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1.
PLoS One ; 16(3): e0247867, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33661996

RESUMO

The Abstinence-Related Motivational Engagement (ARME) scale was developed to assess motivation to remain abstinent after a smoking cessation attempt. The ARME demonstrated reliability and validity among a small sample of ex-smokers. This study expands the psychometric evaluation of the ARME and tests the ARME as a predictor of smoking status among a sample of participants quitting smoking. The parent trial tested the efficacy of a self-help smoking cessation intervention (N = 1874), with assessments every 6 months. Internal consistency and factor structure of the ARME was evaluated at each assessment to confirm use of the measure as designed. Discriminant validity was assessed by comparing the ARME to the Situation-specific Abstinence Self-Efficacy (SSE) scale via inter-correlations and prediction of future smoking status. Finally, the trajectories of both the ARME and SSE were compared among continuous abstainers and continuous smokers. A single-factor structure was observed at each assessment. Cronbach's alphas ranged from 0.88-0.91 for the total sample. Correlations between the ARME and the SSE ranged from 0.38-0.47 (ps <0.001) among smokers; and from 0.09-0.15 (most ps > 0.05) among abstainers. Among current smokers, the ARME and SSE were independent positive predictors of subsequent abstinence (AORs 1.28-2.29, ps <0.001). For those currently abstinent, only the SSE predicted subsequent abstinence (AORs 1.69-2.60, ps <0.05). GEE analyses showed different trajectories for the two measures, as well as between abstainers and smokers. In conclusion, the ARME is a reliable, valid measure with unique predictive utility for current smokers and a distinct trajectory among those who have successfully quit.

2.
JMIR Res Protoc ; 10(2): e22877, 2021 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-33625366

RESUMO

BACKGROUND: Cigarette smoking has numerous health consequences and is the leading cause of morbidity and mortality in the United States. Mindfulness has the ability to enhance resilience to stressors and can strengthen an individual's ability to deal with discomfort, which may be particularly useful when managing withdrawal and craving to smoke. OBJECTIVE: This study aims to evaluate feasibility results from an intervention that provides real-time, real-world mindfulness strategies to a sample of racially and ethnically diverse smokers making a quit attempt. METHODS: This study uses a microrandomized trial design to deliver mindfulness-based strategies in real time to individuals attempting to quit smoking. Data will be collected via wearable sensors, a study smartphone, and questionnaires filled out during the in-person study visits. RESULTS: Recruitment is complete, and data management is ongoing. CONCLUSIONS: The data collected during this feasibility trial will provide preliminary findings about whether mindfulness strategies delivered in real time are a useful quit smoking aid that warrants additional investigation. TRIAL REGISTRATION: Clinicaltrials.gov NCT03404596; https://clinicaltrials.gov/ct2/show/NCT03404596. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/22877.

3.
Nicotine Tob Res ; 2020 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-33277653

RESUMO

BACKGROUND: Cue exposure for extinguishing conditioned urges to smoking cues has been promising in the laboratory, but difficult to implement in natural environments. The recent availability of augmented reality (AR) via smartphone provides an opportunity to overcome this limitation. Testing the ability of AR to elicit cue-provoked urges to smoke (i.e., cue reactivity [CR]) is the first step to systemically testing the efficacy of AR for cue exposure therapy. OBJECTIVES: To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues. METHODS: A 2 x 2 within-subject design comparing cue content (smoking vs. neutral) and presentation modality (AR vs. in vivo) on urge response. Seventeen smokers viewed six smoking-related and six neutral cues via AR smartphone app and also six smoking and six neutral in vivo cues. Participants rated their urge to smoke and reality/co-existence of the cue. RESULTS: Average urge to smoke was higher following smoking-related AR images (Median=7.50) than neutral images (Median=3.33) (Z=-3.44; P=.001; d=1.37). Similarly, average urge ratings for in vivo smoking-related cues (Median=8.12) were higher than for neutral cues (Median=2.12) (Z=-3.44; P=.001; d=1.64). Also, greater CR was observed for in vivo cues than to AR cues (Z=-2.67, P=.008; d=.36). AR cues were generally perceived as being realistic and well-integrated. CONCLUSIONS: CR was demonstrated with very large effect sizes in response to AR smoking cues, although slightly smaller than with in vivo smoking cues. This satisfies the first criterion for the potential use of AR for exposure therapy.

4.
JMIR Mhealth Uhealth ; 8(12): e21643, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-33382377

RESUMO

BACKGROUND: The recent widespread availability of augmented reality via smartphone offers an opportunity to translate cue exposure therapy for smoking cessation from the laboratory to the real world. Despite significant reductions in the smoking rates in the last decade, approximately 13.7% of the adults in the United States continue to smoke. Smoking-related cue exposure has demonstrated promise as an adjuvant therapy in the laboratory, but practical limitations have prevented its success in the real world. Augmented reality technology presents an innovative approach to overcome these limitations. OBJECTIVE: The aim of this study was to develop a smartphone app that presents smoking-related augmented reality images for cue exposure. Smokers provided feedback on the images and reported on the perceived urge to smoke, qualities of reality/coexistence, and general feedback about quality and functioning. The feedback was used to refine the augmented reality images within the app. METHODS: In collaboration with an augmented reality design company, we developed 6 smoking-related images (cigarette, lighter, ashtray, lit cigarette in ashtray, etc) and 6 neutral images similar in size or complexity for comparison (pen, eraser, notebook, soda bottle with droplets, etc). Ten smokers completed a survey of demographic characteristics, smoking history and behavior, dependence on nicotine, motivation to quit smoking, and familiarity with augmented reality technology. Then, participants viewed each augmented reality image and provided ratings on 10-point Likert scales for urge to smoke and reality/coexistence of the image into the scene. Participants were also queried with open-ended questions regarding the features of the images. RESULTS: Of the 10 participants, 5 (50%) had experienced augmented reality prior to the laboratory visit, but only 4 of those 5 participants used augmented reality at least weekly. Although the sample was small (N=10), smokers reported significantly higher urge to smoke after viewing the smoking-related augmented reality images (median 4.58, SD 3.49) versus the neutral images (median 1.42, SD 3.01) (Z=-2.14, P=.03; d=0.70). The average reality and coexistence ratings of the images did not differ between smoking-related and neutral images (all P>.29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting). CONCLUSIONS: All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed.


Assuntos
Realidade Aumentada , Motivação , Abandono do Hábito de Fumar , Adulto , Humanos , Aplicativos Móveis , Fumantes , Fumar/efeitos adversos , Estados Unidos
5.
Contemp Clin Trials ; 100: 106218, 2020 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-33197610

RESUMO

The combined use of cigarettes and alcohol is associated with an increased risk of morbidity and mortality. Yet, efficacious interventions that address both behaviors concurrently are lacking. Smoking cessation and alcohol modification not only garner health benefits, but there is also value in addressing alcohol use in the context of smoking cessation to reduce the risk for smoking relapse. In this paper we describe the development of mindfulness-based relapse prevention for smoking cessation and alcohol modification (MBRP-SA) and pilot study findings (Phase 1). Next, details regarding the methods and design of an ongoing, randomized controlled trial, Project RISE (Phase 2), are described. MBRP-SA is a group-based intervention that consists of eight weekly treatment sessions. Results from the Phase 1 pilot study (N = 21 enrolled) indicated that participants planned to use the skills learned in their everyday activities and to address their smoking and alcohol goals. Based on the progression of Phase 1 cohorts, modifications were made to the inclusion/exclusion criteria and recruitment methods that will be implemented in Phase 2. Phase 2 will assess the feasibility and acceptability of MBRP-SA, delivered via live online groups, as a primary treatment option for smoking cessation and alcohol use modification.

6.
Contemp Clin Trials ; 98: 106172, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33038504

RESUMO

Smoking cigarettes with substantially lower nicotine than conventional cigarettes prior to a quit attempt may reduce the reinforcing effects of smoking, which could facilitate smoking cessation through extinction learning. This paper describes the development of a smoking cessation intervention designed to optimize extinction processes using reduced nicotine cigarettes, as well as the design and methods for an ongoing randomized controlled trial (RCT) to evaluate this intervention. Qualitative methods and pilot testing were conducted to develop the novel facilitated extinction (FE) intervention, with a key focus on maximizing opportunities for extinction learning during a five-week pre-quit period. The primary aims of the RCT are to test the effects of the FE intervention versus a standard (cognitive-behavioral) intervention, while also comparing two nicotine reduction schedules for providing very low nicotine content (VLNC) cigarettes. The efficacy of the intervention is currently being evaluated with treatment-seeking smokers (n = 208) randomly assigned to one of four conditions crossing FE versus standard intervention with immediate versus gradual transition to VLNC cigarettes.

7.
Patient Educ Couns ; 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32981814

RESUMO

OBJECTIVES: Sexual and gender minority (SGM) individuals experience cancer-related health disparities and reduced quality of cancer care compared to the general population in part due to a lack of knowledgeable providers. This study explored oncologists' experiences and perspectives in providing patient-centered care for SGM individuals with cancer. METHODS: We conducted a qualitative analysis of oncologists' responses to four open-ended items on a national survey eliciting their experiences, reservations, and suggestions in treating SGM patients. RESULTS: Over 50 % of the 149 respondents of the national survey responded to at least one open-ended item. Many oncologists reported positive experiences reflecting personal growth and affirmative care practices, such as open, non-judgmental communication, compassion, competence, and supporting patients' identity. There was a notable lack of experience with transgender patients in particular. Lack of knowledge, interpersonal communication concerns (e.g., fear of offending patients), and microaggressions ("don't ask, don't tell") were identified as barriers to providing affirming care. CONCLUSIONS: Oncologists recognize their knowledge deficits and need strategies to overcome communication barriers and microaggressions among the cancer care team to provide SGM-affirming care. PRACTICE IMPLICATIONS: Curricula are needed to train oncologists in SGM healthcare needs and affirming communication skills to facilitate patient-centered care for SGM individuals with cancer.

8.
Cancer ; 126(23): 5165-5172, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902856

RESUMO

BACKGROUND: Abstaining from smoking after a cancer diagnosis is critical to mitigating the risk of multiple adverse health outcomes. Although many patients with cancer attempt to quit smoking, the majority relapse. The current randomized controlled trial evaluated the efficacy of adapting an evidence-based smoking relapse prevention (SRP) intervention for patients with cancer. METHODS: The trial enrolled 412 patients newly diagnosed with cancer who had recently quit smoking. Participants were randomized to usual care (UC) or SRP. Participants in the UC group received the institution's standard of care for treating tobacco use. Participants in the SRP group in addition received a targeted educational DVD plus a validated self-help intervention for preventing smoking relapse. The primary outcome was smoking abstinence at 2 months, 6 months, and 12 months. RESULTS: Abstinence rates for participants in the SRP and UC groups were 75% versus 71% at 2 months and 69% versus 64% at 6 months (Ps > .20). At 12 months, abstinence rates among survivors were 68% for those in the SRP group and 63% for those in the UC group (P = .38). Post hoc analyses revealed that across 2 months and 6 months, patients who were married/partnered were more likely to be abstinent after SRP than UC (P = .03). CONCLUSIONS: A smoking relapse prevention intervention did not reduce relapse rates overall, but did appear to have benefited those participants who had the social support of a partner. Future work is needed to extend this effect to the larger population of patients.

9.
J Med Internet Res ; 22(8): e19389, 2020 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795986

RESUMO

BACKGROUND: There is a pressing need to address the unacceptable disparities and underrepresentation of racial and ethnic minority groups, including Hispanics or Latinxs, in smoking cessation trials. OBJECTIVE: Given the lack of research on recruitment strategies for this population, this study aims to assess effective recruitment methods based on enrollment and cost. METHODS: Recruitment and enrollment data were collected from a nationwide randomized controlled trial (RCT) of a Spanish-language smoking cessation intervention (N=1417). The effectiveness of each recruitment strategy was evaluated by computing the cost per participant (CPP), which is the ratio of direct cost over the number enrolled. More effective strategies yielded lower CPPs. Demographic and smoking-related characteristics of participants recruited via the two most effective strategies were also compared (n=1307). RESULTS: Facebook was the most effective method (CPP=US $74.12), followed by TV advertisements (CPP=US $191.31), whereas public bus interior card advertising was the least effective method (CPP=US $642.50). Participants recruited via Facebook had lower average age (P=.008) and had spent fewer years in the United States (P<.001). Among the participants recruited via Facebook, a greater percentage of individuals had at least a high school education (P<.001) and an annual income above US $10,000 (P<.001). In addition, a greater percentage of individuals were employed (P<.001) and foreign born (P=.003). In terms of subethnicity, among the subjects recruited via Facebook, a lower percentage of individuals were of Mexican origin (P<.001) and a greater percentage of individuals were of Central American (P=.02), South American (P=.01), and Cuban (P<.001) origin. CONCLUSIONS: Facebook was the most effective method for recruiting Hispanic or Latinx smokers in the United States for this RCT. However, using multiple methods was necessary to recruit a more diverse sample of Spanish-preferring Hispanic or Latinx smokers.

10.
J Clin Nurs ; 29(15-16): 2953-2966, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32320511

RESUMO

AIMS AND OBJECTIVES: To evaluate the knowledge and attitudes towards sexual and gender minority (SGM) oncology patients' needs among advanced practice providers (APPs). BACKGROUND: SGM individuals experience health disparities, in part due to lack of access to knowledgeable providers. Despite the important role of APPs in cancer care, less is known about their attitudes and knowledge towards SGM cancer patients. DESIGN: Cross-sectional study. METHODS: A survey of APPs at a National Cancer Institute-Designated Comprehensive Cancer Center assessed self-reported demographics, attitudes, knowledge and postsurvey confidence in knowledge of SGM oncology patient needs. Reporting of this study adheres to STROBE guidelines. RESULTS: Knowledge of health needs was low with an average of 2.56 (SD = 1.27) items answered correctly out of 6. The majority of APPs self-reported being comfortable treating SGM patients (93.6% and 87.2%, respectively), but less confident in knowledge of their health needs (68.0% and 53.8%, respectively). Although less than half of APPs believed education should be mandatory (44.9%), 79.5% were interested in education about SGMs' unique health needs. Political affiliation, medical specialty, licensure, and having SGM friends or family were associated with various attitude items, but not knowledge. Moderation analyses indicated that APPs who had greater overall knowledge scores were more likely to agree, on average, that knowing sexual orientation, gender identity and sex assigned at birth are important to providing quality oncology care. CONCLUSION: APPs report being comfortable providing care for SGMs with cancer, but knowledge gaps remain that may inhibit the quality of care provided. Given the interest in education, results would support the development of SGM-related healthcare training for oncology APPs. RELEVANCE TO CLINICAL PRACTICE: Targeted education for providers during training and continuing education is likely to improve the provision of quality care for SGMs with cancer.


Assuntos
Prática Avançada de Enfermagem/métodos , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/enfermagem , Minorias Sexuais e de Gênero/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Autorrelato , Inquéritos e Questionários
11.
Patient Educ Couns ; 103(2): 385-391, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31466881

RESUMO

OBJECTIVES: Individuals with limited health literacy often experience suboptimal health outcomes. This study examined the frequency of limited health literacy and demographic and psychosocial factors associated with limited health literacy in a sample of older Black Americans. METHODS: Participants (n = 330) enrolled in a community-based intervention to promote colorectal cancer (CRC) screening completed baseline surveys assessing health literacy with the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test, CRC awareness, cancer fatalism, Preventive Health Model (PHM) constructs, and demographics. RESULTS: Approximately 52% of participants had limited health literacy, the REALM-R score was 5.4 (SD = 2.7). Univariable correlates of limited health literacy were gender, employment, income, prior screening, cancer fatalism, CRC awareness, and PHM constructs (religious beliefs, salience/coherence, perceived susceptibility). Multivariable correlates of limited health literacy were male gender (OR = 2.3, CI = 1.4-3.8), unable to work (OR = 2.8, CI = 1.3-6.1), lower household income (OR = 3.0, CI = 1.6, 5.5), and higher PHM religious beliefs (OR = 1.1, CI = 1.0-1.2). CONCLUSION: Limited health literacy was associated with multiple complex factors. Interventions should incorporate patient health literacy and low-literacy materials that can be delivered through multiple channels. PRACTICE IMPLICATIONS: Future studies are needed to understand the role of health literacy in an individual's health behavior and the provision of effective healthcare.


Assuntos
Neoplasias Colorretais/diagnóstico , Discriminação Psicológica , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Letramento em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Programas de Rastreamento/estatística & dados numéricos , Afro-Americanos , Idoso , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/psicologia , Pesquisa Participativa Baseada na Comunidade , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Religião , Fatores Socioeconômicos , Confiança
12.
Contemp Clin Trials ; 85: 105836, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31473331

RESUMO

Although the current smoking prevalence among Hispanics/Latinxs (10%) is lower than in non-Hispanic whites (15%), higher prevalence is observed among certain subgroups (e.g., Puerto Rican males, 19%). Hispanic/Latinx smokers face unique challenges such as lower awareness and acceptability of nicotine replacement aids, lower prevalence of using counseling or medication, and receiving less advice to quit by their health care providers. Despite these barriers to smoking cessation, few interventions specifically targeted to Hispanic/Latinx smokers have been developed and evaluated. This paper summarizes the design, methods, analysis plan, and sample baseline characteristics of an ongoing randomized controlled trial to assess the efficacy of a Spanish-language self-help smoking cessation intervention among Hispanics/Latinxs. Current smokers who prefer health education materials in Spanish were randomized to one of two conditions. The usual care group received a standard smoking cessation booklet developed by the National Cancer Institute. The intervention group received 10 booklets, 9 pamphlets and a booklet for family and friends mailed monthly over 18 months. All participants complete self-report surveys every 6 months over 2 years. Smoking abstinence is biochemically verified at 12- and 24-month follow-up. A total of 2387 smokers were screened, 2056 were eligible and 1417 were enrolled in the study. The primary outcome is self-reported 7-day point prevalence abstinence. If the intervention is deemed efficacious, it has potential to have a large public health impact with respect to reducing smoking rates and smoking related morbidity and mortality among a large underserved minority population.


Assuntos
Hispano-Americanos , Autogestão/métodos , Abandono do Hábito de Fumar/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Abandono do Hábito de Fumar/etnologia
13.
Psychooncology ; 28(8): 1702-1711, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31212391

RESUMO

OBJECTIVE: Smoking cessation improves quality of life (QOL) in the general population. However, there is limited information on the role of smoking status on QOL among cancer patients. Moreover, previous studies tended to analyze smoking status dichotomously and at a single point in time, potentially reducing the strength of the relation between smoking cessation and QOL. This study examined the association of smoking abstinence and QOL over time, including depression, pain, and fatigue in patients with a wide variety of cancers. METHODS: Participants were 332 cancer patients (eg, gynecologic, breast, thoracic, head and neck, and genitourinary) who had been abstinent for at least 24 hours. Days abstinent and QOL were assessed at baseline and 2, 6, and 12 months later. Latent growth curve models examined if days abstinent was associated with QOL at each assessment. Baseline demographics (eg, sex and income) and smoking history variables (eg, nicotine dependence) were used as time-invariant covariates. RESULTS: The final model for each QOL component had good-to-excellent fit. More days abstinent was associated with lower depression at all follow-ups and with lower fatigue at 12 months but was not associated with pain. CONCLUSIONS: QOL was better among patients who quit smoking for longer periods. Findings suggest different timelines, with smoking abstinence most immediately associated with lower depression, followed by lower fatigue. Although pain decreased over time, it was not associated with length of smoking abstinence. Results reinforce the relationship between sustained smoking cessation and QOL, which should be communicated to patients.


Assuntos
Dor do Câncer/epidemiologia , Depressão/epidemiologia , Fadiga/epidemiologia , Neoplasias/epidemiologia , Qualidade de Vida , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Estados Unidos/epidemiologia
14.
Health Educ Res ; 34(3): 310-320, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30929015

RESUMO

Despite established benefits, colorectal cancer (CRC) screening is underutilized among Latinos/Hispanics. We conducted a pilot 2-arm randomized controlled trial evaluating efficacy of two intervention conditions on CRC screening uptake among Latinos receiving care in community clinics. Participants (N = 76) were aged 50-75, most were foreign-born, preferred to receive their health information in Spanish, and not up-to-date with CRC screening. Participants were randomized to either a culturally linguistically targeted Spanish-language fotonovela booklet and DVD intervention plus fecal immunochemical test [FIT] (the LCARES, Latinos Colorectal Cancer Awareness, Research, Education and Screening intervention group); or a non-targeted intervention that included a standard Spanish-language booklet plus FIT (comparison group). Measures assessed socio-demographic variables, health literacy, CRC screening behavior, awareness and beliefs. Overall, FIT uptake was 87%, exceeding the National Colorectal Cancer Roundtable's goal of 80% by 2018. The LCARES intervention group had higher FIT uptake than did the comparison group (90% versus 83%), albeit not statistically significant (P = 0.379). The LCARES intervention group was associated with greater increases in CRC awareness (P = 0.046) and susceptibility (P = 0.013). In contrast, cancer worry increased more in the comparison group (P = 0.045). Providing educational materials and a FIT kit to Spanish-language preferring Latinos receiving care in community clinics is a promising strategy to bolster CRC screening uptake to meet national targets.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Promoção da Saúde/organização & administração , Hispano-Americanos , Provedores de Redes de Segurança/organização & administração , Idoso , Neoplasias Colorretais/etnologia , Competência Cultural , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Sangue Oculto , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos
15.
J Clin Oncol ; 37(7): 547-558, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30650044

RESUMO

PURPOSE: To identify potential gaps in attitudes, knowledge, and institutional practices toward lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients, a national survey of oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers was conducted to measure these attributes related to LGBTQ patients and desire for future training and education. METHODS: A random sample of 450 oncologists from 45 cancer centers was selected from the American Medical Association's Physician Masterfile to complete a survey measuring attitudes and knowledge about LGBTQ health and institutional practices. Results were quantified using descriptive and stratified analyses and by a novel attitude summary measure. RESULTS: Of the 149 respondents, there was high agreement (65.8%) regarding the importance of knowing the gender identity of patients, which was contrasted by low agreement (39.6%) regarding the importance of knowing sexual orientation. There was high interest in receiving education regarding the unique health needs of LGBTQ patients (70.4%), and knowledge questions yielded high percentages of "neutral" and "do not know or prefer not to answer" responses. After completing the survey, there was a significant decrease ( P < .001) in confidence in knowledge of health needs for LGB (53.1% agreed they were confident during survey assessment v 38.9% postsurvey) and transgender patients (36.9% v 19.5% postsurvey). Stratified analyses revealed some but limited influence on attitudes and knowledge by having LGBTQ friends and/or family members, political affiliation, oncology specialty, years since graduation, and respondents' region of the country. CONCLUSION: This was the first nationwide study, to our knowledge, of oncologists assessing attitudes, knowledge, and institutional practices of LGBTQ patients with cancer. Overall, there was limited knowledge about LGBTQ health and cancer needs but a high interest in receiving education regarding this community.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/terapia , Oncologistas/psicologia , Minorias Sexuais e de Gênero , Adulto , Competência Clínica , Assistência à Saúde Culturalmente Competente , Educação Médica , Feminino , Identidade de Gênero , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Oncologistas/educação , Comportamento Sexual , Pessoas Transgênero
16.
Addiction ; 114(5): 896-906, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30644627

RESUMO

BACKGROUND AND AIMS: Most e-cigarette users who also smoke combustible cigarettes (dual users) begin vaping to quit smoking, yet only a subset succeeds. We hypothesized that reinforcing characteristics of e-cigarettes (vaping reinforcement) would positively predict smoking cessation propensity (SCP) among dual users. DESIGN: Secondary analysis of cross-sectional baseline data from dual users in an ongoing smoking cessation trial. Exploratory and confirmatory factor analysis (EFA and CFA) created latent variables for vaping reinforcement and SCP. A structural equation modeling (SEM) approach was used to test the hypothesis. SETTING: United States. PARTICIPANTS: A national sample of dual users of combustible and electronic cigarettes who smoke and vape at least once per week (n = 2896) were enrolled (63% male; mean age = 29.9 years) into a randomized controlled trial in which they would receive either smoking cessation materials or no smoking cessation materials. MEASUREMENTS: Vaping reinforcement was indexed by vaping frequency (days/week vaping, times/day vaping, puffs/e-cigarette use), e-cigarette characteristics [numbers of modifications and tobacco or non-tobacco flavors, nicotine content (mg) and positive e-cigarette expectancies]. SCP was measured by items of confidence, commitment to being smoke-free, cessation motivation (contemplation ladder), change in cigarettes per day since beginning e-cigarette use and negative smoking expectancies. FINDINGS: Four factors emerged from the EFA: vaping propensity (vaping frequency, positive expectancies), vaping enthusiasm (e-cigarette modifications, using non-tobacco flavors, puffs per use), nicotine/tobacco flavor (nicotine strength, tobacco flavors) and SCP (negative expectancies about smoking, motivation to quit smoking, reduction in smoking). A CFA upheld the exploratory factor structure [root mean square error of approximation (RMSEA) = 0.046, CFI = 0.91]. An SEM with the three vaping latent variables directly predicting SCP had good model fit (RMSEA = 0.030, CFI = 0.97) with a positive relationship of vaping propensity (0.509, P < 0.001), and small negative relationships of vaping enthusiasm (-0.158, P = 0.014) and nicotine/tobacco flavor (-0.230, P < 0.001). CONCLUSIONS: Among e-cigarette users who also smoke combustible cigarettes, frequent vaping combined with positive e-cigarette expectancies appears to predict greater smoking cessation propensity. However, vaping enthusiasm (measured by e-cigarette modifications, using non-tobacco flavors and puffs per use), higher nicotine content and use of tobacco flavored solution may reduce cessation propensity.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Motivação , Abandono do Hábito de Fumar/psicologia , Vaping/psicologia , Adulto , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pontuação de Propensão , Abandono do Hábito de Fumar/estatística & dados numéricos , Vaping/epidemiologia
17.
J Clin Pathw ; 5(8): 33-40, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31930172

RESUMO

Background: Lung cancer biomarker-driven therapies are the gold standard of treatment and recent studies suggest a higher prevalence of specific targetable biomarkers among Hispanic/Latinos (H/L) than Non-Hispanic Whites (NHW). The study aimed (1) to identify Florida (FL) and Puerto Rico (PR) physicians' knowledge and perceived value of newer genomic data regarding race/ethnicity in relation to optimal lung cancer treatment and survival; and (2) to identify modifiable practice barriers both across and within each location regarding biomarker testing in lung cancer. Methods: A 25-item survey was administered to a stratified random sample of physicians in FL and PR (medical oncologists, radiation oncologists, pulmonologists, and pathologists). Questions targeted domains of biomarker knowledge, attitudes toward testing, barriers, and practice behaviors regarding lung cancer biomarker testing. Results: The response rate was 45%. Participants identified guiding treatment decisions (82%) and personalizing treatments for patients (78%) as key benefits to mutation testing. PR physicians were more likely (p=0.022) to believe H/L had an elevated incidence of targetable epidermal growth factor receptor (EGFR) mutations compared to NHW. They also perceived lack of appropriate testing resources as a primary barrier compared to FL physicians (43.6% vs. 20.6%, p<0.001), whereas FL physicians identified mutation tests not conducted routinely as part of patient diagnosis as a primary barrier (43.1% vs 24.2%, p= 0.008). Conclusions: Practice behaviors differed by specialty and between locations, and differences were noted concerning physician's preferences for ordering mutation testing, indicating a clear need for education among physicians in both locations. Impact: Educating physicians regarding biomarker testing is imperative to improve patient care.

18.
J Cancer Educ ; 34(2): 297-303, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29177920

RESUMO

The current study examines changes in awareness and health beliefs from baseline to 12 months post-intervention following receipt of one of two colorectal cancer (CRC) educational interventions that aimed to promote CRC screening among a racially and ethnically diverse and medically underserved population. Participants (N = 270) were enrolled in a randomized controlled trial to increase CRC screening and completed both baseline and 12-month follow-up assessments. Participants were aged 50-75, at average CRC risk, not up-to-date with CRC screening guidelines, and receiving care at one of three community-based clinics. Participants were randomized to receive either a targeted, low-literacy intervention informed by the Preventive Health Model [PHM] (photonovella and DVD plus fecal immunochemical test [FIT]) or a non-targeted intervention (standard educational brochure plus FIT). Changes in CRC awareness and health beliefs from baseline to 12 months were examined both within and between intervention groups using Student's t tests. Participants in both intervention conditions demonstrated an increase in CRC awareness, PHM social influence, and trust in the healthcare system (all p's < .0001), with no significant between-group differences. Among those receiving the targeted intervention, there also was an increase in PHM salience (p < .05). Among individuals receiving the non-targeted intervention, there was an increase in PHM response efficacy (p < .01) and PHM self-efficacy (p < .0001). Both CRC screening interventions promoted positive changes in awareness and several health beliefs from baseline to 12 months, suggesting important benefits of CRC education. Regardless of whether education was targeted or non-targeted, providing CRC screening education successfully promoted durable changes in awareness and health beliefs.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Feminino , Florida , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Sangue Oculto
19.
J Psychosoc Oncol ; 37(2): 228-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30372376

RESUMO

OBJECTIVE: Describe communication between patients with advanced cancer and their spouse/partner caregivers. DESIGN: Prospective observational study. SAMPLE: 83 advanced cancer patient-spouse caregiver couples. METHODS: Couples completed surveys and recorded naturalistic communication for one day. Descriptive analysis was performed on self-report and observational communication data. FINDINGS: Both patients and caregivers self-reported high likelihood of engaging in positive interactions. The majority of observed communication was logistical or social small-talk. Cancer and relationship talk was highly skewed; many couples had no talk in these domains. CONCLUSION: This study is one of the first to assess continuous naturalistic observation of communication in the homes of couples coping with advanced cancer. We found that routine aspects of daily life continue even when couples are facing important challenges. Implications for Psychosocial Providers: There appear to be few naturalistic cues encouraging couples to discuss potentially difficult topics. More work is needed to determine appropriate levels of communication.


Assuntos
Cuidadores/psicologia , Comunicação , Relações Interpessoais , Neoplasias/patologia , Neoplasias/psicologia , Cônjuges/psicologia , Adaptação Psicológica , Idoso , Cuidadores/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/terapia , Estudos Prospectivos , Autorrelato , Cônjuges/estatística & dados numéricos
20.
Psychol Addict Behav ; 32(7): 710-714, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30284878

RESUMO

There is a need for effective smoking cessation interventions that can be disseminated easily in health care and other settings. We previously reported that an extended self-help intervention comprising intensive repeated mailings over 18 months improved abstinence rates through 6 months beyond the end of the intervention when compared to both a reduced version of the self-help materials and a traditional self-help booklet. This report extends the follow-up for an additional 6 months (30-months postbaseline) to examine long-term maintenance of the intervention effect. We hypothesized that the previously observed "dose-response" effect of treatment intensity would be maintained. Participants were randomized to Traditional Self-Help (TSH, n = 638), Standard Repeated Mailings (SRM, n = 614), or Intensive Repeated Mailings (IRM, n = 622). TSH received an existing self-help smoking cessation booklet. SRM received 8 cessation booklets mailed over 12 months. IRM received monthly mailings of 10 booklets and additional material to enhance social support over 18 months. Follow-up assessments occurred every 6 months through 30 months. Data were collected 2010-2013 and analyzed 2014-2017. At 1 year posttreatment, there was a linear dose effect with the highest abstinence rates observed in IRM (33%), followed by SRM (29%), and then TSH (23%; p = .002). Paired comparisons indicated that IRM was superior to TSH (p = .002). Results revealed a robust intervention effect for the intensive self-help intervention that was maintained 12 months after treatment completion. This further supports extended self-help as a low-cost intervention for smoking cessation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Folhetos , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Apoio Social , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Autocuidado/métodos , Fumar/psicologia , Resultado do Tratamento
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