Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care.

INTRODUCTION: Obesity treatment is less successful for socioeconomically disadvantaged populations, particularly when delivered in primary care. Digital health strategies can extend the reach of clinical obesity treatments to care settings serving patients at highest risk. METHODS: Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded within a community health center system. Participants were 351 adult patients (aged 21-65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients were randomized to usual care (n=175) or an intervention (n=176) comprising app-based self-monitoring of behavior change goals with tailored feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations, delivered via electronic health record. The primary outcome was 12-month weight change. Randomization began on June 18, 2013, final assessments were completed on September 10, 2015. Data analysis was conducted in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants at 12 months. RESULTS: The Track intervention produced larger weight losses relative to usual care at 6 months (net effect: -4.4 kg, 95% CI= -5.5, -3.3, p<0.001) and 12 months (net effect: -3.8 kg, 95% CI= -5.0, -2.5, p<0.001). Intervention participants were more likely to lose ≥5% of their baseline weight at 6 months (43% vs 6%, p<0.001) and 12 months (40% vs 17%, p<0.001). Intervention participants completing ≥80% of expected self-monitoring episodes (-3.5 kg); counseling calls (-3.0 kg); or self-weighing days (-4.4 kg) lost significantly more weight than less engaged intervention participants (all p<0.01). CONCLUSIONS: A digital obesity treatment, integrated with health system resources, can produce clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary care patients with elevated cardiovascular disease risk. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01827800.

The patient-centered medical home model: healthcare services utilization and cost for non-elderly adults with mental illness.

BACKGROUND: The patient-centered medical home (PCMH) model is designed to improve health outcomes while containing the cost of care. However, the evidence is inconclusive. AIMS: The aim of this study was to examine the associations between receipt of care consistent with the PCMH and healthcare services utilization and expenditures for non-elderly adults with mental illness in the USA. METHOD: A surveillance study was conducted using self-reported data for 6908 non-elderly adults with mental illness participating in the 2007-2012 Medical Expenditure Panel Survey. Healthcare services utilization and expenditures were compared for study participants who received care consistent with the PCMH, participants with a non-PCMH usual source of care (USC), and participants without a USC. RESULTS: Differences in utilization and expenditures between participants who received care consistent with the PCMH and participants who had a non-PCMH USC were not statistically significant for any healthcare services category. CONCLUSIONS: Receipt of care consistent with the PCMH was not significantly associated with differences in healthcare services utilization or expenditures compared to having a non-PCMH USC. Research assessing whether the PCMH is cost-effective for non-elderly adults with mental illness is needed.

Social Support for Changing Multiple Behaviors: Factors Associated With Seeking Support and the Impact of Offered Support.

INTRODUCTION: Social support is important for behavior change, and it may be particularly important for the complexities of changing multiple risk behaviors (MRB). Research is needed to determine if participants in an MRB intervention can be encouraged to activate their social network to aid their change efforts. METHODS: Healthy Directions 2, a cluster-randomized controlled trial of an intervention conducted in two urban health centers, targeted five behaviors (physical activity, fruit and vegetable intake, red meat consumption, multivitamin use, and smoking). The self-guided intervention emphasized changing MRB simultaneously, focused on self-monitoring and action planning, and encouraged participants to seek support from social network members. An MRB score was calculated for each participant, with one point being assigned for each behavioral recommendation that was not met. Analyses were conducted to identify demographic and social contextual factors (e.g., interpersonal, neighborhood, and organizational resources) associated with seeking support and to determine if type and frequency of offered support were associated with changes in MRB score. RESULTS: Half (49.6%) of participants identified a support person. Interpersonal resources were the only contextual factor that predicted engagement of a support person. Compared to individuals who did not seek support, those who identified one support person had 61% greater reduction in MRB score, and participants identifying multiple support persons had 100% greater reduction. CONCLUSION: Engagement of one's social network leads to significantly greater change across multiple risk behaviors. Future research should explore strategies to address support need for individuals with limited interpersonal resources.

Associations between the patient-centered medical home and preventive care and healthcare quality for non-elderly adults with mental illness: A surveillance study analysis.

BACKGROUND: Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness. METHODS: This surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007-2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH. RESULTS: Compared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care. CONCLUSIONS: Compared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population.

Feasibility and Effects of Short Activity Breaks for Increasing Preschool-Age Children's Physical Activity Levels.

BACKGROUND: We examined the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on preschoolers PA. METHODS: Preschools were randomized to SBS-PA (centers, N = 5; participants, N = 141) or unstructured free playtime (UPA) (centers, N = 5; participants, N = 150). SBS-PA consisted of structured PA implemented in the classroom during the first 10 minutes of gross-motor playtime followed by 20 minutes of free playtime. UPA consisted of 30 minutes of unstructured free playtime. Teachers implemented both conditions for 5 days/week for 6 months. PA was assessed with accelerometers (preschool-day) and direct observation (30-minute sessions). Generalized linear mixed models were used to examine the impact of the intervention. RESULTS: Regarding the 30-minute sessions, significant group main effects were observed for intervals spent at light (p < .001) and moderate-to-vigorous PA (MVPA, p < .001). Regarding the preschool-day PA, significant group by visit interaction was observed for percent time spent in total preschool-day MVPA (F (2, 254) = 3.54, p = .03). Percent of time spent in MVPA significantly decreased in both groups at 3 months and at 6 months. CONCLUSION: SBS-PA can be implemented in classroom settings; however, further research is needed to examine its impact on preschoolers PA levels.

Much Ventured, Much Gained: Community-Engaged Data Collection by Adolescents and Young Adults.

BACKGROUND: Community-engaged data collection offers an important opportunity to build community capacity to harness the power of data and create social change. OBJECTIVES: To share lessons learned from engaging 16 adolescents and young adults from a partner community to collect data for a public opinion survey as part of a broader community-based participatory research (CBPR) project. METHODS: We conducted an analysis of archival documents, process data, and an assessment of survey assistants' experiences. LESSONS LEARNED: High-quality data were collected from a hard-to-reach population. Survey assistants benefited from exposure to research and gained professional skills. Key challenges included conducting surveys in challenging environments and managing schedule constraints during the school year. The tremendous investment made by project partners was vital for success. CONCLUSIONS: Investments required to support engaged data collection were larger than anticipated, as were the rewards, prompting greater attention to the integration of adolescents and young adults in research efforts.

Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients.

INTRODUCTION: Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. METHODS: Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months. RESULTS: Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. CONCLUSIONS: Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment.

Effectiveness of an Electronic Booster Session Delivered to Mandated Students.

College student drinking continues to be a problem in the United States. Students who have violated campus alcohol policy are at particularly high risk for dangerous drinking. While Brief Alcohol Screening and Intervention for College Students (BASICS) has been found to be an effective strategy in reducing high-risk drinking and associated consequences, questions remain about ways to further reduce risk or sustain changes associated with a face-to face intervention. The purpose of this study was to assess the effectiveness of a computer-delivered personalized feedback (electronic booster) delivered to policy violators who completed a mandated BASICS program. At 3-month post-intervention, 346 participants (60.4% male and 39.6% female) were randomized to one of two conditions: assessment only (n = 171) or electronic booster feedback (n = 175). Follow-up assessments were given to all participants at 3, 6, and 12-month post-initial intervention. Both groups showed reductions in drinking after the in-person BASICS intervention, but no additional reductions were seen with the addition of an electronic booster session. Findings suggest that although brief motivational interventions delivered in person to mandated students have been shown to be effective with mandated students, there is no additional benefit from an electronic booster session delivered 3-month post-intervention for this population.

Effects of Pomegranate Juice on Hormonal Biomarkers of Breast Cancer Risk.

Pomegranate is a rich source of polyphenols. Laboratory studies suggest polyphenols may exert breast cancer preventive effects through modulation of endogenous sex hormone levels. The aim of this study was to determine the effect of pomegranate juice consumption on serum levels of estradiol, estrone, testosterone, androstenedione, and sex hormone binding globulin (SHBG). Sixty-four healthy postmenopausal women were randomly assigned to drink 8 ounces of either 100% commercial pomegranate juice (intervention) or apple juice (control) for 3 weeks. Overall, women in the intervention group did not experience any significant decline in serum sex hormones or SHBG compared to women in the control group. In subgroup analyses restricted to 38 normal weight women, women in the intervention group compared to control group had a significant decline in estrone (pg/mL) and testosterone levels (pg/mL): pomegranate: -61.6 [95% confidence interval (CI): -175.8 to 52.6), apple: 1.1 (95% CI: -5.4 to 7.7), P = 0.05, and pomegranate: -289.1 (95% CI: -630.7 to 52.5), apple: 79.6 (95% CI: -77.8 to 236.9), P = 0.03, respectively. Because of several study limitations, results should be considered preliminary. Additional larger trials would be needed to determine effects in normal versus overweight/obese women.

Changes in colorectal cancer screening intention among people aged 18-49 in the United States.

BACKGROUND: To determine whether exposure to a peer-led intervention focused on colorectal cancer (CRC) screening, physical activity, and multi-vitamin intake can lead to increased intentions to be screened for CRC once age eligible among adults under the age of 50. METHODS: Participants were residents of low-income housing sites, and CRC screening intentions were assessed at baseline and at follow-up (approximately 2 years later) to determine changes in screening intentions and factors associated with changes in intentions. RESULTS: Participants (n = 692) were 78.4% female, 42.6% Hispanic and 50.8% black. At follow-up, 51% maintained their intention to be screened and 14.6% newly intended to get screened. Individuals newly intending to get screened were more likely to have participated in the intervention, be older, male, and born in Puerto Rico or the United States compared to those who maintained their intention not to get screened (p < 0.05). CONCLUSION: Exposure to CRC prevention messages before the age of 50 can increase screening intentions among individuals who did not initially intend to get screened. Peer-led interventions to promote CRC screening should include individual less than 50 years of age, as this may contribute to increased screening at the recommended age threshold.

Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial.

BACKGROUND: eHealth interventions are effective for weight control and have the potential for broad reach. Little is known about the use of interactive voice response (IVR) technology for self-monitoring in weight control interventions, particularly among populations disproportionately affected by obesity. OBJECTIVE: This analysis sought to examine patterns and predictors of IVR self-monitoring adherence and the association between adherence and weight change among low-income black women enrolled in a weight gain prevention intervention. METHODS: The Shape Program was a randomized controlled trial comparing a 12-month eHealth behavioral weight gain prevention intervention to usual care among overweight and obese black women in the primary care setting. Intervention participants (n=91) used IVR technology to self-monitor behavior change goals (eg, no sugary drinks, 10,000 steps per day) via weekly IVR calls. Weight data were collected in clinic at baseline, 6, and 12 months. Self-monitoring data was stored in a study database and adherence was operationalized as the percent of weeks with a successful IVR call. RESULTS: Over 12 months, the average IVR completion rate was 71.6% (SD 28.1) and 52% (47/91) had an IVR completion rate ≥80%. At 12 months, IVR call completion was significantly correlated with weight loss (r =-.22; P=.04) and participants with an IVR completion rate ≥80% had significantly greater weight loss compared to those with an IVR completion rate <80% (-1.97 kg, SE 0.67 vs 0.48 kg, SE 0.69; P=.01). Similar outcomes were found for change in body mass index (BMI; mean difference -0.94 kg, 95% CI -1.64 to -0.24; P=.009). Older, more educated participants were more likely to achieve high IVR call completion. Participants reported positive attitudes toward IVR self-monitoring. CONCLUSIONS: Adherence to IVR self-monitoring was high among socioeconomically disadvantaged black women enrolled in a weight gain prevention intervention. Higher adherence to IVR self-monitoring was also associated with greater weight change. IVR is an effective and useful tool to promote self-monitoring and has the potential for widespread use and long-term sustainability. TRIAL REGISTRATION: Clinicaltrials.gov NCT00938535; http://www.clinicaltrials.gov/ct2/show/NCT00938535.

Health media use among childhood and young adult cancer survivors who smoke.

PURPOSE: Promoting healthy behaviors may reduce the risk of co-morbidities among childhood and young adult (CYA) cancer survivors. Although behavioral interventions are one way to encourage such activities, there is increasing evidence that health media use-particularly health information seeking-also may influence health knowledge, beliefs, and behaviors. The current study explores patterns of health media use among survivors of CYA cancer. Our focus is on survivors who smoke and thus are at even greater risk of co-morbidities. METHODS: We analyzed data from the Partnership for Health-2 study, a web-based smoking cessation intervention, to examine the prevalence of and factors associated with health media use (N = 329). RESULTS: Nearly two thirds (65.3 %) of CYA survivors who smoke reported infrequent or no online health information seeking. Many reported never reading health sections of newspapers or general magazines (46.2 %) or watching health segments on local television news (32.3 %). Factors associated with health media use include education and employment, cancer-related distress, and smoking quit attempts. CONCLUSIONS: Health information engagement is low among CYA survivors who smoke, particularly active seeking of health information online. Population subgroups differ in their media use patterns; some of these differences reflect communication inequalities, which have the potential to exacerbate health disparities. Clinicians have an opportunity to guide CYA survivors towards useful and reliable information sources. This guidance could help survivors fulfill their unmet information and support needs and may be particularly important for less educated survivors and other underserved populations.

Perceptions of risk among childhood and young adult cancer survivors who smoke.

PURPOSE: Despite the fact that childhood and young adult cancer survivors are at increased risk for chronic health problems as a result of their cancer treatment, many use tobacco, thereby increasing their risks. Perceptions of risk related to tobacco use can be targeted for interventions aimed at improving health behaviors for childhood, adolescent, and young adult cancer survivors. Understanding the covariates of perceptions of health risks among young adult survivors who smoke will help to determine targets for intervention. METHOD: Three hundred seventy-four participants who were diagnosed with cancer prior to age 35, currently between 18 and 55 years of age, and current smokers were recruited as part of a larger smoking cessation study, Partnership for Health-2 (PFH-2). Data were collected by telephone survey. RESULTS: Overall, women had the highest perception of risk for serious health problems, a second cancer, and heart problems. Additionally, those participants who were dependent on nicotine endorsed that they were at higher risk of serious health problems and second cancers, but not heart problems. Finally, Hodgkin lymphoma survivors reported that they were at increased risk for second cancers and heart problems compared to their "healthy" peers. CONCLUSION: Young adult cancer survivors who smoke correctly perceived some of their increased health risks. Additional motivation and education is needed for those young adult cancer survivors who perceive their increased health risks yet continue to smoke. Further education is needed for young survivors so they have a fully appropriate sense of risk, especially as it relates to their tobacco use.

A randomized comparative effectiveness study of Healthy Directions 2--a multiple risk behavior intervention for primary care.

OBJECTIVE: To evaluate the effectiveness of the Healthy Directions 2 (HD2) intervention in the primary care setting. METHODS: HD2 was a cluster randomized trial (conducted 3/09-11/11). The primary sampling unit was provider (n=33), with secondary sampling of patients within provider (n=2440). Study arms included: 1) usual care (UC); 2) HD2--a patient self-guided intervention targeting 5 risk behaviors; and 3) HD2 plus 2 brief telephone coaching calls (HD2+CC). The outcome measure was the proportion of participants with a lower multiple risk behavior (MRB) score by follow-up. RESULTS: At baseline, only 4% of the participants met all behavioral recommendations. Both HD2 and HD2+CC led to improvements in MRB score, relative to UC, with no differences between the two HD2 conditions. Twenty-eight percent of the UC participants had improved MRB scores at 6 months, vs. 39% and 43% in HD2 and HD2+CC, respectively (ps≤.001); results were similar at 18 months (p≤.05). The incremental cost of one risk factor reduction in MRB score was $310 for HD2 and $450 for HD2+CC. CONCLUSIONS: Self-guided and coached intervention conditions had equivalent levels of effect in reducing multiple chronic disease risk factors, were relatively low cost, and thus are potentially useful for routine implementation in similar health settings.

Factors associated with choice of web or print intervention materials in the healthy directions 2 study.

BACKGROUND: Many U.S. adults have multiple behavioral risk factors, and effective, scalable interventions are needed to promote population-level health. In the health care setting, interventions are often provided in print, although accessible to nearly everyone, are brief (e.g., pamphlets), are not interactive, and can require some logistics around distribution. Web-based interventions offer more interactivity but may not be accessible to all. Healthy Directions 2 was a primary care-based cluster randomized controlled trial designed to improve five behavioral cancer risk factors among a diverse sample of adults (n = 2,440) in metropolitan Boston. Intervention materials were available via print or the web. Purpose. To (a) describe the Healthy Directions 2 study design and (b) identify baseline factors associated with whether participants opted for print or web-based materials. METHODS: Hierarchical regression models corrected for clustering by physician were built to examine factors associated with choice of intervention modality. RESULTS: At baseline, just 4.0% of participants met all behavioral recommendations. Nearly equivalent numbers of intervention participants opted for print and web-based materials (44.6% vs. 55.4%). Participants choosing web-based materials were younger, and reported having a better financial status, better perceived health, greater computer comfort, and more frequent Internet use (p < .05) than those opting for print. In addition, Whites were more likely to pick web-based material than Black participants. CONCLUSIONS: Interventions addressing multiple behaviors are needed in the primary care setting, but they should be available in web and print formats as nearly equal number of participants chose each option, and there are significant differences in the population groups using each modality.

Partnership for health-2, a web-based versus print smoking cessation intervention for childhood and young adult cancer survivors: randomized comparative effectiveness study.

BACKGROUND: Smoking among cancer survivors increases the risk of late effects and second cancers. This article reports on Partnership for Health-2 (PFH-2)-an effort to develop an effective and scalable version of Partnership for Health (PFH), which was a previously tested peer-delivered telephone counseling program that doubled smoking cessation rates among childhood cancer survivors who smoke. OBJECTIVE: This paper presents results from a randomized controlled trial evaluating the effectiveness of PFH-2 in targeted and tailored Web-based versus print formats. The overall goal was to determine whether the intervention outcomes in these self-guided scalable formats approximate what was found in a more intensive telephone counseling program. METHODS: This study was a randomized controlled trial with a 15-month follow-up that included 374 smokers who were survivors of childhood or young adult cancers, recruited from five survivorship clinics. Participants were randomly assigned to a Web-based or print format of the PFH intervention; all had access to free pharmacotherapy. The website was designed to provide new content at each log-on, and a peer counselor moderated a forum/chat feature. The primary outcome was smoking status at 15 months post randomization. RESULTS: In total, 58.3% (77/132) of Web participants logged on at least once (mean visits 3.25). Using multiple imputation methods for missing data, there were similar rates of cessation in the two arms (print: 20/128, 15.6%; Web: 33/201, 6.4%), and no differences in quit attempts or readiness to quit. The quit rates were equivalent to those found in our previous telephone counseling intervention. There were high rates of satisfaction with both of the PFH-2 interventions. CONCLUSIONS: The print and Web formats yielded equivalent levels of success to those found with our telephone-delivered intervention and are comparable to other Internet treatment studies. This study provides important options for survivorship programs that may not have resources for interpersonal forms of cessation counseling. Efforts to increase patient use of the interventions may result in higher cessation rates.

Behavioral treatment for weight gain prevention among black women in primary care practice: a randomized clinical trial.

IMPORTANCE: Few weight loss treatments produce clinically meaningful weight loss outcomes among black women, particularly in the primary care setting. New weight management strategies are necessary for this population. Weight gain prevention might be an effective treatment option, with particular benefits for overweight and class 1 obese black women. OBJECTIVE: To compare changes in weight and cardiometabolic risk during a 12-month period among black women randomized to a primary care-based behavioral weight gain prevention intervention, relative to usual care. DESIGN, SETTING, AND PARTICIPANTS: Two-arm randomized clinical trial (the Shape Program). We recruited patients from a 6-site community health center system. We randomized 194 overweight and class 1 obese (body mass index [calculated as weight in kilograms divided by height in meters squared], 25-34.9) premenopausal black women aged 25 to 44 years. Enrollment began on December 7, 2009; 12- and 18-month assessments were completed in February and October 2, 2012. INTERVENTIONS: The medium-intensity intervention included tailored behavior change goals, weekly self-monitoring via interactive voice response, monthly counseling calls, tailored skills training materials, and a gym membership. MAIN OUTCOMES AND MEASURES: Twelve-month change in weight and body mass index and maintenance of change at 18 months. RESULTS: Participants had a mean age of 35.4 years, a mean weight of 81.1 kg, and a mean body mass index of 30.2 at baseline. Most were socioeconomically disadvantaged (79.7% with educational level less than a college degree; 74.3% reporting annual income <$30,000). The 12-month weight change was larger among intervention participants (mean [SD], -1.0 [0.5] kg), relative to usual care (0.5 [0.5] kg; mean difference, -1.4 kg [95% CI, -2.8 to -0.1 kg]; P = .04). At month 12, 62% of intervention participants were at or below their baseline weights compared with 45% of usual-care participants (P = .03). By 18 months, intervention participants maintained significantly larger changes in weight (mean difference, -1.7 kg; 95% CI, -3.3 to -0.2 kg). CONCLUSIONS AND RELEVANCE: A medium-intensity primary care-based behavioral intervention demonstrated efficacy for weight gain prevention among socioeconomically disadvantaged black women. A "maintain, don't gain" approach might be a useful alternative treatment for reducing obesity-associated disease risk among some premenopausal black women. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00938535.

Provider advice about smoking cessation and pharmacotherapy among cancer survivors who smoke: practice guidelines are not translating.

Smoking among childhood and young adult cancer survivors may increase risk for late effects of treatment, and survivors need assistance in quitting. This paper reports on the prevalence of discussions between childhood cancer survivors and their health care providers about smoking cessation and pharmacotherapy and explores factors that are associated with these discussions. This is a longitudinal study that included 329 smokers who were childhood or young adult cancer survivors, recruited from five cancer centers in the USA and Canada. Fifty-five percent of smokers reported receiving advice to quit smoking from their regular provider during the study period, and only 36 % of smokers reported discussing pharmacotherapy with their provider. Receipt of advice was associated with being female and having a heavier smoking rate. Pharmacotherapy discussions were associated with readiness to quit, heavier smoking rate, and previous provider advice to quit. Health care providers are missing key opportunities to advise cancer survivors about cessation and evidence-based interventions. Systematic efforts are needed to ensure that survivors who smoke get the treatment that they need.

Smoking Restrictions Among Households of Childhood and Young Adult Cancer Survivors: Implications for Tobacco Control Efforts.

PURPOSE: This study assessed the prevalence of smoking restrictions among households of survivors of childhood and young adult cancer who smoke. It also examined the relationship between home smoking restrictions and motivation to quit smoking, as well as other smoking, psychosocial, and environmental factors. METHODS: Participants included 374 smokers who were childhood or young adult cancer survivors (between the ages of 18 and 55 years) recruited from five cancer centers to participate in a randomized smoking cessation trial. Survivors completed baseline measures about the smoking restrictions in their households, their smoking behavior, and related psychological and environmental factors, which are the focus of the current manuscript. RESULTS: Almost 54% of survivors reported that smoking was prohibited in their households. Living with a nonsmoking partner, having a strict smoking policy at work, and not being nicotine dependent all increased the likelihood of having a total home smoking ban. Participants who were older, smoked more cigarettes per day over the prior week, and received prior chemotherapy were less likely to reside in households that adopted total bans. CONCLUSION: Findings suggest that socio-environmental factors and current smoking behaviors are associated with complete smoking restrictions in the homes of survivors. These factors should be considered when communicating with survivors about the importance of establishing strict smoking policies in their private residences.

Life course effects on age at menopause among Bangladeshi sedentees and migrants to the UK.

OBJECTIVES: To assess how different variables experienced across the life course, but particularly during early life, might affect age at menopause among 174 Bangladeshi migrants to London by comparing them to 157 nonmigrant sedentees and 154 women of European descent in London. METHODS: Participants were aged 35-59 years, with no exogenous hormone use in the past three months, not pregnant or lactating, with no history of hysterectomy or oophorectomy. Face-to-face interviews and anthropometric measures were carried out. In addition to mean recalled age at natural menopause, median age was computed by probit analysis. Ages at menopause were examined by bivariate and Cox regression analyses in relation to demographic, reproductive, and lifestyle variables, and in relation to potential exposure to cyclones in early childhood. RESULTS: Ages at menopause were significantly earlier among Bangladeshi sedentees and immigrants compared to Londoners of European origin. Ages at menopause were earlier among sedentees compared to immigrants. Urban birthplace, more infectious diseases during childhood, and lower levels of education increased the risk of an earlier menopause. CONCLUSIONS: Changes in environmental conditions during adulthood appeared to modify age at menopause among Bangladeshi immigrants in London compared to women living in Bangladesh; however, Bangladeshi immigrants still experienced an earlier age at menopause compared with their London neighbors of European descent.