The Effect of Minority Stress Processes on Stage of Change and Nicotine Dependence Level for Sexual and Gender Minority Smokers in the Deep South.

Purpose: Minority stress has been posited as a cause for sexual and gender minority (SGM) individuals to smoke as a coping mechanism. The purpose of this study was to elucidate the relationship between minority stress processes and nicotine dependence level and stage of change for SGM smokers living in the Deep South region of the United States. Methods: A one-time, cross-sectional online survey was administered to SGM smokers living in the Deep South. Survey measurements included demographics, minority stress processes (prejudice events, perceived stigma, and internalized queerphobia), and smoking cessation outcomes (nicotine dependence level and stage of change). Multivariable linear regression was used to assess the effect of each minority stress process on smoking outcomes, after adjusting for demographics and stratifying by gender and sexual identity. Results: Across all participants (n = 1296), lower levels of perceived stigma were significantly associated with further stage of change. Greater levels of internalized queerphobia were significantly associated with greater nicotine dependence level. After stratifying by gender and sexual identity, these significant associations were only maintained in cisgender males and gay individuals. An additional significant association between lower prejudice events and further stage of change for smoking cessation was found only for individuals whose sexual identity was labeled as "other." Conclusion: Addressing minority stress in smoking cessation and prevention programs has the potential to decrease nicotine dependence and further stage of change.

Exploring Successful Implementation of Organizational Supports at the Worksite Environment: A Mixed Methods Approach.

While there is evidence that organizational supports may lead to better employee health, research on implementing such organizational supports is lacking. This research sought to understand organizational supports and implementation of those supports using an Explanatory Sequential Mixed Methods design approach. Employee survey responses (n = 202) were used to classify organizations into "high" and "low" categories for employee-reported health behavior improvement, agreement, and readiness for implementing change. For the qualitative phase of research (organization-level), semi-structured interviews were conducted with organization leads, and data were analyzed through constant comparative analysis procedure. Analyses sought to identify differences between "high" versus "low" organizations. In addition, the researcher used the "high" and "low" classifications to further review themes that emerged, to determine where there may be differences in organizations classified as "high" versus "low." Study results found the following nine themes to explain how organizations can improve implementing organizational supports: provide a contracted wellness program, formalized programming, and wellness incentives; create a culture of wellness in the organization; provide consistency in the supports offered; provide clear communication to employees; utilize leadership role modeling to show support; focus on leadership support that ensures organizational supports are implemented and sustained; and work to combat employee hesitation of organizational supports. The results of this study show that organizations have the opportunity to improve implementation of their organizational supports by applying the nine themes found.

Use of Geographic Information System Technology to Evaluate Health Disparities in Smoking Cessation Class Accessibility for Patients in Louisiana Public Hospitals.

Research has shown cigarette smoking is a major risk factors for many type of cancer or cancer prognosis. Tobacco related health disparities were addressed continually in cancer screening, diagnosis, treatment, prevention and control. The present study evaluated the health disparities in attendance of smoking cessation counseling classes for 4,826 patients scheduled to attend between 2005 and 2007. Of 3,781 (78.4%) patients with records to calculate the distance from their home domicile to counseling sites using Geographic Information System technology, 1,435 (38%) of smokers who attended counseling had shorter travel distances to counseling sites (11.6 miles, SD = 11.29) compared to non-attendees (13.4 miles, SD = 16.72). When the travel distance was >20 miles, the estimated odds of attending decreased with greater travel distance. Smokers who actually attended were more likely to be older, female, White, living in urban areas, and receiving free healthcare. After controlling for other socio-demographic factors, shorter distances were associated with greater class attendance, and individuals more likely to attend included those that lived closer to the counseling site and in urban settings, were female, White, commercially insured, and older than their counterparts. These findings have the potential to provide important insights for reducing health disparities for cancer prevention and control, and to improve shared decision making between providers and smokers.

Association Between the 5As and Stage of Change Among African American Smokers Eligible for Low-Dose Computed Tomography Screening.

We investigated the association between the 5As (Ask, Advise, Assess, Assist, and Arrange) clinical protocol and stage of change among African American smokers who are eligible for low-dose computed tomography screening. In 2019, 60 African American daily smokers aged 55 years or older were recruited in a large hospital in New Orleans, Louisiana. Smokers who received assistance for smoking cessation were more likely to be in the preparation stage than those who did not receive any assistance. Assistance from health professionals is an essential form of support and may substantially enhance smokers' motivation to quit smoking in this population that is at higher risk for mortality from lung cancer.

Smoking Relapse and Type 2 Diabetes Mellitus-Related Emergency Department Visits Among Senior Patients with Diabetes.

INTRODUCTION: Quitting smoking has been proven to benefit smokers with diabetes. However, among older patients with diabetes, the evidence regarding an association between smoking status and the risk of type 2 diabetes mellitus-related emergency department (ED) visits has not been well investigated. METHODS: A retrospective cohort study was performed by using the Louisiana State University Health Care Services Division electronic health records from 2009 to 2011. Patients aged 65 years or older with type 2 diabetes and smoking status recorded at least twice in 2010 were selected. Selected patients with diabetes were classified into nonsmokers, former smokers, continuing smokers, and relapsed smokers. Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) of 1-year type 2 diabetes-related ED visits for each group compared with nonsmokers. RESULTS: There were 174 (8.2%) continuing smokers and 77 (3.6%) relapsed smokers in 2,114 patients with diabetes who were studied. Rates of type 2 diabetes-related ED visits were highest in relapsed smokers (28.6%). Compared with nonsmokers, relapsed smokers had a significantly higher risk of type 2 diabetes-related ED visits (aHR = 1.62; 95% confidence interval [CI], 1.04-2.50). After stratifying by sex, a significantly increased risk of type 2 diabetes-related ED visits was shown only in male relapsed smokers (aHR = 2.05; 95% CI, 1.13-3.71) and female continuing smokers (aHR = 1.65; 95% CI, 1.10-2.47) compared with nonsmokers. CONCLUSION: Older men with diabetes who were relapsed smokers had a higher risk of type 2 diabetes-related ED visits. Future research and clinical practice should focus on these patients and create more effective interventions for smoking cessation and diabetes management.

Racial and Income Disparities in Health-Related Quality of Life among Smokers with a Quit Attempt in Louisiana.

Background and objectives: Smoking is associated with a lower health-related quality of life (HRQOL). However, there is little information about the association between HRQOL in relation to race, income, and smoking status. The present study aimed to assess the association between HRQOL and smoking status for those of different races and income levels. Materials and Methods: This study applied a cross-sectional design using data from the 2017 patient survey of the Louisiana Tobacco Control Initiative. We obtained 1108 responses from patients at eight Louisiana public hospitals. The EuroQol (EQ-5D) US index score assessed HRQOL. Smoking status was classified into four groups: never smoked, former smoker, current smoker with a quit attempt, and current smoker without a quit attempt. Multivariate linear regression analyses were used to estimate the HRQOL for black or African Americans and whites. Results: The patients were predominantly black or African American (58.9%) with lower-income (71.2%). Bivariate analyses showed that there were differences in income levels between black or African Americans and whites (p = 0.006). Moreover, black or African Americans (median = 0.80) had a higher mean of HRQOL than whites (median = 0.76). Among lower-income black or African Americans, current smokers with a quit attempt had a lower HRQOL than current smokers (coefficient = -0.12; p < 0.01). Conclusions: Racial and income disparities were evident with regards to HRQOL, with lower-income black or African Americans who were current smokers with a quit attempt having a lower HRQOL. Intervention programs for smoking cessation should target lower-income black or African American smokers who have a prior quit attempt and provide effective cessation services to help them quit smoking and improve their HRQOL.

Knowledge and attitudes towards low dose computed tomography lung cancer screening and smoking among African Americans-a mixed method study.

BACKGROUND: The purpose of this study is to investigate knowledge, attitudes, and smoking cessation needs for African Americans who receive low dose computed tomography (LDCT) in an effort to reduce the health burden of lung cancer. METHODS: A mixed method study was conducted among African Americans who received LDCT. Data were gathered using a self-administered questionnaire and structured in-depth interview. Descriptive statistics were used to provide summary information on knowledge, attitude and smoking behaviors. Thematic analysis was used to analyze interview data. The sample size for both the quantitative and qualitative approach was fifteen. RESULTS: The results showed that 73% of participants were male, the mean age was 61.8 (SD =4.6) years old, and 66.7% of participants had an income less than $20,000. Eighty percent had an education level of high school or below and 73.3% were overweight or obese. Smoking history was long (mean years =39 SD =14.9), but the number of cigarettes smoked per day was low (mean =9.2 SD =7.3), and 64% of the patients had a low nicotine dependence. Assessment of knowledge and attitudes towards LDCT revealed that participants had a moderate/lower knowledge score (mean =4.3 SD =2.6), and most had a positive attitude. All participants planned to quit smoking, with 73% planning to quit within the next 6 months. Similar findings were also observed in the qualitative analysis. CONCLUSIONS: African Americans who receive LDCT lung cancer screening in this study have a moderate/lower knowledge score and positive attitude towards LDCT. Most were not heavy smokers and had a lower nicotine dependence. Understanding the factors associated with smoking cessation among at-risk African American smokers will help reduce disparities in lung cancer burden, and is important to improve health for medically underserved minority populations.

Health beliefs associated with poor disease self-management in smokers with asthma and/or COPD: a pilot study.

Background: Compared to nonsmokers, smokers with chronic disease are less likely to adhere to self-management recommendations for the management of their chronic conditions. Although the literature notes poor adherence trends in smokers, actual influences of adherence in these patients require further study. This study examines the health beliefs that influence self-management behaviors in smokers with chronic lung disease. Methods: This prospective, cross-sectional study surveyed patients (n = 83) seen in the pulmonary outpatient clinics of the University Medical Center of New Orleans between November 2015 and February 2016. Eligible patients included those between 40-64 years old diagnosed with asthma and/or chronic obstructive pulmonary disease (COPD). Primary measures included perceived beliefs related to the susceptibility to asthma and/or COPD becoming worse, perceived barriers to adherence, and perceived benefits to adherence. Patient characteristics under-study included smoking status, race, gender, and diagnosis. Descriptive and chi-square analyses were performed to characterize the sample. Student's t and and regression analyses were conducted to examine the relationships between perceptions, smoking status, race, gender, and diagnosis. Results: Compared to nonsmokers, smokers perceived their asthma and/or COPD becoming worse (p = 0.0023). Smokers also perceived more barriers (p < 0.0001), and fewer benefits to adherence than nonsmokers (p = 0.0021). Conclusion: The health beliefs of smokers may influence their self-management behaviors. Results of this study can inform the development of services that target smokers in order to improve adherence to self-management behaviors and health outcomes.

Differences in Treating Tobacco Use Across National, State, and Public Hospital System Surveys.

The Louisiana Tobacco Control Initiative (TCI), a multidisciplinary program specializing in helping tobacco users quit, assisted health care providers in Louisiana's public hospitals with integrating evidence-based treatment of tobacco use into clinical practice. Our study compared smoking behavior, provider adherence to the 5 A's tobacco cessation intervention (ask, advise, assess, assist, and arrange), cessation assistance awareness, quit attempts, and treatment preference among respondents to a TCI survey with a sample of respondents from the National Adult Tobacco Survey (NATS) and a sample from the Louisiana Adult Tobacco Survey (LATS). In 2010, more TCI respondents were asked if they smoked, advised to quit, helped to set a quit date, counseled, and arranged to be contacted for follow-up than respondents to NATS or LATS. Fewer TCI respondents received self-help material or were prescribed medication to assist in quitting than NATS and LATS respondents. In 2010 and 2013, TCI participants reported more quit attempts when 4 or more of the 5 A's were received. Thus, public health systems can promote treatment of tobacco use.

Effect of systems change and use of electronic health records on quit rates among tobacco users in a public hospital system.

OBJECTIVES: We examined electronic health records (EHRs) to assess the impact of systems change on tobacco use screening, treatment, and quit rates among low-income primary care patients in Louisiana. METHODS: We examined EHR data on 79,777 patients with more than 1.2 million adult primary care encounters from January 1, 2009, through January 31, 2012, for evidence of systems change. We adapted a definition of "systems change" to evaluate a tobacco screening and treatment protocol used by medical staff during primary care visits at 7 sites in a public hospital system. RESULTS: Six of 7 sites met the definition of systems change, with routine screening rates for tobacco use higher than 50%. Within the first year, a 99.7% screening rate was reached. Sites had a 9.5% relative decrease in prevalence over the study period. Patients were 1.03 times more likely to sustain quit with each additional intervention (95% confidence interval = 1.02, 1.04). CONCLUSIONS: EHRs can be used to demonstrate that routine clinical interventions with low-income primary care patients result in reductions in tobacco use and sustained quits.

Partnering with health care systems to assess tobacco treatment practices and beliefs among clinicians: evaluating the process.

BACKGROUND: Tobacco is a major cause of preventable illness and death. However, clinician use of an evidence-based guideline for treatment of tobacco use is low. This case study describes the process for conducting a pre-intervention assessment of clinician practices and beliefs regarding treatment of tobacco use. COMMUNITY CONTEXT: Louisiana State University Health System, one of the largest safety-net public hospital systems in the United States, consists of 10 facilities in population centers across the state of Louisiana. The system serves a large proportion of the state's underinsured and uninsured, low-income, and racial/ethnic minority populations, groups that have high rates of tobacco use. METHODS: Activities included 1) partnering with hospital administrators to generate support for conducting a clinician assessment, 2) identifying and adapting a survey tool to assess clinicians' practices and beliefs regarding treatment of tobacco use, 3) developing a survey protocol and obtaining approval from the institutional review board, and 4) administering the survey electronically, using the hospital's e-mail system. OUTCOME: Existing partnerships and system resources aided survey administration. Use of the hospital's internal e-mail system and distribution of an online survey were effective means to engage clinicians. Following notification, 43.6% of 4,508 clinicians opened their e-mail containing the invitation letter with a Web link to the survey; of these, 83.1% (1,634) completed the survey. INTERPRETATION: Partnering with stakeholders and using existing resources within the health care system are essential to successful implementation of a system-wide survey of clinician practices and beliefs regarding treatment of tobacco use.

Using a health informatics system to assess effect of a federal cigarette tax increase on readiness to quit among low-income smokers, Louisiana, 2009.

INTRODUCTION: Health informatics systems are a proven tool for tobacco control interventions. To address the needs of low-income groups, the Tobacco Control Initiative was established in partnership with the Louisiana State University Health Care Services Division to provide cost-effective tobacco use cessation services through the health informatics system in the state public hospital system. METHODS: In this study we used a Web-based, result-reporting application to monitor and assess the effect of the 2009 federal cigarette tax increase. We assessed readiness to quit tobacco use before and after a cigarette tax increase among low-income tobacco users who were outpatients in a public hospital system. RESULTS: Overall, there was an increase in readiness to quit, from 22% during the first week of February to 33% during the first week of April, when the tax went into effect. Smokers who were female, 31 or older, African American, and assessed at a clinic visit in April were more likely to report readiness to quit than were men, those aged 30 or younger, those who were white, and those who were assessed at a clinic visit in February. CONCLUSION: A health informatics system that efficiently tracks trends in readiness to quit can be used in combination with other strategies and thus optimize efforts to control tobacco use. Our data suggest that a cigarette tax increase affects smokers' readiness to quit and provides an opportunity to intervene at the most beneficial time.

Patient tobacco use, quit attempts, and perceptions of healthcare provider practices in a safety-net healthcare system.

BACKGROUND: Although smoking rates in the United States (US) are high, healthcare systems and clinicians can increase cessation rates through application of the US Public Health Service tobacco treatment guideline (2000, 2008). In primary care settings, however, guideline implementation remains low. This report presents the results from an assessment of patient tobacco use, quit attempts, and perceptions of provider treatment before (2004) and after (2010) guideline implementation. METHODS: By use of a systems approach, the Louisiana Tobacco Control Initiative integrated evidence-based treatment of tobacco use into patient care practices in Louisiana's public hospital system. This prospective study, designed to collect data at 2 time points for the purpose of evaluating the effect of the 5A protocol (ask, advise, assess, assist, and arrange), included 571 and 889 adult patients selected from primary care clinics in 2004 and 2010, respectively. Chi-square analyses determined differences between survey administrations, along with direct standardization of weighted rates to control for confounding factors. RESULTS: Patient reports indicated that provider adherence to the 5A clinical protocol increased from 2004 to 2010. Significant (P<0.001) improvements were observed for the assess (39% vs 72%), assist (24% vs 76%), and arrange (8% vs 31%) treatment variables. Patient-reported quit attempts increased, along with awareness of cessation services (from 19% to 70%, P<0.001), while use of cessation medications decreased (from 23% to 5%, P<0.002). CONCLUSION: Following implementation of the guideline, significant improvements were noted in patient reports of provider treatment and awareness of cessation services.

Design and validation of a multi-electrode bioimpedance system for enhancing spatial resolution of cellular impedance studies.

This paper reports the design and evaluation of a multi-electrode design that improves upon the statistical significance and spatial resolution of cellular impedance data measured using commercial electric cell-substrate impedance sensing (ECIS) systems. By evaluating cellular impedance using eight independent sensing electrodes, position-dependent impedance measurements can be recorded across the device and compare commonly used equivalent circuit and mathematical models for extraction of cell parameters. Data from the 8-electrode device was compared to data taken from commercial electric cell-substrate impedance sensing (ECIS) system by deriving a relationship between equivalent circuit and mathematically modelled parameters. The impedance systems were evaluated and compared by investigating the effects of arsenic trioxide (As2O3), a well-established chemotherapeutic agent, on ovarian cancer cells. Impedance spectroscopy, a non-destructive, label-free technique, was used to continuously measure the frequency-dependent cellular properties, without adversely affecting the cells. The importance of multiple measurements within a cell culture was demonstrated; and the data illustrated that the non-uniform response of cells within a culture required redundant measurements in order to obtain statistically significant data, especially for drug discovery applications. Also, a correlation between equivalent circuit modelling and mathematically modelled parameters was derived, allowing data to be compared across different modelling techniques.

One pot, single step, room temperature dielectrophoretic deposition of gold nanoparticles clusters on polyethylene terephthalate substrate.

The major challenge of plastic electronics is the deposition of gold nanoparticles (AuNPs) on flexible substrates at room temperature. Here, we show fast, single step, room temperature deposition of AuNPs on polyethylene terephthalate (PET) and biaxially oriented PET (BoPET) substrate by employing dielectrophoresis. The deposition has been carried out using two-electrode system, with BoPET (or PET) and metallic (Pt or stain steel) mesh, under an AC signal of 20 kHz and 20 V peak-to-peak (V(pp)) (signal for PET is 6 V(pp) and 6 kHz). In this method, we show how to deposit AuNPs on PET-like insulator by exploiting its polarization capability under an AC signal. The polarization of PET has been confirmed by change in the Raman spectra of the PET film under in situ AC signals. Furthermore, we show that using this dielectrophoretic deposition method, the PET films can be patterned by AuNPs at room temperature without any pre- and posttreatment.

Research to reality (R2R) mentorship program: building partnership, capacity, and evidence.

Despite a wealth of intervention research in cancer control, full integration of evidence-based interventions into practice often fails, at least in part because of inadequate collaboration between practitioners and researchers. The National Cancer Institute piloted a mentorship program designed for practitioners to improve their ability to navigate evidence-based decision making within a context of inadequate resources, political barriers, and organizational constraints. The National Cancer Institute simultaneously sought to provide opportunities for practitioners and researchers to share and learn from each other. We identified four key successes and challenges related to translation as experienced by mentees: (a) establishing and maintaining partnerships, (b) data collection and analysis, (c) navigating context, and (d) program adaptation and evaluation. Mentorship programs have the potential to facilitate increased and more successful integration of evidence-based interventions into practice by promoting and building the capacity for collaborative decision making and generating in-depth understanding of the translation barriers and successes as well as strategies to address the complex contextual issues relative to implementation.

Awareness and implementation of the 2000 United States public health service tobacco dependence treatment guideline in a public hospital system.

The 2000 United States Public Health Service (USPHS) clinical practice guideline, "Treating Tobacco Use and Dependence," recommends systems interventions to integrate the treatment of tobacco into routine health care. The Tobacco Control Initiative employed a systems approach to integrate evidence-based treatment for tobacco use into patient care practices in Louisiana's safety net health care system. The purpose of this study was to assess changes in awareness and implementation of the USPHS clinical practice guideline. Surveys were administered to a purposive sample of hospital personnel from key departments in the Louisiana State University system of public hospitals in 2003 (n = 24) and 2007 (n = 44). Perceptions of implementation success improved for 50 of 59 distinct survey items. Rasch scaling was used to assess overall (scaled) change and showed substantial improvement from 2003 to 2007 (P < 0.001). Survey items also were grouped into 6 logical key concept sets. Improvement occurred in perceptions for all 6 key concepts; however, not uniformly. Results of the 2003 and 2007 surveys illustrate the potential effectiveness of using a systems approach to integrate the assessment and treatment of tobacco use into routine care practices in a public health care delivery system that serves medically vulnerable populations.