1
|
Misra S, Swayampakala K, Rajwani A, Davenport E, Fedor J, Saxonhouse S, Holshouser J, Patel N, Thompson J, Beaty E, Jain M, Powell B, Mehta R. Outcomes of an expedited same-day discharge protocol following cardiac implantable electronic device (CIED) implantation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01734-w. [PMID: 38194120 DOI: 10.1007/s10840-024-01734-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND With increasing constraints on healthcare resources, greater attention is being focused on improved resource utilization. Prior studies have demonstrated safety of same-day discharge following CIED implantation but are limited by vague protocols with long observation periods. In this study, we evaluate the safety of an expedited 2 hour same-day discharge protocol following CIED implantation. METHODS Patients undergoing CIED implantation at three centers between 2015 and 2021 were included. Procedural, demographic, and adverse event data were abstracted from the electronic health record. Patients were divided into same-day discharge (SDD) and delayed discharge (DD) cohorts. The primary outcome was complications including lead malfunction requiring revision, pneumothorax, hemothorax, lead dislodgement, lead perforation with tamponade, and mortality within 30 days of procedure. Outcomes were compared between the two cohorts using the χ2 test. RESULTS A total of 4543 CIED implantation procedures were included with 1557 patients (34%) in the SDD cohort. SDD patients were comparatively younger, were more likely to be male, and had fewer comorbidities than DD patients. Among SDD patients, the mean time to post-operative chest X-ray was 2.6 h. SDD had lower rates of complications (1.3% vs 2.1%, p = 0.0487) and acute care utilization post-discharge (9.6% vs 14.0%, p < 0.0001). There was no difference in the 90-day infection rate between the cohorts. CONCLUSIONS An expedited 2 hour same-day discharge protocol is safe and effective with low rates of complications, infection, and post-operative acute care utilization.
Collapse
Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA.
| | - Kamala Swayampakala
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Aparna Rajwani
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elizabeth Davenport
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Fedor
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Sherry Saxonhouse
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Holshouser
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Neel Patel
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Joseph Thompson
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elijah Beaty
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Manish Jain
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Brian Powell
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| |
Collapse
|
2
|
Misra S, Niazi K, Swayampakala K, Blackmon A, Lang M, Davenport E, Saxonhouse S, Fedor J, Powell B, Thompson J, Holshouser J, Mehta R. Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study. JMIR Cardio 2023; 7:e49345. [PMID: 38096021 PMCID: PMC10755650 DOI: 10.2196/49345] [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: 05/25/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. OBJECTIVE This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. METHODS A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. RESULTS The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. CONCLUSIONS An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort.
Collapse
Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - Karen Niazi
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | | | - Amanda Blackmon
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - Melissa Lang
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | | | | | - John Fedor
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - Brian Powell
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - Joseph Thompson
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - John Holshouser
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, Charlotte, NC, United States
| |
Collapse
|
3
|
Serven V, Swayampakala K, Lesassier C, Siekmann T, Rivera‐Camacho G, Rao S, Sullivan DM, Meyers HP, Pearson D. Multicenter analysis to assess risk of major adverse cardiac events in patients undergoing high-sensitivity troponin testing in the emergency department. J Am Coll Emerg Physicians Open 2023; 4:e13047. [PMID: 37811361 PMCID: PMC10560008 DOI: 10.1002/emp2.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Study hypothesis Our objective was to evaluate 30-day major adverse cardiac events (MACE) in emergency department (ED) patients with normal high-sensitivity troponins (hs-trop). We hypothesized that MACE rates would be <1% in patients with (1) two normal troponins regardless of change in troponin (delta) and (2) index hs-trop below the limit of quantitation (LOQ) regardless of the institution modified HEART score. Methods This was a multicenter, retrospective, cohort study of adult patients who presented to 1 of 18 EDs between July 2020 and April 2021 with acute coronary syndrome as defined by an institutional-modified HEART score completed by their treating physician or midlevel, no evidence of ST-elevation myocardial infarction, and an index or serial gender-adjusted hs-trop within normal limits. The primary outcome was MACE within 30 days of index ED encounter. A detailed case review was then performed for those patients experiencing a MACE. Results Of the 9084 patients who had single or serial normal troponins, 31 (0.34%; confidence interval [CI] 0.23%-0.48%) experienced MACE. Of the 6140 patients with 2 normal hs-trop and a delta (change in troponin) <4, 27 patients (0.44%; CI 0.29%-0.64%) experienced MACE. Only 1 of the 69 patients with 2 normal hs-trop results but delta (change in troponin) ≥ 4 (1.45%; CI 0.04%-7.81%) suffered MACE. This patient was classified as non-low risk by our institutional HEART score. Of 7498 patients with an index hs-trop Conclusion Patients with 2 normal hs-trop values in the ED are unlikely to suffer 30-day MACE. Although it remains unclear whether patients with delta (change in troponin) ≥4 despite normal troponins will have a 30-day MACE, this situation is rare. Additionally, a single index hs-trop <6 ng/L demonstrated a low risk for 30-day MACE independent of the institutional HEART score.
Collapse
Affiliation(s)
- Victoria Serven
- Department of Emergency MedicineAtrium Health's Carolinas Medical CenterCharlotteNorth CarolinaUSA
| | | | - Christy Lesassier
- Sanger Heart & Vascular InstituteAtrium HealthCharlotteNorth CarolinaUSA
| | - Tyler Siekmann
- Department of Emergency MedicineAtrium Health's Carolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Gabriel Rivera‐Camacho
- Department of Emergency MedicineAtrium Health's Carolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Santosh Rao
- Sanger Heart & Vascular InstituteAtrium HealthCharlotteNorth CarolinaUSA
| | | | - Harvey Pendell Meyers
- Department of Emergency MedicineAtrium Health's Carolinas Medical CenterCharlotteNorth CarolinaUSA
| | - David Pearson
- Department of Emergency MedicineAtrium Health's Carolinas Medical CenterCharlotteNorth CarolinaUSA
| |
Collapse
|
4
|
Stuckey T, Kowalchuk G, Swayampakala K, Gohs F, Kruse K, Bensimhon D. TCT-370 Carolinas Cardiogenic Shock Initiative: 30-Day Outcomes. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
5
|
Misra S, Swayampakala K, Coons P, Cerbie C, Guifarro A, Lesiczka M, Holshouser JW, Madjarov J, Love C, Mehta R. Outcomes of transvenous lead extraction using the TightRail™ mechanical rotating dilator sheath and excimer laser sheath. J Cardiovasc Electrophysiol 2021; 32:1969-1978. [PMID: 34028112 DOI: 10.1111/jce.15105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is an important part of comprehensive lead management. The selection of tools available has expanded in recent years but data on their efficacy is limited. OBJECTIVE To evaluate outcomes using the TightRail™ mechanical rotating mechanical dilator sheath in comparison to excimer laser sheaths and describe factors predictive of successful extraction. METHODS Patients undergoing TLE at a single tertiary center (2013-2019) were included in a prospective registry. Leads targeted for extraction with either an SLS II/Glidelight™ or TightRail™ sheath were included. Outcomes were analyzed on a per-lead basis. Generalized estimating equation (GEE) models were used to assess differences in lead extraction success by extraction tool used while adjusting for nonindependence of multiple leads extracted from the same patient. Covariates included patient comorbidities, lead characteristics, and sheath size. RESULTS A total of 575 leads extracted from 372 patients were included. Overall success rate was 97%. TightRail™ was the first tool used in 180 (31.3%) leads with success rate of 61.7%; laser sheaths were the first tool in 395 leads (68.7%) with success rate of 67.8%. Predictors of successful extraction included lead age, lead type, and sheath sizing. Extraction success did not differ based on whether a laser or TightRail™ sheath was used (adjusted odds ratio = 0.94; 95% confidence interval = 0.59-1.50). CONCLUSION The TightRail™ sheath is an effective tool for TLE. Lead age, lead type, and sheath sizing were predictive of successful extraction but sheath type was not. These findings are hypothesis generating and warrant further investigation in a prospective, randomized study.
Collapse
Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Kamala Swayampakala
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Patricia Coons
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Claire Cerbie
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Angello Guifarro
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Magdalena Lesiczka
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - John W Holshouser
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Jeko Madjarov
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Charles Love
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| |
Collapse
|
6
|
Misra S, Swayampakala K, Coons T, Lesiczka M, Guifarro A, Holshouser J, Mehta R. SUCCESS OF LEAD EXTRACTION USING MANUFACTURER RECOMMENDED SHEATH SIZE - PREDICTING WHEN TO UPSIZE FROM THE START. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Rinaldi MJ, Swayampakala K, Scherer M, Schwartz J, Kelly N. TRANSCATHETER EDGE TO EDGE MITRAL VALVE REPAIR (TEER) PROCEDURAL COMPLEXITY TOOL AND VALIDATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
8
|
Stanley GA, Ballast JK, Swayampakala K, Briggs CS, Yammine H, Nussbaum T, Crespo-Soto H, Arko FR. Thirty-Day Readmissions After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
9
|
Swayampakala K, Thrasher JF, Yong HH, Nagelhout GE, Li L, Borland R, Hammond D, O'Connor RJ, Hardin JW. Over-Time Impacts of Pictorial Health Warning Labels and their Differences across Smoker Subgroups: Results from Adult Smokers in Canada and Australia. Nicotine Tob Res 2019. [PMID: 28637294 DOI: 10.1093/ntr/ntx134] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction This study examines patterns of change in different smoker subgroups' responses to new pictorial health warning labels (HWLs) over the initial, two year post-implementation period in Canada, where HWLs include package inserts with cessation messages, and Australia, where "plain" packaging (i.e., prohibition of brand imagery) was also implemented. Methods Data were collected from online consumer panels in Canada (nsmokers = 3153; nobservations = 5826) and Australia (nsmokers = 2699; nobservations = 5818) from September 2012 to September 2014, with approximately 1000 adult smokers surveyed in each country every four months, using replenishment to maintain sample size. Data were analyzed using generalized estimating equation models where main effects and interactions among time, country, and socio-demographic factors on HWL responses (i.e., attention to HWLs; cognitive and behavioral responses to HWLs) were examined. Results Over time, attention to HWLs declined but cognitive and forgoing responses to HWLs increased, in both Canada and Australia. In both countries, compared to smokers with low income and/or education, smokers with high income and/or education showed an increase over time in attention and cognitive responses to HWLs (p < .05). In Australia only, compared to older smokers, younger smokers showed less decline over time in attention and greater increase in cognitive and forgoing responses to HWLs (p < .001). Conclusions Novel HWL policies in Canada and Australia appear effective in staving off "wear out" over the first 2 years after implementation, particularly amongst smokers who are from higher SES groups and, in Australia, who are younger. Implications Previous research shows that the effects of health warning label (HWL) on smokers decline over time, but no studies to date have evaluated whether trends differ across socio-demographic groups. This study suggests that innovative policy configurations that combine prominent pictorial HWLs with inserts (Canada) and with "plain" packaging (Australia) may delay wear out over the first 2 years after implementation. While this study found evidence for wear out in attention to HWLs, other HWL responses (cognitive responses, forgoing cigarettes) actually increased over time, with greater increases amongst smokers with higher income and/or education.
Collapse
Affiliation(s)
- Kamala Swayampakala
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA.,Department of Tobacco Research, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Gera E Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands.,Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, the Netherlands
| | - Lin Li
- Cancer Council Victoria, Melbourne, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Australia
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, New York, USA
| | - James W Hardin
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| |
Collapse
|
10
|
Swayampakala K, Thrasher JF, Hardin JW, Titus AR, Liu J, Fong GT, Fleischer NL. Factors associated with changing cigarette consumption patterns among low-intensity smokers: Longitudinal findings across four waves (2008-2012) of ITC Mexico Survey. Addict Behav Rep 2018; 8:154-163. [PMID: 30364679 PMCID: PMC6197769 DOI: 10.1016/j.abrep.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background Light and intermittent smoking has become increasingly prevalent as smokers shift to lower consumption in response to tobacco control policies. We examined changes in cigarette consumption patterns over a four-year period and determined which factors were associated with smoking transitions. Methods We used data from a cohort of smokers from the 2008–2012 ITC Mexico Survey administrations to investigate transitions from non-daily (ND; n = 669), daily light (DL; ≤5 cigarettes per day (cpd); n = 643), and daily heavy (DH; >5 cpd; n = 761) smoking patterns. To identify which factors (i.e., sociodemographic measures, perceived addiction, quit behavior, social norms) were associated with smoking transitions, we stratified on smoking status at time t (ND, DL, DH) and used multinomial (ND, DL) and binomial (DH) logistic regression to examine transitions (quitting/reducing or increasing versus same level for ND and DL, quitting/reducing versus same level for DH). Results ND smokers were more likely to quit at follow-up than DL or DH smokers. DH smokers who reduced their consumption to ND were more likely to quit eventually compared to those who continued as DH. Smokers who perceived themselves as addicted had lower odds of quitting/reducing smoking consumption at follow-up compared to smokers who did not, regardless of smoking status at the prior survey. Quit attempts and quit intentions were also associated with quitting/reducing consumption. Conclusions Reducing consumption may eventually lead to cessation, even for heavier smokers. The findings that perceived addiction and quit behavior were important predictors of changing consumption for all groups may offer insights into potential interventions. Smoking transitions were evaluated in a cohort of Mexican smokers. The cohort consisted mostly of understudied light and intermittent smokers (LITS). Reductions in smoking intensity were found to facilitate smoking cessation. Greater perceived addiction inhibited cessation for smokers at all levels of intensity. LITS patterns warrant attention as number of low-intensity smokers worldwide grows.
Collapse
Affiliation(s)
- Kamala Swayampakala
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James F. Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Andrea R. Titus
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Corresponding author at: Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| |
Collapse
|
11
|
Anshari D, Yong HH, Borland R, Hammond D, Swayampakala K, Thrasher J. Which type of tobacco product warning imagery is more effective and sustainable over time? A longitudinal assessment of smokers in Canada, Australia and Mexico. BMJ Open 2018; 8:e021983. [PMID: 30007932 PMCID: PMC6089327 DOI: 10.1136/bmjopen-2018-021983] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study examined smokers' responses to pictorial health warnings (PHWs) with different types of imagery under natural exposure conditions. METHODS Adult smokers from online panels in Canada (n=2357), Australia (n=1671) and Mexico (n=2537) were surveyed every 4 months from 2012 to 2013. Participants were shown PHWs on packs in their respective countries and asked about: (1) noticing PHWs; (2) negative affects towards PHWs; (3) believability of PHWs; (4) PHW-stimulated discussions; and (5) quit motivation due to PHWs. Country-specific generalised estimating equation models regressed these outcomes on time (ie, survey wave), PHW imagery type (ie, symbolic representations of risk, suffering from smoking and graphic depictions of bodily harm) and interactions between them. RESULTS In all countries, PHW responses did not significantly change over time, except for increased noticing PHWs in Canada and Mexico, increased negative affect in Australia and decreased negative affect in Mexico. For all outcomes, symbolic PHWs were rated lower than suffering and graphic PHWs in Canada (the only country with symbolic PHWs). Graphic PHWs were rated higher than suffering PHWs for negative affect (all countries), discussions (Canada) and quit motivation (Australia). Suffering PHWs were rated higher than graphic PHWs for noticing PHWs (Canada), believability (all countries), discussions (AustraliaandMexico) and quit motivation (Mexico). Changes in noticing, believability and discussions varied somewhat by imagery type across countries. CONCLUSIONS The different PHW imagery appears to have different pathways of influence on adult smokers. Reactions to specific PHWs are similar over 1-2 years, suggesting that wear-out of PHW effects is due to decreased attention rather than the diminishing effectiveness of content.
Collapse
Affiliation(s)
- Dien Anshari
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Hua-Hie Yong
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kamala Swayampakala
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jim Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
12
|
Cho YJ, Thrasher JF, Swayampakala K, Lipkus I, Hammond D, Cummings KM, Borland R, Yong HH, Hardin JW. Does Adding Information on Toxic Constituents to Cigarette Pack Warnings Increase Smokers' Perceptions About the Health Risks of Smoking? A Longitudinal Study in Australia, Canada, Mexico, and the United States. Health Educ Behav 2017; 45:32-42. [PMID: 28715260 DOI: 10.1177/1090198117709884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health warning labels (HWLs) on cigarette packs in Australia, Canada, Mexico, and the United States include varying information about toxic cigarette smoke constituents and smoking-related health risks. HWL information changed more recently in Australia, Canada, and Mexico than in the United States. AIMS To investigate whether smokers' knowledge of toxic constituents and perceived smoking-related risks increased after adding this information to HWLs and how knowledge of toxic constituents is associated with perceptions of smoking-related risks. METHODS Data come from a longitudinal, online cohort of 4,621 adult smokers surveyed every 4 months from September 2012 (Wave 1) to January 2014 (Wave 5) in Australia, Canada, and Mexico, with the United States being surveyed from Waves 2 to 5. Generalized estimating equation models estimated the association between perceived smoking-related risk at follow-up and prior wave knowledge of toxic constituents, adjusting for attention to HWLs, sociodemographics, and smoking-related characteristics. RESULTS Between 2012 and 2014, knowledge of toxic constituents increased in Australia, Canada, and Mexico ( p < .001), but not in the United States. Higher levels of both attention to HWLs and knowledge of toxic constituents were associated with a higher perceived risk of smoking-related conditions at follow-up across all countries except for the United States. CONCLUSIONS Our results suggest that information about toxic constituents on prominent HWLs not only increases smoker's knowledge of toxic constituents, but that it may also reinforce the effects of HWL messages about specific, smoking-related health outcomes.
Collapse
Affiliation(s)
- Yoo Jin Cho
- 1 University of South Carolina, Columbia, SC, USA
| | - James F Thrasher
- 1 University of South Carolina, Columbia, SC, USA.,2 National Institute of Public Health, Cuernavaca, Mexico
| | | | | | | | | | - Ron Borland
- 6 Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Hua-Hie Yong
- 6 Cancer Council Victoria, Melbourne, Victoria, Australia
| | | |
Collapse
|
13
|
Thrasher JF, Swayampakala K, Borland R, Nagelhout G, Yong HH, Hammond D, Bansal-Travers M, Thompson M, Hardin J. Influences of Self-Efficacy, Response Efficacy, and Reactance on Responses to Cigarette Health Warnings: A Longitudinal Study of Adult Smokers in Australia and Canada. Health Commun 2016; 31:1517-26. [PMID: 27135826 PMCID: PMC4972657 DOI: 10.1080/10410236.2015.1089456] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Guided by the extended parallel process model (EPPM) and reactance theory, this study examined the relationship between efficacy beliefs, reactance, and adult smokers' responses to pictorial health warning labels (HWL) on cigarette packaging, including whether efficacy beliefs or reactance modify the relationship between HWL responses and subsequent smoking cessation behavior. Four waves of data were analyzed from prospective cohorts of smokers in Australia and Canada (n = 7,120 observations) over a period of time after implementation of more prominent, pictorial HWLs. Three types of HWL responses were studied: psychological threat responses (i.e., thinking about risks from smoking), forgoing cigarettes due to HWLs, and avoiding HWLs. The results from Generalized Estimating Equation models indicated that stronger efficacy beliefs and lower trait reactance were significantly associated with greater psychological threat responses to HWLs. Similar results were found for models predicting forgoing behavior, although response efficacy was inversely associated with it. Only response efficacy was significantly associated with avoiding HWLs, showing a positive relationship. Higher self-efficacy and stronger responses to HWLs, no matter the type, were associated with attempting to quit in the follow-up period; reactance was unassociated. No statistically significant interactions were found. These results suggest that stronger efficacy beliefs and lower trait reactance are associated with some stronger responses to fear-arousing HWL responses; however, these HWL responses appear no less likely to lead to cessation attempts among smokers with different levels of self-efficacy to quit, of response efficacy beliefs, or of trait reactance against attempts to control their behavior.
Collapse
Affiliation(s)
- James F. Thrasher
- Department of Health Promotion, Education & Behavior, University of South Carolina
- Department of Tobacco Research, National Institute of Public Health, Mexico
- CONTACT James F. Thrasher Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Discovery I Building, 534D, 915 Greene Street, Columbia, SC29208
| | - Kamala Swayampakala
- Department of Health Promotion, Education & Behavior, University of South Carolina
| | | | - Gera Nagelhout
- Health Promotion and Health Communication, Maastricht University
| | | | - David Hammond
- School of Public Health & Health Systems, University of Waterloo
| | | | - Mary Thompson
- Department of Statistics and Actuarial Sciences, University of Waterloo
| | - James Hardin
- Department of Epidemiology & Biostatistics, University of South Carolina
| |
Collapse
|
14
|
Cho YJ, Thrasher JF, Swayampakala K, Yong HH, McKeever R, Hammond D, Anshari D, Cummings KM, Borland R. Does Reactance against Cigarette Warning Labels Matter? Warning Label Responses and Downstream Smoking Cessation amongst Adult Smokers in Australia, Canada, Mexico and the United States. PLoS One 2016; 11:e0159245. [PMID: 27411100 PMCID: PMC4943644 DOI: 10.1371/journal.pone.0159245] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 10/23/2015] [Accepted: 06/29/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Some researchers have raised concerns that pictorial health warning labels (HWLs) on cigarette packages may lead to message rejection and reduced effectiveness of HWL messages. This study aimed to determine how state reactance (i.e., negative affect due to perceived manipulation) in response to both pictorial and text-only HWLs is associated with other types of HWL responses and with subsequent cessation attempts. Methods Survey data were collected every 4 months between September 2013 and 2014 from online panels of adult smokers in Australia, Canada, Mexico, and the US were analyzed. Participants with at least one wave of follow-up were included in the analysis (n = 4,072 smokers; 7,459 observations). Surveys assessed psychological and behavioral responses to HWLs (i.e., attention to HWLs, cognitive elaboration of risks due to HWLs, avoiding HWLs, and forgoing cigarettes because of HWLs) and cessation attempts. Participants then viewed specific HWLs from their countries and were queried about affective state reactance. Logistic and linear Generalized Estimating Equation (GEE) models regressed each of the psychological and behavioral HWL responses on reactance, while controlling for socio-demographic and smoking-related variables. Logistic GEE models also regressed having attempted to quit by the subsequent survey on reactance, each of the psychological and behavioral HWL responses (analyzed separately), adjustment variables. Data from all countries were initially pooled, with interactions between country and reactance assessed; when interactions were statistically significant, country-stratified models were estimated. Results Interactions between country and reactance were found in all models that regressed psychological and behavioral HWL responses on study variables. In the US, stronger reactance was associated with more frequent reading of HWLs and thinking about health risks. Smokers from all four countries with stronger reactance reported greater likelihood of avoiding warnings and forgoing cigarettes due to warnings, although the association appeared stronger in the US. Both stronger HWLs responses and reactance were positively associated with subsequent cessation attempts, with no significant interaction between country and reactance. Conclusions Reactance towards HWLs does not appear to interfere with quitting, which is consistent with its being an indicator of concern, not a systematic effort to avoid HWL message engagement.
Collapse
Affiliation(s)
- Yoo Jin Cho
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail:
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Kamala Swayampakala
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
| | - Hua-Hie Yong
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Robert McKeever
- School of Journalism and Mass Communications, University of South Carolina, Columbia, South Carolina, United States of America
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Dien Anshari
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
- Department of Health Education & Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Swayampakala K, Thrasher JF, Hammond D, Yong HH, Bansal-Travers M, Krugman D, Brown A, Borland R, Hardin J. Pictorial health warning label content and smokers' understanding of smoking-related risks-a cross-country comparison. Health Educ Res 2015; 30:35-45. [PMID: 24848554 PMCID: PMC4296885 DOI: 10.1093/her/cyu022] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 04/08/2014] [Indexed: 05/21/2023]
Abstract
The aim of the present study was to assess smokers' level of agreement with smoking-related risks and toxic tobacco constituents relative to inclusion of these topics on health warning labels (HWLs). 1000 adult smokers were interviewed between 2012 and 2013 from online consumer panels of adult smokers from each of the three countries: Australia (AU), Canada (CA) and Mexico (MX). Generalized estimating equation models were estimated to compare agreement with smoking-related risks and toxic tobacco constituents. For disease outcomes described on HWLs across all three countries, there were few statistical differences in agreement with health outcomes (e.g. emphysema and heart attack). By contrast, increases in agreement where the HWLs were revised or introduced on HWLs for the first time (e.g. blindness in AU and CA, bladder cancer in CA). Similarly, samples from countries that have specific health content or toxic constituents on HWLs showed higher agreement for that particular disease or toxin than countries without (e.g. higher agreement for gangrene and blindness in AU, higher agreement for bladder cancer and all toxic constituents except nitrosamines and radioactive polonium in CA). Pictorial HWL content is associated with greater awareness of smoking-related risks and toxic tobacco constituents.
Collapse
Affiliation(s)
- Kamala Swayampakala
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - James F Thrasher
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - David Hammond
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - Hua-Hie Yong
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - Maansi Bansal-Travers
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - Dean Krugman
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - Abraham Brown
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - Ron Borland
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| | - James Hardin
- Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK
| |
Collapse
|
16
|
Swayampakala K, Thrasher J, Carpenter MJ, Shigematsu LMR, Cupertio AP, Berg CJ. Level of cigarette consumption and quit behavior in a population of low-intensity smokers--longitudinal results from the International Tobacco Control (ITC) survey in Mexico. Addict Behav 2013; 38:1958-65. [PMID: 23380491 DOI: 10.1016/j.addbeh.2012.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 10/22/2011] [Revised: 10/16/2012] [Accepted: 12/07/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mexican smokers are more likely to be non-daily smokers and to consume fewer cigarettes per day than smokers in other countries. Little is known about their quit behaviors. AIM The aim of this study is to determine factors associated with having made a quit attempt and being successfully quit at 14-month follow-up in a population-based cohort of adult Mexicans who smoke at different levels of intensity. DESIGN A longitudinal analysis of wave-III and wave-IV (2010) Mexican administration of International Tobacco Control Policy Evaluation Project was conducted. SETTING This study was conducted in six large urban centers in Mexico PARTICIPANTS The participants of this study comprised 1206 adults who were current smokers at wave-III and who were followed to wave-IV. MEASUREMENTS We compared three groups of smokers: non-daily smokers-who did not smoke every day in the past 30 days (n=398), daily light smokers who smoked every day at a rate of ≤5 cigarettes per day (n=368) and daily heavy smokers who smoked every day at a rate of >5 cigarettes per day (n=434). Data on smoking behavior, psychosocial characteristics and socio-demographics were collected at baseline and after 14 months. FINDINGS In multivariate logistic regression predicting having made a quit attempt at follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=1.83, 95% CI: 1.19-2.83), less perceived addiction (ORadj=1.86, 95% CI: 1.20-2.87), greater worry that cigarettes will damage health (ORadj=2.04, 95% CI: 1.16-3.61) and having made a quit attempt in the past year at baseline (ORadj=1.70, 95% CI: 1.23-2.36). In multivariate logistic regression predicting being successfully quit at one-year follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=2.54, 95% CI: 1.37-4.70) and less perceived addiction (not addicted: ORadj=3.26, 95% CI: 1.73-6.14; not much: ORadj=1.95, 95% CI: 1.05-3.62 versus very much). CONCLUSIONS Mexican adult smokers who are non-daily smokers were more likely than daily heavy smokers to have attempted to quit during follow-up and to succeed in their quit attempt. Future research should determine whether tobacco control policies and programs potentiate this tendency and which interventions are needed to help heavier smokers to quit.
Collapse
Affiliation(s)
- Kamala Swayampakala
- Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, United States.
| | | | | | | | | | | |
Collapse
|
17
|
Wigfall LT, Richter DL, Torres ME, Annang L, Lindley LL, Swayampakala K, Sebastian N, Glover SH, Duffus WA. HIV testing among midlife women in the deep south: an analysis of the 2008 Behavioral Risk Factor Surveillance System survey data. J Womens Health (Larchmt) 2011; 20:933-41. [PMID: 21671778 DOI: 10.1089/jwh.2010.2096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE AND BACKGROUND Our objective was to examine HIV testing uptake among postmenopausal women. Many women are routinely tested for HIV during pregnancy. Disproportionate numbers of women beyond reproductive age are diagnosed HIV-positive late in the disease course. Some older women and healthcare providers have dismissed early AIDS symptoms as signs of aging. This has resulted in missed opportunities for early initiation of effective antiretroviral therapy. METHODS Behavioral Risk Factor Surveillance System (BRFSS) 2008 data were analyzed for non-Hispanic white and non-Hispanic black women (50-64 years) from six deep south states. Logistic regression models examined associations between uptake of HIV testing and population/behavioral characteristics. RESULTS More than half of our sample (1091 of 2027) had an HIV test during their postreproductive years (>45 years old). Women 50-54 years old were about 40% as likely to have been tested for HIV during their postreproductive years as those 60-64 years old (adjusted odds ratio [AOR] 0.62, 95% confidence interval [CI] 0.45-0.84). Population characteristics, such as race/ethnicity, family poverty status, and urbanization, as well as HIV exposure risk, were all potential confounders of this relationship. CONCLUSIONS Routine HIV testing is underused among women during their postreproductive years. HIV prevention messages that target midlife women are needed to reduce the prevalence of HIV/AIDS and disproportionate burden of late diagnosed HIV infection in this population.
Collapse
Affiliation(s)
- Lisa T Wigfall
- University of South Carolina-Arnold School of Public Health, Institute for Partnerships to Eliminate Health Disparities, 220 Stoneridge Drive, Columbia, SC 29210, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Colabianchi N, Maslow AL, Swayampakala K. Features and amenities of school playgrounds: a direct observation study of utilization and physical activity levels outside of school time. Int J Behav Nutr Phys Act 2011; 8:32. [PMID: 21492455 PMCID: PMC3094267 DOI: 10.1186/1479-5868-8-32] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 04/14/2011] [Indexed: 11/30/2022] Open
Abstract
Background A significant amount of research has examined whether park or playground availability is associated with physical activity. However, little research has examined whether specific features or amenities of parks or playgrounds, such as the number of unique types of playground equipment or the safety of the equipment is associated with utilization of the facility or physical activity levels while at the facility. There are no studies that use direct observation and a detailed park assessment to examine these associations. Methods Twenty urban schoolyards in the Midwest, ten of which were renovated, were included in this study. Using a detailed environmental assessment tool (i.e., Environmental Assessment of Public Recreation Spaces), information on a variety of playground attributes was collected. Using direct observation (i.e., System for Observing Play and Leisure Activity in Youth), the number of adults, girls and boys attending each schoolyard and their physical activity levels were recorded. Each schoolyard was observed ten times for 90 minutes each time outside of school hours. Clustered multivariable negative binomial regressions and linear regressions were completed to examine the association between playground attributes and utilization of the schoolyard and the proportion active on the playground, respectively. Effect modification by renovation status was also examined. Results At renovated schoolyards, the total number of play features was significantly associated with greater utilization in adults and girls; overall cleanliness was significantly associated with less utilization in girls and boys; and coverage/shade for resting features was significantly associated with greater utilization in adults and boys. At unrenovated schoolyards, overall safety was significantly associated with greater utilization in boys. No playground attribute was associated with the proportion active on the playground after adjusting for all other significant playground attributes. Conclusions Having a large quantity of play features and shade at renovated playgrounds were positively associated with utilization of the schoolyard. Modifying playgrounds to have these features may increase the utilization of these facilities outside of school time. Additional research should explore what features and amenities are associated with increased physical activity levels of children and adults who utilize the facilities.
Collapse
Affiliation(s)
- Natalie Colabianchi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of School Carolina, 800 Sumter Street, Columbia, SC 29208, USA.
| | | | | |
Collapse
|
19
|
Thrasher JF, Pérez-Hernández R, Swayampakala K, Arillo-Santillán E, Bottai M. Policy support, norms, and secondhand smoke exposure before and after implementation of a comprehensive smoke-free law in Mexico city. Am J Public Health 2010; 100:1789-98. [PMID: 20466952 PMCID: PMC2920995 DOI: 10.2105/ajph.2009.180950] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed attitudes and beliefs about smoke-free laws, compliance, and secondhand smoke exposure before and after implementation of a comprehensive smoke-free law in Mexico City. METHODS Trends and odds of change in attitudes and beliefs were analyzed across 3 representative surveys of Mexico City inhabitants: before implementation of the policy (n=800), 4 months after implementation (n=961), and 8 months after implementation (n=761). RESULTS Results indicated high and increasing support for 100% smoke-free policies, although support did not increase for smoke-free bars. Agreement that such policies improved health and reinforced rights was high before policy implementation and increased thereafter. Social unacceptability of smoking increased substantially, although 25% of nonsmokers and 50% of smokers agreed with smokers' rights to smoke in public places at the final survey wave. Secondhand smoke exposure declined generally as well as in venues covered by the law, although compliance was incomplete, especially in bars. CONCLUSIONS Comprehensive smoke-free legislation in Mexico City has been relatively successful, with changes in perceptions and behavior consistent with those revealed by studies conducted in high-income countries. Normative changes may prime populations for additional tobacco control interventions.
Collapse
Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter St, Room 215, Columbia, SC 29208, USA.
| | | | | | | | | |
Collapse
|
20
|
Thrasher JF, Swayampakala K, Arillo-Santillán E, Sebrié E, Walsemann KM, Bottai M. Differential impact of local and federal smoke-free legislation in Mexico: a longitudinal study among adult smokers. Salud Publica Mex 2010; 52 Suppl 2:S244-53. [PMID: 21243195 PMCID: PMC4600968 DOI: 10.1590/s0036-36342010000800020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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: 02/05/2010] [Accepted: 05/14/2010] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To assess the impact of Mexico City and federal smoke-free legislation on secondhand tobacco smoke (SHS) exposure and support for smoke-free laws. MATERIAL AND METHODS Pre- and post-law data were analyzed from a cohort of adult smokers who participated in the International Tobacco Control (ITC) Policy Evaluation Suvey in four Mexican cities. For each indicator, we estimated prevalence, changes in prevalence, and between-city differences in rates of change. RESULTS Self-reported exposure to smoke-free media campaigns generally increased more dramatically in Mexico City. Support for prohibiting smoking in regulated venues increased overall, but at a greater rate in Mexico City than in other cities. In bars and restaurants/cafés, self-reported SHS exposure had significantly greater decreases in Mexico City than in other cities; however, workplace exposure decreased in Tijuana and Guadalajara, but not in Mexico City or Ciudad Juárez. CONCLUSIONS Although federal smoke-free legislation was associated with important changes smoke-free policy impact, the comprehensive smoke-free law in Mexico City was generally accompanied by a greater rate of change.
Collapse
Affiliation(s)
- James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Bowen SA, Heidari K, Byrd MD, Swayampakala K, Young VM, Gibson JJ. The epidemiological profile of South Carolina women who do not receive regular pap test: improving access to care. J S C Med Assoc 2009; 105:246-253. [PMID: 20108712] [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: 05/28/2023]
|