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BACKGROUND: Research designed to elicit smokers' cognitive and affective reactions to information about chemicals that tobacco companies add to cigarettes ("additives") found that knowledge is limited. However, little is known about smokers' unprompted thoughts and feelings about additives. Such information could be used to shape future communication efforts. We explored the content and possible functions of spontaneous statements about cigarette additives made by smokers during a study examining reactions to learning about the genetic link to nicotine addiction. METHODS: Adult smokers (N = 84) were recruited from a medium-sized Midwestern city. Focus groups (N = 13) were conducted between April-September 2012. Data were analyzed by 2 coders using thematic analysis. RESULTS: Comments about cigarette additives arose without prompting by the focus group moderator. Three main themes were identified: (1) discussing additives helped participants navigate the conceptual link between smoking and genetics, (2) additives were discussed as an alternative mechanism for addiction to cigarettes, and (3) additives provided an alternative mechanism by which cigarette smoking exacerbates physical harm. Notably, discussion of additives contained a pervasive tone of mistrust illustrated by words like "they" and "them," by statements of uncertainty such as "you don't know what they're putting into cigarettes," and by negative affective verbalizations such as "nasty" and "disgusting". CONCLUSIONS: Participants had distinct beliefs about cigarette additives, each of which seemed to serve a purpose. Although mistrust may complicate communication about the health risks of tobacco use, health communication experts could use smokers' existing beliefs and feelings to better design more effective anti-smoking messages.
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Conducta Adictiva/genética , Fumadores/psicología , Productos de Tabaco , Tabaquismo/genética , Adulto , Emociones , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Fumadores/estadística & datos numéricosRESUMEN
OBJECTIVES: To summarize the overall impact of the Nurses' Health Study (NHS) over the past 40 years on the health of populations through its contributions on prevention, translation, and control. METHODS: We performed a narrative review of the findings of the NHS, NHS II, and NHS3 between 1976 and 2016. RESULTS: The NHS has generated significant findings about the associations between (1) smoking and type 2 diabetes, cardiovascular diseases, colorectal and pancreatic cancer, psoriasis, multiple sclerosis, and eye diseases; (2) physical activity and cardiovascular diseases, breast cancer, psoriasis, and neurodegeneration; (3) obesity and cardiovascular diseases, numerous cancer sites, psoriasis, multiple sclerosis, kidney stones, and eye diseases; (4) oral contraceptives and cardiovascular disease, melanoma, and breast, colorectal, and ovarian cancer; (5) hormone therapy and cardiovascular diseases, breast and endometrial cancer, and neurodegeneration; (6) endogenous hormones and breast cancer; (7) dietary factors and type 2 diabetes, cardiovascular diseases, breast and pancreatic cancer, non-Hodgkin's lymphoma, neurodegeneration, multiple sclerosis, kidney stones, and eye diseases; and (8) sleep and shift work and chronic diseases. CONCLUSIONS: The NHS findings have influenced public health policy and practice both locally and globally to improve women's health.
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Encuestas Epidemiológicas , Enfermeras y Enfermeros , Salud Pública , Salud de la Mujer , Adulto , Estudios Epidemiológicos , Femenino , Política de Salud , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Estudios Prospectivos , Mejoramiento de la Calidad , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To examine 1) parent-provider communication about pediatric health/safety guidelines, 2) trust in child's provider, 3) comfort discussing guidelines, 4) agreement with guideline advice, 5) self-efficacy following guidelines, and their impact on guideline adherence. METHOD: 256 parents of children ages 0-6 completed an online survey about sunscreen use, newborn Vitamin K injections, influenza vaccination, routine vaccination, car seats, infant safe sleep, furniture anchoring, large trampoline use, and firearm safety. Multivariable models regressed: 1) communication about each guideline on parents' corresponding guideline adherence; 2) trust, comfort discussing guidelines, agreement with guideline advice, self-efficacy, on parents' total guideline adherence. RESULTS: Communication about furniture anchoring (ORâ¯=â¯2.26), sunscreen (ORâ¯=â¯5.28), Vitamin K injections (ORâ¯=â¯3.20), influenza vaccination (ORâ¯=â¯13.71), routine vaccination (ORâ¯=â¯6.43), car seats (ORâ¯=â¯6.15), and infant safe sleep (ORâ¯=â¯3.40) related to corresponding guideline adherence (psâ¯<â¯0.05). Firearm safety communication was not related to adherence (ORâ¯=â¯1.11, n.s.). Trampoline communication related to lower likelihood of trampoline guideline adherence (ORâ¯=â¯0.24, pâ¯=â¯0.001). Agreement with guideline advice (ßâ¯=â¯0.35), trust (ßâ¯=â¯0.34), self-efficacy (ßâ¯=â¯0.45), comfort discussing guidelines (ßâ¯=â¯0.35) positively related to total guideline adherence (psâ¯<â¯0.001). CONCLUSION: Findings underscore the importance of provider communication about health/safety guidelines. PRACTICE IMPLICATIONS: Providers should respectfully engage and build relationships with parents to support health/safety guideline adherence.
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Comunicación , Adhesión a Directriz , Comunicación en Salud , Padres/psicología , Relaciones Profesional-Familia , Autoeficacia , Adulto , Niño , Preescolar , Femenino , Conductas Relacionadas con la Salud , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , ConfianzaRESUMEN
Objective. Numerous electronic tools help consumers select health insurance plans based on their estimated health care utilization. However, the best way to personalize these tools is unknown. The purpose of this study was to compare two common methods of personalizing health insurance plan displays: 1) quantitative healthcare utilization predictions using nationally representative Medical Expenditure Panel Survey (MEPS) data and 2) subjective-health status predictions. We also explored their relations to self-reported health care utilization. Methods. Secondary data analysis was conducted with responses from 327 adults under age 65 considering health insurance enrollment in the Affordable Care Act (ACA) marketplace. Participants were asked to report their subjective health, health conditions, and demographic information. MEPS data were used to estimate predicted annual expenditures based on age, gender, and reported health conditions. Self-reported health care utilization was obtained for 120 participants at a 1-year follow-up. Results. MEPS-based predictions and subjective-health status were related (P < 0.0001). However, MEPS-predicted ranges within subjective-health categories were large. Subjective health was a less reliable predictor of expenses among older adults (age × subjective health, P = 0.04). Neither significantly related to subsequent self-reported health care utilization (P = 0.18, P = 0.92, respectively). Conclusions. Because MEPS data are nationally representative, they may approximate utilization better than subjective health, particularly among older adults. However, approximating health care utilization is difficult, especially among newly insured. Findings have implications for health insurance decision support tools that personalize plan displays based on cost estimates.
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BACKGROUND: Postmastectomy breast reconstruction (PMBR) is an elective, preference-sensitive decision made during a stressful, time-pressured period after a cancer diagnosis. Shared decision making (SDM) can improve decision quality about preference-sensitive choices. Stakeholders' perspectives on ways to support PMBR decision-making were explored. METHODS: Forty semi-structured interviews with stakeholders (20 postmastectomy patients, 10 PMBR surgeons, 10 PMBR nurses) were conducted. Clinicians were recruited from diverse practices across the United States. Patients were recruited using purposive sampling with varying PMBR experiences, including no reconstruction. The interview guide was based on an implementation research framework. Themes were identified using grounded theory approach, based on frequency and emotive force conveyed. RESULTS: Engagement in SDM was variable. Some patients wanted more information about PMBR from clinicians, particularly about risks. Some clinicians acknowledged highlighting benefits and downplaying risks. Many patients felt pressured to make a choice by their clinicians. Clinicians who successfully engaged patients through decisions often used outside resources to supplement conversations. CONCLUSIONS: Patient-clinician trust was critical to high-quality decisions, and many patients expressed decision regret when they were not engaged in PMBR discussions. Patients often perceived a race- or age-related bias in clinician information sharing. Interventions to support SDM may enhance decision quality and reduce decision regret about PMBR, ultimately improving patient-centered care for women with breast cancer.
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OBJECTIVE: We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations. METHODS: We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions. Outcomes included time spent clarifying values (primary), attitudes and beliefs about the parent (secondary). RESULTS: 132 medical students and pediatric residents enrolled; 119 (90%) completed the study. There were no differences in time participants would spend clarifying values (antibiotics 26±12%; equipoise 28±11%; vaccine-hesitancy 22±11%; p=0.058). Participants in the vaccine-hesitancy group (vs. other groups) would spend less time answering questions (p=0.006). Participants in the antibiotics (vs. equipoise) group perceived the parent as difficult (p=0.0002). Those in the vaccine-hesitancy group (vs. other groups) perceived the parent as difficult, saw less value in the conversation, and had lower respect for the parent's views (all ps<0.0001). Most (76%) wanted additional training navigating these discussions. CONCLUSION: Clinicians' attitudes may impact conversations when patients question evidence-based recommendations. PRACTICE IMPLICATIONS: Clinicians should consider ways to discuss evidence and clarify patients' values to optimize health without damaging patient-clinician relationships.
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Actitud del Personal de Salud , Comunicación en Salud/métodos , Padres/psicología , Relaciones Profesional-Familia , Adulto , Práctica Clínica Basada en la Evidencia , Femenino , Humanos , Lactante , Internado y Residencia , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Estudiantes de MedicinaRESUMEN
INTRODUCTION: Since the Affordable Care Act was passed, more than 12 million individuals have enrolled in the health insurance marketplace. Without support, many struggle to make an informed plan choice that meets their health and financial needs. METHODS: We designed and evaluated a decision aid, Show Me My Health Plans (SMHP), that provides education, preference assessment, and an annual out-of-pocket cost calculator with plan recommendations produced by a tailored, risk-adjusted algorithm incorporating age, gender, and health status. We evaluated whether SMHP compared to HealthCare.gov improved health insurance decision quality and the match between plan choice, needs, and preferences among 328 Missourians enrolling in the marketplace. RESULTS: Participants who used SMHP had higher health insurance knowledge (LS-Mean = 78 vs. 62; P < 0.001), decision self-efficacy (LS-Mean = 83 vs. 75; P < 0.002), confidence in their choice (LS-Mean = 3.5 vs. 2.9; P < 0.001), and improved health insurance literacy (odds ratio = 2.52, P <0.001) compared to participants using HealthCare.gov. Those using SMHP were 10.3 times more likely to select a silver- or gold-tier plan (P < 0.0001). DISCUSSION: SMHP can improve health insurance decision quality and the odds that consumers select an insurance plan with coverage likely needed to meet their health needs. This study represents a unique context through which to apply principles of decision support to improve health insurance choices.
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Early mobilization of critically ill patients with the acute respiratory distress syndrome (ARDS) has emerged as a therapeutic strategy that improves patient outcomes, such as the duration of mechanical ventilation and muscle strength. Despite the apparent efficacy of early mobility programs, their use in clinical practice is limited outside of specialized centers and clinical trials. To evaluate the mechanisms underlying mobility therapy, we exercised acute lung injury (ALI) mice for 2 days after the instillation of lipopolysaccharides into their lungs. We found that a short duration of moderate intensity exercise in ALI mice attenuated muscle ring finger 1 (MuRF1)-mediated atrophy of the limb and respiratory muscles and improved limb muscle force generation. Exercise also limited the influx of neutrophils into the alveolar space through modulation of a coordinated systemic neutrophil chemokine response. Granulocyte colony-stimulating factor (G-CSF) concentrations were systemically reduced by exercise in ALI mice, and in vivo blockade of the G-CSF receptor recapitulated the lung exercise phenotype in ALI mice. Additionally, plasma G-CSF concentrations in humans with acute respiratory failure (ARF) undergoing early mobility therapy showed greater decrements over time compared to control ARF patients. Together, these data provide a mechanism whereby early mobility therapy attenuates muscle wasting and limits ongoing alveolar neutrophilia through modulation of systemic neutrophil chemokines in lung-injured mice and humans.