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Tsai MH, Moore JX, Odhiambo LA, Andrzejak SE, Tingen MS. Colorectal cancer screening utilization among breast, cervical, prostate, skin, and lung cancer survivors. J Cancer Surviv 2024; 18:541-552. [PMID: 36217067 PMCID: PMC9549837 DOI: 10.1007/s11764-022-01258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To examine whether sociodemographic characteristics, access to care, risk behavior factors, and chronic health conditions were associated with colorectal cancer (CRC) screening utilization among breast, cervical, prostate, skin, and lung cancer survivors. METHODS We analyzed the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data on 9780 eligible cancer survivors. Descriptive statistics and multivariable logistic regression models were applied to assess the association between guideline-concordant CRC screening and the mentioned characteristics. RESULTS Overall, 81.9%, 65%, 88%,78.1%, and 80.1% of breast, cervical, prostate, skin, and lung cancer survivors received CRC screening, respectively (p-value < 0.001). In multivariable analysis, breast, cervical, and skin cancer survivors aged 60 years or older were associated with higher odds of receiving CRC screening. Respondents that had their recency of routine checkup two or more years before had lower odds of having CRC screening among cervical (OR = 0.06; 95% CI, 0.02-0.22), prostate (OR = 0.26; 95% CI, 0.14-0.49), and skin cancer (OR = 0.50; 95% CI, 0.36-0.70) survivors. The presence of chronic diseases was also associated with guideline-concordant CRC screening among breast, prostate, and skin cancer survivors. CONCLUSIONS Our findings provide important evidence on potential factors that are associated with guideline-concordant CRC screening utilization across different cancer survivors, which include older age, recency of routine checkup, and multiple chronic diseases. Moreover, variation in CRC screening utilization across cancer survivors may highlight missed opportunities for secondary cancer prevention. IMPLICATIONS FOR CANCER SURVIVORS Establishing clear CRC screening guidelines and including patient-provider communication on recommendation in cancer survivorship care may increase adherence to CRC screening.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA.
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA.
| | - Justin X Moore
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Lorriane A Odhiambo
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Martha S Tingen
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA
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Sasaki K, Morita K, Kantarjian H, Garcia-Manero G, Jabbour E, Ravandi F, Konopleva M, Borthakur G, Wierda W, Daver N, Takahashi K, DiNardo C, Bravo GM, Issa GC, Pierce SA, Soltysiak KA, Tingen MS, Cortes JE. Geographic Disparity of Outcome in Patients With Cancer Over Decades: The Surveillance, Epidemiology, and End Results. Clin Lymphoma Myeloma Leuk 2023; 23:e369-e378. [PMID: 37690903 DOI: 10.1016/j.clml.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Improvements in prevention, early detection, and effective cancer therapy have decreased cancer-related mortality; however, significant health disparities exist. Therefore, we investigated the impact of these disparities on survival. METHODS In the Surveillance, Epidemiology, and End Results, we identified 784,341 patients with cancer between 1990 and 2016 in Georgia, 68,493 between 1990 and 1999; 371,353 between 2000 and 2009; and 322,932 between 2010 and 2016. We assessed the overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer, given the dramatic improvement in outcomes in patients with CML since 2000 compared to the generally considerably worse outcomes in lung cancer. In addition, we assessed the distance from each county to the Georgia Cancer Center (GCC) or the National Cancer Institute-designated Cancer Center (NCI-CC). RESULTS The 5-year OS of patients with any cancer was 55%, and the 5-year OS of each county ranged from 33% to 82% (interquartile range, 51%-65%) (P < .001). In patients with lung cancer and CML, the 5-year OS rates were 15% and 52%, respectively. The geographic differences between counties were relatively small and constant over time for patients with lung cancer. However, geographic differences were more prominent in patients with CML and widened after the introduction of modern therapies. Multivariate Cox regression showed that age, median county income, race, and distance to GCC or NCI-CC were predictive factors. CONCLUSIONS Significant disparities in cancer care exist among geographic locations. Geographic differences in survival appear more prominent when highly effective therapies are available.
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Affiliation(s)
- Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kiyomi Morita
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherry A Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly A Soltysiak
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Martha S Tingen
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
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Andrzejak SE, Lewis-Thames MW, Langston ME, Han Y, Khan S, Nettles DA, Fuzzell LN, Tingen MS, Moore JX. The Role of BMI in Allostatic Load and Risk of Cancer Death. Am J Prev Med 2023; 65:417-426. [PMID: 36889531 PMCID: PMC10440242 DOI: 10.1016/j.amepre.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Obesity and proinflammatory conditions are associated with increased risks of cancer. The associations of baseline allostatic load with cancer mortality and whether this association is modified by body mass index (BMI) were examined. METHODS A retrospective analysis was performed in March-September 2022 using National Health and Nutrition Examination Survey years 1988 through 2010 linked with the National Death Index through December 31, 2019. Fine and Gray Cox proportional hazard models were stratified by BMI status to estimate subdistribution hazard ratios of cancer death between high and low allostatic load status (adjusted for age, sociodemographics, and health factors). RESULTS In fully adjusted models, high allostatic load was associated with a 23% increased risk of cancer death (adjusted subdistribution hazard ratio=1.23; 95% CI=1.06, 1.43) among all participants, a 3% increased risk of cancer death (adjusted subdistribution hazard ratio=1.03; 95% CI=0.78, 1.34) among underweight/healthy weight adults, a 31% increased risk of cancer death (adjusted subdistribution hazard ratio=1.31; 95% CI=1.02, 1.67) among overweight adults, and a 39% increased risk of death (adjusted subdistribution hazard ratio=1.39; 95% CI=1.04, 1.88) among obese adults, when compared to those with low allostatic load. CONCLUSIONS The risk of cancer death is highest among those with high allostatic load and obese BMI, but this effect was attenuated among those with high allostatic load and underweight/healthy or overweight BMI.
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Affiliation(s)
- Sydney E Andrzejak
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois
| | - Marvin E Langston
- Department of Epidemiology & Population Health, Stanford University, Stanford, California
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Darryl A Nettles
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Lindsay N Fuzzell
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Martha S Tingen
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Justin X Moore
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia; Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Coughlin SS, Datta B, Moore JX, Vernon MM, Tingen MS. Preventive behaviors and behavioral risk factors among gynecologic cancer survivors: Results from the 2020 Behavioral Risk Factor Surveillance System Survey. Cancer Med 2023; 12:15435-15446. [PMID: 37387412 PMCID: PMC10417268 DOI: 10.1002/cam4.6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Maintaining a healthy lifestyle is an important factor in promoting positive outcomes for gynecologic cancer survivors. METHODS We examined preventive behaviors among gynecologic cancer survivors (n = 1824) and persons without a history of cancer in a cross-sectional analysis, using data from the 2020 Behavioral Risk Factor Surveillance System survey (BRFSS). BRFSS is a cross-sectional telephone-based survey of U.S. residents 18 years of age and older, which collects information about health-related factors and use of preventive services. RESULTS The prevalence rates of colorectal cancer screening were respectively 7.9 (95% CI: 4.0-11.9) and 15.0 (95% CI: 4.0-11.9) %-points higher among gynecologic and other cancer survivors compared to that of 65.2% among those without any history of cancer. However, no differences were observed in breast cancer screening between gynecologic cancer survivors (78.5%) and respondents without any history of cancer (78.7%). Coverage of influenza vaccination among gynecologic cancer survivors were 4.0 (95% CI: 0.3-7.6) %-points higher than that of the no cancer group, but 11.6 (95% CI: 7.6-15.6) %-points lower than that of the other cancer group. Pneumonia vaccination rate among gynecologic cancer survivors, however, was not statistically different than that of other cancer survivors and respondents with no history of cancer. When examining modifiable risk behaviors, the prevalence of smoking among gynecologic cancer survivors was 12.8 (95% CI: 9.5-16.0) and 14.2 (95% CI: 10.8-17.7) %-points higher than smoking prevalence among other cancer survivors and respondents without any history of cancer. The rate differentials were even higher in rural areas, 17.4 (95% CI: 7.2-27.6) and 18.4 (95% CI: 7.4-29.4) %-points respectively. There were no differences in the prevalence of heavy drinking across the groups. Lastly, gynecologic and other cancer survivors were less likely to be physically active (Δ = -12.3, 95% CI: -15.8 to -8.8 and Δ = -6.9, 95% CI: -8.5 to -5.3, respectively) than those without any history of cancer. CONCLUSION Smoking prevalence among gynecologic cancer survivors is alarmingly high. Intervention studies are needed to identify effective ways to assist gynecologic cancer survivors to quit smoking and refrain from hazardous alcohol consumption. In addition, women with gynecologic malignancies should made aware of the importance of physical activity.
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Affiliation(s)
- Steven S. Coughlin
- Department of Population Health SciencesAugusta UniversityAugustaGeorgiaUSA
- Institute of Public and Preventive Health, Augusta UniversityAugustaGeorgiaUSA
| | - Biplab Datta
- Department of Population Health SciencesAugusta UniversityAugustaGeorgiaUSA
- Institute of Public and Preventive Health, Augusta UniversityAugustaGeorgiaUSA
| | - Justin Xavier Moore
- Institute of Public and Preventive Health, Augusta UniversityAugustaGeorgiaUSA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Department of Medicine, Medical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Marlo M. Vernon
- Institute of Public and Preventive Health, Augusta UniversityAugustaGeorgiaUSA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Department of Medicine, Medical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Martha S. Tingen
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Department of Medicine, Medical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
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Moore JX, Tingen MS, Coughlin SS, O’Meara C, Odhiambo L, Vernon M, Jones S, Petcu R, Johnson R, Islam KM, Nettles D, Albashir G, Cortes J. Understanding geographic and racial/ethnic disparities in mortality from four major cancers in the state of Georgia: a spatial epidemiologic analysis, 1999–2019. Sci Rep 2022; 12:14143. [PMID: 35986041 PMCID: PMC9391349 DOI: 10.1038/s41598-022-18374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
We examined geographic and racial variation in cancer mortality within the state of Georgia, and investigated the correlation between the observed spatial differences and county-level characteristics. We analyzed county-level cancer mortality data collected by the Centers for Disease Control and Prevention on breast, colorectal, lung, and prostate cancer mortality among adults (aged ≥ 18 years) in 159 Georgia counties from years 1999 through 2019. Geospatial methods were applied, and we identified hot spot counties based on cancer mortality rates overall and stratified by non-Hispanic white (NH-white) and NH-black race/ethnicity. Among all adults, 5.0% (8 of 159), 8.2% (13 of 159), 5.0% (8 of 159), and 6.9% (11 of 159) of Georgia counties were estimated hot spots for breast cancer, colorectal, lung, and prostate cancer mortality, respectively. Cancer mortality hot spots were heavily concentrated in three major areas: (1) eastern Piedmont to Coastal Plain regions, (2) southwestern rural Georgia area, or (3) northern-most rural Georgia. Overall, hot spot counties generally had higher proportion of NH-black adults, older adult population, greater poverty, and more rurality. In Georgia, targeted cancer prevention strategies and allocation of health resources are needed in counties with elevated cancer mortality rates, focusing on interventions suitable for NH-black race/ethnicity, low-income, and rural residents.
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Moore JX, Andrzejak SE, Bevel MS, Jones SR, Tingen MS. Exploring racial disparities on the association between allostatic load and cancer mortality: A retrospective cohort analysis of NHANES, 1988 through 2019. SSM Popul Health 2022; 19:101185. [PMID: 35990411 PMCID: PMC9382324 DOI: 10.1016/j.ssmph.2022.101185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/24/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Methods Results Conclusions Impact Allostatic load (AL) is a biologic measure for the ‘wear and tear’ of chronic stress. Studies suggests that racial minorities have higher allostatic load. There is limited knowledge on the association between allostatic and cancer, by race. We observed that AL may increase the risk of cancer death by 14%. Among those aged <40 years, high AL increased cancer death risk by more than 80%.
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Affiliation(s)
- Justin Xavier Moore
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Corresponding author. Cancer Prevention, Control & Population Health Program, Georgia Cancer Center, Department of Medicine, Institute of Public and Preventive Health, Medical College of Georgia at Augusta University, 1410 Laney Walker Blvd. CN-2135, Augusta, GA, 30912, USA.
| | - Sydney Elizabeth Andrzejak
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Malcolm S. Bevel
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Samantha R. Jones
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Martha S. Tingen
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
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Vernon MM, Jones S, Moore JX, Coughlin SS, Heboyan V, Clarke S, Idun B, Tingen MS. Abstract 1020: Cancer health awareness through screening and education (CHANGE): Understanding community experience accessing cancer care. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION. Incidence and mortality rates for breast, prostate, and colorectal cancers all exceed national rates in Georgia and are higher among African Americans (AAs). Ensuring culturally competent and equitable health care delivery relies on creating an educated and engaged health care team. Patient stories are powerful examples of community-learned experiences and can be used to educate better providers and health care students who serve diverse populations, particularly when communicating risk and prevention of cancer. The goal of the CHANGE project is to provide a sustainable model of evidence-based cancer awareness through education - with an emphasis on prevention and early detection behaviors. We will develop a health disparities and culturally competent cancer care e-Learning curriculum for health care professionals, hematology-oncology fellows, residents, and medical students at the Medical College of Georgia.
METHODS. Thirty community members and stakeholders (93% AA, 76% female, all adults) were recruited through public housing, healthcare clinics and providers, and community organizations. Vignettes describing patient access and care interactions were used in semi-structured interviews to guide conversations about experiences accessing care, attitudes towards cancer prevention, and community cancer beliefs. Interviews were recorded, professionally transcribed, and content analyzed using NVivo 12.0 by two independent raters.
RESULTS. Three common themes emerged: accessibility of healthcare (transportation, finances, and difficulties in scheduling were primary barriers); cancer myths and cultural norms (no interpersonal discussion of cancer, seen as “taboo,” cancer will spread if cut into and cancer is contagious); and experience of racial bias in health care (historical racial bias and systemic racism; receipt of treatment and care perceived to be different due to race; lack of AA providers).
CONCLUSION. This sample adequately represented those most at risk for cancer in Augusta, GA area. Their shared experiences will be used to design and inform an e-learning curriculum, in conjunction with education on health disparities across the state and specific to the local community. This will provide a comprehensive approach to provider education that will begin to improve patient care satisfaction and health outcomes.
Citation Format: Marlo M. Vernon, Samantha Jones, Justin X. Moore, Steve S. Coughlin, Vahe Heboyan, Shakirah Clarke, Barbara Idun, Martha S. Tingen. Cancer health awareness through screening and education (CHANGE): Understanding community experience accessing cancer care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1020.
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Affiliation(s)
- Marlo M. Vernon
- 1Augusta University, Medical College of Georgia, Augusta, GA
| | - Samantha Jones
- 1Augusta University, Medical College of Georgia, Augusta, GA
| | - Justin X. Moore
- 1Augusta University, Medical College of Georgia, Augusta, GA
| | | | - Vahe Heboyan
- 1Augusta University, Medical College of Georgia, Augusta, GA
| | - Shakirah Clarke
- 1Augusta University, Medical College of Georgia, Augusta, GA
| | - Barbara Idun
- 1Augusta University, Medical College of Georgia, Augusta, GA
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Moore JX, Tingen MS, Coughlin SS, O'Meara C, Odhiambo L, Vernon M, Jones S, Petcu R, Johnson R, Islam KM, Nettles D, Albashir G, Cortes J. Abstract 5908: Understanding geographic and racial disparities in mortality from four major cancers in the state of Georgia: A spatial epidemiologic analysis, 1999 - 2019. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose of the study: Progress in cancer outcomes in the general population are not equitable among all populations, leaving some, such as rural and non-Hispanic Blacks (NH-Black) behind. We examined geographic and racial variation in cancer mortality in the state of Georgia, and investigated the correlation between the observed spatial differences and county-level characteristics.
Methods: We analyzed data on breast, colorectal, lung, and prostate cancer mortality among adults (aged >18 years) in 159 Georgia counties from years 1999 through 2019. Geospatial methods were applied, and we identified hot spot counties based on cancer mortality rates overall and stratified by non-Hispanic White (NH-White) and NH-Black races. We assessed differences in county-level characteristics between hot spot and non-hot spot counties using Wilcoxon rank-sum test and Spearman correlation and stratified all analyses by race/ethnicity.
Results: Among all adults, 5.0% (8 of 159), 8.2% (13 of 159), 5.0% (8 of 159), and 6.9% (11 of 159) of Georgia counties were estimated hot spots for breast cancer, colorectal, lung, and prostate cancer mortality, respectively. Among NH-Whites, 5.7% (9 of 159), 4.4% (7 of 159), 4.4% (7 of 159) counties, and 5.0% (8 of 159) of counties were identified as hot spots for breast, colorectal, lung, and prostate cancer mortality, respectively. Among NH-Blacks, 5.7% (9 of 159), 3.8% (6 of 159), 7.4% (11 of 159), and 5.7% (9 of 159) counties were identified as hot spots for breast, colorectal, lung, prostate cancer mortality, respectively. Cancer mortality hot spots were heavily concentrated in three major areas: 1) eastern Piedmont to Coastal Plain regions, 2) southwestern rural Georgia area, or 3) northern-most rural Georgia. Overall, hot spot counties generally had higher proportion of NH-Blacks, older adult population, greater poverty, and more rurality.
Conclusions: We observed distinct geographic and racial/ethnic disparities in mortality from breast, colorectal, lung, and prostate cancer in Georgia. Targeted cancer prevention strategies and allocation of health resources are needed in counties with elevated cancer mortality rates, focusing on interventions suitable for NH-Black, low-income, and rural residents.
Citation Format: Justin Xavier Moore, Martha S. Tingen, Steven S. Coughlin, Christine O'Meara, Lorriane Odhiambo, Marlo Vernon, Samantha Jones, Robert Petcu, Ryan Johnson, K.M. Monirul Islam, Darryl Nettles, Ghadeer Albashir, Jorge Cortes. Understanding geographic and racial disparities in mortality from four major cancers in the state of Georgia: A spatial epidemiologic analysis, 1999 - 2019 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5908.
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Derella CC, Tingen MS, Blanks A, Sojourner SJ, Tucker MA, Thomas J, Harris RA. Smoking cessation reduces systemic inflammation and circulating endothelin-1. Sci Rep 2021; 11:24122. [PMID: 34916543 PMCID: PMC8677816 DOI: 10.1038/s41598-021-03476-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/30/2021] [Indexed: 01/14/2023] Open
Abstract
Smoking increases systemic inflammation and circulating endothelin-1 (ET-1), both of which contribute to an elevated risk of cardiovascular disease (CVD). The present study sought to test the hypothesis that a 12-week smoking cessation intervention would contribute to a long-term reduction in circulating ET-1, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6). 30 individuals participated in a 12-week evidence-based smoking cessation program at Augusta University. Serum cotinine, plasma inflammatory cytokines, and plasma ET-1 were determined at baseline, immediately after the 12-week cessation program (end of treatment, EOT), and 12-months (12M) following the cessation program. Serum cotinine was significantly reduced (p < 0.001) at EOT and 12M following the smoking cessation program. Compared to BL (7.0 ± 1.6 pg/mL), TNF-α was significantly reduced at EOT (6.3 ± 1.5 pg/mL, p = 0.001) and 12M (5.2 ± 2.7 pg/mL, p < 0.001). ET-1 was significantly lower at EOT (1.9 ± 0.6 pg/mL, p = 0.013) and at 12M (2.0 ± 0.8 pg/mL, p = 0.091) following smoking cessation compared with BL (2.3 ± 0.6 pg/mL). BL concentrations of cotinine were significantly associated with basal ET-1 (r = 0.449, p = 0.013) and the change in cotinine at 12M following smoking cessation was significantly associated with the change in plasma ET-1 at 12M (r = 0.457, p = 0.011). Findings from the present pilot investigation demonstrate that a 12-week smoking cessation program reduces circulating concentrations of ET-1 and TNF-α for at least a year. The reduction in serum cotinine was associated with the decrease in circulating ET-1. The attenuation in ET-1 and inflammation may in part, contribute to the lower risk of CVD that is observed with smoking cessation.
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Affiliation(s)
- Cassandra C. Derella
- grid.410427.40000 0001 2284 9329Department of Physiology, Augusta University, Augusta, GA USA ,grid.410427.40000 0001 2284 9329Department of Medicine, Georgia Prevention Institute, Augusta University, Augusta, GA USA
| | - Martha S. Tingen
- grid.410427.40000 0001 2284 9329Department of Medicine, Georgia Prevention Institute, Augusta University, Augusta, GA USA ,grid.410427.40000 0001 2284 9329Georgia Cancer Center, Medical College of Georgia, Augusta University, 1410 Laney Walker Blvd., CN-2120, Augusta, GA 30912 USA
| | - Anson Blanks
- grid.410427.40000 0001 2284 9329Department of Medicine, Georgia Prevention Institute, Augusta University, Augusta, GA USA
| | - Samantha J. Sojourner
- grid.410427.40000 0001 2284 9329Department of Medicine, Georgia Prevention Institute, Augusta University, Augusta, GA USA ,grid.410427.40000 0001 2284 9329Georgia Cancer Center, Medical College of Georgia, Augusta University, 1410 Laney Walker Blvd., CN-2120, Augusta, GA 30912 USA
| | - Matthew A. Tucker
- grid.410427.40000 0001 2284 9329Department of Medicine, Georgia Prevention Institute, Augusta University, Augusta, GA USA
| | - Jeffrey Thomas
- grid.410427.40000 0001 2284 9329Department of Medicine, Georgia Prevention Institute, Augusta University, Augusta, GA USA
| | - Ryan A. Harris
- grid.410427.40000 0001 2284 9329Department of Medicine, Georgia Prevention Institute, Augusta University, Augusta, GA USA
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Sojourner SJ, Vernon MM, Albashir G, Moore JX, Looney SW, Tingen MS. Abstract 2608: Lung cancer prevention and an early detection educational intervention in minority and underserved communities. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Lung cancer is the leading cause of cancer death in African Americans (AAs). The 5-year relative survival rate for localized lung cancer among AAs is 52%; however, only 16% of lung cancer cases are detected at this early stage. Even when lung cancer is diagnosed early, AAs are less likely than whites to receive life-saving surgery.
Procedures: An educational intervention was delivered in 16 sites across the CSRA: 12 AA churches, three Federally-Qualified Health Centers, and one Community Center serving low-income and minority families. Community Health Workers at each site were selected and trained to deliver the educational content in four (4) 90-minute weekly sessions to participants in their congregation/facility. Content included cancer risk factors, the health consequences of tobacco use, tobacco cessation for current smokers, and the benefits of low-dose computed tomography (LDCT) screening for lung cancer. Pre- and post-intervention “site surveys” were administered to individuals who were members/visitors of the intervention sites (i.e. members of the church, patients at the FQHC, and visitors of the Community Center) to assess community changes in knowledge, attitudes and beliefs regarding lung cancer following the intervention. This report is on the surveys completed anonymously by the people at the sites, not on those enrolled in the study.
Results: Data were collected from 2136 participants (n=1404 baseline and 732 follow-up). Baseline and follow-up surveys were independent observations. Approximately 70.1% of respondents were female, 29.9% male, and 91.9% AA. There was significant improvement in the self-reported frequency of exercise among respondents, with 41.5% reporting 2-3 days of exercise at follow-up compared to 34.2% at baseline (p=0.006). Other significant findings include: current smoking status decreased from 13.5% at baseline to 8.0% at follow-up (p=0.001); knowledge of the recommended screening test for lung cancer increased from 35.2% at baseline to 43.4% at follow-up (p=0.002); men who have had a Prostate Specific Antigen (PSA) blood test within the last year increased from 54.4% at baseline to 72.2% at follow-up (p=0.006); and women answering whether they had ever had a mammogram increased from 78.0% at baseline to 86.6% at follow-up (p<0.001).
Conclusion: AAs are at greater risk for lung cancer incidence and mortality due to low access to quality healthcare, education, and prevention efforts. This project demonstrates that education and prevention efforts can be used to increase community knowledge about lung cancer and cancer risk factors, provide resources to decrease risk factors (smoking cessation) and increase access to screening for early detection. These efforts are promising for reducing cancer incidence and increasing early detection, and decreasing mortality rates among AAs who suffer disproportionate cancer health disparities.
Citation Format: Samantha J. Sojourner, Marlo M. Vernon, Ghadeer Albashir, Justin X. Moore, Stephen W. Looney, Martha S. Tingen. Lung cancer prevention and an early detection educational intervention in minority and underserved communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2608.
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Vernon MM, Albashir G, Sojourner SJ, Moore JX, Looney SW, Tingen MS. Abstract 2553: Using a “train-the-trainer” approach with urban and rural minority community health workers to implement the cancer-Community Awareness Access Research and Education (c-CARE) Project. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Community health workers (CHW) are often a key component to effective implementation of health promotion interventions; training on intervention delivery and self-efficacy enhances CHW effectiveness. The cancer-Community Awareness Access Research and Education (c-CARE) project utilized a train-the-trainer approach to equip CHWs to teach the four-week c-CARE lung cancer module. Project objectives included providing and facilitating: 1) education on risks of lung cancer, 2) low-dose CT (LCDT) screening for eligible participants, 3) smoking cessation, and 4) training CHWs to deliver the educational intervention and thus promote sustainability.
Methods: Lay CHWs (n=63, 54 urban, 9 rural, 92% female, 56% having ≥Bachelors degree, 79% healthcare providers) were selected from 16 historically African American (AA) churches (n = 9 urban, 3 rural), Federally-Qualified Health centers (n=3) and one community center, all in Georgia or South Carolina. CHW inclusion criteria included pastor recommendation from the churches' healthcare ministry (primarily nurses and other allied health professionals) or community clinic workers who were public health practitioners, nurses, and paraprofessionals. CHWs participated in a 2-day implementation training. Training topics included: their role as a c-CARE facilitator, knowledge of cancer risk factors and lung cancer screening, and using the c-CARE materials to teach the sessions. Pre and post surveys assessed knowledge, satisfaction with the training, and self-efficacy regarding teaching the content. Responses were summarized; all significance tests were two-tailed using a significance level of 0.05.
Result: Improvement in each of the six items was strongly significant (p < 0.001), with a mean improvement of at least 2 points on the 0-10 scale in: 1) understanding of their roles as c-CARE facilitators, 2) knowledge of cancer risk factors, 3) knowledge of lung cancer screening, 4) confidence in conducting a c-CARE group, 5) confidence in their abilities to implement a policy change, and 6) confidence in using c-CARE materials to teach participants. Participants also reported satisfaction with the c-CARE training they received. There were no significant differences between urban and rural CHW participants. CHWs conducted 64 sessions for 586 participants as a part of the c-CARE project.
Discussion: Use of lay CHWs to deliver culturally competent cancer education and screening navigation was an important component of the c-CARE project. Increases in knowledge regarding cancer risk factors, screening requirements, and self-efficacy in leading the sessions were reported by the CHWs. Use of local lay CHWs ensures sustainability, positively affecting community knowledge, attitude and beliefs regarding lung cancer, prevention, and screening behaviors.
Citation Format: Marlo M. Vernon, Ghadeer Albashir, Samantha J. Sojourner, Justin X. Moore, Stephen W. Looney, Martha S. Tingen. Using a “train-the-trainer” approach with urban and rural minority community health workers to implement the cancer-Community Awareness Access Research and Education (c-CARE) Project [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2553.
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Coughlin SS, Vernon M, Klaassen Z, Tingen MS, Cortes JE. Knowledge of prostate cancer among African American men: A systematic review. Prostate 2021; 81:202-213. [PMID: 33368465 DOI: 10.1002/pros.24097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recent studies indicate that many African American men may not be making informed decisions about prostate cancer early detection. This is partly due to patients having limited knowledge about early detection of the disease. METHODS The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles (n = 235) published in English from 1993 through July 31, 2020 were identified using the following MESH search terms and Boolean algebra commands: prostate cancer and knowledge and African Americans. RESULTS Forty-two articles were eligible for inclusion. The results of this literature review indicate that many African American men have inadequate knowledge of prostate cancer and prostate cancer early detection. Studies indicate that knowledge of prostate cancer is particularly low among older, less-educated, lower-income, and unmarried men, along with those who lack a regular physician or health insurance. Many African American men are unaware that they are at increased risk of prostate cancer because of their age or race. CONCLUSIONS Culturally appropriate educational efforts are needed to inform African- American men about the pros and cons of prostate cancer early detection and about risk factors for the disease so that they can make an informed decision about whether prostate cancer early detection is right for them. Of particular concern is the prostate cancer knowledge of low-income and less-educated men, along with those who lack health care insurance or a regular provider.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, USA
| | - Marlo Vernon
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Zachary Klaassen
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Martha S Tingen
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
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Sakurai K, Kantarjian HM, Sasaki K, Jabbour E, Ravandi F, Konopleva M, Borthakur G, Wierda WG, Daver NG, Takahashi K, Naqvi K, Dinardo CD, Bravo GM, Issa GC, Jain P, Pierce SA, Soltysiak KA, Garcia-Manero G, Tingen MS, Cortes JE. Geographic disparity of outcome in patients with cancer over decades: The surveillance, epidemiology, and end results. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1574 Background: Improvements in prevention, early detection and therapy of cancer have decreased cancer related mortality yet health disparities continue to exist. We investigated the impact of such disparities in cancer survival. Methods: In the Surveillance, Epidemiology, and End Results, we identified 784,341 patients with cancer from 1990 to 2016 in Georgia; 68,493 in 1990-1999, 371,353 in 2000-2009, and 322,932 in 2010-2016. We assessed overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer given the dramatic improvement in patient outcomes in CML since 2000 compared to the consistently poor outcome in lung cancer. We assessed distance from each county to the one National Cancer Institute-designated cancer center (NCI-CC) in Georgia. Results: The 5-year OS of patients with any cancer was 55% with median OS 80 months; the 5-y OS of each county ranged from 33% to 82% (interquartile range[IQR], 51%-65%)(P < 0.001). The improvement of OS was minimal over decades: 5-year OS was 52%, 55%, and 55% in 1990-1999, 2000-2009, and 2010-2016, respectively; the median was 69 months, 80 months, not reached, respectively (P < 0.001). In patients with lung cancer and CML, the 5-year OS was 15% and 52% with the median of 9 months and 67 months, respectively. The geographic difference between counties was relatively small and constant over time in patients with lung cancer, represented by the width in the range and IQR: range 5%-17%, IQR 9%-13%, median 13% in 1990-1999; range 2%-24%, IQR 10%-14%, median 14% in 2000-2009; and range 4%-24%, IQR 12%-17%, median 17% in 2010-2016. However, the geographic difference was more prominent in patients with CML and widened after introduction of modern therapy: range 20%-42%, IQR 26%-34%, median 32% in 1990-1999; range 14%-83%, IQR 38%-64%, median 53% in 2000-2009; and range 14%-80%, IQR 40%-57%, median 57% in 2010-2016. Multivariate Cox regression showed age (hazard ratio[HR],1.040;95% confidence interval[CI],1.039-1.040;P < 0.001), median county income (HR,0.919;95% CI,0.916-0.921;P < 0.001), African American (HR,1.021;95% CI,1.210-1.227;P < 0.001), and distance to NCI-CC (each 100 kilometers) (HR,1.021;95% CI,1.017-1.025;P < 0.001) as predictive factors. Conclusions: The disparity of cancer care exists between geographic locations. The geographic difference of survival seems more prominent when highly effective therapies are available.
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Affiliation(s)
- Kenichi Sakurai
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop M. Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William G. Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kiran Naqvi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ghayas C. Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Preetesh Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherry A. Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly A Soltysiak
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Martha S Tingen
- Georgia Cancer Center, Medical College of Georgia, Augusta, GA
| | - Jorge E. Cortes
- Georgia Cancer Center, Medical College of Georgia, Augusta, GA
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Coughlin SS, Vernon M, Majeed B, Clary C, Moore J, Islam K, Tingen MS. Tobacco Cessation, Rural Residence, and Lung Cancer. J Environ Health Sci 2020; 6:1-4. [PMID: 33163626 PMCID: PMC7644114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA,Institute of Public and Preventive Health, Augusta University, Augusta, GA,Corresponding author: Professor Steven S. Coughlin, Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th Street, AE-1042, Augusta, GA 30912, Tel: (706) 721-2270;
| | - Marlo Vernon
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA,Georgia Cancer Center, Augusta University, Augusta, GA
| | - Ban Majeed
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
| | - Catherine Clary
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Justin Moore
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA,Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - K.M. Islam
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA,Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Martha S. Tingen
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA,Georgia Cancer Center, Augusta University, Augusta, GA
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Jeong J, Zhu H, Harris RA, Dong Y, Su S, Tingen MS, Kapuku G, Pollock JS, Pollock DM, Harshfield GA, Wang X. Ethnic Differences in Nighttime Melatonin and Nighttime Blood Pressure: A Study in European Americans and African Americans. Am J Hypertens 2019; 32:968-974. [PMID: 31112592 DOI: 10.1093/ajh/hpz083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/26/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ethnic differences in nighttime blood pressure (BP) have long been documented with African Americans (AAs) having higher BP than European Americans (EAs). At present, lower nighttime melatonin, a key regulator of circadian rhythms, has been associated with higher nighttime BP levels in EAs. This study sought to test the hypothesis that AAs have lower nighttime melatonin secretion compared with EAs. We also determined if this ethnic difference in melatonin could partially explain the ethnic difference in nighttime BP. METHODS A total of 150 young adults (71 AA; 46% females; mean age: 27.7 years) enrolled in the Georgia Stress and Heart study provided an overnight urine sample for the measurement of 6-sulfatoxymelatonin, a major metabolite of melatonin. Urine melatonin excretion (UME) was calculated as the ratio between 6-sulfatoxymelatonin concentration and creatinine concentration. Twenty-four-hour ambulatory BP was assessed and nighttime systolic BP (SBP) was used as a major index of BP regulation. RESULTS After adjustment of age, sex, body mass index, and smoking, AAs had significantly lower UME (P = 0.002) and higher nighttime SBP than EAs (P = 0.036). Lower UME was significantly associated with higher nighttime SBP and this relationship did not depend on ethnicity. The ethnicity difference in nighttime SBP was significantly attenuated after adding UME into the model (P = 0.163). CONCLUSION This study is the first to document the ethnic difference in nighttime melatonin excretion, demonstrating that AAs have lower melatonin secretion compared with EAs. Furthermore, the ethnic difference in nighttime melatonin can partially account for the established ethnic difference in nighttime SBP.
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Affiliation(s)
- Jinhee Jeong
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Haidong Zhu
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Ryan A Harris
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Yanbin Dong
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Shaoyong Su
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Martha S Tingen
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Gaston Kapuku
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jennifer S Pollock
- Cardio Renal Physiology and Medicine Section, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David M Pollock
- Cardio Renal Physiology and Medicine Section, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gregory A Harshfield
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Xiaoling Wang
- Department of Population Health Sciences, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Rangachari P, May KR, Stepleman LM, Tingen MS, Looney S, Liang Y, Rockich-Winston N, Rethemeyer RK. Measurement of Key Constructs in a Holistic Framework for Assessing Self-Management Effectiveness of Pediatric Asthma. Int J Environ Res Public Health 2019; 16:E3060. [PMID: 31443605 PMCID: PMC6747253 DOI: 10.3390/ijerph16173060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022]
Abstract
The 2007 U.S. National Institutes of Health EPR-3 guidelines emphasize the importance creating a provider-patient partnership to enable patients/families to monitor and take control of their asthma, so that treatment can be adjusted as needed. However, major shortfalls continue to be reported in provider adherence to EPR-3 guidelines. For providers to be more engaged in asthma management, they need a comprehensive set of resources for measuring self-management effectiveness of asthma, which currently do not exist. In a previously published article in the Journal of Asthma and Allergy, the authors conducted a literature review, to develop a holistic framework for understanding self-management effectiveness of pediatric asthma. The essence of this framework, is that broad socioecological factors can influence self-agency (patient/family activation), to impact self-management effectiveness, in children with asthma. A component of socio-ecological factors of special relevance to providers, would be the quality of provider-patient/family communication on asthma management. Therefore, the framework encompasses three key constructs: (1) Provider-patient/family communication; (2) Patient/family activation; and (3) Self-management effectiveness. This paper conducts an integrative review of the literature, to identify existing, validated measures of the three key constructs, with a view to operationalizing the framework, and discussing its implications for asthma research and practice.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA.
| | - Kathleen R May
- Division of Allergy-Immunology and Pediatric Rheumatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Lara M Stepleman
- Department of Psychiatry & Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Martha S Tingen
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Stephen Looney
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Yan Liang
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA
| | - Nicole Rockich-Winston
- Department of Pharmacology & Toxicology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - R Karl Rethemeyer
- Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY 12222, USA
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Tingen MS, Sojourner SJ, Tucker MA, Derella CC, Harris RA. Biochemical verification of smoking cessation and the role of endothelin‐1: Impact on cardiovascular disease risk. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.lb420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martha S Tingen
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGA
| | - Samantha J Sojourner
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGA
| | - Matthew A Tucker
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGA
| | - Cassandra C Derella
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGA
| | - Ryan A Harris
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGA
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Tingen MS, Sojourner SJ, Harris RA, Treiber FA. Effects of Gene‐Environment Interactions on Endothelial Function in Adolescents: GSTM1 and GSTT1 Polymorphisms and Tobacco Smoke Exposure. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.lb469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martha S Tingen
- Georgia Prevention Institute, Medical College of Georgia, Augusta UniversityAugustaGA
- South Carolina Centers of Economic Excellence Technology Center, College of Nursing, Medical University of South CarolinaCharlestonSC
| | - Samantha J Sojourner
- Georgia Prevention Institute, Medical College of Georgia, Augusta UniversityAugustaGA
| | - Ryan A Harris
- Georgia Prevention Institute, Medical College of Georgia, Augusta UniversityAugustaGA
| | - Frank A Treiber
- South Carolina Centers of Economic Excellence Technology Center, College of Nursing, Medical University of South CarolinaCharlestonSC
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Williams LB, McCall A, Joshua TV, Looney SW, Tingen MS. Design of a Community-Based Lung Cancer Education, Prevention, and Screening Program. West J Nurs Res 2019; 41:1152-1169. [PMID: 30698501 DOI: 10.1177/0193945919827261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Uptake of low-dose computed tomography (LDCT) for lung cancer screening is extremely low. Efforts to promote screening are warranted, especially among disparate groups such as racial/ethnic minorities and those of lower socioeconomic status. This article describes the design and implementation strategies of the ongoing cancer-Community Awareness Access Research and Education (c-CARE) program. The purpose of c-CARE is to increase community awareness of lung cancer screening through education. Community health workers were trained to implement the intervention in 12 community sites. The Health Belief Model guided the evaluation and intervention development methods. Aims include changing participants' knowledge, attitude, and beliefs related to lung cancer and increasing lung cancer early detection and prevention behaviors by identifying and connecting high-risk and/or nicotine-dependent individuals to LDCT screening and/or tobacco cessation services. If effective, these methods could model increased dissemination to other high-risk communities.
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Affiliation(s)
- Lovoria B Williams
- 1 Augusta University, Augusta, GA USA.,2 University of Kentucky, Lexington, KY USA
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Jordan DM, Bush JS, Ownby DR, Waller JL, Tingen MS. The impact of traditional literacy and education on health literacy in adolescents with asthma. J Asthma 2018; 56:882-890. [PMID: 29984589 DOI: 10.1080/02770903.2018.1494191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: People with low health literacy have poorer self-management of chronic diseases like asthma. Studies of parent health literacy and education level on the management of children's chronic illnesses reveal inconclusive results. We hypothesized a correlation between parent and adolescent health literacy in teens with asthma. Methods: Sociodemographic data were obtained; health literacy was assessed on adolescents and parents with three instruments: Rapid Estimate of Adolescent/Adult Literacy in Medicine (REALM), Single Item Literacy Screener (SILS) and Newest Vital Sign (NVS). Agreement between scores was examined by calculating weighted kappa statistics and performing Bowkers test of symmetry. Results: In all, 243 adolescents and 203 parents completed health literacy assessments yielding 198 paired observations. 9th-12th graders, 60.6% female, 72.7% African-American (AA), mean age: 15.3 years (±0.9). Parent education ranged from < high school (19.1%) to college graduate (24.0%). Agreement between adolescent and parent scores was poor: REALM (κw = 0.26), SILS (κw = 0.12), and NVS (κw = 0.29) and disagreement did not significantly differ by race. Positive correlations of moderate strength (overall and between racial groups) were found between reading scores and both REALM and NVS scores, and between REALM and NVS scores. Due to the inverse relationship of SILS scores with health literacy level, SILS scores (overall and between racial groups) were weakly and negatively correlated with reading scores, REALM and NVS. Conclusion: Correlation between education level and traditional literacy suggests that these are contributing factors to the health literacy of adolescents with asthma. Correlation between adolescent and caregiver health literacy was not supported.
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Affiliation(s)
- Desha M Jordan
- a Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University , Augusta , GA , USA
| | - Jeana S Bush
- a Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University , Augusta , GA , USA
| | - Dennis R Ownby
- a Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University , Augusta , GA , USA
| | - Jennifer L Waller
- b Department of Biostatistics & Epidemiology, Medical College of Georgia, Augusta University , Augusta , GA , USA
| | - Martha S Tingen
- a Division of Allergy-Immunology & Rheumatology, Medical College of Georgia, Augusta University , Augusta , GA , USA.,c Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia , Augusta University , Augusta , GA , USA
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Williams LB, McCall A, Looney SW, Joshua T, Tingen MS. Demographic, psychosocial, and behavioral associations with cancer screening among a homeless population. Public Health Nurs 2018; 35:281-290. [PMID: 29473212 DOI: 10.1111/phn.12391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although cancer incidence and mortality is declining, cancer remains among the leading causes of death in the United States. Research shows that cancer morbidity and mortality can be reduced by early detection. Yet, both cancer risks and screening behavior remain understudied in the homeless population. METHODS Researchers conducted a cross-sectional survey of homeless individuals (n = 201). The analysis describes the demographic, psychosocial, and behavioral associations with cancer screenings and knowledge of the lung cancer screening recommendation. RESULTS Participants' mean age was 51.7 years (SD 13.6); the group was largely African American (77.3%) and male (67.9%). Among women, the breast and cervical cancer screening rates were 46.5% and 85.1%. Among men the prostate cancer screening rate was 34.2%. Among all participants, the colon cancer screening rate was 44%. Cancer risk behaviors were high. Lung cancer screening knowledge was low (23.0%). Some cancer screening behaviors were associated with age, income, health status, obesity, tobacco use, and physical activity. DISCUSSION Despite higher cancer risk behaviors, knowledge and general participation rates for cancer screenings were below national benchmarks. CONCLUSION To improve cancer survival among disparate populations, sustained community outreach is necessary to increase awareness of screening recommendations, identify high-risk individuals, and navigate them to resources.
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Affiliation(s)
- Lovoria B Williams
- Biobehavioral Department, College of Nursing, Augusta University, Augusta, GA, USA
| | - Amber McCall
- Department of Physiological & Technological Nursing, College of Nursing, Augusta University, Augusta, GA, USA
| | - Stephen W Looney
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Thomas Joshua
- Biobehavioral Department, College of Nursing, Augusta University, Augusta, GA, USA
| | - Martha S Tingen
- Department of Pediatrics and the Georgia Prevention Institute, Medical College of Georgia, Population Health Sciences, Augusta University, Augusta, GA, USA
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Caldwell AL, Tingen MS, Nguyen JT, Andrews JO, Heath J, Waller JL, Treiber FA. Parental Smoking Cessation: Impacting Children's Tobacco Smoke Exposure in the Home. Pediatrics 2018; 141:S96-S106. [PMID: 29292310 PMCID: PMC5745674 DOI: 10.1542/peds.2017-1026m] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There is no safe or risk-free level of tobacco use or tobacco smoke exposure. In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention. METHODS Ps/Cs and children were recruited from 14 elementary schools across rural and urban settings. Approximately one-fourth (24.3%; n = 110) of the total Ps/Cs enrolled in the randomized controlled trial (n = 453) were smokers, predominantly women (80.9%), with a mean age of 37.7 years. (SD 12.2); 62.7% were African American, 44% had less than a high school education, and 58% earned <$20 000 annually. P/C smokers were offered a tailored cessation intervention in years 1 and 2. Self-report smoking status and saliva cotinine were obtained at baseline, the end of treatment (EOT) and/or year 2, and in the year 4 follow-up. RESULTS Ps/Cs in the intervention group showed a larger increase in self-reported smoking abstinence over time (EOT: 6.5% [SE = 5.7%]; year 4: 40.6% [SE = 5.7%]) than the control group (EOT: 0.0% [SE = 6.5%]; year 4: 13.2% [SE = 6.4%]; F = 4.82; P = .0306). For cotinine, the intervention group showed a decrease from baseline (239.9 [SE = 1.3]) to EOT 99.3 [SE = 1.4]) and then maintenance through year 4 (109.6 [SE = 1.4]), whereas the control group showed increases from baseline (221.1 [SE = 1.4]) to EOT (239.0 [SE = 1.4]) to year 4 (325.8 [SE = 14]; F = 5.72; P = .0039). CONCLUSIONS This study provides evidence that tailored cessation offered to Ps/Cs in their children's schools during their children's enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.
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Affiliation(s)
| | - Martha S. Tingen
- Departments of Pediatrics and,Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Joshua T. Nguyen
- Departments of Pediatrics and,Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| | | | - Janie Heath
- College of Nursing, University of Kentucky, Lexington, Kentucky; and
| | | | - Frank A. Treiber
- Colleges of Medicine and Nursing, Medical University of South Carolina, Charleston, South Carolina
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Makadia LD, Roper PJ, Andrews JO, Tingen MS. Tobacco Use and Smoke Exposure in Children: New Trends, Harm, and Strategies to Improve Health Outcomes. Curr Allergy Asthma Rep 2017; 17:55. [PMID: 28741144 DOI: 10.1007/s11882-017-0723-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Every day in the USA, approximately 4000 adolescents begin smoking and the adolescent brain is particularly susceptible to nicotine addiction. We present current pediatric trends on tobacco use and exposures, various new products used by adolescents, the adverse biological and behavioral effects of tobacco use and exposures, and tobacco control strategies to eliminate tobacco-related illnesses and deaths in the pediatric population. RECENT FINDINGS Twelve-20% of women continue to smoke during pregnancy. New research reveals cognitive differences and behavior-control disorders are seen in elementary school children from prenatal and postnatal exposures. Traditional cigarette smoking has decreased in adolescents; novel and appealing tobacco products have captured their attention, particularly electronic cigarettes, and rates double and often triple from middle to high school. Children with asthma and those living in multi-housing units have higher rates of secondhand smoke exposure than non-asthmatics and children living in single-home dwellings. There is no "safe or risk-free" level of tobacco use or exposure. Tobacco use and exposure in childhood and adolescence must be decreased using evidenced-based strategies to improve child health.
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Affiliation(s)
- Luv D Makadia
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - P Jervey Roper
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Martha S Tingen
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta University, HS-1755, 1499 Walton Way, Augusta, GA, 30912, USA.
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Dinetz SF, Waller JL, Tingen MS. Is the association between exhaled nitric oxide and asthma symptoms altered by body weight in rural adolescents? Ann Allergy Asthma Immunol 2016; 117:718-719.e1. [PMID: 27789122 DOI: 10.1016/j.anai.2016.09.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/01/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Stephen F Dinetz
- Division of Allergy-Immunology and Pediatric Rheumatology, Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jennifer L Waller
- Department of Biostatistics and Epidemiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Martha S Tingen
- Division of Allergy-Immunology and Pediatric Rheumatology, Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia; Georgia Prevention Institute, Medical College of Georgia at Augusta University, Augusta, Georgia.
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Andrews JO, Mueller M, Dooley M, Newman SD, Magwood GS, Tingen MS. Effect of a smoking cessation intervention for women in subsidized neighborhoods: A randomized controlled trial. Prev Med 2016; 90:170-6. [PMID: 27423320 PMCID: PMC5871346 DOI: 10.1016/j.ypmed.2016.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/16/2016] [Accepted: 07/08/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a community based participatory research (CBPR) developed, multi-level smoking cessation intervention among women in subsidized housing neighborhoods in the Southeastern US. METHODS A total of n=409 women in 14 subsidized housing neighborhoods in Georgia and South Carolina participated in this group randomized controlled trial conducted from 2009 to 2013. Intervention neighborhoods received a 24-week intervention with 1:1 community health worker contact, behavioral peer group sessions, and nicotine replacement. Control neighborhoods received written cessation materials at weeks 1, 6, 12, 18. Random coefficient models were used to compare smoking abstinence outcomes at 6 and 12months. Significance was set a p<0.05. RESULTS The majority of participants (91.2%) were retained during the 12-month intervention period. Smoking abstinence rates at 12months for intervention vs. control were 9% vs. 4.3%, p=0.05. Additional analyses accounting for passive smoke exposure in these multi-unit housing settings demonstrated 12month abstinence rates of 12% vs. 5.3%, p=0.016. However, in the multivariate regression analyses, there was no significant effect of the intervention on the odds of being a non-smoker (OR=0.44, 95% CI: 0.18-1.07). Intervention participants who kept coach visits, attended group sessions, and used patches were more likely to remain abstinent. CONCLUSIONS This CBPR developed intervention showed potential to engage smokers and reduce smoking among women in these high-poverty neighborhoods. Effectiveness in promoting cessation in communities burdened with fiscal, environmental and social inequities remains a public health priority.
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Affiliation(s)
- Jeannette O Andrews
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia, SC 29208, USA.
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Mary Dooley
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Susan D Newman
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Gayenell S Magwood
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Martha S Tingen
- Augusta University, Medical College of Georgia, 1120 Fifteenth Street, HS-1755, Augusta, GA 30912, USA
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26
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Davis CL, Tingen MS, Jia J, Sherman F, Williams CF, Bhavsar K, Wood N, Kobleur J, Waller JL. Passive Smoke Exposure and Its Effects on Cognition, Sleep, and Health Outcomes in Overweight and Obese Children. Child Obes 2016; 12:119-25. [PMID: 26812049 PMCID: PMC4817566 DOI: 10.1089/chi.2015.0083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Passive smoke exposure (PSE) may be a risk factor for childhood overweight and obesity and is associated with worse neurocognitive development, cognition, and sleep in children. The purpose of the study is to examine the effects of PSE on adiposity, cognition, and sleep in overweight and obese children using an objective measure of PSE. METHODS Overweight or obese children (n = 222) aged 7-11 (9.4 ± 1.1 years; 58% black; 58% female; 85% obese) were recruited from schools near Augusta, Georgia, over the course of the school year from 2003-2006 for a clinical trial, with data analyzed in 2009-2010. Passive smoke exposure was measured with plasma cotinine. Health, cognitive, and sleep measures and parent report of smoke exposure were obtained. RESULTS Overweight and obese children with PSE had greater overall and central adiposity than nonexposed overweight and obese children (p < 0.03). However, PSE was unrelated to prediabetes, insulin resistance, or visceral fat. PSE was linked to poorer cognitive scores (p < 0.04) independent of adiposity, but was not related to sleep-disordered breathing. CONCLUSIONS PSE is associated with fatness and poorer cognition in children. Tailored interventions that target multiple health risk factors including nutrition, physical activity, and tobacco use in children and families are needed to prevent adverse health outcomes related to tobacco use and obesity.
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Affiliation(s)
- Catherine L. Davis
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA
| | - Martha S. Tingen
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA
| | - Jenny Jia
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA
| | - Forrest Sherman
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA
| | - Celestine F. Williams
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA
| | - Kruti Bhavsar
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA
| | - Nancy Wood
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA.,Pediatric Associates of Mobile, Mobile, AL
| | - Jessica Kobleur
- Georgia Prevention Institute, Department of Pediatrics, Augusta University, Augusta, GA.,University Pediatrics, Memorial University Medical Center, Savannah, GA
| | - Jennifer L. Waller
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University, Augusta, GA
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Tingen MS, Andrews JO, Heath J, Williams LB, Schroeder C, Dainer P, Khleif SN, Waller JL. Abstract B62: Tailored parental cessation delivered concurrently with tobacco prevention in children enrolled in urban and rural southern elementary schools. Cancer Epidemiol Biomarkers Prev 2016. [DOI: 10.1158/1538-7755.disp15-b62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Socioeconomically disadvantaged populations have higher tobacco use rates resulting in more disparate cancer outcomes. The effectiveness of tailored cessation interventions in parent/caregiver smokers delivered within an elementary school setting while their child is concurrently enrolled in a smoking prevention program has been minimally explored.
Procedures/Methods: During a randomized controlled trial (RCT) that included children and one parent/caregiver per child, parent/caregiver smokers were offered cessation in years 1 and 2 (if relapsed/refused in year 1) at their child's respective school or local community setting. Parent/caregiver smokers in the intervention group received tailored cessation including eight individual face-to-face motivational interviewing sessions with a matched gender and/or racial/ethnically similar counselor and eight weeks of nicotine replacement therapy. The control parents/caregivers who smoked received information for contacting the state toll-free Tobacco Quit Line and tailored (based on race/ethnicity) written materials to assist with cessation. Children in the intervention arm received concurrently a tobacco prevention curriculum, Botvin's LifeSkills Training, over the same time period in years 1 & 2. The control group children received the standard health education curriculum for public school systems. This study reports on the effectiveness of the parent/caregiver cessation intervention including outcomes of self-reported smoking status (percentages) and the biological measure, salivary cotinine (ng/ml), both obtained at baseline, end of treatment (EOT)/year 2, and in year 4 follow-up.
Results/Summary: Parent/Caregiver smokers (n=110) comprised 24.6% of the enrolled (n=447) parent/caregiver sample. The parent/caregiver smokers were predominantly female (81%), mean age 37.2 yrs. (SD 11.1); 37% Black; 54% had < a high school education; 54% earned < $20,000 annually; and 61% were covered by Medicaid and/or Medicare. Using repeated measures, binomial generalized estimating equation or mixed models, differences over time between parents/caregivers in the intervention and control groups were found for quitting smoking and cotinine levels. Parents/caregivers in the intervention group [EOT: 6.5% (SE=5.7%), Yr.4: 40.6%(SE=5.7%)] showed a larger increase in quitting smoking over time than the control group [EOT: 0.0%(SE=6.5%), Yr.4: 13.2%(SE=6.4%)] (F=4.82, p=0.0306). For cotinine (F=5.72, p=0.0039), the intervention group showed a decrease from baseline (239.9,[SE=1.3]) to EOT (99.3,[SE=1.4]) and then maintenance through Yr.4 (109.6,[SE=1.4]), while the control group showed increases from baseline (221.1,[SE=1.4]) to EOT (239.0,[SE=1.4]) to Yr.4 (325.8,[SE=14]).
Conclusions: This study provides beginning evidence that tailored cessation offered to parents/caregivers in their child's school setting while their child is enrolled in tobacco prevention classes may be an avenue for more robust success in quitting smoking. Such a strategy may serve as an initial step for improving public health and for decreasing tobacco-related disparities and associated poor health outcomes among disadvantaged populations. By improving parent's/caregiver's success and maintenance of tobacco cessation, a joint program may reinforce the child's resistance to the lure of tobacco products and may also potentially decrease his or her secondhand smoke exposure within the home.
Citation Format: Martha S. Tingen, Jeannette O. Andrews, Janie Heath, Lovoria B. Williams, Carsten Schroeder, Paul Dainer, Samir N. Khleif, Jennifer L. Waller. Tailored parental cessation delivered concurrently with tobacco prevention in children enrolled in urban and rural southern elementary schools. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B62.
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Affiliation(s)
- Martha S. Tingen
- 1Medical College of Georgia, Georgia Regents University, Augusta, GA,
| | | | - Janie Heath
- 3College of Nursing, University of Kentucky, Lexington, KY,
| | | | | | - Paul Dainer
- 5GRU Cancer Center, Georgia Regents University, Augusta, GA
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Ownby DR, Tingen MS, Havstad S, Waller JL, Johnson CC, Joseph CLM. Comparison of asthma prevalence among African American teenage youth attending public high schools in rural Georgia and urban Detroit. J Allergy Clin Immunol 2015; 136:595-600.e3. [PMID: 25825215 DOI: 10.1016/j.jaci.2015.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 01/30/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The high prevalence of asthma among urban African American (AA) populations has attracted research attention, whereas the prevalence among rural AA populations is poorly documented. OBJECTIVE We sought to compare the prevalence of asthma among AA youth in rural Georgia and urban Detroit, Michigan. METHODS The prevalence of asthma was compared in population-based samples of 7297 youth attending Detroit public high schools and in 2523 youth attending public high schools in rural Georgia. Current asthma was defined as a physician diagnosis and symptoms in the previous 12 months. Undiagnosed asthma was defined as multiple respiratory symptoms in the previous 12 months without a physician diagnosis. RESULTS In Detroit, 6994 (95.8%) youth were AA compared with 1514 (60.0%) in Georgia. Average population density in high school postal codes was 5628 people/mile(2) in Detroit and 45.1 people/mile(2) in Georgia. The percentages of poverty and of students qualifying for free or reduced lunches were similar in both areas. The prevalence of current diagnosed asthma among AA youth in Detroit and Georgia was similar: 15.0% (95% CI, 14.1-15.8) and 13.7% (95% CI, 12.0-17.1) (P = .22), respectively. The prevalence of undiagnosed asthma in AA youth was 8.0% in Detroit and 7.5% in Georgia (P = .56). Asthma symptoms were reported more frequently among those with diagnosed asthma in Detroit, whereas those with undiagnosed asthma in Georgia reported more symptoms. CONCLUSIONS Among AA youth living in similar socioeconomic circumstances, asthma prevalence is as high in rural Georgia as it is in urban Detroit, suggesting that urban residence is not an asthma risk factor.
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Affiliation(s)
- Dennis R Ownby
- Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, Ga.
| | - Martha S Tingen
- Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, Ga
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
| | - Jennifer L Waller
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Georgia Regents University, Augusta, Ga
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Bush JS, Ownby DR, Waller JL, Tingen MS. Risk Factors for Depression in Rural Adolescents with Asthma. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Andrews JO, Mueller M, Newman SD, Magwood G, Ahluwalia JS, White K, Tingen MS. The association of individual and neighborhood social cohesion, stressors, and crime on smoking status among African-American women in southeastern US subsidized housing neighborhoods. J Urban Health 2014; 91:1158-74. [PMID: 25316192 PMCID: PMC4242849 DOI: 10.1007/s11524-014-9911-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to examine the associations between individual and neighborhood social contextual factors and smoking prevalence among African-American women in subsidized neighborhoods. We randomly sampled 663 adult women in 17 subsidized neighborhoods in two Southeastern US states. The smoking prevalence among participants was 37.6%, with an estimated neighborhood household prevalence ranging from 30 to 68%. Smokers were more likely to be older, have lower incomes, have lower BMI, and live with other smokers. Women with high social cohesion were less likely to smoke, although living in neighborhoods with higher social cohesion was not associated with smoking prevalence. Women with higher social cohesion were more likely to be older and had lived in the neighborhood longer. Women with high stress (related to violence and disorder) and who lived in neighborhoods with higher stress were more likely to smoke. Younger women were more likely to have higher stress than older women. There were no statistically significant associations with objective neighborhood crime data in any model. This is the first study to examine both individual and neighborhood social contextual correlates among African-American women in subsidized neighborhoods. This study extends findings about smoking behaviors and neighborhood social contexts in this high-risk, urban population. Future research is needed to explore age and residential stability differences and perceptions of social cohesion, neighborhood disorder, and perceived violence in subsidized housing. Further research is also warranted on African-American women, subsidized housing, smoking, social context, health disparities' effective strategies to address these individual and contextual factors to better inform future ecological-based multilevel prevention, and cessation intervention strategies.
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Tingen MS, Andrews JO, Heath J, Turnmire AE, Waller JL, Treiber FA. Comparison of enrollment rates of African-American families into a school-based tobacco prevention trial using two recruitment strategies in urban and rural settings. Am J Health Promot 2014; 27:e91-e100. [PMID: 23448420 DOI: 10.4278/ajhp.110204-quan-53] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study evaluated similarities and differences of enrollment rates using two different recruitment strategies for a tobacco control trial in rural and urban African-American (AA) elementary school families. DESIGN A comparative study, nested within a larger randomized controlled trial, was used to test the effectiveness of two recruitment approaches on enrollment rates in rural and urban AA families. SETTING The study was conducted in 14 Title 1 elementary schools in the southeastern United States: 7 rural and 7 urban. SUBJECTS There were 736 eligible AA families, and 332 (45%) completed informed consent and were enrolled into the study. INTERVENTION The Facilitate, Open and transparent communication, Shared benefits, Team and tailored, Educate bilaterally, and Relationships, realistic and rewards (FOSTER) approach guided the two recruitment strategies: (1) written informational packets provided to fourth graders to take home to parents; and (2) proactive, face-to-face family information sessions held at schools. MEASURES Enrollment rates were based on responsiveness to the two recruitment strategies and completion of the informed consent process. ANALYSIS Chi-square, Cochran-Mantel-Haenszel, and Breslow-Day tests were performed. RESULTS Higher enrollment rates occurred during the family session for both rural and urban families (100% rural, 93.6% urban; p = .0475) than informational packets alone (28.7% rural, 22% urban; p < .0001). Rural family enrollment rates were overall higher than urban rates regardless of recruitment strategy (52.0% rural vs. 39.6% urban; p = .0008). CONCLUSION The findings suggest the FOSTER approach, although effective in both rural and urban settings, was more successful in recruiting rural families.
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Affiliation(s)
- Martha S Tingen
- Child Health Discovery Institute, Georgia Prevention Institute, Medical College of Georgia, Georgia Health Sciences University, Augusta, GA 30912, USA.
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Andrews JO, Tingen MS, Jarriel SC, Caleb M, Simmons A, Brunson J, Mueller M, Ahluwalia JS, Newman SD, Cox MJ, Magwood G, Hurman C. Application of a CBPR framework to inform a multi-level tobacco cessation intervention in public housing neighborhoods. Am J Community Psychol 2012; 50:129-40. [PMID: 22124619 PMCID: PMC4448934 DOI: 10.1007/s10464-011-9482-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
African American women in urban, high poverty neighborhoods have high rates of smoking, difficulties with quitting, and disproportionate tobacco-related health disparities. Prior research utilizing conventional "outsider driven" interventions targeted to individuals has failed to show effective cessation outcomes. This paper describes the application of a community-based participatory research (CBPR) framework to inform a culturally situated, ecological based, multi-level tobacco cessation intervention in public housing neighborhoods. The CBPR framework encompasses problem identification, planning and feasibility/pilot testing, implementation, evaluation, and dissemination. There have been multiple partners in this process including public housing residents, housing authority administrators, community health workers, tenant associations, and academic investigators. The advisory process has evolved from an initial small steering group to our current institutional community advisory boards. Our decade-long CBPR journey produced design innovations, promising preliminary outcomes, and a full-scaled implementation study in two states. Challenges include sustaining engagement with evolving study partners, maintaining equity and power in the partnerships, and long-term sustainability of the intervention. Implications include applicability of the framework with other CBPR partnerships, especially scaling up evolutionary grassroots involvement to multi-regional partnerships.
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Affiliation(s)
- Jeannette O Andrews
- College of Nursing, Medical University of South Carolina, 99 Jonathon Lucas Street, MSC 160, Charleston, SC 29426-1600, USA.
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Andrews JO, Newman SD, Heath J, Williams LB, Tingen MS. Community-based participatory research and smoking cessation interventions: a review of the evidence. Nurs Clin North Am 2012; 47:81-96. [PMID: 22289400 PMCID: PMC3269631 DOI: 10.1016/j.cnur.2011.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article reviews the evidence of the use of community-based participatory research (CBPR) and smoking cessation interventions. An overview of CBPR is provided, along with a description of the search methods and quality scoring. Research questions are explored to determine if CBPR improves the quality of research methods and community involvement in cessation intervention studies and cessation outcomes when using CBPR approaches. Results of the review are provided along with a comprehensive table summarizing all the included studies. Strengths and challenges of the CBPR approach are presented with recommendations for future research.
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Affiliation(s)
- Jeannette O. Andrews
- College of Nursing, Director, SCTR Community Engagement Core and Center for Community Health, Partnerships, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425-1600, , 843-792-1188
| | - Susan D. Newman
- Center for Community Health Partnerships, College of Nursing, Medical University of South Carolina, Charleston, SC 29425 – 1600, , 843-792-9255
| | - Janie Heath
- E. Louise Grant Endowed Chair, College of Nursing, Georgia Health Sciences University, 987 St. Sebastian Way, Augusta, Georgia 30912, , 706-721-0422
| | - Lovoria B. Williams
- College of Nursing, Georgia Health Sciences University, 987 St. Sebastian Way EC-4511, Augusta, GA 30912, , 706 721-4781
| | - Martha S. Tingen
- Child Health Discovery Institute, Georgia Prevention Institute, Medical College of Georgia, Georgia Health Sciences University, Augusta, GA. 30912, , 706-721-0471
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Wright LB, Gregoski MJ, Tingen MS, Barnes VA, Treiber FA. Impact of Stress Reduction Interventions on Hostility and Ambulatory Systolic Blood Pressure in African American Adolescents. J Black Psychol 2011; 37:210-233. [PMID: 22485058 PMCID: PMC3319013 DOI: 10.1177/0095798410380203] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the impact of breathing awareness meditation (BAM), life skills (LS) training, and health education (HE) interventions on self-reported hostility and 24-hour ambulatory blood pressure (ABP) in 121 African American (AA) ninth graders at increased risk for development of essential hypertension. They were randomly assigned to BAM, LS, or HE and engaged in intervention sessions during health class for 3 months. Before, after, and 3 months following intervention cessation, self-reported hostility and 24-hour ABP were measured. Results indicated that between pre- and postintervention, BAM participants displayed significant reductions in self-reported hostility and 24-hour systolic ABP. Reductions in hostility were significantly related to reductions in 24-hour systolic ABP. Between postintervention and follow-up, participants receiving LS showed a significant reduction in hostility but not in 24-hour ABP. Significant changes were not found for the HE group in 24-hour ABP or self-reported hostility, but these change scores were significantly correlated. The implications of the findings are discussed with regard to behavioral stress reduction programs for the physical and emotional health of AAs.
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Gregoski MJ, Barnes VA, Tingen MS, Harshfield GA, Treiber FA. Breathing awareness meditation and LifeSkills Training programs influence upon ambulatory blood pressure and sodium excretion among African American adolescents. J Adolesc Health 2011; 48:59-64. [PMID: 21185525 PMCID: PMC3026442 DOI: 10.1016/j.jadohealth.2010.05.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effect of breathing awareness meditation (BAM), Botvin LifeSkills Training (LST), and health education control (HEC) on ambulatory blood pressure and sodium excretion in African American adolescents. METHODS Following 3 consecutive days of systolic blood pressure (SBP) screenings, 166 eligible participants (i.e., SBP >50th-95th percentile) were randomized by school to either BAM (n = 53), LST (n = 69), or HEC (n = 44). In-school intervention sessions were administered for 3 months by health education teachers. Before and after the intervention, overnight urine samples and 24-hour ambulatory SBP, diastolic blood pressure, and heart rate were obtained. RESULTS Significant group differences were found for changes in overnight SBP and SBP, diastolic blood pressure, and heart rate over the 24-hour period and during school hours. The BAM treatment exhibited the greatest overall decreases on these measures (Bonferroni adjusted, ps < .05). For example, for school-time SBP, BAM showed a change of -3.7 mmHg compared with no change for LST and a change of -.1 mmHg for HEC. There was a nonsignificant trend for overnight urinary sodium excretion (p = .07), with the BAM group displaying a reduction of -.92 ± 1.1 mEq/hr compared with increases of .89 ± 1.2 mEq/hr for LST and .58 ± .9 mEq/hr for HEC group. CONCLUSION BAM appears to improve hemodynamic function and may affect sodium handling among African American adolescents who are at increased risk for development of cardiovascular disease.
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Affiliation(s)
- Mathew J. Gregoski
- Medical University of South Carolina, College of Nursing and Medicine, Charleston, South Carolina
| | - Vernon A. Barnes
- Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Medical College of Georgia, Augusta, Georgia
| | - Martha S. Tingen
- Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Medical College of Georgia, Augusta, Georgia
| | - Gregory A. Harshfield
- Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Medical College of Georgia, Augusta, Georgia
| | - Frank A. Treiber
- Medical University of South Carolina, College of Nursing and Medicine, Charleston, South Carolina
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Abstract
Nursing research has a tremendous influence on current and future professional nursing practice, thus rendering it an essential component of the educational process. This article chronicles the learning experiences of two undergraduate nursing students who were provided with the opportunity to become team members in a study funded by the National Institute of Nursing Research. The application process, the various learning opportunities and responsibilities performed by the students, and the benefits and outcomes of the experience are described. The authors hope that by sharing their learning experiences, more students will be given similar opportunities using the strategies presented in this article. Nursing research is critical to the nursing profession and is necessary for continuing advancements that promote optimal nursing care.
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Affiliation(s)
- Martha S Tingen
- Medical College of Georgia, Georgia Prevention Institute, HS-1755, Augusta, GA 30912, USA.
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Abstract
The childhood years represent a critical time for tobacco experimentation and addiction. This chapter presents risk factors for youth smoking, state of the science of nurse-led primary and secondary tobacco prevention research in youth, and implications for future research, policy, and practice. Nursing research on both primary and secondary tobacco prevention efforts that are school-based, family-based, and community-based are presented. Interventions, including both state and community approaches, and media and policy endeavors to prevent tobacco use and foster successful cessation are discussed. The nursing profession has made an impact on primary and secondary prevention in youth regarding tobacco; however, much remains to be accomplished. As one of the largest health care professions, nurses should seize the important opportunity of positively impacting the health of children and youth through comprehensive and effective primary and secondary tobacco prevention efforts.
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Affiliation(s)
- Martha S Tingen
- Department of Pediatrics, School of Medicine, Medical College of Georgia, USA
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Andrews JO, Bentley G, Crawford S, Pretlow L, Tingen MS. Using community-based participatory research to develop a culturally sensitive smoking cessation intervention with public housing neighborhoods. Ethn Dis 2007; 17:331-7. [PMID: 17682367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
PURPOSE To describe surface and deep structure dimensions of a culturally sensitive smoking cessation intervention developed with southeastern US public housing neighborhoods. PROCEDURES Community-based participatory research (CBPR) methods were used to develop this culturally sensitive smoking cessation intervention by the following research partners: academicians, neighborhood residents, community health workers, and community advisory board. This CBPR involved a cyclical process with the following phases: assembling a research team; identifying smoking cessation as the health need of interest; developing the research method; establishing evaluation, feedback, and dissemination mechanisms; implementing the initial "Sister to Sister" community trial; analyzing and interpreting the data; disseminating the results; revising the intervention; and, establishing mechanisms to sustain outcomes. Culturally sensitive dimensions emerged during this process and were categorized as surface structure and deep structure. FINDINGS Surface structure dimensions included written materials, incentives and food, and protocol delivery strategies. Deep structure dimensions included kinships, collectivism, storytelling, and spiritual expressions. Community health workers and the advisory board contributed to the identification and integration of both surface and deep structure dimensions. The six-month continuous smoking abstinence outcomes from the initial community trial were 27.5% vs 5.77% for the intervention and comparison groups, respectively. CONCLUSIONS Community-based participatory research (CBPR) methods facilitate processes in which culturally sensitive dimensions can be effectively identified and integrated into health promotion interventions for marginalized populations. The incorporation of surface structure dimensions increases acceptance and feasibility, while deep structure improves overall impact and efficacy of the intervention.
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Affiliation(s)
- Jeannette O Andrews
- School of Nursing, Department of Biobehavioral Nursing, Medical College of Georgia, Augusta, Georgia 30912, USA.
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Abstract
PURPOSE To examine the effects of a theory-driven tobacco prevention program in sixth-grade children with a family tobacco cessation component implemented by school nurses in conjunction with the initiation of a statewide toll-free Quit Line. DATA SOURCES Self-report questionnaires completed by the sixth-grade children and their parents/guardians (N= 1024) representing largely rural southern school systems from disparate areas with high prevalence rates of tobacco use and lung cancer diagnoses. Pre- and posttest measures that evaluated the impact of both student and parent/guardian interventions were obtained over a 10-week period. Paired t-tests were used to examine differences between pre- and posttest scores for all student and parent/guardian variables. Repeated-measures analysis of variance was used to examine the effect of parent/guardian smoking on student pre- and posttest scores. CONCLUSIONS The student program resulted in significant improvements in drug knowledge, refusal skills, attitudes, normative expectations, assertiveness, and anxiety reduction techniques. In addition, the effectiveness of several components of the tobacco prevention program for the children was impacted by the smoking status of their parents/guardians. Drug-use intentions and behaviors were lower at posttest for children from homes of nonsmokers versus children from homes of smokers. Parents/guardians consistently reported that smoking was detrimental to themselves, the public, and their children. Of those parents/guardians who identified themselves as smokers (26%) and received cessation materials, 46.4% indicated that the information motivated them to want to quit. IMPLICATIONS FOR PRACTICE Tobacco use continues to be the leading cause of preventable death in the United States, with greater than 2000 new youth becoming regular smokers each day. School nurses and nurse practitioners are in various pivotal positions to address tobacco and its related health concerns through delivery of effective family interventions that target children for tobacco prevention and parent/guardian smokers for cessation.
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Affiliation(s)
- Martha S Tingen
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, Georgia, USA.
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Andrews JO, Tingen MS. The effect of smoking, smoking cessation, and passive smoke exposure on common laboratory values in clinical settings: a review of the evidence. Crit Care Nurs Clin North Am 2006; 18:63-9, xii. [PMID: 16546009 DOI: 10.1016/j.ccell.2005.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Evidence now supports that active and passive cigarette smoke exposure increase the risk for disease manifestations and adverse outcomes for patients in acute and critical care settings. By understanding the effect of active and passive smoke exposure on common laboratory tests, nurses in acute and critical care settings can plan essential components of care more accurately. This article addresses the effects of active and passive smoking and cessation on common parameters of hematology, hemostasis, immunology and inflammation, and chemistry laboratory tests.
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Affiliation(s)
- Jeannette O Andrews
- Department of Health Environments and Systems, School of Nursing, Medical College of Georgia, EB 204, 997 St. Sebastian Way, Augusta, GA 30912, USA.
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Abstract
PURPOSE To review the pathophysiology of asthma, present a case study, and provide management strategies for treating this common, yet complex disorder in children and adults. DATA SOURCES Selected clinical guidelines, clinical articles, and research studies. CONCLUSIONS Asthma is a chronic inflammatory airway disorder with acute exacerbations that currently affects approximately 14 million-15 million children and adults in the United States. Costs for asthma are staggering and nurse practitioners (NPs) are frequently presented with management decisions for the acute treatment and chronic management of this disorder. Disparities exist with the occurrence of asthma between race and gender. Additionally, there is an increased incidence in acute exacerbations resulting from poor long-term control and follow-up care among the socioeconomically disadvantaged. IMPLICATIONS FOR PRACTICE Standards of care, along with new and emerging treatment strategies, guide NPs in providing the most comprehensive care to those affected with this chronic disorder. Knowledge about the pathophysiology of asthma and correlated to the case presentation enhances understanding treatment strategies for NPs who are often faced with providing care for patients with this chronic disorder that may sometimes present in an acute exacerbation.
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Meister L, Heath J, Andrews J, Tingen MS. Professional nursing portfolios: a global perspective. Medsurg Nurs 2002; 11:177-82. [PMID: 12219429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
In some countries, nurses develop professional portfolios to obtain or maintain licensure, employment, and promotion. A professional portfolio is an important marketing tool that enables nurses to demonstrate their competence. Currently, regulatory bodies worldwide are considering requirements for portfolio development. This global perspective provides information on how to endure a professional portfolio.
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Affiliation(s)
- Lisa Meister
- Primary Care Services, VA Medical Center, Augusta, GA, USA
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Abstract
BACKGROUND This study evaluated the effect of primary care providers' adherence with the AHCPR Smoking Cessation Guideline after receiving a multicomponent intervention. METHODS A quasi-experimental study with one intervention and one control team was conducted in a southeastern Veterans Affairs Medical Center primary care setting. During phase I, chart reviews were conducted to measure baseline provider adherence and documentation of the four A's (ask, advise, assist, arrange). In phase II, the intervention team received a single educational session on the AHCPR Guideline, four A's, and tobacco dependence treatment. This was followed by chart reviews of patients seen 4 to 8 weeks after the educational intervention to measure provider adherence and documentation of the four A's. During phase III, the intervention team received individual and team feedback from the chart reviews in phases I and II and booster education on the AHCPR Guideline. Chart reviews were conducted from patient visits 4 to 8 weeks after the feedback and booster education to determine provider adherence and documentation of the four A's. RESULTS A nested repeated measures two-factor analysis of variance was performed for each of the following outcomes: ask, advise, assist, and arrange. Data analyses revealed that both the control and the intervention teams had 100% compliance in asking the patient about smoking status. There was a prestudy implementation of the vital sign stamp that included smoking status in this setting. Education on tobacco dependence and the AHCPR Guideline had no significant impact on provider performance with the advisement, assistance, and arrangement of follow-up. However, significant improvements occurred in the intervention team in the advisement (P = 0.05), assistance (P = 0.001), and arrangement of follow-up (P = 0.001) phase after individual and team feedback was provided. This research supports the fact that feedback impacts individuals and team performances and facilitated positive system changes to improve provider adherence with the AHCPR recommendations in treating tobacco dependence.
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Affiliation(s)
- J O Andrews
- Department of Community Nursing, Medical College of Georgia, Augusta 30912, USA.
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Bell RM, Tingen MS. The impact of tobacco use in women: exploring smoking cessation strategies. Clin J Oncol Nurs 2001; 5:101-4. [PMID: 11899366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The incidence of lung cancer in women has escalated during the last several decades. Lung cancer death rates in women also have risen and now exceed the number of deaths from breast cancer. Tobacco use accounts for more than 30% of all cancer deaths. Currently, 22 million adult women smoke, and more than 1.5 million adolescent females are smokers (American Cancer Society, 2000a). The use of tobacco by young female adolescents is on the rise, and those who are current smokers typically began smoking prior to high school graduation. Oncology nurses have an opportunity in inpatient and outpatient settings to impact the smoking habits of females, regardless of age. This article presents the guidelines for assisting women in smoking cessation. Clinical implications are presented that all oncology nurses should consider implementing in their practice setting.
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Abstract
The revised prostate cancer screening guidelines of the American Cancer Society recommend that men be informed of the risks associated with prostate cancer screening. However, there are no published studies on men's fear of impotence and its impact on prostate cancer screening. In addition, little is known about barriers to prostate cancer screening when the two main barriers of cost and lack of knowledge are eliminated. This study reports the association between barriers and free prostate cancer screening after a prostate cancer education program. All men were called 1 month after a prostate cancer education program and asked: "What would (or did) make it hard for you to get your prostate checkup done?" A total postbarrier score was created to measure how many barriers each man indicated. The following barriers were significant in predicting participation in prostate cancer screening: "put it off," "doctor hours not convenient," "didn't know kind of doctor," "didn't know where to go," and "refuse to go." Fear of impotence was not a significant barrier. Suggestions for reducing barriers to prostate cancer screening are given.
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Affiliation(s)
- S P Weinrich
- College of Nursing, University of South Carolina, Columbia, USA
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Tingen MS, Andrews JO, Gruber JL, Harper RJ. Implementing the Agency for Health Care Policy and Research smoking cessation guidelines: a call to action. Clin Excell Nurse Pract 1999; 3:323-8. [PMID: 10865569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Smoking is the single most preventable cause of death in our society. Each year, cigarettes kill more Americans than AIDS, alcohol, car accidents, fires, illegal drugs, murders, and suicides combined. An estimated 46 million adults in the United States smoke--28% of all men and 23.5% of all women. Seventy percent of Americans who smoke say that they would like to quit. Additionally, 70% who smoke visit a healthcare provider each year. Unfortunately, half of these who seek health care each year say they have never been advised to quit smoking or provided specific strategies to be successful at quitting. In 1996, the Agency for Health Care Policy and Research (AHCPR) published smoking cessation materials in several formats that target different audiences. This article describes the significant health problems of smoking and the AHCPR publications for smoking cessation. Providers are encouraged to identify smoking cessation as a priority and incorporate the AHCPR guidelines into routine health care for all patient encounters.
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Affiliation(s)
- M S Tingen
- School of Nursing, Medical College of Georgia, Augusta 30912, USA.
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Andrews JO, Tingen MS, Harper RJ. A model nurse practitioner-managed smoking cessation clinic. Oncol Nurs Forum 1999; 26:1603-10. [PMID: 10573678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE/OBJECTIVES To describe an intensive nurse practitioner (NP)-managed smoking cessation clinic that evolved from a primary-care quality-management initiative. DATA SOURCE Published articles, abstracts, books, clinical experience, and clinical data. DATA SYNTHESIS Smoking continues to be the leading cause of preventable deaths in the United States and accounts for 87% of all lung cancers. Although smoking is responsible for nearly 30% of all cancer deaths, smoking prevalence rates remain stagnant in adults and are continuing to increase in adolescents. Twenty-five percent of all Americans smoke. An NP-managed clinic was developed within a large teaching hospital located in the southeastern United States based on the Agency for Health Care Policy and Research guideline for smoking cessation. The clinic provided effective smoking cessation interventions that can be replicated by experienced nurses with a smoking cessation background. All nurses have opportunities to assist patients to stop smoking through brief counseling and minimum interventions. CONCLUSIONS Nurses can effectively manage an intensive smoking cessation clinic that is utilized by the interdisciplinary team to treat referrals. Cessation rates were high because therapies combined intensive behavioral sessions and pharmacologic approaches rather than either single modality. IMPLICATIONS FOR NURSING PRACTICE Nurses can replicate this practice in a variety of healthcare settings. Innovations in clinical practice often facilitate research studies to further define effective approaches for smoking cessation. Nurses need to identify and target smoking as the serious health problem it is and conduct much-needed research on cessation approaches within the inpatient and outpatient settings.
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Affiliation(s)
- J O Andrews
- Veterans Affairs Medical Center, Augusta, GA, USA.
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Affiliation(s)
- A Bryant
- School of Nursing, Nursing Anesthesia Program, Medical College of Georgia, Augusta, USA
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Abstract
Of the many controversies that have accompanied the growth of nursing as a discipline, few have been debated as long and as vigorously as the question of which paradigm should guide nursing science. Despite more than 20 years of discussion, the question remains unresolved. This article discusses the concept of paradigm, explores the paradigms that influence nursing science, and presents a comparison of the advantages and disadvantages of theoretical unification and mutiparadigmism. Additionally, the implications and consequences of multiparadigmism for the present and future development of nursing as a science within a practice discipline are presented.
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Affiliation(s)
- E J Monti
- Nursing Anesthesia Program, Medical College of Georgia, Augusta, USA
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