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Yang YT. Protecting humanitarian aid workers: an urgent call. Lancet 2024; 403:1847. [PMID: 38703780 DOI: 10.1016/s0140-6736(24)00854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement and the Global Food Institute, The George Washington University, Washington, DC 20006, USA.
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Yang YT, Schaffer DeRoo S. Equitable Access to RSV Prevention: Challenges and Opportunities With Nirsevimab's Rollout. J Public Health Manag Pract 2024; 30:153-154. [PMID: 37934085 DOI: 10.1097/phh.0000000000001856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, and Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, District of Columbia (Dr Yang); Division of General and Community Pediatrics, Children's National Hospital, Washington, District of Columbia (Dr Schaffer DeRoo)
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3
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Yang YT, Sudarshan S. Data disaggregation and unintended consequences. Lancet 2024; 403:528. [PMID: 38237627 DOI: 10.1016/s0140-6736(23)01361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/27/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Y Tony Yang
- School of Nursing, Milken Institute School of Public Health, George Washington University, Washington, DC 20006, USA.
| | - Sawali Sudarshan
- School of Medicine and Health Science, George Washington University, Washington, DC 20006, USA
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Yang YT, Socal M, Bennett CL. Addressing the Drug-Shortage Crisis in Oncology. JAMA Oncol 2024; 10:155-156. [PMID: 38175651 DOI: 10.1001/jamaoncol.2023.5722] [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] [Indexed: 01/05/2024]
Abstract
This Viewpoint offers strategies for addressing shortages in essential chemotherapeutic drugs.
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
- George Washington University Cancer Center, Washington, DC
| | - Mariana Socal
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Charles L Bennett
- Center for Medication Safety and Efficacy, University of South Carolina, Columbia
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LoParco CR, Cui Y, Bar-Zeev Y, Levine H, Duan Z, Wang Y, Abroms LC, Khayat A, Yang YT, Berg CJ. Driving under the influence of cannabis versus alcohol: A mixed-methods study examining perceptions and related risk behaviors among US and Israeli adults. Addict Behav 2024; 148:107843. [PMID: 37660497 PMCID: PMC10591998 DOI: 10.1016/j.addbeh.2023.107843] [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: 06/27/2023] [Revised: 08/11/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Despite the dangers of driving under the influence (DUI), little is known about DUI substance-specific risk perceptions or risk factors for riding with drunk/drugged drivers (RDD). METHODS In this sequential exploratory mixed-methods study, we conducted: 1) multivariable analyses of cross-sectional survey data from 2222 US and Israeli adults to identify correlates of perceived cannabis- vs. alcohol-related DUI risks (linear regression) and past-month RDD involving alcohol-only, cannabis-only, or both (alcohol-cannabis) (multinomial logistic regression); and 2) deductive-inductive thematic analyses of qualitative interview data from 84 participants to identify themes elaborating on survey findings regarding DUI-related risk perceptions. RESULTS 54.0 % reported past-month alcohol use, 16.7 % cannabis use, 4.2 % alcohol-only RDD, 5.5 % cannabis-only RDD, and 7.9 % alcohol-cannabis RDD. Being from the US, not having children at home, and cannabis non-use correlated with lower perceived cannabis vs. alcohol DUI risk. Lower perceived cannabis vs. alcohol DUI risk correlated with cannabis-only and alcohol-cannabis (vs. no) RDD, and with alcohol-cannabis (vs. cannabis-only) RDD. Alcohol use correlated with alcohol-only (vs. no) RDD and alcohol-cannabis (vs. cannabis-only) RDD. Cannabis use correlated with cannabis-only and alcohol-cannabis (vs. no) RDD, and with alcohol-cannabis (vs. alcohol-only) RDD. Being from the US correlated with alcohol-only (vs. alcohol-cannabis and none) RDD and cannabis-only (vs. alcohol-cannabis) RDD; being from Israel correlated with alcohol-cannabis (vs. no) RDD. Qualitative data indicated most participants perceived greater risk of DUI of alcohol vs. cannabis and desired more effective DUI-related prevention and regulatory efforts. CONCLUSIONS Prevention interventions targeting DUI- and RDD-related risk perceptions are needed, particularly for high-risk populations.
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Affiliation(s)
- Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel.
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel.
| | - Y Tony Yang
- School of Nursing, George Washington University, Washington, DC, USA.
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
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Romm KF, Cavazos-Rehg PA, Williams R, Dopke C, Cui Y, LoParco CR, Wang Y, Duan Z, Yang YT, Burris S, Berg CJ. Cannabis Retailer Communication About Cannabis Products, Health Benefits, and Risks: A Mystery Shopper Study of Licensed Retailers in Five U.S. Cities. J Stud Alcohol Drugs 2024; 85:100-108. [PMID: 37917012 PMCID: PMC10846606 DOI: 10.15288/jsad.23-00034] [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] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/09/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE As the U.S. cannabis market expands, surveillance of retailer practices, especially product health claims and risks, is crucial to protect consumers. In this study, mystery shoppers (i.e., staff not explicitly identified as researchers) examined retail personnel communication regarding product recommendations, health benefits, safety, and/or risks among U.S. cannabis retailers. METHOD In Summer 2022, mystery shoppers audited 140 licensed cannabis retailers in 5 cities in states with established nonmedical (i.e., recreational) cannabis sales and diverse regulations (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive and bivariate analyses characterized retail personnel communication overall and across cities. RESULTS Common product recommendations for new users included edibles, pre-rolled joints, and bud/flower, and 8.6% offered free/inexpensive ways to sample products. Although Colorado, Washington, and Oregon explicitly prohibited health claims in advertising or labels, more than 90% of retailers there endorsed use for anxiety, insomnia, and/or pain. Whereas 54.3% endorsed use for pregnancy-related nausea (least common in Denver, 23.3%; most common in Seattle, 76.7%), 26.4% warned against use during pregnancy (most frequently in Denver, 46.7%; least frequently in Seattle and Portland, 13.3%). Overall, 52.1% warned against driving after use (most frequently in Denver, 80.0%; least frequently in Las Vegas, 20.0%). Almost all (≥90%) sold cannabidiol (CBD) products and endorsed their health benefits and safety, but few (<10%) sold or endorsed delta-8 tetrahydrocannabinol (THC), etc. (all of which were in Los Angeles). CONCLUSIONS Ongoing cannabis retail surveillance, particularly using protocols assessing factors outside those visibly observable, is needed to inform regulatory and enforcement efforts, especially related to health claims.
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Affiliation(s)
- Katelyn F. Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - River Williams
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Campbell Dopke
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Cassidy R. LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
- George Washington Cancer Center, George Washington University, Washington, DC
| | - Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, DC
| | - Scott Burris
- Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, Pennsylvania
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
- George Washington Cancer Center, George Washington University, Washington, DC
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Delamater PL, Goel V, Strack CN, Yang YT. Provisional Entrants, Exemptions, and Kindergarteners Up-to-Date on Vaccination Before and After a Regulatory Change in Pennsylvania, 2015-2019. Public Health Rep 2024; 139:66-71. [PMID: 36927265 PMCID: PMC10905753 DOI: 10.1177/00333549231156569] [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: 03/18/2023] Open
Abstract
OBJECTIVES Before the 2017-2018 school year, Pennsylvania shortened the grace period for provisional entrants-kindergarteners who are not up-to-date on vaccination and do not have medical or nonmedical exemption-from 8 months to 5 days. We analyzed the impact of this change on school-entry vaccination status. METHODS Using data from the Pennsylvania Department of Health for school years 2015-2016 through 2018-2019, we examined state-level trends in Pennsylvania kindergarteners' vaccination status, including the percentage who were up-to-date on each required vaccine, provisionally enrolled, medically exempted from vaccination, and nonmedically exempted from vaccination. Using the Spearman correlation coefficient, we assessed associations at the school level among changes in kindergarteners' vaccination status after the grace period was shortened. RESULTS From 2016-2017 to 2017-2018, the provisional entrance rate of kindergarteners in Pennsylvania decreased substantially after the change in the grace period (from 8.1% to 2.2%), the medical exemption rate remained stable, and the nonmedical exemption rate increased slightly (from 1.8% to 2.5%). The percentage of kindergarteners up-to-date on required vaccines increased or remained stable across the study period except for polio, which decreased from 97.9% in 2015-2016 to 96.2% in 2018-2019. The change in provisional entrance rate was negatively associated with change in kindergarteners up-to-date on required vaccines (ρ range, -0.30 to -0.70) but not with change in medical or nonmedical exemptions (ρ range, -0.01 to -0.08). CONCLUSIONS Efforts to reduce provisional entrants may increase the percentage of kindergarteners up-to-date on vaccinations at school entry without a corresponding increase in exemptions.
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Affiliation(s)
- Paul L. Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Varun Goel
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire N. Strack
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, DC, USA
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Yang YT. The need for medical sanctity in conflict zones. Lancet 2023; 402:2191-2192. [PMID: 38008107 DOI: 10.1016/s0140-6736(23)02505-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, The George Washington University, Washington, DC 20006, USA.
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Kamin-Friedman S, Davidovitch N, Yang YT. Israel's repeal of a sweet beverages tax harms public health. Front Public Health 2023; 11:1231709. [PMID: 38162613 PMCID: PMC10755473 DOI: 10.3389/fpubh.2023.1231709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Shelly Kamin-Friedman
- Department of Health Policy and Management, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Policy and Management, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC, United States
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Yang YT, Strack CN, Delamater PL. Students Provisionally Enrolled Due to Vaccination Requirements: Variation in State Laws and Rates. J Public Health Manag Pract 2023; 29:810-814. [PMID: 37199410 DOI: 10.1097/phh.0000000000001772] [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] [Indexed: 05/19/2023]
Abstract
This research examined the laws and regulations surrounding provisional enrollment in schools across the United States. Provisional enrollment refers to children who have started, but not completed, their required vaccinations and are allowed to attend school while completing their vaccinations. We found that nearly all states have laws regarding provisional enrollment, with 5 essential components to compare the laws including vaccine- and dose-specific requirements, type of personnel permitted to authorize, length of time that the children have to become up to date on their vaccinations (grace period), follow-up procedures, and consequences for noncompliance. In addition, we found that the percentage of provisionally enrolled kindergarteners varied greatly from state to state, with some states having less than 1% of provisionally enrolled kindergarteners and others having more than 8% between school years 2015-2016 and 2020-2021. We suggest that reducing the number of provisional entrants could be an alternative intervention to increase vaccination coverage.
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, District of Columbia (Dr Yang); Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, District of Columbia (Dr Yang); and Department of Geography (Ms Strack and Dr Delamater) and Carolina Population Center (Dr Delamater), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Yang YT, Olick RS, Shaw J. Religious Exemptions, Public Health, and School Vaccination Requirements. JAMA Pediatr 2023; 177:1001-1002. [PMID: 37639242 DOI: 10.1001/jamapediatrics.2023.3075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
This Viewpoint examines 2 recent cases that encapsulate the debate on religious exemptions to school vaccination requirements and further argues against these exemptions for schoolchildren.
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Robert S Olick
- Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse
| | - Jana Shaw
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse
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Yang YT, Mahoney AD. Redefining nursing: advancing health equity post-pandemic. Lancet 2023; 402:1039. [PMID: 37741672 DOI: 10.1016/s0140-6736(23)01417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Y Tony Yang
- School of Nursing, Milken Institute School of Public Health, George Washington University, Washington, DC 20006, USA.
| | - Ashley Darcy Mahoney
- School of Nursing, School of Medicine and Health Science, George Washington University, Washington, DC 20006, USA
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Yang YT, Sudarshan S. Beyond Stricter Gun Control Measures: Lessons From the Nashville Shooting. J Public Health Manag Pract 2023; 29:609-610. [PMID: 37478092 DOI: 10.1097/phh.0000000000001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, District of Columbia (Dr Yang); Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, District of Columbia (Dr Yang) and George Washington University School of Medicine and Health Science, Washington, District of Columbia (Dr Sudarshan)
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Kamin-Friedman S, Levine H, Davidovitch N, Troen AM, Yang YT. Israel's judicial overhaul: a threat to the Health in All Policies approach. Lancet 2023; 402:689-690. [PMID: 37573861 DOI: 10.1016/s0140-6736(23)01663-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Affiliation(s)
| | - Hagai Levine
- Israel Association of Public Health Physicians, Ramat Gan, Israel
| | - Nadav Davidovitch
- School of Public Health, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Aron M Troen
- The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, The George Washington University, Washington, DC 20006, USA.
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Berg CJ, Romm KF, Pannell A, Sridharan P, Sapra T, Rajamahanty A, Cui Y, Wang Y, Yang YT, Cavazos-Rehg PA. Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities. Addict Behav 2023; 143:107696. [PMID: 36966547 PMCID: PMC10674052 DOI: 10.1016/j.addbeh.2023.107696] [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: 01/13/2023] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
As cannabis retail expands in the US, its surveillance is crucial to inform regulations and protect consumers. This study addresses this need by conducting point-of-sale audits examining regulatory compliance (e.g., age verification, signage), advertising/promotional strategies, products, and pricing among 150 randomly-selected cannabis retailers in 5 US cities (30/city: Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California) in Summer 2022. Descriptive and bivariate analyses characterized the retailers overall and across cities. Age verification rates were high (>90%). The majority of retailers had signage indicating restricted access (e.g., no minors; 87.3%), onsite consumption (73.3%), and distribution to minors (53.3%). Retailers were likely to post warnings regarding use during pregnancy/breastfeeding (72.0%), followed by health risks (38.0%), impacts on children/youth (18.7%), and DUI (14.0%). Overall, 28.7% posted health claims, 20.7% posted youth-oriented signage, and 18.0% had youth-oriented packaging. Price promotions were prevalent, particularly price specials (75.3%), daily/weekly/monthly specials (66.7%), and membership programs (39.3%). One-fourth had signs/promotions indicating curbside delivery/pick-up (28.0%) and/or online ordering (25.3%); 64.7% promoted their website or social media page. The most potent cannabis products were most often e-liquids (38.0%) or oils (24.7%); the least potent were often edibles (53.0%). The most expensive product was often bud/flower (58.0%); the least was joints (54.0%). The vast majority (≥81%) sold vaporizers, wrapping papers, and hookah/waterpipes/bongs, and 22.6% sold CBD products. Marketing strategies differed across cities, reflecting differences in state-specific regulations and/or gaps in compliance/enforcement. Findings underscore the need for ongoing cannabis retail surveillance to inform future regulatory and enforcement efforts.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington Cancer Center, George Washington University, Washington, DC, USA.
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alexandria Pannell
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Priyanka Sridharan
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Tanvi Sapra
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Aishwarya Rajamahanty
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Y Tony Yang
- George Washington Cancer Center, George Washington University, Washington, DC, USA; Department of Community of Policy, Populations and Systems, School of Nursing, George Washington University, Washington, DC, USA
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Affiliation(s)
- Y Tony Yang
- George Washington University School of Nursing and Milken Institute School of Public Health, Washington, DC, USA
- AcademyHealth Education Council, Washington, DC, USA
| | - Sawali Sudarshan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Berg CJ, LoParco CR, Cui Y, Pannell A, Kong G, Griffith L, Romm KF, Yang YT, Wang Y, Cavazos-Rehg PA. A review of social media platform policies that address cannabis promotion, marketing and sales. Subst Abuse Treat Prev Policy 2023; 18:35. [PMID: 37337216 PMCID: PMC10278361 DOI: 10.1186/s13011-023-00546-x] [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: 01/26/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Cannabis marketing exposure via social media may impact use in youth and young adults. Most states with recreational cannabis lack policies regarding social media-based marketing. Thus, we examined such policies among prominent platforms, particularly those popular among youth and young adults. METHODS In September-October 2022, 3 research team members extracted policies applying to the general community, advertising, and any specific content regarding drug-related content for 11 social media sites: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter, and YouTube. Using inductive thematic analysis, they then dual-coded restrictions on cannabis-related content (e.g., paid advertising, unpaid promotion, sales). Descriptive analyses were conducted. RESULTS Ten (all except TikTok) referenced cannabis/marijuana, 7 (all except Discord, Instagram, TikTok, and YouTube) distinguished different cannabis-derived products, and 5 (Reddit, Snapchat, TikTok, Tumblr, Twitter) noted jurisdictional differences in cannabis regulations/legality. All prohibited sales, 9 (all except Snapchat and Tumblr) prohibited paid advertising, and 4 (Discord, Reddit, Snapchat, TikTok) prohibited unpaid promotion (e.g., user-generated content). All restricted underage access to cannabis-related content. However, policies varied and were ambiguous regarding how "promotion" was defined, whether/how jurisdictional differences in legality were addressed, how businesses may interact on social media, barriers implemented to inhibit the facilitation of sales, and enforcement protocols. CONCLUSIONS Social media policies regarding cannabis marketing are ambiguous and may facilitate cannabis marketing, promotion, sales, and underage exposure, thus compounding concerns regarding insufficient governmental regulations. Greater specificity in social media cannabis-related policies and enforcement is needed.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA.
- George Washington Cancer Center, George Washington University, 2121 I St NW, Washington, DC, 20052, USA.
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
| | - Alexandria Pannell
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 2121 I St NW, Washington, DC, 20052, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, 06519, USA
| | - Lynniah Griffith
- Wellesley College, 106 Central Street, Wellesley, MA, 02481, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Y Tony Yang
- George Washington Cancer Center, George Washington University, 2121 I St NW, Washington, DC, 20052, USA
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, 1919 Pennsylvania Ave NW #500, Washington, DC, 20006, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000C, Washington, DC, 20052, USA
- George Washington Cancer Center, George Washington University, 2121 I St NW, Washington, DC, 20052, USA
| | - Patricia A Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
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Yang YT, Berg CJ, Burris S. Cannabis Equity Initiatives: Progress, Problems, and Potentials. Am J Public Health 2023; 113:487-489. [PMID: 36926969 PMCID: PMC10088935 DOI: 10.2105/ajph.2023.307255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Y Tony Yang
- Y. Tony Yang is with School of Nursing, Milken Institute School of Public Health, GW Cancer Center, the George Washington University, Washington, DC. Carla J. Berg is with Milken Institute School of Public Health, GW Cancer Center, the George Washington University. Scott Burris is with the Center for Public Health Law Research at the Beasley School of Law, Temple University, Philadelphia, PA
| | - Carla J Berg
- Y. Tony Yang is with School of Nursing, Milken Institute School of Public Health, GW Cancer Center, the George Washington University, Washington, DC. Carla J. Berg is with Milken Institute School of Public Health, GW Cancer Center, the George Washington University. Scott Burris is with the Center for Public Health Law Research at the Beasley School of Law, Temple University, Philadelphia, PA
| | - Scott Burris
- Y. Tony Yang is with School of Nursing, Milken Institute School of Public Health, GW Cancer Center, the George Washington University, Washington, DC. Carla J. Berg is with Milken Institute School of Public Health, GW Cancer Center, the George Washington University. Scott Burris is with the Center for Public Health Law Research at the Beasley School of Law, Temple University, Philadelphia, PA
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19
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Ziemann M, Strasser J, Krips M, Yang YT, Pittman P. How Governor Directives Changed Health Workforce Flexibility in Response to the COVID-19 Pandemic. Public Health Rep 2023; 138:78S-89S. [PMID: 37226941 DOI: 10.1177/00333549221132534] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES In times of heightened population health needs, the health workforce must respond quickly and efficiently, especially at the state level. We examined state governors' executive orders related to 2 key health workforce flexibility issues, scope of practice (SOP) and licensing, in response to the COVID-19 pandemic. METHODS We conducted an in-depth document review of state governors' executive orders introduced in 2020 in all 50 states and the District of Columbia. We conducted a thematic content analysis of the executive order language using an inductive process and then categorized executive orders by profession (advanced practice registered nurses, physician assistants, and pharmacists) and degree of flexibility granted; for licensing, we indicated yes or no for easing or waiving cross-state regulatory barriers. RESULTS We identified executive orders in 36 states containing explicit directives addressing SOP or out-of-state licensing, with those in 20 states easing regulatory barriers pertaining to both workforce issues. Seventeen states issued executive orders expanding SOP for advanced practice nurses and physician assistants, most commonly by completely waiving physician practice agreements, while those in 9 states expanded pharmacist SOP. Executive orders in 31 states and the District of Columbia eased or waived out-of-state licensing regulatory barriers, usually for all health care professionals. CONCLUSION Governor directives issued through executive orders played an important role in expanding health workforce flexibility in the first year of the pandemic, especially in states with restrictive practice regulations prior to COVID-19. Future research should examine what effects these temporary flexibilities may have had on patient and practice outcomes or on permanent efforts to relax practice restrictions for health care professionals.
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Affiliation(s)
- Margaret Ziemann
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Julia Strasser
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Maddie Krips
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Y Tony Yang
- School of Nursing, George Washington University, Washington, DC, USA
| | - Patricia Pittman
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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20
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Olick RS, Yang YT, Shaw J. When Adolescents Disagree with Their Vaccine-Hesitant Parents about COVID-19 Vaccination. J Clin Ethics 2023; 34:158-168. [PMID: 37229735 DOI: 10.1086/724746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AbstractAs we journey into the fourth year of the COVID-19 pandemic, a majority of Americans express relief at a "return to normal," experience pandemic fatigue, or embrace the idea of living with COVID-19 in much the same way we live with the seasonal flu. But transition to a new phase of life with SARS-CoV-2 does not diminish the importance of vaccination. The US Centers for Disease Control and the Food and Drug Administration recently recommended another round of booster dose for persons age 5 and up, or an initial series for those not previously vaccinated, with an updated bivalent formula that protects against both the original virus strain and Omicron subvariants that are now the dominant source of infection. By most accounts most of the population has been or will become infected with SARS-CoV-2. Suboptimal uptake of the COVID-19 vaccines among the approximately 25 million adolescents in the United States is a significant obstacle to population coverage, public health, and the health and well-being of adolescents. A major cause of low adolescent uptake is parental vaccine hesitancy. This article discusses parental vaccine hesitancy and argues that permitting independent adolescent consent to COVID-19 vaccination should be an ethical and policy priority as we continue to confront the threat of Omicron and other variants of the coronavirus. We discuss the central role of the pediatric healthcare team in caring for adolescent patients who disagree with their parents about vaccination.
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21
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Yang YT, Schaffer DeRoo S. Disciplining Physicians Who Spread Medical Misinformation. J Public Health Manag Pract 2022; 28:595-598. [PMID: 36070583 PMCID: PMC9555612 DOI: 10.1097/phh.0000000000001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Y. Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing (Dr Yang), and Department of Health Policy and Management, Milken Institute School of Public Health (Dr Yang), The George Washington University, Washington, District of Columbia; and Division of General and Community Pediatrics, Children's National Hospital, Washington, District of Columbia (Dr Schaffer DeRoo)
| | - Sarah Schaffer DeRoo
- Center for Health Policy and Media Engagement, School of Nursing (Dr Yang), and Department of Health Policy and Management, Milken Institute School of Public Health (Dr Yang), The George Washington University, Washington, District of Columbia; and Division of General and Community Pediatrics, Children's National Hospital, Washington, District of Columbia (Dr Schaffer DeRoo)
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22
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Han YF, Yang YT, Fang Y. [Association between depression tendency and cognitive trajectory in the elderly in rural area in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1491-1496. [PMID: 36117359 DOI: 10.3760/cma.j.cn112338-20220415-00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore cognitive trajectory and its association with depression tendency in the elderly in rural area in China. Methods: Based on the data of the rural elderly aged ≥65 years in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018, unconditional and conditional latent variable growth curve models were constructed to analyze the mini-mental state examination (MMSE) score trajectory and its association with depression tendency in the elderly. Results: A total of 1 788 elderly persons were included, and 19.1% of them had a depression tendency. The average MMSE score of those with and without a depression tendency at baseline survey were 26.62±3.54 and 27.59±3.17 respectively. The rate of MMSE score decline was 0.52 points (P<0.05). Before and after controlling covariates, the initial score was 0.84 points lower (P<0.05) and 0.81 points lower (P<0.05) in those with depressive tendency than in those without depressive tendency respectively, furthermore, the decline rate of MMSE score was 0.33 points lower (P<0.05) and 0.40 points lower (P<0.05) in those with depressive tendency than in those without respectively. Conclusions: The depression tendency in the elderly in rural area in China was associated with the cognitive function change trajectory, with those with depression tendency had lower-level trajectory. Attention should be paid to the mental health of the elderly in rural area to prevent dementia and slow its development.
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Affiliation(s)
- Y F Han
- School of Public Health, Xiamen University, Xiamen 361102, China Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen 361102, China
| | - Y T Yang
- School of Public Health, Xiamen University, Xiamen 361102, China Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen 361102, China
| | - Y Fang
- School of Public Health, Xiamen University, Xiamen 361102, China Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen 361102, China
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23
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Yang YT, Berg CJ. How Preemption Can Lead to Inequity. Int J Environ Res Public Health 2022; 19:10476. [PMID: 36078191 PMCID: PMC9518357 DOI: 10.3390/ijerph191710476] [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] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
American cities and localities have historically been places of innovation and incubation when it comes to advancing equity and inclusion. Now, local governments in many states are leading the fight for stronger public health protections against COVID-19-through mask mandates, stay-at-home orders, and paid leave provisions, among other actions. However, state lawmakers have long used preemption-state laws that block, override, or limit local ordinances-to stifle local government action, often under pressure from corporate interests and political ideology. Through preemption, state lawmakers have obstructed local communities-often majority-minority communities-from responding to the expressed needs and values of their residents through policies. In this article, we first look at the context behind preemption and its disparate effects. After establishing a conceptual framework for measuring disparities, we discuss how the current COVID-19 pandemic is disproportionately harming the same communities that have been preempted from taking local action, limiting their ability to effectively combat the public health crisis. We argue that all stakeholders interested in health equity have a role to play in addressing the misuse of state preemption.
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Affiliation(s)
- Y. Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, 1919 Pennsylvania Ave. #500, Washington, DC 20006, USA
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, 800 22nd Street NW, #7000C, Washington, DC 20052, USA
| | - Carla J. Berg
- George Washington Cancer Center, George Washington University, 800 22nd Street NW, #7000C, Washington, DC 20052, USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA
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24
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Yang YT, Stratmann T, Pillai D. Effects of State Preemption of Local Smoke-Free Restrictions on US Adult Cigarette Smoking Prevalence, 1997 to 2017. J Gen Intern Med 2022; 37:2591-2593. [PMID: 34495465 PMCID: PMC9360284 DOI: 10.1007/s11606-021-07115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC, USA.
| | - Thomas Stratmann
- Department of Economics, George Mason University, Fairfax, VA, USA
| | - Drishti Pillai
- Department of Health Policy and Management, George Washington University, Washington, DC, USA
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25
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Yang YT, Chen B. Imposing a health insurance surcharge on the unvaccinated. Am J Manag Care 2022; 28:310-312. [PMID: 35852879 DOI: 10.37765/ajmc.2022.89169] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
COVID-19 hospitalizations among unvaccinated individuals cost billions of dollars. More employers are considering imposing a premium surcharge on employees participating in the company's health plan who are not vaccinated against COVID-19. These employers see this approach as similar to health premium surcharges for tobacco use, justifying the higher premiums on the basis that unvaccinated individuals could cause the plan to experience higher hospitalization and related costs. However, imposing a surcharge on unvaccinated employees will require employers to think through legal and policy implications and the interests of their employees and their businesses. Employers should weigh their vaccination goals against these interests and consider whether a legally compliant surcharge would further their goals. Employers should carefully consider the prevailing culture among their employees and assess whether the policy would be effective and noncoercive. Premium surcharges may be effective for some but not all employers.
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Affiliation(s)
- Y Tony Yang
- George Washington University, 1919 Pennsylvania Ave NW, Ste 500, Washington, DC 20006.
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26
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Wallington SF, Jeon MJ, Nguyen TA, Byambaa C, Yang YT, Le D. Perceptions and patient care needs among hepatitis B patients during COVID-19. BMC Health Serv Res 2022; 22:846. [PMID: 35773673 PMCID: PMC9246354 DOI: 10.1186/s12913-022-08153-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background The novel coronavirus of 2019 (COVID-19) has been and continues to be a rapidly developing public health crisis, that has also disrupted routine and maintenance health care for people living with chronic conditions. Some of these chronic conditions also put individuals at increased risk of COVID-19 complications, particularly if the condition is not under control. For these reasons, the exploratory study reported here examined the needs and preparedness of patients at a community health organization that specifically provides hepatitis B virus (HBV) care for high-risk groups that had previously tested positive for HBV. Methods Current study utilized exploratory analysis of qualitative COVID-19-related statements collected during calls to a total of 44 patients reached during April and May, 2020 in the Washington D.C. area. Researchers worked with a community based non-profit organization to reach current HBV + and HCV + patients to provide retention in care and assess patient needs in maintaining management of their condition adapted to include offering medication refills, telehealth, and other resources. We gathered emergent themes, using socio-ecological framework, regarding capacity and needs for managing their chronic condition in a vulnerable population during the initial, most interrupted, time period of a global public health crisis. Results From the notes of the calls, five thematic categories emerged: COVID-19 prevention awareness, assistance program access, medical resource access, access to knowledge and awareness about assistance programs, and needs and barriers. From these five themes, providers can develop strategies to better prepare their patients and provide care to patients with chronic conditions during major disruptions. Conclusions Future recommendations include increasing hepatitis and COVID-19 vaccine efforts, collaborating with community partners, and screening and understanding social determinants of health that affect racial and ethnic minorities.
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Affiliation(s)
| | - Min Jeong Jeon
- School of Nursing, George Washington University, Washington, DC, USA
| | | | | | - Y Tony Yang
- School of Nursing, George Washington University, Washington, DC, USA
| | - Daisy Le
- School of Nursing, George Washington University, Washington, DC, USA
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27
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Affiliation(s)
- William M Sage
- School of Law and Dell Medical School, The University of Texas at Austin
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
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28
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Yang YT, Deng H. [Role of KIF3 complex in the development of diseases]. Zhonghua Bing Li Xue Za Zhi 2022; 51:380-384. [PMID: 35359059 DOI: 10.3760/cma.j.cn112151-20210831-00634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Y T Yang
- Department of Pathology and Pathophysiology, Zhejiang Key Laboratory for Disease Proteomics, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - H Deng
- Department of Pathology and Pathophysiology, Zhejiang Key Laboratory for Disease Proteomics, School of Medicine, Zhejiang University, Hangzhou 310058, China
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29
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Yang YT, Chen BK. Liability Waivers for COVID-19: Law, Policy, and Practice. J Public Health Manag Pract 2022; 28:E456-E460. [PMID: 34225303 DOI: 10.1097/phh.0000000000001398] [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] [Indexed: 11/25/2022]
Abstract
As businesses reopen, the practice of asking customers to sign COVID-19 liability waivers is increasing throughout the United States. Although the courts have not yet decided the enforceability of COVID-19-related liability waivers, existing case law, as well as new executive and legislative actions, suggests that such waivers may offer some protection to businesses from liability. Nevertheless, we believe that the legal and ethical rationales underlying liability waivers are not applicable to a pandemic. We further argue that the challenging nature of and the substantial unknowns about the novel coronavirus make waivers contrary to public policy. Fears over floods of litigation appear thus far unfounded, and businesses should not be relieved from their obligation of taking reasonable safety precautions. Waivers are not a panacea to reopen businesses in an ongoing pandemic, and the ultimate protection against liability is to operate in a manner that minimizes the spread of the virus consistent with evidence-based guidelines.
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, District of Columbia (Dr Yang); and Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Dr Chen)
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30
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Parent B, Yang YT, Caplan A. "Should Patients Who Refuse COVID Vaccination Be Denied Transplantation Eligibility?". J Card Fail 2022; 28:1042-1043. [PMID: 35150871 DOI: 10.1016/j.cardfail.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Brendan Parent
- NYU Grossman School of Medicine, Division of Medical Ethics, New York, New York.
| | - Y Tony Yang
- George Washington University, School of Nursing, Center for Health Policy and Media Engagement, Washington, DC; George Washington University, Milken Institute School of Public Health, Department of Health Policy and Management, Washington, DC
| | - Arthur Caplan
- NYU Grossman School of Medicine, Division of Medical Ethics, New York, New York
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31
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Le D, Ciceron AC, Pan J, Juon HS, Berg CJ, Nguyen TA, Le HC, Yang YT. Linkage-to-Care Following Community-Based HBV and HCV Screening Among Immigrants from the Washington–Baltimore Metropolitan Area, 2016–2019. J Immigr Minor Health 2022; 24:1137-1144. [PMID: 35064900 PMCID: PMC8783186 DOI: 10.1007/s10903-022-01327-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
Understanding characteristics that impact linkage-to-care (LTC) among individuals living with HBV and/or HCV can enhance public health efforts to provide tailored care services to prevent and treat viral hepatitis among immigrants. Using HBV/HCV screening and LTC data from immigrants (2016–2019), descriptive and logistic regression analyses were conducted to assess (1) the relationship between LTC and sociodemographic factors and (2) factors associated with HBV/HCV LTC. About 87% of those positive HBsAg had LTC and 52% had LTC among those with HCVAB and confirmed PCR. Access to care was an important LTC predictor for HBV–LTC: those who had neither health insurance nor primary care provider (PCP) were more likely to have HBV–LTC than those who had either health insurance or PCP (aOR = 2.95, 95% CI = 1.32–6.59). It is essential to equally provide HBV/HCV LTC support to all immigrants from countries with high prevalence regardless of access to care.
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Affiliation(s)
- Daisy Le
- School of Nursing, The George Washington University, 1919 Pennsylvania NW, Suite 500, Washington, DC, 20006, USA.
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
| | - Annie Coriolan Ciceron
- School of Nursing, The George Washington University, 1919 Pennsylvania NW, Suite 500, Washington, DC, 20006, USA
| | - Jane Pan
- Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC, USA
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carla J Berg
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - T Angeline Nguyen
- Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC, USA
| | - Hai Chi Le
- Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC, USA
| | - Y Tony Yang
- School of Nursing, The George Washington University, 1919 Pennsylvania NW, Suite 500, Washington, DC, 20006, USA
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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32
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Yu L, Yang YT, Liu W. [Differences of water barrier function between keloid and its surrounding normal skin in patients with keloids and its related mechanism]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2022; 38:63-68. [PMID: 34954936 DOI: 10.3760/cma.j.cn501120-20210427-00156] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the differences of water barrier function between keloids and its surrounding normal skin in patients with keloids, and to explore the primary mechanism. Methods: A cross-sectional observational study was conducted. From October 2020 to March 2021, 30 patients with keloids who met the inclusion criteria visited Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 18 females and 12 males, aged 20-48 years. The transepidermal water loss (TEWL) of their keloids and the surrounding normal skin of the 30 patients were measured by multi probe adapter on the reception day. The keloid tissues and normal skin of 5 patients after keloid repair surgery were processed for hematoxylin-eosin staining to measure the thickness of epidermis. Immunohistochemistry was performed on samples from 3 of those 5 patients to detect the expressions of cytokeratin-10, involucrin, and filaggrin in keloids and normal skin. Data were statistically analyzed with paired sample t test and independent sample t test. Results: On the reception day, the TEWL of keloids of 30 patients was 9.0 (6.9, 13.4) g·m-2·h-1 and the TEWL of the normal skin was 8.1 (6.4, 18.1) g·m-2·h-1, between which the difference was not statistically significant (t=0.44, P>0.05). After keloid repair surgery, the thickness of epidermis in the keloids of 5 patients was (194±44) μm, which was significantly thicker than that of the normal skin (44±11) μm, (t=6.88, P<0.01). Furthermore, increased keratinocytes, lack of normal epidermal ridge structures, and thickened stratum corneum were observed in the keloid area. After keloid repair surgery, the expression level of cytokeratin-10 in keloids was significantly lower than that in normal skin of 3 patients (t=8.50, P<0.01), but there were no statistically significant differences in the expression levels of involucrin or filaggrin between keloids and normal skin (with t values of 0.07 and 0.96, respectively, P>0.05). Conclusions: Keloid tissue from patients with keloids displays increased number of keratinocytes and thickened epidermis. But the water barrier function in keloid area is similar to the surrounding normal skin, suggesting that TEWL may not be the main mechanism lead to the persistent development of keloids.
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Affiliation(s)
- L Yu
- Plastic Surgery Research Institute, Weifang Medical University, Weifang 261042, China
| | - Y T Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Tissue Engineering Key Laboratory, Shanghai 200011, China
| | - W Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Tissue Engineering Key Laboratory, Shanghai 200011, China
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Berg CJ, Windle M, Dodge T, Cavazos-Rehg P, Yang YT, Ma Y, Haardörfer R. Marijuana Use and Increases in Use over Time among Young Adult College Students in the State of Georgia: Analyses of Sociocontexual Predictors. Subst Use Misuse 2022; 57:350-359. [PMID: 34913832 DOI: 10.1080/10826084.2021.2012691] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND While research has assessed correlates of marijuana use, there has been less focus on predictors of differing levels of changes in use during young adulthood, a critical period for use/escalation. OBJECTIVES We examined changes in marijuana use and related sociocontextual predictors (e.g., earlier-onset substance use, parental use, college type). METHODS Using data from Georgia college students (ages 18-25 years) in a 2-year, 6-wave longitudinal study (64.6% female, 63.4% White), 2-part random-effects modeling examined use at any assessment and number of days used. RESULTS Predictors of use status at any assessment included being male (OR = 1.87, 95%CI = [1.28-2.73]), Black (OR = 1.91, 95%CI = [1.15-3.19]), earlier-onset marijuana (OR = 2.63, 95%CI = [1.70-4.06]), cigarette (OR = 2.04, 95%CI = [1.19-3.48]), and alcohol users (OR = 1.49, 95%CI = 1.00-2.22]), parental tobacco (OR = 2.14, 95%CI = [1.18-3.86]) and/or alcohol use (OR = 1.55, 95%CI = [1.09-2.20]), and attending private (vs. public) institutions (OR = 1.68, 95%CI = [1.10-2.59]). Predictors of lower likelihood of use over time included being male (OR = 0.87, 95%CI = [0.77-0.98]), earlier-onset cigarette use (OR = 0.82, 95%CI = [0.68-0.98]), parental alcohol use (OR = 0.86, 95%CI = [0.77-0.97]), and private institution students (OR = 1.17, 95%CI = [1.02-1.34]). Predictors of more days used at baseline included being male (OR = 1.77, 95%CI = [1.40-2.23]), Black (OR = 1.42, 95%CI = [1.04-1.93]), earlier-onset marijuana (OR = 2.32, 95%CI = [1.78-3.01]) and alcohol users (OR = 1.29, 95%CI = [1.01-1.66]), and parental tobacco use (OR = 1.90, 95%CI = [1.32-2.73]). Predictors of fewer days used over time included being older (OR = 0.98, 95%CI = [0.97-1.00]), parental tobacco use (OR = 0.86, 95%CI = [0.78-0.95]), and attending private institutions (OR = 0.89, 95%CI = [0.83-0.93]). CONCLUSIONS Intervention efforts can be informed by current findings that correlates of baseline use (e.g., being male, attending private institutions) also predicted less use over time, and one's earlier use and parents' use of various substances impacted young adult use.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Michael Windle
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Yan Ma
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Affiliation(s)
- Y. Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University and Department of Health Policy and Management, School of Public Health, George Washington University Milken Institute, Washington, DC,Address correspondence to Y. Tony Yang, ScD, LLM, MPH, 1919 Pennsylvania Ave, NW, Suite 500, Washington, DC 20006. E-mail:
| | - Sarah Schaffer DeRoo
- Division of General and Community Pediatrics, Children’s National Hospital, Washington, DC
| | - Stephanie R. Morain
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
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Olick RS, Shaw J, Yang YT. Ethical Issues in Mandating COVID-19 Vaccination for Health Care Personnel. Mayo Clin Proc 2021; 96:2958-2962. [PMID: 34863393 PMCID: PMC8633920 DOI: 10.1016/j.mayocp.2021.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Robert S Olick
- Center for Bioethics and Humanities; Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Jana Shaw
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC
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Affiliation(s)
- Robert S. Olick
- Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse, NY, USA,Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA,Robert S. Olick, JD, PhD, Center for Bioethics and Humanities, State University of New York Upstate Medical University, 618 Irving Ave, Syracuse, NY 13210, USA.
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC, USA
| | - Jana Shaw
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, USA
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Jiang N, Yang YT, Bi RY, Cao PY, Hou Y, Zhu SS. [Comprehensive measurement and quantification of bio-mechanical properties of the temporomandibular joint disc]. Zhonghua Kou Qiang Yi Xue Za Zhi 2021; 56:764-768. [PMID: 34404142 DOI: 10.3760/cma.j.cn112144-20210322-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To comprehensively investigate the biomechanical properties of the temporomandibular joint (TMJ) disc and to perfect the mechanical testing system of the TMJ disc by conducting tests of compression, tension, cyclic compression, cyclic tension, creep and friction. Methods: Fifteen fresh goat heads (weighing 2.5-3.0 kg) were purchased from the market. They were all ordinary goats (9-12 months old, body weighing 18-21 kg) regardless of gender. Bilateral articular discs (a total of 30) were dissected within 30 minutes after execution. According to the national standard for mechanical testing of viscoelastic materials, fresh TMJ disc specimens of goat were prepared and tests were carried out in physiological conditions. The universal mechanical testing machine was utilized to test biomechanical properties of TMJ discs. Results: The compressive modulus of TMJ discs was (8.41±2.12) MPa and the tensile modulus was (9.54±3.26) MPa. The mechanical characteristics would be irreversibly altered once the load exceeded the physiological range. In addition, it underwent apparent creep relaxation under continuous strain (0.5 MPa or 3.0 MPa) and the surface friction coefficient of the TMJ discs (0.015+0.011) was much lower than that of general viscoelastic materials. Conclusions: The TMJ disc was a bio-viscoelastic structure with excellent tensile and compressive properties and its surface was extremely smooth in wet conditions.
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Affiliation(s)
- N Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Disease & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Y T Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Disease & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - R Y Bi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Disease & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - P Y Cao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Disease & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Y Hou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Disease & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - S S Zhu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Disease & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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38
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Berg CJ, Yang YT, Pratt-Chapman ML, Douglas Evans W, Cupertino AP, Horn K, Bernat DH, Abroms LC, Tercyak KP. Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities. Transl Behav Med 2021; 11:1030-1036. [PMID: 32893870 PMCID: PMC8075612 DOI: 10.1093/tbm/ibaa083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC USA
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Y Tony Yang
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
- Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, DC, USA
| | - Mandi L Pratt-Chapman
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - W Douglas Evans
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC USA
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Ana-Paula Cupertino
- Department of Public Health Sciences, Wilmot Cancer Institute, Community Outreach, Engagement, and Disparities Research, University of Rochester, Rochester, NY, USA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech-Carilion Fralin Biomedical Research Institute, Virginia Tech, Blacksburg, VA, USA
| | - Debra H Bernat
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC USA
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Yang YT, Du Y, Yuan WJ, Wang L. [Role of histone demethylase KDM6B in HBx-mediated podocyte-macrophage transdifferentiation]. Zhonghua Yi Xue Za Zhi 2021; 101:866-871. [PMID: 33789369 DOI: 10.3760/cma.j.cn112137-20210119-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the expression of lysine (k)-specific demethylase 6B (KDM6B) in the renal tissues of hepatitis B virus-associated glomerulonephritis (HBV-GN) patients and human podocytes transfected with hepatitis B virus X (HBx) gene, and its role in HBx-mediated podocyte-macrophage transdifferentiation (PMT). Methods: Forty-eight patients diagnosed as HBV-GN by renal biopsy from 2013 to 2018 at the Shanghai Jiaotong University Affiliated First People's Hospital were included in this study. Thirty patients with primary glomerulonephritis (PGN) and fifteen patients with renal tumor were chosen as control group. The expression of KDM6B and macrophage marker F4/80 in renal tissues of HBV-GN patients was observed by immunofluorescence and immunohistochemistry. The association between kidney KDM6B levels and clinical features of HBV-GN patients was analyzed. The expression of KDM6B, F4/80, major histocompatibility complex (MHC)-Ⅱ and CD40 in the podocytes was detected by Western blotting. The contents of interferon-γ (IFN-γ) and interleukin-6 (IL-6) in the supernatant were determined by enzyme-linked immunosorbent assay (ELISA). The small interfering RNA of KDM6B (KDM6B siRNA) was used to silence the expression of KDM6B and the protein levels of KDM6B, F4/80 and tri-methylation of lysine 27 of histone H3 (H3K27me3) induced by HBx gene transfection were detected by Western blotting. Results: Renal KDM6B expression was significantly increased in HBV-GN patients compared to normal control (0.022±0.004 vs 0.006±0.002, P=0.006). There was no significant difference in the positive rate of KDM6B among different pathological types of HBV-GN (P=0.139). Moreover, co-expression of KDM6B and F4/80 could be observed in the podocytes of HBV-GN patients. Patients with estimated glomerular filtration (eGFR)<60 ml·min-1·(1.73 m2)-1or proteinuria ≥ 3.5 g/day had a significantly higher renal KDM6B expression compared to control groups (all P<0.05). In addition, the expression of KDM6B, F4/80, MHC-II and CD40 was significantly up-regulated in the podocytes transfected with HBx gene (all P<0.05). The content of IFN-γ and IL-6 in the supernatant was significantly increased (all P<0.05). After gene silencing of KDM6B, the expression of F4/80 induced by HBx in the podocytes was significantly down-regulated, while the level of H3K27me3 was significantly increased (both P<0.05). Conclusions: HBx could induce KDM6B expression in podocytes and initiate PMT, thereby involving in the dysfunction of immune microenviroment in the renal tissues of HBV-GN.
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Affiliation(s)
- Y T Yang
- Department of Nephrology, Qingdao Municipal Hospital, Qingdao 266071, China
| | - Y Du
- Department of Nephrology, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - W J Yuan
- Department of Nephrology, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - L Wang
- Department of Nephrology, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
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Wu SR, Chen XD, Li JL, Yang YT, Cui ZH, Yao JH. Effect of alfalfa hay and starter feed supplementation on caecal microbiota and fermentation, growth, and health of yak calves. Animal 2021; 15:100019. [PMID: 33610512 DOI: 10.1016/j.animal.2020.100019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
The caecum is the primary site where microbial fermentation and acidosis occurred. The supplementation of starter feed and alfalfa hay has the potential to influence caecal microbiota and then affect caecal fermentation. This study aims to investigate the effect of starter feed and alfalfa hay supplementation on caecal microbiota, immune homeostasis, and growth of preweaning yaks. Twenty 30-day-old male yak calves were randomly assigned to four groups, which separately fed with milk replacer (CON group), milk replacer with alfalfa hay (A group), milk replacer with starter feed (S group), and milk replacer with starter feed plus alfalfa hay (SA group) throughout the trial. Growth performance and plasma physiological and biochemical indicators were measured every 30 days. Calves were sacrificed at 120 days of age. The caecal contents were collected for measuring pH and contents of volatile fatty acids (VFAs) and lipopolysaccharide (LPS) and for characterizing caecal microbiota. The results indicated that individual or simultaneous supplementation with alfalfa hay and starter feed all significantly increased the BW, body height, body length, and chest girth of yak calves. However, supplementation with starter feed significantly increased plasma cortisol, nitric oxide, tumor necrosis factor-α, and interferon-γ concentrations and the ratio of aspartate aminotransferase to alanine aminotransferase of yak calves when compared with the control and alfalfa hay feeding groups, while the co-supplementation of starter feed and alfalfa hay could significantly decrease these inflammation-related indices when compared with the starter feeding group. Sequencing of the 16S rRNA gene showed that starter feed and alfalfa hay separately stimulated the proliferation of starch-decomposing and cellulose- or hemicellulose-decomposing bacteria. This also significantly increased the levels of acetate, propionate, butyrate, valerate, isobutyrate, and isovalerate in the caecal contents. Furthermore, compared with the S and CON groups, the significantly increased genera of Desulfobulbus, Olsenella, Pseudoflavonifractor, and Stomatobaculum in the SA and A groups were beneficial to the immune homeostasis, and the significantly decreased Blautia, Clostridium IV, Bacteroides, Eubacterium, Clostridium XVIII, and Mogibacterium in the SA and A groups were related to the reduced caecal lactate and LPS contents, the decreased inflammatory reaction, and the improved healthy hepatic condition of yak calves. In conclusion, milk replacer supplemented with alfalfa hay and starter feed is recommended during preweaning to improve yak calf health and growth because this regimen promotes the growth and maintains the immune homeostasis of yak calves.
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Affiliation(s)
- S R Wu
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi, China
| | - X D Chen
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi, China
| | - J L Li
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi, China
| | - Y T Yang
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi, China
| | - Z H Cui
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi, China; Qinghai Academy of Animal Science and Veterinary Medicine, Xining, Qinghai, China
| | - J H Yao
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi, China.
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Bennett CL, Nagai S, Bennett AC, Hoque S, Nabhan C, Schoen MW, Hrushesky WJ, Luminari S, Ray P, Yarnold PR, Witherspoon B, Riente J, Bobolts L, Brusk J, Tombleson R, Knopf K, Fishman M, Yang YT, Carson KR, Djulbegovic B, Restaino J, Armitage JO, Sartor OA. The First 2 Years of Biosimilar Epoetin for Cancer and Chemotherapy-Induced Anemia in the U.S.: A Review from the Southern Network on Adverse Reactions. Oncologist 2021; 26:e1418-e1426. [PMID: 33586299 DOI: 10.1002/onco.13713] [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: 08/07/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
Biosimilars are biologic drug products that are highly similar to reference products in analytic features, pharmacokinetics and pharmacodynamics, immunogenicity, safety, and efficacy. Biosimilar epoetin received Food and Drug Administration (FDA) approval in 2018. The manufacturer received an FDA nonapproval letter in 2017, despite receiving a favorable review by FDA's Oncologic Drugs Advisory Committee (ODAC) and an FDA nonapproval letter in 2015 for an earlier formulation. We discuss the 2018 FDA approval, the 2017 FDA ODAC Committee review, and the FDA complete response letters in 2015 and 2017; review concepts of litigation, naming, labeling, substitution, interchangeability, and pharmacovigilance; review European and U.S. oncology experiences with biosimilar epoetin; and review the safety of erythropoiesis-stimulating agents. In 2020, policy statements from AETNA, United Health Care, and Humana indicated that new epoetin oncology starts must be for biosimilar epoetin unless medical need for other epoetins is documented. Empirical studies report that as of 2012, reference epoetin use decreased from 40%-60% of all patients with cancer with chemotherapy-induced anemia to <5% of such patients because of safety concerns. Between 2018 and 2020, biosimilar epoetin use varied, increasing to 81% among one private insurer's patients covered by Medicare whose cancer care is administered with Oncology Analytics and to 41% with the same private insurer's patients with cancer covered by commercial health insurance and administered by the private insurer, to 0% in several Veterans Administration Hospitals, increasing to 100% in one large county hospital in California, and with yet-to-be-reported data from most oncology settings. We conclude that biosimilar epoetin appears to have overcome some barriers since 2015, although current uptake in the U.S. is variable. Pricing and safety considerations for all erythropoiesis-stimulating agents are primary determinants of biosimilar epoetin oncology uptake. IMPLICATIONS FOR PRACTICE: Few oncologists understand substitution and interchangeability of biosimilars with reference drugs. Epoetin biosimilar is new to the market, and physician and patient understanding is limited. The development of epoetin biosimilar is not familiar to oncologists.
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Affiliation(s)
- Charles L Bennett
- Toni Stephenson Lymphoma Center, the Hematologic Malignancies Research Institute, the Beckman Research Institute, of the City of Hope Cancer Center, Duarte, California.,College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | | | - Andrew C Bennett
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Shamia Hoque
- Department of Civil and Environmental Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina
| | - Chadi Nabhan
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Martin W Schoen
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | | | - Stefano Luminari
- Hematology, AUSL IRCCS Reggio Emilia.,Department CHIMOMO, University of Modena and Reggio Emilia, Regio Emilia, Italy
| | - Paul Ray
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Paul R Yarnold
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Bart Witherspoon
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Josh Riente
- William J Bryan Dorn Veterans Administration Medical Center, Columbia, South Carolina
| | - Laura Bobolts
- Oncology Analytics, Atlanta, Georgia.,College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - John Brusk
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rebecca Tombleson
- College of Pharmacy, University of South Carolina, Columbia, South Carolina.,College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Kevin Knopf
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Marc Fishman
- College of Pharmacy, University of South Carolina, Columbia, South Carolina.,Oncology Analytics, Atlanta, Georgia
| | - Y Tony Yang
- George Washington University School of Nursing and Milken Institute School of Public Health, Washington, DC
| | - Kenneth R Carson
- The Division of Hematology/Oncology, Department of Medicine, Rush University School of Medicine, Chicago, Illinois
| | - Benjamin Djulbegovic
- The City of Hope, Beckman Research Institute, Department of Computational and Quantitative Medicine, Division of Health Analytics, Evidence-based Medicine & Comparative Effectiveness Research, Duarte, CA
| | - John Restaino
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - James O Armitage
- The Department of Medicine, The University of Nebraska School of Medicine, Omaha, Nebraska
| | - Oliver A Sartor
- The Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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Yang YT, Largent EA. The lost decade: clinical trials data access after Seife v HHS. Am J Manag Care 2021; 27:e34-e35. [PMID: 33577158 DOI: 10.37765/ajmc.2021.88550] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 2020 federal court ruling requires clinical trial sponsors to report a decade's worth of previously exempted data to the National Institutes of Health (NIH) for publication on ClinicalTrials.gov. In Seife v HHS, the US District Court for the Southern District of New York invalidated NIH regulations that exempted certain clinical trials conducted between 2007 and 2017 from results reporting requirements mandated by the Food and Drug Administration Amendments Act. Sharing data from publicly funded research can maximize the benefits of that research by allowing taxpayers, who effectively fund the research, to see the results of their investment. Regardless of the source of their funding, clinical trial data also facilitate replicability, critical analysis, and trust in the scientific community. These benefits make the recent decision in Seife particularly significant. However, its impact will be dampened if the government does not take steps to enforce it.
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Affiliation(s)
- Y Tony Yang
- George Washington University, 1919 Pennsylvania Ave NW, Ste 500, Washington, DC 20006.
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43
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Diana J Mason
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
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Bennett CL, Schoen MW, Hoque S, Witherspoon BJ, Aboulafia DM, Hwang CS, Ray P, Yarnold PR, Chen BK, Schooley B, Taylor MA, Wyatt MD, Hrushesky WJ, Yang YT. Improving oncology biosimilar launches in the EU, the USA, and Japan: an updated Policy Review from the Southern Network on Adverse Reactions. Lancet Oncol 2021; 21:e575-e588. [PMID: 33271114 DOI: 10.1016/s1470-2045(20)30485-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Abstract
The EU, the USA, and Japan account for the majority of biological pharmacotherapy use worldwide. Biosimilar regulatory approval pathways were authorised in the EU (2006), in Japan (2009), and in the USA (2015), to facilitate approval of biological drugs that are highly similar to reference products and to encourage market competition. Between 2007 and 2020, 33 biosimilars for oncology were approved by the European Medicines Agency (EMA), 16 by the US Food and Drug Administration (FDA), and ten by the Japan Pharmaceuticals and Medical Devices Agency (PMDA). Some of these approved applications were initially rejected because of manufacturing concerns (four of 36 [11%] with the EMA, seven of 16 [44%] with the FDA, none of ten for the PMDA). Median times from initial regulatory submission before approval of oncology biosimilars were 1·5 years (EMA), 1·3 years (FDA), and 0·9 years (PMDA). Pharmacists can substitute biosimilars for reference biologics in some EU countries, but not in the USA or Japan. US regulation prohibits substitution, unless the biosimilar has been approved as interchangeable, a designation not yet achieved for any biosimilar in the USA. Japan does not permit biosimilar substitution, as prescribers must include the product name on each prescription and that specific product must be given to the patient. Policy Reviews published in 2014 and 2016 in The Lancet Oncology focused on premarket and postmarket policies for oncology biosimilars before most of these drugs received regulatory approval. In this Policy Review from the Southern Network on Adverse Reactions, we identify factors preventing the effective launch of oncology biosimilars. Introduction to the market has been more challenging with therapeutic than for supportive care oncology biosimilars. Addressing region-specific competition barriers and educational needs would improve the regulatory approval process and market launches for these biologics, therefore expanding patient access to these products in the EU, the USA, and Japan.
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Affiliation(s)
- Charles L Bennett
- College of Pharmacy, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA; Department of Comparative Medicine and Evidence Based Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Martin W Schoen
- Saint Louis University School of Medicine, Saint Louis, MO, USA; John Cochran VA Medical Center, Saint Louis, MO, USA
| | - Shamia Hoque
- College of Engineering and Computing, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA
| | | | | | | | - Paul Ray
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Paul R Yarnold
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Brian K Chen
- The Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Benjamin Schooley
- College of Engineering and Computing, University of South Carolina, Columbia, SC, USA
| | - Matthew A Taylor
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Michael D Wyatt
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | | | - Y Tony Yang
- School of Nursing and Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Bennett CL, Hoque S, Olivieri N, Taylor MA, Aboulafia D, Lubaczewski C, Bennett AC, Vemula J, Schooley B, Witherspoon BJ, Godwin AC, Ray PS, Yarnold PR, Ausdenmoore HC, Fishman M, Herring G, Ventrone A, Aldaco J, Hrushesky WJ, Restaino J, Thomsen HS, Yarnold PR, Marx R, Migliorati C, Ruggiero S, Nabhan C, Carson KR, McKoy JM, Yang YT, Schoen MW, Knopf K, Martin L, Sartor O, Rosen S, Smith WK. Consequences to patients, clinicians, and manufacturers when very serious adverse drug reactions are identified (1997-2019): A qualitative analysis from the Southern Network on Adverse Reactions (SONAR). EClinicalMedicine 2021; 31:100693. [PMID: 33554084 PMCID: PMC7846671 DOI: 10.1016/j.eclinm.2020.100693] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adverse drug/device reactions (ADRs) can result in severe patient harm. We define very serious ADRs as being associated with severe toxicity, as measured on the Common Toxicity Criteria Adverse Events (CTCAE)) scale, following use of drugs or devices with large sales, large financial settlements, and large numbers of injured persons. We report on impacts on patients, clinicians, and manufacturers following very serious ADR reporting. METHODS We reviewed clinician identified very serious ADRs published between 1997 and 2019. Drugs and devices associated with reports of very serious ADRs were identified. Included drugs or devices had market removal discussed at Food and Drug Advisory (FDA) Advisory Committee meetings, were published by clinicians, had sales > $1 billion, were associated with CTCAE Grade 4 or 5 toxicity effects, and had either >$1 billion in settlements or >1,000 injured patients. Data sources included journals, Congressional transcripts, and news reports. We reviewed data on: 1) timing of ADR reports, Boxed warnings, and product withdrawals, and 2) patient, clinician, and manufacturer impacts. Binomial analysis was used to compare sales pre- and post-FDA Advisory Committee meetings. FINDINGS Twenty very serious ADRs involved fifteen drugs and one device. Legal settlements totaled $38.4 billion for 753,900 injured persons. Eleven of 18 clinicians (61%) reported harms, including verbal threats from manufacturer (five) and loss of a faculty position (one). Annual sales decreased 94% from $29.1 billion pre-FDA meeting to $4.9 billion afterwards (p<0.0018). Manufacturers of four drugs paid $1.7 billion total in criminal fines for failing to inform the FDA and physicians about very serious ADRs. Following FDA approval, the median time to ADR reporting was 7.5 years (Interquartile range 3,13 years). Twelve drugs received Box warnings and one drug received a warning (median, 7.5 years following ADR reporting (IQR 5,11 years). Six drugs and 1 device were withdrawn from marketing (median, 5 years after ADR reporting (IQR 4,6 years)). INTERPRETATION Because very serious ADRs impacts are so large, policy makers should consider developing independently funded pharmacovigilance centers of excellence to assist with clinician investigations. FUNDING This work received support from the National Cancer Institute (1R01 CA102713 (CLB), https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-cancer-institute-nci; and two Pilot Project grants from the American Cancer Society's Institutional Grant Award to the University of South Carolina (IRG-13-043-01) https://www.cancer.org/ (SH; BS).
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Affiliation(s)
- Charles L. Bennett
- City of Hope National Medical Center in Duarte, California, United States
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Shamia Hoque
- University of South Carolina College of Engineering and Computing in Columbia, South Carolina, United States
| | | | - Matthew A. Taylor
- University of South Carolina School of Medicine in Columbia, South Carolina, United States
| | - David Aboulafia
- Virginia Mason Medical Center in Seattle, Washington, United States
| | - Courtney Lubaczewski
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Andrew C. Bennett
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Jay Vemula
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Benjamin Schooley
- University of South Carolina College of Engineering and Computing in Columbia, South Carolina, United States
| | - Bartlett J. Witherspoon
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Ashley C Godwin
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Paul S. Ray
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Paul R. Yarnold
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Henry C. Ausdenmoore
- City of Hope National Medical Center in Duarte, California, United States
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- University of South Carolina College of Engineering and Computing in Columbia, South Carolina, United States
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
- University of South Carolina School of Medicine in Columbia, South Carolina, United States
- University of Miami Miller School of Medicine in Miami, Florida, United States
- Uniformed Services University F. Edward Hebert School of Medicine in Bethesda, Maryland, United States
- Tulane University School of Medicine in New Orleans, Louisiana, United States
- Northwestern University Feinberg School of Medicine in Chicago, Illinois, United States
- Rush University School of Medicine in Chicago, Illinois, United States
- Saint Louis University School of Medicine in Saint Louis, Missouri, United States
- University of Copenhagen in Copenhagen, Denmark
- Caris Life Sciences in Chicago, Illinois, United States
- Highland Hospital in Oakland, California, United States
- Virginia Mason Medical Center in Seattle, Washington, United States
- New York Center for Oral and Maxillofacial Surgery in New Hyde Park, New York, United States
- University of Florida in Gainesville, Florida, United States
| | - Marc Fishman
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Georgne Herring
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Anne Ventrone
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Juan Aldaco
- City of Hope National Medical Center in Duarte, California, United States
| | - William J. Hrushesky
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - John Restaino
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | | | - Paul R. Yarnold
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Robert Marx
- University of Miami Miller School of Medicine in Miami, Florida, United States
| | | | - Salvatore Ruggiero
- New York Center for Oral and Maxillofacial Surgery in New Hyde Park, New York, United States
| | - Chadi Nabhan
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- Caris Life Sciences in Chicago, Illinois, United States
| | - Kenneth R. Carson
- Rush University School of Medicine in Chicago, Illinois, United States
| | - June M. McKoy
- Northwestern University Feinberg School of Medicine in Chicago, Illinois, United States
| | - Y. Tony Yang
- George Washington University School of Nursing and Milken Institute School of Public Health in Washington, District of Columbia, United States
| | - Martin W. Schoen
- Saint Louis University School of Medicine in Saint Louis, Missouri, United States
| | - Kevin Knopf
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- Highland Hospital in Oakland, California, United States
| | - Linda Martin
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Oliver Sartor
- Tulane University School of Medicine in New Orleans, Louisiana, United States
| | - Steven Rosen
- City of Hope National Medical Center in Duarte, California, United States
| | - William K. Smith
- Uniformed Services University F. Edward Hebert School of Medicine in Bethesda, Maryland, United States
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Le D, Coriolan A, Pan J, Berg CJ, Hong YA, Nguyen A, Le HC, Abroms LC, Juon HS, Yang YT. Abstract PO-242: Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Viral hepatitis is a major public health problem around the world and in the United States, with significant morbidity and mortality. This research aimed to provide updated prevalence estimates and linkage-to-care rates for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among foreign-born immigrants in the Washington-Baltimore metropolitan area. Methods: This retrospective cohort study analyzed screening data obtained from over 275 community-based outreach events held from 2015 to 2019. Through strategic collaborations and culturally-appropriate programs, the Hepatitis B Initiative of Washington DC was able to provide no-cost HBV and HCV testing, vaccination, and treatment linkage-to-care services to 9,489 and 9,427 individuals, respectively. We examined the prevalence of positive HBV (HBsAg+) and HCV (HCVAb+) infections and linkage-to-care with associated sociodemographic characteristics. Results: Overall, prevalence amongst foreign-born clients screened over the 5-year period was 4.3% for HBV and 1.1% for HCV. The highest HBV prevalence was among participants born in Malaysia (8.5%), Cambodia (7.7%), and Vietnam (6.9%), whereas HCV prevalence was highest among participants born in Mongolia (5.0%), Cameroon (3.2%), and Burma (1.5%). Among the 378 HBV- and 102 HCV-infected individuals who were referred to care, linkage- to-care rates were 87.0% (2016-2019) and 47.1% (2017-2019) respectively. Among those linked to care, an overwhelming proportion reported not having health insurance (74.8%) and/or a usual source of care (75.3%); the majority were also female (52.8%), over 30 years of age (96.6%), and born in Asia (78.0%). Conclusions: Foreign-born individuals from Asia and Africa had the highest prevalence of viral hepatitis. These results underscore the need to disaggregate screening data by country of birth to inform prevention and linkage-to-care programs and their impact. Additionally, optimal HBV and HCV screening and linkage-to-care can be achieved among harder-to-reach at-risk populations through partnerships with community organizations, health centers, and public health departments.
Citation Format: Daisy Le, Annie Coriolan, Jane Pan, Carla Jean Berg, Y. Alicia Hong, Angeline Nguyen, Hai Chi Le, Lorien Cindy Abroms, Hee-Soon Juon, Y. Tony Yang. Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-242.
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Affiliation(s)
- Daisy Le
- 1George Washington University, Washington, DC,
| | | | - Jane Pan
- 2Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC,
| | | | | | - Angeline Nguyen
- 2Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC,
| | - Hai Chi Le
- 2Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC,
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47
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Chen BK, Jindal D, Yang YT, Hair N, Yang CY. Associations Between Physician Supply Levels and Amenable Mortality Rates: An Analysis of Taiwan Over Nearly 4 Decades. Health Serv Insights 2020; 13:1178632920954878. [PMID: 32973374 PMCID: PMC7495524 DOI: 10.1177/1178632920954878] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022] Open
Abstract
Access to health care is an important determinant of health, but it remains unclear whether having more physicians reduces mortality. In this study, we used Taiwan’s population-level National Death Certification Registry data to investigate whether a greater supply of physicians is associated with lower rates of amenable mortality, defined as deaths that can be delayed with appropriate and timely medical treatment. Our baseline regression analysis adjusting only for age and sex shows that an increase in the number of physicians per 1000 is associated with a reduction of 1.7 (P < .01) and 0.97 (P < .01) age-standardized deaths per 100 000 for men and women, respectively. However, in our full analyses that control for socioeconomic factors and Taiwan’s health insurance expansion, we find that physician supply is no longer statistically associated with amenable mortality rates. Nevertheless, we found that greater physician supply levels are associated with a reduction in deaths from ischemic heart disease (−0.13 (P < .05) for men, and −0.066 (P < .05) for women). These findings suggest that overall, physician supply is not associated with amenable mortality rates after controlling for socioeconomic factors but may help reduce amenable mortality rates in specific causes of death.
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Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dakshu Jindal
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Ashburn, VA, USA
| | - Nicole Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung
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48
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Wang X, Yang RR, Yang YT, Liu HJ, Yan H. [Research value of 50 MHz high-frequency ultrasound on sonography of normal facial skin in adult]. Zhonghua Shao Shang Za Zhi 2020; 36:853-860. [PMID: 32972071 DOI: 10.3760/cma.j.cn501120-20190701-00288] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the differences in normal facial skin thickness and echo density by different ages and sites of healthy adults of the same sex using 50 MHz high-frequency ultrasound. Methods: From January to June 2019, 200 healthy adult volunteers with normal facial skin who were from Sichuan, Yunnan, Guizhou, and Chongqing and met the inclusion criteria were recruited by the Affiliated Hospital of Southwest Medical University with simple random sampling method, and then were included in this cross-sectional investigation study. Then 50 MHz high-frequency ultrasound was used to obtain skin ultrasonogram of volunteers' forehead, canthus, eyelid, and cheek. According to the ages, 100 female volunteers were divided into 20-29 years old (30 females), 30-39 years old (25 females), 40-49 years old (20 females), and 50-70 years old (25 females) groups; 100 male volunteers were divided into 20-29 years old (30 males), 30-39 years old (25 males), 40-49 years old (20 males), and 50-70 years old (25 males) groups. The thickness of full-skin, the upper dermal echo density, and the lower dermal echo density of the female and male volunteers'forehead, canthus, eyelid, and cheek were recorded respectively. Data were statistically analyzed with one-way analysis of variance, analysis of variance for repeated measurement, least significant difference test, and Bonferroni correction. Results: (1) The thickness of full-thickness skin in forehead, canthus, eyelid, and cheek of female and male volunteers in 20-29 years old group were (1.86±0.26), (1.36±0.11), (1.24±0.25), and (1.90±0.21) mm, (2.45±0.37), (1.64±0.19), (1.44±0.16), and (2.53±0.26) mm, respectively, in 30-39 years old group were (1.98±0.24), (1.43±0.13), (1.15±0.15), and (2.12±0.13) mm, (2.34±0.27), (1.63±0.27), (1.50±0.38), and (2.43±0.40) mm, respectively, in 40-49 years old group were (1.90±0.21), (1.43±0.18), (1.24±0.27), and (1.98±0.12) mm, (2.14±0.24), (1.54±0.25), (1.28±0.14), and (2.39±0.36) mm, respectively, in 50-70 years old group were (1.64±0.25), (1.36±0.19), (1.16±0.12), and (1.89±0.29) mm, (2.28±0.27), (1.73±0.25), (1.58±0.18), and (2.38±0.32) mm, respectively. There were no statistically significant differences between female volunteers in the 4 groups and male volunteers in the 4 groups in thickness of full-thickness skin in canthus, eyelid, and cheek (F=0.677, 0.666, 0.136, 0.697, 0.294, 0.888, P>0.05). The thickness of full-thickness skin in forehead and cheek of the female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05), and was significantly higher than that of canthus and eyelid (P<0.05). The thickness of full-thickness skin in canthus and eyelid of female volunteers in 20-29 years old, 40-49 years old, and 50-70 years old group was similar (P>0.05), while thickness of full-thickness skin in canthus and eyelid of male volunteers in the 4 groups was similar (P>0.05). (2) The upper dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly lower than that in 20-29 years old and 30-39 years old groups (P<0.05). The upper dermal echo density of forehead, canthus, eyelid, and cheek of male volunteers in 50-70 years old group was significantly lower than that in 20-29 years old group (P<0.05). The upper dermal echo density of forehead, canthus, eyelid, and cheek of female and male volunteers in 20-29 years old and 30-39 years old groups was similar (P>0.05). The upper dermal echo density of forehead and cheek of female volunteers in 20-29 years old, 40-49 years old, and 50-70 years old groups was significantly lower than that of canthus and eyelid (P<0.05). The echo density of upper dermis of cheek of male volunteers in the 4 groups was significantly lower than that of canthus and eyelid (P<0.05). The upper dermal echo density of canthus and eyelid of female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05), the upper dermal echo density of forehead and cheek was similar (P>0.05). (3) The lower dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly higher than that in 20-29 years old and 30-39 years old groups (P<0.05). The lower dermal echo density of forehead, canthus, eyelid, and cheek of male volunteers in 50-70 years old group was significantly higher than that in 20-29 years old group (P<0.05). The echo density of the lower dermis of forehead, eyelid, and cheek of female and male volunteers in 20-29 years old, 30-39 years old, and 40-49 years old groups was similar (P>0.05). The lower dermal echo density of forehead and cheek of female volunteers in the 4 groups was significantly lower than that of canthus and eyelid (P<0.05). The lower dermal echo density of forehead and cheek of male volunteers in 30-39 years old, 40-49 years old, and 50-70 years old groups was significantly lower than that of canthus and eyelid (P<0.05). The lower dermal echo density between canthus and eyelid and between forehead and check of female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05). Conclusions: The 50 MHz high-frequency ultrasonography shows that the thickness of full-thickness skin of canthus, eyelid, and cheek is similar in all age groups of female and male adult volunteers with normal facial skin. In the same age group, the thickness of full-thickness skin of forehead and cheek of male and female volunteers is significantly higher than that of canthus and eyelid. The upper dermal echo density of forehead, canthus, eyelid, and cheek of female and male volunteers shows a decreasing trend with age, while the lower dermal echo density shows an increasing trend with age. In addition, the echo density of upper and lower dermis of canthus and eyelid was significantly higher than that of cheek in all the four age groups.
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Affiliation(s)
- X Wang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - R R Yang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Y T Yang
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - H J Liu
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - H Yan
- Department of Plastic Surgery and Burns, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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Tan J, Yang YT, Sun WJ, Zhu ZL, Deng H. [The functional heterogeneity and source diversity of cancer associated fibroblasts]. Zhonghua Bing Li Xue Za Zhi 2020; 49:764-767. [PMID: 32610399 DOI: 10.3760/cma.j.cn112151-20200420-00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Tan
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Y T Yang
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - W J Sun
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Z L Zhu
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - H Deng
- Department of Pathology, Key Laboratory of Disease Proteomics of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou 310058, China
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50
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Hoque S, Chen BJ, Schoen MW, Carson KR, Keller J, Witherspoon BJ, Knopf KB, Yang YT, Schooley B, Nabhan C, Sartor O, Yarnold PR, Ray P, Bobolts L, Hrushesky WJ, Dickson M, Bennett CL. End of an era of administering erythropoiesis stimulating agents among Veterans Administration cancer patients with chemotherapy-induced anemia. PLoS One 2020; 15:e0234541. [PMID: 32584835 PMCID: PMC7316310 DOI: 10.1371/journal.pone.0234541] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/18/2020] [Indexed: 11/18/2022] Open
Abstract
Erythropoisis stimulating agent (ESA) use was addressed in Food and Drug Administration (FDA) Oncology Drug Advisory Committee (ODAC) meetings between 2004 and 2008. FDA safety-focused regulatory actions occurred in 2007 and 2008. In 2007, black box warnings advised of early death and venous thromboembolism (VTE) risks with ESAs in oncology. In 2010, a Risk Evaluation Strategies (REMS) was initiated, with cancer patient consent that mortality and VTE risks were noted with ESAs. We report warnings and REMS impacts on ESA utilization among Veterans Administration (VA) cancer patients with chemotherapy-induced anemia (CIA). Data were from Veterans Affairs database (2003–2012). Epoetin and darbepoetin use were primary outcomes. Segmented linear regression was used to estimate changes in ESA use levels and trends, clinical appropriateness, and adverse events (VTEs) among chemotherapy-treated cancer patients. To estimate changes in level of drug prescription rate after policy actions, model-specific indicator variables as covariates based on specific actions were included. ESA use fell by 95% and 90% from 2005, for epoetin and darbepoetin, from 22% and 11%, respectively, to 1% and 1%, respectively, among cancer patients with CIA, respectively (p<0.01). Following REMS in 2010, mean hematocrit levels at ESA initiation decreased from 30% to 21% (p<0.01). Black box warnings preceded decreased ESA use among VA cancer patients with CIA. REMS was followed by reduced hematocrit levels at ESA initiation. Our findings contrast with privately- insured and Medicaid insured cancer patient data on chemotherapy-induced anemia where ESA use decreased to 3% to 7% by 2010–2012. By 2012, the era of ESA administration to VA to cancer patients had ended but the warnings remain relevant and significant. In 2019, oncology/hematology national guidelines (ASCO/ASH) recommend that cancer patients with chemotherapy-induced anemia should receive ESAs or red blood cell transfusions after risk-benefit evaluation.
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Affiliation(s)
- Shamia Hoque
- Department of Civil and Environmental Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail:
| | - Brian J. Chen
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Martin W. Schoen
- Department of Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, United States of America
| | - Kenneth R. Carson
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
| | - Jesse Keller
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
| | | | - Kevin B. Knopf
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Y. Tony Yang
- George Washington University, Washington, DC, United States of America
| | - Benjamin Schooley
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, United States of America
| | - Chadi Nabhan
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Paul R. Yarnold
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Paul Ray
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Laura Bobolts
- Oncology Analytics, Plantation, Florida, United States of America
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - William J. Hrushesky
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Michael Dickson
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Charles L. Bennett
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
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