The digital divide in adoption and use of mobile health technology among caregivers of pediatric surgery patients.

PURPOSE: The purpose of this study was to identify mobile Health (mHealth) technology utilization among caregivers of pediatric surgery patients. METHODS: We provided a modified version of the 2012 mobile health survey from the Pew Research Center to English and Spanish-speaking caregivers of children aged <18years presenting to pediatric surgical outpatient clinics from June to July of 2016. RESULTS: A total of 171 caregivers completed the survey and included 57 (34%) whites, 30 (18%) blacks, 75 (44%) Hispanics, and 6 (4%) other races. Among these, 160 (94%) were smartphone owners. mHealth users were identified as individuals who used their phone to look up health information online, receive text updates from healthcare providers or pharmacists, or use any health-related smartphone applications. On univariate ordered logistic regression, race/ethnicity, primary language, education level, and income quartile were associated with level of mHealth technology use. The majority of responders (n=126, 76%) said that they would be very or moderately interested in trying a new smartphone app related to management of their child's health. CONCLUSION: While the majority of pediatric caregivers are smartphone owners, there are significant racial and socioeconomic differences in mHealth usage. Understanding these differences may be important in identifying barriers to adoption of mHealth technology. LEVEL OF EVIDENCE: Level IV case series with no comparison group.

The role of pain in quitting among human immunodeficiency virus (HIV)-positive smokers enrolled in a smoking cessation trial.

BACKGROUND: Smoking rates among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS; PLWHA) are at least twice as high as rates in the general population. Consistent with the reciprocal model of pain and smoking, PLWHA with pain who smoke may use smoking as a means of coping with pain, thus presenting a potential barrier to quitting. The aim of this study is to better understand how pain relates to smoking cessation among 474 HIV-positive adults enrolled in a cell phone-delivered smoking cessation trial. METHODS: Participants were randomly assigned to usual care (cessation advice and self-help materials) or 11 sessions of cell phone-delivered smoking cessation treatment. Pain, as assessed by the Medical Outcomes Study-HIV Health Survey (MOS-HIV), and point prevalence abstinence were collected at the 3-month treatment end and at 6- and 12-month follow-ups. Self-reported abstinence was biochemically verified by expired carbon monoxide (CO) level of <7 ppm. RESULTS: Using multilevel modeling for binary outcome data, the authors examined the relationship between pain and abstinence, from treatment end through the 12-month follow-up. Consistent with the authors' hypothesis, less pain was associated with greater likelihood of 24-hour (ß = .01, t(651) = 2.53, P = .01) and 7-day (ß = .01, t(651) = 2.35, P = .02) point prevalence abstinence, controlling for age, gender, baseline pain, nicotine dependence, and treatment group. No pain × treatment group interaction was observed. CONCLUSIONS: These results can help us to better identify PLWHA at greater risk for relapse in smoking cessation treatment. Future research may examine the effectiveness of more comprehensive smoking cessation treatment that incorporates aspects of pain management for PLWHA who smoke and have high pain and symptom burden.

A pilot randomized trial to prevent sexual dysfunction in postmenopausal breast cancer survivors starting adjuvant aromatase inhibitor therapy.

PURPOSE: A randomized pilot trial evaluated the hypothesis that early intervention lessens sexual dysfunction in the first year on aromatase inhibitors. A secondary aim was comparing the efficacy of two vaginal moisturizers. METHODS: Fifty-seven postmenopausal women with early stage breast cancer starting aromatase inhibitors were randomized to three treatment groups. All received a handout on managing sexual and other side effects. The Usual Care group received no additional therapy. The Active Treatment groups received a 6-month supply of a vaginal moisturizer (hyaluronic acid-based in Active Group-H and prebiotic in Active Group-P) and a vaginal lubricant and dilator, plus access to an educational website and phone coaching. Questionnaires completed at baseline, 6, and 12 months included the Female Sexual Function Index (FSFI), Menopausal Sexual Interest Questionnaire (MSIQ), Female Sexual Distress Scale-Revised (FSDS-R), and a menopausal symptom scale. RESULTS: Forty-nine women (86%) provided follow-up data. Mean age was 59 and 77% were non-Hispanic Caucasian. Sexual function was impaired at baseline, but remained stable over 12 months for all groups. The combined active treatment group had less dyspareunia (P = 0.07) and sexual distress (P = 0.02) at 6 months than the Usual Care group. At 6 months, the Active-H group improved significantly more than the Active-P group on FSFI total score (P = 0.04). CONCLUSIONS: Sexual counseling helped women maintain stable sexual function on aromatase inhibitors. Active intervention resulted in better outcomes at 6 months. IMPLICATIONS FOR CANCER SURVIVORS: This promising pilot trial suggests a need for more research on preventive counseling to maintain sexual function during aromatase inhibitor treatment.

The Association of Pain With Smoking and Quit Attempts in an Electronic Diary Study of Cancer Patients Trying to Quit.

INTRODUCTION: The purpose of this electronic daily diary study was to examine the relation of pain to smoking and quit attempts among 34 cancer patients with pain enrolled in a smoking cessation program. METHODS: Electronic daily diary assessments of pain and smoking were collected at the end of each day for a 2-week period during smoking cessation treatment. Pain experienced throughout the day was measured on a scale from 1 to 5, from "no pain" to "pain as bad as you can imagine." Smoking was defined as the number of cigarettes smoked per day. RESULTS: Linear multilevel modeling was used in examining associations between pain and smoking. A within-person pain and smoking association was found, such that greater daily pain was linked to greater daily smoking within individuals, controlling for baseline symptoms, nicotine dependence, smoking urge, age, and gender. No between-person pain and smoking association was observed. Additionally, cancer patients with higher average pain across the 2-week assessment period were less likely to make a quit attempt (defined as a day on which participants smoked no cigarettes) during the study period. CONCLUSIONS: The findings of this study add to a nascent literature on pain and smoking by providing initial evidence that pain may be a barrier to quitting among cancer patients who smoke and have pain. Future research examining the effectiveness of integrated pain and smoking cessation treatment in this population may be warranted.

Sexual problems during the first 2 years of adjuvant treatment with aromatase inhibitors.

INTRODUCTION: Sexual dysfunction has only recently been recognized as a highly prevalent side effect of adjuvant aromatase inhibitor (AI) therapy for breast cancer. AIMS: A cross-sectional survey using standardized measures of female sexual function was designed to provide a detailed view of sexual problems during the first 2 years of adjuvant AI therapy and secondarily to examine whether sexual dysfunction leads to nonadherence to this therapy. METHODS: Questionnaires were mailed to all 296 women in a breast oncology registry who had been prescribed a first-time AI for localized breast cancer 18-24 months previously. MAIN OUTCOME MEASURES: Items assessed medication adherence, demographic, and medical information. Scales included the Female Sexual Function Index, the Menopausal Sexual Interest Questionnaire, the Female Sexual Distress Scale-Revised, the Breast Cancer Prevention Trial Eight Symptom Scale to assess menopausal symptoms, and the Merck Adherence Estimator(®) . RESULTS: Questionnaires were returned by 129 of 296 eligible women (43.6%). Respondents were 81% non-Hispanic white with a mean age of 63 and 48% had at least a college degree. Only 15.5% were nonadherent. Ninety-three percent of women scored as dysfunctional on the Female Sexual Function Index, and 75% of dysfunctional women were distressed about sexual problems. Although only 52% of women were sexually active when starting their AI, 79% of this group developed a new sexual problem. Fifty-two percent took action to resolve it, including 24% who stopped partner sex, 13% who changed hormone therapies, and 6% who began a vaginal estrogen. Scores on the Adherence Estimator (beliefs about efficacy, value, and cost of medication) were significantly associated with adherence (P = 0.0301) but sexual function was not. CONCLUSIONS: The great majority of women taking AIs have sexual dysfunction that is distressing and difficult to resolve. Most continue their AI therapy, but a large minority cease sexual activity.

Reducing patient burden to the FACT-Melanoma quality-of-life questionnaire.

Respondent burden has been defined as the cumulative demand placed on study participants related to the use of questionnaires or measurement instruments. The aim of this study was to reduce respondent burden associated with the Functional Assessment of Cancer Therapy-Melanoma (FACT-M), a melanoma-specific quality-of-life questionnaire, through item reduction using multiple psychometric approaches. Data for this study were pooled from three institutional review board-approved protocols. Poorly performing items were identified through distributional and correlation analyses, confirmatory factor analysis, reliability estimation, and Rasch-based approaches in a developmental dataset, and the reduced scale was assessed in a separate testing cohort. Validity, reliability, goodness of fit, and Rasch-based testing were carried out for both the full and the reduced scales. The clinical characteristics of the development (n=198) and testing (n=204) cohorts were similar. Three items identified through classical psychometric approaches and three items identified by Rasch-based analyses were excluded from the FACT-M subscale. Two additional items were identified for potential reduction but were ultimately maintained due to the adverse consequences to the psychometric integrity of the reduced instrument. The reduced FACT-M module contains 18 items. In addition to psychometric assessment, expert consultation was essential when examining areas of content redundancy and was critical when considering specific items for removal. This methodological approach reduced respondent burden by 25% while maintaining the psychometric integrity of the FACT-M.

Accelerometry and self-report in sedentary populations.

OBJECTIVES: To determine whether self-reported exercise duration and intensity matched accelerometer data in sedentary endometrial cancer survivors and age-matched controls. METHODS: Participants were asked to wear an accelerometer and self-report exercise bouts, duration, and intensity for one week. Self-reported duration was compared with accelerometer data. RESULTS: Self-reported exercise-bout duration matched accelerometer duration 93% for survivors and 99% for controls. Self-reported exercise-bout intensity matched accelerometer intensity 70% for survivors and 66% for controls. There were no significant differences between groups. CONCLUSIONS: Sedentary endometrial cancer survivors and controls self-reported duration and intensity of physical activity consistent with accelerometer data.

Effects of treatment factors, comorbidities and health-related quality of life on self-efficacy for physical activity in cancer survivors.

OBJECTIVE: The physical and psychological benefits of exercise for cancer survivors are well documented. Researchers have examined self-efficacy (SE) as a target for promoting exercise; however, the predictors of SE, including treatment factors and comorbidities, have not been examined extensively. The purpose of this cross-sectional analysis was to examine how variables related to cancer and cancer treatment, comorbid health problems, health-related quality of life (QOL), and depression relate to SE for physical activity in cancer survivors. METHODS: This secondary analysis examined treatment factors, comorbidity, and QOL data from 148 breast cancer and 134 prostate cancer survivors who had participated in studies examining exercise and QOL. A predictive regression model was developed by testing each variable individually with SE and including the variables that had a significance of

Outcome expectations, expectancy accessibility, and exercise in endometrial cancer survivors.

Studies have shown that expectations about exercise outcomes are associated with exercise behavior. Outcome expectations can be assessed by self-report questionnaires, but a new method-the expectancy accessibility task-may convey unique information about outcome expectations that is less subject to respondent biases. This method involves measuring the reaction time to endorse or reject an outcome We examined the relationship of self-reported outcome expectations and expectancy accessibility tasks in a pilot study of sedentary endometrial cancer survivors (N = 20). After measuring outcome expectations and expectancy accessibility, participants were given an exercise program and asked to monitor exercise for 7 days using diaries and accelerometers. Analyses revealed no relationship between outcome expectation scores and exercise, but shorter response times to endorse positive exercise outcomes was related to more exercise in the next week (p = .02).