sarah Perry
- Harbor Health Services, Inc., Mattapan, MA, USA
| | - Deepinder Singh
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Zupanc SN, Lakin JR, Volandes AE, Paasche-Orlow MK, Moseley ET, Gundersen DA, Das S, Penumarthy A, Martins-Welch D, Burns EA, Carney MT, Itty JE, Emmert K, Tulsky JA, Lindvall C. Forms or Free-Text? Measuring Advance Care Planning Activity Using Electronic Health Records. J Pain Symptom Manage 2023; 66:e615-e624. [PMID: 37536523 PMCID: PMC10592170 DOI: 10.1016/j.jpainsymman.2023.07.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
Advance care planning (ACP) discussions seek to guide future serious illness care. These discussions may be recorded in the electronic health record by documentation in clinical notes, structured forms and directives, and physician orders. Yet, most studies of ACP prevalence have only examined structured electronic health record elements and ignored data existing in notes. We sought to investigate the relative comprehensiveness and accuracy of ACP documentation from structured and unstructured electronic health record data sources. We evaluated structured and unstructured ACP documentation present in the electronic health records of 435 patients with cancer drawn from three separate healthcare systems. We extracted structured ACP documentation by manually annotating written documents and forms scanned into the electronic health record. We coded unstructured ACP documentation using a rule-based natural language processing software that identified ACP keywords within clinical notes and was subsequently reviewed for accuracy. The unstructured approach identified more instances of ACP documentation (238, 54.7% of patients) than the structured ACP approach (187, 42.9% of patients). Additionally, 16.6% of all patients with structured ACP documentation only had documents that were judged as misclassified, incomplete, blank, unavailable, or a duplicate of a previously entered erroneous document. ACP documents scanned into electronic health records represent a limited view of ACP activity. Research and measures of clinical practice with ACP should incorporate information from unstructured data.
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Affiliation(s)
- Sophia N Zupanc
- Department of Psychosocial Oncology and Palliative Care (S.N.Z., J.R.L., E.T.M., S.D., A.P., J.A.T., C.L.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care (S.N.Z., J.R.L., E.T.M., S.D., A.P., J.A.T., C.L.), Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School (J.R.L., A.E.V., J.A.T.), Boston, Massachusetts; Department of Medicine (J.R.L., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Angelo E Volandes
- Harvard Medical School (J.R.L., A.E.V., J.A.T.), Boston, Massachusetts; Department of Medicine (A.E.V.), Massachusetts General Hospital, Boston, Massachusetts; ACP Decisions (A.E.V.), Waban, Massachusetts
| | | | - Edward T Moseley
- Department of Psychosocial Oncology and Palliative Care (S.N.Z., J.R.L., E.T.M., S.D., A.P., J.A.T., C.L.), Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Computer Science (E.T.M.), School of Engineering, Tufts University, Medford, Massachusetts
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core (D.A.G.), Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences (D.A.G.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sophiya Das
- Department of Psychosocial Oncology and Palliative Care (S.N.Z., J.R.L., E.T.M., S.D., A.P., J.A.T., C.L.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Akhila Penumarthy
- Department of Psychosocial Oncology and Palliative Care (S.N.Z., J.R.L., E.T.M., S.D., A.P., J.A.T., C.L.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Diana Martins-Welch
- Institute of Health System Science (D.M.W., E.A.B., M.T.C., J.E.I., K.E.), Feinstein Institutes for Medical Research, Manhasset, New York; Department of Medicine (D.M.W., E.A.B., M.T.C.), Zucker School of Medicine Hofstra/Northwell, New Hyde Park, New York
| | - Edith A Burns
- Institute of Health System Science (D.M.W., E.A.B., M.T.C., J.E.I., K.E.), Feinstein Institutes for Medical Research, Manhasset, New York; Department of Medicine (D.M.W., E.A.B., M.T.C.), Zucker School of Medicine Hofstra/Northwell, New Hyde Park, New York
| | - Maria T Carney
- Institute of Health System Science (D.M.W., E.A.B., M.T.C., J.E.I., K.E.), Feinstein Institutes for Medical Research, Manhasset, New York; Department of Medicine (D.M.W., E.A.B., M.T.C.), Zucker School of Medicine Hofstra/Northwell, New Hyde Park, New York
| | - Jennifer E Itty
- Institute of Health System Science (D.M.W., E.A.B., M.T.C., J.E.I., K.E.), Feinstein Institutes for Medical Research, Manhasset, New York
| | - Kaitlin Emmert
- Institute of Health System Science (D.M.W., E.A.B., M.T.C., J.E.I., K.E.), Feinstein Institutes for Medical Research, Manhasset, New York
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care (S.N.Z., J.R.L., E.T.M., S.D., A.P., J.A.T., C.L.), Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School (J.R.L., A.E.V., J.A.T.), Boston, Massachusetts; Department of Medicine (J.R.L., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care (S.N.Z., J.R.L., E.T.M., S.D., A.P., J.A.T., C.L.), Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School (J.R.L., A.E.V., J.A.T.), Boston, Massachusetts; Department of Medicine (J.R.L., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts.
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Easterling DV, Jacob RR, Brownson RC, Haire-Joshu D, Gundersen DA, Angier H, DeVoe JE, Likumahuwa-Ackman S, Vu T, Glasgow RE, Schnoll R. Participatory logic modeling in a multi-site initiative to advance implementation science. Implement Sci Commun 2023; 4:106. [PMID: 37644495 PMCID: PMC10466752 DOI: 10.1186/s43058-023-00468-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Logic models map the short-term and long-term outcomes that are expected to occur with a program, and thus are an essential tool for evaluation. Funding agencies, especially in the United States (US), have encouraged the use of logic models among their grantees. They also use logic models to clarify expectations for their own funding initiatives. It is increasingly recognized that logic models should be developed through a participatory approach which allows input from those who carry out the program being evaluated. While there are many positive examples of participatory logic modeling, funders have generally not engaged grantees in developing the logic model associated with their own initiatives. This article describes an instance where a US funder of a multi-site initiative fully engaged the funded organizations in developing the initiative logic model. The focus of the case study is Implementation Science Centers in Cancer Control (ISC3), a multi-year initiative funded by the National Cancer Institute. METHODS The reflective case study was collectively constructed by representatives of the seven centers funded under ISC3. Members of the Cross-Center Evaluation (CCE) Work Group jointly articulated the process through which the logic model was developed and refined. Individual Work Group members contributed descriptions of how their respective centers reviewed and used the logic model. Cross-cutting themes and lessons emerged through CCE Work Group meetings and the writing process. RESULTS The initial logic model for ISC3 changed in significant ways as a result of the input of the funded groups. Authentic participation in the development of the logic model led to strong buy-in among the centers, as evidenced by their utilization. The centers shifted both their evaluation design and their programmatic strategy to better accommodate the expectations reflected in the initiative logic model. CONCLUSIONS The ISC3 case study demonstrates how participatory logic modeling can be mutually beneficial to funders, grantees and evaluators of multi-site initiatives. Funded groups have important insights about what is feasible and what will be required to achieve the initiative's stated objectives. They can also help identify the contextual factors that either inhibit or facilitate success, which can then be incorporated into both the logic model and the evaluation design. In addition, when grantees co-develop the logic model, they have a better understanding and appreciation of the funder's expectations and thus are better positioned to meet those expectations.
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Affiliation(s)
- Douglas V Easterling
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Rebekah R Jacob
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63117, USA
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Daniel A Gundersen
- Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Heather Angier
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Sonja Likumahuwa-Ackman
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Thuy Vu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, 98195, USA
| | - Russell E Glasgow
- Department of Family Medicine, University of Colorado, 1890 N Revere Ct, 3Rd Floor, Aurora, CO, 80045, USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4Th Floor, Philadelphia, PA, 19104, USA
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Liu J, Roberts J, Reynolds MJ, Hanby E, Gundersen DA, Winickoff JP, Rees VW, Emmons KM, Tan ASL. Barriers and facilitators to address vaping in Massachusetts schools: a mixed-methods study of school-based stakeholders. Transl Behav Med 2023; 13:589-600. [PMID: 37084410 PMCID: PMC10415734 DOI: 10.1093/tbm/ibad012] [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] [Indexed: 04/23/2023] Open
Abstract
We assessed vaping behaviors, environments, COVID-19 influences, and barriers and facilitators of existing approaches that address adolescent vaping in Massachusetts middle and high schools. Findings from this study will provide considerations for individual schools or districts as they advance adolescent vaping prevention and treatment efforts. We analyzed 310 open-ended comments from Massachusetts school administrators who completed a survey between November 2020 and January 2021. Further, we analyzed nine semi-structured interviews with administrators (e.g., principals, vice principals, school nurses) from Massachusetts school systems (n = 6) and school-based anti-tobacco advocates (n = 3); interviews took place between May and December 2021. Informed by Green's PRECEDE model, we conducted a framework analysis using deductive codes based on the model constructs (enabling, reinforcing, and predisposing factors) and inductive codes of key themes emerging from the interviews. Challenges to addressing adolescent vaping included staff capacity, funding, and lack of mental health and counseling supports. The COVID-19 pandemic was a major barrier to conducting usual in-person vaping programs, but also reduced student vaping at school due to new social distancing practices and bathroom use policies. Facilitators of vaping interventions included peer-led initiatives and parental involvement. Participants discussed the importance of educating adolescents on the harms of vaping and the move toward alternatives-to-suspension programs rather than disciplinary action. School-based anti-vaping program implementers-such as school districts, state departments of education, or local health departments-will need to leverage facilitators such as peer-led initiatives, alternatives-to-suspension approaches, and parental involvement, to increase the potential impact of these programs.
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Affiliation(s)
- Jessica Liu
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Jane Roberts
- Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA, USA
| | | | - Elaine Hanby
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA
| | - Daniel A Gundersen
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
- Dana-Farber Cancer Institute, Survey and Qualitative Methods Core, Boston, MA, USA
| | - Jonathan P Winickoff
- MassGeneral Hospital Division of General Academic Pediatrics, Boston, MA, USA
- MGH Tobacco Research and Treatment Center, Boston, MA, USA
- American Academy of Pediatrics Julius B. Richmond Center, Itasca, IL, USA
| | - Vaughan W Rees
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Karen M Emmons
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Andy S L Tan
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA
- University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
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Easterling D, Jacob RR, Brownson RC, Haire-Joshu D, Gundersen DA, Angier H, DeVoe JE, Likumahuwa-Ackman S, Vu T, Glasgow RE, Schnoll R. Participatory Logic Modeling in a Multi-Site Initiative to Advance Implementation Science. RESEARCH SQUARE 2023:rs.3.rs-2846665. [PMID: 37292912 PMCID: PMC10246100 DOI: 10.21203/rs.3.rs-2846665/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: It is increasingly being recognized that logic models should be developed through a participatory approach which allows input from those who carry out the program being evaluated. While there are many positive examples of participatory logic modeling, funders have generally not used this approach in the context of multi-site initiatives. This article describes an instance where the funder and evaluator of a multi-site initiative fully engaged the funded organizations in developing the initiative logic model. The focus of the case study is Implementation Science Centers in Cancer Control (ISC 3 ), a multi-year initiative funded by the National Cancer Institute (NCI). Methods: The case study was collectively constructed by representatives of the seven centers funded under ISC 3 . Members of the Cross-Center Evaluation (CCE) Work Group jointly articulated the process through which the logic model was developed and refined. Individual Work Group members contributed descriptions of how their respective centers reviewed and used the logic model. Cross-cutting themes and lessons emerged through CCE Work Group meetings and the writing process. Results: The initial logic model for ISC 3 changed in significant ways as a result of the input of the funded groups. Authentic participation in the development of the logic model led to strong buy-in among the centers, as evidenced by their utilization. The centers shifted both their evaluation design and their programmatic strategy to better accommodate the expectations reflected in the initiative logic model. Conclusions: The ISC 3 case study provides a positive example of how participatory logic modeling can be mutually beneficial to funders, grantees and evaluators of multi-site initiatives. Funded groups have important insights about what is feasible and what will be required to achieve the initiative's stated objectives. They can also help identify the contextual factors that either inhibit or facilitate success, which can then be incorporated into both the logic model and the evaluation design. In addition, when grantees co-develop the logic model, they have a better understanding and appreciation of the funder's expectations, and thus are better positioned to meet those expectations.
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Affiliation(s)
| | - Rebekah R Jacob
- Washington University In St Louis: Washington University in St Louis
| | - Ross C Brownson
- Washington University In St Louis: Washington University in St Louis
| | - Debra Haire-Joshu
- Washington University In St Louis: Washington University in St Louis
| | | | | | | | | | - Thuy Vu
- University of Washington Seattle Campus: University of Washington
| | - Russell E Glasgow
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
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Odai-Afotey A, Lederman RI, Ko NY, Gagnon H, Fikre T, Gundersen DA, Revette AC, Hershman DL, Crew KD, Keating NL, Freedman RA. Breast cancer treatment receipt and the role of financial stress, health literacy, and numeracy among diverse breast cancer survivors. Breast Cancer Res Treat 2023; 200:127-137. [PMID: 37178432 PMCID: PMC10182756 DOI: 10.1007/s10549-023-06960-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Disparities in breast cancer treatment for low-income and minority women are well documented. We examined economic hardship, health literacy, and numeracy and whether these factors were associated with differences in receipt of recommended treatment among breast cancer survivors. METHODS During 2018-2020, we surveyed adult women diagnosed with stage I-III breast cancer between 2013 and 2017 and received care at three centers in Boston and New York. We inquired about treatment receipt and treatment decision-making. We used Chi-squared and Fisher's exact tests to examine associations between financial strain, health literacy, numeracy (using validated measures), and treatment receipt by race and ethnicity. RESULTS The 296 participants studied were 60.1% Non-Hispanic (NH) White, 25.0% NH Black, and 14.9% Hispanic; NH Black and Hispanic women had lower health literacy and numeracy and reported more financial concerns. Overall, 21 (7.1%) women declined at least one component of recommended therapy, without differences by race and ethnicity. Those not initiating recommended treatment(s) reported more worry about paying large medical bills (52.4% vs. 27.1%), worse household finances since diagnosis (42.9% vs. 22.2%), and more uninsurance before diagnosis (9.5% vs. 1.5%); all P < .05. No differences in treatment receipt by health literacy or numeracy were observed. CONCLUSION In this diverse population of breast cancer survivors, rates of treatment initiation were high. Worry about paying medical bills and financial strain were frequent, especially among non-White participants. Although we observed associations of financial strain with treatment initiation, because few women declined treatments, understanding the scope of impact is limited. Our results highlight the importance of assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures of financial strain and inclusion of health literacy and numeracy.
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Affiliation(s)
- Ashley Odai-Afotey
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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9
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Peters SE, Gundersen DA, Katz JN, Sorensen G, Wagner GR. Thriving from Work Questionnaire: Dimensionality, reliability, and validity of the long and short form questionnaires. Am J Ind Med 2023; 66:281-296. [PMID: 36748853 DOI: 10.1002/ajim.23465] [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: 09/06/2022] [Revised: 01/04/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Thriving from Work is defined as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential at work, at home, and in the community. The purpose of this study was to develop a psychometrically-sound questionnaire measuring the positive contribution that work can have on one's well-being both at, and outside of, their work. METHODS We used both a qualitative and quantitative approach of item reduction, domain mapping dimensionality testing, development of "long-" and "short-" versions of the questionnaire, reliability, and construct and criterion validity testing. This was established in two independent online samples of US based workers (n = 1550, n = 500). RESULTS We developed a bi-factor model 30-item long-form and a uni-factorial 8-item short-version. The long-form measures both the latent construct of Thriving from Work and six domains (psychological/emotional; work-life integration; social; experience of work; basic needs; health). Both long- and short- forms were found to have high empirical reliability (0.93 and 0.87 respectively). The short-form captures 94% of variance of the long-form. Construct and criterion validity were supported. Test-retest reliability was high. CONCLUSIONS The Thriving from Work Questionnaire appears to be a valid and reliable measure of work-related well-being in United States workers. Further testing is needed to refine and test the instrument in specific industries, unique worker populations, and across geographic regions.
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Affiliation(s)
- Susan E Peters
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Survey and Qualitative Methods Core, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeffrey N Katz
- Departments of Orthopedic Surgery and Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Glorian Sorensen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gregory R Wagner
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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10
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Stockman LS, Gundersen DA, Gikandi A, Akindele RN, Svoboda L, Pohl S, Drews MR, Lathan CS. The Colocation Model in Community Cancer Care: A Description of Patient Clinical and Demographic Attributes and Referral Pathways. JCO Oncol Pract 2023:OP2200487. [PMID: 36940391 DOI: 10.1200/op.22.00487] [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: 03/22/2023] Open
Abstract
PURPOSE Cancer disparities are well documented among Black, Indigenous, and People of Color, yet little is known about the characteristics of programs that serve these populations. Integrating specialized cancer care services within community settings is important for addressing the needs of historically marginalized populations. Our National Cancer Institute-Designated Cancer Center initiated a clinical outreach program incorporating cancer diagnostic services and patient navigation within a Federally Qualified Health Center (FQHC) to expedite evaluation and resolution of potential cancer diagnoses with the goal of collaboration between oncology specialists and primary care providers in a historically marginalized community in Boston, MA. MATERIALS AND METHODS Sociodemographic and clinical characteristics were analyzed from patients who were referred to the program for cancer-related care between January 2012 and July 2018. RESULTS The majority of patients self-identified as Black (non-Hispanic) followed by Hispanic (Black and White). Twenty-two percent of patients had a cancer diagnosis. Treatment and surveillance plans were established for those with and without cancer at a median time to diagnostic resolution of 12 and 28 days, respectively. The majority of patients presented with comorbid health conditions. There was a high prevalence of self-reported financial distress among patients seeking care through this program. CONCLUSION These findings highlight the wide spectrum of cancer care concerns in historically marginalized communities. This review of the program suggests that integrating cancer evaluation services within community-based primary health care settings offers promise for enhancing the coordination and delivery of cancer diagnostic services among historically marginalized populations and could be a method to address clinical access disparities.
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Affiliation(s)
- Leah S Stockman
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Daniel A Gundersen
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ajami Gikandi
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ruth N Akindele
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ludmila Svoboda
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sarah Pohl
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Christopher S Lathan
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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11
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Freedman RA, Ko NY, Lederman RI, Gagnon H, Fikre T, Gundersen DA, Revette AC, Odai-Afotey A, Kantor O, Hershman DL, Crew KD, Keating NL. Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors. Breast Cancer Res Treat 2022; 196:623-633. [PMID: 36220997 PMCID: PMC9552717 DOI: 10.1007/s10549-022-06752-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022]
Abstract
Purpose The degree to which breast cancer survivors know about their tumors and understand treatment rationales is not well understood. We sought to identify information gaps within a diverse sample and explore whether knowledge about breast cancer and treatment may impact care. Methods We conducted a one-time, interviewer-administered survey of women who were diagnosed with breast cancer during 2013–2017 and received care at one of three centers in Boston, MA, and New York, NY. We examined knowledge of breast cancer and treatment rationales, information preferences, and treatment receipt. Results During 2018–2020, we interviewed 313 women (American Association for Public Opinion Research Cooperation Rates 58.4–76.5% across centers) who were 56.9% White, 23.6% Black, 14.1% Hispanic, and 5.4% other. Among the 296 included in analyses, we observed high variability in knowledge of breast cancer and treatment rationales, with a substantial number demonstrating limited knowledge despite feeling highly informed; > 25% actively avoided information. Black and Hispanic (vs. White) women consistently knew less about their cancers. Lack of understanding of treatment rationales for chemotherapy, radiation, and hormonal therapy was common but not consistently different by race and ethnicity. Understanding treatment rationale (but not cancer knowledge) was associated with treatment initiation, but small sample sizes limited in-depth examination. Conclusions Our study highlights the need for enhanced informational support for breast cancer survivors, who are challenged with complex information during the decision-making process and beyond. More research is needed to understand how to further educate and empower diverse populations of patients with breast cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06752-8.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Olga Kantor
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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12
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Kruse GR, Pelton-Cairns L, Taveras EM, Dargon-Hart S, Gundersen DA, Lee RM, Bierer BE, Lawlor E, LaRocque RC, Marcus JL, Davies ME, Emmons KM. Implementing expanded COVID-19 testing in Massachusetts community health centers through community partnerships: Protocol for an interrupted time series and stepped wedge study design. Contemp Clin Trials 2022; 118:106783. [PMID: 35533978 PMCID: PMC9076025 DOI: 10.1016/j.cct.2022.106783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/15/2022] [Accepted: 05/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Community Health Centers (CHCs) are a critical source of care for low-income and non-privately insured populations. During the pandemic, CHCs have leveraged their infrastructure and role as a trusted source of care to engage the communities they serve in COVID-19 testing. METHODS To directly address the impact that COVID-19 has had on historically marginalized populations in Massachusetts, we designed a study of community-engaged COVID-19 testing expansion: (1) leveraging existing partnerships to accelerate COVID-19 testing and rapidly disseminate effective implementation strategies; (2) incorporating efforts to address key barriers to testing participation in communities at increased risk for COVID-19; (3) further developing partnerships between communities and CHCs to address testing access and disparities; (4) grounding the study in the development of a shared ethical framework for advancing equity in situations of scarcity; and (5) developing mechanisms for communication and science translation to support community outreach. We use a controlled interrupted time series design, comparing number of COVID-19 tests overall and among people identified as members of high-risk groups served by intervention CHCs compared with six matched control CHCs in Massachusetts, followed by a stepped wedge design to pilot test strategies for tailored outreach by CHCs. CONCLUSIONS Here, we describe a community-partnered strategy to accelerate COVID-19 testing in historically marginalized populations that provides ongoing resources to CHCs for addressing testing needs in their communities. The study aligns with principles of community-engaged research including shared leadership, adequate resources for community partners, and the flexibility to respond to changing needs over time.
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Affiliation(s)
- Gina R Kruse
- Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02114, USA.
| | | | - Elsie M Taveras
- Harvard Medical School, Boston, MA 02114, USA; Massachusetts General Hospital, Kraft Center for Community Health, Boston, MA 02114, USA; Massachusetts General Hospital, Division of Academic Pediatrics, Boston, MA 02114, USA
| | - Susan Dargon-Hart
- Massachusetts League of Community Health Centers, Boston, MA 02114, USA
| | - Daniel A Gundersen
- Dana Farber Cancer Institute, Division of Population Sciences, Boston, MA, USA
| | - Rebekka M Lee
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA
| | - Barbara E Bierer
- Harvard Medical School, Boston, MA 02114, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Erica Lawlor
- Harvard Medical School, Boston, MA 02114, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA
| | - Regina C LaRocque
- Harvard Medical School, Boston, MA 02114, USA; Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA 02114, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Madeline E Davies
- Massachusetts General Hospital, Kraft Center for Community Health, Boston, MA 02114, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA
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13
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Odai-Afotey A, Lederman R, Ko NY, Gagnon H, Hershman DL, Crew KD, Keating NL, Gundersen DA, Revette AC, Freedman RA. Financial distress, health literacy, numeracy, and treatment receipt by race/ethnicity amongst breast cancer survivors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18554] [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
e18554 Background: Low-income and minority women are less likely to receive breast cancer treatments and have higher mortality rates compared with other women.We examined economic hardship, health literacy, and numeracy by race/ethnicity and whether these factors were associated with differences in receipt of recommended treatment. Methods: We conducted a telephone survey in 2018-2020 of adult women diagnosed with stage I-III breast cancer between 2013-2016 at three centers in Boston and New York. We asked women about treatment receipt and factors contributing to decision-making. We used X2 and Fischer exact tests to examine associations between economic distress, health literacy/numeracy, and treatment receipt by race/ethnicity. Results: Among 326 respondents (AAPOR cooperation rate 63-80% across sites), 55% were Non-Hispanic (NH) White, 23% were NH Black, and 14% Hispanic; 15% were Medicaid-insured. Due to item non-response, sample sizes ranged from 294-315 per question. A substantial proportion of women, and particularly Black and Hispanic women, reported economic distress, worse finances over time, and low literacy/numeracy (Table). Overall, 7% (n = 22) did not initiate at least one recommended treatment. Although we observed no differences in treatment by race/ethnicity (p = 0.70), those not initiating recommended treatment(s) reported more worry about paying large medical bills (52% vs. 27%) and covering visit costs (27 vs. 10%); p < .05 for both. Conclusions: In a diverse sample of breast cancer survivors, financial distress was common, particularly for non-White participants; non-White women also had lower literacy/numeracy. Although we observed some associations of these factors (but not race/ethnicity) with less receipt of recommended treatments, because few women declined treatments, understanding the scope of impact is limited. However, our results highlight the importance of up-front and longer-term assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures on financial distress and the focus on health literacy/numeracy among a diverse population.[Table: see text]
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Affiliation(s)
| | | | - Naomi Y Ko
- Boston University Medical Center, Boston, MA
| | | | - Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | - Anna C. Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA
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14
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Jacob RR, Korn AR, Huang GC, Easterling D, Gundersen DA, Ramanadhan S, Vu T, Angier H, Brownson RC, Haire-Joshu D, Oh AY, Schnoll R. Collaboration networks of the implementation science centers for cancer control: a social network analysis. Implement Sci Commun 2022; 3:41. [PMID: 35418309 PMCID: PMC9009020 DOI: 10.1186/s43058-022-00290-6] [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: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Multi-center research initiatives offer opportunities to develop and strengthen connections among researchers. These initiatives often have goals of increased scientific collaboration which can be examined using social network analysis. METHODS The National Cancer Institute (NCI)-funded Implementation Science Centers in Cancer Control (ISC3) initiative conducted an online social network survey in its first year of funding (2020) to (1) establish baseline network measures including the extent of cross-center collaboration and (2) assess factors associated with a network member's access to the network such as one's implementation science (IS) expertise. Members of the seven funded centers and NCI program staff identified collaborations in planning/conducting research, capacity building, product development, scientific dissemination, and practice/policy dissemination. RESULTS Of the 192 invitees, 182 network members completed the survey (95%). The most prevalent roles were faculty (60%) and research staff (24%). Almost one-quarter (23%) of members reported advanced expertise in IS, 42% intermediate, and 35% beginner. Most members were female (69%) and white (79%). One-third (33%) of collaboration ties were among members from different centers. Across all collaboration activities, the network had a density of 14%, suggesting moderate cohesion. Degree centralization (0.33) and betweenness centralization (0.07) measures suggest a fairly dispersed network (no single or few central member(s) holding all connections). The most prevalent and densely connected collaboration was in planning/conducting research (1470 ties; 8% density). Practice/policy dissemination had the fewest collaboration, lowest density (284 ties' 3% density), and the largest number of non-connected members (n=43). Access to the ISC3 network varied significantly depending on members' level of IS expertise, role within the network, and racial/ethnic background. Across all collaboration activities, most connected members included those with advanced IS expertise, faculty and NCI staff, and Hispanic or Latino and white members. CONCLUSIONS Results establish a baseline for assessing the growth of cross-center collaborations, highlighting specific areas in need of particular growth in network collaborations such as increasing engagement of racial and ethnic minorities and trainees or those with less expertise in IS.
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Affiliation(s)
- Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Grace C Huang
- Westat, 1600 Research Blvd., Rockville, MD, 20850, USA
| | - Douglas Easterling
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Division of Population Sciences, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Thuy Vu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, 98195, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, 63130, USA
| | - Debra Haire-Joshu
- Center for Diabetes Translation Research, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63117, USA
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - April Y Oh
- Division of Cancer Control and Population Sciences, Implementation Science Team, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA, 19104, USA
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15
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Volandes AE, Zupanc SN, Paasche-Orlow MK, Lakin JR, Chang Y, Burns EA, LaVine NA, Carney MT, Martins-Welch D, Emmert K, Itty JE, Moseley ET, Davis AD, El-Jawahri A, Gundersen DA, Fix GM, Yacoub AM, Schwartz P, Gabry-Kalikow S, Garde C, Fischer J, Henault L, Burgess L, Goldman J, Kwok A, Singh N, Alvarez Suarez AL, Gromova V, Jacome S, Tulsky JA, Lindvall C. Association of an Advance Care Planning Video and Communication Intervention With Documentation of Advance Care Planning Among Older Adults: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e220354. [PMID: 35201306 PMCID: PMC8874350 DOI: 10.1001/jamanetworkopen.2022.0354] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE COVID-19 has disproportionately killed older adults and racial and ethnic minority individuals, raising questions about the relevance of advance care planning (ACP) in this population. Video decision aids and communication skills training offer scalable delivery models. OBJECTIVE To assess whether ACP video decision aids and a clinician communication intervention improved the rate of ACP documentation during an evolving pandemic, with a focus on African American and Hispanic patients. DESIGN, SETTING, AND PARTICIPANTS The Advance Care Planning: Communicating With Outpatients for Vital Informed Decisions trial was a pre-post, open-cohort nonrandomized controlled trial that compared ACP documentation across the baseline pre-COVID-19 period (September 15, 2019, to March 14, 2020), the COVID-19 wave 1 period (March 15, 2020, to September 14, 2020), and an intervention period (December 15, 2020, to June 14, 2021) at a New York metropolitan area ambulatory network of 22 clinics. All patients 65 years or older who had at least 1 clinic or telehealth visit during any of the 3 study periods were included. MAIN OUTCOMES AND MEASURES The primary outcome was ACP documentation. RESULTS A total of 14 107 patients (mean [SD] age, 81.0 [8.4] years; 8856 [62.8%] female; and 2248 [15.9%] African American or Hispanic) interacted with clinicians during the pre-COVID-19 period; 12 806 (mean [SD] age, 81.2 [8.5] years; 8047 [62.8%] female; and 1992 [15.6%] African American or Hispanic), during wave 1; and 15 106 (mean [SD] 80.9 [8.3] years; 9543 [63.2%] female; and 2535 [16.8%] African American or Hispanic), during the intervention period. Clinicians documented ACP in 3587 patients (23.8%) during the intervention period compared with 2525 (17.9%) during the pre-COVID-19 period (rate difference [RD], 5.8%; 95% CI, 0.9%-7.9%; P = .01) and 1598 (12.5%) during wave 1 (RD, 11.3%; 95% CI, 6.3%-12.1%; P < .001). Advance care planning was documented in 447 African American patients (30.0%) during the intervention period compared with 233 (18.1%) during the pre-COVID-19 period (RD, 11.9%; 95% CI, 4.1%-15.9%; P < .001) and 130 (11.0%) during wave 1 (RD, 19.1%; 95% CI, 11.7%-21.2%; P < .001). Advance care planning was documented for 222 Hispanic patients (21.2%) during the intervention period compared with 127 (13.2%) during the pre-COVID-19 period (RD, 8.0%; 95% CI, 2.1%-10.9%; P = .004) and 82 (10.2%) during wave 1 (RD, 11.1%; 95% CI, 5.5%-14.5%; P < .001). CONCLUSIONS AND RELEVANCE This intervention, implemented during the evolving COVID-19 pandemic, was associated with higher rates of ACP documentation, especially for African American and Hispanic patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04660422.
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Affiliation(s)
- Angelo E. Volandes
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- ACP Decisions, Boston, Massachusetts
| | - Sophia N. Zupanc
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael K. Paasche-Orlow
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Joshua R. Lakin
- Harvard Medical School, Boston, Massachusetts
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Edith A. Burns
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Medicine, Zucker School of Medicine Hosftra/Northwell, New Hyde Park, New York
| | - Nancy A. LaVine
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Medicine, Zucker School of Medicine Hosftra/Northwell, New Hyde Park, New York
| | - Maria T. Carney
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Medicine, Zucker School of Medicine Hosftra/Northwell, New Hyde Park, New York
| | - Diana Martins-Welch
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Medicine, Zucker School of Medicine Hosftra/Northwell, New Hyde Park, New York
| | - Kaitlin Emmert
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Jennifer E. Itty
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Edward T. Moseley
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Daniel A. Gundersen
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gemmae M. Fix
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
| | - Andrea M. Yacoub
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | | | | | | | - Jonathan Fischer
- Department of Community Health and Family Medicine, Hospice and Palliative Care, Duke University Health System, Durham, North Carolina
| | - Lori Henault
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Leah Burgess
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Julie Goldman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anne Kwok
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nimisha Singh
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Armando L. Alvarez Suarez
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Valeria Gromova
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | - Sonia Jacome
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York
| | - James A. Tulsky
- Harvard Medical School, Boston, Massachusetts
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Charlotta Lindvall
- Harvard Medical School, Boston, Massachusetts
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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16
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Bekalu MA, Gundersen DA, Viswanath K. Beyond Educating the Masses: The Role of Public Health Communication in Addressing Socioeconomic- and Residence-based Disparities in Tobacco Risk Perception. Health Commun 2022; 37:214-221. [PMID: 33054385 PMCID: PMC9261016 DOI: 10.1080/10410236.2020.1831755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Public health communication has long been a key component of tobacco control efforts. However, little is known whether and how such an effort could address disparities in tobacco risk perceptions among population subgroups. In this study, using data from the Global Adult Tobacco Survey of Ethiopia, we examined if tobacco risk perceptions varied across socioeconomic and urban vs. rural population subgroups, and whether and how exposure to anti-smoking message was associated with disparities in risk perceptions across socioeconomic and urban-rural subgroups. The results indicated that health risk perceptions of smoking and secondhand smoke exposure were significantly lower among rural, less educated and less affluent population subgroups. Controlling for age, gender, education, wealth, place of residence, and pro-smoking message exposure, anti-smoking message exposure was associated with greater risk perceptions of smoking. Moreover, anti-smoking message exposure moderated the associations of place of residence and education with risk perceptions of smoking and secondhand smoke exposure, respectively. The probability of risk perception of smoking associated with anti-smoking message exposure was higher among the rural populace compared to urbanites. Similarly, the probability of risk perception of secondhand smoke exposure associated with anti-smoking message exposure was the highest among individuals without formal education compared to those with primary, secondary, and college-level education. The findings suggest that efforts should be made to make sure adequate anti-smoking message exposure among less educated and rural audiences so as to reduce disparities in tobacco risk perceptions.
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Affiliation(s)
- Mesfin A. Bekalu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University
- Center for Community-Based Research, Dana-Farber Cancer Institute
| | | | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University
- Center for Community-Based Research, Dana-Farber Cancer Institute
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17
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Chua IS, Fratt E, Ho JJ, Roldan CS, Gundersen DA, Childers J. Primary Addiction Medicine Skills for Hospice and Palliative Medicine Physicians: A Modified Delphi Study. J Pain Symptom Manage 2021; 62:720-729. [PMID: 33677071 DOI: 10.1016/j.jpainsymman.2021.02.035] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/22/2023]
Abstract
CONTEXT Hospice and palliative medicine (HPM) physicians frequently care for patients with substance use disorders (SUDs), but there is no consensus on which primary addiction medicine (AM) skills are essential. OBJECTIVES Identify key primary AM skills that physicians should acquire during an ACGME-accredited HPM fellowship program. METHODS A modified Delphi study consisting of 18 experts on SUD in HPM and medical education. A literature review and expert input identified initial AM skills. In three Delphi rounds, participants rated each skill on a nine-point scale from "not at all important to include" to "crucial to include." We calculated medians (IQRs), analyzed panelists' comments, and grouped skills using the RAND / UCLA appropriateness method. RESULTS Among 62 proposed AM skills, 53 skills were rated as appropriate to include (38 of which achieved agreement), and nine skills were rated as uncertain. AM skills most relevant to HPM included 1) defining chemical coping, median 8.5 (IQR 2); 2) balancing life expectancy with risks of opioid use for patients with SUD, 9 (IQR 0); 3) explaining best practices to dispose unused opioids postmortem, 8 (IQR 2); 4) managing pain for hospice patients with SUD, 9 (IQR 0.75); and 5) partnering with hospice to manage patients on methadone and buprenorphine, 9 (IQR 2). Experts did not achieve consensus on whether HPM physicians should be encouraged to learn to prescribe buprenorphine for patients with opioid use disorder, 6 (IQR 3). CONCLUSION HPM fellowships should consider incorporating the primary AM skills identified in this study in their curricula.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Ellie Fratt
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - J Janet Ho
- Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Claudia S Roldan
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Massachusetts, USA; Section for Treatment, Research, and Education in Addiction Medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Massachusetts, USA
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18
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Eng K, Donohue CC, Wagner AJ, Dougherty DW, Salehi E, Lowenstein C, Gundersen DA, Lederman R, Kadish S. Assessing oncology patient and provider telehealth experience. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.284] [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
284 Background: Due to COVID-19, telehealth volume at our comprehensive cancer center rose from less than 5% of exam visits to over 25% in April 2020. We sought to understand the experience of telehealth and compare it to in-person experiences for patients and providers (physicians, nurse practitioners, and physician assistants) to identify areas for improvement. Methods: A multidisciplinary team adapted our existing patient satisfaction survey to incorporate telehealth, defined as phone and video exam visits. A technology section was created to assess aspects unique to telehealth. Questions about the patient-provider experience were the same for telehealth and in-person visits. A provider experience survey was conducted during a two-week period in May and June 2020. The provider survey aligned questions with the patient survey to compare the perceptions of the provider-patient interaction. Results: Patient experience scores for in-person and telehealth visits were comparable, with a slightly higher mean score for in-person visits. The mean scores for patient perception of care given at our cancer center was 97.5 (n=11,969) and 96.9 (n=4670) and the likelihood to recommend was 97.8 (n=12,072) and 97.4 (n=4,398) for in-person and telehealth, respectively, between June and December 2020. Patient feedback prioritized addressing technical barriers. We implemented several interventions and increased the telehealth technology section mean scores from 93.2 (n=1,095) to 95.2 (n=700) between June and December 2020. When comparing the percent of respondents scoring good or very good, provider scores showed sizable gaps between in-person and telehealth experiences on all questions (see table). The question “degree to which the care team was well coordinated” had the largest difference between in-person and telehealth scores for both patients and providers. Several interventions to adapt staffing and workflows have been implemented to improve care telehealth coordination. Conclusions: While patients reported similar satisfaction between in-person and telehealth visits, increasing coordination remains vital to improving the experience for both patients and providers. Furthermore, understanding the gap in the provider experience between in-person and telehealth is critical for successful adoption of telehealth as a long-term strategy for healthcare delivery.[Table: see text]
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Affiliation(s)
- Kelly Eng
- Dana-Farber Cancer Institute, Boston, MA
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19
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Peters SE, Sorensen G, Katz JN, Gundersen DA, Wagner GR. Thriving from Work: Conceptualization and Measurement. Int J Environ Res Public Health 2021; 18:7196. [PMID: 34281131 PMCID: PMC8296939 DOI: 10.3390/ijerph18137196] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
Work is a major contributor to our health and well-being. Workers' thriving is directly influenced by their job design, work environment and organization. The purpose of this report is to describe the qualitative methods used to develop the candidate items for a novel measure of Thriving from Work through a multi-step iterative process including: a literature review, workshop, interviews with experts, and cognitive testing of the candidate items. Through this process, we defined Thriving from Work as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential in their work, home, and community. Thriving from Work was conceptualized into 37 attributes across seven dimensions: psychological, emotional, social, work-life integration, basic needs, experience of work, and health. We ultimately identified, developed and/or modified 87 candidate questionnaire items mapped to these attributes that performed well in cognitive testing in demographically and occupationally diverse workers. The Thriving from Work Questionnaire will be subjected to psychometric testing and item reduction in future studies. Individual items demonstrated face validity and good cognitive response properties and may be used independently from the questionnaire.
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Affiliation(s)
- Susan E. Peters
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Glorian Sorensen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jeffrey N. Katz
- Departments of Orthopedic Surgery and Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Daniel A. Gundersen
- Survey and Qualitative Methods Core, Division of Population Health, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Gregory R. Wagner
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
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20
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López Gómez MA, Gundersen DA, Boden LI, Sorensen G, Katz JN, Collins JE, Wagner G, Vriniotis MG, Williams JA. Validation of the Workplace Integrated Safety and Health (WISH) assessment in a sample of nursing homes using Item Response Theory (IRT) methods. BMJ Open 2021; 11:e045656. [PMID: 34145013 PMCID: PMC8215260 DOI: 10.1136/bmjopen-2020-045656] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To validate and test the dimensionality of six constructs from the Workplace Integrated Safety and Health (WISH) assessment, an instrument that assesses the extent to which organisations implement integrated systems approaches for protecting and promoting worker health, safety and well-being, in a sample of nursing homes in the USA. DESIGN Validation of an assessment scale using data from a cross-sectional survey. SETTING Nursing homes certified by the Centers for Medicaid and Medicare services in three states of the USA: Ohio, California and Massachusetts. PARTICIPANTS 569 directors of nursing from nursing homes serving adults and with more than 30 beds participated in the study. RESULTS Graded response Item Response Theory (IRT) models showed that five out of six constructs were unidimensional based on balanced interpretation of model fit statistics-M2 or C2 with p value >0.05, Comparative Fit Index >0.95, lower bound of the root mean squared error of approximation 90% CI <0.06 and standardised root mean square residual <0.08. Overall measure and construct reliability ranged from acceptable to good. Category boundary location parameters indicated that items were most informative for respondents in lower range of latent scores (ie, β1, β2, β3 typically below 0). A few items were recommended to be dropped from future administrations of the instrument based on empirical and substantive interpretation. CONCLUSIONS The WISH instrument has utility to understand to what extent organisations integrate protection and promotion of worker health, safety and well-being; however, it is most informative in organisations that present lower scores.
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Affiliation(s)
- María Andrée López Gómez
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Leslie I Boden
- Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Glorian Sorensen
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Social and Behavioral Sciences, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeffrey N Katz
- Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie E Collins
- Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Wagner
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mary G Vriniotis
- Center for Work, Health and Well-being, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica Ar Williams
- Health Policy and Management, University of Kansas School of Medicine, Kansas City, Kansas, USA
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21
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Williams JA, Vriniotis MG, Gundersen DA, Boden LI, Collins JE, Katz JN, Wagner GR, Sorensen G. How to ask: Surveying nursing directors of nursing homes. Health Sci Rep 2021; 4:e304. [PMID: 34136659 PMCID: PMC8177897 DOI: 10.1002/hsr2.304] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS Nursing home research may involve eliciting information from managers, yet response rates for Directors of Nursing have not been recently studied. As a part of a more extensive study, we surveyed all nursing homes in three states in 2018 and 2019, updating how to survey these leaders effectively. We focus on response rates as a measure of non-response error and comparison of nursing home's characteristics to their population values as a measure of representation error. METHODS We surveyed Directors of Nursing or their designees in nursing homes serving adult residents with at least 30 beds in California, Massachusetts, and Ohio (N = 2389). We collected contact information for respondents and then emailed survey invitations and links, followed by three email reminders and a paper version. Nursing home associations in two of the states contacted their members on our behalf. We compared the response rates across waves and states. We also compared the characteristics of nursing homes based on whether the response was via email or paper. In a multivariable logit regression, we used characteristics of the survey and the nursing homes to predict whether their DON responded to the survey using adjustments for multiple comparisons. RESULTS The response rate was higher for the first wave than for the second (30% vs 20.5%). The highest response rate was in Massachusetts (31.8%), followed by Ohio (25.8%) and California (19.5%). Nursing home characteristics did not vary by response mode. Additionally, we did not find any statistically significant predictors of whether a nursing home responded. CONCLUSION A single-mode survey may provide a reasonably representative sample at the cost of sample size. With that said, however, switching modes can increase sample size without potentially biasing the sample.
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Affiliation(s)
| | - Mary G. Vriniotis
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Daniel A. Gundersen
- Survey and Qualitative Methods CoreDana‐Farber Cancer InstituteBostonMassachusetts
| | - Leslie I. Boden
- Environmental HealthBoston University School of Public HealthBostonMassachusetts
| | - Jamie E. Collins
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Jeffrey N. Katz
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Gregory R. Wagner
- Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Glorian Sorensen
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
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22
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Lakin JR, Gundersen DA, Lindvall C, Paasche-Orlow MK, Tulsky JA, Brannen EN, Pollak KI, Kennedy D, McLeggon JA, Stout JJ, Volandes A. A Yet Unrealized Promise: Structured Advance Care Planning Elements in the Electronic Health Record. J Palliat Med 2021; 24:1221-1225. [PMID: 33826860 DOI: 10.1089/jpm.2020.0774] [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: 11/13/2022] Open
Abstract
Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older adults with cancer from three large health care systems, participating in an ongoing multisite pragmatic trial (4UH3AG060626-02). We compared data extracted from dedicated structured EHR fields for ACP to a chart review of corresponding ACP documentation contained in the medical chart. Results: Structured ACP data existed for 43.2% of patients and varied by site (25.7% -48.9%). Of the identified structured ACP data elements, 59.2% of recorded elements were correct, 23.7% were incorrect, and 17.1% were duplicates with heterogeneity across sites. Conclusion: Structured ACP data in EHRs were frequently incorrect. This represents a problem for patients and their families, as well as quality improvement and research efforts. Clinical Trials Registration: NCT03609177.
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Affiliation(s)
- Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Elise N Brannen
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.,Cancer Control and Population Sciences, Duke Cancer Institute, Durham, North Carolina, USA
| | - Danielle Kennedy
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, North Carolina, USA
| | - Jody-Ann McLeggon
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | | | - Angelo Volandes
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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23
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Pozzar R, Hammer MJ, Underhill-Blazey M, Wright AA, Tulsky JA, Hong F, Gundersen DA, Berry DL. Threats of Bots and Other Bad Actors to Data Quality Following Research Participant Recruitment Through Social Media: Cross-Sectional Questionnaire. J Med Internet Res 2020; 22:e23021. [PMID: 33026360 PMCID: PMC7578815 DOI: 10.2196/23021] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/26/2023] Open
Abstract
Background Recruitment of health research participants through social media is becoming more common. In the United States, 80% of adults use at least one social media platform. Social media platforms may allow researchers to reach potential participants efficiently. However, online research methods may be associated with unique threats to sample validity and data integrity. Limited research has described issues of data quality and authenticity associated with the recruitment of health research participants through social media, and sources of low-quality and fraudulent data in this context are poorly understood. Objective The goal of the research was to describe and explain threats to sample validity and data integrity following recruitment of health research participants through social media and summarize recommended strategies to mitigate these threats. Our experience designing and implementing a research study using social media recruitment and online data collection serves as a case study. Methods Using published strategies to preserve data integrity, we recruited participants to complete an online survey through the social media platforms Twitter and Facebook. Participants were to receive $15 upon survey completion. Prior to manually issuing remuneration, we reviewed completed surveys for indicators of fraudulent or low-quality data. Indicators attributable to respondent error were labeled suspicious, while those suggesting misrepresentation were labeled fraudulent. We planned to remove cases with 1 fraudulent indicator or at least 3 suspicious indicators. Results Within 7 hours of survey activation, we received 271 completed surveys. We classified 94.5% (256/271) of cases as fraudulent and 5.5% (15/271) as suspicious. In total, 86.7% (235/271) provided inconsistent responses to verifiable items and 16.2% (44/271) exhibited evidence of bot automation. Of the fraudulent cases, 53.9% (138/256) provided a duplicate or unusual response to one or more open-ended items and 52.0% (133/256) exhibited evidence of inattention. Conclusions Research findings from several disciplines suggest studies in which research participants are recruited through social media are susceptible to data quality issues. Opportunistic individuals who use virtual private servers to fraudulently complete research surveys for profit may contribute to low-quality data. Strategies to preserve data integrity following research participant recruitment through social media are limited. Development and testing of novel strategies to prevent and detect fraud is a research priority.
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Affiliation(s)
- Rachel Pozzar
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Marilyn J Hammer
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Meghan Underhill-Blazey
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States.,School of Nursing, University of Rochester, Rochester, NY, United States
| | - Alexi A Wright
- McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Fangxin Hong
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Daniel A Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Donna L Berry
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
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24
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Lakin JR, Brannen EN, Tulsky JA, Paasche-Orlow MK, Lindvall C, Chang Y, Gundersen DA, El-Jawahri A, Volandes A. Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly (ACP-PEACE): the study protocol for a pragmatic stepped-wedge trial of older patients with cancer. BMJ Open 2020; 10:e040999. [PMID: 32665394 PMCID: PMC7365491 DOI: 10.1136/bmjopen-2020-040999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Advance care planning (ACP) is associated with improved health outcomes for patients with cancer, and its absence is associated with unfavourable outcomes for patients and their caregivers. However, older adults do not complete ACP at expected rates due to patient and clinician barriers. We present the original design, methods and rationale for a trial aimed at improving ACP for older patients with advanced cancer and the modified protocol in response to changes brought by the COVID-19 pandemic. METHODS AND ANALYSIS The Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly study is a pragmatic, stepped-wedge cluster randomised trial examining a Comprehensive ACP Program. The programme combines two complementary evidence-based interventions: clinician communication skills training (VitalTalk) and patient video decision aids (ACP Decisions). We will implement the programme at 36 oncology clinics across three unique US health systems. Our primary outcome is the proportion of eligible patients with ACP documentation completed in the electronic health record. Our secondary outcomes include resuscitation preferences, palliative care consultations, death, hospice use and final cancer-directed therapy. From a subset of our patient population, we will collect surveys and video-based declarations of goals and preferences. We estimate 11 000 patients from the three sites will be enrolled in the study. ETHICS AND DISSEMINATION Regulatory and ethical aspects of this trial include Institutional Review Board (IRB) approval via single IRB of record mechanism at Dana-Farber Cancer Institute, Data Use Agreements among partners and a Data Safety and Monitoring Board. We plan to present findings at national meetings and publish the results. TRIAL REGISTRATION NUMBER NCT03609177; Pre-results.
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Affiliation(s)
- Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elise N Brannen
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Paasche-Orlow
- Department of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Department of Survey and Data Management Core, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Angelo Volandes
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Underhill-Blazey M, Stopfer J, Chittenden A, Nayak MM, Lansang K, Lederman R, Garber J, Gundersen DA. Development and testing of the KnowGene scale to assess general cancer genetic knowledge related to multigene panel testing. Patient Educ Couns 2019; 102:1558-1564. [PMID: 31010603 DOI: 10.1016/j.pec.2019.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/13/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To develop and evaluate a measure of cancer genetics knowledge relevant to multigene panel testing. METHODS The instrument was developed using systematic input from a national panel of genetics experts, acceptability evaluation by patient advocates, and cognitive testing. Twenty-four candidate items were completed by 591 breast or gynecological patients who had undergone genetic counseling and multigene panel testing in the past 18 months. A unidimensional item response theory model was fit with a mix of 2-parameter logistic nested response (2 plnrm) and 2-parameter logistic (2 pl) items. RESULTS Key domains addressing cancer genetics knowledge were found to be overlapping. Of the 24 candidate items, 8 items were removed due to poor discrimination or local dependence. The remaining 16 items had good fit (RMSEA = 0.045, CFI = 0.946) and discrimination parameters ranging from 0.49 to 1.60. The items specified as 2 plnrm distinguish between those answering incorrect versus don't know, with discrimination ranging from 0.51 to 1.02. Information curves were highest among those with lower knowledge. CONCLUSION KnowGene is a rigorously developed and effective measure of knowledge after cancer genetic counseling and multigene panel testing. PRACTICE IMPLICATIONS Measuring knowledge in a systematic way will inform practice and research initiatives in cancer genetics.
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Affiliation(s)
| | - Jill Stopfer
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Anu Chittenden
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Manan M Nayak
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Kristina Lansang
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Ruth Lederman
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Judy Garber
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
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Kasza KA, Coleman B, Sharma E, Conway KP, Cummings KM, Goniewicz ML, Niaura RS, Lambert EY, Schneller LM, Feirman SP, Donaldson EA, Cheng YC, Murphy I, Pearson JL, Trinidad DR, Bansal-Travers M, Elton-Marshall T, Gundersen DA, Stanton CA, Abrams DB, Fong GT, Borek N, Compton WM, Hyland AJ. Correlates of Transitions in Tobacco Product Use by U.S. Adult Tobacco Users between 2013⁻2014 and 2014⁻2015: Findings from the PATH Study Wave 1 and Wave 2. Int J Environ Res Public Health 2018; 15:E2556. [PMID: 30441875 PMCID: PMC6266124 DOI: 10.3390/ijerph15112556] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 11/16/2022]
Abstract
More than half of adult tobacco users in the United States (U.S.) transitioned in tobacco product use between 2013⁻2014 and 2014⁻2015. We examine how characteristics of adult tobacco users in the U.S. relate to transitions in tobacco product use. Population Assessment of Tobacco and Health (PATH) Study data were analyzed from 12,862 adult current tobacco users who participated in Wave 1 (W1, 2013⁻2014) and Wave 2 (W2, 2014⁻2015). Three types of transitions were examined-(1) adding tobacco product(s); (2) switching to non-cigarette tobacco product(s); and (3) discontinuing all tobacco use-among those currently using: (1) any tobacco product; (2) cigarettes only (i.e., exclusive cigarette); and (3) cigarettes plus another tobacco product(s) (i.e., poly-cigarette). Multinomial logistic regression analyses determined relative risk of type of transition versus no transition as a function of demographic and tobacco use characteristics. Transitions in tobacco product use among adult tobacco users were common overall, but varied among different demographic groups, including by age, sex, sexual orientation, race/ethnicity, educational attainment, and poverty level. Further, cigarette smokers with higher dependence scores were more likely to add product(s) and less likely to discontinue tobacco use compared to those with low dependence scores. That high nicotine dependence is a barrier to discontinuing tobacco use adds evidence to support policy to lower nicotine content of cigarettes and to evaluate new products for their potential to reduce cigarette use.
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Affiliation(s)
- Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Blair Coleman
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | | | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA.
| | - Elizabeth Y Lambert
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Liane M Schneller
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Shari P Feirman
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Elisabeth A Donaldson
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Yu-Ching Cheng
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Iilun Murphy
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA.
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California, La Jolla, CA 92093, USA.
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, ON M5T 1R8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada.
- Ontario Tobacco Research Unit, Toronto, ON M5S 2S1, Canada.
| | - Daniel A Gundersen
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers, Somerset, NJ 08873, USA.
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
| | | | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC 20001, USA.
| | - Geoffrey T Fong
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada.
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
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Abstract
Emergency medicine is one of the medical fields with the highest rates of physician burnout. Research demonstrates hospitalists believe increasing workloads contribute to decreases in patient safety and satisfaction, and increases in morbidity and mortality. Our objective was to identify if emergency physicians who believe workload impacts patient care also experience worse rates of burnout symptoms. This two-phase study used an online survey with cross-sectional design distributed to emergency medicine physicians following the New Jersey American College of Emergency Physicians (NJ ACEP) Scientific Assembly in May 2016 and members of the ACEP Well-Being Committee and Wellness Section in December 2016. Respondents felt the greatest workload burdens by being '…unable to fully discuss treatment options or answer questions of a patient or family member' or leading to 'Delay in admitting or discharging patients.' Excessive workload also contributed to respondents having to 'Admit to hospital instead of discharge' and resulted in 'Worsened patient satisfaction.' The 'Emotional Exhaustion' domain of the Maslach Burnout Inventory was the most highly affected by the perceived effects of workload on patient outcomes and 'Personal Accomplishment' was least affected. This research highlights the perception that workload contributing to patient harm may be associated with emergency medicine burnout.
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Affiliation(s)
| | - Jonathan V McCoy
- b Department of Emergency Medicine , Rutgers-Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - JoAnn Mathew
- c Department of Internal Medicine , St. Vincent Health , Indianapolis , IN , USA
| | - Daniel A Gundersen
- d Survey and Data Management Core, Population Sciences , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Robert M Eisenstein
- b Department of Emergency Medicine , Rutgers-Robert Wood Johnson Medical School , New Brunswick , NJ , USA
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Jadotte YT, Santer M, Vakirlis E, Schwartz RA, Bauer A, Gundersen DA, Mossman K, Lewith G. Complementary and alternative medicine treatments for atopic eczema. Hippokratia 2017. [DOI: 10.1002/14651858.cd010938.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuri T Jadotte
- Rutgers, The State University of New Jersey - School of Nursing; Northeast Institute for Evidence Synthesis and Translation, a Centre of Excellence of the Joanna Briggs Institute; 180 University Avenue Ackerson Hall Room 364 Newark New Jersey USA 07102
| | - Miriam Santer
- University of Southampton; Primary Care and Population Sciences; Aldermoor Health Centre, Aldermoor Close Southampton UK SO16 5ST
| | - Efstratios Vakirlis
- Aristotle University Medical School; A' Department of Dermatology; Kanari 13 Thessaloniki Greece 54644
| | - Robert A Schwartz
- The State University of New Jersey - New Jersey Medical School; Department of Dermatology, Rutgers; 185 South Orange Avenue, MSB H-576 Newark New Jersey USA 07103
| | - Andrea Bauer
- University Hospital Carl Gustav Carus, Technical University Dresden; Department of Dermatology; Fetscherstr. 74 Dresden Germany 01307
| | - Daniel A Gundersen
- Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School; Department of Family Medicine and Community Health; 1 Worlds Fair Drive, Suite 1500 Somerset New Jersey USA 08873
| | - Kaspar Mossman
- The University of Nottingham; c/o Cochrane Skin Group; A103, King's Meadow Campus Lenton Lane Nottingham UK NG7 2NR
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Delnevo CD, Gundersen DA, Manderski MTB, Giovenco DP, Giovino GA. Importance of Survey Design for Studying the Epidemiology of Emerging Tobacco Product Use Among Youth. Am J Epidemiol 2017; 186:405-410. [PMID: 28369184 DOI: 10.1093/aje/kwx031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Accurate surveillance is critical for monitoring the epidemiology of emerging tobacco products in the United States, and survey science suggests that survey response format can impact prevalence estimates. We utilized data from the 2014 New Jersey Youth Tobacco Survey (n = 3,909) to compare estimates of the prevalence of 4 behaviors (ever hookah use, current hookah use, ever e-cigarette use, and current e-cigarette use) among New Jersey high school students, as assessed using "check-all-that-apply" questions, with estimates measured by means of "forced-choice" questions. Measurement discrepancies were apparent for all 4 outcomes, with the forced-choice questions yielding prevalence estimates approximately twice those of the check-all-that-apply questions, and agreement was fair to moderate. The sensitivity of the check-all-that-apply questions, treating the forced-choice format as the "gold standard," ranged from 38.1% (current hookah use) to 58.3% (ever e-cigarette use), indicating substantial false-negative rates. These findings highlight the impact of question response format on prevalence estimates of emerging tobacco products among youth and suggest that estimates generated by means of check-all-that-apply questions may be biased downward. Alternative survey designs should be considered to avoid check-all-that-apply response formats, and researchers should use caution when interpreting tobacco use data obtained from check-all-that-apply formats.
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Lathan CS, Akindele RN, Svoboda L, Gundersen DA. Self-reported financial stress among patients evaluated at a community cancer program. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6553] [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
6553 Background: Cancer related financial stress has been linked to a multitude of factors including socio-economic status, but its impact on the quality of life (QOL) for underserved populations is less well characterized. We evaluated patient reported financial stress, QOL, and quality of health (QOH) at an outreach cancer program located in a federally qualified health center. Methods: Study participants were interviewed at initial clinic visit for financial stress, QOH and QOL between January 2012 and December 2016. Demographic information, insurance coverage, clinical parameters, and comorbidities were abstracted from participants’ medical records. Responses to the financial stress index question “how difficult is it for you or your family to meet monthly payment of your/your family bills?” and overall QOL and QOH of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 were analyzed. Proportional odds logistic regression models were constructed for 5-point quality of life measures and three levels of financial toxicity. Results: Of the 288 participants analyzed, 52% and 12% reported somewhat and extreme financial stress. In an adjusted analysis, patients who reported financial stress were more likely to be younger in age (OR = 4.03, p < 0.001) unemployed (OR = 3.24, p = 0.002), have less than bachelor’s degree (OR = 0.035, p = 0.018), insured by Medicaid (OR = 3.22, p < 0.011), and were more likely to rate their QOL (OR = 3.76, p = 0.031) as poor, compared to those without financial stress. Race, gender, presence of cancer diagnosis and comorbidities were not associated with financial distress. Independent predictors of poor QOL were disability (OR = 3.12, p = 0.005), depression (OR = 2.12, p = 0.007) and extreme financial difficulty (OR = 2.57, p = 0.011). There was a nearly perfect positive correlation between overall QOL and QOH (r = 0.984, p < 0.001). Conclusions: There is a high prevalence of financial burden among underserved minority patients seeking cancer related care, and this is closely associated with poor quality of life. Interventions targeting cancer disparities need to assess financial stress in order to address this issue.
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O'Malley D, Dewan AA, Ohman-Strickland PA, Gundersen DA, Miller SM, Hudson SV. Determinants of patient activation in a community sample of breast and prostate cancer survivors. Psychooncology 2017; 27:132-140. [PMID: 28133892 DOI: 10.1002/pon.4387] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/16/2016] [Accepted: 01/23/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patient activation-the knowledge, skills, and confidence to manage one's health-is associated with improved self-management behaviors for several chronic conditions. This study assesses rates of patient activation in breast and prostate cancer survivors and explores the characteristics associated with patient activation. METHODS A cross-sectional study of survivors with localized (Stage I or II) breast and prostate cancers who were post-treatment (between 1-10+ years) were recruited from 4 community hospital sites in New Jersey. Survey data on patient characteristics (demographic and psychosocial) and clinical factors were assessed to explore the relationships with patient activation using the Patient Activation Measure-13. RESULTS Among 325 survivors (112 prostate; 213 breast), overall patient activation was high (M = 3.25). Activation was significantly lower among prostate survivors when compared with breast cancer survivors (M = 3.25 [SD, 0.38] vs M = 3.34 [SD, 0.37], P<.05). For prostate survivors, race (P < .05), marital status (P < .001), employment status (P < .01), household income (P < .05), and fear of recurrence (P < .01) were significantly associated with patient activation. For both groups, ease of access to oncology team and primary care physicians (PCPs) (all P values < .001) and perceptions of time spent with oncologists' team and PCPs (all P values < .01) were positive predictors of activation. CONCLUSIONS In both breast and prostate survivors, access to providers (both PCPs and oncologists) and perception that adequate time spent with providers were associated with activation. Therefore, clinical interventions maybe a promising avenue to improve patient activation. Research is needed to develop and test tailored patient activation interventions to improve self-management among cancer survivors.
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Affiliation(s)
- Denalee O'Malley
- Rutgers Biomedical and Health Sciences, Robert Wood Johnson Medical School, Department of Family Medicine and Community Health, Rutgers University, New Brunswick, NJ, USA.,School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Asa A Dewan
- School of Public Health, Biostatistics, Rutgers University, New Brunswick, NJ, USA
| | - Pamela A Ohman-Strickland
- School of Public Health, Biostatistics, Rutgers University, New Brunswick, NJ, USA.,Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | | | - Shawna V Hudson
- Rutgers Biomedical and Health Sciences, Robert Wood Johnson Medical School, Department of Family Medicine and Community Health, Rutgers University, New Brunswick, NJ, USA.,Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
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Wu JP, Gundersen DA, Pickle S. Are the Contraceptive Recommendations of Family Medicine Educators Evidence-Based? A CERA Survey. Fam Med 2016; 48:345-352. [PMID: 27159092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Our study aims were to: (1) describe the scope of contraceptive methods provided by US family medicine educators and (2) assess the extent to which US family medicine educators' recommendations regarding eligibility criteria for contraceptive methods are consistent with Centers for Disease Control and Prevention (CDC) guidelines. METHODS We contributed survey items as part of the 2014 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey, which is distributed annually to a national cohort of US family medicine educators. We created two summary scales, comprised of clinical scenarios, to assess the extent to which provider recommendations regarding eligibility criteria for oral contraceptive pills (OCPs, six scenarios) and the intrauterine device (IUD, eight scenarios) were consistent with CDC guidelines. RESULTS Among the 1,054 respondents (33% response rate), 98% prescribe OCPs and 66% insert IUDs. The OCP scale mean was 4.6 ± SD 1.6 (range 0-6), and the IUD scale mean was 4.8 SD ± 2.3 (range 0-8). These scores reflect that 23% of providers' OCP recommendations and 40% of their IUD recommendations were inconsistent with CDC guidelines. CONCLUSIONS The contraceptive recommendations of this cohort of family medicine educators only partially reflected evidence-based guidelines. More misconceptions were noted regarding eligibility criteria for the IUD than for OCPs. To avoid denying safe and effective contraception to otherwise appropriate candidates and putting women at risk of unintended pregnancy, evidence-based contraceptive recommendations must be improved among family medicine educators.
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Affiliation(s)
- Justine P Wu
- Department of Family Medicine and Department of Obstetrics and Gynecology, University of Michigan
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Abstract
BACKGROUND Young adulthood provides an enormous opportunity to alter trajectories of smoking behaviour for a large public health impact. OBJECTIVE The purpose of this study was to examine correlates of perceived barriers to quitting smoking and reasons to quit in a sample of young adult current and former smokers. METHODS This study used data from the 2011 National Young Adult Health Survey, a random-digit-dial cellphone survey. Participants were US young adult current smokers aged 18-34 (n = 699) and young adults who were either current smokers who had made a quit attempt in the past-year (n = 402) or former smokers (n = 289). Correlates of barriers to quitting smoking and reasons for quitting smoking were assessed using bivariate and multivariable analyses. RESULTS More than half of current smokers identified 'loss of a way to handle stress' (59%) and 'cravings or withdrawal' (52%) as barriers to quitting. Female gender, daily smoking and intention to quit remained significantly associated with endorsing 'loss of a way to handle stress' as a barrier to quitting in multivariable analyses. The two most popular reasons for quitting smoking were physical fitness (64%) and the cost of tobacco (64%). CONCLUSION These findings highlight barriers to cessation and the reasons that young smokers give for quitting. This information may be helpful to physicians as they counsel their young adult patients to quit smoking.
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Affiliation(s)
- Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Daniel A Gundersen
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and
| | - Michael B Steinberg
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and
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O'Malley DM, Hudson SV, Ohman-Strickland PA, Bator A, Lee HS, Gundersen DA, Miller SM. Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance. J Cancer Educ 2016; 31:63-9. [PMID: 25524391 PMCID: PMC4475492 DOI: 10.1007/s13187-014-0775-y] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates despite their increased risk for future illness. Survivorship care plans and other educational strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up care and health risks are needed. In a sample of cancer survivors, we identified patient characteristics and psychosocial predictors associated with increased follow-up care informational needs. Cross-sectional surveys were administered to early-stage breast and prostate survivors (N = 278; 68 % breast) at least 2 years post treatment from four community hospital programs in New Jersey between May 2012 and July 2013. Patient demographics, medical history, psychosocial characteristics (i.e., worries about the future, fear of disease recurrence, and patient activation), and perceptions of oncology and primary care were assessed. African-American survivors (AOR = 2.69, 95 % confidence interval [CI] 1.27-5.68) and survivors with higher comorbidity (AOR =1.16, CI 1.01-1.33) were more likely to want additional information to guide follow-up care. Adjusting for race and comorbidities, survivors who wanted more information to guide their follow-up care reported greater worries about the future (p < 0.05) and fears about disease recurrence (p < 0.05) compared to those who did not want additional information. Results emphasize the need to develop cancer survivorship educational strategies that are both responsive to the needs of specific populations (e.g., African-American survivors and patients with multiple comorbidities) and the psychosocial profiles that motivate requests for more extensive follow-up guidance.
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Affiliation(s)
- Denalee M O'Malley
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA.
- Rutgers, School of Social Work, New Brunswick, NJ, USA.
| | - Shawna V Hudson
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Pamela A Ohman-Strickland
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Biometrics Division, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Alicja Bator
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
| | - Heather S Lee
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
| | - Daniel A Gundersen
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 1 World's Fair Drive, Suite 1502, Somerset, NJ, 08873, USA
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Abstract
OBJECTIVE To explore the feasibility of a random-digit dial (RDD) cellular phone survey in order to reach a national and representative sample of college students. METHODS Demographic distributions from the 2011 National Young Adult Health Survey (NYAHS) were benchmarked against enrollment numbers from the Integrated Postsecondary Education System (IPEDS). The sample quality was compared with the Harvard School of Public Health College Alcohol Study (1993), National College Health Risk Behavior Survey (1995), and National College Health Assessment (2011). RESULTS Overall, the NYAHS performed as well, if not better, than previous college health surveys at reaching important demographic subgroups. CONCLUSIONS Cellular phone RDD is one feasible approach for studies of the general population of college students that can potentially generate national estimates of health behavior.
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Affiliation(s)
- Daniel P. Giovenco
- Center for Tobacco Studies, Rutgers School of Public Health, 732-235-9338
| | - Daniel A. Gundersen
- Department of Family Medicine and Community Health, Rutgers University Robert Wood, Johnson Medical School
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Delnevo CD, Villanti AC, Wackowski OA, Gundersen DA, Giovenco DP. The influence of menthol, e-cigarettes and other tobacco products on young adults' self-reported changes in past year smoking. Tob Control 2015; 25:571-4. [PMID: 26243809 DOI: 10.1136/tobaccocontrol-2015-052325] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 03/02/2015] [Accepted: 07/13/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Progression to regular smoking often occurs during young adulthood. This study examines self-reported changes in past year smoking among young adults and the potential influence of tobacco products on these trajectories. METHODS Respondents to the 2011 National Young Adult Health Survey who smoked 100 cigarettes in their lifetime (n=909) described smoking behaviour at the time of the survey and 1 year prior. Cigarette smoking trajectories were categorised as: no change, quit, decreased smoking or increased smoking. Participants were also asked about current use of menthol cigarettes and other tobacco products (ie, cigars, smokeless tobacco, hookah) and ever use of e-cigarettes. RESULTS Most young adults (73.1%) reported stable cigarette smoking behaviours, while 8.2% reported having quit, 5.8% reported that they smoke on fewer days, 5% progressed from someday to daily smoking and 8% increased from not at all to current smoking. The youngest smokers (18-20) had significantly higher odds (adjusted OR (AOR) =2.6) of increasing cigarette use over the past year compared to those aged 30-34, as did blacks versus whites (AOR=2.35). Menthol cigarette use nearly doubled (AOR=1.87) the odds of increased smoking behaviour. E-cigarette and other tobacco product (OTP) use were not associated with increasing smoking but OTP use was negatively associated with remaining quit from cigarettes. CONCLUSIONS Young adulthood is a critical period for smoking interventions, particularly among those most vulnerable to increasing smoking behaviours (ie, black and younger young adults). Policy efforts to restrict menthol cigarettes may reduce young adult smoking progression.
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Affiliation(s)
- Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington DC, USA Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Daniel A Gundersen
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA Department of Family Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Daniel P Giovenco
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
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Cantwell RE, Napierkowski D, Gundersen DA, Naqvi Z. Nursing as an Additional Language and Culture (NALC): Supporting Student Success in a Second-Degree Nursing Program. Nurs Educ Perspect 2015; 36:121-123. [PMID: 29194139 DOI: 10.5480/12-1007.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
: The nursing workforce does not represent the diversity of the United States population and while recruitment of diverse nursing students is high, so are their rates of attrition. The Nursing as an Additional Language and Culture Program (NALC) was implemented in an accelerated, second-degree baccalaureate nursing program to enhance retention by minimizing barriers and supporting activities to enhance student success. Results suggest that the NALC program was successful in decreasing the attrition rate of nursing students, including minority students.
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Gundersen DA, Peters KR, Conner A, Dayton J, Delnevo CD. Stability of sample quality for a national random-digit dialing cellular phone survey of young adults. Am J Epidemiol 2014; 180:1047-9. [PMID: 25352574 PMCID: PMC4224366 DOI: 10.1093/aje/kwu271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniel A Gundersen
- Department of Family Medicine and Community Health, Research Division, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Somerset, NJ Center for Tobacco Studies, Department of Health Education and Behavioral Science, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ
| | | | | | - James Dayton
- Survey Research, ICF International, Burlington, VT
| | - Cristine D Delnevo
- Center for Tobacco Studies, Department of Health Education and Behavioral Science, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ
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Jadotte YT, Santer M, Vakirlis E, Schwartz RA, Bauer A, Gundersen DA, Mossman K, Lewith G. Complementary and alternative medicine treatments for atopic eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gundersen DA, ZuWallack RS, Dayton J, Echeverría SE, Delnevo CD. Assessing the feasibility and sample quality of a national random-digit dialing cellular phone survey of young adults. Am J Epidemiol 2014; 179:39-47. [PMID: 24100957 DOI: 10.1093/aje/kwt226] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The majority of adults aged 18-34 years have only cellular phones, making random-digit dialing of landline telephones an obsolete methodology for surveillance of this population. However, 95% of this group has cellular phones. This article reports on the 2011 National Young Adult Health Survey (NYAHS), a pilot study conducted in the 50 US states and Washington, DC, that used random-digit dialing of cellular phones and benchmarked this methodology against that of the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Comparisons of the demographic distributions of subjects in the NYAHS and BRFSS (aged 18-34 years) with US Census data revealed adequate reach for all demographic subgroups. After adjustment for design factors, the mean absolute deviations across demographic groups were 3 percentage points for the NYAHS and 2.8 percentage points for the BRFSS, nationally, and were comparable for each census region. Two-sided z tests comparing cigarette smoking prevalence revealed no significant differences between NYAHS and BRFSS participants overall or by subgroups. The design effects of the sampling weight were 2.09 for the NYAHS and 3.26 for the BRFSS. Response rates for the NYAHS and BRFSS cellular phone sampling frames were comparable. Our assessment of the NYAHS methodology found that random-digit dialing of cellular phones is a feasible methodology for surveillance of young adults.
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Echeverría SE, Pentakota SR, Abraído-Lanza AF, Janevic T, Gundersen DA, Ramirez SM, Delnevo CD. Clashing paradigms: an empirical examination of cultural proxies and socioeconomic condition shaping Latino health. Ann Epidemiol 2013; 23:608-13. [PMID: 23972617 DOI: 10.1016/j.annepidem.2013.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 02/21/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Much debate exists regarding the role of culture versus socioeconomic position in shaping the health of Latino populations. We propose that both may matter for health and explicitly test their independent and joint effects on smoking and physical activity. METHODS We used the 2010 National Health Interview Survey, a population-based survey of the U.S. population, to estimate the prevalence of smoking and physical activity by language use (cultural proxy) and education among Latino adults (n = 4929). We fit log binomial regression models to estimate prevalence ratios and test for interaction. RESULTS English-language use and educational attainment were each independently associated with smoking and physical activity. Joint effect models showed that individuals with both greater use of the English language and low levels of education were nearly three times more likely to smoke (prevalence ratio, 2.59; 95% confidence interval, 1.83-3.65) than those with low English language use and high education (referent group); high acculturation and high education were jointly associated with increased activity (prevalence ratio 2.24, 95% confidence interval, 1.79-2.81). CONCLUSIONS Cultural proxies such as language use and educational attainment are both important determinants of health among Latinos. Their joint effect suggests the need to simultaneously consider Latinos' socioeconomic position and their increased risk of adopting health-damaging behaviors while addressing culturally-specific factors that may mitigate risk.
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Affiliation(s)
- Sandra E Echeverría
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ.
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Steinberg MB, Zimmermann MH, Gundersen DA, Hart C, Delnevo CD. Physicians' perceptions regarding effectiveness of tobacco cessation medications: are they aligned with the evidence? Prev Med 2011; 53:433-4. [PMID: 22001686 DOI: 10.1016/j.ypmed.2011.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 09/06/2011] [Accepted: 09/21/2011] [Indexed: 11/15/2022]
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Delnevo CD, Gundersen DA, Hrywna M, Echeverria SE, Steinberg MB. Smoking-cessation prevalence among U.S. smokers of menthol versus non-menthol cigarettes. Am J Prev Med 2011; 41:357-65. [PMID: 21961462 DOI: 10.1016/j.amepre.2011.06.039] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 06/27/2011] [Accepted: 06/28/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Food and Drug Administration currently is assessing the public health impact of menthol cigarettes. Whether menthol cigarettes pose increased barriers to quitting is a critical issue because previous declines in smoking prevalence have stalled. PURPOSE To explore whether menthol cigarette smokers are less likely to quit than non-menthol smokers at the population level and whether this relationship differs by race/ethnicity. METHODS Cross-sectional analyses of the 2003 and 2006/2007 Tobacco Use Supplement to the Current Population Survey were conducted in 2010. Multiple logistic regressions were used to calculate the adjusted odds of cessation for menthol smoking relative to non-menthol smoking. Five different sample restrictions were used to assess the robustness of the findings. RESULTS In the broadest sample restriction, menthol smokers were less likely to have quit smoking (AOR=0.91, 95% CI=0.87, 0.96). This relationship holds among whites (AOR=0.93, 95% CI=0.88, 0.98) and blacks (AOR=0.81, 95% CI=0.67, 0.98). The magnitude of the relationship among Hispanics was similar to that among whites, but differed by Hispanic origin. Among those of Mexican origin, the AOR for menthol smokers was protective but not significant (AOR=1.29, 95% CI=0.99, 1.61), whereas among those of Puerto Rican origin, menthol smokers were less likely to have quit (AOR=0.57, 95% CI=0.37, 0.87). These findings were robust and significant in four of five sample restrictions. CONCLUSIONS Smoking menthol cigarettes is associated with decreased cessation at the population level, and this association is more pronounced among black and Puerto Rican smokers. These findings support the recent calls to ban menthol flavoring in cigarettes.
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Affiliation(s)
- Cristine D Delnevo
- Center for Tobacco Surveillance and Evaluation Research, School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA.
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Katz MA, Delnevo CD, Gundersen DA, Rich DQ. Methodologic artifacts in adult sun-protection trends. Am J Prev Med 2011; 40:72-5. [PMID: 21146771 DOI: 10.1016/j.amepre.2010.09.020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/12/2010] [Accepted: 09/03/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Skin cancer is the most common of all cancers and a public health concern of increasing magnitude in the U.S. PURPOSE A mid-year review of Healthy People 2010 found that the percentage of adults engaging in sun-safe practices increased from 59% in 2000 to 71% in 2005. This paper examines whether this increase in sun-safe practices in adults is an artifact caused by the change from 2000 to 2005 in the operational definition of "sun-safe practices" in the National Health Interview Survey (NHIS). METHODS This study analyzed the 2000 and 2005 NHIS data sets in 2009 to examine changes in sun-safe practice prevalence estimates and to estimate the relative odds of practicing sun-safe behaviors associated with gender, age, race/ethnicity, education, and geographic region. RESULTS Contrary to the Healthy People 2010 mid-year review, it was found that engaging in sun-safe practices by adults decreased from 59% (2000) to 55% (2005). A question order effect and use of images for use of sun-safe hats likely caused an artificial change in "cover-up" behavior estimates from 31% (2000) to 18% (2005) and wide-brim hat usage from 27% (2000) to 12% (2005). When eliminating data from these two questions added in 2005, the relative odds of practicing sun-safe behaviors was significantly lower for men in both 2000 and 2005 but were not different for other demographic characteristics. CONCLUSIONS The current analyses suggest that the increase in sun-safe behaviors in adults and a notable decrease in "hat use" may be due to methodologic artifacts. When operational definitions change, caution should be used in interpreting estimates over time.
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Affiliation(s)
- Marc A Katz
- Hunterdon County Department of Health, Flemington, New Jersey, USA
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Delnevo CD, Gundersen DA, Hrywna M, Wackowski O, Zuwallack RS. Estimates of cigarette smoking from the NJ adult tobacco survey: real or spurious? Am J Health Behav 2010; 34:585-92. [PMID: 20524888 DOI: 10.5993/ajhb.34.5.8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore, post hoc, whether a large decline in smoking estimates between the 2005 and 2006 New Jersey Adult Tobacco Surveys is real or spurious given various methodological and environmental changes between the 2 time periods of data collection. METHODS Using multiple data sources, we explored survey timing, poststratification approach, midinterview terminations, wireless substitution, and question order. RESULTS Changes in question order were likely responsible for the majority of the unexpected decline in smoking prevalence; to a lesser degree, wireless substitution and midinterview terminations also likely contributed to an artificially exaggerated decline. CONCLUSION Methodological changes can artificially affect trends in prevalence estimates.
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Affiliation(s)
- Cristine D Delnevo
- UMDNJ-School of Public Health 335 George Street, Suite 2100, New Brunswick, NJ 08903, USA.
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Gundersen DA, Delnevo CD, Wackowski O. Exploring the relationship between race/ethnicity, menthol smoking, and cessation, in a nationally representative sample of adults. Prev Med 2009; 49:553-7. [PMID: 19850064 DOI: 10.1016/j.ypmed.2009.10.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 10/09/2009] [Accepted: 10/09/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the relationship between race/ethnicity, menthol smoking, and cessation in a nationally representative sample of adults. METHODS Data from the 2005 U.S. National Health Interview Survey was analyzed. Our analyses were restricted to 7815 white, black, and Hispanic current and former cigarette smokers who indicated that they do not currently use other tobacco products and have made a quit attempt. We used multiple logistic regressions to test the relationship of menthol smoking and cessation controlling for various factors. RESULTS Significant interaction effects were found indicating that the association between menthol smoking and cessation differs between whites and blacks, and whites and Hispanics. When blacks and Hispanics are collapsed as non-white, we found that non-white menthol smokers were significantly less likely to have quit smoking (adjusted odds ratio=0.55, p<0.01) compared to their non-menthol smoking counterparts. In contrast, among whites, menthol smokers were more likely to be former smokers than nonmenthol smokers (adjusted odds ratio=1.17, p<0.05). CONCLUSION Our findings provide some support for the hypothesis that menthol smoking can lead to poorer cessation outcomes, but only for non-white smokers.
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Affiliation(s)
- Daniel A Gundersen
- Center for Tobacco Surveillance and Evaluation Research, University of Medicine and Dentistry of New Jersey-School of Public Health, New Brunswick, NJ 08903, USA.
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Delnevo CD, Gundersen DA, Hagman BT. Declining estimated prevalence of alcohol drinking and smoking among young adults nationally: artifacts of sample undercoverage? Am J Epidemiol 2008; 167:15-9. [PMID: 17977896 DOI: 10.1093/aje/kwm313] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [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] [Indexed: 11/12/2022] Open
Abstract
A growing concern in public health surveillance surveys that rely on random digit dialing for sampling is the exclusion of adults in cell-phone-only households. The purpose of this study was to examine whether recent increases in wireless substitution have affected estimates of tobacco and alcohol use in the Behavioral Risk Factor Surveillance System (BRFSS) in a subpopulation with notable cell-phone usage (i.e., young adults). BRFSS data from 2001-2005 were examined. Analyses were limited to participants aged 18-24 years, and the sample contained approximately 18,500 persons in each year. Prevalence estimates were generated with SUDAAN software for three health behaviors: cigarette smoking, binge drinking, and heavy alcohol consumption. In addition, the authors examined sample completeness for young adults relative to US Census estimates. Overall, prevalences of all three health behaviors among young adults were fairly stable between 2001 and 2003 but significantly decreased between 2003 and 2005. These trends are not replicated in national surveys that use area probability samples. The authors found a declining trend in the sample completeness ratio for young adults; it declined from 0.32 in 2001 to 0.15 in 2005. Given the high prevalence of wireless substitution among young adults and the declining sample completeness ratio, the authors suspect that the observed decreases in prevalence are artifacts of undercoverage.
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Affiliation(s)
- Cristine D Delnevo
- Department of Health Education and Behavioral Sciences, School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA.
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