The Relationships of Expectancies With E-cigarette Use Among Hospitalized Smokers: A Prospective Longitudinal Study.

Background: Expectancies demonstrate cross-sectional associations with e-cigarette use, but the prospective relationships between expectancies and e-cigarette use are unknown. This study examined the longitudinal associations of expectancies with e-cigarette use among hospitalized tobacco cigarette smokers. Methods: E-cigarette expectancies (e-cigarette-specific Brief Smoking Consequences Questionnaire-Adult [BSCQ-A]), tobacco cigarette expectancies (tobacco-specific BSCQ-A), and number of days used e-cigarettes in the past 30 days were assessed at baseline hospitalization, 6-months post-hospitalization, and 12-months post-hospitalization among 978 hospitalized tobacco cigarette smokers. Expectancy difference scores (e-cigarette-specific expectancies minus tobacco-specific expectancies) were computed for each of the 10 BSCQ-A scales. Cross-lagged panel models tested the relationships between expectancy difference scores and number of days used e-cigarettes in the past 30 days for each of the 10 BSCQ-A scales. Results: Though some models revealed partial associations between expectancies and e-cigarette use, only one yielded results consistent with hypotheses. Greater e-cigarette use at baseline predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 6 months, which then predicted greater e-cigarette use at 12 months. To a lesser degree greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at baseline predicted greater e-cigarette use at 6 months, which then predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 12 months. Conclusions: Expectancies that e-cigarettes provide similar or more pleasant taste sensations as compared to tobacco cigarettes may be both a cause and consequence of e-cigarette use. Focusing on the taste experience may prove most effective in modifying e-cigarette use behavior. Implications: The current study offers the first longitudinal examination of expectancies and e-cigarette use. Results suggest expectancies that e-cigarettes provide similar or more pleasant taste sensations relative to tobacco cigarettes are both a cause and consequence of e-cigarette use. Efforts that focus on the e-cigarette taste experience may prove most effective in modifying e-cigarette use behavior.

On Some Practical Considerations Regarding Community-Based Participatory Research for Addressing Cancer Health Disparities.

There is a consensus about the benefits of community-based participatory research and the important role it can play in reducing cancer health disparities. Although every community-based participatory research project is unique in many ways, several fundamental issues deserve consideration. We discuss issues concerning community representation, possible tensions within community-based participatory research (CBPR) projects, and staffing CBPR projects. Flexibility, open-mindedness, transparency, and above all, caring, are characteristics that best ensure successful and rewarding outcomes.

Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study.

BACKGROUND: Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation-induced colorectal cancer (CRC). The Children's Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at-risk survivors. METHODS: Analyses included 702 five-year survivors (Childhood Cancer Survivor Study) aged ≥36 years who received ≥30 gray of abdominal, pelvic, or spinal radiotherapy. Multivariate generalized linear models were used to calculate relative risks (RR) with 95% confidence intervals (95% CI) for adherence to the Children's Oncology Group's CRC surveillance recommendations. RESULTS: With a median age of 43 years (range, 36-58 years), 29.5% of the survivors (207 of 702 survivors) met surveillance recommendations. In multivariate analyses, age ≥50 years versus age 36 to 49 years (RR, 2.6; 95% CI, 2.0-3.4), reporting a routine cancer follow-up visit within 1 year before the study (RR, 1.5; 95% CI, 1.0-2.2), reporting ≥10 physician visits within the past year versus 0 to 9 visits (RR, 1.4; 95% CI, 1.1-1.7), and discussing future cancer risk with a physician at the time of the most recent follow-up visit (RR, 1.4; 95% CI, 1.1-1.7) were found to be associated with adherence to CRC surveillance recommendations. CONCLUSIONS: Greater than 70% of survivors at an increased risk of CRC were not screened as recommended. Regular physician contact and discussion of screening were associated with a 60% increase in CRC surveillance. Educational interventions targeted at survivors and their primary care physicians are needed to heighten knowledge of CRC risk after radiotherapy and the importance of appropriate surveillance.

Exploring pre-school vision screening in primary care offices in Alabama.

PURPOSE: To investigate practices, barriers, and facilitators of universal pre-school vision screening (PVS) at pediatric primary care offices. METHODS: Focus group sessions (FGS) were moderated on-site at nine pediatric practices. A semi-structured topic guide was used to standardize and facilitate FGS. Discussions were audiotaped, and transcriptions were used to develop themes. All authors reviewed and agreed on the resultant themes. RESULTS: FGS included 13 physicians and 32 nurses/certified medical assistants (CMAs), of whom 82% personally conducted some facet of PVS. In all practices, nurses/CMAs tested visual acuity (most using a non-recommended test), and physicians completed vision screening with external observation, fix/follow, red reflex, and cover test. Facilitators included (1) accepting that PVS is a routine part of the well-child visit, and (2) using an electronic medical record with prompts to record acuity (eight of nine practices). Barriers were related to difficulty testing pre-schoolers, distractions in the office setting, time constraints, and limited reimbursement. CONCLUSIONS: Responsibility for PVS is shared by physicians and nurses/CMAs; thus, interventions to improve PVS should target both. Few practices are aware of new evidence-based PVS tests; thus, active translational efforts are needed to change current primary care practices.

Explaining and improving breast cancer information acquisition among African American women in the Deep South.

OBJECTIVES: A major challenge facing contemporary cancer educators is how to optimize the dissemination of breast cancer prevention and control information to African American women in the Deep South who are believed to be cancer free. The purpose of this research was to provide insight into the breast cancer information-acquisition experiences of African American women in Alabama and Mississippi and to make recommendations on ways to better reach members of this high-risk, underserved population. METHODS: Focus group methodology was used in a repeated, cross-sectional research design with 64 African American women, 35 years old or older who lived in one of four urban or rural counties in Alabama and Mississippi. RESULTS: Axial-coded themes emerged around sources of cancer information, patterns of information acquisition, characteristics of preferred sources, and characteristics of least-preferred sources. CONCLUSIONS: It is important to invest in lay health educators to optimize the dissemination of breast cancer information to African American women who are believed to be cancer free in the Deep South.

Fourth graders' reports of fruit and vegetable intake at school lunch: does treatment assignment affect accuracy?

OBJECTIVE: Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition. DESIGN: Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention. SUBJECTS/SETTING: Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day. MAIN OUTCOME MEASURES: Food items were coded as: "match," "omission," or "intrusion." Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake. ANALYSES: Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or chi(2) analyses. RESULTS: Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report. CONCLUSIONS: Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.

Internet delivered support for tobacco control in dental practice: randomized controlled trial.

BACKGROUND: The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized. OBJECTIVE: To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings. METHODS: Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention. RESULTS: Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices' mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK. CONCLUSION: This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit. TRIAL REGISTRATION: clinicaltrials.gov NCT00627185, http://www.webcitation.org/5c5Kugvzj.

Effectiveness evaluation of the N-O-T smoking cessation program for adolescents.

OBJECTIVE: To evaluate the effectiveness of the Not-On-Tobacco Program. METHODS: Forty-four high schools implemented the program (n=241 students), with 27 comparison schools (n=251 students). Students reported smoking in the last 7 and 30 days at baseline and follow-up. RESULTS: Those in the program had an increased likelihood of reporting 30-day abstinence at end of program (OR = 4.2) but not at 6 or 12 months. For 7-day abstinence there was no significant difference for any time point. CONCLUSIONS: In this effectiveness evaluation the N-O-T Program increased quitting during the program, but the effects were not present at 6 or 12 months.

Toward a model of prostate cancer information seeking: identifying salient behavioral and normative beliefs among African American men.

Public health actions to improve African American men's ability to make informed decisions about participation in prostate cancer control activities have a greater likelihood of success when they are theory driven and informed by members of the target population. This article reports on formative research to evaluate the usefulness of the theory of reasoned action as a model to explain and predict prostate cancer information-seeking behavior by African American men. Fifty-two men participated in eight focus group interviews. Positive behavioral beliefs for obtaining prostate cancer information from physicians included increasing awareness of and obtaining accurate information about the disease, early detection and screening, and treatment. Negative beliefs included fear, distrust, and inconvenience. Significant others, peers, siblings, and religious leaders were identified as individuals who could influence this behavior. These findings provide additional insight into ways to reach and intervene with African American men to influence this important cancer control activity.

The theory of reasoned action and intention to seek cancer information.

OBJECTIVES: To evaluate the applicability of the theory of reasoned action to explain men's intentions to seek prostate cancer information. METHODS: Three hundred randomly selected African American men participated in telephone interviews. Correlational and regression analyses were conducted to examine relationships among measures. RESULTS: All relationships were significant in regression analyses. Attitudes and subjective norm were significantly related to intentions. Indirect measures of beliefs derived from elicitation research were associated with direct measures of attitude and subjective norms. CONCLUSIONS: The data are sufficiently clear to support the applicability of the theory for this behavioral domain with African American men and suggest several important areas for future research.

Evaluation of an intervention for hospitalized African American smokers.

OBJECTIVE: To evaluate the effectiveness of a smoking cessation intervention based on the transtheoretical model of change with a sample of low-income African American smokers admitted to an indigent-care hospital. METHODS: The intervention incorporated components shown to be effective in increasing cessation in other populations, tailored to a bedside counseling format with follow-up contact postdischarge. RESULTS: Intervention patients were significantly more likely to advance in stage than were control patients. CONCLUSION: A hospital-offered bedside intervention offers promise in reaching underserved smokers with effective, though limited, cessation assistance.

Hospitalized smokers' expectancies for electronic cigarettes versus tobacco cigarettes.

INTRODUCTION: The objectives of the current study were to compare hospitalized smokers' expectancies for electronic cigarettes (e-cigarettes) against their expectancies for tobacco cigarettes and evaluate relationships between e-cigarette expectancies and intention to use e-cigarettes. METHODS: Analysis of baseline data from a one-year longitudinal observational study. The setting was a tertiary care academic center hospital in the Southeastern U.S. Participants were 958 hospitalized tobacco cigarette smokers. A questionnaire of e-cigarette expectancies based on the Brief Smoking Consequences Questionnaire-Adult (BSCQ-A) was developed and administered along with the original, tobacco-specific, BSCQ-A. Intention to use e-cigarettes was assessed with a single 10-point Likert scale item. RESULTS: Participants reported significantly weaker expectancies for e-cigarettes relative to tobacco cigarettes on all 10 BSCQ-A scales. Participants held sizably weaker expectancies that e-cigarettes pose health risks (p<.001, Cohen's d=-2.07), relieve negative affect (p<.001, Cohen's d=-1.01), satisfy the desire for nicotine (p<.001, Cohen's d=-.83), and taste pleasant (p<.001, Cohen's d=-.73). Among the strongest predictors of intention to use e-cigarettes were greater expectancies that e-cigarettes taste pleasant (p<.001, adjusted ß=.34), relieve negative affect (p<.001, adjusted ß=.32), and satisfy the desire for nicotine (p<.001, adjusted ß=.31). CONCLUSIONS: Hospitalized tobacco smokers expect fewer negative and positive outcomes from e-cigarettes versus tobacco cigarettes. This suggests that e-cigarettes might be viable though imperfect substitutes for tobacco cigarettes.

The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease.

From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function; thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities.

Transtheoretical model of change among hospitalized African American smokers.

OBJECTIVE: To examine predicted relationships among transtheoretical model of change measures in a sample of 211 low-income, African American hospitalized smokers. METHODS: We used discriminant analysis to examine differences in decisional balance and self-efficacy across stages of change for quitting. RESULTS: Differences in decisional balance and self-efficacy were concurrent with stage differences. The function discriminated among all 3 stages with the clearest differences between precontemplation and preparation. CONCLUSION: Although results with this specialized sample are not generalizable, they add to the evidence that transtheoretical model of change variables are robust across populations.

Improving the validity and reliability of a health promotion survey for physical therapists.

PURPOSE: Physical therapists (PTs) have a unique opportunity to intervene in the area of health promotion. However, no instrument has been validated to measure PTs' views on health promotion in physical therapy practice. The purpose of this study was to evaluate the content validity and test-retest reliability of a health promotion survey designed for PTs. METHODS: An expert panel of PTs assessed the content validity of "The Role of Health Promotion in Physical Therapy Survey" and provided suggestions for revision. Item content validity was assessed using the content validity ratio (CVR) as well as the modified kappa statistic. Therapists then participated in the test-retest reliability assessment of the revised health promotion survey, which was assessed using a weighted kappa statistic. RESULTS: Based on feedback from the expert panelists, significant revisions were made to the original survey. The expert panel reached at least a majority consensus agreement for all items in the revised survey and the survey-CVR improved from 0.44 to 0.66. Only one item on the revised survey had substantial test-retest agreement, with 55% of the items having moderate agreement and 43% poor agreement. CONCLUSIONS: All items on the revised health promotion survey demonstrated at least fair validity, but few items had reasonable test-retest reliability. Further modifications should be made to strengthen the validity and improve the reliability of this survey.

Crowdsourced peer- versus expert-written smoking-cessation messages.

BACKGROUND: Tailored, web-assisted interventions can reach many smokers. Content from other smokers (peers) through crowdsourcing could enhance relevance. PURPOSE: To evaluate whether peers can generate tailored messages encouraging other smokers to use a web-assisted tobacco intervention (Decide2Quit.org). METHODS: Phase 1: In 2009, smokers wrote messages in response to scenarios for peer advice. These smoker-to-smoker (S2S) messages were coded to identify themes. Phase 2: resulting S2S messages, and comparison expert messages, were then e-mailed to newly registered smokers. In 2012, subsequent Decide2Quit.org visits following S2S or expert-written e-mails were compared. RESULTS: Phase 1: a total of 39 smokers produced 2886 messages (message themes: attitudes and expectations, improvements in quality of life, seeking help, and behavioral strategies). For not-ready-to-quit scenarios, S2S messages focused more on expectations around a quit attempt and how quitting would change an individual's quality of life. In contrast, for ready-to-quit scenarios, S2S messages focused on behavioral strategies for quitting. Phase 2: In multivariable analysis, S2S messages were more likely to generate a return visit (OR=2.03, 95% CI=1.74, 2.35), compared to expert messages. A significant effect modification of this association was found, by time-from-registration and message codes (both interaction terms p<0.01). In stratified analyses, S2S codes that were related more to "social" and "real-life" aspects of smoking were driving the main association of S2S and increased return visits. CONCLUSIONS: S2S peer messages that increased longitudinal engagement in a web-assisted tobacco intervention were successfully collected and delivered. S2S messages expanded beyond the biomedical model to enhance relevance of messages. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT00797628 (web-delivered provider intervention for tobacco control [QUIT-PRIMO]) and NCT01108432 (DPBRN Hygienists Internet Quality Improvement in Tobacco Cessation [HiQuit]).

Pulmonary tuberculosis in mumbai, India: factors responsible for patient and treatment delays.

PURPOSE: To determine the factors responsible for patient delay and treatment delay in newly diagnosed sputum smear-positive pulmonary tuberculosis (TB) patients. METHODS: Study subjects (N = 150) were randomly selected from municipal health centers in Mumbai, India. Duration of symptoms, treatment, and reason for delay were assessed using interviews and medical records. We defined patient delay as presentation to a health care provider (HCP) >20 days of the onset of TB-related symptoms and treatment delay as therapy initiated more than 14 days after the first consultation (for TB-related symptoms) with an HCP. RESULTS: Of the 150 subjects, 29% had patient delays and 81% had treatment delays. In multivariable analysis, patient delay was significantly associated with the self-perception that initial symptoms were due to TB [odds ratio (OR) = 3.8, 95% confidence interval (CI) = 1.1-12.6] and perceived inability to pay for care (OR = 2.9, 95% CI = 1.2-7.1). Treatment delay was significantly associated with consulting a non-allopathic provider (OR = 12.3, 95% CI = 1.4-105) and consulting >3 providers (OR = 5.0, 95% CI = 1.4-17.4). Patient interval was half the treatment interval (median days: 15 vs. 31). Women were slightly more likely to experience patient and treatment delays than men. For two-thirds of the patients, another TB patient was a source of TB-related knowledge, while health education material (16%) and television (10%) played a smaller role. CONCLUSION: Treatment delay, primarily due to diagnosis delay, was a greater problem than patient delay. Expanding public-public and public-private partnerships and regular training sessions for HCPs might decrease treatment delay. Media coverage and cured TB patients as peer advocates may help to reinforce TB-related health education messages.

Efficacy of a web-based intervention to improve and sustain knowledge and screening for amblyopia in primary care settings.

PURPOSE: To evaluate the efficacy of a physician-targeted website to improve knowledge and self-reported behavior relevant to strabismus and amblyopia ("vision") in primary care settings. METHODS: Eligible providers (filing Medicaid claims for at least eight well-child checks at ages 3 or 4 years, 1 year before study enrollment), randomly assigned to control (chlamydia and blood pressure) or vision groups, accessed four web-based educational modules, programmed to present interactive case vignettes with embedded questions and feedback. Each correct response, assigned a value of +1 to a maximum of +7, was used to calculate a summary score per provider. Responses from intervention providers (IPs) at baseline and two follow-up points were compared to responses to vision questions, taken at the end of the study, from control providers (CPs). RESULTS: Most IPs (57/65) responded at baseline and after the short delay (within 1 hour after baseline for 38 IPs). A subgroup (27 IPs and 42 CPs) completed all vision questions after a long delay averaging 1.8 years. Scores from IPs improved after the short delay (median score, 3 vs. 6; P = 0.0065). Compared to CPs, scores from IPs were similar at baseline (P = 0.6473) and higher after the short-term (P < 0.0001) and long-term (P < 0.05) delay. CONCLUSIONS: Significant improvements after the short delay demonstrate the efficacy of the website and the potential for accessible, standardized vision education. Although improvements subsided over time, the IPs' scores did not return to baseline levels and were significantly better compared to CPs tested 1 to 3 years later.

Medication adherence among rural, low-income hypertensive adults: a randomized trial of a multimedia community-based intervention.

PURPOSE: Examine the effectiveness of a community-based, multimedia intervention on medication adherence among hypertensive adults. DESIGN: Randomized controlled trial. SETTING: Rural south Alabama. SUBJECTS: Low-income adults (N  =  434) receiving medication at no charge from a public health department or a Federally Qualified Health Center. INTERVENTION: Both interventions were home-based and delivered via computer by a community health advisor. The adherence promotion (AP) intervention focused on theoretical variables related to adherence (e.g., barriers, decisional balance, and role models). The cancer control condition received general cancer information. MEASURES: Adherence was assessed by pill count. Other adherence-related variables, including barriers, self-efficacy, depression, and sociodemographic variables, were collected via a telephone survey. ANALYSIS: Chi-square analysis tested the hypothesis that a greater proportion of participants in the AP intervention are ≥80% adherent compared to the control group. General linear modeling examined adherence as a continuous variable. RESULTS: Participants receiving the intervention did not differ from individuals in the control group (51% vs. 49% adherent, respectively; p  =  .67). Clinic type predicted adherence (p < .0001), as did forgetting to take medications (p  =  .01) and difficulty getting to the clinic to obtain medications (p < .001). CONCLUSIONS: Multilevel interventions that focus on individual behavior and community-level targets (e.g., how health care is accessed and delivered) may be needed to improve medication adherence among low-income rural residents.