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Michel AD, Fontenot HB, Fuzzell L, Brownstein NC, Lake P, Vadaparampil ST, Perkins RB. Attitudes toward the American Cancer Society's 2020 cervical cancer screening guidelines: A qualitative study of a national sample of US clinicians. Cancer 2024. [PMID: 38436396 DOI: 10.1002/cncr.35269] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The 2020 American Cancer Society (ACS) guidelines are the most recent national guidelines for cervical cancer screening. These guidelines propose two major changes from current practice: initiating screening at age 25 years and using primary human papillomavirus (HPV) testing. Adoption of guidelines often occurs slowly, and therefore understanding clinician attitudes is important to facilitate practice change. METHODS Interviews with a national sample of clinicians who perform cervical cancer screening in a variety of settings explored attitudes toward the two major changes from the 2020 ACS cervical cancer screening guidelines. Clinicians participated in 30- to 60-min interviews exploring their attitudes toward various aspects of cervical cancer screening. Qualitative analysis was performed. RESULTS Seventy clinicians participated from across the United States. Few respondents were initiating screening at age 25 years, and none were using primary HPV testing. However, over half would be willing to adopt these practices if supported by scientific evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional societies, lack of laboratory availability and insurance coverage, limited autonomy within large health care systems, and concerns related to missed disease. CONCLUSIONS Few clinicians have adopted screening initiation or primary HPV testing, as recommended by the 2020 ACS guidelines, but over half were open to adopting these changes. Implementation may be facilitated via professional organization endorsement, clinician education, and laboratory, health care system, and insurance support. PLAIN LANGUAGE SUMMARY In 2020, the American Cancer Society (ACS) released updated guidelines for cervical cancer screening. The main changes to current practices were to initiate screening at age 25 years instead of age 21 years and to screen using primary human papillomavirus (HPV) testing rather than cytology alone or in combination with HPV testing. We performed in-depth interviews with 70 obstetrics and gynecology, family medicine, and internal medicine physicians and advanced practice providers about their attitudes toward these guidelines. Few clinicians are following the 2020 ACS guidelines, but over half were open to changing practice if the changes were supported by evidence and recommended by professional medical organizations. Barriers to adoption included the lack of endorsement by professional medical organizations, logistical issues, and concerns about missed disease.
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Affiliation(s)
- Alexandra D Michel
- College of Nursing, Rosalind Franklin University, North Chicago, Illinois, USA
| | - Holly B Fontenot
- School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Lindsay Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Naomi C Brownstein
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paige Lake
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Rebecca B Perkins
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
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Sonawane K, Zhu Y, Damgacioglu H, Garg A, Graboyes EM, Montealegre JR, Brownstein NC, Ford ME, Roberts JR, Sterba KR, Giuliano AR, Deshmukh AA. Factors associated with parental human papillomavirus vaccination intentions among adolescents from socioeconomically advantaged versus deprived households: a nationwide, cross-sectional survey. Lancet Reg Health Am 2024; 31:100694. [PMID: 38500960 PMCID: PMC10945422 DOI: 10.1016/j.lana.2024.100694] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 03/20/2024]
Abstract
Background In the USA, HPV vaccine coverage is substantially lower among adolescents from high-income households compared to their low-income counterparts. We examined and compared the factors associated with parental HPV vaccination intentions between socioeconomically divergent groups. Methods Data from unvaccinated and not fully HPV-vaccinated adolescents from the 2017-2021 National Immunization Survey (NIS)-Teen were analyzed. Socioeconomically advantaged vs. deprived groups were identified based on dichotomized income (material capital) and education (social capital). Parental intent to initiate and complete the HPV vaccine series was compared using bivariable analysis and the factors associated with lacking intent were identified. Findings The 2017-2021 NIS-Teen included a total of 212,643 participants; the final analytical sample consisted of 105,958 adolescents (an estimated 10.3 million adolescents) who were unvaccinated or not fully vaccinated. In the advantaged group, 64.7% of parents of unvaccinated adolescents (equating to 2.4 million US adolescents) had no intention to initiate the HPV vaccine compared to 40.9% of parents in the deprived group (equating to 0.2 million adolescents) (P < 0.0001; S > 13.29). The most frequent reason for lacking intent in the advantaged group was 'safety concerns' (25.5%). In the deprived group, 'lack of knowledge', 'not recommended', and 'not needed' were common reasons (nearly 15% each). Lack of intent to complete the HPV vaccine series was higher in the advantaged group (43.9%; 1.1 million adolescents) compared to the deprived group (25.2%; 0.08 million adolescents) (P < 0.0001; S > 13.29). More than half in the advantaged group (58.4%) and over a third (37.1%) in the deprived group cited 'already up to date' as the main reason for not completing the HPV vaccine series. Interpretation Lack of intent to initiate and complete the HPV vaccination series, particularly among socioeconomically advantaged parents is a significant barrier to achieving the national goal in the USA. Funding The US National Institute on Minority Health and Health Disparities, the National Center for Advancing Translational Sciences, MUSC Hollings Cancer Center Seed funding, and the US National Cancer Institutes.
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Affiliation(s)
- Kalyani Sonawane
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Yenan Zhu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Haluk Damgacioglu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Ashvita Garg
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Evan M. Graboyes
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | | | - Naomi C. Brownstein
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Marvella E. Ford
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - James R. Roberts
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R. Sterba
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
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Perkins RB, Fuzzell L, Lake P, Brownstein NC, Fontenot HB, Michel A, Whitmer A, Vadaparampil ST. Factors Associated With Guideline-concordant and Excessive Cervical Cancer Screening: A Mixed Methods Study. Womens Health Issues 2024:S1049-3867(24)00001-X. [PMID: 38383228 DOI: 10.1016/j.whi.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION National guidelines recommend cervical cancer screening with Papanicolaou (Pap) testing at 3-year intervals or with human papillomavirus (HPV) testing alone or HPV/Pap cotesting at 5-year intervals for average-risk individuals aged 30-65 years. METHODS We explored factors associated with clinician-reported guideline-concordant screening, as well as facilitators and barriers to appropriate cervical cancer screening. RESULTS A national sample of clinicians (N = 1,251) completed surveys; a subset (n = 55) completed interviews. Most (94%) screened average-risk patients aged 30-65 years with cotesting. Nearly all clinicians who were categorized as nonadherent to national guidelines were overscreening (98%). Guideline concordant screening was reported by 47% and 82% of those using cotesting and HPV testing, respectively (5-year intervals), and by 62% of those using Pap testing only (3-year intervals). Concordant screening was reported more often by clinicians who were aged <40 years, non-Hispanic, and practicing in the West or Midwest, and less often by obstetrician-gynecologists and private practice physicians. Concordant screening was facilitated by beliefs that updated guidelines were evidence-based and reduced harms, health care system dissemination of guidelines, and electronic medical record prompts. Barriers to concordant screening included using outdated guidelines, relying on personal judgment, concern about missing cancers, inappropriate patient risk assessment, and lack of support for guideline adoption through health care systems or electronic medical records. CONCLUSIONS Most clinicians screened with Pap/HPV cotesting and approximately one-half endorsed a 5-year screening interval. Clinician knowledge gaps include understanding the evidence underlying 5-year intervals and appropriate risk assessment to determine which patients should be screened more frequently. Education and tracking systems can promote guideline-concordant screening.
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Affiliation(s)
- Rebecca B Perkins
- Boston University, Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and Behavior, Office of Community Outreach, Engagement, and Equity, Tampa, Florida
| | - Paige Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and Behavior, Office of Community Outreach, Engagement, and Equity, Tampa, Florida
| | - Naomi C Brownstein
- Medical University of South Carolina, Public Health Sciences, Charleston, South Carolina
| | | | | | - Ashley Whitmer
- Boston University, Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and Behavior, Office of Community Outreach, Engagement, and Equity, Tampa, Florida
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Garg A, Nyitray AG, Roberts JR, Shungu N, Ruggiero KJ, Chandler J, Damgacioglu H, Zhu Y, Brownstein NC, Sterba KR, Deshmukh AA, Sonawane K. Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context. J Med Internet Res 2024; 26:e49749. [PMID: 38224476 PMCID: PMC10825763 DOI: 10.2196/49749] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/01/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Nearly 70% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known. OBJECTIVE We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics. METHODS We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms "HPV" and "HPV vaccine" on YouTube. RESULTS In 2022, 59.6% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4% in 2017 to 59.8% in 2022; P<.001) and rural (from 22.4% in 2017 to 58% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term "HPV" was more frequently searched on YouTube compared with "HPV vaccine." Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine. CONCLUSIONS The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics.
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Affiliation(s)
- Ashvita Garg
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Alan G Nyitray
- Medical College of Wisconsin, Milwaukee, IL, United States
- Medical College of Wisconsin Cancer Center, Milwaukee, IL, United States
| | - James R Roberts
- Medical University of South Carolina, Charleston, SC, United States
| | - Nicholas Shungu
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | | | - Jessica Chandler
- Medical University of South Carolina, Charleston, SC, United States
- Applications Center for Healthful Lifestyles, Charleston, SC, United States
| | - Haluk Damgacioglu
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Yenan Zhu
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | | | - Katherine R Sterba
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Ashish A Deshmukh
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Kalyani Sonawane
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
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Sanford BT, Brownstein NC, Baker NL, Palmer AM, Smith TT, Rojewski AM, Toll BA. Shift From Smoking Cigarettes to Vaping Nicotine in Young Adults. JAMA Intern Med 2024; 184:106-108. [PMID: 37955869 PMCID: PMC10644245 DOI: 10.1001/jamainternmed.2023.5239] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/10/2023] [Indexed: 11/14/2023]
Abstract
This survey study assesses trends in nicotine use among young adults in the US between 2013 and 2021.
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Affiliation(s)
| | | | | | | | - Tracy T Smith
- Medical University of South Carolina, Charleston
- Medical University of South Carolina Hollings Cancer Center, Charleston
| | - Alana M Rojewski
- Medical University of South Carolina, Charleston
- Medical University of South Carolina Hollings Cancer Center, Charleston
| | - Benjamin A Toll
- Medical University of South Carolina, Charleston
- Medical University of South Carolina Hollings Cancer Center, Charleston
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Lake P, Fuzzell L, Brownstein NC, Fontenot HB, Michel A, McIntyre M, Whitmer A, Rossi SL, Perkins RB, Vadaparampil ST. HPV vaccine recommendations by age: A survey of providers in federally qualified health centers. Hum Vaccin Immunother 2023; 19:2181610. [PMID: 36882951 PMCID: PMC10054304 DOI: 10.1080/21645515.2023.2181610] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/09/2023] Open
Abstract
Clinician recommendation remains a critical factor in improving HPV vaccine uptake. Clinicians practicing in federally qualified health centers were surveyed between October 2021 and July 2022. Clinicians were asked how they recommended HPV vaccination for patients aged 9-10, 11-12, 13-18, 19-26, and 27-45 y (strongly recommend, offer but do not recommend strongly, discuss only if the patient initiates the conversation, or recommend against). Descriptive statistics were assessed, and exact binomial logistic regression analyses were utilized to examine factors associated with HPV vaccination recommendation in 9-10-y-old patients. Respondents (n = 148) were primarily female (85%), between the ages of 30-39 (38%), white, non-Hispanic (62%), advanced practice providers (55%), family medicine specialty (70%), and practicing in the Northeast (63%). Strong recommendations for HPV vaccination varied by age: 65% strongly recommended for ages 9-10, 94% for ages 11-12, 96% for ages 13-18, 82% for age 19-26, and 26% for ages 27-45 y. Compared to Women's Health/OBGYN specialty, family medicine clinicians were less likely to recommend HPV vaccination at ages 9-10 (p = .03). Approximately two-thirds of clinicians practicing in federally qualified health centers or safety net settings strongly recommend HPV vaccine series initiation at ages 9-10. Additional research is needed to improve recommendations in younger age groups.
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Affiliation(s)
- Paige Lake
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Lindsay Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Naomi C Brownstein
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Alexandra Michel
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | - McKenzie McIntyre
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ashley Whitmer
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Sarah L Rossi
- Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, MA, USA
| | - Rebecca B Perkins
- Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, MA, USA
| | - Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Conley CC, Rodriguez JD, McIntyre M, Brownstein NC, Niell BL, O'Neill SC, Vadaparampil ST. Self-reported barriers to screening breast MRI among women at high risk for breast cancer. Breast Cancer Res Treat 2023; 202:345-355. [PMID: 37640965 DOI: 10.1007/s10549-023-07085-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Annual screening breast MRI is recommended for women at high (≥ 20% lifetime) breast cancer risk, but is underutilized. Guided by the Health Services Utilization Model (HSUM), we assessed factors associated with screening breast MRI among high-risk women. METHODS From August 2020-January 2021, we recruited an online convenience sample of high-risk women ages 25-85 (N = 232). High-risk was defined as: pathogenic genetic mutation in self or first-degree relative; history of lobular carcinoma in situ; history of thoracic radiation; or estimated lifetime risk ≥ 20%. Participants self-reported predisposing factors (breast cancer knowledge, health locus of control), enabling factors (health insurance type, social support), need factors (perceived risk, screening-supportive social norms, provider recommendation), and prior receipt of screening breast MRI. Multivariable logistic regression analysis with backward selection identified HSUM factors associated with receipt of screening breast MRI. RESULTS About half (51%) of participants had received a provider recommendation for screening breast MRI; only 32% had ever received a breast MRI. Breast cancer knowledge (OR = 1.15, 95% CI = 1.04-1.27) and screening-supportive social norms (OR = 2.21, 95% CI = 1.64-2.97) were positively related to breast MRI receipt. No other HSUM variables were associated with breast MRI receipt (all p's > 0.1). CONCLUSIONS High-risk women reported low uptake of screening breast MRI, indicating a gap in guideline-concordant care. Breast cancer knowledge and screening-supportive social norms are two key areas to target in future interventions. Data were collected during the COVID-19 pandemic and generalizability of results is unclear. Future studies with larger, more heterogeneous samples are needed to replicate these findings.
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Affiliation(s)
- Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA.
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, 20007, Washington, DC, USA.
| | | | - McKenzie McIntyre
- Moffitt Cancer Center, Health Outcomes and Behavior Program, Tampa, FL, USA
| | - Naomi C Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Bethany L Niell
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
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Cummings KM, Talbot V, Roberson A, Bliss AA, Likins E, Brownstein NC, Stansell S, Adams-Ludd D, Harris B, Louder D, McCutcheon E, Zebian R, Rojewski A, Toll BA. Implementation of an "Opt-Out" Tobacco Treatment Program in Six Hospitals in South Carolina. Res Sq 2023:rs.3.rs-3318088. [PMID: 37720041 PMCID: PMC10503831 DOI: 10.21203/rs.3.rs-3318088/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Objective To describe the implementation an opt-out tobacco treatment program (TTP) in 6 diverse hospitals located in different regions of South Carolina. Methods Between March 8, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to 6 hospitals affiliated with the Medical University of South Carolina (MUSC) were screened for their cigarette status. Patients who smoked cigarettes were referred to an TTP offering a brief bedside consult and automated post-discharge follow-up calls with an opportunity to receive a referral to the South Carolina Quitline (SCQL). The hospitals included in this study ranged in size from 82 to 715 beds with diverse patient populations. Herein, we report on the results of screening and referring patients to the TTP, delivery of smoking cessation treatments, and patient smoking status assessed in a sample of patients followed 6-weeks after discharge from the hospital. Results Smoking prevalence ranged from 14-49% across the 6 hospitals. Among eligible patients reached, 85.6% accepted the bedside consult. Only 3.4% of patients reached were deemed ineligible because they claimed not to be currently smoking cigarettes. The automated post-discharge follow-up calls were answered by 43% of patients, with about a third of those who had relapsed back to smoking accepting the offer of a referral to the SCQL. Overall, about half of the 6,000 patients referred to the TTP received some type of treatment. Self-reported smoking abstinence rates assessed 6-weeks after discharge were similar across the five acute care hospitals ranging from about 20-30%. Conclusion The findings demonstrate the broad reach of implementing an opt-out TTP for patients in hospitals of varying size, rurality and patient populations.
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Fuzzell L, Lake P, Brownstein NC, Fontenot HB, Whitmer A, Michel A, McIntyre M, Rossi SL, Kajtezovic S, Vadaparampil ST, Perkins R. Examining the perceived impact of the COVID-19 pandemic on cervical cancer screening practices among clinicians practicing in Federally Qualified Health Centers: A mixed methods study. eLife 2023; 12:e86358. [PMID: 37664989 PMCID: PMC10476963 DOI: 10.7554/elife.86358] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed methods study we explored perceived pandemic-related practice changes to cervical cancer screenings in federally qualified health centers (FQHCs). Methods Between October 2021 and June 2022, we conducted a national web survey of clinicians (physicians and advanced practice providers) who performed cervical cancer screening in FQHCs in the United States during the post-acute phase of the COVID-19 pandemic, along with a sub-set of qualitative interviews via video conference, to examine perceived changes in cervical cancer screening practices during the pandemic. Results A total of 148 clinicians completed surveys; a subset (n=13) completed qualitative interviews. Most (86%) reported reduced cervical cancer screening early in the pandemic, and 28% reported continued reduction in services at the time of survey completion (October 2021- July 2022). Nearly half (45%) reported staff shortages impacting their ability to screen or track patients. Compared to clinicians in Obstetrics/Gynecology/Women's health, those in family medicine and other specialties more often reported reduced screening compared to pre-pandemic. Most (92%) felt that screening using HPV self-sampling would be very or somewhat helpful to address screening backlogs. Qualitative interviews highlighted the impacts of staff shortages and strategies for improvement. Conclusions Findings highlight that in late 2021 and early 2022, many clinicians in FQHCs reported reduced cervical cancer screening and of pandemic-related staffing shortages impacting screening and follow-up. If not addressed, reduced screenings among underserved populations could worsen cervical cancer disparities in the future. Funding This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
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Affiliation(s)
- Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Paige Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Naomi C Brownstein
- Medical University of South Carolina, Public Health SciencesCharlestonUnited States
| | - Holly B Fontenot
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Ashley Whitmer
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Alexandra Michel
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - McKenzie McIntyre
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Sarah L Rossi
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Sidika Kajtezovic
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
- H. Lee Moffitt Cancer Center & Research Institute, Office of Community Outreach, Engagement, and EquityTampaUnited States
| | - Rebecca Perkins
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
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Vadaparampil ST, Fuzzell LN, Brownstein NC, Fontenot HB, Lake P, Michel A, McIntyre M, Whitmer A, Perkins RB. A cross-sectional survey examining clinician characteristics, practices, and attitudes associated with adoption of the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines. Cancer 2023; 129:2671-2684. [PMID: 37221653 DOI: 10.1002/cncr.34838] [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: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management consensus guidelines are the most recent national guidelines for the management of abnormal cervical cancer screening tests. These guidelines benefit patients by concentrating testing and treatment in those at highest cervical cancer risk. Adoption of guidelines often occurs slowly, with few studies examining the factors associated with guideline-adherent management of abnormal results. METHODS To elucidate the factors associated with the use of the 2019 ASCCP guidelines among clinicians who perform cervical cancer screening, physicians and advanced practice professionals who perform cervical cancer screening were cross-sectionally surveyed. Clinicians responded to screening vignettes with differing recommendations for management between the 2019 and prior management guidelines. Screening vignette 1 involved reduction of invasive testing on a low-risk patient; screening vignette 2 involved increased surveillance testing on a high-risk patient. Binomial logistic regression models determined the factors associated with the use of the 2019 guidelines. RESULTS A total of 1251 clinicians participated from across the United States. For screening vignettes 1 and 2, guideline-adherent responses were given by 28% and 36% of participants, respectively. Management recommendations differed by specialty and were incorrect in different situations: there was inappropriate invasive testing by obstetrics and gynecology physicians (vignette 1) and inappropriate discontinuation of screening by family and internal medicine physicians (vignette 2). Regardless of their chosen response, over half erroneously believed they were guideline adherent. CONCLUSIONS Many clinicians who believe they are following appropriate guidelines may not realize their management strategy is inconsistent with the 2019 guidelines. Education initiatives tailored to clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms. PLAIN LANGUAGE SUMMARY The 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines are the most recent national guidelines for abnormal cervical cancer screening test management. We surveyed over 1200 obstetrics and gynecology (OB/GYN), family medicine, and internal medicine physicians and advanced practice providers about their screening and abnormal results follow-up practices in relation to guidelines. Few clinicians are following the 2019 guidelines. Management recommendations differed by clinician specialty and were incorrect in different situations: there was inappropriate invasive testing by OB/GYN physicians and inappropriate screening discontinuation by family and internal medicine physicians. Education tailored by clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.
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Affiliation(s)
- Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Lindsay N Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Naomi C Brownstein
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Paige Lake
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Alexandra Michel
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - McKenzie McIntyre
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Ashley Whitmer
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Rebecca B Perkins
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
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Fuzzell L, Brownstein NC, Fontenot HB, Lake PW, Michel A, Whitmer A, Rossi SL, McIntyre M, Vadaparampil ST, Perkins RB. Examining the association of clinician characteristics with perceived changes in cervical cancer screening and colposcopy practice during the COVID-19 pandemic: a mixed methods assessment. eLife 2023; 12:e85682. [PMID: 37656169 PMCID: PMC10473834 DOI: 10.7554/elife.85682] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Background The COVID-19 pandemic led to reductions in cervical cancer screening and colposcopy. Therefore, in this mixed method study we explored perceived pandemic-related practice changes to cervical cancer screenings and colposcopies. Methods In 2021, a national sample of 1251 clinicians completed surveys, including 675 clinicians who performed colposcopy; a subset (n=55) of clinicians completed qualitative interviews. Results Nearly half of all clinicians reported they were currently performing fewer cervical cancer screenings (47%) and colposcopies (44% of those who perform the procedure) than before the pandemic. About one-fifth (18.6%) of colposcopists reported performing fewer LEEPs than prior to the pandemic. Binomial regression analyses indicated that older, as well as internal medicine and family medicine clinicians (compared to OB-GYNs), and those practicing in community health centers (compared to private practice) had higher odds of reporting reduced screening. Among colposcopists, internal medicine physicians and those practicing in community health centers had higher odds of reporting reduced colposcopies. Qualitative interviews highlighted pandemic-related care disruptions and lack of tracking systems to identify overdue screenings. Conclusions Reductions in cervical cancer screening and colposcopy among nearly half of clinicians more than 1 year into the pandemic raise concerns that inadequate screening and follow-up will lead to future increases in preventable cancers. Funding This study was funded by the American Cancer Society, who had no role in the study's design, conduct, or reporting.
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Affiliation(s)
- Lindsay Fuzzell
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | | | - Holly B Fontenot
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Paige W Lake
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Alexandra Michel
- University of Hawaii at Manoa, Nancy Atmospera-Walch School of NursingHonoluluUnited States
| | - Ashley Whitmer
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Sarah L Rossi
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
| | - McKenzie McIntyre
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
| | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center & Research Institute, Health Outcomes and BehaviorTampaUnited States
- H. Lee Moffitt Cancer Center & Research Institute, Office of Community Outreach, Engagement, and EquityTampaUnited States
| | - Rebecca B Perkins
- Boston University, Chobanian & Avedisian School of MedicineBostonUnited States
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Arevalo M, Brownstein NC, Whiting J, Vadaparampil ST, Head KJ, Meade CD, Islam JY, Kasting ML, Gwede CK, Barrios-Monroy V, Christy SM. Factors related to human papillomavirus vaccine uptake and intentions among adults aged 18-26 and 27-45 years in the United States: A cross-sectional study. Cancer 2023; 129:1237-1252. [PMID: 36759972 PMCID: PMC10470643 DOI: 10.1002/cncr.34680] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND The current study examined self-reported human papillomavirus (HPV) vaccination uptake and intentions, and associations with psychosocial constructs among United States adults aged 18 to 26 and 27 to 45 years. METHODS Data were collected via an online survey from participants recruited from a research panel. Outcomes were HPV vaccination uptake and intentions. Multivariable binary and ordered logistic regression models were used to examine associations between HPV vaccination outcomes and psychosocial constructs, sociodemographics, and previous health behaviors. RESULTS HPV vaccination uptake in both age cohorts (N = 2722) was associated with multiple variables, including but not limited to: provider recommendation (adjusted odds ratio [aOR], 11.63 [95% CI, 7.70-17.56] and aOR, 14.26 [95% CI, 9.52-21.38], for those aged 18 to 26 and 27 to 45 years, respectively) and positive HPV vaccine attitudes (aOR, 2.40 [95% CI, 1.70-3.40] and aOR, 1.46 [95% CI,1.06-2.02]). Among those who did not report or were unsure of prior HPV vaccination (N =1894), only 4.6% and 8.1% (aged 18-26 and 27-45 years, respectively) reported being very likely to receive the HPV vaccine in the next year. Increased intentions were associated with more positive vaccine attitudes (aOR, 2.45 [95% CI, 1.91-3.15] and aOR, 2.19 [95% CI, 1.72-2.78]) and provider recommendation (yes vs no; aOR, 1.97 [95% CI, 1.38-2.83] and aOR, 1.82 [95% CI, 1.31-2.52]; don't know/can't remember vs no; aOR, 1.38 [95% CI, 1.03-1.84] and aOR, 1.60 [95% CI, 1.17-2.18]). Sociodemographics and health behaviors associated with increased intentions differed for each age cohort. CONCLUSIONS Individual and interpersonal factors were associated with HPV vaccination uptake and intentions. Findings reveal the need for targeted interventions to improve HPV vaccination rates among these age groups.
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Affiliation(s)
- Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Naomi C. Brownstein
- Department of Public Health Services, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Monica L. Kasting
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Laborde J, Stewart PA, Chen Z, Chen YA, Brownstein NC. Sparse clusterability: testing for cluster structure in high dimensions. BMC Bioinformatics 2023; 24:125. [PMID: 37003995 PMCID: PMC10064666 DOI: 10.1186/s12859-023-05210-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/24/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Cluster analysis is utilized frequently in scientific theory and applications to separate data into groups. A key assumption in many clustering algorithms is that the data was generated from a population consisting of multiple distinct clusters. Clusterability testing allows users to question the inherent assumption of latent cluster structure, a theoretical requirement for meaningful results in cluster analysis. RESULTS This paper proposes methods for clusterability testing designed for high-dimensional data by utilizing sparse principal component analysis. Type I error and power of the clusterability tests are evaluated using simulated data with different types of cluster structure in high dimensions. Empirical performance of the new methods is evaluated and compared with prior methods on gene expression, microarray, and shotgun proteomics data. Our methods had reasonably low Type I error and maintained power for many datasets with a variety of structures and dimensions. Cluster structure was not detectable in other datasets with spatially close clusters. CONCLUSION This is the first analysis of clusterability testing on both simulated and real-world high-dimensional data.
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Affiliation(s)
- Jose Laborde
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.
| | - Paul A Stewart
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Zhihua Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Yian A Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
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Cousin L, Roberts S, Brownstein NC, Whiting J, Kasting ML, Head KJ, Vadaparampil ST, Giuliano AR, Gwede CK, Meade CD, Christy SM. Factors associated with parental COVID-19 vaccine attitudes and intentions among a national sample of United States adults ages 18-45. J Pediatr Nurs 2023; 69:108-115. [PMID: 36716520 PMCID: PMC9852321 DOI: 10.1016/j.pedn.2023.01.003] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/27/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE This study explored factors associated with parents' attitudes and intentions to seek information about the COVID-19 vaccine for their children (ages 0-18) and intentions to vaccinate their age-eligible children. DESIGN AND METHODS As part of an anonymous online cross-sectional survey, parents' vaccine attitudes, COVID-19 vaccine intentions for their children, health literacy, health numeracy, and sociodemographic variables were assessed. Multivariable ordered logistic regression models identified factors associated with parents' COVID-19 vaccine intentions for their children. RESULTS Parents/guardians (n = 963) were mostly White (82.3%), insured (88.0%), and college graduates (57.3%). Men reported higher intentions than women to seek information about the COVID-19 vaccine for their children (p = 0.003) and higher intentions to vaccinate their children (p = 0.049). Parental characteristics associated with increased intentions to have their children vaccinated included higher educational attainment (p < 0.001), more positive general vaccine attitudes (p < 0.001), preference for health information in a language other than English (p = 0.006), higher income (p = 0.048), having health insurance (p = 0.05), health literacy (p = 0.024), and health numeracy (p = 0.049). CONCLUSIONS Multiple sociodemographic characteristics including male gender, higher health literacy and numeracy, and language preference are noteworthy factors associated with parental COVID-19 vaccine intentions that could inform the planning and implementation of educational interventions. PRACTICE IMPLICATIONS Nurses are important sources of trusted information and play an important role in parent/family health education and in understanding myriad factors that may improve attitudes and enhance readiness toward vaccine uptake. Our findings emphasize the potential value of examining tailored/targeted COVID-19 vaccine education according to key influencing factors.
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Affiliation(s)
- Lakeshia Cousin
- College of Nursing, University of Florida, Gainesville, FL, United States of America
| | - Stephanie Roberts
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America
| | - Naomi C Brownstein
- Dept. of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Junmin Whiting
- Dept. of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Monica L Kasting
- Dept. of Public Health, Purdue University, West Lafayette, IN, United States of America; Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, United States of America
| | - Katharine J Head
- Dept. of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Susan T Vadaparampil
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Anna R Giuliano
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Clement K Gwede
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Cathy D Meade
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Shannon M Christy
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America.
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Turner K, Brownstein NC, Whiting J, Arevalo M, Vadaparampil S, Giuliano AR, Islam JY, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18-45: A cross-sectional study. Prev Med Rep 2023; 31:102067. [PMID: 36439896 PMCID: PMC9677560 DOI: 10.1016/j.pmedr.2022.102067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18-45). The current study leverages a national, cross-sectional sample of US adults ages 18-45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of 'no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20; 95 % CI: 1.99-5.13), being a parent/guardian (OR: 1.77; 95 % CI: 1.18-2.66), having at least one healthcare visit in the past year (OR: 1.97; 95 % CI: 1.10-3.53), being up-to-date on the tetanus vaccine (OR: 1.81; 95 % CI: 1.19-2.75), and being a cancer survivor (OR: 2.57; 95 % CI: 1.52-4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN 47907, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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Turner K, Brownstein NC, Whiting J, Arevalo M, Islam JY, Vadaparampil ST, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 Pandemic on Women's Health Care Access: A Cross-Sectional Study. J Womens Health (Larchmt) 2022; 31:1690-1702. [PMID: 36318766 PMCID: PMC9805885 DOI: 10.1089/jwh.2022.0128] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There has been limited study of how the COVID-19 pandemic has affected women's health care access. Our study aims to examine the prevalence and correlates of COVID-19-related disruptions to (1) primary care; (2) gynecologic care; and (3) preventive health care among women. Materials and Methods: We recruited 4,000 participants from a probability-based online panel. We conducted four multinomial logistic regression models, one for each of the study outcomes: (1) primary care access; (2) gynecologic care access; (3) patient-initiated disruptions to preventive visits; and (4) provider-initiated disruptions to preventive visits. Results: The sample included 1,285 women. One in four women (28.5%) reported that the pandemic affected their primary care access. Sexual minority women (SMW) (odds ratios [OR]: 1.67; 95% confidence intervals [CI]: 1.19-2.33) had higher odds of reporting pandemic-related effects on primary care access compared to women identifying as heterosexual. Cancer survivors (OR: 2.07; 95% CI: 1.25-3.42) had higher odds of reporting pandemic-related effects on primary care access compared to women without a cancer history. About 16% of women reported that the pandemic affected their gynecologic care access. Women with a cancer history (OR: 2.34; 95% CI: 1.35-4.08) had higher odds of reporting pandemic-related effects on gynecologic care compared to women without a cancer history. SMW were more likely to report patient- and provider-initiated delays in preventive health care. Other factors that affected health care access included income, insurance status, and having a usual source of care. Conclusions: The COVID-19 pandemic disrupted women's health care access and disproportionately affected access among SMW and women with a cancer history, suggesting that targeted interventions may be needed to ensure adequate health care access during the COVID-19 pandemic.
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Affiliation(s)
- Kea Turner
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T. Vadaparampil
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cathy D. Meade
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Clement K. Gwede
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Shannon M. Christy
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
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17
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Conley CC, Rodriguez JD, Brownstein NC, O'Neill SC, Vadaparampil ST. Characteristics associated with healthcare disruptions during the COVID-19 pandemic for women in the United States at high risk for breast cancer. Prev Med Rep 2022; 30:101975. [PMID: 36090472 PMCID: PMC9446594 DOI: 10.1016/j.pmedr.2022.101975] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Abstract
Delays in healthcare, including breast cancer screening, were documented during the coronavirus disease 2019 (COVID-19) pandemic. However, no studies have examined the impact of COVID-19 on healthcare among women at high (≥20 % lifetime) risk for breast cancer. This study fills that gap. Between August 2020 and January 2021, high-risk women (N = 225) living in the United States (US) completed an online survey assessing COVID-related healthcare disruptions. Descriptive statistics characterized the frequency of breast cancer screening (mammogram and breast magnetic resonance imaging [MRI]) since the beginning of the COVID-19 pandemic. Multivariable linear regression analysis with backward selection examined demographic characteristics associated with COVID-related healthcare disruptions. Since March 2020, 40 % of participants had received a mammogram and 12 % had received a screening breast MRI. On average, participants reported low levels of COVID-related healthcare disruptions (M = 1.97 on a 0-4 scale, higher = more disruptions). Participants who were younger (β = -0.21, p = 0.002) and not working (β = 0.18, p = 0.009) reported more COVID-related healthcare disruptions. Compared to non-Hispanic White participants, those from any other racial or ethnic group reported fewer COVID-related healthcare disruptions (β = -0.15, p = 0.020). Although few high-risk women received breast cancer screening after the declaration of the COVID-19 pandemic, they reported overall low levels of COVID-related healthcare disruptions. Results identify subgroups of high-risk women whose healthcare may have been more affected by the pandemic. Efforts to encourage US women at high risk for breast cancer to return to routine preventive care (including breast cancer screening) may need to be targeted towards women who are younger, not working, and non-Hispanic White.
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Affiliation(s)
- Claire C Conley
- Georgetown University, Department of Oncology, Washington, DC, USA
| | | | - Naomi C Brownstein
- Medical University of South Carolina, Department of Public Health Sciences, Charleston, SC, USA
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18
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Coghill AE, Brownstein NC, Sinha S, Thompson ZJ, Dickey BL, Hoogland AI, Johnstone PA, Suneja G, Jim HS. Patient-Reported Outcomes in Cancer Patients with HIV. Cancers (Basel) 2022; 14:cancers14235889. [PMID: 36497369 PMCID: PMC9739107 DOI: 10.3390/cancers14235889] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
Elevated cancer-specific mortality in PWH has been demonstrated for non-AIDS-defining malignancies. However, additional clinical endpoints of interest, including patient-reported outcomes (PROs), have not been systematically examined in PWH and cancer. We evaluated differences in patient-reported symptomology between cancer patients with versus without HIV using data from 12,529 patients at the Moffitt Cancer Center, including 55 with HIV. The symptoms were assessed using the Edmonton Symptom Assessment Scale (ESAS), which asks patients to rank 12 symptoms on a scale of 1−10, with scores ≥7 considered severe. The responses across all questions were summed to create a composite score. Vital status through t July 2021 was determined through linkage to the electronic health record. PWH reported a higher composite ESAS score on average (44.4) compared to HIV-uninfected cancer patients (30.7, p-value < 0.01). In zero-inflated negative binomial regression models adjusted for cancer site, sex, and race, the composite ESAS scores and the count of severe symptoms were 1.41 times (95% CI: 1.13−1.77) and 1.45 times (95% CI: 1.09−1.93) higher, respectively, in cancer patients with HIV. Among PWH, higher ESAS scores were associated with mortality (p-value = 0.02). This is the first demonstration of uniquely poor PROs in PWH and cancer and suggests that patient symptom monitoring to improve clinical endpoints deserves further study.
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Affiliation(s)
- Anna E. Coghill
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Correspondence: ; Tel.: +1-813-745-7147
| | - Naomi C. Brownstein
- Biostatistics and Bioinformatics Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Sweta Sinha
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Zachary J. Thompson
- Biostatistics and Bioinformatics Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Brittney L. Dickey
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Aasha I. Hoogland
- Health Outcomes & Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Peter A. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT 84108, USA
| | - Heather S. Jim
- Health Outcomes & Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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19
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Brownstein NC, Reddy H, Whiting J, Kasting ML, Head KJ, Vadaparampil ST, Giuliano AR, Gwede CK, Meade CD, Christy SM. COVID-19 vaccine behaviors and intentions among a national sample of United States adults ages 18-45. Prev Med 2022; 160:107038. [PMID: 35398369 PMCID: PMC8988441 DOI: 10.1016/j.ypmed.2022.107038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 07/23/2021] [Revised: 12/31/2021] [Accepted: 04/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Vaccination for SARS-CoV-2, the virus that causes COVID-19 illness, is an important public health tool to reduce hospitalizations and deaths. PURPOSE This report focuses on intentions and behaviors related to COVID-19 vaccination among United States (U.S.) adults ages 18-45. METHODS From February 25-March 24, 2021, we conducted an online survey assessing COVID-19 vaccine intentions and behaviors, health beliefs, vaccine attitudes, and sociodemographic characteristics. Participants were adults aged 18-45, living throughout the U.S. with oversampling in Florida, panelists of a research panel company directly or via verified partners, and able to read, write, and understand English. Associations between COVID-19 vaccination uptake, intentions, and other study variables were examined through multivariable logistic and proportional odds regression analyses. RESULTS Among participants in the final analytic sample (n = 2722), 18% reported having received at least one dose of a COVID-19 vaccine. Approximately 31% of unvaccinated participants reported strong intentions to receive a COVID-19 vaccine in the next year, whereas 35% reported strong intentions to receive a COVID-19 vaccine if it were strongly recommended by a healthcare provider. All COVID-19 vaccination outcomes were associated with male gender, sexual minority status, higher levels of education, and previous influenza vaccination. All vaccination intention outcomes were associated with vaccine attitudes and geographic region. Vaccination status and intentions were differentially associated with multiple additional sociodemographic, attitudinal, and/or healthcare experience variables. CONCLUSIONS Several demographic variables, vaccine attitudes, and healthcare experiences were found to contribute to COVID-19 vaccine receipt and intentions. Targeted efforts are necessary to increase uptake of the vaccine in the U.S.
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Affiliation(s)
- Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America; Department of Oncologic Sciences, University of South Florida, United States of America.
| | - Harika Reddy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; College of Public Health and Health Professions, University of Florida, United States of America
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, United States of America; Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, United States of America
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Susan T Vadaparampil
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Clement K Gwede
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Cathy D Meade
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Shannon M Christy
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
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20
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Arevalo M, Brownstein NC, Whiting J, Meade CD, Gwede CK, Vadaparampil ST, Tillery KJ, Islam JY, Giuliano AR, Christy SM. Strategies and Lessons Learned During Cleaning of Data From Research Panel Participants: Cross-sectional Web-Based Health Behavior Survey Study. JMIR Form Res 2022; 6:e35797. [PMID: 35737436 PMCID: PMC9264135 DOI: 10.2196/35797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background The use of web-based methods to collect population-based health behavior data has burgeoned over the past two decades. Researchers have used web-based platforms and research panels to study a myriad of topics. Data cleaning prior to statistical analysis of web-based survey data is an important step for data integrity. However, the data cleaning processes used by research teams are often not reported. Objective The objectives of this manuscript are to describe the use of a systematic approach to clean the data collected via a web-based platform from panelists and to share lessons learned with other research teams to promote high-quality data cleaning process improvements. Methods Data for this web-based survey study were collected from a research panel that is available for scientific and marketing research. Participants (N=4000) were panelists recruited either directly or through verified partners of the research panel, were aged 18 to 45 years, were living in the United States, had proficiency in the English language, and had access to the internet. Eligible participants completed a health behavior survey via Qualtrics. Informed by recommendations from the literature, our interdisciplinary research team developed and implemented a systematic and sequential plan to inform data cleaning processes. This included the following: (1) reviewing survey completion speed, (2) identifying consecutive responses, (3) identifying cases with contradictory responses, and (4) assessing the quality of open-ended responses. Implementation of these strategies is described in detail, and the Checklist for E-Survey Data Integrity is offered as a tool for other investigators. Results Data cleaning procedures resulted in the removal of 1278 out of 4000 (31.95%) response records, which failed one or more data quality checks. First, approximately one-sixth of records (n=648, 16.20%) were removed because respondents completed the survey unrealistically quickly (ie, <10 minutes). Next, 7.30% (n=292) of records were removed because they contained evidence of consecutive responses. A total of 4.68% (n=187) of records were subsequently removed due to instances of conflicting responses. Finally, a total of 3.78% (n=151) of records were removed due to poor-quality open-ended responses. Thus, after these data cleaning steps, the final sample contained 2722 responses, representing 68.05% of the original sample. Conclusions Examining data integrity and promoting transparency of data cleaning reporting is imperative for web-based survey research. Ensuring a high quality of data both prior to and following data collection is important. Our systematic approach helped eliminate records flagged as being of questionable quality. Data cleaning and management procedures should be reported more frequently, and systematic approaches should be adopted as standards of good practice in this type of research.
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Affiliation(s)
- Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United States
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
| | - Kristin J Tillery
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, Tampa, FL, United States
| | - Jessica Y Islam
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States
| | - Anna R Giuliano
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States
| | - Shannon M Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
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21
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Gonzalez BD, Brownstein NC, Fan W, Dicker AP, Oswald LB, Dhillon HM, Jim HS, Sandhu SK, Tagawa ST, Williams S, Hofman MS. Improvements in symptoms related to bone metastasis in recipients of Lutetium-177 PSMA-617 for prostate cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.096] [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
96 Background: Prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) targeted to prostate-specific membrane antigen (PSMA) is a new targeted treatment for progressive metastatic castration-resistant prostate cancer (mCRPC). PSMA-RLT conjugates a radionuclide to a small molecule ligand with affinity for PSMA. Recent trials, such as TheraP and VISION, established improvements in progression free survival, overall survival, and patient-reported outcomes (PROs) for PSMA-RLT. Less is known about the impact of PSMA-RLT on symptoms related to bone metastasis (BM), commonly causing significant morbidity in men with mCRPC. The optimal tools for PRO collection with PSMA-RLT are also uncertain. We previously reported improvements in Brief Pain Inventory and now report EORTC QLQ-BM22 data to describe change in symptoms related to bone metastasis among men receiving PSMA-RLT for mCRPC. Methods: From 2015 to 2017, 50 patients received up to 4 cycles of 177Lu-PSMA-617 every 6 weeks (trial registration: ACTRN12615000912583). Patients completed a validated assessment of bone metastasis-related pain (EORTC QLQ-BM22) prior to each cycle and 6 or 12 weeks after the last cycle of 177Lu-PSMA. Change in pain over the course of the study was examined using linear mixed effects models. We also examined whether unadjusted changes in PROs exceeded published cutoffs for minimal clinically important difference scores. Results: Patients reported reduced bone metastasis-related pain at various sites over time ( p =.01). Of 44 patients completing this scale before cycle 2, 22 (50%) reported clinically significant improvement in pain at various sites. At follow-up, of the 37 patients alive, 25 provided evaluable data on bone metastasis-related pain. Of these, 10 (40%) reported clinically significant improvement in pain at various sites. Patients also reported less functional interference from pain over time ( p <.01) and lower consistency, intermittency, and difficulty alleviating pain with medication over time ( p =.01). Before cycle 2 and at follow-up, 26% and 38% of respondents reported clinically significant reduction in functional interference from pain. Before cycle 2 and at follow-up, 33% and 42% of respondents reported clinically significant improvement in consistency, intermittency, and difficulty alleviating pain with medication. Conclusions: 177Lu-PSMA RLT resulted in improvements in bone metastasis-related symptoms, supporting prior findings using other PRO measures. At follow-up, 38-42% of patients completing PRO assessment reported clinically meaningful improvements in bone metastasis-related pain, a significant contributor to quality of life. Clinical trial information: ACTRN12615000912583.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Scott Williams
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
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22
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Turner K, Brownstein NC, Thompson Z, Naqa IE, Luo Y, Jim HS, Rollison DE, Howard R, Zeng D, Rosenberg SA, Perez B, Saltos A, Oswald LB, Gonzalez BD, Islam JY, Tabriz AA, Zhang W, Dilling TJ. Longitudinal patient-reported outcomes and survival among early-stage non-small cell lung cancer patients receiving stereotactic body radiotherapy. Radiother Oncol 2022; 167:116-121. [PMID: 34953934 PMCID: PMC8934278 DOI: 10.1016/j.radonc.2021.12.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE The study objective was to determine whether longitudinal changes in patient-reported outcomes (PROs) were associated with survival among early-stage, non-small cell lung cancer (NSCLC) patients undergoing stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS Data were obtained from January 2015 through March 2020. We ran a joint probability model to assess the relationship between time-to-death, and longitudinal PRO measurements. PROs were measured through the Edmonton Symptom Assessment Scale (ESAS). We controlled for other covariates likely to affect symptom burden and survival including stage, tumor diameter, comorbidities, gender, race/ethnicity, relationship status, age, and smoking status. RESULTS The sample included 510 early-stage NSCLC patients undergoing SBRT. The median age was 73.8 (range: 46.3-94.6). The survival component of the joint model demonstrates that longitudinal changes in ESAS scores are significantly associated with worse survival (HR: 1.04; 95% CI: 1.02-1.05). This finding suggests a one-unit increase in ESAS score increased probability of death by 4%. Other factors significantly associated with worse survival included older age (HR: 1.04; 95% CI: 1.03-1.05), larger tumor diameter (HR: 1.21; 95% CI: 1.01-1.46), male gender (HR: 1.87; 95% CI: 1.36-2.57), and current smoking status (HR: 2.39; 95% CI: 1.25-4.56). CONCLUSION PROs are increasingly being collected as a part of routine care delivery to improve symptom management. Healthcare systems can integrate these data with other real-world data to predict patient outcomes, such as survival. Capturing longitudinal PROs-in addition to PROs at diagnosis-may add prognostic value for estimating survival among early-stage NSCLC patients undergoing SBRT.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Naomi C. Brownstein
- Department of Biostatistics and Bioinformatics, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Zachary Thompson
- Department of Biostatistics and Bioinformatics, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Issam El Naqa
- Department of Machine Learning, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Yi Luo
- Department of Machine Learning, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Dana E. Rollison
- Department of Cancer Epidemiology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US
| | - Rachel Howard
- Department of Health Informatics, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US
| | - Desmond Zeng
- Morsani College of Medicine, 12901 Bruce B. Downs
Boulevard, University of South Florida, US
| | - Stephen A. Rosenberg
- Department of Radiation Oncology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US,Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Bradford Perez
- Department of Radiation Oncology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US,Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Andreas Saltos
- Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Jessica Y. Islam
- Department of Cancer Epidemiology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Wenbin Zhang
- Department of Machine Learning, 500 Forbes Avenue, Gates
Hillman Center, Carnegie Mellon University, US
| | - Thomas J. Dilling
- Department of Radiation Oncology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US,Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
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23
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Oswald LB, Brownstein NC, Whiting J, Hoogland AI, Saravia S, Kirtane K, Chung CH, Vinci C, Gonzalez BD, Johnstone PAS, Jim HSL. OUP accepted manuscript. Oncologist 2022; 27:e176-e184. [PMID: 35641215 PMCID: PMC8895733 DOI: 10.1093/oncolo/oyab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Cigarette smoking is related to greater cancer incidence, worse cancer-related clinical outcomes, and worse patient quality of life. Few studies have evaluated the role of smoking in patients’ experiences of cancer-related symptom burden. This study examined relationships between smoking and total symptom burden as well as the incidence of severe symptoms among adult cancer patients. Patients and Methods Patients at Moffitt Cancer Center completed self-report surveys as part of routine cancer care. Symptom burden was evaluated as the sum of individual symptom ratings (total symptom burden) and the number of symptoms rated severe (incidence of severe symptoms). Zero-inflated negative binomial modeling was used to evaluate the relationships between smoking status (ever vs never smoker) and symptom burden outcomes controlling for relevant sociodemographic and clinical covariates and accounting for the proportion of participants reporting no symptom burden. Results This study included 12 571 cancer patients. More than half reported a history of cigarette smoking (n = 6771, 55%). Relative to never smokers, participants with a smoking history had 15% worse expected total symptom burden (ratio = 1.15, 95% confidence interval [CI] 1.11-1.20, P < .001) and 13% more expected severe symptoms (ratio = 1.13, 95% CI 1.05-1.21, P = .001) above and beyond the effects of relevant sociodemographic and clinical characteristics. Conclusion Results provide support that smoking is associated with worse cancer symptom burden. More research is needed to evaluate how smoking history (ie, current vs former smoker) and smoking cessation influence cancer symptom burden.
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Affiliation(s)
- Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Corresponding author: Laura B. Oswald, PhD, Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, MFC-EDU, Tampa, FL 33612, USA. Tel: 813-745-1338;
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Sabrina Saravia
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kedar Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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24
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Dhahri A, Kaplan J, Naqvi SMH, Brownstein NC, Ntiri SO, Imanirad I, Felder SI, Dineen SP, Sanchez J, Dessureault S, Carballido E, Powers BD. The impact of socioeconomic status on survival in stage III colon cancer patients: A retrospective cohort study using the SEER census-tract dataset. Cancer Med 2021; 10:5643-5652. [PMID: 34197047 PMCID: PMC8366079 DOI: 10.1002/cam4.4099] [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: 01/11/2021] [Revised: 04/20/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background The impact of socioeconomic status (SES) has been described for screening and accessing treatment for colon cancer. However, little is known about the “downstream” effect in patients who receive guideline‐concordant treatment. This study assessed the impact of SES on cancer‐specific survival (CSS) and overall survival (OS) for stage III colon cancer patients. Methods The SEER Census Tract‐Level SES Dataset from 2004 to 2015 was used to identify stage III colon adenocarcinoma patients who received curative‐intent surgery and adjuvant chemotherapy. The predictor variable was census tract SES. SES was analyzed as quintiles. The outcome variables were OR and CSS. Statistical analysis included chi square tests for association, Kaplan–Meier, Cox, Fine and Gray regression for survival analysis. Results In total, 27,222 patients met inclusion criteria. Lower SES was associated with younger age, Black or Hispanic race/ethnicity, Medicaid/uninsured, higher T stage, and lower grade tumors. CSS at the 25th percentile was 54 months for the lowest SES quintile and 80 for the highest. Median OS was 113 months for the lowest SES quintile and not reached for highest. The 5‐year CSS rate was 72.4% for the lowest SES quintile compared to 78.9% in the highest (p < 0.001). The 5‐year OS rate was 66.5% for the lowest SES quintile and 74.6% in the highest (p < 0.001). Conclusion This is the first study to evaluate CSS and OS in an incidence‐based cohort of stage III colon cancer patients using a granular, standardized measure of SES. Despite receipt of guideline‐based treatment, SES was associated with disparities in CSS and OS.
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Affiliation(s)
- Amina Dhahri
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Jori Kaplan
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Syeda M H Naqvi
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shana O Ntiri
- The University of Maryland Greenbaum Comprehensive Cancer Center, University of Maryland Greenbaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Iman Imanirad
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Seth I Felder
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Sean P Dineen
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Julian Sanchez
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Sophie Dessureault
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Estrella Carballido
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Benjamin D Powers
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.,Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
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Bulls HW, Chang PH, Brownstein NC, Zhou JM, Hoogland AI, Gonzalez BD, Johnstone P, Jim HSL. Patient-reported symptom burden in routine oncology care: Examining racial and ethnic disparities. Cancer Rep (Hoboken) 2021; 5:e1478. [PMID: 34165256 PMCID: PMC8955049 DOI: 10.1002/cnr2.1478] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/07/2022] Open
Abstract
Background Racial and ethnic disparities are well‐documented in cancer outcomes such as disease progression and survival, but less is known regarding potential disparities in symptom burden. Aims The goal of this retrospective study was to examine differences in symptom burden by race and ethnicity in a large sample of cancer patients. We hypothesized that racial and ethnic minority patients would report greater symptom burden than non‐Hispanic and White patients. Methods and results A total of 5798 cancer patients completed the Edmonton Symptom Assessment Scale—revised (ESAS‐r‐CSS) at least once as part of clinical care. Two indicators of symptom burden were evaluated: (1) total ESAS‐r‐CSS score (i.e., overall symptom burden) and (2) number of severe symptoms (i.e., severe symptomatology). For patients completing the ESAS‐r‐CSS on multiple occasions, the highest score for each indicator was used. Zero‐inflated negative binomial regression analyses were conducted, adjusting for other sociodemographic and clinical characteristics. Symptomology varied across race. Patients who self‐identified as Black reported higher symptom burden (p = .016) and were more likely to report severe symptoms (p < .001) than self‐identified White patients. Patients with “other” race were also more likely to report severe symptoms than White patients (p = .032), but reported similar total symptom burden (p = .315). Asian and Hispanic patients did not differ from White or non‐Hispanic patients on symptom burden (ps > .05). Conclusion This study describes racial disparities in patient‐reported symptom burden during routine oncology care, primarily observed in Black patients. Clinic‐based electronic symptom monitoring may be useful to detect high symptom burden, particularly in patients who self‐identify their race as Black or other. Future research is needed to reduce symptom burden in racially diverse cancer populations.
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Affiliation(s)
- Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pi-Hua Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Peter Johnstone
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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Abstract
Antibodies testing in the coronavirus era is frequently promoted, but the underlying statistics behind their validation has come under more scrutiny in recent weeks. We provide calculations, interpretations, and plots of positive and negative predictive values under a variety of scenarios. Prevalence, sensitivity, and specificity are estimated within ranges of values from researchers and antibodies manufacturers. Illustrative examples are highlighted, and interactive plots are provided in the Supplementary Information. Implications are discussed for society overall and across diverse locations with different levels of disease burden. Specifically, the proportion of positive serology tests that are false can differ drastically from up to 3%-88% for people from different places with different proportions of infected people in the populations while the false negative rate is typically under 10%.
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Affiliation(s)
- Naomi C Brownstein
- Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL, USA.
| | - Yian Ann Chen
- Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL, USA
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27
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Brownstein NC, Bunn V, Castro LM, Sinha D. Bayesian analysis of survival data with missing censoring indicators. Biometrics 2020; 77:305-315. [PMID: 32282929 DOI: 10.1111/biom.13280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/19/2018] [Revised: 12/16/2019] [Accepted: 02/27/2020] [Indexed: 11/30/2022]
Abstract
In some large clinical studies, it may be impractical to perform the physical examination to every subject at his/her last monitoring time in order to diagnose the occurrence of the event of interest. This gives rise to survival data with missing censoring indicators where the probability of missing may depend on time of last monitoring and some covariates. We present a fully Bayesian semi-parametric method for such survival data to estimate regression parameters of the proportional hazards model of Cox. Theoretical investigation and simulation studies show that our method performs better than competing methods. We apply the proposed method to analyze the survival data with missing censoring indicators from the Orofacial Pain: Prospective Evaluation and Risk Assessment study.
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Affiliation(s)
- Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida.,Department of Department of Oncologic Sciences, University of South Florida, Tampa, Florida.,Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, Florida.,Department of Statistics, Florida State University, Tallahassee, Florida
| | - Veronica Bunn
- Department of Statistics, Florida State University, Tallahassee, Florida
| | - Luis M Castro
- Department of Statistics, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus Center for the Discovery of Structures in Complex Data, Santiago, Chile.,Centro de Riesgos y Seguros UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Debajyoti Sinha
- Department of Statistics, Florida State University, Tallahassee, Florida
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28
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Jim HSL, Hoogland AI, Brownstein NC, Barata A, Dicker AP, Knoop H, Gonzalez BD, Perkins R, Rollison D, Gilbert SM, Nanda R, Berglund A, Mitchell R, Johnstone PAS. Innovations in research and clinical care using patient-generated health data. CA Cancer J Clin 2020; 70:182-199. [PMID: 32311776 PMCID: PMC7488179 DOI: 10.3322/caac.21608] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 12/01/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Patient-generated health data (PGHD), or health-related data gathered from patients to help address a health concern, are used increasingly in oncology to make regulatory decisions and evaluate quality of care. PGHD include self-reported health and treatment histories, patient-reported outcomes (PROs), and biometric sensor data. Advances in wireless technology, smartphones, and the Internet of Things have facilitated new ways to collect PGHD during clinic visits and in daily life. The goal of the current review was to provide an overview of the current clinical, regulatory, technological, and analytic landscape as it relates to PGHD in oncology research and care. The review begins with a rationale for PGHD as described by the US Food and Drug Administration, the Institute of Medicine, and other regulatory and scientific organizations. The evidence base for clinic-based and remote symptom monitoring using PGHD is described, with an emphasis on PROs. An overview is presented of current approaches to digital phenotyping or device-based, real-time assessment of biometric, behavioral, self-report, and performance data. Analytic opportunities regarding PGHD are envisioned in the context of big data and artificial intelligence in medicine. Finally, challenges and solutions for the integration of PGHD into clinical care are presented. The challenges include electronic medical record integration of PROs and biometric data, analysis of large and complex biometric data sets, and potential clinic workflow redesign. In addition, there is currently more limited evidence for the use of biometric data relative to PROs. Despite these challenges, the potential benefits of PGHD make them increasingly likely to be integrated into oncology research and clinical care.
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Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Randa Perkins
- Department of Clinical Informatics and Clinical Systems, Moffitt Cancer Center, Tampa, Florida
| | - Dana Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ronica Nanda
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- BayCare Health Systems Inc, Morton Plant Hospital, Clearwater, Florida
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Ross Mitchell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
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29
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Middlemiss W, Brownstein NC, Nelson SP, Manchiraju S, Leddy M, Steliotes N, Grzywacz JG. Crafting effective messages to enhance safe infant sleep. J Am Assoc Nurse Pract 2020; 33:441-450. [PMID: 32039958 DOI: 10.1097/jxx.0000000000000365] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care professionals are continually challenged by the need to provide health information in a way that successfully changes health practices. Research has documented this as a concern in relation to safe infant sleep health campaigns. Often, caregivers' knowledge of recommended practices is not associated with a change in infant sleep choices. PURPOSE Health campaigns, including most safe infant sleep efforts, often share specific risk factors and steps for avoiding risk, that is, in a verbatim format. Research has shown that caregivers' behavior may be more likely to change when presented with messages based on their general understanding of risk, that is, gist-based format. This research examines caregivers' responses as related to verbatim- and gist-based safe sleep information. METHODS Five hundred forty-one caregivers of infants were shown 12 images depicting infants in safe or unsafe sleep spaces. Images varied across three commercially available spaces, infant race, and presence/absence of one policy-based risk factor. RESULTS Differences in caregivers' discernment of safe and unsafe sleep images paralleled reported differences in knowledge of safe sleep recommendations. Discernment of safe/unsafe images was greater for White than Black caregivers, as well as for females in comparison with male caregivers. Gist-based considerations, such as familiarity with the sleeper depicted or infant race, were also associated with caregivers' discernment of safe/unsafe images. IMPLICATIONS FOR PRACTICE Attending to both gist- and verbatim-based knowledge regarding safe infant sleep campaign information may help to effectively facilitate caregivers' ability to always create safe sleep spaces for their infants.
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Affiliation(s)
- Wendy Middlemiss
- Department of Educational Psychology, University of North Texas, Denton, Texas
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida
| | - Scott P Nelson
- College of Medicine, Florida State University, Tallahassee, Florida
| | - Srikant Manchiraju
- The Jim Moran School of Entrepreneurship, Florida State University, Tallahassee, Florida
| | - Miranda Leddy
- Department of Educational Psychology, University of North Texas, Denton, Texas
| | - Nicole Steliotes
- Department of Nutrition, Food, and Exercise Science, Florida State University, Tallahassee, Florida
| | - Joseph G Grzywacz
- Department of Family and Child Sciences, Florida State University, Tallahassee, Florida
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30
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Brownstein NC, Adolfsson A, Ackerman M. Descriptive statistics and visualization of data from the R datasets package with implications for clusterability. Data Brief 2019; 25:104004. [PMID: 31317060 PMCID: PMC6612012 DOI: 10.1016/j.dib.2019.104004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022] Open
Abstract
The manuscript describes and visualizes datasets from the datasets package in the R statistical software, focusing on descriptive statistics and visualizations that provide insights into the clusterability of these datasets. These publicly available datasets are contained in the R software system, and can be downloaded at https://www.r-project.org/, with documentation provided at https://stat.ethz.ch/R-manual/R-devel/library/datasets/html/00Index.html. Further information on clusterability is found in the companion to this article, To Cluster or Not to Cluster: An Analysis of Clusterability Methods? (https://doi.org/10.1016/j.patcog.2018.10.026). Brief descriptions and graphs of the variables contained in each dataset are provided in the form of means, extrema, quartiles, standard deviation and standard error. Two-dimensional plots for each pair of variables are provided. Original references to the data sets are included when available. Further, each dataset is reduced to a single dimension by each of two different methods: pairwise distances and principal component analysis. For the latter, only the first component is used. Histograms of the reduced data are included for every dataset using both methods.
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Affiliation(s)
- Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 32612, USA.,Department of Behavioral Sciences and Social Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306-4300, USA
| | - Andreas Adolfsson
- Department of Computer Engineering, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA
| | - Margareta Ackerman
- Department of Computer Engineering, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA
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31
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Affiliation(s)
- Wendy Middlemiss
- Department of Educational Psychology, University of North Texas, Denton, TX, USA
| | - Naomi C. Brownstein
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Miranda Leddy
- Department of Educational Psychology, University of North Texas, Denton, TX, USA
| | - Scott Nelson
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Srikant Manchiraju
- Department of Retail Merchandising and Product Development, Florida State University, Tallahassee, FL, USA
| | - Joseph G. Grzywacz
- Department of Family and Child Sciences, Florida State University, Tallahassee, FL, USA
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32
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Brownstein NC, Louis TA, O'Hagan A, Pendergast J. The Role of Expert Judgment in Statistical Inference and Evidence-Based Decision-Making. AM STAT 2019; 73:56-68. [PMID: 31057338 PMCID: PMC6474725 DOI: 10.1080/00031305.2018.1529623] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 03/14/2018] [Revised: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 11/21/2022]
Abstract
This article resulted from our participation in the session on the “role of expert opinion and judgment in statistical inference” at the October 2017 ASA Symposium on Statistical Inference. We present a strong, unified statement on roles of expert judgment in statistics with processes for obtaining input, whether from a Bayesian or frequentist perspective. Topics include the role of subjectivity in the cycle of scientific inference and decisions, followed by a clinical trial and a greenhouse gas emissions case study that illustrate the role of judgments and the importance of basing them on objective information and a comprehensive uncertainty assessment. We close with a call for increased proactivity and involvement of statisticians in study conceptualization, design, conduct, analysis, and communication.
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Affiliation(s)
- Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL.,Department of Oncologic Sciences, University of South Florida, Tampa, FL.,Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL
| | - Thomas A Louis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony O'Hagan
- School of Mathematics and Statistics, The University of Sheffield, Sheffield, UK
| | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
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33
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Brownstein NC, Cai J. Tests of trend between disease outcomes and ordinal covariates discretized from underlying continuous variables: simulation studies and applications to NHANES 2007-2008. BMC Med Res Methodol 2019; 19:2. [PMID: 30611216 PMCID: PMC6321711 DOI: 10.1186/s12874-018-0630-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/10/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background Many epidemiological studies test trends when investigating the association between a risk factor and a disease outcome. Continuous exposures are commonly discretized when the outcome is nonlinearly related to exposure as well as to facilitate interpretation and reduce measurement error. Guidance is needed regarding statistically valid trend tests for epidemiological data of this nature. Methods The association between a discretized variable and a disease is modeled through logistic regression or survival analysis. Linear regression is then conducted by regressing the odds ratio or relative risk on the midpoint of the exposure interval. The trend test is based on the slope of the regression line. In order to investigate the performance of this approach, we conducted simulation studies, considering ten different approaches for the linear regression based on the inclusion or exclusion of an intercept in the model and the form of the weights. The proposed methods are applied to the National Health and Nutrition Examination Survey (NHANES) 2007–2008 for illustration. Results The simulation studies show that eight of these methods are valid, and the relative efficiency depends on the underlying relationship between the covariate and the outcome. Conclusions The significance of the study is its potential to help practitioners select an appropriate method to test for trend in their future studies that utilize ordinal covariates.
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Affiliation(s)
- Naomi C Brownstein
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA. .,Department of Statistics, Florida State University, Tallahassee, Florida, USA.
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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34
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Rappazzo KM, Warren JL, Davalos AD, Meyer RE, Sanders AP, Brownstein NC, Luben TJ. Maternal residential exposure to specific agricultural pesticide active ingredients and birth defects in a 2003-2005 North Carolina birth cohort. Birth Defects Res 2018; 111:312-323. [PMID: 30592382 DOI: 10.1002/bdr2.1448] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previously we observed elevated odds ratios (ORs) for total pesticide exposure and 10 birth defects: three congenital heart defects and structural defects affecting the gastrointestinal, genitourinary and musculoskeletal systems. This analysis examines association of those defects with exposure to seven commonly applied pesticide active ingredients. METHODS Cases were live-born singleton infants from the North Carolina Birth Defects Monitoring Program linked to birth records for 2003-2005; noncases served as controls (total n = 304,906). Pesticide active ingredient exposure was assigned using a previously constructed metric based on crops within 500 m of residence, dates of pregnancy, and likely chemical application dates for each pesticide-crop combination. ORs (95% CI) were estimated with logistic regression for categories of exposure compared to unexposed. Models were adjusted for maternal race/ethnicity, age at delivery, education, marital status, and smoking status. RESULTS Associations varied by birth defect and pesticide combinations. For example, hypospadias was positively associated with exposures to 2,4-D (OR50th to <90th percentile : 1.39 [1.18, 1.64]), mepiquat (OR50th to <90th percentile : 1.10 [0.90, 1.34]), paraquat (OR50th to <90th : 1.14 [0.93, 1.39]), and pendimethalin (OR50th to <90th : 1.21 [1.01, 1.44]), but not S-metolachlor (OR50th to <90th : 1.00 [0.81, 1.22]). Whereas atrial septal defects were positively associated with higher levels of exposure to glyphosate, cyhalothrin, S-metolachlor, mepiquat, and pendimethalin (ORs ranged from 1.22 to 1.35 for 50th to <90th exposures, and 1.72 to 2.09 for >90th exposures); associations with paraquat were null or inconsistent (OR 50th to <90th: 1.05 (0.87, 1.27). CONCLUSION Our results suggest differing patterns of association for birth defects with residential exposure to seven pesticide active ingredients in North Carolina.
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Affiliation(s)
- Kristen M Rappazzo
- Office of Research and Development, U.S. Environmental Research Triangle Park, Research Triangle Park, North Carolina.,Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Angel D Davalos
- Department of Biostatistics, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert E Meyer
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.,Department of Maternal and Child Health, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison P Sanders
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naomi C Brownstein
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida.,Department of Statistics, Florida State University, Tallahassee, Florida
| | - Thomas J Luben
- Office of Research and Development, U.S. Environmental Research Triangle Park, Research Triangle Park, North Carolina
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35
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Naar S, Ellis D, Cunningham P, Pennar AL, Lam P, Brownstein NC, Bruzzese JM. Comprehensive Community-Based Intervention and Asthma Outcomes in African American Adolescents. Pediatrics 2018; 142:peds.2017-3737. [PMID: 30185428 PMCID: PMC6317763 DOI: 10.1542/peds.2017-3737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/10/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5804911922001PEDS-VA_2017-3737Video Abstract BACKGROUND: African American adolescents appear to be the most at risk for asthma morbidity and mortality even compared with other minority groups, yet there are few successful interventions for this population that are used to target poorly controlled asthma. METHODS African American adolescents (age 12-16 years) with moderate-to-severe persistent asthma and ≥1 inpatient hospitalization or ≥2 emergency department visits in 12 months were randomly assigned to Multisystemic Therapy-Health Care or an attention control group (N = 167). Multisystemic Therapy-Health Care is a 6-month home- and community-based treatment that has been shown to improve illness management and health outcomes in high-risk adolescents by addressing the unique barriers for each individual family with cognitive behavioral interventions. The attention control condition was weekly family supportive counseling, which was also provided for 6 months in the home. The primary outcome was lung function (forced expiratory volume in 1 second [FEV1]) measured over 12 months of follow-up. RESULTS Linear mixed-effects models revealed that compared with adolescents in the comparison group, adolescents in the treatment group had significantly greater improvements in FEV1 secondary outcomes of adherence to controller medication, and the frequency of asthma symptoms. Adolescents in the treatment group had greater reductions in hospitalizations, but there were no differences in reductions in emergency department visits. CONCLUSIONS A comprehensive family- and community-based treatment significantly improved FEV1, medication adherence, asthma symptom frequency, and inpatient hospitalizations in African American adolescents with poorly controlled asthma. Further evaluation in effectiveness and implementation trials is warranted.
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Affiliation(s)
- Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Research, College of Medicine, Florida State University, Tallahassee, Florida;
| | - Deborah Ellis
- Department of Family Medicine and Public Health
Services, School of Medicine, Wayne State University, Detroit, Michigan
| | - Phillippe Cunningham
- Department of Psychiatry and Behavioral Sciences,
Medical University of South Carolina, Charleston, South Carolina
| | - Amy L. Pennar
- Department of Family Medicine and Public Health
Services, School of Medicine, Wayne State University, Detroit, Michigan
| | - Phebe Lam
- Faculty of Arts, Humanities, and Social Sciences,
University of Windsor, Windsor, Canada; and
| | - Naomi C. Brownstein
- Department of Behavioral Sciences and Social
Medicine, Center for Translational Behavioral Research, College of Medicine,
Florida State University, Tallahassee, Florida
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Affiliation(s)
- Zachariah Neville
- Department of Statistics, Florida State University, Tallahassee, USA
| | - Naomi C. Brownstein
- Department of Behavioral Sciences & Social Medicine, Florida State University, College of Medicine, Tallahassee, FL, USA
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Abstract
OBJECTIVES Despite the efforts of various leading organizations in medical education, representation of black students in US medical schools has declined since the mid-1990s. The Florida State University College of Medicine (FSUCOM) has undertaken efforts to increase black and other underrepresented minority in medicine (URMM) representation in medical school through the Bridge to Clinical Medicine Program. This program is described and analyzed by the authors. METHODS Demographic information, Medical College Admission Test scores, undergraduate grade point average, US Medical Licensing Examination (USMLE) scores (Steps 1 and 2), residency match information, and current practice location from 2006 to 2015 were collected from the FSUCOM. Data were analyzed using SAS and linear regression analyses were performed, comparing Bridge students with the College of Medicine and national averages. RESULTS Sixty percent of Bridge students were black, 21% were other URMM, and the remainder were non-URMM. Black Bridge students scored 7.4 points lower on their Medical College Admission Test, and other-URMM Bridge students scored 6.0 points lower (P < 0.0001) than their non-URMM non-Bridge classmates. Black Bridge students also started with a grade point average that was 0.28 points lower than their non-URMM non-Bridge counterparts, but there was no statistical difference for other-URMM Bridge students. Black students, regardless of Bridge participation, were less likely to pass USMLE Step 1 when compared with non-URMM classmates (P < 0.0001). For USMLE Step 2, however, there were no significant differences in passing rates for Bridge students compared with non-Bridge students. CONCLUSIONS The FSUCOM Bridge program has not only increased its URMM enrollment but it also has effectively doubled the number of black students in its medical college. Other universities could produce similar results using the program outlined in this article.
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Affiliation(s)
- Kendall M Campbell
- From the Brody School of Medicine, East Carolina University, Greenville, North Carolina, the Florida State University College of Medicine, Tallahassee, and the Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | - Naomi C Brownstein
- From the Brody School of Medicine, East Carolina University, Greenville, North Carolina, the Florida State University College of Medicine, Tallahassee, and the Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | - Helen Livingston
- From the Brody School of Medicine, East Carolina University, Greenville, North Carolina, the Florida State University College of Medicine, Tallahassee, and the Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | - José E Rodríguez
- From the Brody School of Medicine, East Carolina University, Greenville, North Carolina, the Florida State University College of Medicine, Tallahassee, and the Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
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Wright KN, Strong CE, Addonizio MN, Brownstein NC, Kabbaj M. Reinforcing properties of an intermittent, low dose of ketamine in rats: effects of sex and cycle. Psychopharmacology (Berl) 2017; 234:393-401. [PMID: 27837330 PMCID: PMC5384643 DOI: 10.1007/s00213-016-4470-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 03/18/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022]
Abstract
RATIONALE Repeated intermittent exposure to ketamine has rapid and long-lasting antidepressant effects, but the abuse potential has only been assessed at high doses. Furthermore, while females are more susceptible to depression and more sensitive to ketamine's antidepressant-like effects, the abuse potential for ketamine in females is unknown. OBJECTIVES The objectives of this study are to determine the reinforcing properties of low-dose intermittent ketamine in adult rats of both sexes and determine whether cycling gonadal hormones influence females' response to ketamine. In male rats, we also aimed to determine whether reinstatement to intermittent ketamine is comparable to intermittent cocaine. METHODS Male rats intravenously self-administered cocaine (0.75 mg/kg/infusion) or ketamine (0.1 mg/kg/infusion) once every fourth day, while intact cycling female rats self-administered ketamine only during preidentified stages of their 4-day estrus cycle, when gonadal hormones are either high (proestrus) or low (diestrus). After acquiring self-administration, rats underwent daily extinction training followed by cue-primed and drug-primed reinstatement to assess drug-seeking behavior. RESULTS Diestrus-trained females fail to maintain ketamine self-administration and did not display reinstatement to ketamine-paired cues. Males and proestrus-trained females reinstated to ketamine-paired cues. Ketamine-primed reinstatement was dependent on simultaneous cue presentation. Male rats reinstated to cocaine priming independent of cue presentation. CONCLUSION These findings indicate that females's responsivity to this dose of ketamine depends on stage of cycle, as only proestrus-trained females and males respond to ketamine's reinforcing effects under this treatment paradigm.
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Affiliation(s)
- Katherine N. Wright
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Caroline E. Strong
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Marjorie N. Addonizio
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Naomi C. Brownstein
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA,Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Mohamed Kabbaj
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA. .,College of Medicine, Department of Biomedical Sciences, Florida State University, 1115 W. Call St., Tallahassee, FL, 32306, USA.
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39
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Guan X, Brownstein NC, Young NL, Marshall AG. Ultrahigh-resolution Fourier transform ion cyclotron resonance mass spectrometry and tandem mass spectrometry for peptide de novo amino acid sequencing for a seven-protein mixture by paired single-residue transposed Lys-N and Lys-C digestion. Rapid Commun Mass Spectrom 2017; 31:207-217. [PMID: 27813191 DOI: 10.1002/rcm.7783] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/29/2016] [Accepted: 10/30/2016] [Indexed: 06/06/2023]
Abstract
RATIONALE Bottom-up tandem mass spectrometry (MS/MS) is regularly used in proteomics to identify proteins from a sequence database. De novo sequencing is also available for sequencing peptides with relatively short sequence lengths. We recently showed that paired Lys-C and Lys-N proteases produce peptides of identical mass and similar retention time, but different tandem mass spectra. Such parallel experiments provide complementary information, and allow for up to 100% MS/MS sequence coverage. METHODS Here, we report digestion by paired Lys-C and Lys-N proteases of a seven-protein mixture: human hemoglobin alpha, bovine carbonic anhydrase 2, horse skeletal muscle myoglobin, hen egg white lysozyme, bovine pancreatic ribonuclease, bovine rhodanese, and bovine serum albumin, followed by reversed-phase nanoflow liquid chromatography, collision-induced dissociation, and 14.5 T Fourier transform ion cyclotron resonance mass spectrometry. RESULTS Matched pairs of product peptide ions of equal precursor mass and similar retention times from each digestion are compared, leveraging single-residue transposed information with independent interferences to confidently identify fragment ion types, residues, and peptides. Selected pairs of product ion mass spectra for de novo sequenced protein segments from each member of the mixture are presented. CONCLUSIONS Pairs of the transposed product ions as well as complementary information from the parallel experiments allow for both high MS/MS coverage for long peptide sequences and high confidence in the amino acid identification. Moreover, the parallel experiments in the de novo sequencing reduce false-positive matches of product ions from the single-residue transposed peptides from the same segment, and thereby further improve the confidence in protein identification. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xiaoyan Guan
- Ion Cyclotron Resonance Program, National High Magnetic Field Laboratory, Florida State University, 1800 East Paul Dirac Drive, Tallahassee, FL, 32310, USA
| | - Naomi C Brownstein
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 W. Call St., Tallahassee, FL, 32306, USA
- Department of Statistics, Florida State University, 117 N. Woodward Ave., Tallahassee, FL, 32306, USA
| | - Nicolas L Young
- Verna & Marrs McLean Department of Biochemistry & Molecular Biology, Baylor College of Medicine, One Baylor Plaza, MS-125, Houston, TX, 77030-3411, USA
| | - Alan G Marshall
- Ion Cyclotron Resonance Program, National High Magnetic Field Laboratory, Florida State University, 1800 East Paul Dirac Drive, Tallahassee, FL, 32310, USA
- Department of Chemistry and Biochemistry, Florida State University, 95 Chieftain Way, Tallahassee, FL, 32303, USA
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40
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Hurwitz SN, Conlon MM, Rider MA, Brownstein NC, Meckes DG. Nanoparticle analysis sheds budding insights into genetic drivers of extracellular vesicle biogenesis. J Extracell Vesicles 2016; 5:31295. [PMID: 27421995 PMCID: PMC4947197 DOI: 10.3402/jev.v5.31295] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 01/22/2023] Open
Abstract
Background Extracellular vesicles (EVs) are important mediators of cell-to-cell communication in healthy and pathological environments. Because EVs are present in a variety of biological fluids and contain molecular signatures of their cell or tissue of origin, they have great diagnostic and prognostic value. The ability of EVs to deliver biologically active proteins, RNAs and lipids to cells has generated interest in developing novel therapeutics. Despite their potential medical use, many of the mechanisms underlying EV biogenesis and secretion remain unknown. Methods Here, we characterized vesicle secretion across the NCI-60 panel of human cancer cells by nanoparticle tracking analysis. Using CellMiner, the quantity of EVs secreted by each cell line was compared to reference transcriptomics data to identify gene products associated with vesicle secretion. Results Gene products positively associated with the quantity of exosomal-sized vesicles included vesicular trafficking classes of proteins with Rab GTPase function and sphingolipid metabolism. Positive correlates of larger microvesicle-sized vesicle secretion included gene products involved in cytoskeletal dynamics and exocytosis, as well as Rab GTPase activation. One of the identified targets, CD63, was further evaluated for its role in vesicle secretion. Clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 knockout of the CD63 gene in HEK293 cells resulted in a decrease in small vesicle secretion, suggesting the importance of CD63 in exosome biogenesis. Conclusion These observations reveal new insights into genes involved in exosome and microvesicle formation, and may provide a means to distinguish EV sub-populations. This study offers a foundation for further exploration of targets involved in EV biogenesis and secretion.
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Affiliation(s)
- Stephanie N Hurwitz
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Meghan M Conlon
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Mark A Rider
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Naomi C Brownstein
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - David G Meckes
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA;
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41
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Rappazzo KM, Warren JL, Meyer RE, Herring AH, Sanders AP, Brownstein NC, Luben TJ. Maternal residential exposure to agricultural pesticides and birth defects in a 2003 to 2005 North Carolina birth cohort. ACTA ACUST UNITED AC 2016; 106:240-9. [PMID: 26970546 DOI: 10.1002/bdra.23479] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 09/04/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Birth defects are responsible for a large proportion of disability and infant mortality. Exposure to a variety of pesticides have been linked to increased risk of birth defects. METHODS We conducted a case-control study to estimate the associations between a residence-based metric of agricultural pesticide exposure and birth defects. We linked singleton live birth records for 2003 to 2005 from the North Carolina (NC) State Center for Health Statistics to data from the NC Birth Defects Monitoring Program. Included women had residence at delivery inside NC and infants with gestational ages from 20 to 44 weeks (n = 304,906). Pesticide exposure was assigned using a previously constructed metric, estimating total chemical exposure (pounds of active ingredient) based on crops within 500 meters of maternal residence, specific dates of pregnancy, and chemical application dates based on the planting/harvesting dates of each crop. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals for four categories of exposure (<10(th) , 10-50(th) , 50-90(th) , and >90(th) percentiles) compared with unexposed. Models were adjusted for maternal race, age at delivery, education, marital status, and smoking status. RESULTS We observed elevated ORs for congenital heart defects and certain structural defects affecting the gastrointestinal, genitourinary and musculoskeletal systems (e.g., OR [95% confidence interval] [highest exposure vs. unexposed] for tracheal esophageal fistula/esophageal atresia = 1.98 [0.69, 5.66], and OR for atrial septal defects: 1.70 [1.34, 2.14]). CONCLUSION Our results provide some evidence of associations between residential exposure to agricultural pesticides and several birth defects phenotypes. Birth Defects Research (Part A) 106:240-249, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kristen M Rappazzo
- Oak Ridge Institute for Science and Education at the U.S. Environmental Protection Agency, National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Joshua L Warren
- Yale School of Public Health, Department of Biostatistics, New Haven, Connecticut
| | - Robert E Meyer
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Amy H Herring
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, Department of Biostatistics, Chapel Hill, North Carolina
| | - Alison P Sanders
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naomi C Brownstein
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida.,Department of Statistics, Florida State University, Tallahassee, Florida
| | - Thomas J Luben
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
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42
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Campbell KM, Rodríguez JE, Brownstein NC, Fisher ZE. Status of Tenure Among Black and Latino Faculty in Academic Medicine. J Racial Ethn Health Disparities 2016; 4:134-139. [PMID: 26931546 DOI: 10.1007/s40615-016-0210-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
Tenure has been used for years to recruit, promote, and retain faculty in higher education and has been associated with job security and academic freedom. Absence of tenure and not being in tenure-earning tracks is grouped with the challenges faced by underrepresented minorities in academic medicine. Those challenges include being found at the assistant professor rank more often, having more clinical responsibilities, and not being in leadership positions as often as compared to non-minority faculty. The role of tenure and tenure tracks is unclear as it relates to the presence of minority faculty. This article presents a look at the status of tenure among black and Latino faculty in academic medicine at US medical schools.
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Affiliation(s)
- Kendall M Campbell
- Center for Underrepresented Minorities in Academic Medicine, Family Medicine and Rural Health, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32306, USA.
| | - José E Rodríguez
- Center for Underrepresented Minorities in Academic Medicine, Family Medicine and Rural Health, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32306, USA
| | - Naomi C Brownstein
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Zedeena E Fisher
- Florida State University College of Medicine, Tallahassee, FL, USA
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43
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Brownstein NC, Cai J, Slade GD, Bair E. Parameter estimation in Cox models with missing failure indicators and the OPPERA study. Stat Med 2015; 34:3984-96. [PMID: 26242613 DOI: 10.1002/sim.6604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 11/06/2022]
Abstract
In a prospective cohort study, examining all participants for incidence of the condition of interest may be prohibitively expensive. For example, the "gold standard" for diagnosing temporomandibular disorder (TMD) is a physical examination by a trained clinician. In large studies, examining all participants in this manner is infeasible. Instead, it is common to use questionnaires to screen for incidence of TMD and perform the "gold standard" examination only on participants who screen positively. Unfortunately, some participants may leave the study before receiving the "gold standard" examination. Within the framework of survival analysis, this results in missing failure indicators. Motivated by the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study, a large cohort study of TMD, we propose a method for parameter estimation in survival models with missing failure indicators. We estimate the probability of being an incident case for those lacking a "gold standard" examination using logistic regression. These estimated probabilities are used to generate multiple imputations of case status for each missing examination that are combined with observed data in appropriate regression models. The variance introduced by the procedure is estimated using multiple imputation. The method can be used to estimate both regression coefficients in Cox proportional hazard models as well as incidence rates using Poisson regression. We simulate data with missing failure indicators and show that our method performs as well as or better than competing methods. Finally, we apply the proposed method to data from the OPPERA study.
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Affiliation(s)
- Naomi C Brownstein
- Ion Cyclotron Resonance Facility, National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, U.S.A.,Department of Statistics, Florida State University, Tallahassee, FL, U.S.A
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A
| | - Gary D Slade
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A
| | - Eric Bair
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A.,School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A
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Warren JL, Luben TJ, Sanders AP, Brownstein NC, Herring AH, Meyer RE. An evaluation of metrics for assessing maternal exposure to agricultural pesticides. J Expo Sci Environ Epidemiol 2014; 24:497-503. [PMID: 24149974 PMCID: PMC3997755 DOI: 10.1038/jes.2013.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Received: 02/09/2013] [Accepted: 09/05/2013] [Indexed: 05/19/2023]
Abstract
We evaluate the use of three different exposure metrics to estimate maternal agricultural pesticide exposure during pregnancy. Using a geographic information system-based method of pesticide exposure estimation, we combine data on crop density and specific pesticide application amounts/dates to create the three exposure metrics. For illustration purposes, we create each metric for a North Carolina cohort of pregnant women, 2003-2005, and analyze the risk of congenital anomaly development with a focus on metric comparisons. Based on the results, and the need to balance data collection efforts/computational efficiency with accuracy, the metric which estimates total chemical exposure using application dates based on crop-specific earliest planting and latest harvesting information is preferred. Benefits and drawbacks of each metric are discussed and recommendations for extending the analysis to other states are provided.
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Affiliation(s)
- Joshua L. Warren
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas J. Luben
- National Center for Environmental Assessment, United States Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Alison P. Sanders
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Naomi C. Brownstein
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy H. Herring
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert E. Meyer
- Birth Defects Monitoring Program, State Center for Health Statistics, North Carolina Division of Public Health, Raleigh, North Carolina, USA
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Bair E, Brownstein NC, Ohrbach R, Greenspan JD, Dubner R, Fillingim RB, Maixner W, Smith SB, Diatchenko L, Gonzalez Y, Gordon SM, Lim PF, Ribeiro-Dasilva M, Dampier D, Knott C, Slade GD. Study protocol, sample characteristics, and loss to follow-up: the OPPERA prospective cohort study. J Pain 2014; 14:T2-19. [PMID: 24275220 DOI: 10.1016/j.jpain.2013.06.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/13/2013] [Accepted: 06/20/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED When studying incidence of pain conditions such as temporomandibular disorder (TMD), repeated monitoring is needed in prospective cohort studies. However, monitoring methods usually have limitations and, over a period of years, some loss to follow-up is inevitable. The OPPERA prospective cohort study of first-onset TMD screened for symptoms using quarterly questionnaires and examined symptomatic participants to definitively ascertain TMD incidence. During the median 2.8-year observation period, 16% of the 3,263 enrollees completed no follow-up questionnaires, others provided incomplete follow-up, and examinations were not conducted for one third of symptomatic episodes. Although screening methods and examinations were found to have excellent reliability and validity, they were not perfect. Loss to follow-up varied according to some putative TMD risk factors, although multiple imputation to correct the problem suggested that bias was minimal. A second method of multiple imputation that evaluated bias associated with omitted and dubious examinations revealed a slight underestimate of incidence and some small biases in hazard ratios used to quantify effects of risk factors. Although "bottom line" statistical conclusions were not affected, multiply-imputed estimates should be considered when evaluating the large number of risk factors under investigation in the OPPERA study. PERSPECTIVE These findings support the validity of the OPPERA prospective cohort study for the purpose of investigating the etiology of first-onset TMD, providing the foundation for other papers investigating risk factors hypothesized in the OPPERA project.
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Affiliation(s)
- Eric Bair
- Regional Center for Neurosensory Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Brownstein NC. Statistical considerations are necessary in assessing associations between micronutrient intake and times to clinical events. J Nutr 2012; 142:1917; author reply 1918. [PMID: 22996166 PMCID: PMC3442797 DOI: 10.3945/jn.112.161042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 04/20/2012] [Accepted: 07/19/2012] [Indexed: 11/14/2022] Open
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