Development and usability testing of HEARTPA♀N: protocol for a mixed methods strategy to develop an integrated smartphone and web-based intervention for women with cardiac pain.

INTRODUCTION: More women experience cardiac pain related to coronary artery disease and cardiac procedures compared with men. The overall goal of this programme of research is to develop an integrated smartphone and web-based intervention (HEARTPA♀N) to help women recognise and self-manage cardiac pain. METHODS AND ANALYSIS: This protocol outlines the mixed methods strategy used for the development of the HEARTPA♀N content/core feature set (phase 2A), usability testing (phase 2B) and evaluation with a pilot randomised controlled trial (RCT) (phase 3). We are using the individual and family self-management theory, mobile device functionality and pervasive information architecture of mHealth interventions, and following a sequential phased approach recommended by the Medical Research Council to develop HEARTPA♀N. The phase 3 pilot RCT will enable us to refine the prototype, inform the methodology and calculate the sample size for a larger multisite RCT (phase 4, future work). Patient partners have been actively involved in setting the HEARTPA♀N research agenda, including defining patient-reported outcome measures for the pilot RCT: pain and health-related quality of life (HRQoL). As such, the guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols (SPIRIT-PRO) are used to report the protocol for the pilot RCT (phase 3). Quantitative data (eg, demographic and clinical information) will be summarised using descriptive statistics (phases 2AB and 3) and a content analysis will be used to identify themes (phase 2AB). A process evaluation will be used to assess the feasibility of the implementation of the intervention and a preliminary efficacy evaluation will be undertaken focusing on the outcomes of pain and HRQoL (phase 3). ETHICS AND DISSEMINATION: Ethics approval was obtained from the University of Toronto (36415; 26 November 2018). We will disseminate knowledge of HEARTPA♀N through publication, conference presentation and national public forums (Café Scientifique), and through fact sheets, tweets and webinars. TRIAL REGISTRATION NUMBER: NCT03800082.

Acceptability and feasibility of self-sampling for the screening of sexually transmitted infections in cabana privacy shelters.

Screening for sexually transmitted infections (STIs) outside of traditional health-care facilities is limited by the privacy needed for sample collection. We explored the acceptability of privacy shelters for the self-collection of genital swabs and tested the use of privacy shelters during mobile STI screening. Attendees ≥14 years old at two outdoor community events completed a questionnaire that assessed participant characteristics, health-care access, and rating of acceptability of self-collecting penile or vaginal swabs in a privacy shelter and four other private spaces: portable restroom, health van, home, and doctor's office. A privacy shelter was used during mobile STI screening. The majority (65%) of the 95 participants reported that using a privacy shelter was somewhat or very acceptable. No participant characteristics or health-care access factors were associated with the acceptability of privacy shelters. Women rated a privacy shelter more acceptable than a portable restroom or health van. Men rated a privacy shelter more acceptable than a portable restroom. During mobile STI screening, all 13 men and women who requested STI testing used the privacy shelter for self-sampling. Rating of acceptability before and after privacy shelter use was the same. Privacy shelters may enable STI screening without using a building or vehicle for sample collection.

Syphilis among adolescents and young adults in Cincinnati, Ohio: testing, infection and characteristics of youth with syphilis infection.

Little is known about the epidemiology of syphilis among adolescents and young adults. This study examined, among more than 17000 young people aged 13-22 years old, trends in rates of syphilis testing and infection; characteristics of infected adolescents; and agreement about syphilis staging and treatment between provider and chart reviewer. Rates of syphilis testing increased but rates of syphilis infection did not increase significantly over a 5-year period. A majority of infected men reported only opposite-sex sexual contact. High agreement between providers and chart reviewers was found. These findings demonstrate the need for complete assessment of risk factors and use of local epidemiology in screening practices.

Feasibility and acceptability of point-of-care testing for sexually transmissible infections among men and women in mobile van settings.

To demonstrate the feasibility and acceptability of mobile point-of-care and near-patient testing for sexually transmissible infections, we offered services during an annual community event and surveyed event-goers. Forty-two participants were tested. When provided with options, the majority of participants chose point-of-care or near-patient testing. Trichomoniasis, chlamydia and gonorrhea were detected. All but one infected participant were notified and prescribed treatment. Participants responding to a written questionnaire reported sample self-collection and testing in a van as acceptable, although men reported self-collection in a van as less acceptable than a doctor's office. Providing mobile point-of-care and near-patient sexually transmitted infection testing to the general population is feasible and acceptable.

Access to cigarettes by young New Zealand smokers: little change from 2000 to 2008.

OBJECTIVE: To examine trends in young New Zealanders' access to cigarettes from 2002 to 2008. METHODS: Self-reports of young smokers' commercial sources of cigarettes, requests for proof of age and being refused a sale, and the amount spent on cigarettes, were analysed from the 2002 and 2004 Youth Lifestyles Surveys and 2006 and 2008 Year 10 In-depth Surveys of 14 to 15 year olds in New Zealand (NZ). RESULTS: Most young smokers obtain cigarettes through non-commercial sources; however, one-third bought their cigarettes from shops in 2008, with no evidence of a change in proportions purchasing from major retail outlets since 2000. Few young smokers were asked to show proof of age when purchasing cigarettes, with no evidence over time of more young smokers being asked for proof of age, but reports of being refused the sale of cigarettes decreased from 2000. Participants reporting being asked for proof of age had nearly six times the odds of being refused sale. The amount spent on cigarettes did not change over the study period. CONCLUSION: Many young smokers continue to purchase cigarettes from commercial outlets, with no evidence of change in purchasing from major outlets such as dairies, service stations, supermarkets or liquor stores since 2000. The fact that few young smokers reported being asked to show proof of age suggests the need for stronger measures to ensure that retailers comply with New Zealand legislation regarding under-age sales of tobacco. IMPLICATIONS: With an infringement notice scheme being implemented and tobacco price rises, there may be an increase in accessing cigarettes through social sources. It remains important to monitor commercial tobacco sales to young people to determine the efficacy of policy change.

Youth experiences of secondhand smoke exposure in New Zealand: evidence from 5 national surveys (2000 to 2008).

AIMS: To describe trends in young people's exposure to secondhand smoke (SHS), and to their exposure to household rules around smoking in New Zealand (NZ) over the period 2000 to 2008. METHODS: We examined self-assessed perceptions of exposure to SHS in the home and while travelling in vehicles, and home smoking restrictions, both inside the home (indoor) and on the property (outside). Data were from the 2000, 2002 and 2004 Youth Lifestyle Study and 2006 and 2008 Youth In-depth Survey of 14- to 15-year-olds in NZ. RESULTS: Downward trends in young people being exposed to SHS at home since 2000 (p<0.001) and in vehicles since 2002 (p<0.001) were found. Unrestricted indoor and outdoor smoking declined, with 31% of homes being completely smokefree in 2008. Maori and Pacific young people were significantly more likely to be exposed to SHS at home (OR 3.2 and 2.0 respectively) and in vehicles (OR 3.1 and 2.3 respectively). CONCLUSIONS: Declining rates of SHS exposure for young people in their homes and while travelling in vehicles are encouraging. However, 35% of young people are still being exposed to SHS in their homes and 32% in vehicles. Although smokefree homes are increasing, there is still much work needed to reduce the rates of SHS exposure for our young people, and especially Maori and Pacific young people.