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Hashemi S, Bai L, Gao S, Burstein F, Renzenbrink K. Sharpening clinical decision support alert and reminder designs with MINDSPACE: A systematic review. Int J Med Inform 2024; 181:105276. [PMID: 37948981 DOI: 10.1016/j.ijmedinf.2023.105276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/07/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Clinical decision support (CDS) alerts and reminders aim to influence clinical decisions, yet they are often designed without considering human decision-making behaviour. While this behaviour is comprehensively described by behavioural economics (BE), the sheer volume of BE literature poses a challenge to designers when identifying behavioural effects with utility to alert and reminder designs. This study tackles this challenge by focusing on the MINDSPACE framework for behaviour change, which collates nine behavioural effects that profoundly influence human decision-making behaviour: Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitment, and Ego. METHOD A systematic review searching MEDLINE, Embase, PsycINFO, and CINAHL Plus to explore (i) the usage of MINDSPACE effects in alert and reminder designs and (ii) the efficacy of those alerts and reminders in influencing clinical decisions. The search queries comprised ten Boolean searches, with nine focusing on the MINDSPACE effects and one focusing on the term mindspace. RESULTS 50 studies were selected from 1791 peer-reviewed journal articles in English from 1970 to 2022. Except for ego, eight of nine MINDSPACE effects were utilised to design alerts and reminders, with defaults and norms utilised the most in alerts and reminders, respectively. Overall, alerts and reminders informed by MINDSPACE effects showed an average 71% success rate in influencing clinical decisions (alerts 73%, reminders 69%). Most studies utilised a single effect in their design, with higher efficacy for alerts (64%) than reminders (41%). Others utilised multiple effects, showing higher efficacy for reminders (28%) than alerts (9%). CONCLUSION This review presents sufficient evidence demonstrating the MINDSPACE framework's merits for designing CDS alerts and reminders with human decision-making considerations. The framework can adequately address challenges in identifying behavioural effects pertinent to the effective design of CDS alerts and reminders. The review also identified opportunities for future research into other relevant effects (e.g., framing).
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Affiliation(s)
- Sarang Hashemi
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia.
| | - Lu Bai
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Shijia Gao
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Frada Burstein
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
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Asfar T, Livingstone-Banks J, Ward KD, Eissenberg T, Oluwole O, Bursac Z, Ghaddar T, Maziak W. Interventions for waterpipe smoking cessation. Cochrane Database Syst Rev 2023; 6:CD005549. [PMID: 37286509 PMCID: PMC10245833 DOI: 10.1002/14651858.cd005549.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND While cigarette smoking has declined globally, waterpipe smoking is rising, especially among youth. The impact of this rise is amplified by mounting evidence of its addictive and harmful nature. Waterpipe smoking is influenced by multiple factors, including appealing flavors, marketing, use in social settings, and misperceptions that waterpipe is less harmful or addictive than cigarettes. People who use waterpipes are interested in quitting, but are often unsuccessful at doing so on their own. Therefore, developing and testing waterpipe cessation interventions to help people quit was identified as a priority for global tobacco control efforts. OBJECTIVES: To evaluate the effectiveness of tobacco cessation interventions for people who smoke waterpipes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Review Group Specialized Register from database inception to 29 July 2022, using variant terms and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for trials, published or unpublished, in any language. SELECTION CRITERIA We sought randomized controlled trials (RCTs), quasi-RCTs, or cluster-RCTs of any smoking cessation interventions for people who use waterpipes, of any age or gender. In order to be included, studies had to measure waterpipe abstinence at a three-month follow-up or longer. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was abstinence from waterpipe use at least three months after baseline. We also collected data on adverse events. Individual study effects and pooled effects were summarized as risk ratios (RR) and 95% confidence intervals (95% CI), using Mantel-Haenszel random-effects models to combine studies, where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarized secondary outcomes narratively. We used the five GRADE considerations (risk of bias, inconsistency of effect, imprecision, indirectness, and publication bias) to assess the certainty of the body of evidence for our primary outcome in four categories high, moderate, low, or very low. MAIN RESULTS This review included nine studies, involving 2841 participants. All studies were conducted in adults, and were carried out in Iran, Vietnam, Syria, Lebanon, Egypt, Pakistan, and the USA. Studies were conducted in several settings, including colleges/universities, community healthcare centers, tuberculosis hospitals, and cancer treatment centers, while two studies tested e-health interventions (online web-based educational intervention, text message intervention). Overall, we judged three studies to be at low risk of bias, and six studies at high risk of bias. We pooled data from five studies (1030 participants) that tested intensive face-to-face behavioral interventions compared with brief behavioral intervention (e.g. one behavioral counseling session), usual care (e.g. self-help materials), or no intervention. In our meta-analysis, we included people who used waterpipe exclusively, or with another form of tobacco. Overall, we found low-certainty evidence of a benefit of behavioral support for waterpipe abstinence (RR 3.19 95% CI 2.17 to 4.69; I2 = 41%; 5 studies, N = 1030). We downgraded the evidence because of imprecision and risk of bias. We pooled data from two studies (N = 662 participants) that tested varenicline combined with behavioral intervention compared with placebo combined with behavioral intervention. Although the point estimate favored varenicline, 95% CIs were imprecise, and incorporated the potential for no difference and lower quit rates in the varenicline groups, as well as a benefit as large as that found in cigarette smoking cessation (RR 1.24, 95% CI 0.69 to 2.24; I2 = 0%; 2 studies, N = 662; low-certainty evidence). We downgraded the evidence because of imprecision. We found no clear evidence of a difference in the number of participants experiencing adverse events (RR 0.98, 95% CI 0.67 to 1.44; I2 = 31%; 2 studies, N = 662). The studies did not report serious adverse events. One study tested the efficacy of seven weeks of bupropion therapy combined with behavioral intervention. There was no clear evidence of benefit for waterpipe cessation when compared with behavioral support alone (RR 0.77, 95% CI 0.42 to 1.41; 1 study, N = 121; very low-certainty evidence), or with self-help (RR 1.94, 95% CI 0.94 to 4.00; 1 study, N = 86; very low-certainty evidence). Two studies tested e-health interventions. One study reported higher waterpipe quit rates among participants randomized to either a tailored mobile phone or untailored mobile phone intervention compared with those randomized to no intervention (RR 1.48, 95% CI 1.07 to 2.05; 2 studies, N = 319; very low-certainty evidence). Another study reported higher waterpipe abstinence rates following an intensive online educational intervention compared with a brief online educational intervention (RR 1.86, 95% CI 1.08 to 3.21; 1 study, N = 70; very low-certainty evidence). AUTHORS' CONCLUSIONS: We found low-certainty evidence that behavioral waterpipe cessation interventions can increase waterpipe quit rates among waterpipe smokers. We found insufficient evidence to assess whether varenicline or bupropion increased waterpipe abstinence; available evidence is compatible with effect sizes similar to those seen for cigarette smoking cessation. Given e-health interventions' potential reach and effectiveness for waterpipe cessation, trials with large samples and long follow-up periods are needed. Future studies should use biochemical validation of abstinence to prevent the risk of detection bias. Finally, there has been limited attention given to high-risk groups for waterpipe smoking, such as youth, young adults, pregnant women, and dual or poly tobacco users. These groups would benefit from targeted studies.
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Affiliation(s)
- Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Olusanya Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoran Bursac
- Biostatistics, Florida International University, Miami, FL, USA
| | - Tarek Ghaddar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
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Seitz CM, Ward KD, Kabir Z. Country Participation in the WHO Framework Convention on Tobacco Control Health Warnings Database. Tob Use Insights 2021; 14:1179173X211064214. [PMID: 34880697 PMCID: PMC8646821 DOI: 10.1177/1179173x211064214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/03/2021] [Indexed: 12/05/2022] Open
Abstract
Background The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) Health Warnings Database is an online, publicly available resource created for countries to upload and share pictorial health warnings for tobacco packaging. The purpose of this study was to evaluate the extent to which the database is used by countries for the sharing of pictorial warnings. Methods The study’s sample included parties to the FCTC who required graphic health warning labels on cigarette packaging from. Those countries were categorized as having a low, middle, and high Socio-Demographic Index (SDI). The Health Warnings Database was then analyzed for those countries’ unique pictorial images, as well as the number of pictorials that were shared between countries. Results Of the 110 countries that required pictorial warnings on cigarette packaging, only 53 (48%) voluntarily contributed pictorials to the database, with most of those (53%) being high SDI-level countries. There were 342 unique pictorials on the database, with 62 images posted by seven countries that were used by 13 other countries. Conclusion While sharing was evident from the database, there remains a need for more countries to upload the pictorials to the database. There is also a need to expand the database to include alternative tobacco products, such as waterpipe tobacco and e-cigarettes.
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Affiliation(s)
- Christopher M Seitz
- Department of Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, The University of Memphis, Memphis, TN, USA
| | - Zubair Kabir
- School of Public Health, University College Cork, Cork, Ireland
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Stevens EM, Villanti AC, Leshner G, Wagener TL, Keller-Hamilton B, Mays D. Integrating Self-Report and Psychophysiological Measures in Waterpipe Tobacco Message Testing: A Novel Application of Multi-Attribute Decision Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11814. [PMID: 34831571 PMCID: PMC8617707 DOI: 10.3390/ijerph182211814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Waterpipe (i.e., hookah) tobacco smoking (WTS) is one of the most prevalent types of smoking among young people, yet there is little public education communicating the risks of WTS to the population. Using self-report and psychophysiological measures, this study proposes an innovative message testing and data integration approach to choose optimal content for health communication messaging focusing on WTS. METHODS In a two-part study, we tested 12 WTS risk messages. Using crowdsourcing, participants (N = 713) rated WTS messages based on self-reported receptivity, engagement, attitudes, and negative emotions. In an in-lab study, participants (N = 120) viewed the 12 WTS risk messages while being monitored for heart rate and eye-tracking, and then completed a recognition task. Using a multi-attribute decision-making (MADM) model, we integrated data from these two methods with scenarios assigning different weights to the self-report and laboratory data to identify optimal messages. RESULTS We identified different optimal messages when differently weighting the importance of specific attributes or data collection method (self-report, laboratory). Across all scenarios, five messages consistently ranked in the top half: four addressed harms content, both alone and with themes regarding social use and flavors and one addiction alone message. DISCUSSION Results showed that the self-report and psychophysiological data did not always have the same ranking and differed based on weighting of the two methods. These findings highlight the need to formatively test messages using multiple methods and use an integrated approach when selecting content.
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Affiliation(s)
- Elise M. Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Andrea C. Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05405, USA;
| | - Glenn Leshner
- Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, OK 73019, USA;
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, OH 43214, USA; (T.L.W.); (B.K.-H.); (D.M.)
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Brittney Keller-Hamilton
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, OH 43214, USA; (T.L.W.); (B.K.-H.); (D.M.)
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, OH 43214, USA; (T.L.W.); (B.K.-H.); (D.M.)
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
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Mays D, Johnson AC, Phan L, Sanders C, Shoben A, Tercyak KP, Wagener TL, Brinkman MC, Lipkus IM. Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial. Am J Public Health 2021; 111:1686-1695. [PMID: 34436927 PMCID: PMC8589064 DOI: 10.2105/ajph.2021.306389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.
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Affiliation(s)
- Darren Mays
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Johnson
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lilianna Phan
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Camilla Sanders
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Abigail Shoben
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kenneth P Tercyak
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Theodore L Wagener
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marielle C Brinkman
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Isaac M Lipkus
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238752. [PMID: 33255675 PMCID: PMC7728075 DOI: 10.3390/ijerph17238752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 12/23/2022]
Abstract
Young adults’ hookah tobacco use is fueled by misperceptions about risks, appealing flavors, and social use. We developed and pretested public education messages to prevent and reduce hookah tobacco smoking among young adults. We used a two (user status: current hookah user, susceptible never user) by two (risk content: health harms or addiction) by three (message theme: harms/addiction risk alone, harms/addiction risk flavors, or harms/addiction risk social use) design with two messages/condition (n = 12 total messages). Young adults aged 18–30 (N = 713) were randomized to 1 of 12 messages and completed measures assessing message receptivity, attitudes, and negative emotional response. Harms messages were associated with greater receptivity (p < 0.001), positive attitudes (p < 0.001), and negative emotional response (p < 0.001) than addiction messages. Messages with harm or addiction content alone were associated with greater receptivity than social use-themed messages (p = 0.058). Flavor-themed messages did not differ in receptivity from harm or addiction content alone or social use-themed messages. Messages about the health harms of hookah tobacco use resonate more with young adults than addiction risk messages. Social use-themed messages produce the lowest receptivity. These findings can guide population-based approaches to communicate hookah tobacco risks to young adults.
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Johnson AC, Mays D. Testing the Effects of Hookah Tobacco Social Media Risk Communication Messages Among Young Adults. HEALTH EDUCATION & BEHAVIOR 2020; 48:627-636. [PMID: 33073594 DOI: 10.1177/1090198120963104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hookah tobacco is commonly used among young adults, and use is driven in part by widespread misperceptions about risks. Social media use, particularly Instagram, is prominent in this population and exposure to commercial and user-generated content promoting hookah commonly occurs. AIMS This study tested the effects of hookah tobacco risk messaging for delivery via Instagram as a strategy to offset exposure to content promoting hookah use among young adults. METHOD Young adult hookah smokers were recruited online for a 2 × 3 between-subjects experiment (n = 601). Participants completed preexposure measures and were randomized to view hookah tobacco Instagram ads (commercial or user generated) with risk messages (none, risk education, or graphic risk). Stimuli were presented as a simulated Instagram feed. After viewing the stimuli, participants completed postexposure outcome measures. RESULTS There was a statistically significant main effect of risk message type but no significant main effect of Instagram ad type or risk message type by ad type interactions. Exposure to the graphic risk and risk education messages were associated with lower intentions to engage with hookah tobacco ads on Instagram. Graphic risk and risk education messages produced greater negative emotional response and the graphic messages increased motivation to quit compared with Instagram ads alone. DISCUSSION Findings provide preliminary evidence that hookah tobacco risk messages delivered via Instagram can offset the influence of content promoting the use of hookah tobacco. CONCLUSION This study represents an example of risk message testing and the results suggest the messages warrant further testing via social media delivery.
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Affiliation(s)
| | - Darren Mays
- The Ohio State University, Columbus, OH, USA
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The Digital Health Landscape in Addiction and Substance Use Research: Will Digital Health Exacerbate or Mitigate Health Inequities in Vulnerable Populations? CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00325-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Arslan HN, Oruc MA, Terzi O, Bilir N. Evaluation of the Opinions of Family Physicians on Some Tobacco Products. J Community Health 2020; 45:1132-1138. [PMID: 32613534 DOI: 10.1007/s10900-020-00872-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study aimed to evaluate the opinions of family physicians, who have an important place in preventive health services, on some tobacco products. The sample of the descriptive study was composed of family physicians working in 408 family health centers serving Samsun, Turkey. The data were obtained by distributing a questionnaire prepared by the researchers to volunteer family physicians during in-service trainings organized by the Samsun Provincial Directorate of Health in February and March 2019. In all, 322 (79%) family physicians who participated in the trainings were included in the study. The average age of the participating physicians was 45.0 ± 7.6 years; 61.5% of them were male. More than one third (36.0%) of family physicians said that they had never smoked, while 23.6% of them were current smokers. Most (85.0%) said that they knew what an electronic cigarette was, 94.7% of them were familiar with hookahs, and 9.0% knew about I Quit Ordinary Smoking (IQOS). It is important to inform all healthcare professionals, and especially family physicians, about those products marketed by the tobacco industry as "less harmful" than cigarettes. It is thought that providing appropriate counseling services to these professionals will contribute to the fight against tobacco use.
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Affiliation(s)
- Hatice Nilden Arslan
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | | | - Ozlem Terzi
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Mays D, Phan L, Johnson AC, Tercyak KP, Snow K, Luta G, Rehberg K, Lipkus I. Results of a Single Arm Pilot Study of a Mobile Messaging Intervention for Hookah Tobacco Cessation in Young Adults. Tob Use Insights 2020; 13:1179173X20915200. [PMID: 32440243 PMCID: PMC7225829 DOI: 10.1177/1179173x20915200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background Hookah tobacco use is common among young adults. Unlike cigarette smoking, there is limited evidence on mobile (ie, mHealth) interventions to promote cessation. Objectives This pilot study tested the preliminary effects of mobile messaging for cessation in young adult hookah smokers. Methods Young adults (N = 20) aged 18 to 30 years who smoke hookah at least monthly and have done so at least once in the past 30 days received a 6-week mHealth multimedia messaging (text and images) intervention. Message scheduling (2 days/week × 6 weeks) was based on the literature. Content was developed iteratively by the study team and focused on health harms and addictiveness of hookah. Content was individually tailored by baseline hookah use frequency, risk beliefs, and responses to interactive text messages assessing participants' hookah tobacco use behavior and beliefs to maximize impact. Engagement was assessed during the intervention, and we examined effects on risk perceptions, risk beliefs, and risk appraisals, motivation to quit, and behavior change immediately post-intervention. Results Participants responded to 11.5 (SD = 0.69) of 12 text message prompts on average, endorsed high message receptivity (M = 6.1, SD = 0.93, range = 1-7), and reported the messages were helpful (M = 8.5, SD = 1.5, range = 1-10). There were significant (P < .05) increases in risk perceptions (d's = 0.22-0.88), risk appraisals (d = 0.49), risk beliefs (d = 1.11), and motivation to quit (d = 0.97) post-intervention. Half of participants reported reducing frequency of hookah use (20%) or quitting completely (30%) by end of treatment. Conclusions These pilot results provide preliminary support for an mHealth messaging intervention about risks of hookah tobacco for promoting cessation. Rigorously examining the efficacy of this promising intervention is warranted.
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Affiliation(s)
- Darren Mays
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Lilianna Phan
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Johnson
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kylie Snow
- Department of Human Science, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn Rehberg
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, NC, USA
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Allegrante JP, Auld ME. Advancing the Promise of Digital Technology and Social Media to Promote Population Health. HEALTH EDUCATION & BEHAVIOR 2019; 46:5-8. [PMID: 31742449 DOI: 10.1177/1090198119875929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In June of 2018, the Society for Public Health Education partnered with The George Washington University Milken Institute School of Public Health, University of Maryland School of Public Health at College Park, and the Public Good Projects to convene the inaugural Digital Health Promotion Executive Leadership Summit in Washington, D.C. We launched the 2018 Summit for several reasons. First, because of the ubiquity of digital technology and reach of social media, it had become apparent to us that the time was right to bring greater focus to the promise that digital technology and social media hold for improving the public's health. Second, while other forums were discussing uses of mHealth and eHealth, it was clear the public and private sectors were talking within siloes; thus we believed that more needed to be done to catalyze a dialogue among the academic, industry, and government sectors to share their efforts and to examine the opportunities-and challenges-of forging collaborative partnerships in developing and evaluating the next generation of digital information and health communication technologies. And third, we hoped to facilitate a conversation among leaders from each of these sectors that would result in a consensus on a "Common Agenda" for future actions to advance digital health promotion efforts.
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Affiliation(s)
| | - M Elaine Auld
- Society for Public Health Education, Washington, DC, USA
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