Communicating medical device recalls: A rapid review of the literature.

OBJECTIVES: The U.S. Food and Drug Administration (FDA) currently regulates more than 190,000 different medical devices. Like all products, these devices may be subject to manufacturing problems, flawed designs, or new and unexpected risks, which in some cases require devices to be recalled. In 2021, the FDA's Patient Engagement Advisory Committee (PEAC) recommended that the FDA consider changes to the communication approach used for medical device recalls to make them more patient-focused, timely, and action-oriented. METHODS: To support this recommendation, we conducted a rapid review of literature published from 2008-2022 to capture and examine information on risk communication approaches, methods, and best practices for recall-related communications about medical products. RESULTS: We identified 23 articles to include in our review. CONCLUSION: Our review found a lack of research-based studies as well as gaps in understanding about consumer perspectives, comprehension, and communication preferences related to recalls. Despite these limitations, we identified current communication approaches, numerous challenges, and recommendations for communicating medical products recall information to consumers. PRACTICE IMPLICATIONS: Further research is needed to assess consumer attitudes, understanding, and preferences and to reach consensus on best practices for effectively communicating recall information to consumers of medical products.

Physical activity and sleep: An updated umbrella review of the 2018 Physical Activity Guidelines Advisory Committee report.

Physical activity (PA) is widely considered to improve sleep, but a comprehensive review of the research on this topic has not been performed. In this umbrella review, conducted initially for the 2018 Physical Activity Guidelines for Americans Advisory Committee and updated to reflect more recent research, we examined whether PA enhances sleep outcomes across the lifespan as well as among individuals with sleep disorders. Systematic reviews and meta-analyses were utilized to assess the evidence. We also examined dose-response considerations and whether the association between PA and sleep was moderated by various factors (e.g., timing, sociodemographic characteristics). We found strong evidence that both acute bouts of PA and regular PA improved sleep outcomes. Moderate evidence indicated that longer bouts of PA (both acute and regular) improved sleep, and that the effects of PA on sleep outcomes were generally preserved across adult age groups and sex. Finally, moderate evidence demonstrated that PA improved sleep in adults with insomnia symptoms or obstructive sleep apnea. Several important areas in need of future research were also identified. Overall, the review supported the claim that PA improves sleep, but highlighted gaps that need to be addressed to facilitate more widespread utilization of PA for improving sleep.

Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians.

As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCP) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude, and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for obstetrics/gynecology, internal medicine, and family medicine) was met. Self-reported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%), and mammograms (92.8%). Although most respondents (48.0%-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.Prevention Relevance: Primary care physicians are becoming more involved in cancer prevention management, so it is important that cancer risk assessment and medical society guideline recommendations for cancer prevention are better integrated into primary care to improve appropriate prescribing of cancer prevention interventions and help reduce cancer risk.

Application of Artificial Intelligence Methods to Pharmacy Data for Cancer Surveillance and Epidemiology Research: A Systematic Review.

PURPOSE: The implementation and utilization of electronic health records is generating a large volume and variety of data, which are difficult to process using traditional techniques. However, these data could help answer important questions in cancer surveillance and epidemiology research. Artificial intelligence (AI) data processing methods are capable of evaluating large volumes of data, yet current literature on their use in this context of pharmacy informatics is not well characterized. METHODS: A systematic literature review was conducted to evaluate relevant publications within four domains (cancer, pharmacy, AI methods, population science) across PubMed, EMBASE, Scopus, and the Cochrane Library and included all publications indexed between July 17, 2008, and December 31, 2018. The search returned 3,271 publications, which were evaluated for inclusion. RESULTS: There were 36 studies that met criteria for full-text abstraction. Of those, only 45% specifically identified the pharmacy data source, and 55% specified drug agents or drug classes. Multiple AI methods were used; 25% used machine learning (ML), 67% used natural language processing (NLP), and 8% combined ML and NLP. CONCLUSION: This review demonstrates that the application of AI data methods for pharmacy informatics and cancer epidemiology research is expanding. However, the data sources and representations are often missing, challenging study replicability. In addition, there is no consistent format for reporting results, and one of the preferred metrics, F-score, is often missing. There is a resultant need for greater transparency of original data sources and performance of AI methods with pharmacy data to improve the translation of these results into meaningful outcomes.

Cancer Prevention in Primary Care: Perception of Importance, Recognition of Risk Factors and Prescribing Behaviors.

PURPOSE: Acceptability and uptake of cancer preventive interventions is associated with physician recommendation, which is dependent on physician familiarity with available preventive options. The goal of this study is to evaluate cancer prevention perceptions, understanding of breast and ovarian cancer risk factors, and prescribing behaviors of primary care physicians. METHODS: We conducted cross-sectional. Web-based survey of 750 primary care physicians (250 each for obstetrics/gynecology, internal medicine, and family medicine) in the United States. Survey respondents were recruited from an opt-in health care provider panel. RESULTS: Perception of importance and the practice of recommending general and cancer-specific preventive screenings and interventions significantly differed by provider type. These perceptions and behaviors reflected the demographics of the population that the primary care physicians see within their respective practices. The majority of respondents recognized genetic/hereditary risk factors for breast or ovarian cancer, while epidemiologic or clinical risk factors were less frequently recognized. Prescribing behaviors were related to familiarity with the interventions, with physicians indicating that they more frequently reinforced a specialist's recommendation rather than prescribed a preventive intervention. CONCLUSIONS: Cancer prevention perceptions, recognition of cancer risk factors, and prescribing behaviors differ among practice types and were related to familiarity with preventive options. Cancer prevention education and risk assessment resources should be more widely available to primary care physicians.

Sedentary Behavior and Health: Update from the 2018 Physical Activity Guidelines Advisory Committee.

PURPOSE: To provide an overview of relationships between sedentary behavior and mortality as well as incidence of several noncommunicable diseases and weight status reported in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report (2018 PAGAC Scientific Report), and to update the evidence from recent studies. METHODS: Evidence related to sedentary behavior in the 2018 PAGAC Scientific Report was summarized, and a systematic review was undertaken to identify original studies published between January 2017 and February 2018. RESULTS: The 2018 PAGAC Scientific Report concluded there was strong evidence that high amounts of sedentary behavior increase the risk for all-cause and cardiovascular disease (CVD) mortality and incident CVD and type 2 diabetes. Moderate evidence indicated sedentary behavior is associated with incident endometrial, colon and lung cancer. Limited evidence suggested sedentary behavior is associated with cancer mortality and weight status. There was strong evidence that the hazardous effects of sedentary behavior are more pronounced in physically inactive people. Evidence was insufficient to determine if bout length or breaks in sedentary behavior are associated with health outcomes. The new literature search yielded seven new studies for all-cause mortality, two for CVD mortality, two for cancer mortality, four for type 2 diabetes, one for weight status, and four for cancer; no new studies were identified for CVD incidence. Results of the new studies supported the conclusions in the 2018 PAGAC Scientific Report. CONCLUSIONS: The results of the updated search add further evidence on the association between sedentary behavior and health. Further research is required on how sex, age, race/ethnicity, socioeconomic status, and weight status may modify associations between sedentary behavior and health outcomes.

Physical Activity Promotion: Highlights from the 2018 Physical Activity Guidelines Advisory Committee Systematic Review.

PURPOSE: This article describes effective interventions to promote regular physical activity and reduce sedentary behavior that were identified as part of the 2018 Physical Activity Guidelines Advisory Committee Scientific Report. METHODS: A comprehensive literature search was conducted of eligible systematic reviews, meta-analyses, and relevant governmental reports published between 2011 and 2016. For the physical activity promotion question, articles were first sorted by four social ecological levels of impact (i.e., individual, community, communication environment, and physical environment and policy levels) and then further sorted into more specific categories that emerged during the review process. For the sedentary behavior reduction question, the literature was sorted directly into emergent categories (i.e., youth, adult, and worksite interventions). RESULTS: Effective physical activity promotion strategies were identified at each level of impact, including those based on behavior change theories and those occurring at different settings throughout the community. Effective interventions also included those delivered in person by trained staff or peer volunteers and through different information and communication technologies, such as by phone, Web or Internet, and computer-tailored print. A range of built environment features were associated with more transit-based and recreational physical activity in children and adults. Effective sedentary reduction interventions were found for youth and in the workplace. CONCLUSIONS: A promising number of interventions with demonstrated effectiveness were identified. Future recommendations for research include investigating the most useful methods for disseminating them to real-world settings; incorporating more diverse population subgroups, including vulnerable and underrepresented subgroups; collecting cost data to inform cost-effectiveness comparisons; and testing strategies across different levels of impact to determine which combinations achieve the greatest effects on different modes of physical activity across the week.

Physical Activity in Cancer Prevention and Survival: A Systematic Review.

PURPOSE: This article reviews and updates the evidence on the associations between physical activity and risk for cancer, and for mortality in persons with cancer, as presented in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report. METHODS: Systematic reviews of meta-analyses, systematic reviews, and pooled analyses were conducted through December 2016. An updated systematic review of such reports plus original research through February 2018 was conducted. This article also identifies future research needs. RESULTS: In reviewing 45 reports comprising hundreds of epidemiologic studies with several million study participants, the report found strong evidence for an association between highest versus lowest physical activity levels and reduced risks of bladder, breast, colon, endometrial, esophageal adenocarcinoma, renal, and gastric cancers. Relative risk reductions ranged from approximately 10% to 20%. Based on 18 systematic reviews and meta-analyses, the report also found moderate or limited associations between greater amounts of physical activity and decreased all-cause and cancer-specific mortality in individuals with a diagnosis of breast, colorectal, or prostate cancer, with relative risk reductions ranging almost up to 40% to 50%. The updated search, with five meta-analyses and 25 source articles reviewed, confirmed these findings. CONCLUSIONS: Levels of physical activity recommended in the 2018 Guidelines are associated with reduced risk and improved survival for several cancers. More research is needed to determine the associations between physical activity and incidence for less common cancers and associations with survival for other cancers. Future studies of cancer incidence and mortality should consider these associations for population subgroups, to determine dose-response relationships between physical activity and cancer risk and prognosis, and to establish mechanisms to explain these associations.

Acceptability of Localized Cancer Risk Reduction Interventions Among Individuals at Average or High Risk for Cancer.

Individuals at high risk for cancer, including those already diagnosed with premalignant lesions, can potentially benefit from chemopreventive interventions to reduce cancer risk. However, uptake and acceptability have been hindered due to the risk of systemic toxicity and other adverse effects. Locally delivered chemopreventive agents, where direct action on the primary organ may limit systemic toxicity, are emerging as an option for high-risk individuals. While a number of clinical trials support the development of chemopreventive agents, it is crucial to understand the factors and barriers that influence their acceptability and use. We conducted 36 focus groups with 198 individuals at average and high risk of breast/ovarian, gynecologic, and head/neck/oral and lung cancers to examine the perceptions and acceptability of chemopreventive agents. Participants' willingness to use chemopreventive agents was influenced by several factors, including perceived risk of cancer, skepticism around prevention, previous knowledge of chemopreventive agents, support from trusted sources of health information, participation in other cancer-related risk-reduction activities, previous experience with similar modalities, cost, regimen, side effects, and perceived effectiveness of the preventive intervention. Our findings indicate that individuals may be more receptive to locally delivered chemopreventive agents if they perceive themselves to be at high risk for cancer and are given the necessary information regarding regimen and side effects to make an informed decision. Clinical trials that collect additional patient-centered data including side effects and how these interventions fit into an individual's lifestyle are imperative to improve uptake of chemopreventive agents.

A qualitative study of barriers and opportunities for concussion communication and management among parents of youth sports athletes.

BACKGROUND: Concussion, a commonly reported injury among young athletes, can lead to short- and long-term physical, cognitive, emotional, and sleep-related symptoms. Parents are in a unique position to help identify a possible concussion and to support an athlete's recovery. METHODS: This qualitative study used a focus group methodology to explore five research questions focused on two main topics: (1) parents' perception of concussion and (2) parent-athlete communication. Two authors independently reviewed notes from each of the focus groups and then generated a list of emerging themes related to five research questions. RESULTS: Parents in this study valued and were interested in discussing concussion with their athletes. However, parents were uncertain about their role in promoting concussion safety and often rely on coaches to communicate with athletes about concussion reporting and recovery. Participants described barriers their athletes may face in concussion reporting and suggested strategies to improve communication about both reporting and recovery. CONCLUSION: Concussion education efforts may benefit from promoting specific actions parents can take to prevent concussion and how to communicate effectively with their child about reporting a possible concussion.

Umbrella and Systematic Review Methodology to Support the 2018 Physical Activity Guidelines Advisory Committee.

INTRODUCTION: In 2016, the 2018 Physical Activity Guidelines Advisory Committee, a group of experts in exercise science and health, began an extensive review of the literature to inform the second edition of the Physical Activity Guidelines for Americans. METHODS: The purpose of this paper is to describe the evidence-based methodology used to review, evaluate, and synthesize published, peer-reviewed physical activity research. The protocol-driven methodology was designed to maximize transparency, minimize bias, and ensure relevant, timely, and high-quality systematic reviews. Training protocols, quality control procedures, search strategies, assessment instruments, abstraction guides and forms, and reporting templates were developed. RESULTS: A systematic approach was used to select the evidence for the 2018 Physical Activity Guidelines Advisory Committee Scientific Report that included umbrella reviews and systematic reviews. Within 16 months, 38 searches were conducted; and 20,838 titles, 4913 abstracts, and 2139 full texts were triaged. Of those, 1130 articles were abstracted to answer 38 research questions. CONCLUSIONS: To inform population-based physical activity guidelines, this systematic process facilitated a vast review of the literature on physical activity and health in a short period of time. This flexible, yet rigorous and transparent process included a clear and detailed methodology with a focus on training and quality control.

Healthcare providers' attitudes and behaviours related to paediatric mild traumatic brain injury: results from the 2014 DocStyles survey.

OBJECTIVE: Explore healthcare providers' experiences managing mTBI and better understand their use of mTBI assessment tools and guidelines. Cross-sectional Methods: A random sample of 1,760 healthcare providers responded to the web-based DocStyles survey between June 18 and 30, 2014. The sample included family/general practitioners, internists, pediatricians, and nurse practitioners who reported seeing pediatric patients. We examined their experiences with mTBI to identify opportunities to increase preparedness and improve management of mTBI. RESULTS: Fifty-nine percent of healthcare providers reported that they diagnosed or managed pediatric patients with mTBI within the last 12 months. Of those, 44.4% felt 'very prepared' to make decisions about when pediatric patients can safety return to activities, such as school and sports after a mTBI. When asked how often they use screening or assessment tools to assess pediatric patients with mTBI, almost half reported that they 'seldom' or 'never' use those resources (24.6% and 22.0%, respectively). CONCLUSION: Most healthcare providers reported seeing pediatric patients with mTBI, yet most feel only somewhat prepared to manage this injury in their practise. Broader use of screening tools and guidelines, that include clinical decision support tools, may be useful for healthcare providers who care for pediatric patients with mTBI.

Geospatial approaches to cancer control and population sciences at the United States cancer centers.

PURPOSE: Geospatial, contextual, and multilevel research is integral to cancer prevention and control. NCI-designated Cancer Centers are at the forefront of cancer research; therefore, this paper sought to review the geospatial, contextual, and multilevel research at these cancer centers. METHODS: Investigators used PubMed and Web of Science to compile geospatial publications from 1971 to February 2016 with cancer center-affiliated authors. Relevant abstracts were pulled and classified by six geospatial approaches, eight geospatial scales, and eight cancer sites. RESULTS: The searches identified 802 geospatial, contextual, and multilevel publications with authors affiliated at 60 of the 68 NCI-designated Cancer Centers. Over 90% were published after 2000. Five cancer centers accounted for approximately 50% of total publications, and 30 cancer centers accounted for over 85% of total publications. Publications covered all geospatial approaches and scales to varying degrees, and 90% dealt with cancer. CONCLUSIONS: The NCI-designated Cancer Center network is increasingly pursuing geospatial, contextual, and multilevel cancer research, although many cancer centers still conduct limited to no research in this area. Expanding geospatial efforts to research programs across all cancer centers will further enrich cancer prevention and control. Similar reviews may benefit other domestic and international cancer research institutions.

Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey.

BACKGROUND: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. OBJECTIVE: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. METHODS: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. RESULTS: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than -2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. CONCLUSIONS: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations.

eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults.

BACKGROUND: Baby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information. OBJECTIVE: The intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults. METHODS: A random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information. RESULTS: Almost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t217.60=-2.98, P=.003. Younger age (b=-0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R(2) =.17, R(2)adj =.14, F9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information. CONCLUSIONS: Being younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making.

Engaging community stakeholders to evaluate the design, usability, and acceptability of a chronic obstructive pulmonary disease social media resource center.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often report inadequate access to comprehensive patient education resources. OBJECTIVE: The purpose of this study was to incorporate community-engagement principles within a mixed-method research design to evaluate the usability and acceptability of a self-tailored social media resource center for medically underserved patients with COPD. METHODS: A multiphase sequential design (qual → QUANT → quant + QUAL) was incorporated into the current study, whereby a small-scale qualitative (qual) study informed the design of a social media website prototype that was tested with patients during a computer-based usability study (QUANT). To identify usability violations and determine whether or not patients found the website prototype acceptable for use, each patient was asked to complete an 18-item website usability and acceptability questionnaire, as well as a retrospective, in-depth, semistructured interview (quant + QUAL). RESULTS: The majority of medically underserved patients with COPD (n=8, mean 56 years, SD 7) found the social media website prototype to be easy to navigate and relevant to their self-management information needs. Mean responses on the 18-item website usability and acceptability questionnaire were very high on a scale of 1 (strongly disagree) to 5 (strongly agree) (mean 4.72, SD 0.33). However, the majority of patients identified several usability violations related to the prototype's information design, interactive capabilities, and navigational structure. Specifically, 6 out of 8 (75%) patients struggled to create a log-in account to access the prototype, and 7 out of 8 patients (88%) experienced difficulty posting and replying to comments on an interactive discussion forum. CONCLUSIONS: Patient perceptions of most social media website prototype features (eg, clickable picture-based screenshots of videos, comment tools) were largely positive. Mixed-method stakeholder feedback was used to make design recommendations, categorize usability violations, and prioritize potential solutions for improving the usability of a social media resource center for COPD patient education.

Web 2.0 chronic disease self-management for older adults: a systematic review.

BACKGROUND: Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults. OBJECTIVE: To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s). METHODS: A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles. RESULTS: Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions. CONCLUSIONS: There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

Examining the association between binge drinking and propensity to join the military.

It is unclear to what degree previous and/or current alcohol consumption predicts enlistment into the military. The current investigation explored the extent to which binge drinking was related to propensity to join the military among a national sample of high school seniors (n = 14,577) responding to the 2008 Monitoring the Future survey. Independent sample t-tests and logistic regression analyses were employed to explore the research question. Results indicated that twelfth grade students who intended to join the military after graduating from high school binge drank a significantly greater number of days (p < 0.001, Cohen's d = -0.22) than those not intending to enlist. Even after controlling for various sociodemographic and lifetime drinking characteristics, binge drinkers had a higher propensity to join the military (odds ratio = 1.079, Wald = 5.53, df = 1, p < 0.05) than those who did not binge. Moreover, as binge drinking increased, so did one's propensity to join the military. Our findings lend credence to the notion that high school binge drinkers may be self-selecting into military service. These findings underscore the importance of adequately assessing the frequency of high-risk alcohol consumption and their associated correlates among potential military recruits before accession.

Analysis of ehealth search perspectives among female college students in the health professions using Q methodology.

BACKGROUND: The current "Millennial Generation" of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students. OBJECTIVE: To systematically identify health professional college student perspectives of personal eHealth search practices. METHODS: Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives. RESULTS: Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants' objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task. CONCLUSIONS: Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet.

eHealth literacy among college students: a systematic review with implications for eHealth education.

BACKGROUND: eHealth literacy refers to the ability of individuals to seek, find, understand, and appraise health information from electronic resources and apply such knowledge to addressing or solving a health problem. While the current generation of college students has access to a multitude of health information on the Internet, access alone does not ensure that students are skilled at conducting Internet searches for health information. Ensuring that college students have the knowledge and skills necessary to conduct advanced eHealth searches is an important responsibility particularly for the medical education community. It is unclear if college students, especially those in the medical and health professions, need customized eHealth literacy training for finding, interpreting, and evaluating health- and medical-related information available on the Internet. OBJECTIVE: The objective of our review was to summarize and critically evaluate the evidence from existing research on eHealth literacy levels among college students between the ages of 17 and 26 years attending various 4-year colleges and universities located around the world. METHODS: We conducted a systematic literature review on numerous scholarly databases using various combinations of relevant search terms and Boolean operators. The records were screened and assessed for inclusion in the review based on preestablished criteria. Findings from each study that met inclusion criteria were synthesized and summarized into emergent themes. RESULTS: In the final review we analyzed 6 peer-reviewed articles and 1 doctoral dissertation that satisfied the inclusion criteria. The number of participants in each reviewed study varied widely (from 34 to 5030). The representativeness of the results from smaller studies is questionable. All studies measured knowledge and/or behaviors related to college student ability to locate, use, and evaluate eHealth information. These studies indicated that many college students lack eHealth literacy skills, suggesting that there is significant room for improvement in college students' ability to obtain and evaluate eHealth information. CONCLUSION: Although college students are highly connected to, and feel comfortable with, using the Internet to find health information, their eHealth literacy skills are generally sub par. College students, especially in the health and medical professions, would be well served to receive more customized college-level instruction that improves general eHealth literacy.