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Zulkiewicz BA, Winickoff JP, Gottlieb MA, Emmons KM, Tan AS. "Tobacco-free nicotine" electronic cigarette perceptions and use among adolescents and adults in five New England states. Addict Behav Rep 2024; 19:100524. [PMID: 38226008 PMCID: PMC10788778 DOI: 10.1016/j.abrep.2024.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/08/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
Introduction More brands are using tobacco-free nicotine (TFN) in electronic cigarettes (e-cigarettes) and these products are becoming increasingly popular. The term TFN and claims about its properties can mislead consumers about the harms and addictiveness of TFN e-cigarettes, which may increase initiation of these products among non-smokers or influence current smokers' decisions to adopt TFN e-cigarettes as a harm reduction measure. Methods We conducted an observational, cross-sectional survey of 777 adolesc aged 13-17 and 655 current adult cigarette smokers residing in Massachusetts, Connecticut, New Hampshire, Rhode Island, or Vermont about their TFN e-cigarette awareness, use, perceptions, and susceptibility. We examined the association between prior awareness of TFN and use, perceptions, and susceptibility. Results One-third of adolescents and adults reported being aware of TFN. TFN e-cigarette use was less common than tobacco-derived nicotine (TDN) e-cigarette use among adolescents (8.9 % vs. 30.5 %) and adults (21.1 % vs. 79.4 %). Compared to unaware adolescents, adolescents who were aware of TFN more frequently reported being more likely to use TFN compared to TDN e-cigarettes and that TFN e-cigarettes are more addictive than those containing TDN. Aware adult smokers more frequently reported that TFN e-cigarettes are more addictive than TDN e-cigarettes, TFN e-cigarettes cause some harm, TDN e-cigarettes cause little harm, and that TFN and TDN e-cigarettes are equally harmful than those who were unaware previously. Conclusion Public health education campaigns are needed to educate consumers about the harms and addictiveness of TFN e-cigarettes.
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Affiliation(s)
- Brittany A. Zulkiewicz
- University of Pennsylvania Annenberg School for Communication, 3620 Walnut St, Philadelphia, PA 19104, United States
| | - Jonathan P. Winickoff
- Massachusetts General Hospital, Division of General Academic Pediatrics, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States
| | - Mark A. Gottlieb
- Northeastern University School of Law, Public Health Advocacy Institute, 360 Huntington Ave, Suit 1170CU, Boston, MA 02115, United States
| | - Karen M. Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Andy S.L. Tan
- University of Pennsylvania Annenberg School for Communication, 3620 Walnut St, Philadelphia, PA 19104, United States
- University of Pennsylvania Leonard Davis Institute of Health Economics, 3641 Locust Walk #210, Philadelphia, PA 19104, United States
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McLoughlin GM, Kumanyika S, Su Y, Brownson RC, Fisher JO, Emmons KM. Mending the gap: Measurement needs to address policy implementation through a health equity lens. Transl Behav Med 2024; 14:207-214. [PMID: 38402599 PMCID: PMC10956956 DOI: 10.1093/tbm/ibae004] [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: 02/27/2024] Open
Abstract
Policies represent a key opportunity to improve the health outcomes of populations, and if implemented well, can reduce disparities affecting marginalized populations. Many policies are only evaluated on whether they elicit their intended health outcome. However, a lack of understanding regarding if and how they are implemented may hinder the intended impact overall and on addressing health disparities. Implementation science offers an array of frameworks and methodological approaches for assessing policy delivery, yet few examples exist that meaningfully include health equity as a core focus. This commentary describes the importance of equity-informed implementation measurement by providing case examples and implications for assessment. In addition, we highlight examples of emerging work in policy implementation grounded in health equity with suggested steps for moving the field forward. The ultimate goal is to move toward open-access measurement approaches that can be adapted to study implementation of a variety of policies at different stages of implementation, driven by input from marginalized populations and implementation practitioners, to move the needle on addressing health disparities.
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Affiliation(s)
- Gabriella M McLoughlin
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA
- Implementation Science Center for Cancer Control, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Shiriki Kumanyika
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Yanfang Su
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Ross C Brownson
- Implementation Science Center for Cancer Control, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer O Fisher
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Chambers DA, Emmons KM. Navigating the field of implementation science towards maturity: challenges and opportunities. Implement Sci 2024; 19:26. [PMID: 38481286 PMCID: PMC10936041 DOI: 10.1186/s13012-024-01352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The field of implementation science has significantly expanded in size and scope over the past two decades, although work related to understanding implementation processes have of course long preceded the more systematic efforts to improve integration of evidence-based interventions into practice settings. While this growth has had significant benefits to research, practice, and policy, there are some clear challenges that this period of adolescence has uncovered. MAIN BODY This invited commentary reflects on the development of implementation science, its rapid growth, and milestones in its establishment as a viable component of the biomedical research enterprise. The authors reflect on progress in research and training, and then unpack some of the consequences of rapid growth, as the field has grappled with the competing challenges of legitimacy among the research community set against the necessary integration and engagement with practice and policy partners. The article then enumerates a set of principles for the field's next developmental stage and espouses the aspirational goal of a "big tent" to support the next generation of impactful science. CONCLUSION For implementation science to expand its relevance and impact to practice and policy, researchers must not lose sight of the original purpose of the field-to support improvements in health and health care at scale, the importance of building a community of research and practice among key partners, and the balance of rigor, relevance, and societal benefit.
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Affiliation(s)
- David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Room 3E-414, Rockville, Bethesda, MD, 20850, USA.
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Zhou ES, Revette A, Waitt J, Lehmann LE, Diller LR, Emmons KM, Valenzuela AF, Redline S. A nursing perspective on inpatient sleep and circadian disruptions for pediatric stem cell transplant patients. Pediatr Blood Cancer 2024; 71:e30816. [PMID: 38110847 DOI: 10.1002/pbc.30816] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Children treated with stem cell transplant (SCT) are routinely hospitalized for long periods where they are exposed to significant sleep and circadian disruptions. As nurses play a primary role in symptom management during SCT, we sought to understand their perspective on patient sleep and circadian disruptions, perceived barriers to a good sleep and circadian environment, and suggestions for improvement. PROCEDURE Four focus groups were conducted with pediatric SCT nurses (N = 25 participants). A semistructured focus group guide was administered, with the discussions recorded and transcribed. A multistage thematic analysis combining prefigured and emergent dimensions was conducted. Our analysis focused on drawing comparisons within and across focus groups to understand the unique work experiences that participants had related to the patient's sleep and circadian environment. RESULTS Three key themes emerged. First, nurses expressed a high awareness of how disruptive the hospital environment is for patients. Second, nurses described their extensive efforts to try to minimize the impact of these disruptions. Finally, they provided clear recommendations for how to improve upon these concerns, along with barriers that they perceive could impede implementation. CONCLUSIONS Front-line caregivers on a pediatric SCT unit describe key contributors to sleep/circadian disturbances for patients. Within the constraints of the considerable medical needs of this patient population and the physical room/hospital environment, nurses strive to minimize these disruptions to the best of their ability. It is crucial that hospitals assess and remediate these disturbances for these children that have important implications for overall health.
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Affiliation(s)
- Eric S Zhou
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Julie Waitt
- Hematopoietic Stem Cell Transplant Unit, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Leslie E Lehmann
- Hematopoietic Stem Cell Transplant Unit, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lisa R Diller
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ariana F Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Vickery KD, Gelberg L, Hyson AR, Strother E, Carter J, Oranday Perez O, Franco M, Kavistan S, Gust S, Adair E, Anderson-Campbell A, Brito L, Butler A, Robinson T, Connett J, Evans MD, Emmons KM, Comulada WS, Busch AM. Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless. Front Psychiatry 2024; 15:1329138. [PMID: 38487573 PMCID: PMC10937567 DOI: 10.3389/fpsyt.2024.1329138] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction People living with type 2 diabetes who experience homelessness face a myriad of barriers to engaging in diabetes self-care behaviors that lead to premature complications and death. This is exacerbated by high rates of comorbid mental illness, substance use disorder, and other physical health problems. Despite strong evidence to support lay health coach and behavioral activation, little research has effectively engaged people living with type 2 diabetes who had experienced homelessness (DH). Methods We used community engaged research and incremental behavioral treatment development to design the Diabetes HOmeless MEdication Support (D-HOMES) program, a one-on-one, 3 month, coaching intervention to improve medication adherence and psychological wellness for DH. We present results of our pilot randomized trial (with baseline, 3 mo., 6 mo. assessments) comparing D-HOMES to enhanced usual care (EUC; brief diabetes education session and routine care; NCT05258630). Participants were English-speaking adults with type 2 diabetes, current/recent (<24 mo.) homelessness, and an HbA1c‗7.5%. We focused on feasibility (recruitment, retention, engagement) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Our primary clinical outcome was glycemic control (HbA1c) and primary behavioral outcome was medication adherence. Secondary outcomes included psychological wellness and diabetes self-care. Results Thirty-six eligible participants enrolled, 18 in each arm. Most participants identified as Black males, had high rates of co-morbidities, and lived in subsidized housing. We retained 100% of participants at 3-months, and 94% at 6-months. Participants reported high satisfaction (mean CSQ-8 scores=28.64 [SD 3.94] of 32). HbA1c reduced to clinically significant levels in both groups, but we found no between group differences. Mean blood pressure improved more in D-HOMES than EUC between baseline and 6 mo. with between group mean differences of systolic -19.5 mmHg (p=0.030) and diastolic blood pressure -11.1 mmHg (p=0.049). We found no significant between group differences in other secondary outcomes. Conclusion We effectively recruited and retained DH over 6 months. Data support that the D-HOMES intervention was acceptable and feasible. We observe preliminary blood pressure improvement favoring D-HOMES that were statistically and clinically significant. D-HOMES warrants testing in a fully powered trial which could inform future high quality behavioral trials to promote health equity. Clinical trial registration https://clinicaltrials.gov/study/NCT05258630?term=D-HOMES&rank=1, identifier NCT05258630.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Audrey Rose Hyson
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Jill Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Oscar Oranday Perez
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Moncies Franco
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Silvio Kavistan
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | | | - Lelis Brito
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Annette Butler
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Tahiti Robinson
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - W. Scott Comulada
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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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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Carroll BR, Zheng Y, Ruddy KJ, Emmons KM, Partridge AH, Rosenberg SM. Satisfaction with Care and Attention to Age-Specific Concerns by Race and Ethnicity in a National Sample of Young Women with Breast Cancer. J Adolesc Young Adult Oncol 2024; 13:105-111. [PMID: 37594766 PMCID: PMC10877381 DOI: 10.1089/jayao.2023.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Purpose: In light of disparities in breast cancer care and outcomes, we explored whether attention to fertility, genetic, and emotional health concerns, as well as satisfaction with care, differs by race/ethnicity among young breast cancer patients. Methods: The Young and Strong Study was a cluster randomized trial of an intervention for patients and providers at 54 U.S. oncology practices enrolling women diagnosed with breast cancer at ≤45 years of age. Provider attention to fertility, genetics, and emotional health was evaluated by medical record review. The proportions of patients with attention to these concerns were compared by race/ethnicity (Hispanic, non-Hispanic Black [NHB], Asian, non-Hispanic White [NHW], or multiracial/other). Satisfaction with care was assessed with the Patient Satisfaction Questionnaire-18 (PSQ-18) at 3 months, with median scores for each of 7 PSQ-18 subscales (general satisfaction, interpersonal manner, communication, financial, time spent with doctor, accessibility, and technical quality) compared by race/ethnicity. Results: Among 465 patients, median age at diagnosis was 40; 6% were Hispanic, 11% NHB, 4% were Asian, 75% NHW, and 3% multiracial/other. Provider attention to genetics, emotional health, and fertility did not differ by race/ethnicity. Median PSQ-18 scores did not differ by race/ethnicity, with median subscale scores ranging from 3.0 to 4.5 across groups, indicating high levels of satisfaction. Conclusion: Satisfaction with care and provider attention to age-specific concerns were similar across racial/ethnic groups among young patients enrolled in an educational and supportive care intervention study. These data suggest that high-quality, equitable care is feasible. Further care delivery research is warranted in more diverse patient and practice settings. Clinical Trial Registration number: NCT01647607.
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Affiliation(s)
- Bridget Rose Carroll
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts, USA
| | - Yue Zheng
- Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ann H. Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shoshana M. Rosenberg
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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Aschbrenner KA, Cruz JL, Kruse GR, Nguyen H, Huebner Torres C, Celli M, Sarcione C, Singh D, Emmons KM. Leveraging an implementation science partnership network to understand how Federally Qualified Health Centers operationalize and address health equity. Transl Behav Med 2024; 14:23-33. [PMID: 37542519 PMCID: PMC10782902 DOI: 10.1093/tbm/ibad046] [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: 08/07/2023] Open
Abstract
Health equity-focused implementation research requires using definitions and approaches that are relevant and meaningful to implementation partners. We examined how health equity was operationalized and addressed at Federally Qualified Health Centers (FQHCs). We conducted semi-structured interviews with leadership (n = 19) and staff (n = 12) at 10 FQHCs in an implementation science partnership network for cancer control equity to understand how they operationalized and addressed health equity. We performed rapid qualitative analysis and shared findings with a larger group of 13 community health centers (including the 10 FQHCs) at an Implementation Learning Community (ILC) to identify action areas for research and practice, followed by a second phase of synthesizing qualitative codes into themes and mapping themes onto a framework for advancing health equity in healthcare organizations. Participants defined health equity as central to the mission of FQHCs, and identified barriers (e.g. financing models) and facilitators (e.g. interpreter services) to advancing health equity at FQHCs. These findings resonated with ILC participants who emphasized the challenge of addressing root cause social determinants of inequities using limited available resources in FQHCs and the importance of developing meaningful collaboration with communities for data collection, data interpretation, data use, and data ownership. Themes captured recommendations to advance health equity in daily work at FQHCs, including investments in staffing, training, and resources. Mapping qualitative themes from health equity-centered interviews with FQHC partners onto a framework for advancing health equity in healthcare organizations can provide clear, context-specific direction for actions aimed at improving health and healthcare equity.
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Affiliation(s)
- Kelly A Aschbrenner
- Geisel School of Medicine at Dartmouth College, Hanover, USA
- Dartmouth Health System, Lebanon, USA
| | | | | | | | | | - Maria Celli
- Brockton Neighborhood Health Center, Brockton, MA, USA
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Liu J, Winickoff JP, Hanby E, Rees V, Emmons KM, Tan AS. Prevalence and correlates of past 30-day dual-vaping of nicotine and cannabis among adolescents in five New England states. Drug Alcohol Depend 2024; 254:111055. [PMID: 38071894 PMCID: PMC10872281 DOI: 10.1016/j.drugalcdep.2023.111055] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023]
Abstract
SIGNIFICANCE Adolescent vaping behavior includes vaping of multiple substances, including both nicotine and cannabis (dual-vaping). This study describes the prevalence and the sociodemographic correlates of past 30-day dual-vaping. METHODS We recruited adolescents ages 13-17 from five New England states (Massachusetts, Connecticut, Rhode Island, Vermont, New Hampshire) through the Prodege online survey panel from April 2021 to August 2022. Dual-vaping was defined as vaping both nicotine and cannabis (THC and/or CBD) in the past 30-days. We analyzed the prevalence of sole-nicotine, sole-cannabis, and dual-vaping of nicotine and cannabis and used multinomial logistic regression to examine associations between sociodemographic factors and sole- and dual-vaping of nicotine and cannabis. RESULTS The analytic sample included 2013 observations from 1858 participants (mean age 15.1 years, 46.2% female, 74.1% White, 82.2% heterosexual). Among these observations, 5.6% reported past 30-day sole-nicotine vaping, 5.5% reported sole-cannabis vaping, and 7.3% had dual-vaped. Correlates for higher odds of past 30-day dual-vaping included total social media sites used and household tobacco use, in contrast with sole-cannabis vaping, which included older age and self-reported depression (all p's <0.05). DISCUSSION Adolescent past 30-day dual-vaping of nicotine and cannabis was more prevalent than past 30-day sole-vaping of either nicotine or cannabis alone. Future studies should continue to collect detailed data on the type of substances, besides nicotine, that adolescents are vaping.
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Affiliation(s)
- Jessica Liu
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Kresge Building, Boston, MA, USA; REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
| | - Jonathan P Winickoff
- Massachusetts General for Children, 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
| | - Elaine Hanby
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA
| | - Vaughan Rees
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Kresge Building, Boston, MA, USA
| | - Karen M Emmons
- Harvard University, T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Kresge Building, Boston, MA, USA
| | - Andy Sl Tan
- University of Pennsylvania, Annenberg School for Communication, Philadelphia, PA, USA; University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA; Abramson Cancer Center, Tobacco and Environmental Carcinogenesis Program, Philadelphia, PA, USA
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de Kermadec E, Zheng Y, Rosenberg S, Ruddy KJ, Ligibel JA, Emmons KM, Partridge AH. Fertility concerns and treatment decision-making among national sample of young women with breast cancer. Cancer Med 2023; 13:e6838. [PMID: 38131887 PMCID: PMC10807590 DOI: 10.1002/cam4.6838] [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: 08/24/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Diagnosis of breast cancer in young women has been shown to affect their decision-making with regard to fertility and family planning. Limited data are available from populations across the U.S. regarding this issue; thus, we sought to describe fertility concerns and efforts to preserve fertility in a national clinical trial population of young breast cancer patients. METHODS The young and strong study was a cluster-randomized controlled trial testing an intervention program for young women with breast cancer. Patients were surveyed within 3 months after diagnosis and at 3, 6, and 12 months after. Surveys asked about sociodemographics, psychosocial domains, fertility concerns, and fertility preservation strategies. Univariable and multivariable models were used to investigate sociodemographic, clinical, and psychosocial predictors of fertility concerns. RESULTS Of 467 women from 54 clinical sites across the U.S. (14 academic, 40 community), 419 were evaluable regarding fertility concerns. Median age was 40 years (range 22-45), 11% were Black, 6% Hispanic, and 75% had children. Tumor stage was I (35%), II (51%), or III (14%); 82% received chemotherapy. At time of the treatment decision, 133 (32%) participants had fertility concerns, among whom 47% indicated this affected their treatment decisions. Sixty percent of participants reported having discussed fertility with their physician. Twenty percent of those with fertility concerns used fertility preservation strategies. History of difficulty becoming pregnant and younger age were associated with higher odds of fertility concerns in multivariable modeling. CONCLUSION Many young women with newly diagnosed breast cancer are concerned about fertility in a way that impacts their treatment decisions. Concerns were discussed, but few used fertility preservation strategies. These findings have implications for counseling young patients.
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Affiliation(s)
- Elisabeth de Kermadec
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Present address:
SanofiCambridgeMassachusettsUSA
| | - Yue Zheng
- Data ScienceDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Shoshana Rosenberg
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Present address:
Weill Cornell MedicineNew YorkNew YorkUSA
| | | | - Jennifer A. Ligibel
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Karen M. Emmons
- Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ann H. Partridge
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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11
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Asada Y, Kroll-Desrosiers A, Chriqui JF, Curran GM, Emmons KM, Haire-Joshu D, Brownson RC. Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science. Front Health Serv 2023; 3:1220629. [PMID: 37771411 PMCID: PMC10524255 DOI: 10.3389/frhs.2023.1220629] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
Policy implementation science (IS) is complex, dynamic, and fraught with unique study challenges that set it apart from biomedical or clinical research. One important consideration is the ways in which policy interacts with local contexts, such as power and social disadvantage (e.g., based on ability, race, class, sexual identity, geography). The complex nature of policy IS and the need for more intentional integration of equity principles into study approaches calls for creative adaptations to existing implementation science knowledge and guidance. Effectiveness-implementation hybrid studies were developed to enhance translation of clinical research by addressing research questions around the effectiveness of an intervention and its implementation in the same study. The original work on hybrid designs mainly focused on clinical experimental trials; however, over the last decade, researchers have applied it to a wide range of initiatives and contexts, including more widespread application in community-based studies. This perspectives article demonstrates how effectiveness-implementation hybrid studies can be adapted for and applied to equity-centered policy IS research. We draw upon principles of targeted universalism and Equity in Implementation Research frameworks to guide adaptations to hybrid study typologies, and suggest research and engagement activities to enhance equity considerations; for example, in the design and testing of implementing strategies. We also provide examples of equity-centered policy IS studies. As the field of policy IS rapidly evolves, these adapted hybrid type studies are offered to researchers as a starting guide.
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Affiliation(s)
- Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago (UIC), Chicago, IL, United States
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Health Care System, Leeds, MA, United States
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, UMass Amherst, Amherst, MA, United States
| | - Jamie F. Chriqui
- Health Policy Research, Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
- Department of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Debra Haire-Joshu
- Department is Public Health, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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12
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Korn AR, Walsh-Bailey C, Correa-Mendez M, DelNero P, Pilar M, Sandler B, Brownson RC, Emmons KM, Oh AY. Social determinants of health and US cancer screening interventions: A systematic review. CA Cancer J Clin 2023; 73:461-479. [PMID: 37329257 PMCID: PMC10529377 DOI: 10.3322/caac.21801] [Citation(s) in RCA: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.
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Affiliation(s)
- Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Behavioral and Policy Sciences Department, RAND Corporation, Boston, MA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Margarita Correa-Mendez
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - April Y. Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Anyane‐Yeboa A, Aubertine M, Parker A, Sylvester K, Levell C, Bell E, Emmons KM, May FP. Use of a mixed-methods approach to develop a guidebook with messaging to encourage colorectal cancer screening among Black individuals 45 and older. Cancer Med 2023; 12:19047-19056. [PMID: 37602823 PMCID: PMC10557828 DOI: 10.1002/cam4.6461] [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: 04/04/2023] [Revised: 07/07/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States and disproportionately impacts Black individuals. Here, we describe the mixed-methods approach used to develop a tailored message guidebook to promote CRC screening among Black individuals in the setting of recently updated screening guidelines. METHODS This mixed-methods study included 10 in-depth qualitative interviews and 490 surveys in a nationally representative sample of unscreened Black individuals age ≥ 45. Messages were developed based on American Cancer Society (ACS) and National Colorectal Cancer Roundtable (NCCRT) research findings, tested among Black individuals using MaxDiff analytic methods, and reviewed by a multi-sector expert advisory committee of NCCRT members. RESULTS The most frequently reported screening barrier in all age groups was self-reported procrastination (40.0% in age 45-49, 42.8% for age 50-54, 34.2% for age ≥ 55). Reasons for procrastination varied by age and included financial concerns, COVID-19 concerns, and fear of the test and bowel preparation. Additional screening barriers included lack of symptoms, provider recommendation, and family history of CRC. Most individuals age 45-49 preferred to receive screening information from a healthcare provider (57.5%); however, only 20% reported that a provider had initiated a screening conversation. CONCLUSIONS We identified age-specific barriers to CRC screening and tailored messaging to motivate participation among unscreened Black people age ≥ 45. Findings informed the development of the NCCRT and ACS guidebook for organizations and institutions aiming to increase CRC screening participation in Black individuals.
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Affiliation(s)
| | | | | | - Kaitlin Sylvester
- American Cancer Society National Colorectal Cancer RoundtableKennesawGeorgiaUSA
| | - Caleb Levell
- American Cancer Society National Colorectal Cancer RoundtableKennesawGeorgiaUSA
| | - Emily Bell
- American Cancer Society National Colorectal Cancer RoundtableKennesawGeorgiaUSA
| | - Karen M. Emmons
- Harvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Folasade P. May
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Kaiser Permanente Center for Health Equity and Jonsson Comprehensive Cancer Center, University of California Los AngelesLos AngelesCaliforniaUSA
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Lee RM, Daly JG, Mallick K, Ramanadhan S, Torres CH, Hayes CR, Bertolini A, Nalls R, Emmons KM. Implementation of evidence-based primary cancer prevention interventions in MA community health centers: an explanatory sequential mixed methods study. Implement Sci Commun 2023; 4:101. [PMID: 37620976 PMCID: PMC10463327 DOI: 10.1186/s43058-023-00483-7] [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: 02/14/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND More than half of cancers could be prevented by employing evidence-based interventions (EBIs), including prevention interventions targeting nutrition, physical activity, and tobacco. Federally qualified health centers (FQHCs) are the primary source of patient care for over 30 million Americans - making them an optimal setting for ensuring evidence-based prevention that advances health equity. The aims of this study are to (1) determine the degree to which primary cancer prevention EBIs are being implemented within Massachusetts FQHCs and (2) describe how these EBIs are implemented internally and via community partnerships. METHODS We used an explanatory sequential mixed methods design to assess the implementation of cancer prevention EBIs. First, we collected 34 quantitative surveys from staff at 16 FQHCs across Massachusetts to determine the frequency of EBI implementation. We followed up with 12 qualitative one-on-one interviews among a sample of staff to understand how the EBIs selected on the survey were implemented. Exploration of contextual influences on implementation and use of partnerships was guided by the Consolidated Framework for Implementation Research (CFIR). Quantitative data were summarized descriptively, and qualitative analyses used reflexive, thematic approaches, beginning deductively with codes from CFIR, then inductively coding additional categories. RESULTS All FQHCs indicated they offered clinic-based tobacco interventions, such as clinician-delivered screening practices and prescription of tobacco cessation medications. Quitline interventions and some diet/physical activity EBIs were available at all FQHCs, but staff perceptions of penetration were low. Only 38% of FQHCs offered group tobacco cessation counseling and 63% referred patients to mobile phone-based cessation interventions. We found multilevel factors influenced implementation across intervention types - including the complexity of intervention trainings, available time and staffing, motivation of clinicians, funding, and external policies and incentives. While partnerships were described as valuable, only one FQHC reported using clinical-community linkages for primary cancer prevention EBIs. CONCLUSIONS Adoption of primary prevention EBIs in Massachusetts FQHCs is relatively high, but stable staffing and funding are required to successfully reach all eligible patients. FQHC staff are enthusiastic about the potential of community partnerships to foster improved implementation-providing training and support to build these relationships will be key to fulfilling that promise.
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Affiliation(s)
- Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - James G Daly
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Kamini Mallick
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Cassidy R Hayes
- Caring Health Center, 1049 Main Street, Springfield, MA, 01103, USA
| | - Alyssa Bertolini
- Caring Health Center, 1049 Main Street, Springfield, MA, 01103, USA
| | - Ra'Shaun Nalls
- Office of Diversity & Inclusion, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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15
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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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16
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Warner ET, Huguet N, Fredericks M, Gundersen D, Nederveld A, Brown MC, Houston TK, Davis KL, Mazzucca S, Rendle KA, Emmons KM. Advancing health equity through implementation science: Identifying and examining measures of the outer setting. Soc Sci Med 2023; 331:116095. [PMID: 37473542 PMCID: PMC10530521 DOI: 10.1016/j.socscimed.2023.116095] [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: 10/27/2022] [Revised: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Implementation science (IS) could accelerate progress toward achieving health equity goals. However, the lack of attention to the outer setting where interventions are implemented limits applicability and generalizability of findings to different populations, settings, and time periods. We developed a data resource to assess outer setting across seven centers funded by the National Cancer Institute's IS Centers in Cancer Control (ISC3) Network Program. OBJECTIVE To describe the development of the Outer Setting Data Resource and characterize the county-level outer context across Centers. METHODS Our Data Resource captures seven key environments, including: (1) food; (2) physical; (3) economic; (4) social; (5) health care; (6) cancer behavioral and screening; and (7) cancer-related policy. Data were obtained from public sources including the US Census and American Community Survey. We present medians and interquartile ranges based on the distribution of all counties in the US, all ISC3 centers, and within each Center for twelve selected measures. Distributions of each factor are compared with the national estimate using single sample sign tests. RESULTS ISC3 centers' catchment areas include 458 counties and over 126 million people across 28 states. The median percentage of population living within ½ mile of a park is higher in ISC3 counties (38.0%, interquartile range (IQR): 16.0%-59.0%) compared to nationally (18.0%, IQR: 7.0%-38.0%; p < 0.0001). The median percentage of households with no broadband access is significantly lower in ISC3 counties (28.4%, IQR: 21.4%-35.6%) compared the nation overall (32.8%, IQR: 25.8%-41.2%; p < 0.0001). The median unemployment rate was significantly higher in ISC3 counties (5.2%, IQR: 4.1%-6.4%) compared to nationally (4.9%, 3.6%-6.3%, p = 0.0006). CONCLUSIONS Our results indicate that the outer setting varies across Centers and often differs from the national level. These findings demonstrate the importance of assessing the contextual environment in which interventions are implemented and suggest potential implications for intervention generalizability and scalability.
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Affiliation(s)
- Erica T Warner
- Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michelle Fredericks
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daniel Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meagan C Brown
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Thomas K Houston
- General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kia L Davis
- Washington University School of Medicine, Department of Surgery, St. Louis, Missouri, USA
| | - Stephanie Mazzucca
- Washington University in St. Louis, Brown School, Prevention Research Center, St. Louis, MO, United States
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia Perelman School of Medicine, PA, USA
| | - Karen M Emmons
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
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Poole MK, Gortmaker SL, Barrett JL, McCulloch SM, Rimm EB, Emmons KM, Ward ZJ, Kenney EL. The societal costs and health impacts on obesity of BMI report cards in US schools. Obesity (Silver Spring) 2023; 31:2110-2118. [PMID: 37395361 PMCID: PMC10524592 DOI: 10.1002/oby.23788] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/05/2023] [Accepted: 04/01/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE This study aimed to estimate the 10-year cost-effectiveness of school-based BMI report cards, a commonly implemented program for childhood obesity prevention in the US where student BMI is reported to parents/guardians by letter with nutrition and physical activity resources, for students in grades 3 to 7. METHODS A microsimulation model, using data inputs from evidence reviews on health impacts and costs, estimated: how many students would be reached if the 15 states currently measuring student BMI (but not reporting to parents/guardians) implemented BMI report cards from 2023 to 2032; how many cases of childhood obesity would be prevented; expected changes in childhood obesity prevalence; and costs to society. RESULTS BMI report cards were projected to reach 8.3 million children with overweight or obesity (95% uncertainty interval [UI]: 7.7-8.9 million) but were not projected to prevent any cases of childhood obesity or significantly decrease childhood obesity prevalence. Ten-year costs totaled $210 million (95% UI: $30.5-$408 million) or $3.33 per child per year with overweight or obesity (95% UI: $3.11-$3.68). CONCLUSIONS School-based BMI report cards are not cost-effective childhood obesity interventions. Deimplementation should be considered to free up resources for implementing effective programs.
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Affiliation(s)
- Mary Kathryn Poole
- Department of Nutrition, Harvard T.H. Chan School of Public Health (Boston, MA, US)
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (Boston, MA, US)
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (Boston, MA, US)
| | - Stephanie M. McCulloch
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (Boston, MA, US)
| | - Eric B. Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health (Boston, MA, US)
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (Boston, MA, US)
| | - Zachary J. Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health (Boston, MA, US)
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health (Boston, MA, US)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (Boston, MA, US)
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18
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Emmons KM, Mendez S, Lee RM, Erani D, Mascioli L, Abreu M, Adams S, Daly J, Bierer BE. Data sharing in the context of community-engaged research partnerships. Soc Sci Med 2023; 325:115895. [PMID: 37062144 PMCID: PMC10308954 DOI: 10.1016/j.socscimed.2023.115895] [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: 11/27/2022] [Revised: 03/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Over the past 20 years, the National Institutes for Health (NIH) has implemented several policies designed to improve sharing of research data, such as the NIH public access policy for publications, NIH genomic data sharing policy, and National Cancer Institute (NCI) Cancer Moonshot public access and data sharing policy. In January 2023, a new NIH data sharing policy has gone into effect, requiring researchers to submit a Data Management and Sharing Plan in proposals for NIH funding (NIH. Supplemental information to the, 2020b; NIH. Final policy for data, 2020a). These policies are based on the idea that sharing data is a key component of the scientific method, as it enables the creation of larger data repositories that can lead to research questions that may not be possible in individual studies (Alter and Gonzalez, 2018; Jwa and Poldrack, 2022), allows enhanced collaboration, and maximizes the federal investment in research. Important questions that we must consider as data sharing is expanded are to whom do benefits of data sharing accrue and to whom do benefits not accrue? In an era of growing efforts to engage diverse communities in research, we must consider the impact of data sharing for all research participants and the communities that they represent. We examine the issue of data sharing through a community-engaged research lens, informed by a long-standing partnership between community-engaged researchers and a key community health organization (Kruse et al., 2022). We contend that without effective community engagement and rich contextual knowledge, biases resulting from data sharing can remain unchecked. We provide several recommendations that would allow better community engagement related to data sharing to ensure both community and researcher understanding of the issues involved and move toward shared benefits. By identifying good models for evaluating the impact of data sharing on communities that contribute data, and then using those models systematically, we will advance the consideration of the community perspective and increase the likelihood of benefits for all.
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Affiliation(s)
- Karen M Emmons
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Samuel Mendez
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Rebekka M Lee
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Diana Erani
- Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, MA, 02108, USA
| | - Lynette Mascioli
- Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, MA, 02108, USA
| | - Marlene Abreu
- Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, MA, 02108, USA
| | - Susan Adams
- Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, MA, 02108, USA
| | - James Daly
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Barbara E Bierer
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
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Geller AC, Coroiu A, Keske RR, Haneuse S, Davine JA, Emmons KM, Daniel CL, Gibson TM, McDonald AJ, Robison LL, Mertens AC, Elkin EB, Marghoob A, Armstrong GT. Advancing Survivors Knowledge (ASK Study) of Skin Cancer Surveillance After Childhood Cancer: A Randomized Controlled Trial in the Childhood Cancer Survivor Study. J Clin Oncol 2023; 41:2269-2280. [PMID: 36623247 PMCID: PMC10448942 DOI: 10.1200/jco.22.00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To improve skin cancer screening among survivors of childhood cancer treated with radiotherapy where skin cancers make up 58% of all subsequent neoplasms. Less than 30% of survivors currently complete recommended skin cancer screening. PATIENTS AND METHODS This randomized controlled comparative effectiveness trial evaluated patient and provider activation (PAE + MD) and patient and provider activation with teledermoscopy (PAE + MD + TD) compared with patient activation alone (PAE), which included print materials, text messaging, and a website on skin cancer risk factors and screening behaviors. Seven hundred twenty-eight participants from the Childhood Cancer Survivor Study (median age at baseline 44 years), age > 18 years, treated with radiotherapy as children, and without previous history of skin cancer were randomly assigned (1:1:1). Primary outcomes included receiving a physician skin examination at 12 months and conducting a skin self-examination at 18 months after intervention. RESULTS Rates of physician skin examinations increased significantly from baseline to 12 months in all three intervention groups: PAE, 24%-39%, relative risk [RR], 1.65, 95% CI, 1.32 to 2.08; PAE + MD, 24% to 39%, RR, 1.56, 95% CI, 1.25 to 1.97; PAE + MD + TD, 24% to 46%, RR, 1.89, 95% CI, 1.51 to 2.37. The increase in rates did not differ between groups (P = .49). Similarly, rates of skin self-examinations increased significantly from baseline to 18 months in all three groups: PAE, 29% to 50%, RR, 1.75, 95% CI, 1.42 to 2.16; PAE + MD, 31% to 58%, RR, 1.85, 95% CI, 1.52 to 2.26; PAE + MD + TD, 29% to 58%, RR, 1.95, 95% CI, 1.59 to 2.40, but the increase in rates did not differ between groups (P = .43). CONCLUSION Although skin cancer screening rates increased more than 1.5-fold in each of the intervention groups, there were no differences between groups. Any of these interventions, if implemented, could improve skin cancer prevention behaviors among childhood cancer survivors.
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Affiliation(s)
- Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Robyn R. Keske
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica A. Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Casey L. Daniel
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Todd M. Gibson
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, MD
| | - Aaron J. McDonald
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Ann C. Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Elena B. Elkin
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY
| | - Ashfaq Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
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20
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Ligibel JA, Zheng Y, Barry WT, Sella T, Ruddy KJ, Greaney ML, Rosenberg SM, Emmons KM, Partridge AH. Effects of an educational physical activity intervention in young women with newly diagnosed breast cancer: Findings from the Young and Strong Study. Cancer 2023. [PMID: 37016839 DOI: 10.1002/cncr.34779] [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: 01/06/2023] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Obesity and inactivity are poor prognostic factors in breast cancer, but less is known regarding physical activity (PA) and weight patterns in young breast cancer survivors. METHODS The Young and Strong Study was a cluster-randomized trial evaluating education and support interventions for young women (age <45 years) with newly diagnosed breast cancer. Sites were randomized 1:1 to a Young Women's Intervention (YWI) or a contact-time control physical activity intervention (PAI). Changes in PA and weight were compared between groups using general estimating equations to evaluate clustered binary and Gaussian data. RESULTS A total of 467 patients enrolled between July 2012 and December 2013 across 54 sites. Median age at diagnosis was 40 years (range, 22-45). At baseline, median body mass index (BMI) was 25.4 kg/m2 (range, 16.1-61.1), and participants reported a median of 0 minutes (range, 0-2190) of moderate/vigorous PA/week. PA increased significantly over time in both groups (p < .001), with no difference between groups at any time point. BMI increased modestly but significantly (p < .001) over time in both groups. Provider attention to PA was observed in 74% of participants on PAI and 61% on YWI (p = .145) and correlated with PA at 12 months (median 100 min/week of PA in participants with provider attention to PA vs. 60 min/week in those without, p = .016). CONCLUSIONS In a cohort of young women with breast cancer, rates of obesity and inactivity were high. PA and BMI increased over time and were not impacted by an educational PA intervention. Findings provide important information for developing lifestyle interventions for young breast cancer survivors.
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Affiliation(s)
- Jennifer A Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yue Zheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - William T Barry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tal Sella
- Sheba Medical Center, Tel HaShomer, Israel
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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21
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Lee RM, Daly JG, Mallick K, Ramanadhan S, Torres CH, Hayes CR, Manuel A, Nalls R, Emmons KM. Implementation of evidence-based primary cancer prevention interventions in MA community health centers: an explanatory sequential mixed methods study. Res Sq 2023:rs.3.rs-2588180. [PMID: 36865149 PMCID: PMC9980207 DOI: 10.21203/rs.3.rs-2588180/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] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background More than half of cancers could be prevented by employing evidence-based interventions (EBIs), including prevention interventions targeting nutrition, physical activity, and tobacco. Federally qualified health centers (FQHCs) are the primary source of patient care for over 30 million Americans - making them an optimal setting for ensuring evidence-based prevention that advances health equity. The aims of this study are to: 1) determine the degree to which primary cancer prevention EBIs are being implemented within Massachusetts FQHCs and 2) describe how these EBIs are implemented internally and via community partnerships. Methods We used an explanatory sequential mixed methods design to assess the implementation of cancer prevention EBIs. First, we used quantitative surveys of FQHC staff to determine the frequency of EBI implementation. We followed up with qualitative one-on-one interviews among a sample of staff to understand how the EBIs selected on the survey were implemented. Exploration of contextual influences on implementation and use of partnerships was guided by the Consolidated Framework for Implementation Research (CFIR). Quantitative data were summarized descriptively, and qualitative analyses used reflexive, thematic approaches, beginning deductively with codes from CFIR, then inductively coding additional categories. Results All FQHCs indicated they offered clinic-based tobacco interventions, such as clinician-delivered screening practices and prescription of tobacco cessation medications. Quitline interventions and some diet/physical activity EBIs were available at all FQHCs, but staff perceptions of penetration were low. Only 38% of FQHCs offered group tobacco cessation counseling and 63% referred patients to mobile phone-based cessation interventions. We found multilevel factors influenced implementation across intervention types - including the complexity of intervention trainings, available time and staffing, motivation of clinicians, funding, and external policies and incentives. While partnerships were described as valuable, only one FQHC reported using clinical-community linkages for primary cancer prevention EBIs. Conclusions Adoption of primary prevention EBIs in Massachusetts FQHCs is relatively high, but stable staffing and funding are required to successfully reach all eligible patients. FQHC staff are enthusiastic about the potential of community partnerships to foster improved implementation - providing training and support to build these relationships will be key to fulfilling that promise.
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Affiliation(s)
| | - James G Daly
- Harvard University T H Chan School of Public Health
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22
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Oh AY, Emmons KM, Brownson RC, Glasgow RE, Foley KL, Lewis CC, Schnoll R, Huguet N, Caplon A, Chambers DA. Speeding implementation in cancer: The National Cancer Institute's Implementation Science Centers in Cancer Control. J Natl Cancer Inst 2023; 115:131-138. [PMID: 36315080 PMCID: PMC9905952 DOI: 10.1093/jnci/djac198] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/29/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
Abstract
The National Cancer Institute's Implementation Science Centers in Cancer Control (ISC3) Network represents a large-scale initiative to create an infrastructure to support and enable the efficient, effective, and equitable translation of approaches and evidence-based treatments to reduce cancer risk and improve outcomes. This Cancer MoonshotSM-funded ISC3 Network consists of 7 P50 Centers that support and advance the rapid development, testing, and refinement of innovative approaches to implement a range of evidence-based cancer control interventions. The Centers were designed to have research-practice partnerships at their core and to create the opportunity for a series of pilot studies that could explore new and sometimes risky ideas and embed in their infrastructure a 2-way engagement and collaboration essential to stimulating lasting change. ISC3 also seeks to enhance capacity of researchers, practitioners, and communities to apply implementation science approaches, methods, and measures. The Organizing Framework that guides the work of ISC3 highlights a collective set of 3 core areas of collaboration within and among Centers, including to 1) assess and incorporate dynamic, multilevel context; 2) develop and conduct rapid and responsive pilot and methods studies; and 3) build capacity for knowledge development and exchange. Core operating principles that undergird the Framework include open collaboration, consideration of the dynamic context, and engagement of multiple implementation partners to advance pragmatic methods and health equity and facilitate leadership and capacity building across implementation science and cancer control.
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Affiliation(s)
- April Y Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Karen M Emmons
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, 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, USA
| | - Russell E Glasgow
- Dissemination and Implementation Science Program and Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristie L Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amy Caplon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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23
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Aschbrenner KA, Kruse G, Emmons KM, Singh D, Barber-Dubois ME, Miller AM, Thomas AN, Bartels SJ. Stakeholder and Equity Data-Driven Implementation: a Mixed Methods Pilot Feasibility Study. Prev Sci 2022:10.1007/s11121-022-01442-9. [PMID: 36194312 PMCID: PMC9530430 DOI: 10.1007/s11121-022-01442-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 10/30/2022]
Abstract
We conducted a mixed methods pilot feasibility study of a Stakeholder and Equity Data-Driven Implementation (SEDDI) process to facilitate using healthcare data to identify patient groups experiencing gaps in the use of evidence-based interventions (EBIs) and rapidly adapt EBIs to achieve greater access and equitable outcomes. We evaluated the feasibility and acceptability of SEDDI in a pilot hybrid type 2 effectiveness-implementation trial of a paired colorectal cancer (CRC) and social needs screening intervention at four federally qualified community health centers (CHCs). An external facilitator partnered with CHC teams to support initial implementation, followed by the SEDDI phase focused on advancing health equity. Facilitation sessions were delivered over 8 months. Preliminary evaluation of SEDDI involved convergent mixed methods with quantitative survey and focus group data. CHCs used data to identify gaps in outreach and completion of CRC screening with respect to race/ethnicity, gender, age, and language. Adaptations to improve access and use of the intervention included cultural, linguistic, and health literacy tailoring. CHC teams reported that facilitation and systematic review of data were helpful in identifying and prioritizing gaps. None of the four CHCs completed rapid cycle testing of adaptations largely due to competing priorities during the COVID-19 response. SEDDI has the potential for advancing chronic disease prevention and management by providing a stakeholder and data-driven approach to identify and prioritize health equity targets and guide adaptations to improve health equity. ClinicalTrials.gov Identifier: NCT04585919.
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Affiliation(s)
| | - Gina Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen M Emmons
- Clinical Research Coordinator, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Annette N Thomas
- Department of Social & Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
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24
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Tomsho KS, Polka E, Chacker S, Queeley D, Alvarez M, Scammell MK, Emmons KM, Rudd RE, Adamkiewicz G. A process for creating data report-back tools to improve equity in environmental health. Environ Health 2022; 21:67. [PMID: 35821055 PMCID: PMC9277935 DOI: 10.1186/s12940-022-00880-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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although there is increasing interest in reporting results of environmental research efforts back to participants, evidence-based tools have not yet been applied to developed materials to ensure their accessibility in terms of literacy, numeracy, and data visualization demand. Additionally, there is not yet guidance as to how to formally assess the created materials to assure a match with the intended audience. METHODS Relying on formative qualitative research with participants of an indoor air quality study in Dorchester, Massachusetts, we identified means of enhancing accessibility of indoor air quality data report-back materials for participants. Participants (n = 20) engaged in semi-structured interviews in which they described challenges they encountered with scientific and medical materials and outlined written and verbal communication techniques that would help facilitate engagement with and accessibility of environmental health report-back materials. We coupled these insights from participants with best practice guidelines for written materials by operationalizing health literacy tools to produce accessible audience-informed data report-back materials. RESULTS The resulting data report-back materials had a 7th -grade reading level, and between a 4th -8th grade level of overall document complexity. The numeracy skills required to engage with the material were of the lowest demand, and we incorporated best practices for risk communication and facilitating understanding and actionability of the materials. Use of a rigorous assessment tool provides evidence of accessibility and appropriateness of the material for the audience. CONCLUSIONS We outline a process for developing and evaluating environmental health data reports that are tailored to inspire risk-reduction actions, and are demonstrably accessible in terms of their literacy, numeracy, and data visualization demand. Adapting health literacy tools to create and evaluate environmental data report-back materials is a novel and evidence-based means of ensuring their accessibility.
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Affiliation(s)
- Kathryn S. Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Erin Polka
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | | | - David Queeley
- Mystic River Watershed Association, 02476 Arlington, MA USA
| | - Marty Alvarez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Madeleine K. Scammell
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Rima E. Rudd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
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25
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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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26
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Korn AR, Walsh-Bailey C, Pilar M, Sandler B, Bhattacharjee P, Moore WT, Brownson RC, Emmons KM, Oh AY. Social determinants of health and cancer screening implementation and outcomes in the USA: a systematic review protocol. Syst Rev 2022; 11:117. [PMID: 35676720 PMCID: PMC9175338 DOI: 10.1186/s13643-022-01995-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the delivery, uptake, and implementation of cancer screening to meet evidence-based recommendations is needed to reduce persistent cancer health disparities in the USA. Current national public health targets emphasize the role of social determinants of health (SDOH) on cancer screening. However, there remains a need to explicate these linkages, toward the goal of identifying and implementing effective interventions that target and address SDOH to reduce inequities in cancer screening. METHODS We will conduct a systematic review of English language peer-reviewed original research articles published between 2010 and 2021 that describe observational (qualitative and quantitative) and intervention studies conducted in the USA. In alignment with Healthy People 2030, we will include studies of breast, cervical, colorectal, and/or lung cancer screening. Guided by multiple SDOH frameworks, we will broadly define SDOH by five domain areas: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Following systematic literature searches in five databases (Ovid MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library) and piloting of screening procedures, reviewers will independently screen titles/abstracts for potential relevance. Reviewer pairs will then screen full text articles for eligibility criteria. We will extract data items from included articles, including study characteristics, cancer screening intervention information, and coding of SDOH constructs. We will assess study quality using the Mixed Methods Appraisal Tool and synthesize our findings using narrative, descriptive statistics, tables, and figures. Our approach will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. DISCUSSION By completing this systematic review, we will summarize recent literature on SDOH and cancer screening, identify research gaps for inclusion of SDOH, and propose future opportunities for advancing equity in cancer screening by integrating SDOH as part of the implementation context to promote uptake, sustainability, and scale-up in the implementation of screening guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021276582 .
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Affiliation(s)
- Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20850, USA.
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Brittney Sandler
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Prema Bhattacharjee
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - W Todd Moore
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.,University of Kansas Medical Center, Kansas, KS, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, USA.,Department of Surgery, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MT, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - April Y Oh
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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27
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Abstract
Implementation science offers a rigorous set of tools to help mitigate long-standing and worsening gender disparities in academia.
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Affiliation(s)
| | | | - Aimee S James
- Washington University in St. Louis, St. Louis, MO, USA
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28
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Lee RM, Handunge VL, Augenbraun SL, Nguyen H, Torres CH, Ruiz A, Emmons KM. Addressing COVID-19 Testing Inequities Among Underserved Populations in Massachusetts: A Rapid Qualitative Exploration of Health Center Staff, Partner, and Resident Perceptions. Front Public Health 2022; 10:838544. [PMID: 35400042 PMCID: PMC8987278 DOI: 10.3389/fpubh.2022.838544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Access to COVID-19 testing has been inequitable and misaligned with community need. However, community health centers have played a critical role in addressing the COVID-19 testing needs of historically disadvantaged communities. The aim of this paper is to explore the perceptions of COVID-19 testing barriers in six Massachusetts communities that are predominantly low income and describe how these findings were used to build tailored clinical-community strategies to addressing testing inequities. Methods Between November 2020 and February 2021, we conducted 84 semi-structured qualitative interviews with 107 community health center staff, community partners, and residents. Resident interviews were conducted in English, Spanish, Vietnamese, and Arabic. We used a 2-phase framework analysis to analyze the data, including deductive coding to facilitate rapid analysis for action and an in-depth thematic analysis applying the Social Ecological Model. Results Through the rapid needs assessment, we developed cross-site suggestions to improve testing implementation and communications, as well as community-specific recommendations (e.g., locations for mobile testing sites and local communication channels). Upstream barriers identified in the thematic analysis included accessibility of state-run testing sites, weak social safety nets, and lack of testing supplies and staffing that contributed to long wait times. These factors hindered residents' abilities to get tested, which was further exacerbated by individual fears surrounding the testing process and limited knowledge on testing availability. Discussion Our rapid, qualitative approach created the foundation for implementing strategies that reached underserved populations at the peak of the COVID-19 pandemic in winter 2021. We explored perceptions of testing barriers and created actionable summaries within 1–2 months of data collection. Partnering community health centers in Massachusetts were able to use these data to respond to the local needs of each community. This study underscores the substantial impact of upstream, structural disparities on the individual experience of COVID-19 and demonstrates the utility of shifting from a typical years' long research translation process to a rapid approach of using data for action.
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Affiliation(s)
- Rebekka M. Lee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- *Correspondence: Rebekka M. Lee
| | - Veronica L. Handunge
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Samantha L. Augenbraun
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Huy Nguyen
- DotHouse Health, Dorchester, MA, United States
| | | | - Alyssa Ruiz
- Lynn Community Health Center, Lynn, MA, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Jacob V, Chattopadhyay SK, Attipoe-Dorcoo S, Peng Y, Hahn RA, Finnie R, Cobb J, Cuellar AE, Emmons KM, Remington PL. Permanent Supportive Housing With Housing First: Findings From a Community Guide Systematic Economic Review. Am J Prev Med 2022; 62:e188-e201. [PMID: 34774389 PMCID: PMC8863642 DOI: 10.1016/j.amepre.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/19/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The annual economic burden of chronic homelessness in the U.S. is estimated to be as high as $3.4 billion. The Permanent Supportive Housing with Housing First (Housing First) program, implemented to address the problem, has been shown to be effective. This paper examines the economic cost and benefit of Housing First Programs. METHODS The search of peer-reviewed and gray literature from inception of databases through November 2019 yielded 20 evaluation studies of Housing First Programs, 17 from the U.S. and 3 from Canada. All analyses were conducted from March 2019 through July 2020. Monetary values are reported in 2019 U.S. dollars. RESULTS Evidence from studies conducted in the U.S. was separated from those conducted in Canada. The median intervention cost per person per year for U.S. studies was $16,479, and for all studies, including those from Canada, it was $16,336. The median total benefit for the U.S. studies was $18,247 per person per year, and it was $17,751 for all studies, including those from Canada. The benefit-to-cost ratio for U.S. studies was 1.80:1, and for all studies, including those from Canada, it was 1.06:1. DISCUSSION The evidence from this review shows that economic benefits exceed the cost of Housing First Programs in the U.S. There were too few studies to determine cost-benefit in the Canadian context.
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Affiliation(s)
- Verughese Jacob
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sajal K Chattopadhyay
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon Attipoe-Dorcoo
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yinan Peng
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert A Hahn
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramona Finnie
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jamaicia Cobb
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison E Cuellar
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, School of Public Health, Harvard T.H. Chan University, Cambridge, Massachusetts
| | - Patrick L Remington
- Department of Population Health Sciences, UW-Madison School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Mueller NM, Hsieh A, Ramanadhan S, Lee RM, Emmons KM. The Prevalence of Dissemination and Implementation Research and Training Grants at National Cancer Institute-Designated Cancer Centers. JNCI Cancer Spectr 2022; 6:pkab092. [PMID: 35005429 PMCID: PMC8735751 DOI: 10.1093/jncics/pkab092] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Dissemination and implementation (D&I) research is a key factor in the uptake and use of evidence-based cancer control interventions. National Cancer Institute (NCI)–designated cancer centers are ideal settings in which to further D&I knowledge. The purpose of this study was to summarize the characteristics of NCI-funded D&I science grants in the nation’s cancer centers to understand the nature, extent, and opportunity for this key type of translational work. Methods We used the National Institutes of Health Research Portfolio Online Reporting Tool to identify active NCI-funded grants in D&I science at NCI clinical cancer centers (n = 13) and comprehensive cancer centers (n = 51) as well as their academic affiliates. Active projects were eligible for inclusion if they 1) were awarded directly to an NCI cancer center or an academic or research affiliate, and 2) identified D&I content in the abstract. Portfolio data were collected in February 2021. Results We identified 104 active NCI-funded D&I research or training grants across the 64 cancer centers; 57.8% of cancer centers had at least 1 NCI-funded D&I grant. Most awards (71.1%) were for research grants. Training grants constituted 29.1% of D&I-focused grants. Overall, 50.0% of grants (n = 52) concentrated on specific cancers. Almost two-thirds of grants (n = 68, 65.4%) had a stated health equity focus. Conclusions More than one-half of NCI-designated cancer centers have active funding in D&I science, reflecting a substantial investment by NCI. There remains considerable room for further development, which would further support NCI’s translational mission.
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Affiliation(s)
- Nora M Mueller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Ada Hsieh
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Dana-Farber/Harvard Cancer Center, Boston, MA, USA
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Emmons KM, Chambers D, Abazeed A. Embracing policy implementation science to ensure translation of evidence to cancer control policy. Transl Behav Med 2021; 11:1972-1979. [PMID: 34850924 DOI: 10.1093/tbm/ibab147] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although health-related policies are abundant, efforts to understand how to ensure that these policies serve as an effective vehicle for translating scientific evidence are relatively sparse. This paper explores how policy-focused implementation science (IS) may contribute to understanding the translation of scientific evidence to health-related policy in governmental and nongovernmental sectors. Expanding the focus of implementation science in cancer control could systematically address policy to both increase the use of scientific evidence in general and to address health equity. In this Commentary, we look to relevant work outside of IS that could be informative, most notably from the field of political science. We propose several ideas for future research that could help move the field of policy implementation science in cancer control in the USA forward. Although most efforts to increase uptake of the scientific evidence base reference translation to "practice and policy," there has been relatively little emphasis in the USA on implementation at the policy level, especially related to cancer control. If we are to achieve the full benefits of scientific discovery on population and public health, we will need to consider policy as a critical mechanism by which evidence can be translated to practice. We have a robust set of methods within implementation science that are increasing the pace of adoption and maintenance of evidence-based programs in a variety of settings. Building on these efforts, the time is right to expand our focus to include policy implementation.
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Affiliation(s)
- Karen M Emmons
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, Office of the Director, National Cancer Institute, Bethesda, MA 20014, USA
| | - Ali Abazeed
- Division of Cancer Control and Population Sciences, Office of the Director, National Cancer Institute, Bethesda, MA 20014, USA
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Abstract
This commentary explores the ways in which robust research focused on policy implementation will increase our ability to understand how to - and how not to - address social determinants of health. We make three key points in this commentary. First, policies that affect our lives and health are developed and implemented every single day, like it or not. These include "small p" policies, such as those at our workplaces that influence whether we have affordable access to healthy food at work, as well as "large P" policies that, for example, determine at a larger level whether our children's schools are required to provide physical education. However, policies interact with context and are likely to have differential effects across different groups based on demographics, socioeconomic status, geography, and culture. We are unlikely to improve health equity if we do not begin to systematically evaluate the ways in which policies can incorporate evidence-based approaches to reducing inequities and to provide structural supports needed for such interventions to have maximal impact. A policy mandating physical education in schools will do little to address disparities in fitness and weight-related outcomes if all schools cannot provide the resources for physical education teachers and safe activity spaces. Second, as we argue for an increased emphasis on policy implementation science, we acknowledge its nascent status. Although the field of implementation science has become increasingly robust in the past decade, there has been only limited application to policy. However, if we are strategic and systematic in application of implementation science approaches and methods to health-related policy, there is great opportunity to discover its impact on social determinants. This will entail fundamental work to develop common measures of policy-relevant implementation processes and outcomes, to develop the capacity to track policy proposal outcomes, and to maximize our capacity to study natural experiments of policy implementation. Third, development of an explicit policy implementation science agenda focused on health equity is critical. This will include efforts to bridge scientific evidence and policy adoption and implementation, to evaluate policy impact on a range of health equity outcomes, and to examine differential effects of varied policy implementation processes across population groups. We cannot escape the reality that policy influences health and health equity. Policy implementation science can have an important bearing in understanding how policy impacts can be health-promoting and equitable.
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Affiliation(s)
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Brownson RC, Jacob RR, Carothers BJ, Chambers DA, Colditz GA, Emmons KM, Haire-Joshu D, Kerner JF, Padek M, Pfund C, Sales A. Building the Next Generation of Researchers: Mentored Training in Dissemination and Implementation Science. Acad Med 2021; 96:86-92. [PMID: 32941251 PMCID: PMC7769184 DOI: 10.1097/acm.0000000000003750] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PROBLEM Dissemination and implementation (D&I) science provides the tools needed to close the gap between known intervention strategies and their effective application. The authors report on the Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) program-a D&I training program for postdoctoral or early-career cancer prevention and control scholars. APPROACH MT-DIRC was a 2-year training institute in which fellows attended 2 annual Summer Institutes and other conferences and received didactic, group, and individual instruction; individualized mentoring; and other supports (e.g., pilot funding). A quasi-experimental design compared changes in 3 areas: mentoring, skills, and network composition. To evaluate mentoring and D&I skills, data from fellows on their mentors' mentoring competencies, their perspectives on the importance of and satisfaction with mentoring priority areas, and their self-rated skills in D&I competency domains were collected. Network composition data were collected from faculty and fellows for 3 core social network domains: contact, mentoring, and collaboration. Paired t tests (mentoring), linear mixed models (skills), and descriptive analyses (network composition) were performed. OUTCOMES Mentors were rated as highly competent across all mentoring competencies, and each mentoring priority area showed reductions in gaps between satisfaction and importance between the 6 and 18 months post-first Summer Institute. Fellows' self-rated skills in D&I competencies improved significantly in all domains over time (range: 42.5%-52.9% increase from baseline to 18 months post-first Summer Institute). Mentorship and collaboration networks grew over time, with the highest number of collaboration network ties for scholarly manuscripts (n = 199) in 2018 and for research projects (n = 160) in 2019. NEXT STEPS Building on study findings and existing literature, mentored training of scholars is an important approach for building D&I skills and networks, and thus to better applying the vast amount of available intervention evidence to benefit cancer control.
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Affiliation(s)
- Ross C. Brownson
- R.C. Brownson is Steven H. and Susan U. Lipstein Distinguished Professor of Public Health, Prevention Research Center, Brown School at Washington University in St. Louis, and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Rebekah R. Jacob
- R.R. Jacob is research manager, Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Bobbi J. Carothers
- B.J. Carothers is senior data analyst, Center for Public Health Systems Science, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - David A. Chambers
- D.A. Chambers is deputy director for implementation science, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Graham A. Colditz
- G.A. Colditz is Niess-Gain Professor of Surgery, Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Karen M. Emmons
- K.M. Emmons is professor of social and behavioral sciences, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Debra Haire-Joshu
- D. Haire-Joshu is Joyce Wood Professor, Center for Diabetes Translation Research and Center for Obesity Prevention and Policy Research, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Jon F. Kerner
- J.F. Kerner was senior scientific advisor, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Margaret Padek
- M. Padek is research manager, Implementation Science Center for Cancer Control, Brown School at Washington University in St. Louis, and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Christine Pfund
- C. Pfund is senior scientist, Center for the Improvement of Mentored Experiences in Research, and Wisconsin Center for Education Research and Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Anne Sales
- A. Sales is professor, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Ojikutu BO, Stephenson KE, Mayer KH, Emmons KM. Building Trust in COVID-19 Vaccines and Beyond Through Authentic Community Investment. Am J Public Health 2020; 111:366-368. [PMID: 33301352 DOI: 10.2105/ajph.2020.306087] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Bisola O Ojikutu
- Bisola O. Ojikutu is with the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Kathyrn E. Stephenson is with the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Kenneth H. Mayer is with the Fenway Institute, Fenway Community Health Center, Boston, MA, and Harvard Medical School, Boston, MA. Karen M. Emmons is with the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kathyrn E Stephenson
- Bisola O. Ojikutu is with the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Kathyrn E. Stephenson is with the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Kenneth H. Mayer is with the Fenway Institute, Fenway Community Health Center, Boston, MA, and Harvard Medical School, Boston, MA. Karen M. Emmons is with the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kenneth H Mayer
- Bisola O. Ojikutu is with the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Kathyrn E. Stephenson is with the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Kenneth H. Mayer is with the Fenway Institute, Fenway Community Health Center, Boston, MA, and Harvard Medical School, Boston, MA. Karen M. Emmons is with the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karen M Emmons
- Bisola O. Ojikutu is with the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Kathyrn E. Stephenson is with the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Kenneth H. Mayer is with the Fenway Institute, Fenway Community Health Center, Boston, MA, and Harvard Medical School, Boston, MA. Karen M. Emmons is with the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Cook EE, Rosenberg SM, Ruddy KJ, Barry WT, Greaney M, Ligibel J, Sprunck-Harrild K, Holmes MD, Tamimi RM, Emmons KM, Partridge AH. Prospective evaluation of the impact of stress, anxiety, and depression on household income among young women with early breast cancer from the Young and Strong trial. BMC Public Health 2020; 20:1514. [PMID: 33023562 PMCID: PMC7541223 DOI: 10.1186/s12889-020-09562-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Young women with breast cancer tend to report lower quality of life and higher levels of stress than older women with breast cancer, and this may have implications for other psychosocial factors including finances. We sought to determine if stress, anxiety, and depression at diagnosis were associated with changes in household income over 12-months in young women with breast cancer in the United States. Methods This study was a prospective, longitudinal cohort study comprised of women enrolled in the Young and Strong trial. Of the 467 women aged 18–45 newly diagnosed with early-stage breast cancer enrolled in the Young and Strong trial from 2012 to 2013, 356 (76%) answered income questions. Change in household income from baseline to 12 months was assessed and women were categorized as having lost, gained, maintained the same household income <$100,000, or maintained household income ≥$100,000. Patient-reported stress, anxiety, and depression were assessed close to diagnosis at trial enrollment. Adjusted multinomial logistic regression models were used to compare women who lost, gained, or maintained household income ≥$100,000 to women who maintained the same household income <$100,000. Results Although most women maintained household income ≥$100,000 (37.1%) or the same household income <$100,000 (32.3%), 15.4% lost household income and 15.2% gained household income. Stress, anxiety, and depression were not associated with gaining or losing household income compared to women maintaining household incomes <$100,000. Women with household incomes <$50,000 had a higher risk of losing household income compared to women with household incomes ≥$50,000. Women who maintained household incomes ≥$100,000 were less likely to report financial or insurance problems. Among women who lost household income, 56% reported financial problems and 20% reported insurance problems at 12 months. Conclusions Baseline stress, anxiety, and depression were not associated with household income changes for young women with breast cancer. However, lower baseline household income was associated with losing household income. Some young survivors encounter financial and insurance problems in the first year after diagnosis, and further support for these women should be considered. Trial registration Clinicaltrials.gov, NCT01647607; date registered: July 23, 2012.
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Affiliation(s)
- Erin E Cook
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Current affiliation: Analysis Group, Inc., Boston, MA, USA
| | - Shoshana M Rosenberg
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | | | - William T Barry
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Jennifer Ligibel
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Kim Sprunck-Harrild
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | - Rulla M Tamimi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, Boston, MA, USA.
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Armenian SH, Lindenfeld L, Iukuridze A, Echevarria M, Bebel S, Coleman C, Nakamura R, Abdullah F, Modi B, Oeffinger KC, Emmons KM, Marghoob AA, Geller AC. Technology-enabled activation of skin cancer screening for hematopoietic cell transplantation survivors and their primary care providers (TEACH). BMC Cancer 2020; 20:721. [PMID: 32746799 PMCID: PMC7397711 DOI: 10.1186/s12885-020-07232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hematopoietic cell transplantation (HCT) is a curative option for a growing number of patients with hematologic diseases and malignancies. However, HCT-related factors, such as total body irradiation used for conditioning, graft-versus-host disease, and prolonged exposure to immunosuppressive therapy, result in very high risk for melanoma and non-melanoma skin cancer (NMSC). In fact, skin cancer is the most common subsequent neoplasm in HCT survivors, tending to develop at a time when survivors' follow-up care has largely transitioned to the primary care setting. The goal of this study is to increase skin cancer screening rates among HCT survivors through patient-directed activation alone or in combination with physician-directed activation. The proposed intervention will identify facilitators of and barriers to risk-based screening in this population and help reduce the burden of cancer-related morbidity after HCT. METHODS/DESIGN 720 HCT survivors will be enrolled in this 12-month randomized controlled trial. This study uses a comparative effectiveness design comparing (1) patient activation and education (PAE, N = 360) including text messaging and print materials to encourage and motivate skin examinations; (2) PAE plus primary care physician activation (PAE + Phys, N = 360) adding print materials for the physician on the HCT survivors' increased risk of skin cancer and importance of conducting a full-body skin exam. Patients on the PAE + Phys arm will be further randomized 1:1 to the teledermoscopy (PAE + Phys+TD) adding physician receipt of a portable dermatoscope to upload images of suspect lesions for review by the study dermatologist and an online course with descriptions of dermoscopic images for skin cancers. DISCUSSION When completed, this study will provide much-needed information regarding strategies to improve skin cancer detection in other high-risk (e.g. radiation-exposed) cancer survivor populations, and to facilitate screening and management of other late effects (e.g. cardiovascular, endocrine) in HCT survivors. TRIAL REGISTRATION ClinicalTrials.gov, NCT04358276 . Registered 24 April 2020.
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Affiliation(s)
- Saro H. Armenian
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Lanie Lindenfeld
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Aleksi Iukuridze
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Meagan Echevarria
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Samantha Bebel
- Department of Population Sciences, City of Hope, 1500, East Duarte Road, Duarte, CA 91010-3000 USA
| | - Catherine Coleman
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA USA
| | | | - Badri Modi
- Department of Surgery, City of Hope, Duarte, CA USA
| | - Kevin C. Oeffinger
- Department of Medicine, Community and Family Medicine and Population Health Sciences, Duke Cancer Institution, Duke, North Carolina USA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Ashfaq A. Marghoob
- Department of Dermatology, Memorial-Sloan Kettering Cancer Center, New York, NY USA
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA USA
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Abstract
IMPORTANCE The use of electronic cigarettes (e-cigarettes) has rapidly increased among youth and young adults, but knowledge gaps exist on the potential health effects of using recently introduced pod-based e-cigarettes. OBJECTIVE To conduct a systematic review of recent peer-reviewed scientific literature on pod-based e-cigarettes. EVIDENCE REVIEW A search of online databases, including PubMed, Web of Science, Embase, and EBSCO HOST, was conducted to identify pod-based e-cigarette-associated articles from June 2015 (the time when JUUL [JUUL Labs] was introduced) to June 2019. We included English-language articles that presented primary data on pod-based e-cigarettes. FINDINGS Pod-based e-cigarettes represent a substantial evolution in design by increasing the efficient delivery of nicotine. While these products may contain less harmful constituents than other types of e-cigarettes and cigarettes, there is no evidence that the levels found are safe among youth. There is evidence for higher nicotine dependence associated with their use. Pod-based e-cigarette brands, compared with other e-cigarette brands, have targeted youth and young adults with social media marketing. There was less discussion about the use of these products as smoking cessation devices or their health risks on social media. The social acceptability and favorable perceptions of pod-based e-cigarettes may underlie the use of these products. CONCLUSIONS AND RELEVANCE The appeal and dependence potential of pod-based e-cigarettes for youth emphasize the need for stronger regulations on product design, social media, marketing channels, and youth access together with health communications that emphasize the risks of nicotine dependence.
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Affiliation(s)
- Stella Juhyun Lee
- Department of Media and Communication, Konkuk University, Seoul, South Korea
| | - Vaughan W. Rees
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Noam Yossefy
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Karen M. Emmons
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Andy S. L. Tan
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts,Dana-Farber Cancer Institute, Population Sciences Division, Center for Community Based Research, Boston, Massachusetts
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Jacob RR, Gacad A, Padek M, Colditz GA, Emmons KM, Kerner JF, Chambers DA, Brownson RC. Mentored training and its association with dissemination and implementation research output: a quasi-experimental evaluation. Implement Sci 2020; 15:30. [PMID: 32393285 PMCID: PMC7216589 DOI: 10.1186/s13012-020-00994-0] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is a continued need to evaluate training programs in dissemination and implementation (D&I) research. Scientific products yielded from trainees are an important and objective measure to understand the capacity growth within the D&I field. This study evaluates our mentored training program in terms of scientific productivity among applicants. Methods Post-doctoral and early-career cancer researchers were recruited and applied to the R25 Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) between 2014 and 2017. Using application details and publicly available bibliometric and funding data, we compared selected fellows with unsuccessful applicants (nonfellows). We extracted Scopus citations and US federal grant funding records for all applicants (N = 102). Funding and publication abstracts were de-identified and coded for D&I focus and aggregated to the applicant level for analysis. Logistic regression models were explored separately for the odds of (1) a D&I publication and (2) US federal grant funding post year of application among fellows (N = 55) and nonfellows (N = 47). Additional models were constructed to include independent variables that attenuated the program’s association by 5% or more. Only US-based applicants (N = 87) were included in the grant funding analysis. Results Fellows and nonfellows were similar across several demographic characteristics. Fellows were more than 3 times more likely than nonfellows to have grant funding after MT-DIRC application year (OR 3.2; 95% CI 1.1–11.0) while controlling for time since application year; the association estimate was 3.1 (95% CI 0.98–11.0) after adjusting for both cancer research area and previous grant funding. For publications, fellows were almost 4 times more likely to publish D&I-focused work adjusting for time (OR 3.8; 95% CI 1.7–9.0). This association lessened after adjusting for previous D&I publication and years since undergraduate degree (OR 2.9; 95% CI 1.2–7.5). Conclusions We document the association of a mentored training approach with built-in networks of peers to yield productive D&I researchers. Future evaluation efforts could be expanded to include other forms of longer-term productivity such as policy or practice change as additional objective measures. D&I research trainings in the USA and internationally should consider common evaluation measures.
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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.
| | - Angeline Gacad
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Margaret Padek
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jon F Kerner
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, 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, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Etaix E, Zheng Y, Rosenberg S, Ruddy KJ, Hoverman JR, Emmons KM, Partridge AH. Abstract P2-13-17: Fertility concerns and treatment decision-making among young women with breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-13-17] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND Fertility can be diminished by adjuvant chemotherapy or by age-related decline in ovarian reserve in young women with breast cancer (BC). We sought to better understand the burden of concern about fertility, utilization of fertility preservation strategies, and the impact of fertility concerns on treatment decision-making among young women newly diagnosed with BC enrolled in a large multi-site study.
METHODS The Young and Strong study was a cluster-randomized study that tested the effect of an educational and supportive care intervention for young women with BC (≤45) and their oncologists, at community and academic sites across the US. Patients were surveyed following diagnosis at enrollment (within 3 months of diagnosis), and at 3, 6 and 12 months thereafter. The surveys included sociodemographic and psychosocial measures (HADS anxiety and depression; Perceived Stress Scale), as well as a modified Fertility Issues Survey, which assessed fertility concerns and preservation. Treatment and tumor pathology data were abstracted from the medical record. Logistic regression was used to identify sociodemographic, clinical, and psychosocial factors that were associated with fertility concern. Variables with p ≤ 0.20 in univariable analyses were evaluated in the multivariable model using stepwise selection; variables achieving significance at p < 0.05 were included in the final model.
RESULTS Of 467 women enrolled from 54 sites (14 academic, 40 community), 419 had evaluable data regarding treatment decision-making. Median age of participants at diagnosis was 40 yrs (range 22-45), 11% were African American, 80% were married/lived with a partner, and 75% had children. 35% of tumors were stage I, 51% stage II, and 14% stage III; 82% of women were treated with chemotherapy. At the time of treatment decision-making, 133 (32%) were concerned about fertility, varying by age, with fertility concern reported by 73%, 28% and 13% of those age ≤35, 36-40 and >40 (p<.01), respectively. 67 (16%) said their treatment decisions had been affected by fertility concerns, including 62 of the 133 (47%) with fertility concern. 12/419 (3%) chose one chemotherapy regimen over another, 4 (1%) chose not to take hormonal medication, and 32 (8%) chose or may choose to take it for less than 5 years. 251 (60%) reported having discussed fertility issues with their physician before starting therapy, including 117/133 (88%) of women with fertility concern. 29 (7%), including 27/133 (20%) of the concerned, took special steps to lessen the chance of infertility: 14 underwent cryopreservation of embryos, 14 cryopreservation of eggs and 12 took GnRH agonist or pursued other strategies. In the multivariable model, history of difficulty becoming pregnant (versus none, OR=3.86, 95%CI: 1.84-8.1) was associated with greater concern about fertility. Older age (OR=.75 per 1-year increase, 95%CI: 0.69-0.81) and having more than one child at diagnosis (versus never delivered, OR=0.14, 95%CI: 0.05-0.40) were associated with less concern about fertility. Race, being partnered, high-education, income, symptoms of depression, stress or anxiety at diagnosis, tumor stage, hormone receptor status and receipt of chemotherapy were not independently associated with concern about fertility in the multivariable model.
CONCLUSION In a geographically and ethnically diverse study of young women with newly diagnosed BC in the U.S., many were concerned about fertility, with potential impact on their treatment decisions. For the majority of women, these concerns were discussed with their providers, though only a minority underwent fertility preservation strategies prior to treatment.
Citation Format: Elisabeth Etaix, Yue Zheng, Shoshana Rosenberg, Kathryn J Ruddy, J Russel Hoverman, Karen M Emmons, Ann H Partridge. Fertility concerns and treatment decision-making among young women with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-17.
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Affiliation(s)
| | - Yue Zheng
- 1Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | - Ann H Partridge
- 2Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Koh HK, Bantham A, Geller AC, Rukavina MA, Emmons KM, Yatsko P, Restuccia R. Anchor Institutions: Best Practices to Address Social Needs and Social Determinants of Health. Am J Public Health 2020; 110:309-316. [PMID: 31944837 DOI: 10.2105/ajph.2019.305472] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
"Anchor Institutions"-universities, hospitals, and other large, place-based organizations-invest in their communities as a way of doing business. Anchor "meds" (anchor institutions dedicated to health) that address social needs and social determinants of health have generated considerable community-based activity over the past several decades.Yet to date, virtually no research has analyzed their current status or effect on community health. To assess the current state and potential best practices of anchor meds, we conducted a search of the literature, a review of Web sites and related public documents of all declared anchor meds in the country, and interviews with 14 key informants.We identified potential best practices in adopting, operationalizing, and implementing an anchor mission and using specific social determinants of health strategies, noting early outcomes and lessons learned. Future dedicated research can bring heightened attention to this emerging force for community health.
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Affiliation(s)
- Howard K Koh
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Amy Bantham
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Alan C Geller
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Mark A Rukavina
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Karen M Emmons
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Pamela Yatsko
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Robert Restuccia
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
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Ashrafzadeh S, Metlay JP, Choudhry NK, Emmons KM, Asgari MM. Using Implementation Science to Optimize the Uptake of Evidence-Based Medicine into Dermatology Practice. J Invest Dermatol 2019; 140:952-958. [PMID: 31862108 DOI: 10.1016/j.jid.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/18/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022]
Abstract
An estimated 17-year lag exists between evidence generation and its integration into routine clinical care. The field of implementation science has emerged to close this gap by applying rigorous methods to systematically study the obstacles and facilitators of the uptake of evidence-based practices. However, implementation science has not gained wide traction in dermatology. In this narrative review, we use literature and expert input to introduce implementation science and key frameworks for implementing interventions and evaluating their uptake. We then highlight opportunities for dermatology-specific interventions at the patient-, provider-, system-, and population-levels, and advocate for the field's expansion into dermatology.
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Affiliation(s)
- Sepideh Ashrafzadeh
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Joshua P Metlay
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
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42
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Vinson CA, Clyne M, Cardoza N, Emmons KM. Building capacity: a cross-sectional evaluation of the US Training Institute for Dissemination and Implementation Research in Health. Implement Sci 2019; 14:97. [PMID: 31752914 PMCID: PMC6869199 DOI: 10.1186/s13012-019-0947-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 07/31/2019] [Accepted: 10/11/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In 2011, the National Institute of Health (NIH) initiated the Training in Dissemination and Implementation Research in Health (TIDIRH) program. Over its first 5 years, TIDIRH provided an in-person, week-long training to 197 investigators who were new to the dissemination and implementation (D&I) field. This paper evaluates the long-term impact of TIDIRH on trainees' use of D&I methods, collaborations, and research funding. METHODS Trainees were selected to participate through a competitive process. We compared the 197 trainees to 125 unselected applicants (UAs) whose application score was within one standard deviation of the mean for all trainees' scores for the same application year. A portfolio analysis examined electronic applications for NIH peer-reviewed funding submitted by trainees and UAs between 2011 and 2019. A survey of trainees and UAs was conducted in 2016, as was a faculty survey among the 87 individuals who served as TIDIRH instructors. RESULTS A major goal of TIDIRH was to build the field, at least in part through networking and collaboration. Thirty-eight percent of trainees indicated they had extensive contact with faculty following the training, and an additional 38% indicated they had at least limited contact. Twenty-four percent of trainees had extensive collaboration with other fellows post-TIDIRH, and 43% had at least limited contact. Collaborative activities included the full range of academic activities, including manuscript development, grant writing, and consultation/collaboration on research studies. The portfolio analysis combining grant mechanisms showed that overall, TIDIRH trainees submitted more peer-reviewed NIH grants per person than UA and had significantly better funding outcomes (25% vs 19% funded, respectively). The greatest difference was for large research project, program/center, and cooperative agreement grants mechanisms. CONCLUSIONS Overall, this evaluation found that TIDIRH is achieving its three primary goals: (1) building a pipeline of D&I investigators, (2) creating a network of scholars to build the field, and (3) improving funding outcomes for D&I grants.
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Affiliation(s)
- Cynthia A Vinson
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Mindy Clyne
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Nina Cardoza
- Kaiser Foundation Research Institute, PO Box 8040, Redwood City, CA, 94063, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Geller AC, Emmons KM. The Time Has Come to Enhance Skin Cancer Screening for Adult Childhood Cancer Survivors. J Natl Cancer Inst 2019; 111:760-761. [PMID: 30802912 DOI: 10.1093/jnci/djy213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alan C Geller
- See the Notes section for the full list of authors' affiliations
| | - Karen M Emmons
- See the Notes section for the full list of authors' affiliations
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44
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Partridge AH, Ruddy KJ, Barry WT, Greaney ML, Ligibel JA, Sprunck-Harrild KM, Rosenberg SM, Baker EL, Hoverman JR, Emmons KM. A randomized study to improve care for young women with breast cancer at community and academic medical oncology practices in the United States: The Young and Strong study. Cancer 2019; 125:1799-1806. [PMID: 30707756 DOI: 10.1002/cncr.31984] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/30/2018] [Revised: 11/19/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The authors conducted a cluster randomized study to determine the effect of an exportable educational intervention for young women with breast cancer (YWI) on improving care. METHODS Sites were randomized 1:1 to the YWI or a contact time control physical activity intervention (PAI) stratified by academic or community site. Up to 15 women aged ≤45 years with newly diagnosed breast cancer were enrolled at each of 14 academic sites and 10 were enrolled at each of 40 community sites. The primary endpoint, attention to fertility, was ascertained by medical record review. Statistical inferences concerning the effect of the intervention used general estimating equations for clustered data. RESULTS A total of 467 patients across 54 sites were enrolled between July 2012 and December 2013. The median age of the patients at the time of diagnosis was 40 years (range, 22-45 years). Attention to fertility by 3 months was observed in 55% of patients in the YWI and 58% of patients in the PAI (P = .88). Rates were found to be strongly correlated with age (P < .0001), and were highest in patients aged <30 years. Attention to genetics was similar (80% in the YWI and 81% in the PAI), whereas attention to emotional health was higher in patients in the YWI (87% vs 76%; estimated odds ratio, 2.63 [95% confidence interval, 1.20-5.76; P = .016]). Patients rated both interventions as valuable in providing education (64% in the YWI and 63% in the PAI). CONCLUSIONS The current study failed to demonstrate differences in attention to fertility with an intervention to improve care for women with breast cancer, although attention to fertility was found to be higher than expected in both groups and emotional health was improved in the YWI group. Greater attention to young women with breast cancer in general may promote more comprehensive care for this population.
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Affiliation(s)
- Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - William T Barry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Mary L Greaney
- Department of Kinesiology, University of Rhode Island at Kingston, Kingston, Rhode Island
| | - Jennifer A Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Shoshana M Rosenberg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Emily L Baker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Abstract
Behavioral medicine has made significant contributions to our understanding of how to prevent disease and improve health. However, social and environmental factors continue to have a major influence on health in ways that will be difficult to combat on a population level without concerted efforts to scale interventions and translate the evidence into public health policies. Now is also the right time to increase our efforts to produce policy relevant research and partnerships that will maximize the chances that our evidence is taken to scale in ways that can influence population health broadly, and perhaps contribute to the reduction of the recalcitrant health disparities that plague virtually every area of behavioral medicine focus. As a field we must take an active role in policy translation, learning from the public policy and political science disciplines, and our own pioneers in policy translation. This article discusses importance of accelerating evidence translation to policy, and suggests several factors that could enhance our translation efforts, including embracing policy translation as a key goal in behavioral medicine, increasing our understanding in variability of evidence-based policy adoption across and within states, improving our understanding of how to most effectively communicate our findings to policy makers, conducting research that is responsive to policy makers' needs, and considering the important role of local policy partnerships.
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Affiliation(s)
- Karen M Emmons
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Room 601, 677 Huntington Ave, Boston, MA, 02115, USA.
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Cooley ME, Poghosyan H, Sprunck-Harrild K, Winickoff JP, Edge SB, Emmons KM. Tobacco treatment implementation within 28 commission on cancer accredited programs in the Northeast region of the USA: A pilot study. Transl Behav Med 2019. [PMID: 29528457 DOI: 10.1093/tbm/ibx024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer survivors are a rapidly growing population and an important target for tobacco treatment interventions. Continued smoking after the diagnosis of cancer is associated with a higher risk of cancer recurrence and mortality. Systematic tobacco cessation programs are effective. This study surveyed American College of Surgeons Commission on Cancer (CoC) programs in the Northeast region of the USA regarding their tobacco control programs. Seventy percent of cancer survivors are treated within CoC programs. The purpose of this study was to describe the extent of implementation of tobacco treatment and determine the organizational delivery of tobacco treatment as measured by the presence of goals to address smoking, leadership support, and integration of tobacco treatment guidelines into care delivery. Data were collected by a survey. The Assessment of Chronic Illness Care questionnaire was used to collect data on implementation of tobacco treatment services. Descriptive statistics were used to analyze the data. Most programs (78.6%) had an electronic health record and of these 68% captured smoking status. Implementation of tobacco treatment was not optimal for identifying smokers, providing patients with community linkages or self-care cessation support. Implementation of decision aides for pharmacotherapy and reassessment of smoking status were the least developed areas. Moreover, the organizational delivery for tobacco treatment was less than optimal. Many cancer programs have not implemented systems to deliver optimal tobacco treatment. Efforts should be made to help cancer programs develop sustainable system-wide programs that address the urgent need to deliver tobacco treatment to all cancer survivors.
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Affiliation(s)
| | | | | | | | - Stephen B Edge
- American College of Surgeons Commission on Cancer, Chicago, IL, USA.,Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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47
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Cooley ME, Blonquist TM, Hong F, Nayak MM, Crouter SE, Hayman LL, Jaklitsch MT, Emmons KM, Bueno R. The effect of a lifestyle risk reduction intervention on lifestyle adherence and health-related quality of life in nonsmall cell lung cancer survivors: Feasibility study outcomes. Psychooncology 2019; 28:920-923. [PMID: 30673155 DOI: 10.1002/pon.5002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/30/2018] [Accepted: 01/03/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mary E Cooley
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Traci M Blonquist
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Fangxin Hong
- Division of Biostatistics, Department of Data Sciences (Dana-Farber Cancer Institute) and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Manan M Nayak
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Scott E Crouter
- College of Education, Health and Human Sciences, University of Tennesee, Knoxville, USA
| | - Laura L Hayman
- College of Nursing and Health Sciences, University of Massachusetts-, Boston, Tennessee, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Emmons KM, Doubeni CA, Fernandez ME, Miglioretti DL, Samet JM. National Institutes of Health Pathways to Prevention Workshop: Methods for Evaluating Natural Experiments in Obesity. Ann Intern Med 2018; 168:809-814. [PMID: 29710235 DOI: 10.7326/m18-0501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 11/22/2022] Open
Abstract
On 5 and 6 December 2017, the National Institutes of Health (NIH) convened the Pathways to Prevention Workshop: Methods for Evaluating Natural Experiments in Obesity to identify the status of methods for assessing natural experiments to reduce obesity, areas in which these methods could be improved, and research needs for advancing the field. This article considers findings from a systematic evidence review on methods for evaluating natural experiments in obesity, workshop presentations by experts and stakeholders, and public comment. Research gaps are identified, and recommendations related to 4 key issues are provided. Recommendations on population-based data sources and data integration include maximizing use and sharing of existing surveillance and research databases and ensuring significant effort to integrate and link databases. Recommendations on measurement include use of standardized and validated measures of obesity-related outcomes and exposures, systematic measurement of co-benefits and unintended consequences, and expanded use of validated technologies for measurement. Study design recommendations include improving guidance, documentation, and communication about methods used; increasing use of designs that minimize bias in natural experiments; and more carefully selecting control groups. Cross-cutting recommendations target activities that the NIH and other funders might undertake to improve the rigor of natural experiments in obesity, including training and collaboration on modeling and causal inference, promoting the importance of community engagement in the conduct of natural experiments, ensuring maintenance of relevant surveillance systems, and supporting extended follow-up assessments for exemplar natural experiments. To combat the significant public health threat posed by obesity, researchers should continue to take advantage of natural experiments. The recommendations in this report aim to strengthen evidence from such studies.
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Affiliation(s)
- Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (K.M.E.)
| | - Chyke A Doubeni
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (C.A.D.)
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston, Houston, Texas (M.E.F.)
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49
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Abstract
As a nation, we underinvest in prevention and fail to implement strategies that ensure all population groups equitably share in the return on investment in prevention research and the benefits of prevention effectiveness. There is significant evidence indicating that by applying knowledge that we already have to reduce tobacco, inactivity, and obesity (known modifiable causes of cancer), we can prevent more than 50% of cancers. Vaccination against HPV, aspirin and selective estrogen receptor modulators, and screening programs further reduce risk. Evidence-based prevention strategies are inconsistently implemented across the United States. Substantial variation across States indicates that there is much room for improvement in implementation of prevention. Implementation science applies innovative approaches to identifying, understanding, and developing strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines that will prevent cancer through application of evidence-based interventions. When we get implementation of prevention programs right and at scale, we achieve substantial population benefits. Although many efforts are underway to maximize our knowledge about the causes and treatments of cancer, we can achieve reductions in the cancer burden right now by doing what we already know. The time to start is now. Cancer Prev Res; 11(4); 171-84. ©2018 AACR.
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Affiliation(s)
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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50
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Padek M, Mir N, Jacob RR, Chambers DA, Dobbins M, Emmons KM, Kerner J, Kumanyika S, Pfund C, Proctor EK, Stange KC, Brownson RC. Training scholars in dissemination and implementation research for cancer prevention and control: a mentored approach. Implement Sci 2018; 13:18. [PMID: 29357876 PMCID: PMC5778694 DOI: 10.1186/s13012-018-0711-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/15/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As the field of D&I (dissemination and implementation) science grows to meet the need for more effective and timely applications of research findings in routine practice, the demand for formalized training programs has increased concurrently. The Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) Program aims to build capacity in the cancer control D&I research workforce, especially among early career researchers. This paper outlines the various components of the program and reports results of systematic evaluations to ascertain its effectiveness. METHODS Essential features of the program include selection of early career fellows or more experienced investigators with a focus relevant to cancer control transitioning to a D&I research focus, a 5-day intensive training institute, ongoing peer and senior mentoring, mentored planning and work on a D&I research proposal or project, limited pilot funding, and training and ongoing improvement activities for mentors. The core faculty and staff members of the MT-DIRC program gathered baseline and ongoing evaluation data regarding D&I skill acquisition and mentoring competency through participant surveys and analyzed it by iterative collective reflection. RESULTS A majority (79%) of fellows are female, assistant professors (55%); 59% are in allied health disciplines, and 48% focus on cancer prevention research. Forty-three D&I research competencies were assessed; all improved from baseline to 6 and 18 months. These effects were apparent across beginner, intermediate, and advanced initial D&I competency levels and across the competency domains. Mentoring competency was rated very highly by the fellows--higher than rated by the mentors themselves. The importance of different mentoring activities, as rated by the fellows, was generally congruent with their satisfaction with the activities, with the exception of relatively greater satisfaction with the degree of emotional support and relatively lower satisfaction for skill building and opportunity initially. CONCLUSIONS These first years of MT-DIRC demonstrated the program's ability to attract, engage, and improve fellows' competencies and skills and implement a multicomponent mentoring program that was well received. This account of the program can serve as a basis for potential replication and evolution of this model in training future D&I science researchers.
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Affiliation(s)
- Margaret Padek
- Prevention Research Center in St. Louis, The Brown School at Washington University in St. Louis, 1 Brookings Drive. Campus Box 1196, St. Louis, MO 63130 USA
| | - Nageen Mir
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave. Campus Box 8100, St. Louis, MO 63110 USA
| | - Rebekah R. Jacob
- Prevention Research Center in St. Louis, The Brown School at Washington University in St. Louis, 1 Brookings Drive. Campus Box 1196, St. Louis, MO 63130 USA
| | - David A. Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850 USA
| | - Maureen Dobbins
- School of Nursing, National Collaborating Centre for Methods and Tools, McMaster University, 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
| | - Karen M. Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 1005, Boston, MA 02115 USA
| | - Jon Kerner
- Canadian Partnership Against Cancer, 6202 Newburn Drive, Bethesda, MD 20816 USA
| | - Shiriki Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, PA 19104 USA
| | - Christine Pfund
- Center for the Improvement of Mentored Experiences in Research, Wisconsin Center for Education Research, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706 USA
| | - Enola K. Proctor
- Center for Mental Health Services Research, The Brown School at Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Kurt C. Stange
- Center for Community Health Integration and the Case Comprehensive Cancer Center, 11000 Cedar Ave., Suite 402, Cleveland, OH 44106-7136 USA
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, The Brown School at Washington University in St. Louis, 1 Brookings Drive. Campus Box 1196, St. Louis, MO 63130 USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
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