Rural areas are disproportionately impacted by smoking and lung cancer.

Rural populations have higher rates of late stage lung cancer incidence and mortality compared to urban populations, making them important target populations for low dose computed tomography (LDCT) screening. LDCT screening has been shown to reduce lung cancer mortality and is recommended by the United States Preventive Services Task Force for individuals who meet certain risk criteria. However, rural populations may experience greater system, provider, and individual-level barriers to screening and related health-seeking behavior (e.g. smoking cessation). LDCT screening was first tested in urban, academic centers, so it is still unknown how readily it may be implemented in rural areas. Additionally, rural populations have limited access to both primary care physicians who may refer to LDCT screening and specialty physicians who may perform the screening. Further, rural populations may be less likely to seek screening due to lack of awareness and understanding or other unknown knowledge or psychosocial barriers. There are several strategies that may address these rural specific challenges. First, further research is needed to better understand the individual-level barriers that rural patients experience. Second, to reduce system-level barriers, additional efforts should be made to increase rural access to screening through improved referral processes. Third, creation of decision support materials to equip rural providers to engage their patients in a shared decision making process regarding screening may help reduce physician level barriers. Fourth, development of a holistic approach to smoking cessation may help reduce lung cancer risk in conjunction with LDCT screening.

Exposure to electronic nicotine delivery systems (ENDS) visual imagery increases smoking urge and desire.

Use and awareness of electronic nicotine delivery systems (ENDS; also known as electronic cigarettes or e-cigarettes) has increased rapidly in recent years, particularly among young adults. As use of ENDS resembles traditional smoking in both hand-to-mouth movements and inhalation and exhalation behaviors, we determined whether exposure to e-cigarette use via video exposure would act as a cue to elicit urge and desire for a combustible cigarette. Young adult smokers (mean age of 26.3 ± 4.1 years) were randomized to view a brief video montage of advertisements depicting either e-cigarette vaping (n = 38) or bottled water drinking (n = 40). Pre- and postcue exposure assessments were conducted in a controlled laboratory setting without other smoking or vaping cues present or behaviors allowed. Primary outcomes included change from pre-exposure baseline in smoking urge (Brief Questionnaire of Smoking Urges) and desire for a combustible and e-cigarette (visual analogue scales). Results showed that relative to exposure to the bottled water video, exposure to the ENDS video significantly increased smoking urge (p < .001) as well as desire for a regular cigarette (p < .05) and an e-cigarette (p < .001). These findings provide preliminary evidence that passive exposure to video imagery of ENDS use may generalize as a condition cue and evoke urges for a combustible cigarette in young adult smokers. It remains to be determined whether such increases in urge and desire correspond to increases in actual smoking behavior.

Complementary and alternative medicine use among breast cancer survivors.

OBJECTIVES: The use complementary and alternative medicine (CAM) by patients with breast cancer and survivors has been widely studied. However, scant research has focused on the degree to which CAM activity is related to the cancer experience, as opposed to use for other reasons. The study objective was to examine the use of CAM in a sample of patients with breast cancer. Additional objectives were to measure associations between psychosocial and medical factors and CAM use both related and unrelated to a breast cancer diagnosis. DESIGN: Breast cancer survivors (N=115) at least 1 year beyond active medical treatment were recruited during routine clinic visits. Survey data collected via structured telephone interview focused on CAM use, motivations for use, perceived risk of cancer recurrence, and breast cancer-specific and general measures of anxiety. RESULTS: Sixty-nine percent (69%) of participants reported use of CAM. Of CAM users, 73% reported initiating or changing CAM activity specifically because of their cancer diagnosis. Patients engaging in CAM for cancer-related reasons were younger (p<0.001) and had been diagnosed with cancer at a younger age (p<0.01). Although overall anxiety scores in this sample were not significantly elevated, higher trait anxiety was associated with CAM use related to one's cancer diagnosis. CONCLUSIONS: Rate of CAM use was high, with the majority of CAM users associating that activity with their breast cancer. Anxiety levels varied between nonusers, CAM users for cancer, and CAM users for other reasons, with highest trait anxiety among those who associate their CAM use with cancer. Assessing motivations for CAM use may be important in future examinations of the relationship between CAM use and quality of life among breast cancer survivors.

Complementary medicine practices in a community-based sample of lesbian and heterosexual women.

While researchers have examined the established the foundation for understanding the correlates of complementary and alternative medicine (CAM) use among some medical populations, less is known about the correlates of CAM use in nonclinical samples of women, and particularly according to sexual orientation. Information on CAM modalities was collected as part of a survey of lesbian and heterosexual women's health. Eighty-two percent of the sample reported CAM use. Predictors of CAM use included a lesbian sexual orientation, less health-related worry, and perceived discrimination in health care settings. Additional research is warranted to better understand how sexual orientation relates to use of CAM. Future studies should also examine the relationships between and experiences with discrimination in traditional medical settings and increased use of complementary and alternative medicine.

A qualitative exploration of the experiences of lesbian and heterosexual patients with breast cancer.

PURPOSE/OBJECTIVES: To explore similarities and differences between lesbian and heterosexual survivors of breast cancer regarding cancer experiences, medical interactions related to cancer treatment, and quality of life (QOL). DESIGN: Qualitative study using focus groups. SETTING: Urban, community-based health center. SAMPLE: A convenience sample of lesbians (n = 13) and heterosexual women (n = 28) with a diagnosis of breast cancer within the past five years. Participants were recruited via posted advertisements. METHODS: Focus groups were conducted as part of a larger study exploring coping and adjustment in lesbian survivors of breast cancer. Transcribed focus group data were analyzed through thematic and representative case study methods. MAIN RESEARCH VARIABLES: Broad aspects of medical interactions and the patient-provider relationship that may be associated with improved QOL of lesbian and heterosexual patients with cancer. FINDINGS: Data suggested similarities between lesbians and heterosexual women in their overall QOL. However, differences did emerge between the groups. Lesbians reported higher stress associated with diagnosis, lower satisfaction with care received from physicians, and a trend toward lower satisfaction with the availability of emotional support. CONCLUSIONS: Study findings have important implications for future research on adjustment and coping among lesbian patients with breast cancer and for the improvement of their mental and physical healthcare services. IMPLICATIONS FOR NURSING: Study findings may help improve healthcare services for lesbians with cancer.