Exposures to the tobacco retail environment among adolescent boys in urban and rural environments.

BACKGROUND: The tobacco industry spends billions on retail marketing and such marketing is associated with tobacco use. Previous research has not examined actual and potential exposures that adolescents have on a daily basis. OBJECTIVE: The objective of this study was to determine whether both self-reported and geographically estimated tobacco retailer exposures differ by participant or neighborhood characteristics among urban and rural adolescents. METHODS: The data for this study were part of a cohort study of 1220 adolescent males residing in urban and rural (Appalachian) regions in Ohio. The baseline survey asked participants how often they visited stores that typically sell tobacco in the past week (self-reported exposures). The number of tobacco retailers between home and school was determined using ArcGIS software (potential exposures). Adjusted regression models were fit to determine the characteristics that were associated with self-reported or potential exposures to retailers. RESULTS: Adolescents who were non-Hispanic black or other racial/ethnic minority, had used tobacco in the past, and lived in rural areas had higher self-reported exposures. Urban adolescents, non-Hispanic black or other racial/ethnic minority, and those living in neighborhoods with a higher percentage of poverty had more potential exposures to tobacco retailers in their path between home and school. CONCLUSIONS: Rural adolescents had more self-reported marketing exposures than urban adolescents. However, urban adolescents had more potential tobacco exposures between home and school. Thus, point of sale marketing limitations might be a more effective policy intervention in rural areas whereas limits on tobacco retailers might be more effective for urban areas.

Utilizing Oral Surveys to Better Understand Patient Satisfaction in a Low-Income, Urban Surgical Clinic.

Oral surveys allow patients to elaborate on their experience in the hospital, giving context to numerical values often used to assess patient satisfaction. This allows patients to speak about factors affecting satisfaction, which is important in complex, low-income populations. Spoken surveys were administered to 80 patients in surgery clinics at Temple University Hospital. Responses were transcribed and coded to analyze patient responses. Relationships among patient responses were identified, and responses were categorized to determine the most important factors related to patient satisfaction. Numerical data were also used to assess satisfaction. Patients were satisfied with their experience with the physician and the hospital, reporting averages scores of 9.73 and 9.19, respectively. Regarding physician satisfaction, patients cited effective communication and professionalism as being most important. As long as nothing went wrong, patients scored their experience outside their interactions with the physician highly. Negative experiences were mainly related to wait times and ineffective communication with office staff and were seldom related to the physician. By using a spoken survey, patients could elaborate on their responses which provides context to the numerical data. Despite the positive feedback for physicians, patients spoke openly about communication. In low-income populations, communication failures can be exacerbated by the power differential present between the patient and physician. Our study demonstrates the utility of oral surveys in understanding complex patient populations, and the results can be used to shape surgical and nonsurgical practices in similar patient populations.

Patient Attitudes Toward Spoken Surveys in a Low-Income Urban Surgical Clinic.

Diverse groups in urban settings demonstrate poor participation in health care and low levels of literacy. It is possible the method of health information delivery (eg, spoken vs. written) in these settings could impact health care related communication and understanding, though little is known on this topic. The objective of this study was to uncover the advantages and disadvantages of spoken survey administration in a low-income urban setting. The data for this study were collected via spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital (TUH) in North Philadelphia. Survey responses were coded into various groups until categories and relationships among them emerged to produce themes relevant in demonstrating the advantages and disadvantages of spoken survey. 69% (55) of respondents preferred a spoken survey format. Of the 55 patients who preferred the spoken format, 33% (18) possessed some level of college education and 47% (26) had finished high school. Of the 23 patients who primarily spoke Spanish or another language at home, 78% (18) preferred a spoken interview format. Overall, 53% (42) of patients experienced at least 1 instance of poor understanding throughout the survey. Patients were better able to understand questions in a spoken survey compared to written ones that they had completed in the past due to the opportunity for surveyors to explain questions when needed. It is possible that question explanation is necessary in low-income urban settings due to low-literacy levels or improved feelings of survey intimacy and efficiency.

Challenges to Understanding and Compliance Among Surgical Patients in Low-Income Urban Teaching Hospitals.

Financial and educational barriers significantly impact low socioeconomic status racial and ethnic minority groups in their pursuit of health care, though less is known about the interplay of these factors in the pursuit of surgical care. This study was designed to uncover the challenges to patient understanding and compliance with pre- and postsurgical clinical advice in low-income urban environments. The data for this study were collected in spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital in Philadelphia. Survey responses were coded into various groups until categories emerged. Relationships among categories were identified to generate themes and subthemes. Key facilitators of patient understanding and compliance were physician likeability and communication. Eighty (100%) patients reported that the physician always treated them with respect, which was important in their interpretation of their experience with the physician. Eighteen (23%) patients identified a language other than English as their primary language and 57 (71%) patients completed high school or less schooling, which likely influenced their communication with the physician. Eighty (100%) patients expressed that the physician always explained things in a way they could understand, focusing on clarity and thoroughness. Challenges to patient understanding and compliance were finances and social resources. Patients noted difficulty paying for medical care and a lack of support at home. Agency could facilitate use of surgical care while a lack thereof could challenge motivation. Ultimately, these themes showed how patients in this environment interact with surgical care.