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Cumbo N, Lessner K, Marshall C, Bozorghadad S, Boehmer S, Olympia RP. Demographics and Reported Symptoms Associated With Marijuana Use Among Adolescents and Young Adults. Cureus 2023; 15:e47844. [PMID: 38021571 PMCID: PMC10678748 DOI: 10.7759/cureus.47844] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Marijuana use has been increasing in the adolescent population. Our objective was to examine the prevalence of marijuana use among a sample of adolescents and young adults, determine an association with risk-taking behaviors, identify reported medical symptoms, and delineate common beliefs about marijuana use. Methods A questionnaire was administered to a sample of patients aged between 12 and 23 years old presenting to the emergency department of Penn State Hershey Medical Center, Hershey, Pennsylvania. Data were stratified by marijuana users and non-users, and further stratified by traditional (vape, pipe, edibles) and non-traditional (oils/concentrates, topical creams) use. Results The analysis was based on 200 questionnaires. Thirty-nine percent (n=78) reported marijuana use. Marijuana users were more likely to report previous sexual intercourse (79.5% vs. 32.8%; p=<0.0001), as well as the use of alcohol (50.0% vs. 10.7%; p=<0.0001), cigarettes (41% vs. 8.2%; p=<0.0001), prescription pain medications (20.5% vs. 4.1%; p=0.002), and cocaine (14.1% vs. 0.8%; p=0.0017). Users more likely reported texting while driving (41.0% vs. 13.1%; p=0.005) and experienced physical or electronic victimization due to bullying (43.6% vs. 19.7%; p=0.002). Users were more likely to report gastroesophageal reflux disease (GERD), attention deficit disorder (ADD), anxiety, and depression. The most common symptoms associated with marijuana use were anxiety (65.4%), headache (61.6%), nausea/vomiting (53.8%), cough (51.3%), and abdominal pain (47.4%). Sixty-nine percent of respondents believed marijuana was "safer than other drugs". Conclusion Based on our sample, we identified risk-taking behaviors, medical symptoms, and beliefs associated with marijuana use. Healthcare professionals may use these data to provide screening and anticipatory guidance to adolescents who use marijuana and consider marijuana use in their differential diagnosis.
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Affiliation(s)
- Nicole Cumbo
- Emergency Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Kaila Lessner
- Emergency Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Ciara Marshall
- Emergency Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Sayeh Bozorghadad
- Emergency Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Susan Boehmer
- Emergency Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Robert P Olympia
- Emergency Medicine and Pediatrics, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
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Rasouli MA, Barrett F, Levy MS, Kim AS, Roytman M, Cumbo N, Talib H, Kaye EC. Publicly available information about fertility benefits for trainees at medical schools in the US. J Assist Reprod Genet 2023:10.1007/s10815-023-02849-1. [PMID: 37326892 DOI: 10.1007/s10815-023-02849-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Infertility affects one in four female physicians, yet current availability of fertility benefits within Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs in the United States (US) is unknown. Our objective was to examine publicly available fertility benefits information for residents and fellows. METHODS The top 50 medical schools in the US for research were identified using US News & World Report 2022. In April 2022, we reviewed fertility benefits available to residents and fellows at these medical schools. Websites of their associated graduate medical education (GME) websites were queried for details surrounding fertility benefits. Two investigators collected data from GME and publicly available institutional websites. The primary outcome was fertility coverage and rates are reported as percentages. RESULTS Within the top 50 medical schools, 66% of institutional websites included publicly available medical benefits, 40% included any mention of fertility benefits, and 32% had no explicit information on fertility or medical benefits. Fertility benefit coverage included infertility diagnostic workup (40%), intrauterine insemination (32%), prescription coverage (12%), and in vitro fertilization (IVF, 30%). No information on coverage for third party reproduction or LGBT family building was available on public websites. Most programs with fertility benefits were in the South (40%) or Midwest (30%). CONCLUSION To support the reproductive autonomy of physicians in training, it is critical to ensure access to information on fertility care coverage. Given the prevalence of infertility among physicians and the impact of medical training on family planning goals, more programs should offer and publicize coverage for fertility care.
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Affiliation(s)
| | | | - Morgan S Levy
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashley S Kim
- Reproductive Endocrinology, and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Nicole Cumbo
- Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Hina Talib
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erica C Kaye
- St. Jude Children's Research Hospital, Memphis, TN, USA
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Pauley AM, Leonard KS, Cumbo N, Teti IF, Pauli JM, Satti M, Stephens M, Corr T, Roeser RW, Legro RS, Mackeen AD, Bailey-Davis L, Downs DS. Women's beliefs of pain after childbirth: Critical insight for promoting behavioral strategies to regulate pain and reduce risks for maternal mortality. Patient Educ Couns 2023; 107:107570. [PMID: 36410313 PMCID: PMC9789185 DOI: 10.1016/j.pec.2022.11.012] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Promoting behavioral strategies to better regulate pain and decrease the use of prescription pain medications immediately after childbirth is an attractive approach to reduce risks for adverse outcomes associated with the maternal mortality crisis. This study aimed to understand women's beliefs and experiences about pain management to identify important insights for promoting behavioral strategies to control postpartum pain. METHODS N = 32 postpartum women participated in a semi-structured interview about beliefs/experiences with managing postpartum pain. Higher- and lower-order themes were coded; descriptive statistics were used to summarize results. RESULTS Major trends emerging from the data were: (1) most women used a combination of medications (e.g., oxycodone and acetaminophen) and behavioral strategies (e.g., physical activity) in the hospital (94 %) and at discharge (83 %); (2) some women reported disadvantages like negative side effects of medications and fatigue from physical activity; and (3) some women reported they would have preferred to receive more evidence-based education on behavioral strategies during prenatal visits. CONCLUSION Our findings showed that most women were prescribed medications while in the hospital and at discharge, and used non-prescription, behavioral strategies. PRACTICAL IMPLICATIONS Future research is needed to test behavioral strategies in randomized clinical trials and clinical care settings to identify impact on reducing adverse maternal health outcomes.
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Affiliation(s)
- Abigail M Pauley
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States.
| | - Krista S Leonard
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States
| | - Nicole Cumbo
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
| | - Isabella F Teti
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States
| | - Jaimey M Pauli
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
| | - Mohamed Satti
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA, United States
| | - Mark Stephens
- Department of Family and Community Medicine, Penn State College of Medicine, University Park, PA 16802, United States
| | - Tammy Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Robert W Roeser
- Department of Health and Human Development, Pennsylvania State University, University Park, PA 16802, United States
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
| | - A Dhanya Mackeen
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA, United States
| | - Lisa Bailey-Davis
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, United States
| | - Danielle Symons Downs
- Department of Kinesiology, The Pennsylvania State University, 276 Recreation Building, University Park, PA 16802, United States; Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States
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Rasouli MA, Barrett F, Levy MS, Kim AS, Roytman M, Cumbo N, Talib H, Kaye EC. FERTILITY BENEFITS FOR RESIDENTS: PUBLICLY AVAILABLE INFORMATION AT THE TOP 50 US MEDICAL SCHOOLS. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mackeen AD, Vigh RS, Davis LB, Satti M, Cumbo N, Pauley AM, Leonard KS, Stephens M, Corr TE, Roeser RW, Deimling T, Legro RS, Pauli JM, Downs DS. Obstetricians' prescribing practices for pain management after delivery. Pain Manag 2022; 12:645-652. [PMID: 35289656 PMCID: PMC10015511 DOI: 10.2217/pmt-2021-0101] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To examine postpartum opioid prescribing practices. Materials & methods: Obstetricians were interviewed about opioids: choice of opioid, clinical factors considered when prescribing, thoughts/beliefs about prescribing, and typical counseling provided. Inductive thematic analyses were used to identify themes. Results: A total of 38 interviews were analyzed. Several key points emerged. The choice of opioid, dosing and number of pills prescribed varied widely. The mode of delivery is the primary consideration for prescribing opioids. All providers would prescribe opioids to breastfeeding women. Some providers offered counseling on nonopioid treatment of pain. Discussion: At two large tertiary centers in Pennsylvania, the 38 physicians interviewed wrote 38 unique opioid prescriptions. Patient counseling addressed short-term pain management, but not the chronic overuse of opioids.
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Affiliation(s)
- A Dhanya Mackeen
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA 17822, USA
| | - Richard S Vigh
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA 17822, USA
| | - Lisa Bailey Davis
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
| | - Mohamed Satti
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA 17822, USA
| | - Nicole Cumbo
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Mark Stephens
- Department of Family & Community Medicine, Penn State College of Medicine, University Park, PA 16802, USA
| | - Tammy E Corr
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - R W Roeser
- Department of Human Development and Family Studies, College of Health and Human Development, Pennsylvania State University, University Park, PA 16802, USA
| | - Timothy Deimling
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Richard S Legro
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Jaimey M Pauli
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Danielle Symons Downs
- Departments of Kinesiology, College of Health & Human Development, & Obstetrics & Gynecology, Penn State College of Medicine, The Pennsylvania State University, University Park, PA 16802, USA
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Downs DS, Pauley AM, Leonard KS, Satti M, Cumbo N, Teti I, Stephens M, Corr T, Roeser R, Deimling T, Legro RS, Pauli JM, Mackeen AD, Bailey-Davis L. Obstetric Physicians' Beliefs and Knowledge on Guidelines and Screening Tools to Reduce Opioid Use After Childbirth. Obstet Gynecol 2021; 137:325-333. [PMID: 33416288 PMCID: PMC10846479 DOI: 10.1097/aog.0000000000004232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine obstetric physicians' beliefs about using professional or regulatory guidelines, opioid risk-screening tools, and preferences for recommending nonanalgesic therapies for postpartum pain management. METHODS A qualitative study design was used to conduct semi-structured interviews with obstetric and maternal-fetal medicine physicians (N=38) from two large academic health care institutions in central Pennsylvania. An interview guide was used to direct the discussion about each physicians' beliefs in response to questions about pain management after childbirth. RESULTS Three trends in the data emerged from physicians' responses: 1) 71% of physicians relied on their clinical insight rather than professional or regulatory guidelines to inform decisions about pain management after childbirth; 2) although many reported that a standard opioid patient screening tool would be useful to inform clinical decisions about pain management, nearly all (92%) physician respondents reported not currently using one; and 3) 63% thought that nonpharmacologic pain management therapies should be used whenever possible to manage pain after childbirth. Key physician barriers (eg, lack time and evidence, being unaware of how to implement) and patient barriers (eg, take away from other responsibilities, no time or patience) to implementation were also identified. CONCLUSION These findings suggest that obstetric physicians' individual beliefs and clinical insight play a key role in pain management decisions for women after childbirth. Practical and scalable strategies are needed to: 1) encourage obstetric physicians to use professional or regulatory guidelines and standard opioid risk-screening tools to inform clinical decisions about pain management after childbirth, and 2) educate physicians and patients about nonopioid and nonpharmacologic pain management options to reduce exposure to prescription opioids after childbirth.
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Affiliation(s)
- Danielle Symons Downs
- Department of Kinesiology, College of Health and Human Development, and the Department of Obstetrics and Gynecology, Penn State College of Medicine, the Exercise Psychology Laboratory, Department of Kinesiology, the Pennsylvania State University, University Park, the Division of Maternal-Fetal Medicine, Women's Health Service Line, Geisinger, Danville, the Department of Obstetrics and Gynecology, Penn State Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, the Department of Family and Community Medicine, Penn State College of Medicine, University Park, the Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, the Department of Health and Human Development, Pennsylvania State University, University Park, and the Department of Epidemiology and Health Services Research, Geisinger, Danville, Pennsylvania
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Rana N, Ross M, LaRock L, Mele J, Cumbo N, Colom L, Trecartin A, Granet J, Behm R. An awareness campaign decreases distracted driving among hospital employees at a rural trauma center. Traffic Inj Prev 2018; 19:S165-S167. [PMID: 30841802 DOI: 10.1080/15389588.2018.1532216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate whether an educational campaign on distracted driving will have an impact in a given community. METHODS Investigators were stationed in an employee parking lot of a 256-bed hospital to determine baseline distracted driving followed by a 4-week hospital-wide distracted-driving awareness campaign. The campaign included signs/posters in the hospital, a booth outside of the cafeteria with flyers, a large banner in the employee lot and an opportunity for people to sign a pledge form to drive distraction free. The same employee lot was observed at the same time of the day to re-assess distracted driving immediately following the campaign. The observations were repeated again one year later to evaluate the short and long-term impact of the campaign. RESULTS A total of 485 vehicles were observed pre-campaign, identifying 170 (35%) distracted drivers at baseline. The awareness campaign resulted in 525 people pledging to drive distraction free. Following the campaign, 495 vehicles were observed and the number of distracted drivers was 64 (12.9%), showing a significant decrease in the number of distracted drivers by 22.1% (p < 0.01). One year later, 530 drivers were observed with 150 (28%) displaying one form of distraction. CONCLUSIONS A local distracted driving educational campaign resulted in a significant decrease in the number of distracted drivers immediately following the campaign. However, one year after the campaign, there was an increase in distracted driving. The proportion of distracted drivers was still significantly lower than the initial rate of distracted-drivers.
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Affiliation(s)
- Navpreet Rana
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
| | - Melissa Ross
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
| | - Lisa LaRock
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
| | - Jennifer Mele
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
| | - Nicole Cumbo
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
- b Geisinger Commonwealth School of Medicine , Danville , Pennsylvania
| | - Lauren Colom
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
| | - Andrew Trecartin
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
| | - Jason Granet
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
| | - Rob Behm
- a Department of Trauma Surgery, Guthrie/Robert Packer Hospital , Sayre , Pennsylvania
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Cumbo N, Kalter V, Hedge A, Thomas L, Quintana J, Pinkerton I, Gutierrez L. Metabolic pathways promoting tumorigenesis in fibroblasts lacking thrombospondin 1. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx679.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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