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Do EK, Tulsiani S, Edwards G, Cha S, Amato MS, Hair EC. Treatment-seeking young people enrolled in a United States vaping cessation intervention trial report high frequency of use and nicotine dependence. Prev Med Rep 2023; 36:102533. [PMID: 38116264 PMCID: PMC10728452 DOI: 10.1016/j.pmedr.2023.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
Objective This study examines characteristics of participants enrolled in a vaping cessation intervention trial and study generalizability of the treatment-seeking sample to the broader population of young people interested in quitting vaping to evaluate dissemination of an evidence-based treatment program. Methods Data was obtained from 697 treatment-seeking participants (aged 13-24 years) from a vaping cessation intervention trial conducted between February and March 2023 with This is Quitting and 665 participants who expressed intent to quit vaping in the Truth Longitudinal Cohort, a nationally representative longitudinal study of United States youth and young adults (aged 15-24 years), collected October 2022 to February 2023. Comparisons were made using two-sample Pearson Chi-square tests and t-tests. Results Treatment-seeking young people were younger, less racially diverse, more diverse in sexual orientation, and reported higher psychological distress, frequency of e-cigarette use, and nicotine dependence, relative to the nationally representative sample of young people expressing intentions to quit vaping. Conclusions Participants enrolled in treatment reported higher levels of dependence and use frequency than the broader population, suggesting that many young e-cigarette users with lower dependence who want to quit might not be reached by current treatment dissemination efforts. The implication of these findings is that communications for vaping cessation programs may need to be adjusted to have broader appeal among young people.
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Affiliation(s)
| | | | | | - Sarah Cha
- Innovations, Truth Initiative, Washington, DC, USA
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Jung J, Oh Y, Cha S, Ohe J. An analysis of contributing factors of head and neck space infections of odontogenic origin: A long-term retrospective clinical study (including COVID-19 pandemic period). Med Oral Patol Oral Cir Bucal 2023; 28:e622-e629. [PMID: 37330958 PMCID: PMC10635621 DOI: 10.4317/medoral.26018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND The purpose of this study is to investigate predisposing factors for the head and neck infections (HNIs), regarding to the demographic data, anatomical spaces, microbiology and antibiotic sensitivity for affected patients. MATERIAL AND METHODS A 13-year of retrospective study evaluating 470 patients with HNIs, treated as inpatient management in the Department of Oral and Maxillofacial Surgery of KyungHee University school of Dentistry, Seoul, Korea, from January 2009 to February 2022. Statistical analysis of demographic, time-related, anatomic, microbiologic, and treatment variables were investigated for each patient. RESULTS The frequency of HNIs was significantly higher in 50's in males, followed by 70's in females. High Severity score (SS) were significantly associated with increased LOH (Length of hospital stay) and LOM (Length of medication), while LOH showed more intensive relationship compared with LOM. The most frequently involved space in abscess was submandibular space, though incidence and severity of HNIs shows declining tendency throughout 13-year research. Streptococcus viridans was the most predominant species isolated from pus culture growth, and a combination of ampicillin and sulbactam was the 1st choice of antibiotics intravenously. According to the comparison analysis between recommended antibiotics from resistance testing result and clinically administered antibiotics, final coincidence rate was estimated about 55%. CONCLUSIONS Due to HNIs being multifactorial, predicting progression and management of HNIs is still a challenge for oral and maxillofacial surgeons. The present study showed several predisposing factors of SHNIs and their correlations, which could contribute to earlier diagnosis and more effective treatment planning for clinicians, thereby leading to the improvement of prognosis for patients, ultimately.
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Affiliation(s)
- J Jung
- Department of Oral and Maxillofacial Surgery 02447 Seoul, Republic of Korea
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Browne J, Chipps KA, Schmidt K, Schatz H, Ahn S, Pain SD, Montes F, Ong WJ, Greife U, Allen J, Bardayan DW, Blackmon JC, Blankstein D, Cha S, Chae KY, Febbraro M, Hall MR, Jones KL, Kontos A, Meisel Z, O'Malley PD, Schmitt KT, Smith K, Smith MS, Thompson P, Toomey R, Vostinar M, Walter D. First Direct Measurement Constraining the ^{34}Ar(α,p)^{37}K Reaction Cross Section for Mixed Hydrogen and Helium Burning in Accreting Neutron Stars. Phys Rev Lett 2023; 130:212701. [PMID: 37295108 DOI: 10.1103/physrevlett.130.212701] [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] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/19/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
The rate of the final step in the astrophysical αp process, the ^{34}Ar(α,p)^{37}K reaction, suffers from large uncertainties due to a lack of experimental data, despite having a considerable impact on the observable light curves of x-ray bursts and the composition of the ashes of hydrogen and helium burning on accreting neutron stars. We present the first direct measurement constraining the ^{34}Ar(α,p)^{37}K reaction cross section, using the Jet Experiments in Nuclear Structure and Astrophysics gas jet target. The combined cross section for the ^{34}Ar,Cl(α,p)^{37}K,Ar reaction is found to agree well with Hauser-Feshbach predictions. The ^{34}Ar(α,2p)^{36}Ar cross section, which can be exclusively attributed to the ^{34}Ar beam component, also agrees to within the typical uncertainties quoted for statistical models. This indicates the applicability of the statistical model for predicting astrophysical (α,p) reaction rates in this part of the αp process, in contrast to earlier findings from indirect reaction studies indicating orders-of-magnitude discrepancies. This removes a significant uncertainty in models of hydrogen and helium burning on accreting neutron stars.
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Affiliation(s)
- J Browne
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - K A Chipps
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - Konrad Schmidt
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
- Institute of Radiation Physics, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - H Schatz
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - S Ahn
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - S D Pain
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - F Montes
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - W J Ong
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - U Greife
- Physics Department, Colorado School of Mines, Golden, Colorado 80401
| | - J Allen
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - D W Bardayan
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - J C Blackmon
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803
| | - D Blankstein
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - S Cha
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - K Y Chae
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - M Febbraro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - M R Hall
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - K L Jones
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - A Kontos
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - Z Meisel
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - P D O'Malley
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - K T Schmitt
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - K Smith
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - M S Smith
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - P Thompson
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - R Toomey
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
| | - M Vostinar
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
| | - D Walter
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
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Jose T, Cha S, Graham AL, Amato MS, Schroeder DR, Warner DO. Effect of messaging content on engagement with a short messaging service for perioperative smoking cessation. Nicotine Tob Res 2023:7120002. [PMID: 37058426 DOI: 10.1093/ntr/ntad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION We determined whether a tobacco cessation intervention targeting brief perioperative abstinence ("quit for a bit") increased engagement of surgical patients with treatment compared with an intervention targeting long-term postoperative abstinence ("quit for good"). METHODS Surgical patients who smoke were stratified according to intended duration of postoperative abstinence, and then randomized within strata to receive either a "quit for a bit" or a "quit for good" intervention. Both employed initial brief counseling and short message service (SMS) to deliver treatment up to 30 days after surgery. The primary outcome of treatment engagement was defined as the rate at which subjects actively responded to system requests delivered via SMS. RESULTS The engagement index did not differ between intervention groups (median [25th, 75th] of 23.7% [8.8, 46.0] for "quit for a bit" group (n=48) and 22.2% [4.8, 46.0] for "quit for good" group (n=50), p=0.74), nor did the proportion of patients continuing SMS use after study completion (33% and 28%, respectively). Exploratory abstinence outcomes at morning of surgery and 7 and 30 days after surgery did not differ between groups. Program satisfaction was high in both groups and did not differ. There was no significant interaction between intended abstinence duration and any outcome, i.e., alignment of intent with intervention did not affect engagement. CONCLUSION Tobacco cessation treatment delivered via SMS was well-accepted by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. IMPLICATIONS Treatment of surgical patients for tobacco use is efficacious and reduces postoperative complications. However, implementation in clinical practice has proved challenging, and new methods of engaging these patients in cessation treatment are needed. We found that tobacco use treatment delivered via short message service (SMS) was feasible and well-utilized by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates.
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Affiliation(s)
- Thulasee Jose
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, 20001, USA
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, 20001, USA
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, 20001, USA
| | - Darrell R Schroeder
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, 55905, USA
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Villanti AC, Peasley-Miklus C, Cha S, Schulz J, Klemperer EM, LePine SE, West JC, Mays D, Mermelstein R, Higgins ST, Graham AL. Tailored text message and web intervention for smoking cessation in U.S. socioeconomically-disadvantaged young adults: A randomized controlled trial. Prev Med 2022; 165:107209. [PMID: 35995105 PMCID: PMC10186588 DOI: 10.1016/j.ypmed.2022.107209] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 02/03/2023]
Abstract
The prevalence of cigarette smoking in young adults is higher among those with socioeconomic disadvantage than those without. Low treatment-seeking among young adult smokers is compounded by few efficacious smoking cessation interventions for this group, particularly socioeconomically-disadvantaged young adults (SDYA) who smoke cigarettes. The goal of this study was to test a tailored smoking-cessation intervention for SDYA. 343 SDYA aged 18-30 living in the U.S. (85% female) who smoke cigarettes with access to a smartphone and interest in quitting smoking in the next six months were recruited online in Spring 2020 and randomized to referral to online quit resources (usual care control; n = 171) or a 12-week tailored text message smoking-cessation program with a companion web-based intervention (n = 172). Intent to treat analyses examined associations between study condition, self-reported 30-day point prevalence abstinence (PPA), and confidence to quit smoking at 12 weeks, controlling for potential confounders. Intervention group participants had greater self-reported 30-day PPA at 12-weeks than controls (adjusted relative risk 3.93, 95% CI 2.14-7.24). Among those who continued smoking, the intervention increased confidence to quit (0.81 points, 95% confidence interval 0.08-1.53). Weekly engagement in the intervention predicted greater cessation. A tailored text message intervention for SDYA increased smoking abstinence and confidence to quit at the end-of-treatment. Findings may have been influenced by recruitment at the start of the COVID pandemic but suggest that text messaging is an acceptable and efficacious cessation strategy for SDYA smokers. Future studies should examine the impact on longer-term smoking-cessation and importance of intervention tailoring for SDYA.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States.
| | - Catherine Peasley-Miklus
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, United States
| | - Jonathan Schulz
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - Elias M Klemperer
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - S Elisha LePine
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, United States
| | - Robin Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States
| | - Amanda L Graham
- Innovations Center, Truth Initiative, United States; Department of Medicine, Mayo Clinic College of Medicine and Science, United States; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, United States
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Graham AL, Cha S, Papandonatos GD, Amato MS, Jacobs MA, Abroms LC, Berg CJ. E-cigarette and combusted tobacco abstinence among young adults: Secondary analyses from a U.S.-based randomized controlled trial of vaping cessation. Prev Med 2022; 165:107119. [PMID: 35777699 DOI: 10.1016/j.ypmed.2022.107119] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/17/2022] [Accepted: 06/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine patterns of abstinence from e-cigarettes, combusted tobacco products (CTPs), both, or neither among young adults enrolled in a U.S.-based randomized trial of a text message vaping cessation intervention. METHODS At baseline, 1829 young adult e-cigarette users were categorized as Exclusive E-cigarette Users (no past 30-day CTP use; n = 1036, 56.6%) or Dual Users (past 30-day CTP use; n = 793, 43.4%). Four groups were defined at 7-months: 1) Dual Abstinent, 2) Exclusive Vaping, 3) Exclusive CTP Use, and 4) Dual Users. The proportion of participants who were Dual Abstinent was the outcome of interest. RESULTS At follow-up, 22.1% (95% CI: 20.3, 24.1) of participants were Dual Abstinent, 44.8% (95% CI: 42.5, 47.1) reported Exclusive Vaping, 6.3% (95% CI: 5.2, 7.5) reported Exclusive CTP Use, and 26.8% (95% CI: 24.8, 28.9) were Dual Users. A higher proportion of participants randomized to Intervention were Dual Abstinent (25.9%, 95% CI 23.1, 28.9) compared to Control (18.5%, 95% CI 16.0, 21.1; p = .0002). Analyses of treatment effects on dual abstinence by baseline tobacco product use favored Intervention over Control among both Exclusive E-cigarette Users (p = .019) and Dual Users (p = .0014). CONCLUSION A text message vaping cessation intervention was effective in promoting dual abstinence from e-cigarettes and CTPs among young adults. The advantage of treatment over control was equivalent for Exclusive E-cigarette Users and Dual Users. Rates of dual abstinence were higher among exclusive vapers than dual users, signaling the need for more research to optimize cessation programs for poly-tobacco users.
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Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, USA; Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, USA
| | | | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, USA; Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington University Cancer Center, George Washington University, Washington, DC, USA
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Richardson G, Park J, Boyer M, Gutierrez M, Carbone D, Savvides P, Kaumaya P, Bekaii-Saab T, Phan T, Chong L, Cha S, Ede N, Nixon B, Withana N, Good A. P1.15-08 Phase 1: IMU-201 (PD1-Vaxx), a B-Cell Immunotherapy as Monotherapy or in Combination with Atezolizumab, in Adults with Non-Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Burke MV, Cha S, Shumaker TM, LaPlante M, McConahey L, Graham AL. Delivery of smoking cessation treatment via live chat: An analysis of client-centered coaching skills and behavior change techniques. Patient Educ Couns 2022; 105:2183-2189. [PMID: 34887156 DOI: 10.1016/j.pec.2021.11.030] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This qualitative study explored whether evidence-based tobacco cessation treatment components can be deployed via web-based live chat coaching. METHODS N = 100 randomly selected chats were coded. Researchers used a structured coding guide to note the presence of 3 Motivational Interviewing (MI) skills and 61 behavior change techniques (BCTs). RESULTS MI skills were observed in 86% of chats: 31 chats incorporated one skill, 31 incorporated two, and 24 incorporated all three. Open-ended questions were most common (76%), followed by affirmations (47%) and reflective listening statements (38%). BCTs were observed in 100% of chats: 21% involved one-five BCTs, 69% involved six-10 BCTs, and 10% involved 11 or more BCTs. Mean number of BCTs per chat was 7.25 (SD=2.5; range 2-17). The most common BCTs were Social Support (99%), Reward/Threat (95%), Natural Consequences (82%), Regulation (82%), Goals/Planning (64%), and Self Belief (42%). CONCLUSIONS Tobacco cessation coaching using MI skills and evidence-based BCTs can be delivered via live chat. This synchronous modality allows the delivery of an intervention tailored to the user's motivations and goals. PRACTICE IMPLICATIONS Web-based live chat can broaden the reach of tobacco treatment specialists to deploy evidence-based counseling skills and behavior change techniques in personalized, accessible coaching.
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Affiliation(s)
- Michael V Burke
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, USA.
| | | | | | - Laura McConahey
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.
| | - Amanda L Graham
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Innovations Center, Truth Initiative, Washington, DC, USA.
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Graham AL, Papandonatos GD, Cha S, Amato MS, Jacobs MA, Cohn AM, Abroms LC, Whittaker R. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022; 117:1035-1046. [PMID: 34472676 PMCID: PMC9293135 DOI: 10.1111/add.15677] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. DESIGN A parallel, two-group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow-up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. SETTING United States: a digital study conducted among new registrants on a free tobacco cessation website. PARTICIPANTS Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). INTERVENTIONS The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 9 months post-randomization analyzed under intent to treat (ITT), counting non-responders as smoking. Secondary outcomes included 3-month measures of 30-day ppa, intervention engagement and intervention satisfaction. FINDINGS Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69-1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26-0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). CONCLUSIONS A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9-month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Sarah Cha
- Innovations Center, Truth InitiativeWashingtonDCUSA
| | - Michael S. Amato
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Amy M. Cohn
- Health Promotion Research CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA,Department of Pediatrics, Children's HospitalUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonDCUSA
| | - Robyn Whittaker
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
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Vajapeyam S, Brown D, Ziaei A, Wu S, Vezina G, Stern J, Panigrahy A, Patay Z, Tamrazi B, Jones J, Haque S, Enterline D, Cha S, Jones B, Yeom K, Onar-Thomas A, Dunkel I, Fouladi M, Fangusaro J, Poussaint T. ADC Histogram Analysis of Pediatric Low-Grade Glioma Treated with Selumetinib: A Report from the Pediatric Brain Tumor Consortium. AJNR Am J Neuroradiol 2022; 43:455-461. [PMID: 35210278 PMCID: PMC8910799 DOI: 10.3174/ajnr.a7433] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/01/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Selumetinib is a promising MAP (mitogen-activated protein) kinase (MEK) 1/2 inhibitor treatment for pediatric low-grade gliomas. We hypothesized that MR imaging-derived ADC histogram metrics would be associated with survival and response to treatment with selumetinib. MATERIALS AND METHODS Children with recurrent, refractory, or progressive pediatric low-grade gliomas who had World Health Organization grade I pilocytic astrocytoma with KIAA1549-BRAF fusion or the BRAF V600E mutation (stratum 1), neurofibromatosis type 1-associated pediatric low-grade gliomas (stratum 3), or sporadic non-neurofibromatosis type 1 optic pathway and hypothalamic glioma (OPHG) (stratum 4) were treated with selumetinib for up to 2 years. Quantitative ADC histogram metrics were analyzed for total and enhancing tumor volumes at baseline and during treatment. RESULTS Each stratum comprised 25 patients. Stratum 1 responders showed lower values of SD of baseline ADC_total as well as a larger decrease with time on treatment in ADC_total mean, mode, and median compared with nonresponders. Stratum 3 responders showed a greater longitudinal decrease in ADC_total. In stratum 4, higher baseline ADC_total skewness and kurtosis were associated with shorter progression-free survival. When all 3 strata were combined, responders showed a greater decrease with time in ADC_total mode and median. Compared with sporadic OPHG, neurofibromatosis type 1-associated OPHG had lower values of ADC_total mean, mode, and median as well as ADC_enhancement mean and median and higher values of ADC_total skewness and kurtosis at baseline. The longitudinal decrease in ADC_total median during treatment was significantly greater in sporadic OPHG compared with neurofibromatosis type 1-associated OPHG. CONCLUSIONS ADC histogram metrics are associated with progression-free survival and response to treatment with selumetinib in pediatric low-grade gliomas.
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Affiliation(s)
- S. Vajapeyam
- From the Department of Radiology (S.V., T.Y.P.), Boston Children’s Hospital,Harvard Medical School, Boston, Massachusetts
| | - D. Brown
- Department of Radiology (D.B.), Massachusetts General Hospital, Boston, Massachusetts
| | - A. Ziaei
- Department of Radiology (A.Z.), Boston Children’s Hospital, Boston, Massachusetts
| | - S. Wu
- Department of Biostatistics (S.W., A.O.-T.), St Jude Children’s Research Hospital, Memphis, Tennessee
| | - G. Vezina
- Department of Radiology (G.V.), Children’s National Medical Center, Washington, DC
| | - J.S. Stern
- Department of Radiology (J.S.S.), Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - A. Panigrahy
- Department of Radiology (A.P.), Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Z. Patay
- Department of Diagnostic Imaging (Z.P.), St Jude Children’s Research Hospital, Memphis, Tennessee
| | - B. Tamrazi
- Department of Radiology (B.T.), Children’s Hospital Los Angeles, Los Angeles, California
| | - J.Y. Jones
- Department of Radiology (J.Y.J., M.F.), Nationwide Children’s Hospital, Columbus, Ohio
| | - S.S. Haque
- Department of Radiology (S.S.H., I.J.D.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - D.S. Enterline
- Department of Radiology (D.S.E.), Duke University School of Medicine, Durham, North Carolina
| | - S. Cha
- Department of Radiology (S.C.), University of California San Francisco, San Francisco, California
| | - B.V. Jones
- Department of Radiology (B.V.J.), Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - K.W. Yeom
- Department of Radiology (K.W.Y.), Stanford University School of Medicine, Stanford, California
| | - A. Onar-Thomas
- Department of Biostatistics (S.W., A.O.-T.), St Jude Children’s Research Hospital, Memphis, Tennessee
| | - I.J. Dunkel
- Department of Radiology (S.S.H., I.J.D.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - M. Fouladi
- Department of Radiology (J.Y.J., M.F.), Nationwide Children’s Hospital, Columbus, Ohio
| | - J.R. Fangusaro
- Department of Hematology, Oncology, and Stem Cell Transplantation (J.R.F.), Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - T.Y. Poussaint
- From the Department of Radiology (S.V., T.Y.P.), Boston Children’s Hospital,Harvard Medical School, Boston, Massachusetts
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Graham AL, Amato MS, Cha S, Jacobs MA, Bottcher MM, Papandonatos GD. Effectiveness of a Vaping Cessation Text Message Program Among Young Adult e-Cigarette Users: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:923-930. [PMID: 33999133 PMCID: PMC8129897 DOI: 10.1001/jamainternmed.2021.1793] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE e-Cigarettes are the most commonly used tobacco product among young adults (YAs). Despite the harms of nicotine exposure among YAs, there are few, if any, empirically tested vaping cessation interventions available. OBJECTIVE To determine the effectiveness of a text message program for vaping cessation among YAs vs assessment-only control. DESIGN, SETTING, AND PARTICIPANTS A parallel, 2-group, double-blind, individually randomized clinical trial was conducted from December 2019 to November 2020 among YA e-cigarette users. Eligible individuals were US residents aged 18 to 24 years who owned a mobile phone with an active text message plan, reported past 30-day e-cigarette use, and were interested in quitting in the next 30 days. Participants were recruited via social media ads, the intervention was delivered via text message, and assessments were completed via website or mobile phone. Follow-up was conducted at 1 and 7 months postrandomization; follow-up data collection began January 2020 and ended in November 2020. The study was prespecified in the trial protocol. INTERVENTIONS All participants received monthly assessments via text message about e-cigarette use. The assessment-only control arm (n = 1284) received no additional intervention. The active intervention arm (n = 1304) also received This is Quitting, a fully automated text message program for vaping cessation that delivers social support and cognitive and behavioral coping skills training. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 7 months analyzed under intention-to-treat analysis, which counted nonresponders as vaping. Secondary outcomes were 7-day ppa under intention-to-treat analysis and retention weighted complete case analysis of 30-day and 7-day ppa. RESULTS Of the 2588 YA e-cigarette users included in the trial, the mean (SD) age was 20.4 (1.7) years, 1253 (48.4%) were male, 2159 (83.4%) were White, 275 (10.6%) were Hispanic, and 493 (19.0%) were a sexual minority. Most participants (n = 2129; 82.3%) vaped within 30 minutes of waking. The 7-month follow-up rate was 76.0% (n = 1967), with no differential attrition. Abstinence rates were 24.1% (95% CI, 21.8%-26.5%) among intervention participants and 18.6% (95% CI, 16.7%-20.8%) among control participants (odds ratio, 1.39; 95% CI, 1.15-1.68; P < .001). No baseline variables moderated the treatment-outcome relationship, including nicotine dependence. CONCLUSIONS AND RELEVANCE Results of this randomized clinical trial demonstrated that a tailored and interactive text message intervention was effective in promoting vaping cessation among YAs. These results establish a benchmark of intervention effectiveness. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04251273.
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Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC.,Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC.,Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC
| | | | | | - George D Papandonatos
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island
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12
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Park CJ, Han K, Kim H, Ahn SS, Choi D, Park YW, Chang JH, Kim SH, Cha S, Lee SK. MRI Features May Predict Molecular Features of Glioblastoma in Isocitrate Dehydrogenase Wild-Type Lower-Grade Gliomas. AJNR Am J Neuroradiol 2021; 42:448-456. [PMID: 33509914 DOI: 10.3174/ajnr.a6983] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Isocitrate dehydrogenase (IDH) wild-type lower-grade gliomas (histologic grades II and III) with epidermal growth factor receptor (EGFR) amplification or telomerase reverse transcriptase (TERT) promoter mutation are reported to behave similar to glioblastoma. We aimed to evaluate whether MR imaging features could identify a subset of IDH wild-type lower-grade gliomas that carry molecular features of glioblastoma. MATERIALS AND METHODS In this multi-institutional retrospective study, pathologically confirmed IDH wild-type lower-grade gliomas from 2 tertiary institutions and The Cancer Genome Atlas constituted the training set (institution 1 and The Cancer Genome Atlas, 64 patients) and the independent test set (institution 2, 57 patients). Preoperative MRIs were analyzed using the Visually AcceSAble Rembrandt Images and radiomics. The molecular glioblastoma status was determined on the basis of the presence of EGFR amplification and TERT promoter mutation. Molecular glioblastoma was present in 73.4% and 56.1% in the training and test sets, respectively. Models using clinical, Visually AcceSAble Rembrandt Images, and radiomic features were built to predict the molecular glioblastoma status in the training set; then they were validated in the test set. RESULTS In the test set, a model using both Visually AcceSAble Rembrandt Images and radiomic features showed superior predictive performance (area under the curve = 0.854) than that with only clinical features or Visually AcceSAble Rembrandt Images (areas under the curve = 0.514 and 0.648, respectively; P < . 001, both). When both Visually AcceSAble Rembrandt Images and radiomics were added to clinical features, the predictive performance significantly increased (areas under the curve = 0.514 versus 0.863, P < .001). CONCLUSIONS MR imaging features integrated with machine learning classifiers may predict a subset of IDH wild-type lower-grade gliomas that carry molecular features of glioblastoma.
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Affiliation(s)
- C J Park
- From the Department of Radiology (C.J.P.), Yonsei University College of Medicine, Seoul, Korea
| | - K Han
- Department of Radiology (K.H., H.K., S.S.A., Y.W.P., S.-K.L.), Research Institute of Radiological Sciences, Center for Clinical Imaging Data Science
| | - H Kim
- Department of Radiology (K.H., H.K., S.S.A., Y.W.P., S.-K.L.), Research Institute of Radiological Sciences, Center for Clinical Imaging Data Science
| | - S S Ahn
- Department of Radiology (K.H., H.K., S.S.A., Y.W.P., S.-K.L.), Research Institute of Radiological Sciences, Center for Clinical Imaging Data Science
| | - D Choi
- Department of Computer Science (D.C.), Yonsei University, Seoul, Korea
| | - Y W Park
- Department of Radiology (K.H., H.K., S.S.A., Y.W.P., S.-K.L.), Research Institute of Radiological Sciences, Center for Clinical Imaging Data Science
| | | | - S H Kim
- Department of Pathology (S.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - S Cha
- Department of Radiology and Biomedical Imaging (S.C.), University of California San Francisco, San Francisco, California
| | - S-K Lee
- Department of Radiology (K.H., H.K., S.S.A., Y.W.P., S.-K.L.), Research Institute of Radiological Sciences, Center for Clinical Imaging Data Science
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13
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Amato MS, Bottcher MM, Cha S, Jacobs MA, Pearson JL, Graham AL. "It's really addictive and I'm trapped:" A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people. Addict Behav 2021; 112:106599. [PMID: 32950927 DOI: 10.1016/j.addbeh.2020.106599] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 04/23/2020] [Revised: 06/30/2020] [Accepted: 07/31/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Debate continues over how e-cigarettes have impacted the health of young people, and what regulatory policies should be enacted. The debate has appropriately been informed by quantitative studies, often focused on initiation, prevalence, and product transition among the general population and demographic segments. Factors driving cessation and subjective experiences that motivate young users to quit have been largely absent from the debate. This qualitative study highlights the range of motivating experiences among a population of treatment-seeking young e-cigarette users. METHODS Three researchers coded reasons for quitting provided by a sample of n = 1000 youth (13-17) and n = 1000 young adults (18-24) enrolled in a text message cessation program. Data spanned January 18 - February 22, 2019. Codes were adapted from previous literature. RESULTS The most common reasons were health (50.9%; "I want my lungs back"), financial cost (21.7%; "I don't have enough money to feed my addiction"), freedom from addiction (16.0%; "i hate juuling. it's taking over my life"), and social influence (10.1%; "it's affecting my friendships"). Selected quotes highlight a broad range of additional ways in which e-cigarette use negatively impacted young people, including decreased academic performance and mental health. CONCLUSIONS Young people trying to quit e-cigarettes are motivated by a diversity of reasons including health, financial, social, and academic. The range of impacts should be considered in discussions of policies intended to protect young people, and incorporated into cessation programs designed to serve them.
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Affiliation(s)
- Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, USA; Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Mia M Bottcher
- Innovations Center, Truth Initiative, Washington, DC, USA
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, USA
| | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, USA
| | | | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, USA; Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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14
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Graham AL, Papandonatos GD, Jacobs MA, Amato MS, Cha S, Cohn AM, Abroms LC, Whittaker R. Correction: Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment. J Med Internet Res 2020; 22:e21027. [PMID: 32721924 PMCID: PMC7420627 DOI: 10.2196/21027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | | | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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15
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Graham AL, Jacobs MA, Amato MS, Cha S, Bottcher MM, Papandonatos GD. Effectiveness of a Quit Vaping Text Message Program in Promoting Abstinence Among Young Adult E-Cigarette Users: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18327. [PMID: 32356774 PMCID: PMC7229526 DOI: 10.2196/18327] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Millions of young adults currently vape electronic cigarettes (e-cigarettes), yet little research on vaping cessation interventions exists. Text messaging is a promising, scalable intervention strategy for delivering vaping cessation treatment. OBJECTIVE This study evaluates the effectiveness of a text message quit vaping program (This is Quitting) in promoting abstinence from e-cigarettes among young adults; examines changes in self-efficacy, perceived social norms, and social support for quitting as hypothesized mediators of effectiveness; and examines if treatment effectiveness is moderated by gender, race, ethnicity, or sexual minority status. METHODS Overall, 2600 young adult (aged 18-24 years) e-cigarette users in the United States will be recruited via web advertisements to participate in the study. Participants will be randomized to This is Quitting or an assessment-only control condition. The primary outcome measure is 30-day vaping abstinence at 7 months post enrollment. RESULTS Study recruitment began on December 18, 2019, and is projected to be completed by spring 2020. The final 7-month follow-up is anticipated to be completed by fall/winter 2020. Because this is the first-ever evaluation of a quit vaping program, we were unable to draw on existing literature to determine the appropriate sample size. Therefore, we examined abstinence rates among an initial pilot sample of 269 participants (This is Quitting: n=148 and control: n=121) who completed the 1-month follow-up to determine the final sample size. The 1-month response rate was 79.2% (213/269), with no difference between arms. Using intention-to-treat analyses that counted nonresponders as still vaping, 30-day abstinence rates were 16.2% (24/148) among those randomized to This is Quitting and 8.3% (10/121) among those randomized to control. A treatment difference of 16% vs 8% is detectable with 80% power at 2-sided alpha=.05 with 260/group (520 total). To detect treatment differences of this magnitude in a 20% subsample (eg, Hispanic or sexual minority young adult e-cigarette users), we will enroll 1300/group (2600 total). CONCLUSIONS The scientific, clinical, and public health communities are desperate for cessation resources to address vaping among young people. This study is the first-ever comparative effectiveness trial of an intervention to help young people quit vaping. It focuses on evaluating the effectiveness of a theory-grounded, empirically informed text message intervention among young adults. The study is fully powered to examine potentially important subgroup differences among young people who are more vulnerable to e-cigarette use. Although potentially more challenging from a research ethics and pragmatic standpoint, evaluating quit vaping intervention approaches in teens is an important area for future research. Data from this trial will establish a benchmark of effectiveness for other vaping cessation programs and begin to create a body of evidence focused on how best to help young people break free from e-cigarettes. TRIAL REGISTRATION ClinicalTrials.gov NCT04251273; https://clinicaltrials.gov/ct2/show/NCT04251273. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18327.
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Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
- Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
| | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, United States
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Mia M Bottcher
- Innovations Center, Truth Initiative, Washington, DC, United States
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16
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Graham AL, Papandonatos GD, Jacobs MA, Amato MS, Cha S, Cohn AM, Abroms LC, Whittaker R. Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment. J Med Internet Res 2020; 22:e17734. [PMID: 32238338 PMCID: PMC7386536 DOI: 10.2196/17734] [Citation(s) in RCA: 13] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/09/2020] [Accepted: 02/22/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Smoking remains a leading cause of preventable death and illness. Internet interventions for smoking cessation have the potential to significantly impact public health, given their broad reach and proven effectiveness. Given the dose-response association between engagement and behavior change, identifying strategies to promote engagement is a priority across digital health interventions. Text messaging is a proven smoking cessation treatment modality and a powerful strategy to increase intervention engagement in other areas of health, but it has not been tested as an engagement strategy for a digital cessation intervention. OBJECTIVE This study examined the impact of 4 experimental text message design factors on adult smokers' engagement with an internet smoking cessation program. METHODS We conducted a 2×2×2×2 full factorial screening experiment wherein 864 participants were randomized to 1 of 16 experimental conditions after registering with a free internet smoking cessation program and enrolling in its automated text message program. Experimental factors were personalization (on/off), integration between the web and text message platforms (on/off), dynamic tailoring of intervention content based on user engagement (on/off), and message intensity (tapered vs abrupt drop-off). Primary outcomes were 3-month measures of engagement (ie, page views, time on site, and return visits to the website) as well as use of 6 interactive features of the internet program. All metrics were automatically tracked; there were no missing data. RESULTS Main effects were detected for integration and dynamic tailoring. Integration significantly increased interactive feature use by participants, whereas dynamic tailoring increased the number of features used and page views. No main effects were found for message intensity or personalization alone, although several synergistic interactions with other experimental features were observed. Synergistic effects, when all experimental factors were active, resulted in the highest rates of interactive feature use and the greatest proportion of participants at high levels of engagement. Measured in terms of standardized mean differences (SMDs), effects on interactive feature use were highest for Build Support System (SMD 0.56; 95% CI 0.27 to 0.81), Choose Quit Smoking Aid (SMD 0.38; 95% CI 0.10 to 0.66), and Track Smoking Triggers (SMD 0.33; 95% CI 0.05 to 0.61). Among the engagement metrics, the largest effects were on overall feature utilization (SMD 0.33; 95% CI 0.06 to 0.59) and time on site (SMD 0.29; 95% CI 0.01 to 0.57). As no SMD >0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. CONCLUSIONS This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. TRIAL REGISTRATION ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2015-010687.
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Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | | | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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17
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Wu X, Li Y, Glastonbury CM, Cha S. Involvement of the Olfactory Apparatus by Gliomas. AJNR Am J Neuroradiol 2020; 41:712-717. [PMID: 32165363 DOI: 10.3174/ajnr.a6471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/25/2020] [Indexed: 12/16/2022]
Abstract
The olfactory bulbs and tracts are central nervous system white matter tracts maintained by central neuroglia. Although rare, gliomas can originate from and progress to involve the olfactory apparatus. Through a Health Insurance Portability and Accountability Act-compliant retrospective review of the institutional teaching files and brain MR imaging reports spanning 10 years, we identified 12 cases of gliomas involving the olfactory bulbs and tracts, including 6 cases of glioblastoma, 2 cases of anaplastic oligodendroglioma, and 1 case each of pilocytic astrocytoma, diffuse (grade II) astrocytoma, anaplastic astrocytoma (grade III), and diffuse midline glioma. All except the pilocytic astrocytoma occurred in patients with known primary glial tumors elsewhere. Imaging findings of olfactory tumor involvement ranged from well-demarcated enhancing masses to ill-defined enhancing infiltrative lesions to nonenhancing masslike FLAIR signal abnormality within the olfactory tracts. Familiarity with the imaging findings of glioma involvement of the olfactory nerves is important for timely diagnosis and treatment of recurrent gliomas and to distinguish them from other disease processes.
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Affiliation(s)
- X Wu
- From the Department of Radiology and Imaging Sciences (X.W.), Emory University, Atlanta, Georgia
| | - Y Li
- Departments of Clinical Radiology (Y.L., C.M.G.)
| | - C M Glastonbury
- Departments of Clinical Radiology (Y.L., C.M.G.).,Otolaryngology Head and Neck Surgery (C.M.G.).,Radiation Oncology (C.M.G.)
| | - S Cha
- Radiology (S.C.).,Neurological Surgery (S.C.), University of California, San Francisco, San Francisco, California
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18
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Aboian MS, Tong E, Solomon DA, Kline C, Gautam A, Vardapetyan A, Tamrazi B, Li Y, Jordan CD, Felton E, Weinberg B, Braunstein S, Mueller S, Cha S. Diffusion Characteristics of Pediatric Diffuse Midline Gliomas with Histone H3-K27M Mutation Using Apparent Diffusion Coefficient Histogram Analysis. AJNR Am J Neuroradiol 2019; 40:1804-1810. [PMID: 31694820 DOI: 10.3174/ajnr.a6302] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/31/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffuse midline gliomas with histone H3 K27M mutation are biologically aggressive tumors with poor prognosis defined as a new diagnostic entity in the 2016 World Health Organization Classification of Tumors of the Central Nervous System. There are no qualitative imaging differences (enhancement, border, or central necrosis) between histone H3 wildtype and H3 K27M-mutant diffuse midline gliomas. Herein, we evaluated the utility of diffusion-weighted imaging to distinguish H3 K27M-mutant from histone H3 wildtype diffuse midline gliomas. MATERIALS AND METHODS We identified 31 pediatric patients (younger than 21 years of age) with diffuse gliomas centered in midline structures that had undergone assessment for histone H3 K27M mutation. We measured ADC within these tumors using a voxel-based 3D whole-tumor measurement method. RESULTS Our cohort included 18 infratentorial and 13 supratentorial diffuse gliomas centered in midline structures. Twenty-three (74%) tumors carried H3-K27M mutations. There was no difference in ADC histogram parameters (mean, median, minimum, maximum, percentiles) between mutant and wild-type tumors. Subgroup analysis based on tumor location also did not identify a difference in histogram descriptive statistics. Patients who survived <1 year after diagnosis had lower median ADC (1.10 × 10-3mm2/s; 95% CI, 0.90-1.30) compared with patients who survived >1 year (1.46 × 10-3mm2/s; 95% CI, 1.19-1.67; P < .06). Average ADC values for diffuse midline gliomas were 1.28 × 10-3mm2/s (95% CI, 1.21-1.34) and 0.86 × 10-3mm2/s (95% CI, 0.69-1.01) for hemispheric glioblastomas with P < .05. CONCLUSIONS Although no statistically significant difference in diffusion characteristics was found between H3-K27M mutant and H3 wildtype diffuse midline gliomas, lower diffusivity corresponds to a lower survival rate at 1 year after diagnosis. These findings can have an impact on the anticipated clinical course for this patient population and offer providers and families guidance on clinical outcomes.
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Affiliation(s)
- M S Aboian
- From the Department of Radiology and Biomedical Imaging (M.S.A.), Yale School of Medicine, New Haven, Connecticut
| | - E Tong
- Department of Radiology (E.T.), Stanford University, Stanford, California
| | | | - C Kline
- Division of Pediatric Hematology/Oncology (C.K., E.F., S.M.), Department of Pediatrics, University of California, San Francisco, California
| | - A Gautam
- Johns Hopkins University (A.G.), Baltimore, Maryland
| | - A Vardapetyan
- University of California Berkeley (A.V.), Berkeley, California
| | - B Tamrazi
- Department of Radiology (B.T.), Children's Hospital Los Angeles, Los Angeles, California
| | - Y Li
- Department of Pathology, Departments of Radiology (Y.L., C.D.J., S.C.)
| | - C D Jordan
- Department of Pathology, Departments of Radiology (Y.L., C.D.J., S.C.)
| | - E Felton
- Division of Pediatric Hematology/Oncology (C.K., E.F., S.M.), Department of Pediatrics, University of California, San Francisco, California
| | - B Weinberg
- Department of Neuroradiology (B.W.), Emory University, Atlanta, Georgia
| | | | - S Mueller
- Neurological Surgery (S.M.).,Neurology (S.M.).,Division of Pediatric Hematology/Oncology (C.K., E.F., S.M.), Department of Pediatrics, University of California, San Francisco, California
| | - S Cha
- Department of Pathology, Departments of Radiology (Y.L., C.D.J., S.C.)
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Graham AL, Papandonatos GD, Cha S, Erar B, Amato MS. Improving Adherence to Smoking Cessation Treatment: Smoking Outcomes in a Web-based Randomized Trial. Ann Behav Med 2019; 52:331-341. [PMID: 29878062 DOI: 10.1093/abm/kax023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Partial adherence in Internet smoking cessation interventions presents treatment and evaluation challenges. Increasing adherence may improve outcomes. Purpose To present smoking outcomes from an Internet randomized trial of two strategies to encourage adherence to tobacco dependence treatment components: (i) a social network (SN) strategy to integrate smokers into an online community and (ii) free nicotine replacement therapy (NRT). In addition to intent-to-treat analyses, we used novel statistical methods to distinguish the impact of treatment assignment from treatment utilization. Methods A total of 5,290 current smokers on a cessation website (WEB) were randomized to WEB, WEB + SN, WEB + NRT, or WEB + SN + NRT. The main outcome was 30-day point prevalence abstinence at 3 and 9 months post-randomization. Adherence measures included self-reported medication use (meds), and website metrics of skills training (sk) and community use (comm). Inverse Probability of Retention Weighting and Inverse Probability of Treatment Weighting jointly addressed dropout and treatment selection. Propensity weights were used to calculate Average Treatment effects on the Treated. Results Treatment assignment analyses showed no effects on abstinence for either adherence strategy. Abstinence rates were 25.7%-32.2% among participants that used all three treatment components (sk+comm +meds).Treatment utilization analyses revealed that among such participants, sk+comm+meds yielded large percentage point increases in 3-month abstinence rates over sk alone across arms: WEB = 20.6 (95% CI = 10.8, 30.4), WEB + SN = 19.2 (95% CI = 11.1, 27.3), WEB + NRT = 13.1 (95% CI = 4.1, 22.0), and WEB + SN + NRT = 20.0 (95% CI = 12.2, 27.7). Conclusions Novel propensity weighting approaches can serve as a model for establishing efficacy of Internet interventions and yield important insights about mechanisms. Clinical Trials.gov NCT01544153.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, USA.,Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center/Cancer Prevention and Control Program, Washington, DC, USA
| | - George D Papandonatos
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, USA
| | - Bahar Erar
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Michael S Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, USA
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20
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Bowles J, Caminati M, Cha S, Mendoza J. A framework for automated conflict detection and resolution in medical guidelines. Sci Comput Program 2019; 182:42-63. [PMID: 32029957 PMCID: PMC6993806 DOI: 10.1016/j.scico.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/09/2019] [Accepted: 07/01/2019] [Indexed: 05/30/2023]
Abstract
Common chronic conditions are routinely treated following standardised procedures known as clinical guidelines. For patients suffering from two or more chronic conditions, known as multimorbidity, several guidelines have to be applied simultaneously, which may lead to severe adverse effects when the combined recommendations and prescribed medications are inconsistent or incomplete. This paper presents an automated formal framework to detect, highlight and resolve conflicts in the treatments used for patients with multimorbidities focusing on medications. The presented extended framework has a front-end which takes guidelines captured in a standard modelling language and returns the visualisation of the detected conflicts as well as suggested alternative treatments. Internally, the guidelines are transformed into formal models capturing the possible unfoldings of the guidelines. The back-end takes the formal models associated with multiple guidelines and checks their correctness with a theorem prover, and inherent inconsistencies with a constraint solver. Key to our approach is the use of an optimising constraint solver which enables us to search for the best solution that resolves/minimises conflicts according to medication efficacy and the degree of severity in case of harmful combinations, also taking into account their temporal overlapping. The approach is illustrated throughout with a real medical example.
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Affiliation(s)
- J. Bowles
- School of Computer Science, University of St Andrews, Jack Cole Building, St Andrews KY16 9SX, United Kingdom
| | - M.B. Caminati
- School of Computer Science, University of St Andrews, Jack Cole Building, St Andrews KY16 9SX, United Kingdom
| | - S. Cha
- Automation and Information Systems, Technical University of Munich, Germany
| | - J. Mendoza
- School of Computer Science, University of St Andrews, Jack Cole Building, St Andrews KY16 9SX, United Kingdom
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21
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Amato MS, Papandonatos GD, Cha S, Wang X, Zhao K, Cohn AM, Pearson JL, Graham AL. Inferring Smoking Status from User Generated Content in an Online Cessation Community. Nicotine Tob Res 2019; 21:205-211. [PMID: 29365157 DOI: 10.1093/ntr/nty014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022]
Abstract
Introduction User generated content (UGC) is a valuable but underutilized source of information about individuals who participate in online cessation interventions. This study represents a first effort to passively detect smoking status among members of an online cessation program using UGC. Methods Secondary data analysis was performed on data from 826 participants in a web-based smoking cessation randomized trial that included an online community. Domain experts from the online community reviewed each post and comment written by participants and attempted to infer the author's smoking status at the time it was written. Inferences from UGC were validated by comparison with self-reported 30-day point prevalence abstinence (PPA). Following validation, the impact of this method was evaluated across all individuals and time points in the study period. Results Of the 826 participants in the analytic sample, 719 had written at least one post from which content inference was possible. Among participants for whom unambiguous smoking status was inferred during the 30 days preceding their 3-month follow-up survey, concordance with self-report was almost perfect (kappa = 0.94). Posts indicating abstinence tended to be written shortly after enrollment (median = 14 days). Conclusions Passive inference of smoking status from UGC in online cessation communities is possible and highly reliable for smokers who actively produce content. These results lay the groundwork for further development of observational research tools and intervention innovations. Implications A proof-of-concept methodology for inferring smoking status from user generated content in online cessation communities is presented and validated. Content inference of smoking status makes a key cessation variable available for use in observational designs. This method provides a powerful tool for researchers interested in online cessation interventions and establishes a foundation for larger scale application via machine learning.
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Affiliation(s)
- Michael S Amato
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | | | - Sarah Cha
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Kang Zhao
- Department of Management Sciences, The University of Iowa, Iowa City, Iowa
| | - Amy M Cohn
- Battelle Memorial Institute, Arlington, VA.,Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, NV.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda L Graham
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC.,Department of Oncology, Georgetown University Medical Center, Washington, DC
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22
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Wang X, Zhao K, Cha S, Amato MS, Cohn AM, Pearson JL, Papandonatos GD, Graham AL. Mining User-Generated Content in an Online Smoking Cessation Community to Identify Smoking Status: A Machine Learning Approach. Decis Support Syst 2019; 116:26-34. [PMID: 31885411 PMCID: PMC6934371 DOI: 10.1016/j.dss.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Online smoking cessation communities help hundreds of thousands of smokers quit smoking and stay abstinent each year. Content shared by users of such communities may contain important information that could enable more effective and personally tailored cessation treatment recommendations. This study demonstrates a novel approach to determine individuals' smoking status by applying machine learning techniques to classify user-generated content in an online cessation community. Study data were from BecomeAnEX.org, a large, online smoking cessation community. We extracted three types of novel features from a post: domain-specific features, author-based features, and thread-based features. These features helped to improve the smoking status identification (quit vs. not) performance by 9.7% compared to using only text features of a post's content. In other words, knowledge from domain experts, data regarding the post author's patterns of online engagement, and other community member reactions to the post can help to determine the focal post author's smoking status, over and above the actual content of a focal post. We demonstrated that machine learning methods can be applied to user-generated data from online cessation communities to validly and reliably discern important user characteristics, which could aid decision support on intervention tailoring.
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Affiliation(s)
- Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Kang Zhao
- Tippie College of Business, The University of Iowa, Iowa City, Iowa, United States of America
| | - Sarah Cha
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, United States of America
| | - Michael S. Amato
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, United States of America
| | - Amy M. Cohn
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, United States of America
- Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia, United States of America
| | - Jennifer L. Pearson
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, United States of America
| | - George D. Papandonatos
- Center for Statistical Sciences, Brown University, Providence, Rhode Island, United States of America
| | - Amanda L. Graham
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, United States of America
- Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia, United States of America
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Pearson JL, Amato MS, Papandonatos GD, Zhao K, Erar B, Wang X, Cha S, Cohn AM, Graham AL. Exposure to positive peer sentiment about nicotine replacement therapy in an online smoking cessation community is associated with NRT use. Addict Behav 2018; 87:39-45. [PMID: 29940390 DOI: 10.1016/j.addbeh.2018.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/16/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about the influence of online peer interactions on health behavior change. This study examined the relationship between exposure to peer sentiment about nicotine replacement therapy (NRT) in an online social network for smoking cessation and NRT use. METHODS Participants were 3297 current smokers who enrolled in an Internet smoking cessation program, participated in a randomized trial, and completed a 3-month follow-up. Half received free NRT as part of the trial. Automated text classification identified 27,038 posts about NRT that one or more participants were exposed to in the social network. Sentiment towards NRT was rated on Amazon Mechanical Turk. Participants' exposure to peer sentiment about NRT was determined by analysis of clickstream data. Modified Poisson regression examined self-reported use of NRT at 3-months as a function of exposure to NRT sentiment, controlling for study arm and post exposure. RESULTS One in five participants (19.3%, n = 639) were exposed to any NRT-related posts (mean exposure = 6.5 ± 14.7, mean sentiment = 5.4 ± 0.8). The association between sentiment exposure and NRT use varied by receipt of free NRT. Greater exposure to positive NRT sentiment was associated with an increased likelihood of NRT use among participants who did not receive free NRT (adjusted rate ratio 1.22, 95% CI 1.01, 1.47; p = .043), whereas no such relationship was observed among participants who did receive free NRT (p = .48). CONCLUSIONS Exposure to positive sentiment about NRT was associated with increased NRT use when smokers obtained it on their own. Highlighting user-generated content containing positive NRT sentiment may increase NRT use among treatment-seeking smokers.
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Affiliation(s)
| | - Michael S Amato
- Schroeder Institute for Tobacco Research & Policy Studies, Truth Initiative, Washington, DC, United States
| | | | - Kang Zhao
- Tippie College of Business, The University of Iowa, Iowa City, IA, United States
| | - Bahar Erar
- Center for Statistical Sciences, Brown University, Providence, RI, United States
| | - Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Sarah Cha
- Schroeder Institute for Tobacco Research & Policy Studies, Truth Initiative, Washington, DC, United States
| | - Amy M Cohn
- Battelle Memorial Institute, Arlington, VA, United States; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, United States
| | - Amanda L Graham
- Schroeder Institute for Tobacco Research & Policy Studies, Truth Initiative, Washington, DC, United States; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, United States.
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24
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Cohn AM, Amato MS, Zhao K, Wang X, Cha S, Pearson JL, Papandonatos GD, Graham AL. Discussions of Alcohol Use in an Online Social Network for Smoking Cessation: Analysis of Topics, Sentiment, and Social Network Centrality. Alcohol Clin Exp Res 2018; 43:108-114. [PMID: 30326140 DOI: 10.1111/acer.13906] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few Internet smoking cessation programs specifically address the impact of alcohol use during a quit attempt, despite its common role in relapse. This study used topic modeling to describe the most prevalent topics about alcohol in an online smoking cessation community, the prevalence of negative sentiment expressed about alcohol use in the context of a quit attempt (i.e., alcohol should be limited or avoided during a quit attempt) within topics, and the degree to which topics differed by user social connectivity within the network. METHODS Data were analyzed from posts from the online community of a larger Internet cessation program, spanning January 1, 2012 to May 31, 2015 and included records of 814,258 online posts. Posts containing alcohol-related content (n = 7,199) were coded via supervised machine learning text classification to determine whether the post expressed negative sentiment about drinking in the context of a quit attempt. Correlated topic modeling (CTM) was used to identify a set of 10 topics of at least 1% prevalence based on the frequency of word occurrences among alcohol-related posts; the distribution of negative sentiment and user social network connectivity was examined across the most salient topics. RESULTS Three salient topics (with prevalence ≥10%) emerged from the CTM, with distinct themes of (i) cravings and temptations; (ii) parallel between nicotine addiction and alcoholism; and (iii) celebratory discussions of quit milestones including "virtual" alcohol use and toasts. Most topics skewed toward nonnegative sentiment about alcohol. The prevalence of each topic differed by users' social connectivity in the network. CONCLUSIONS Future work should examine whether outcomes in Internet interventions are improved by tailoring social network content to match user characteristics, topics, and network behavior.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, Virginia.,Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia
| | - Michael S Amato
- Schroeder Institute at Truth Initiative, Washington, District of Columbia
| | - Kang Zhao
- Department of Management Sciences, The University of Iowa, Iowa City, Iowa
| | - Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Sarah Cha
- Schroeder Institute at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Nevada.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Amanda L Graham
- Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia.,Schroeder Institute at Truth Initiative, Washington, District of Columbia
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Morin O, Chen W, Villanueva-Meyer J, Gennatas E, Wu A, Cha S, Magill S, Perry A, Sneed P, McDermott M, Solberg T, Valdes G, Braunstein S, Raleigh D. Point-of-Care Local Failure and Overall Survival Prediction Models for Meningioma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Chang P, Grinband J, Weinberg BD, Bardis M, Khy M, Cadena G, Su MY, Cha S, Filippi CG, Bota D, Baldi P, Poisson LM, Jain R, Chow D. Deep-Learning Convolutional Neural Networks Accurately Classify Genetic Mutations in Gliomas. AJNR Am J Neuroradiol 2018; 39:1201-1207. [PMID: 29748206 DOI: 10.3174/ajnr.a5667] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [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: 11/29/2017] [Accepted: 03/20/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The World Health Organization has recently placed new emphasis on the integration of genetic information for gliomas. While tissue sampling remains the criterion standard, noninvasive imaging techniques may provide complimentary insight into clinically relevant genetic mutations. Our aim was to train a convolutional neural network to independently predict underlying molecular genetic mutation status in gliomas with high accuracy and identify the most predictive imaging features for each mutation. MATERIALS AND METHODS MR imaging data and molecular information were retrospectively obtained from The Cancer Imaging Archives for 259 patients with either low- or high-grade gliomas. A convolutional neural network was trained to classify isocitrate dehydrogenase 1 (IDH1) mutation status, 1p/19q codeletion, and O6-methylguanine-DNA methyltransferase (MGMT) promotor methylation status. Principal component analysis of the final convolutional neural network layer was used to extract the key imaging features critical for successful classification. RESULTS Classification had high accuracy: IDH1 mutation status, 94%; 1p/19q codeletion, 92%; and MGMT promotor methylation status, 83%. Each genetic category was also associated with distinctive imaging features such as definition of tumor margins, T1 and FLAIR suppression, extent of edema, extent of necrosis, and textural features. CONCLUSIONS Our results indicate that for The Cancer Imaging Archives dataset, machine-learning approaches allow classification of individual genetic mutations of both low- and high-grade gliomas. We show that relevant MR imaging features acquired from an added dimensionality-reduction technique demonstrate that neural networks are capable of learning key imaging components without prior feature selection or human-directed training.
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Affiliation(s)
- P Chang
- From the Department of Radiology (P.C., S.C.), University of California, San Francisco, San Francisco, California
| | - J Grinband
- Department of Radiology (J.G.), Columbia University, New York, New York
| | - B D Weinberg
- Department of Radiology (B.D.W.), Emory University School of Medicine, Atlanta, Georgia
| | - M Bardis
- Departments of Radiology (M.B., M.K., M.-Y.S., D.C.)
| | - M Khy
- Departments of Radiology (M.B., M.K., M.-Y.S., D.C.)
| | | | - M-Y Su
- Departments of Radiology (M.B., M.K., M.-Y.S., D.C.)
| | - S Cha
- From the Department of Radiology (P.C., S.C.), University of California, San Francisco, San Francisco, California
| | - C G Filippi
- Department of Radiology (C.G.F.), North Shore University Hospital, Long Island, New York
| | | | - P Baldi
- School of Information and Computer Sciences (P.B.), University of California, Irvine, Irvine, California
| | - L M Poisson
- Department of Public Health Sciences (L.M.P.), Henry Ford Health System, Detroit, Michigan
| | - R Jain
- Departments of Radiology and Neurosurgery (R.J.), New York University, New York, New York
| | - D Chow
- Departments of Radiology (M.B., M.K., M.-Y.S., D.C.)
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Jiang L, Qu W, Oh T, Vincent A, Mohabbat A, Mauck W, Law L, Cha S. Sex-related demographic and symptomatologic characteristics of patients with fibromyalgia. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Severson K, Xie D, Cha S, Liang H, Nelson S, Sekulic A, Pittelkow M, Mangold A. 338 Necrobiosis lipoidica comorbidities and complications. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Severson K, Liang H, Nelson S, Xie D, Cha S, Sekulic A, Pittelkow M, Mangold A. 1036 Necrobiosis lipoidica histopathology & inflammatory composition. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Graham AL, Burke MV, Jacobs MA, Cha S, Croghan IT, Schroeder DR, Moriarty JP, Borah BJ, Rasmussen DF, Brookover MJ, Suesse DB, Midthun DE, Hays JT. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial. Trials 2017; 18:568. [PMID: 29179734 PMCID: PMC5704639 DOI: 10.1186/s13063-017-2312-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
Background Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask–Advise–Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2312-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA. .,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Michael V Burke
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Ivana T Croghan
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Donna F Rasmussen
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - M Jody Brookover
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Dale B Suesse
- Division of Research and Education Systems Support, Mayo Clinic, Rochester, MN, USA
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Taylor Hays
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Cha S, Ganz O, Cohn AM, Ehlke SJ, Graham AL. Feasibility of biochemical verification in a web-based smoking cessation study. Addict Behav 2017; 73:204-208. [PMID: 28551588 DOI: 10.1016/j.addbeh.2017.05.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/03/2017] [Accepted: 05/19/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cogent arguments have been made against the need for biochemical verification in population-based studies with low-demand characteristics. Despite this fact, studies involving digital interventions (low-demand) are often required in peer review to report biochemically verified abstinence. To address this discrepancy, we examined the feasibility and costs of biochemical verification in a web-based study conducted with a national sample. METHODS Participants were 600U.S. adult current smokers who registered on a web-based smoking cessation program and completed surveys at baseline and 3months. Saliva sampling kits were sent to participants who reported 7-day abstinence at 3months, and analyzed for cotinine. RESULTS The response rate at 3-months was 41.2% (n=247): 93 participants reported 7-day abstinence (38%) and were mailed a saliva kit (71% returned). The discordance rate was 36.4%. Participants with discordant responses were more likely to report 3-month use of nicotine replacement therapy or e-cigarettes than those with concordant responses (79.2% vs. 45.2%, p=0.007). The total cost of saliva sampling was $8280 ($125/sample). CONCLUSIONS Biochemical verification was both time- and cost-intensive, and yielded a relatively small number of samples due to low response rates and use of other nicotine products during the follow-up period. There was a high rate of discordance of self-reported abstinence and saliva testing. Costs for data collection may be prohibitive for studies with large sample sizes or limited budgets. Our findings echo previous statements that biochemical verification is not necessary in population-based studies, and add evidence specific to technology-based studies.
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Cohn AM, Zhao K, Cha S, Wang X, Amato MS, Pearson JL, Papandonatos GD, Graham AL. A Descriptive Study of the Prevalence and Typology of Alcohol-Related Posts in an Online Social Network for Smoking Cessation. J Stud Alcohol Drugs 2017; 78:665-673. [PMID: 28930053 DOI: 10.15288/jsad.2017.78.665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol use and problem drinking are associated with smoking relapse and poor smoking-cessation success. User-generated content in online social networks for smoking cessation provides an opportunity to understand the challenges and treatment needs of smokers. This study used machine-learning text classification to identify the prevalence, sentiment, and social network correlates of alcohol-related content in the social network of a large online smoking-cessation program, BecomeAnEX.org. METHOD Data were analyzed from 814,258 posts (January 2012 to May 2015). Posts containing alcohol keywords were coded via supervised machine-learning text classification for information about the user's personal experience with drinking, whether the user self-identified as a problem drinker or indicated problem drinking, and negative sentiment about drinking in the context of a quit attempt (i.e., alcohol should be avoided during a quit attempt). RESULTS Less than 1% of posts were related to alcohol, contributed by 13% of users. Roughly a third of alcohol posts described a personal experience with drinking; very few (3%) indicated "problem drinking." The majority (70%) of alcohol posts did not express negative sentiment about drinking alcohol during a quit attempt. Users who did express negative sentiment about drinking were more centrally located within the network compared with those who did not. CONCLUSIONS Discussion of alcohol was rare, and most posts did not signal the need to quit or abstain from drinking during a quit attempt. Featuring expert information or highlighting discussions that are consistent with treatment guidelines may be important steps to ensure smokers are educated about drinking risks.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, Virginia.,Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Kang Zhao
- Department of Management Sciences, Tippie College of Business, The University of Iowa, Iowa City, Iowa
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Michael S Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - George D Papandonatos
- Center for Statistical Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - Amanda L Graham
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
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Welding K, De Leon E, Cha S, Johnson M, Cohen JE, Graham AL. Weekly enrollment and usage patterns in an Internet smoking cessation intervention. Internet Interv 2017; 9:100-105. [PMID: 30135843 PMCID: PMC6096301 DOI: 10.1016/j.invent.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/15/2017] [Accepted: 07/21/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Previous analyses of Google search queries identified circaseptan (weekly) rhythms in smoking cessation information seeking, with Google searches for "quit" and "smoking" peaking early in the week. Similar patterns were observed for smoking cessation treatment seeking, such as calls to quitlines. These findings suggest that smoking cessation behaviors may have a weekly rhythm that could be leveraged to improve smoking cessation efforts. AIMS To assess whether weekly enrollment and usage patterns exist for an Internet smoking cessation intervention. METHODS We used process data from a large, longstanding Internet smoking cessation intervention (www.becomeanex.org). Pearson's chi-squared tests were performed to identify day-of-the week differences in enrollment, first visit to site community pages, and quit date. Differences were considered statistically significant at the 1% level if p < 0.00167 due to multiple comparisons. Regression analysis was used to examine differences in engagement activity based on the day of the week a user enrolled. RESULTS Website users (n = 69,237) were more likely to enroll on the site at the beginning of the week (Mondays and Tuesdays) (p < 0.0001). Current smokers who selected quit dates (n = 5574) preferred quit dates that came early in the week (Sundays and Mondays) compared to other weekdays (p < 0.0001). Generally, there were no significant differences in overall website utilization metrics by day of enrollment, but there were some exceptions. Use of interactive features to select quit dates, track cigarette use, and record coping strategies was generally lower for Friday/Saturday enrollees. CONCLUSIONS Consistent with prior research, the beginning of the week appears to be a time when individuals are more likely to enroll in an Internet smoking cessation intervention and engage with its core features. Emphasizing marketing and promotional efforts during the beginning of the week could result in greater reach of Internet smoking cessation interventions.
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Affiliation(s)
- Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author at: Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St, 4th Floor, Baltimore, MD 21205, USA
| | - Elaine De Leon
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | | | - Joanna E. Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda L. Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC USA
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Villanueva-Meyer JE, Barajas RF, Mabray MC, Chen W, Shankaranarayanan A, Koon P, Barani IJ, Tihan T, Cha S. Differentiation of brain tumor-related edema based on 3D T1rho imaging. Eur J Radiol 2017; 91:88-92. [PMID: 28629576 PMCID: PMC5563444 DOI: 10.1016/j.ejrad.2017.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 10/24/2016] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral edema associated with brain tumors is an important source of morbidity. Its type depends largely on the capillary ultra-structures of the histopathologic subtype of underlying brain tumor. The purpose of our study was to differentiate vasogenic edema associated with brain metastases and infiltrative edema related to diffuse gliomas using quantitative 3D T1 rho (T1ρ) imaging. MATERIALS AND METHODS Preoperative MR examination including whole brain 3D T1ρ imaging was performed in 23 patients with newly diagnosed brain tumors (9 with metastasis, 8 with lower grade glioma, LGG, 6 with glioblastoma, GBM). Mean T1ρ values were measured in regions of peritumoral non-enhancing T2 signal hyperintensity, excluding both enhancing and necrotic or cystic component, and normal-appearing white matter. RESULTS Mean T1ρ values were significantly elevated in the vasogenic edema surrounding intracranial metastases when compared to the infiltrative edema associated with either LGG or GBM (p=0.02 and <0.01, respectively). No significant difference was noted between T1ρ values of infiltrative edema between LGG and GBM (p=0.84 and 0.96, respectively). CONCLUSION Our study demonstrates the feasibility and potential diagnostic role of T1ρ in the quantitative differentiation between edema related to intracranial metastases and gliomas and as a potentially complementary tool to standard MR techniques in further characterizing pathophysiology of vasogenic and infiltrative edema.
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Affiliation(s)
- J E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - R F Barajas
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA; Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA.
| | - M C Mabray
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - W Chen
- Department Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
| | | | - P Koon
- Global Applied Science Laboratory, GE Healthcare, Menlo Park, CA, USA.
| | - I J Barani
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
| | - T Tihan
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - S Cha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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Lee J, Park M, Byeon J, Gu N, Cho I, Cha S. Angiogenic effects of 3 dimensional cell culture system. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee J, Byeon J, Park M, Gu N, Cho I, Cha S. Cellular aging and senescence characteristics of mesenchymal stem cells. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee J, Park M, Byeon J, Gu N, Cho I, Cha S. Application of hydrogel scaffolds on 3d culture of adipose tissue-derived mesenchymal stem cells. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee J, Cho I, Cha S. Proliferating effects of soy peptide on mesenchymal stem cells. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lee J, Byeon J, Park M, Gu N, Cho I, Cha S. Effects of long-term cryopreservation in stem cell stability. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee S, Lee J, Lee J, Chu S, Cha S, Park H. Cell protectant of clinical grade for cell delivery without cryopreservation. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Graham AL, Papandonatos GD, Cha S, Erar B, Amato MS, Cobb NK, Niaura RS, Abrams DB. Improving Adherence to Smoking Cessation Treatment: Intervention Effects in a Web-Based Randomized Trial. Nicotine Tob Res 2017; 19:324-332. [PMID: 27836982 PMCID: PMC6075377 DOI: 10.1093/ntr/ntw282] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 08/26/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Web-based smoking cessation interventions can deliver evidence-based treatments to a wide swath of the population, but effectiveness is often limited by insufficient adherence to proven treatment components. This study evaluated the impact of a social network (SN) intervention and free nicotine replacement therapy (NRT) on adherence to evidence-based components of smoking cessation treatment in the context of a Web-based intervention. METHODS A sample of adult U.S. smokers (N = 5290) was recruited via BecomeAnEX.org, a free smoking cessation Web site. Smokers were randomized to one of four arms: (1) an interactive, evidence-based smoking cessation Web site (WEB) alone; (2) WEB in conjunction with an SN intervention designed to integrate participants into the online community (WEB+SN); (3) WEB plus free NRT (WEB+NRT); and (4) the combination of all treatments (WEB+SN+NRT). Adherence outcomes assessed at 3-month follow-up were as follows: Web site utilization metrics, use of skills training components, intratreatment social support, and pharmacotherapy use. RESULTS WEB+SN+NRT outperformed all others on Web site utilization metrics, use of practical counseling tools, intratreatment social support, and NRT use. It was the only intervention to promote the sending of private messages and the viewing of community pages over WEB alone. Both social network arms outperformed WEB on most metrics of online community engagement. Both NRT arms showed higher medication use compared to WEB alone. CONCLUSIONS This study demonstrated the effectiveness of two approaches for improving adherence to evidence-based components of smoking cessation treatment. Integrated approaches to medication provision and social network engagement can enhance adherence to components known to improve cessation. IMPLICATIONS This study demonstrated that an integrated approach to medication provision and social network integration, when delivered through an online program, can enhance adherence across all three recommended components of an evidence-based smoking cessation program (skills training, social support, and pharmacotherapy use). Nicotine replacement therapy-when provided as part of an integrated program-increases adherence to other program elements, which in turn augment its own therapeutic effects. An explicit focus on approaches to improve treatment adherence is an important first step to identifying leverage points for optimizing intervention effectiveness.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | | | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Bahar Erar
- Center for Statistical Science, Brown University, Providence, RI
| | - Michael S Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Nathan K Cobb
- MeYouHealth, Boston, MA
- Department of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC
| | - Raymond S Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David B Abrams
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Aboian MS, Solomon DA, Felton E, Mabray MC, Villanueva-Meyer JE, Mueller S, Cha S. Imaging Characteristics of Pediatric Diffuse Midline Gliomas with Histone H3 K27M Mutation. AJNR Am J Neuroradiol 2017; 38:795-800. [PMID: 28183840 DOI: 10.3174/ajnr.a5076] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/06/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The 2016 World Health Organization Classification of Tumors of the Central Nervous System includes "diffuse midline glioma with histone H3 K27M mutation" as a new diagnostic entity. We describe the MR imaging characteristics of this new tumor entity in pediatric patients. MATERIALS AND METHODS We retrospectively reviewed imaging features of pediatric patients with midline gliomas with or without the histone H3 K27 mutation. We evaluated the imaging features of these tumors on the basis of location, enhancement pattern, and necrosis. RESULTS Among 33 patients with diffuse midline gliomas, histone H3 K27M mutation was present in 24 patients (72.7%) and absent in 9 (27.3%). Of the tumors, 27.3% (n = 9) were located in the thalamus; 42.4% (n = 14), in the pons; 15% (n = 5), within the vermis/fourth ventricle; and 6% (n = 2), in the spinal cord. The radiographic features of diffuse midline gliomas with histone H3 K27M mutation were highly variable, ranging from expansile masses without enhancement or necrosis with large areas of surrounding infiltrative growth to peripherally enhancing masses with central necrosis with significant mass effect but little surrounding T2/FLAIR hyperintensity. When we compared diffuse midline gliomas on the basis of the presence or absence of histone H3 K27M mutation, there was no significant correlation between enhancement or border characteristics, infiltrative appearance, or presence of edema. CONCLUSIONS We describe, for the first time, the MR imaging features of pediatric diffuse midline gliomas with histone H3 K27M mutation. Similar to the heterogeneous histologic features among these tumors, they also have a diverse imaging appearance without distinguishing features from histone H3 wildtype diffuse gliomas.
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Affiliation(s)
- M S Aboian
- From the Department of Radiology (M.S.A., E.F., M.C.M., J.E.V.-M., S.C.)
| | - D A Solomon
- Division of Neuropathology (D.A.S.), Department of Pathology
| | - E Felton
- From the Department of Radiology (M.S.A., E.F., M.C.M., J.E.V.-M., S.C.)
| | - M C Mabray
- From the Department of Radiology (M.S.A., E.F., M.C.M., J.E.V.-M., S.C.)
| | | | - S Mueller
- Division of Pediatric Hematology/Oncology (S.M.), Department of Pediatrics.,Department of Neurological Surgery (S.M.).,Division of Child Neurology (S.M.), Department of Neurology, University of California, San Francisco, San Francisco, California
| | - S Cha
- From the Department of Radiology (M.S.A., E.F., M.C.M., J.E.V.-M., S.C.)
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Pearson JL, Amato MS, Wang X, Zhao K, Cha S, Cohn AM, Papandonatos GD, Graham AL. How US Smokers Refer to E-cigarettes: An Examination of User-Generated Posts From a Web-Based Smoking Cessation Intervention, 2008-2015. Nicotine Tob Res 2017; 19:253-257. [PMID: 27613899 PMCID: PMC5234368 DOI: 10.1093/ntr/ntw206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 03/29/2016] [Accepted: 07/30/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION A challenge in Electronic Nicotine Delivery System (ENDS) research is how to refer to these devices in ways that are meaningful to current or potential users. The objectives of this study were to: (1) describe the frequency of ENDS terms in a web-based smoking cessation intervention; and (2) determine whether terms vary by US geographic region and date. METHODS Data were drawn from public posts between 2008-2015 on http://BecomeAnEX.org and limited to US users. We conducted "exact" and "fuzzy" searches to find posts containing ENDS keywords using custom Python scripts, and extracted geocoding data and date for each post. We examined counts and frequencies of ENDS terms by unique user, by unique user and region, and by unique user and date. RESULTS We identified 1023 unique US website users who had written a post containing one or more ENDS keywords. Posters were majority female (79%), educated (78% attended at least some college), and had a median age of 47 years. Overall, 92% of ENDS posters employed the term "e-cigarette" or a derivation. Derivations of "vape" became increasingly popular in 2013, whereas "NJoy" and "blu" were employed by fewer than 2% of posters. We found no variation in frequency of ENDS terms by US region. CONCLUSIONS Researchers may have confidence that "e-cigarette" and "vape" are recognizable terms among US treatment-seeking smokers. Conversely, terms such as "ENDS," commonly employed by researchers and public health advocates, are not used by smokers and may be an impediment to tobacco control research. IMPLICATIONS Researchers may have confidence that "e-cigarette," and, to a lesser extent, "vape" are recognizable terms among US adult smokers referring to ENDS (including accessories, brand names, and actions). Conversely, terms such as "electronic nicotine delivery systems," commonly employed by researchers and public health advocates, are not used by US smokers and may be an impediment to tobacco control research and practice.
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Affiliation(s)
- Jennifer L Pearson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC;
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael S Amato
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Xi Wang
- Department of Management Sciences, University of Iowa, Iowa City, IA
| | - Kang Zhao
- Department of Management Sciences, University of Iowa, Iowa City, IA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Amy M Cohn
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
- Department of Oncology, Georgetown University Medical Center/ Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | | | - Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
- Department of Oncology, Georgetown University Medical Center/ Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
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Jung IH, Kurnicka K, Enache R, Nagy AI, Martins E, Cereda A, Vitiello G, Magda SL, Styczynski G, Lo Iudice F, De Barros Viegas H, Shahab F, Trunina I, Mata Caballero R, De Barros Viegas H, Marques A, Shimoni S, Generati G, Generati G, Bendix Salkvist Jorgensen T, Chen TE, Andrianova A, Fernandez-Golfin C, Corneli MC, Ali M, Seo HS, Kim MJ, Lichodziejewska B, Goliszek S, Dzikowska-Diduch O, Zdonczyk O, Kozlowska M, Kostrubiec M, Ciurzynski M, Palczewski P, Pruszczyk P, Popa E, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Jurcut R, Venkateshvaran AI, Sola SC, Govind SC, Dash PK, Lund L, Manouras AI, Merkely B, Magne J, Aboyans V, Boulogne C, Lavergne D, Jaccard A, Mohty D, Casadei F, Spano F, Santambrogio G, Musca F, Belli O, De Chiara B, Bokor D, Giannattasio C, Corradi E, Colombo CA, Moreo A, Vicario ML, Castellani S, Cammelli D, Gallini C, Needleman L, Cruz BK, Maggi E, Marchionni N, Bratu VD, Mincu RI, Mihai CM, Gherghe AM, Florescu M, Cinteza M, Vinereanu D, Sobieraj P, Bielicki P, Krenke R, Szmigielski CA, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A, Trimarco B, Galderisi M, Mendes L, Dores H, Melo I, Madeira V, Patinha J, Encarnacao C, Ferreia Santos J, Habib F, Soesanto AM, Sedyawan J, Abdurrazak G, Sharykin A, Popova NE, Karelina EV, Telezhnikova ND, Hernandez Jimenez V, Saavedra J, Molina L, Alberca MT, Gorriz J, L Pais J, Pavon I, Navea C, Alonso JJ, Mendes L, Sonia S, Madeira V, Encarnacao C, Patinha J, Melo I, Ferreia Santos J, Cruz I, Joao I, Gomes AC, Caldeira D, Lopes L, Fazendas P, Pereira H, Edri O, Edri O, Schneider N, Schneider N, Abaye N, Abaye N, Goerge J, Goerge J, Gandelman G, Gandelman G, Bandera F, Alfonzetti E, Guazzi M, Bandera F, Villani S, Ferraro O, Alfonzetti E, Guazzi M, Ramberg E, Bhardwaj P, Nepper ML, Binko TS, Olausson M, Fink-Jensen T, Andersen AM, Roland J, Gleerup Fornitz G, Ong K, Suri RM, Enrique-Sarano M, Michelena HI, Burkhart HM, Gillespie SM, Cha S, Mankad SV, Saidova MA, Bolotova MN, Salido Tahoces L, Izurieta C, Villareal G, Esteban A, Urena Vacas A, Ayala A, Jimenez Nacher JJ, Hinojar Baydes R, Gonzalez Gomez A, Garcia A, Mestre JL, Hernandez Antolin R, Zamorano Gomez JJ, Perea G, Covelli Y, Henquin R, Ronderos R, Hepinstall MJ, Cassidy CS, Pellikka PA, Pislaru SV, Kane G. P569Diastolic dyssynchrony is associated with exercise intolerance in hypertensive patients with left ventricular hypertrophyP570Echocardiographic pattern of acute pulmonary embolism, analysis of consecutive 511 patientsP571Clinical significance of ventricular interdependence and left ventricular function in patients with pulmonary hypertension receiving specific vasodilator therapyP572Haemodynamic characteristics and ventricular mechanics in post-capillary and combined pre- and post-capillary pulmonary hypertensionP573Relationship between hematological response and echocardiographic features in patients with light chains systemic amyloidosisP574Myocardial changes in patients with anorexia nervosaP575Giant cell arteritis presenting as fever of unknown origin: role of clinical history, early positron emission tomography and ultrasound screeningP576Subclinical systolic dysfunction in systemic sclerosis is not influenced by standard rheumatologic therapy - a 4D echocardiographic studyP577Cardiac index correlates with the degree of hepatic steathosis in obese patients with obstructive sleep apneaP578Myocardial mechanics in top-level endurance athletes: a three-dimensional speckle tracking studyP579The athlete heart: what happens to myocardial deformation in physiological adaptation to sportsP580Association between left ventricle intrinsic function and urine protein-creatinine ratio in preeclampsia before and after deliveryP581Dilatation of the aorta in children with bicuspid aortic valveP582Cardiovascular functional abnormalities in patients with osteogenesis imperfectaP583Dobutamine stress test fast protocol: diagnostic accuracy and securityP584Prognostic value of non-positive exercise echocardiography in the patients submitted to percutaneous coronary interventionP585The use of myocardial strain imaging in the detection of coronary artery disease during stress echocardiographyP586Preserved O2 extraction exercise response in heart failure patients with chronotropic insufficiency: evidence for a central cardiac rather than peripheral oxygen uptake limitationP587Major determinant of O2 artero-venous difference at peak exercise in heart failure and healthy subjectsP588Stress echocardiography with contrast perfusion analysis for a more sensitive test for ischemic heart diseaseP589Assessment of mitral annular physiology in myxomatous mitral disease with 3D transesophageal echocardiography: comparison between early severe mitral regurgitation and decompensated groupP590Three-dimensional transesophageal echocardiographic assessment of the mitral valve geometry in patients with mild, moderate and severe chronic ischemic mitral regurgitationP591Left atrial appendage closure. Multimodality imaging in device size selectionP592Contributions of three-dimensional transesophageal echocardiography in the evaluation of aortic atherosclerotic plaquesP593Agitated blood-saline is superior to agitated air-saline for echocardiographic shunt studies. Eur Heart J Cardiovasc Imaging 2016; 17:ii102-ii109. [DOI: 10.1093/ehjci/jew248.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Traub S, Cha S, Saghafian S. 52 Physician-level Differences in Emergency Department Length of Stay. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhao K, Wang X, Cha S, Cohn AM, Papandonatos GD, Amato MS, Pearson JL, Graham AL. A Multirelational Social Network Analysis of an Online Health Community for Smoking Cessation. J Med Internet Res 2016; 18:e233. [PMID: 27562640 PMCID: PMC5016624 DOI: 10.2196/jmir.5985] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/25/2016] [Accepted: 08/12/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Online health communities (OHCs) provide a convenient and commonly used way for people to connect around shared health experiences, exchange information, and receive social support. Users often interact with peers via multiple communication methods, forming a multirelational social network. Use of OHCs is common among smokers, but to date, there have been no studies on users' online interactions via different means of online communications and how such interactions are related to smoking cessation. Such information can be retrieved in multirelational social networks and could be useful in the design and management of OHCs. OBJECTIVE To examine the social network structure of an OHC for smoking cessation using a multirelational approach, and to explore links between subnetwork position (ie, centrality) and smoking abstinence. METHODS We used NetworkX to construct 4 subnetworks based on users' interactions via blogs, group discussions, message boards, and private messages. We illustrated topological properties of each subnetwork, including its degree distribution, density, and connectedness, and compared similarities among these subnetworks by correlating node centrality and measuring edge overlap. We also investigated coevolution dynamics of this multirelational network by analyzing tie formation sequences across subnetworks. In a subset of users who participated in a randomized, smoking cessation treatment trial, we conducted user profiling based on users' centralities in the 4 subnetworks and identified user groups using clustering techniques. We further examined 30-day smoking abstinence at 3 months postenrollment in relation to users' centralities in the 4 subnetworks. RESULTS The 4 subnetworks have different topological characteristics, with message board having the most nodes (36,536) and group discussion having the highest network density (4.35×10(-3)). Blog and message board subnetworks had the most similar structures with an in-degree correlation of .45, out-degree correlation of .55, and Jaccard coefficient of .23 for edge overlap. A new tie in the group discussion subnetwork had the lowest probability of triggering subsequent ties among the same two users in other subnetworks: 6.33% (54,142/855,893) for 2-tie sequences and 2.13% (18,207/855,893) for 3-tie sequences. Users' centralities varied across the 4 subnetworks. Among a subset of users enrolled in a randomized trial, those with higher centralities across subnetworks generally had higher abstinence rates, although high centrality in the group discussion subnetwork was not associated with higher abstinence rates. CONCLUSIONS A multirelational approach revealed insights that could not be obtained by analyzing the aggregated network alone, such as the ineffectiveness of group discussions in triggering social ties of other types, the advantage of blogs, message boards, and private messages in leading to subsequent social ties of other types, and the weak connection between one's centrality in the group discussion subnetwork and smoking abstinence. These insights have implications for the design and management of online social networks for smoking cessation.
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Affiliation(s)
- Kang Zhao
- Department of Management Sciences, Tippie College of Business, The University of Iowa, Iowa City, IA, United States.
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Saul JE, Amato MS, Cha S, Graham AL. Engagement and attrition in Internet smoking cessation interventions: Insights from a cross-sectional survey of "one-hit-wonders". Internet Interv 2016; 5:23-29. [PMID: 30135803 PMCID: PMC6096296 DOI: 10.1016/j.invent.2016.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/01/2016] [Accepted: 07/03/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Internet interventions can reach large numbers of individuals. However, low levels of engagement and high rates of follow-up attrition are common, presenting major challenges to evaluation. This study investigated why registrants of an Internet smoking cessation intervention did not return after joining ("one hit wonders"), and explored the impact of graduated incentives on survey response rates and responder characteristics. METHODS A sample of "one hit wonders" that registered on a free smoking cessation website between 2014 and 2015 were surveyed. The initial invitation contained no incentive. Subsequent invitations were sent to random subsamples of non-responders from each previous wave offering $25 and $50 respectively. Descriptive statistics characterized respondents on demographic characteristics, reasons for not returning, and length of time since last visit. Differences were investigated with Fisher's Exact tests, Kruskal-Wallis, and logistic regression. RESULTS Of 8779 users who received the initial invitation, 132 completed the survey (1.5%). Among those subsequently offered a $25 incentive, 127 (3.7%) responded. Among those offered a $50 incentive, 97 responded (5.7%). The most common reasons endorsed for not returning were being unable to quit (51%), not having enough time (33%), having forgotten about the website (28%), and not being ready to quit (21%). Notably, however, 23% reported not returning because they had successfully quit smoking. Paid incentives yielded a higher proportion of individuals who were still smoking than the $0 incentive (72% vs. 61%). Among $0 and $25 responders, likelihood of survey response decreased with time since registration; the $50 incentive removed the negative effect of time-since-registration on probability of response. CONCLUSIONS One third of participants that had disengaged from an Internet intervention reported abstinence at follow-up, suggesting that low levels of engagement are not synonymous with treatment failure in all cases. Paid incentives above $25 may be needed to elicit survey responses, especially among those with longer intervals of disengagement from an intervention.
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Affiliation(s)
- Jessie E. Saul
- North American Research & Analysis, Inc., Faribault, MN, United States
| | - Michael S. Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, United States
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, United States
| | - Amanda L. Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, United States,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, United States,Corresponding author at: Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, United States.
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Cha S, Cohn AM, Elmasry H, Graham AL. A Preliminary Exploration of Former Smokers Enrolled in an Internet Smoking Cessation Program. JMIR Res Protoc 2016; 5:e119. [PMID: 27302500 PMCID: PMC4925934 DOI: 10.2196/resprot.5542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/11/2016] [Accepted: 04/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet interventions may have an important role to play in helping self-quitters maintain an initial period of abstinence. Little is known about the characteristics and utilization patterns of former smokers who use Internet cessation programs. OBJECTIVE The overarching aim of this preliminary study was to establish the feasibility of a subsequent randomized trial of the effectiveness of Internet interventions in preventing relapse. Specifically, this study sought to determine the number of former smokers that register on a smoking cessation website, the characteristics of former smokers and their website utilization patterns, and potential predictors of sustained abstinence. METHODS Participants were self-identified former smokers who registered on a free smoking cessation website. Recruitment occurred immediately following site registration. Participants completed Web-based baseline and 1-month follow-up assessments. Website utilization metrics were extracted at 1 month. Descriptive statistics were used to characterize the full sample. Baseline differences were examined between recent quitters (≤7 days of abstinence at enrollment) and more established quitters (8+ days of abstinence at enrollment) using chi-square tests and t tests. Univariate logistic regression examined demographic, smoking, psychosocial characteristics, and website utilization metrics as predictors of 1-month abstinence. RESULTS During the 10-month study period, 1141 former smokers were recruited to participate: 494 accepted the invitation, 395 were eligible, 377 provided informed consent, and 221 completed the baseline and fully enrolled (56% of those eligible). At 1 month, 55.7% (123/221) of participants completed the follow-up survey. Mean age was 44.25 years (SD 12.78) and the sample was primarily female (174/221, 78.7%), white (196/221, 88.7%), and had at least some college education (177/221, 80.1%). Slightly more than half of participants (123/221, 55.7%) reported quitting more than a week prior to website registration and 43.9% (97/221) had quit within 7 days of registration. The website features most likely to be used were an interactive Quit Date tool (166/221, 75.1%) and the Community (134/221, 60.6%). Univariate regression models showed that recent quitters, those with higher motivation to remain abstinent, and those who used cessation medication in the past year were more likely to use the Community. Older age, longer duration of abstinence at registration, better health status, and health care provider advice to quit were associated with 1-month abstinence. Website utilization metrics did not predict abstinence, though odds ratios suggested higher utilization was associated with greater odds of abstinence. CONCLUSIONS This exploratory study demonstrated the feasibility of recruiting former smokers to a research study and documented the uptake of an Internet cessation intervention among this group of self-quitters. Results also showed higher levels of website utilization and greater likelihood of community use among smokers early in their quit attempt compared to those with a longer period of abstinence at enrollment. Important areas for future research include identifying former smokers who may be more susceptible to relapse and determining which components of an Internet intervention are most helpful to prevent relapse in the early and later stages of a quit attempt.
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Affiliation(s)
- Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, United States.
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Graham AL, Carpenter KM, Cha S, Cole S, Jacobs MA, Raskob M, Cole-Lewis H. Systematic review and meta-analysis of Internet interventions for smoking cessation among adults. Subst Abuse Rehabil 2016; 7:55-69. [PMID: 27274333 PMCID: PMC4876804 DOI: 10.2147/sar.s101660] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this systematic review was to determine the effectiveness of Internet interventions in promoting smoking cessation among adult tobacco users relative to other forms of intervention recommended in treatment guidelines. Methods This review followed Cochrane Collaboration guidelines for systematic reviews. Combinations of “Internet,” “web-based,” and “smoking cessation intervention” and related keywords were used in both automated and manual searches. We included randomized trials published from January 1990 through to April 2015. A modified version of the Cochrane risk of bias assessment tool was used. We calculated risk ratios (RRs) for each study. Meta-analysis was conducted using random-effects method to pool RRs. Presentation of results follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results Forty randomized trials involving 98,530 participants were included. Most trials had a low risk of bias in most domains. Pooled results comparing Internet interventions to assessment-only/waitlist control were significant (RR 1.60, 95% confidence interval [CI] 1.15–2.21, I2=51.7%; four studies). Pooled results of largely static Internet interventions compared to print materials were not significant (RR 0.83, 95% CI 0.63–1.10, I2=0%; two studies), whereas comparisons of interactive Internet interventions to print materials were significant (RR 2.10, 95% CI 1.25–3.52, I2=41.6%; two studies). No significant effects were observed in pooled results of Internet interventions compared to face-to-face counseling (RR 1.35, 95% CI 0.97–1.87, I2=0%; four studies) or to telephone counseling (RR 0.95, 95% CI 0.79–1.13, I2=0%; two studies). The majority of trials compared different Internet interventions; pooled results from 15 such trials (24 comparisons) found a significant effect in favor of experimental Internet interventions (RR 1.16, 95% CI 1.03–1.31, I2=76.7%). Conclusion Internet interventions are superior to other broad reach cessation interventions (ie, print materials), equivalent to other currently recommended treatment modes (telephone and in-person counseling), and they have an important role to play in the arsenal of tobacco-dependence treatments.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, USA; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, USA
| | - Sam Cole
- Alere Wellbeing, Seattle, WA, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, USA
| | | | - Heather Cole-Lewis
- Johnson & Johnson Health and Wellness Solutions, Inc., New Brunswick, NJ, USA; ICF International, Rockville, MD, USA
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