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Shah NN, Steinberg MB, Calkins MM, Caban-Martinez AJ, Burgess JL, Austin E, Hollerbach BS, Edwards DL, Black TM, Black K, Hinton KM, Kubiel BS, Graber JM. Prevalence and predictors of colon and prostate cancer screening among volunteer firefighters: The United States Firefighter Cancer Assessment and Prevention Study. Am J Ind Med 2024; 67:483-495. [PMID: 38530105 PMCID: PMC11022136 DOI: 10.1002/ajim.23582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Although firefighters have increased risk for colon and prostate cancer, limited information exists on screening practices for these cancers in volunteer firefighters who compose two-thirds of the US fire service. We estimated the prevalence of colon and prostate cancer screening among volunteer firefighters using eligibility criteria from 4 evidence-based screening recommendations and evaluated factors influencing screening. METHODS We evaluated colon (n = 569) and prostate (n = 498) cancer screening prevalence in a sample of US volunteer firefighters using eligibility criteria from the US Preventive Services Taskforce (USPSTF), National Fire Protection Association, American Cancer Society, and National Comprehensive Cancer Network. We assessed associations with fire service experience, demographics, and cancer risk perception based on USPSTF guidelines. RESULTS For those eligible based on USPSTF guidelines, colon and prostate cancer screening prevalence was 51.7% (95% CI: 45.7, 57.8) and 48.8% (95% CI: 40.0, 57.6), respectively. Higher odds of colon and prostate cancer screening were observed with older age and with some college education compared to those with less education. Fire service experience and cancer risk perception were not associated with screening practices. CONCLUSION This is the first large study to assess colon and prostate cancer screening among US volunteer firefighters based on different screening guidelines. Our findings suggest gaps in cancer prevention efforts in the US volunteer fire service. Promoting cancer screening education and opportunities for volunteer firefighters by their fire departments, healthcare professionals, and public health practitioners, may help to address the gaps.
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Affiliation(s)
- Nimit N. Shah
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Michael B. Steinberg
- Division of General Internal Medicine; Robert Wood Johnson Medical School; Rutgers, The State University of New Jersey; New Brunswick, New Jersey, USA
| | - Miriam M. Calkins
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jefferey L. Burgess
- Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Elena Austin
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Washington, USA
| | | | | | - Taylor M. Black
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Kathleen Black
- Rutgers Environmental and Occupational Health Sciences Institute, Rutgers the State University of New Jersey, Piscataway, New Jersey, USA
| | - Kaleigh M. Hinton
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Brian S. Kubiel
- Toms River Board of Fire Commissioners, District #1, Toms River, New Jersey, USA
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
- Rutgers Environmental and Occupational Health Sciences Institute, Rutgers the State University of New Jersey, Piscataway, New Jersey, USA
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Tan NQP, Lowenstein LM, Douglas EE, Silva J, Bershad JM, An J, Shete SS, Steinberg MB, Ferrante JM, Clark EC, Natale-Pereira A, Sahu NN, Hastings SE, Hoffman RM, Volk RJ, Kinney AY. The TELEhealth Shared decision-making Coaching and Navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators. Res Sq 2024:rs.3.rs-4254047. [PMID: 38746205 PMCID: PMC11092847 DOI: 10.21203/rs.3.rs-4254047/v1] [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: 05/16/2024]
Abstract
Background Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching intervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm. Methods Patients (n = 420) of primary care clinicians (n = 120) are being recruited to a cluster randomized controlled trial. Clinicians are randomly assigned to 1) TELESCOPE intervention: prior to an upcoming non-acute clinic visit, patients participate in a telehealth decision coaching session about LCS delivered by trained patient navigators and nurse navigators place a low-dose CT scan (LDCT) order for each TELESCOPE patient wanting LCS, or 2) EUC: patients receive enhanced usual care from a clinician. Usual care is enhanced by providing clinicians in both arms with access to a Continuing Medical Education (CME) webinar about LCS and an LCS discussion guide. Patients complete surveys at baseline and 1-week after the scheduled clinic visit to assess quality of the SDM process. Re-navigation is attempted with TELESCOPE patients who have not completed the LDCT within 3 months. One month before being due for an annual screening, TELESCOPE patients whose initial LCS showed low-risk findings are randomly assigned to receive a telehealth decision coaching booster session with a navigator or no booster. Electronic health records are abstracted at 6, 12 and 18 months after the initial decision coaching session (TELESCOPE) or clinic visit (EUC) to assess initial and annual LCS uptake, imaging results, follow-up testing for abnormal findings, cancer diagnoses, treatment, and tobacco treatment referrals. This study will evaluate factors that facilitate or interfere with program implementation using mixed methods. Discussion We will assess whether a decision coaching and patient navigation intervention can feasibly support high-quality SDM for LCS and guideline-concordant LCS uptake for patients in busy primary care practices serving diverse patient populations. Trial Registration: This study was registered at ClinicalTrials.gov (NCT05491213) on August 4, 2022.
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Young WJ, Kennedy M, Wackowski OA, Mitarotondo A, Assan MA, Scalia D, Stepanov I, Steinberg MB, Heckman CJ. Measurement of cigarette relighting: A common but understudied behavior. Drug Alcohol Depend 2024; 257:111257. [PMID: 38493565 DOI: 10.1016/j.drugalcdep.2024.111257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Relighting, i.e., extinguishing, saving, and later relighting and smoking unfinished cigarettes, appears prevalent, may be associated with nicotine dependence and negative health outcomes, yet is poorly understood. We estimate the prevalence, frequency, correlates of, and reasons for, cigarette relighting. METHODS Survey respondents (n=676) were 18-45-year-old US-based Amazon Mechanical Turk (MTurk) participants who smoked cigarettes every/some days. Items assessed frequency of and reasons for relighting. Reported smoking sessions per day were compared to calculations based on reported cigarettes per day (CPD) and relighting frequency. RESULTS Seventy-two percent of those who smoked reported relighting cigarettes. Reasons included not having time to finish (77%), not feeling like finishing (75%), saving money or avoiding wasting (70%), and making cigarettes last longer (59%). Nearly half (44%) relight to cut down and 34% to reduce harm. Hispanic (OR=1.73, CI:1.03-2.91) and non-Hispanic Black respondents (OR= 2.23, CI:1.20-4.10) had higher odds of relighting than others, as did those who smoke within 30minutes of waking (OR=2.45, CI:1.33-4.52) or wake up at night to smoke (OR=2.40, CI:1.68-3.44) (all ps <0.05). Respondents demonstrated low consistency in reporting the number of times they smoke (first-lit and relit) compared to calculations based on CPD and relighting frequency. CONCLUSIONS Relighting is associated with race, ethnicity, nicotine dependence, and is often done to save money, cut down smoking, and reduce harm. Among those who relight, "smoking session" frequency seemed to be underestimated. Single item smoking frequency measures may not be ideal for individuals who smoke and relight.
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Affiliation(s)
- William J Young
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street Suite 500, New Brunswick, NJ 08901, USA.
| | - Michelle Kennedy
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street Suite 500, New Brunswick, NJ 08901, USA.
| | - Olivia A Wackowski
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street Suite 500, New Brunswick, NJ 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane W, Piscataway, NJ 08854, USA.
| | - Anna Mitarotondo
- Cancer Prevention and Control Program, Cancer Institute of New Jersey, Rutgers University, 120 Albany Street, New Brunswick, NJ 08901, USA.
| | - Maame Araba Assan
- Cancer Prevention and Control Program, Cancer Institute of New Jersey, Rutgers University, 120 Albany Street, New Brunswick, NJ 08901, USA.
| | - Daniel Scalia
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA.
| | - Irina Stepanov
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, 2231 6th St SE, Minneapolis, MN 55455USA.
| | - Michael B Steinberg
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street Suite 500, New Brunswick, NJ 08901, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA.
| | - Carolyn J Heckman
- Cancer Prevention and Control Program, Cancer Institute of New Jersey, Rutgers University, 120 Albany Street, New Brunswick, NJ 08901, USA.
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Steinberg MB, Young WJ, Miller Lo EJ, Bover-Manderski MT, Jordan HM, Hafiz Z, Kota KJ, Mukherjee R, Garthe NE, Sonnenberg FA, O'Dowd M, Delnevo CD. Electronic Health Record Prompt to Improve Lung Cancer Screening in Primary Care. Am J Prev Med 2023; 65:892-895. [PMID: 37306638 DOI: 10.1016/j.amepre.2023.05.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer death in the U.S. Combusted tobacco use, the primary risk factor, accounts for 90% of all lung cancers. Early detection of lung cancer improves survival, yet lung cancer screening rates are much lower than those of other cancer screening tests. Electronic health record (EHR) systems are an underutilized tool that could improve screening rates. METHODS This study was conducted in the Rutgers Robert Wood Johnson Medical Group, a university-affiliated network in New Brunswick, NJ. Two novel EHR workflow prompts were implemented on July 1, 2018. These prompts included fields to determine tobacco use and lung cancer screening eligibility and facilitated low-dose computed tomography ordering for eligible patients. The prompts were designed to improve tobacco use data entry, allowing for better lung cancer screening eligibility identification. Data were analyzed in 2022 retrospectively for the period July 1, 2017 to June 30, 2019. The analyses represented 48,704 total patient visits. RESULTS The adjusted odds of patient record completeness to determine eligibility for low-dose computed tomography (AOR=1.19, 95% CI=1.15, 1.23), eligibility for low-dose computed tomography (AOR=1.59, 95% CI=1.38, 1.82), and whether low-dose computed tomography was ordered (AOR=1.04, 95% CI=1.01, 1.07) all significantly increased after the electronic medical record prompts were implemented. CONCLUSIONS These findings show the utility and benefit of EHR prompts in primary care settings to increase identification for lung cancer screening eligibility as well as increased low-dose computed tomography ordering.
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Affiliation(s)
- Michael B Steinberg
- The Department of Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; Rutgers Center for Tobacco Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.
| | - William J Young
- Rutgers Center for Tobacco Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Erin J Miller Lo
- Rutgers Center for Tobacco Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Michelle T Bover-Manderski
- Rutgers Center for Tobacco Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Heather M Jordan
- Rutgers Center for Tobacco Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Zibran Hafiz
- Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Karthik J Kota
- The Department of Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Rohit Mukherjee
- The Department of Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Nicolette E Garthe
- Rutgers Center for Tobacco Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Frank A Sonnenberg
- The Department of Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Mary O'Dowd
- Rutgers Biomedical Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Shah NN, Steinberg MB, Caban-Martinez AJ, Austin E, Burgess JL, Hollerbach BS, Edwards DL, Black TM, Black K, Hinton KM, Kubiel BS, Graber JM. Prevalence and predictors of skin cancer screening among a sample of US volunteer firefighters. Am J Ind Med 2023; 66:897-903. [PMID: 37573478 PMCID: PMC10528674 DOI: 10.1002/ajim.23524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/09/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Firefighters have a higher risk of melanoma incidence and mortality compared to the general population. In the United States (US), the National Fire Protection Association recommends all firefighters receive annual skin cancer screening through visual skin examination by a clinician. However, there is limited information on skin cancer screening practices among volunteer firefighters who comprise two-thirds of the US fire service. METHODS This cross-sectional study of 552 US volunteer firefighters estimated the prevalence of skin cancer screening and evaluated associations with their fire service experience, demographics, sun protection practices, and cancer risk perception. RESULTS The prevalence of receiving skin cancer screening among volunteer firefighters was 26.1% (95% confidence interval [CI]: 22.4, 29.8). The odds of being screened for skin cancer, compared to not being screened, were twice as high for firefighters who used sunscreen (odds ratio [OR]: 2.35, 95% CI: 1.48, 3.73) and who perceived their skin likely to burn with prolonged sun exposure (OR: 1.81, 95% CI: 1.10, 3.00). Older age, some college education, and family history of skin cancer were also positively associated with skin cancer screening. A positive exposure-response relationship was observed between more monthly firefighting calls and receiving screening. Cancer risk perception was not associated with screening. CONCLUSION To our knowledge, this is the first large study to assess skin cancer screening among US volunteer firefighters. Our findings suggest gaps in skin cancer prevention efforts in the volunteer fire service. Additional assessment of skin cancer prevention practices within volunteer fire departments could help address these gaps.
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Affiliation(s)
- Nimit N. Shah
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Michael B. Steinberg
- Division of General Internal Medicine; Robert Wood Johnson Medical School; Rutgers, The State University of New Jersey; New Brunswick, New Jersey, USA
- Rutgers, The State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Elena Austin
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Washington, USA
| | - Jefferey L. Burgess
- Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | | | - Taylor M. Black
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Kathleen Black
- Rutgers Environmental and Occupational Health Sciences Institute, Rutgers the State University of New Jersey, Piscataway, New Jersey, USA
| | - Kaleigh M. Hinton
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Brian S. Kubiel
- Toms River Board of Fire Commissioners, District #1, Toms River, New Jersey, USA
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
- Rutgers, The State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Environmental and Occupational Health Sciences Institute, Rutgers the State University of New Jersey, Piscataway, New Jersey, USA
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Wackowski OA, Steinberg MB, Delnevo CD. Impact of IQOS modified risk messaging on physicians' product perceptions and recommendations. Tob Control 2023:tc-2023-057963. [PMID: 37280064 PMCID: PMC10698203 DOI: 10.1136/tc-2023-057963] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Michael B Steinberg
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
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Hrywna M, Bover-Manderski MT, Wackowski OA, Steinberg MB, Delnevo CD. US Physicians' Self-reported Discussions About Tobacco-Free Nicotine Pouches During Clinical Encounters With Patients in 2021. JAMA Netw Open 2023; 6:e2313583. [PMID: 37191964 DOI: 10.1001/jamanetworkopen.2023.13583] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
This survey study assesses the extent to which physicians discussed tobacco-free nicotine pouches during clinical encounters with patients.
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Affiliation(s)
- Mary Hrywna
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Michelle T Bover-Manderski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Michael B Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Hohl SD, Shoenbill KA, Taylor KL, Minion M, Bates-Pappas GE, Hayes RB, Nolan MB, Simmons VN, Steinberg MB, Park ER, Ashing K, Beneventi D, Sanderson Cox L, Goldstein AO, King A, Kotsen C, Presant CA, Sherman SE, Sheffer CE, Warren GW, Adsit RT, Bird JE, D’Angelo H, Fiore MC, Van Thanh Nguyen C, Pauk D, Rolland B, Rigotti NA. The Impact of the COVID-19 Pandemic on Tobacco Treatment Program Implementation at National Cancer Institute-Designated Cancer Centers. Nicotine Tob Res 2023; 25:345-349. [PMID: 35778237 PMCID: PMC9384385 DOI: 10.1093/ntr/ntac160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The COVID-19 pandemic disrupted cancer screening and treatment delivery, but COVID-19's impact on tobacco cessation treatment for cancer patients who smoke has not been widely explored. AIMS AND METHODS We conducted a sequential cross-sectional analysis of data collected from 34 National Cancer Institute (NCI)-designated cancer centers participating in NCI's Cancer Center Cessation Initiative (C3I), across three reporting periods: one prior to COVID-19 (January-June 2019) and two during the pandemic (January-June 2020, January-June 2021). Using McNemar's Test of Homogeneity, we assessed changes in services offered and implementation activities over time. RESULTS The proportion of centers offering remote treatment services increased each year for Quitline referrals (56%, 68%, and 91%; p = .000), telephone counseling (59%, 79%, and 94%; p = .002), and referrals to Smokefree TXT (27%, 47%, and 56%; p = .006). Centers offering video-based counseling increased from 2020 to 2021 (18% to 59%; p = .006), Fewer than 10% of centers reported laying off tobacco treatment staff. Compared to early 2020, in 2021 C3I centers reported improvements in their ability to maintain staff and clinician morale, refer to external treatment services, train providers to deliver tobacco treatment, and modify clinical workflows. CONCLUSIONS The COVID-19 pandemic necessitated a rapid transition to new telehealth program delivery of tobacco treatment for patients with cancer. C3I cancer centers adjusted rapidly to challenges presented by the pandemic, with improvements reported in staff morale and ability to train providers, refer patients to tobacco treatment, and modify clinical workflows. These factors enabled C3I centers to sustain evidence-based tobacco treatment implementation during and beyond the COVID-19 pandemic. IMPLICATIONS This work describes how NCI-designated cancer centers participating in the Cancer Center Cessation Initiative (C3I) adapted to challenges to sustain evidence-based tobacco use treatment programs during the COVID-19 pandemic. This work offers a model for resilience and rapid transition to remote tobacco treatment services delivery and proposes a policy and research agenda for telehealth services as an approach to sustaining evidence-based tobacco treatment programs.
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Affiliation(s)
- Sarah D Hohl
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Kimberly A Shoenbill
- Department of Family Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn L Taylor
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Washington, DC, USA
| | - Mara Minion
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Gleneara E Bates-Pappas
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rashelle B Hayes
- Department of Psychiatry, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Margaret B Nolan
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael B Steinberg
- Center for Tobacco Studies, Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Kimlin Ashing
- Department of Population Sciences, Center of Community Alliance for Research & Education, City of Hope National Medical Center, Duarte, CA, USA
| | - Diane Beneventi
- Tobacco Research and Treatment Program, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Lisa Sanderson Cox
- Cancer Prevention and Control, University of Kansas School of Medicine, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Adam O Goldstein
- Department of Family Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Chris Kotsen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cary A Presant
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Scott E Sherman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, USA
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, USA
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jennifer E Bird
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Heather D’Angelo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael C Fiore
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Danielle Pauk
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Betsy Rolland
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Nancy A Rigotti
- Department of Medicine, Division of General Internal Medicine and Mongan Institute, Tobacco Research and Treatment Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Young WJ, Delnevo CD, Singh B, Steinberg ML, Williams JM, Steinberg MB. Tobacco Treatment Knowledge and Practices Among US Psychiatrists. Community Ment Health J 2023; 59:185-191. [PMID: 35768703 PMCID: PMC10337593 DOI: 10.1007/s10597-022-00997-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/09/2022] [Indexed: 01/07/2023]
Abstract
This study explores the extent to which psychiatrists are familiar with, and utilize, the USPHS guidelines for treating tobacco use and dependence (i.e., the 5A's), deliver cessation treatment, and the barriers they perceive to doing so. An original, national survey of 141 psychiatrists revealed that most Ask patients if they smoke (81.6%). Fewer Advise them to stop (78.7%) and Assess their willingness to quit (73.6%). A minority Assist with a quit plan (15.9%) and Arrange for follow-up (26.4%). Just 11.9% have used the USPHS guidelines in clinical practice; 37% have never heard of them. Even among those who say they have used the USPHS guidelines, implementation of the 5A's is quite low. Time-related factors were the most common barriers to cessation delivery (51.4%). Patient factors (30%) and financial/resource factors (25%) were less common. There is a strong need for increased implementation of clinical guidelines for evidence-based tobacco treatments among psychiatrists.
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Affiliation(s)
- William J Young
- Rutgers Center for Tobacco Studies, Rutgers University, 303 George St., Suite 500, New Brunswick, NJ, 08901, USA.
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, 303 George St., Suite 500, New Brunswick, NJ, 08901, USA
| | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, 303 George St., Suite 500, New Brunswick, NJ, 08901, USA
| | - Marc L Steinberg
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, 317 George St., Suite 105, New Brunswick, NJ, 08901, USA
| | - Jill M Williams
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, 317 George St., Suite 105, New Brunswick, NJ, 08901, USA
| | - Michael B Steinberg
- Rutgers Center for Tobacco Studies, Rutgers University, 303 George St., Suite 500, New Brunswick, NJ, 08901, USA
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, 125 Paterson St., Suite 2300, New Brunswick, NJ, 08901, USA
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10
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Bhurosy T, Bover Manderski MT, Heckman CJ, Gonsalves NJ, Delnevo CD, Steinberg MB. Perceived effectiveness of cancer screening among family medicine and internal medicine physicians in the United States. Prev Med Rep 2022; 28:101842. [PMID: 35669859 PMCID: PMC9163580 DOI: 10.1016/j.pmedr.2022.101842] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
There are limited data on family medicine and internal medicine physicians’ beliefs regarding perceived cancer screening effectiveness. Perceiving specific cancer screening tests as very effective differed in some cases by gender, age, graduation year, and race/ethnicity. Physicians’ perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests. Understanding physicians’ beliefs on screening effectiveness can help improve uptake of evidence-based screening by providers and patients to promote early detection and successful treatment.
Family and internal medicine physicians play an important role in cancer screening, yet there are limited data on their beliefs regarding effectiveness of screening tests, which may affect physicians’ likelihood to recommend such tests. The study purpose was to assess current beliefs among family medicine and internal medicine physicians regarding effectiveness of various types of cancer screening. A national sample of 582 physicians from the American Medical Association’s Physician Masterfile were surveyed. Participants were asked about their perceived effectiveness of screening for colon, lung, breast, prostate, and cervical cancer among average, healthy individuals. Chi-square tests were conducted to assess relationships between perceiving screening tests to be ‘very effective in reducing cancer-related mortality’ and demographic characteristics. A substantial majority of physicians perceived colonoscopy (83.8%) and Pap smear (82.9%) to be very effective. Perceiving low-dose computed tomography (LDCT), Pap smear, and prostate-specific antigen (PSA) as ‘very effective’ differed by gender, with females less likely to endorse LDCT and Pap smear but more likely to endorse PSA. Perceiving PSA as ‘very effective’ differed by age and graduation year, with younger or more recently graduated physicians being less likely to perceive PSA as ‘very effective’. Non-Hispanic Black/African-American physicians were more likely to perceive mammography as ‘very effective’ than other groups. Physicians’ perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests. Understanding physicians’ beliefs can help in improving uptake of evidence-based screening tests by providers and patients to promote early detection and successful treatment.
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Affiliation(s)
- Trishnee Bhurosy
- Department of Population Health, School of Health Professions and Human Services, Hofstra University, Hempstead, NY 11549, USA
| | - Michelle T. Bover Manderski
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Carolyn J. Heckman
- Cancer Prevention and Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Corresponding author.
| | - Nishi J. Gonsalves
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
| | - Cristine D. Delnevo
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Michael B. Steinberg
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Kota KJ, Ji S, Bover-Manderski MT, Delnevo CD, Steinberg MB. Lung Cancer Screening Knowledge and Perceived Barriers Among US Physicians. JTO Clin Res Rep 2022; 3:100331. [PMID: 35769389 PMCID: PMC9234709 DOI: 10.1016/j.jtocrr.2022.100331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Lung cancer remains the leading cause of cancer death in the United States and has historically been detected late in its course. Low-dose computed tomography scan (LDCT) reduces lung cancer mortality by 20% and is currently recommended by clinical practice guidelines. However, compared with other cancer screening modalities, LDCT utilization remains low. This study surveyed office-based primary care physicians across the United States to better understand LDCT utilization. Methods A total of 1500 family and internal medicine physicians selected from the American Medical Association’s physician master file were surveyed between April and July 2019 regarding LDCT practices, eligibility, clinical scenarios, and perceived barriers. Results The American Association for Public Opinion Research response rate 3 was 59% (652 respondents); 599 completed supplemental questions regarding lung cancer screening. A total of 88% of respondents discussed LDCT in the previous year, and 78% had ordered at least one LDCT. Most (59%) knew the tobacco exposure criteria for LDCT and correctly identified appropriate clinical scenarios (49%–86% responded correctly). Less than half of respondents correctly identified the age eligibility criteria (44%–45% responded correctly). In general, male physicians, those who graduated after 1990, and family medicine physicians were more likely to report accurate knowledge regarding LDCT eligibility. The top perceived barriers to LDCT were cost to the patient (48% identified as a major barrier), insurance not covering screening (46% major), and patients being unaware of lung cancer screening (40% major). Conclusion Knowledge and practices about lung cancer screening are improving, though remain suboptimal. The most common barriers remain cost or insurance-based and suggest the need for a systems-based response to increase awareness and reduce the underutilization of LDCT.
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12
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Delnevo CD, Jeong M, Teotia A, Bover Manderski MM, Singh B, Hrywna M, Wackowski OA, Steinberg MB. Communication Between US Physicians and Patients Regarding Electronic Cigarette Use. JAMA Netw Open 2022; 5:e226692. [PMID: 35426926 PMCID: PMC9012960 DOI: 10.1001/jamanetworkopen.2022.6692] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE Physicians play a primary role in patient smoking cessation, yet their communication regarding e-cigarettes is not well understood. OBJECTIVE To assess physician-patient communication regarding e-cigarettes. DESIGN, SETTING, AND PARTICIPANTS A national cross-sectional survey in 2018 and 2019 was conducted. Participants were invited by mail; surveys were completed online. Respondents were 2058 board-certified physicians from family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonary, and oncology. Data were analyzed from August to September 2021. EXPOSURES Physician demographic characteristics, tobacco use, medical specialty, and harm-reduction beliefs (ie, not all tobacco products are equally harmful) applied within 2 hypothetical clinical scenarios. MAIN OUTCOMES AND MEASURES Physicians' self-reported e-cigarette communication (being asked about e-cigarettes by patients and recommending e-cigarettes to patients) and hypothetical e-cigarette communication in 2 clinical scenarios. RESULTS Among 2058 physicians, the mean (SD) age was 51.6 (10.5) years, and 1173 (58.5%) were male. More than 60% of physicians believed all tobacco products to be equally harmful. Overall, 69.8% of physicians reported ever being asked about e-cigarettes by their patients (35.9% in the past 30 days), and 21.7% reported ever recommending e-cigarettes to a patient (9.8% in the past 30 days). Pulmonologists (adjusted odds ratio [aOR], 2.14, 95% CI, 1.10-4.16) and cardiologists (aOR, 2.04; 95% CI, 1.03-4.05), as well as physicians who implemented the US Public Health Service Clinical Practice Guidelines (aOR, 1.77; 95% CI, 1.12-2.80), had greater odds of recommending e-cigarettes to patients. Physicians who endorsed a harm-reduction perspective (aOR, 3.04, 95% CI, 2.15-4.31) and had ever smoked cigarettes (aOR, 1.98; 95% CI, 1.27-3.08) were significantly more likely to recommend e-cigarettes. Physicians who reported being asked about e-cigarettes had greater odds of recommending e-cigarettes (aOR, 16.60; 95% CI, 10.33-26.68). In clinical scenarios, physicians were overall more likely to recommend e-cigarettes for cessation to an older heavy smoker with multiple unsuccessful quit attempts (49.3%; 95% CI, 47.1%-51.4%) than a younger light smoker with no prior cessation treatments (15.2%; 95% CI, 13.6%-16.7%) (P < .001). CONCLUSIONS AND RELEVANCE In this survey study of physicians, findings suggest that physicians may recommend switching to e-cigarettes for some patients who smoke cigarettes under certain circumstances, presumably for cessation. The belief that all tobacco products are equally harmful was associated with lower rates of recommending e-cigarettes. As the evidence base grows for e-cigarette efficacy for smoking cessation, there is need for physician education regarding e-cigarette efficacy.
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Affiliation(s)
- Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Michelle Jeong
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Arjun Teotia
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | | | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Michael B. Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Wackowski OA, Gratale SK, Jeong M, Delnevo CD, Steinberg MB, O'Connor RJ. Over 1 year later: smokers' EVALI awareness, knowledge and perceived impact on e-cigarette interest. Tob Control 2022:tobaccocontrol-2021-057190. [PMID: 35228318 DOI: 10.1136/tobaccocontrol-2021-057190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/14/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The e-cigarette or vaping product use-associated lung injury (EVALI) outbreak caused serious lung injuries in over 2800 people in the USA in 2019. By February 2020, most cases were determined as linked with vaping tetrahydrocannabinol (THC), including black market products using vitamin E acetate. This study examined smokers' EVALI awareness, knowledge and perceived impact on their e-cigarette interest approximately 16 months after its peak. DESIGN Between January and February 2021, we surveyed 1018 adult current smokers from a nationally representative US research panel. Participants were asked if they had heard about EVALI prior to COVID-19, knew its main cause, and if EVALI had impacted their interest in future e-cigarette use. RESULTS Approximately 54% of smokers had heard of EVALI. Among those who had heard of EVALI (n=542), 37.3% believed its main cause was e-cigarettes used to vape nicotine, like JUUL. Fewer (16.6%) thought the main cause was products for vaping marijuana/THC, and 20.2% did not know. About 29% had heard vitamin E acetate was associated with EVALI, and 50.9% indicated EVALI made them less interested in using e-cigarettes in the future. EVALI awareness was significantly associated with e-cigarette risk perceptions (ie, that e-cigarettes are as harmful as smoking). CONCLUSIONS Despite the passage of time, considerable lack of knowledge and misperceptions about EVALI remain among those who smoke. Our findings suggest the need for continued efforts to promote better understanding of EVALI and appropriate behavioural and policy responses.
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Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA .,Deptartment of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | | | - Michelle Jeong
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA.,Deptartment of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA.,Deptartment of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Michael B Steinberg
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA.,Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
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14
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Steinberg MB, Bover Manderski MT, Wackowski OA, Singh B, Strasser AA, Delnevo CD. Nicotine Risk Misperception Among US Physicians. J Gen Intern Med 2021; 36:3888-3890. [PMID: 32875504 PMCID: PMC8642586 DOI: 10.1007/s11606-020-06172-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Michael B Steinberg
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
| | | | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
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15
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Schaer DA, Singh B, Steinberg MB, Delnevo CD. Tobacco Treatment Guideline Use and Predictors Among U.S. Physicians by Specialty. Am J Prev Med 2021; 61:882-889. [PMID: 34364726 PMCID: PMC8608714 DOI: 10.1016/j.amepre.2021.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Physicians play a critical role in tobacco treatment, being a frequent link to smokers and a trusted source of information. Unfortunately, barriers exist that limit physicians' implementation of evidence-based interventions. This study examines the implementation and predictors of the Ask, Advise, Assess, Assist, Arrange model of tobacco treatment clinical guidelines among U.S. physicians. METHODS A national sample of 1,058 U.S. physicians from 6 specialties (family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonology, and oncology) were surveyed in 2018 (51.8% response rate). Survey domains included demographics, awareness of the guidelines, tobacco treatment practices (i.e., Ask, Advise, Assess, Assist, Arrange model), perceived barriers to treatment, and perceived efficacy of various treatments. Multiple logistic regression analyzed the predictors of implementing guideline activities. RESULTS Mean age was 51.3 years, with the majority male (64.4%) and non-Hispanic White (63.9%). Nearly all physicians reported asking patients whether they smoke (95.6%) and advising them to stop (94.8%), slightly fewer assessed the readiness to quit (86.5%), and only a minority assisted with a quit plan (27.4%) or arranged a follow-up (18.6%). Only 18% reported using the U.S. Public Health Service Guidelines in clinical practice. Time-related factors were the most common barriers (53.4%), with patient factors (36.9%) and financial/resource factors (35.1%) cited less frequently. The predictors of implementing aspects of the Ask, Advise, Assess, Assist, Arrange model included physician awareness and utilization of the U.S. Public Health Service Guidelines, specialty, and to a smaller degree, graduating before 1990, not reporting time as a barrier, patient barriers, sex, and higher perceived effectiveness of pharmacotherapy. CONCLUSIONS This national survey highlights the need for increased implementation of all aspects of the latest guidelines for evidence-based tobacco treatments, including community-based resources.
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Affiliation(s)
- Daniel A Schaer
- The Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Michael B Steinberg
- The Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey.
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
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Abstract
Tobacco smoking is the leading cause of preventable death in the United States, and its harms are well established. Physicians have more evidence-based resources than ever before to effectively treat smoking, including new uses and combinations of U.S. Food and Drug Administration-approved pharmacotherapies and expanded community programs. In addition, electronic nicotine delivery systems are potential treatment tools, but their safety and efficacy need to be established. Finally, high-priority groups, such as persons with cancer diagnoses or hospitalized patients, may benefit from particular attention to their tobacco use.
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Affiliation(s)
- Manish S Patel
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sheetal B Patel
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael B Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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17
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Jeong M, Singh B, Wackowski OA, Mukherjee R, Steinberg MB, Delnevo CD. Content Analysis of E-cigarette News Articles Amidst the 2019 Vaping-Associated Lung Injury (EVALI) Outbreak in the U.S. Nicotine Tob Res 2021; 24:799-803. [PMID: 34624099 PMCID: PMC8962717 DOI: 10.1093/ntr/ntab203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION News media can shape public perceptions about e-cigarettes, particularly in the context of ongoing uncertainty from the recent outbreak of e-cigarette or vaping product use-associated lung injury (EVALI). This study aimed to characterize news articles published about e-cigarettes in 2019, including before and during the EVALI outbreak. METHODS Using 24 e-cigarette-related search terms, we gathered all articles published in leading print and online U.S. news sources in 2019 from databases (i.e., Factiva, Access World News) and archival websites (i.e., www.newspapers.com). We conducted a content analysis of e-cigarette themes and statements, identifying differences in themes between articles that did and did not mention EVALI. RESULTS Of the 1,643 e-cigarette news articles published in 2019, 62% mentioned EVALI. Frequency of e-cigarette articles peaked in September (n=532) at the height of the EVALI outbreak. Among all articles discussing e-cigarettes, the most prevalent main topics were policy/regulation (45%) and health effects (35%). Articles that mentioned EVALI frequently discussed youth e-cigarette use (40%) and JUUL (33%). Compared to non-EVALI articles, EVALI articles were more likely to discuss health effects (p<.001) but less likely to discuss policies/regulations, except for flavor bans (47% of EVALI articles vs. 39% of non-EVALI articles, p=.002). EVALI articles were also less likely to discuss e-cigarettes being less risky than cigarettes (p=.005). CONCLUSIONS E-cigarette news coverage was prevalent in 2019, and patterns in frequency and content reflected major events (i.e., EVALI). In turn, news media can shape public perceptions, and even policy, about e-cigarettes and must continue to be monitored. IMPLICATIONS E-cigarette news coverage in 2019 was high, driven in large part by news coverage of the EVALI outbreak. Indeed, the peak in e-cigarette news articles in September directly coincided with the peak in EVALI cases in the U.S. Of note, articles that mentioned EVALI frequently discussed youth e-cigarette use, JUUL, and flavor bans, which may have triggered national and state-level policy responses, and likely influenced public perceptions (including misperceptions) regarding the harms of e-cigarettes.
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Affiliation(s)
- Michelle Jeong
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ
| | - Rohit Mukherjee
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ
| | - Michael B Steinberg
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ.,Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ
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18
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Bover Manderski MT, Steinberg MB, Wackowski OA, Singh B, Young WJ, Delnevo CD. Persistent Misperceptions about Nicotine among US Physicians: Results from a Randomized Survey Experiment. Int J Environ Res Public Health 2021; 18:ijerph18147713. [PMID: 34300168 PMCID: PMC8306881 DOI: 10.3390/ijerph18147713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022]
Abstract
We conducted a survey experiment among US physicians to evaluate whether question wording impacted perceptions about the health effects of nicotine. 926 physicians were randomized to receive one of two versions of a question matrix that asked about the "extent to which they agree or disagree that 'nicotine' (Version 1) or 'nicotine, on its own,' (Version 2) directly contributes to" birth defects, cardiovascular disease (CVD), cancer, depression, and chronic obstructive pulmonary disease (COPD). We evaluated whether question condition predicted strong agreement and/or agreement with each statement, and assessed demographic correlates of each outcome while adjusting for question version. Physicians who received Version 2 were less likely to "strongly agree" that nicotine directly caused birth defects (Prevalence Ratio (PR) 0.84, 95% CI 0.72-0.98), CVD (PR 0.89, 95% CI 0.84-0.95), cancer (PR 0.81, 95% CI 0.75-0.87), and COPD (PR 0.78, 95% CI 0.72-0.84). Females were more likely to "strongly agree" that nicotine directly contributes to birth defects and cancer, and family physicians were most likely to "strongly agree" that nicotine directly contributes to CVD, cancer, and COPD. Question wording is important when measuring physicians' beliefs about nicotine; however, even after accounting for question version, misperceptions about the direct health effects of nicotine were common and varied by sex and specialty.
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Affiliation(s)
- Michelle T. Bover Manderski
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (O.A.W.); (B.S.); (W.J.Y.); (C.D.D.)
- Correspondence:
| | - Michael B. Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA;
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08901, USA
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (O.A.W.); (B.S.); (W.J.Y.); (C.D.D.)
- Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Binu Singh
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (O.A.W.); (B.S.); (W.J.Y.); (C.D.D.)
| | - William J. Young
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (O.A.W.); (B.S.); (W.J.Y.); (C.D.D.)
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (O.A.W.); (B.S.); (W.J.Y.); (C.D.D.)
- Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
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Doose M, Sanchez JI, Cantor JC, Plascak JJ, Steinberg MB, Hong CC, Demissie K, Bandera EV, Tsui J. Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems. JCO Oncol Pract 2021; 17:e637-e644. [PMID: 33974834 DOI: 10.1200/op.20.01089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation. MATERIALS AND METHODS We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation. RESULTS Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer-accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation (P > .05). CONCLUSION The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.
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Affiliation(s)
- Michelle Doose
- Helthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.,Rutgers School of Public Health, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Janeth I Sanchez
- Helthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Joel C Cantor
- Rutgers Center for State Health Policy, New Brunswick, NJ.,Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ
| | | | | | - Chi-Chen Hong
- University at Buffalo, Buffalo, NY.,Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Elisa V Bandera
- Rutgers School of Public Health, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Jennifer Tsui
- Rutgers Center for State Health Policy, New Brunswick, NJ.,Keck School of Medicine, University of Southern California, Los Angeles, CA
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Maloney SR, Udasin IG, Black TM, Shah NN, Steinberg MB, Pratt ME, Graber JM. Perceived Health Risks Among Firefighters; The New Jersey Firefighter Health Survey. J Occup Environ Med 2021; 63:317-321. [PMID: 33769397 DOI: 10.1097/jom.0000000000002125] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE There is a growing literature on the risk of chronic disease among firefighters, including cardiovascular disease (CVD) and cancer. However there is little information on firefighter's perception thereof. METHODS Firefighters attending a union convention in New Jersey completed a survey with four domains: firefighting experience; perceived additional risk for chronic diseases (six-point Likert scale); cancer screening history; demographics, and risk behaviors. RESULTS Among 167 enrolled firefighters, all were men and 86.6% active career. Median perceived risk ranged from high risk (colon, hematologic, breast, prostate, and testicular cancers) to very high risk (CVD, pulmonary diseases, all cancers, lung and oral cancer). CONCLUSIONS NJ Firefighters attributed considerable additional risk to acquiring chronic disease as a result of their firefighting activities. Understanding firefighter perceptions of their own morbidity and mortality will help develop future firefighter preparatory programs.
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Affiliation(s)
- Sean R Maloney
- Environmental and Occupational Health Sciences Institute - Clinical Research and Occupational Medicine (Dr Maloney, Dr Udasin, Ms Black, Dr Steinberg, Dr Pratt, Dr Graber); Rutgers School of Public Health (Dr Udasin, Mr Shah, Dr Graber); Rutgers Robert Wood Johnson Medical School Division of General Internal Medicine (Dr Steinberg), Rutgers, The State University of New Jersey, Piscataway, New Brunswick; RWJBarnabas Health - Jersey City (Dr Maloney), New Jersey
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21
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Doose M, Tsui J, Steinberg MB, Xing CY, Lin Y, Cantor JC, Hong CC, Demissie K, Bandera EV. Patterns of chronic disease management and health outcomes in a population-based cohort of Black women with breast cancer. Cancer Causes Control 2021; 32:157-168. [PMID: 33404907 PMCID: PMC7837275 DOI: 10.1007/s10552-020-01370-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 07/25/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Diabetes and hypertension are two common comorbidities that affect breast cancer patients, particularly Black women. Disruption of chronic disease management during cancer treatment has been speculated. Therefore, this study examined the implementation of clinical practice guidelines and health outcomes for these comorbidities before and during cancer treatment. METHODS We used a population-based, prospective cohort of Black women diagnosed with breast cancer (2012-2016) in New Jersey (n = 563). Chronic disease management for diabetes and hypertension was examined 12 months before and after breast cancer diagnosis and compared using McNemar's test for matched paired and paired t tests. RESULTS Among this cohort, 18.1% had a co-diagnosis of diabetes and 47.2% had a co-diagnosis of hypertension. Implementation of clinical practice guidelines and health outcomes that differed in the 12 months before and after cancer diagnosis included lipid screening (64.5% before versus 50.0% after diagnosis; p = 0.004), glucose screening (72.7% versus 90.7%; p < 0.001), and blood pressure control < 140/90 mmHg (57.6% versus 71.5%; p = 0.004) among patients with hypertension-only. For patients with diabetes, eye and foot care were low (< 35%) and optimal HbA1c < 8.0% was achieved for less than 50% of patients in both time periods. CONCLUSION Chronic disease management continued during cancer treatment; however, eye and foot exams for patients with diabetes and lipid screening for patients with hypertension-only were inadequate. Given that comorbidities may account for half of the Black-White breast cancer survival disparity, strategies are needed to improve chronic disease management during cancer, especially for Black women who bear a disproportionate burden of chronic diseases.
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Affiliation(s)
- Michelle Doose
- Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, 3E502, Rockville, MD, 20850, USA.
- Rutgers School of Public Health, Piscataway, NJ, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Jennifer Tsui
- Rutgers Center for State Health Policy, New Brunswick, NJ, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Yong Lin
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Joel C Cantor
- Rutgers Center for State Health Policy, New Brunswick, NJ, USA
- Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ, USA
| | - Chi-Chen Hong
- University at Buffalo, Buffalo, NY, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kitaw Demissie
- SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Elisa V Bandera
- Rutgers School of Public Health, Piscataway, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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22
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Wackowski OA, Sontag JM, Singh B, King J, Lewis MJ, Steinberg MB, Delnevo CD. From the Deeming Rule to JUUL-US News Coverage of Electronic Cigarettes, 2015-2018. Nicotine Tob Res 2021; 22:1816-1822. [PMID: 32053188 DOI: 10.1093/ntr/ntaa025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/23/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION News media may influence public perceptions and attitudes about electronic cigarettes (e-cigarettes), which may influence product use and attitudes about their regulation. The purpose of this study is to describe trends in US news coverage of e-cigarettes during a period of evolving regulation, science, and trends in the use of e-cigarettes. METHODS We conducted a content analysis of e-cigarette topics and themes covered in US news articles from 2015 to 2018. Online news databases (Access World News, Factiva) were used to obtain US news articles from the top 34 circulating newspapers, four national wire services, and five leading online news sources. RESULTS The number of articles increased by 75.4% between 2015 and 2018 (n = 1609). Most articles focused on policy/regulation (43.5%) as a main topic, followed by health effects (22.3%) and prevalence/trends (17.9%). Discussion about flavor bans quadrupled (6.1% to 24.6%) and discussion of youth e-cigarette use was most prevalent (58.4%) in 2018, coinciding with an increase in coverage about JUUL. JUUL was mentioned in 50.8% of 2018 articles. Across years, articles more frequently mentioned e-cigarette risks (70%) than potential benefits (37.3%). CONCLUSIONS E-cigarettes continue to be a newsworthy topic, with coverage both reflecting numerous changes and events over time, and providing repeated opportunities for informing the public and policymakers about these novel products. Future research should continue to track how discourse changes over time and assess its potential influence on e-cigarette perceptions and policy changes. IMPLICATIONS E-cigarette news coverage in the United States increased between 2015 and 2018 and predominantly focused on policy and regulation. Notable spikes in volume were associated with some but not all major e-cigarette events, including the FDA's deeming rule, Surgeon General's report, and release of the National Youth Tobacco Survey data in 2018. Coverage of the 2018 National Academy of Medicine, Engineering, and Sciences report on the Public Health Consequences of E-cigarettes received minimal news coverage. The high volume in 2018 was driven in large part by coverage of the e-cigarette brand JUUL; over half of news articles in 2018 referenced JUUL specifically.
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Affiliation(s)
| | - Jennah M Sontag
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Binu Singh
- Rutgers Center for Tobacco Studies, New Brunswick, NJ
| | - Jessica King
- College of Health, University of Utah, Salt Lake City, UT
| | - M Jane Lewis
- Rutgers Center for Tobacco Studies, New Brunswick, NJ
| | - Michael B Steinberg
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
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Patel MS, Hogshire LC, Noveck H, Steinberg MB, Hoover DR, Rosenfeld J, Arya A, Carson JL. A Retrospective Cohort Study of the Impact of Nurse Practitioners on Hospitalized Patient Outcomes. Nurs Rep 2021; 11:28-35. [PMID: 34968309 PMCID: PMC8608079 DOI: 10.3390/nursrep11010003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022] Open
Abstract
The role of advanced practice providers has expanded in the hospital setting. However, little data exist examining the impact of these providers. Our purpose was to determine the effect of adding nurse practitioners in a complementary role on the quality and efficiency of care of hospitalized patients. A retrospective cohort study evaluated adult patients admitted by private physicians (without house staff or non-physician providers) to a general medical-surgical unit in an academic medical center. The admissions department allocated patients as beds became available and nurse practitioners were assigned to patients until their caseload was reached. Outcomes included length of hospital stay, in-hospital mortality, admission costs, 30-day readmissions, transfer to a more intensive care level, and discharge order time. Of the 382 patients included in this study, 263 were assigned to the nurse practitioner group. Hospital mortality was lower in the nurse practitioner group [OR 0.11 (95% CI 0.02–0.51)] as was transfer to more intensive care level [OR 0.39 (95% CI 0.20–0.75)]; however, the nurse practitioner group had longer length of stay (geometric mean = 5.80 days for nurse practitioners, 3.63 days for no nurse practitioners; p < 0.0001) and higher cost per patient (geometric mean = USD 6631 vs. USD 5121; p = 0.005). The results were unchanged when models were adjusted for potential confounders. Adding nurse practitioners can yield improved clinical outcomes (lower hospital mortality and fewer transfers to intensive care), but with a potential economic expense (longer hospital stays and higher costs).
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Affiliation(s)
- Manish S. Patel
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.C.H.); (H.N.); (M.B.S.); (J.R.); (J.L.C.)
- Correspondence: ; Tel.: +1-732-235-7112
| | - Lauren C. Hogshire
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.C.H.); (H.N.); (M.B.S.); (J.R.); (J.L.C.)
| | - Helaine Noveck
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.C.H.); (H.N.); (M.B.S.); (J.R.); (J.L.C.)
| | - Michael B. Steinberg
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.C.H.); (H.N.); (M.B.S.); (J.R.); (J.L.C.)
| | - Donald R. Hoover
- Department of Statistics and Institute for Health, Healthcare Policy and Aging Research, Rutgers University, Piscataway, NJ 08854, USA;
| | - Jane Rosenfeld
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.C.H.); (H.N.); (M.B.S.); (J.R.); (J.L.C.)
| | - Akanksha Arya
- Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Jeffrey L. Carson
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.C.H.); (H.N.); (M.B.S.); (J.R.); (J.L.C.)
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Doose M, Steinberg MB, Xing CY, Lin Y, Cantor JC, Hong CC, Demissie K, Bandera EV, Tsui J. Comorbidity Management in Black Women Diagnosed with Breast Cancer: the Role of Primary Care in Shared Care. J Gen Intern Med 2021; 36:138-146. [PMID: 32974725 PMCID: PMC7858725 DOI: 10.1007/s11606-020-06234-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Black women are more likely to have comorbidity at breast cancer diagnosis compared with White women, which may account for half of the Black-White survivor disparity. Comprehensive disease management requires a coordinated team of healthcare professionals including primary care practitioners, but few studies have examined shared care in the management of comorbidities during cancer care, especially among racial/ethnic minorities. OBJECTIVE To examine whether the type of medical team composition is associated with optimal clinical care management of comorbidities. DESIGN We used the Women's Circle of Health Follow-up Study, a population-based cohort of Black women diagnosed with breast cancer. The likelihood of receiving optimal comorbidity management after breast cancer diagnosis was compared by type of medical team composition (shared care versus cancer specialists only) using binomial regression. PARTICIPANTS Black women with a co-diagnosis of diabetes and/or hypertension at breast cancer diagnosis between 2012 and 2016 (N = 274). MAIN MEASURES Outcome-optimal clinical care management of diabetes (i.e., A1C test, LDL-C test, and medical attention for nephropathy) and hypertension (i.e., lipid screening and prescription for hypertension medication). Main predictor-shared care, whether the patient received care from both a cancer specialist and a primary care provider and/or a medical specialist within the 12 months following a breast cancer diagnosis. KEY RESULTS Primary care providers were the main providers involved in managing comorbidities and 90% of patients received shared care during breast cancer care. Only 54% had optimal comorbidity management. Patients with shared care were five times (aRR: 4.62; 95% CI: 1.66, 12.84) more likely to have optimal comorbidity management compared with patients who only saw cancer specialists. CONCLUSIONS Suboptimal management of comorbidities during breast cancer care exists for Black women. However, our findings suggest that shared care is more beneficial at achieving optimal clinical care management for diabetes and hypertension than cancer specialists alone.
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Affiliation(s)
- Michelle Doose
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 3E502, Rockville, MD, 20850, USA.
- Rutgers School of Public Health, Piscataway, NJ, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | | | | | - Yong Lin
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Joel C Cantor
- Rutgers Center for State Health Policy, New Brunswick, NJ, USA
- Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ, USA
| | - Chi-Chen Hong
- University at Buffalo, Buffalo, NY, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kitaw Demissie
- SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Elisa V Bandera
- Rutgers School of Public Health, Piscataway, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jennifer Tsui
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Li J, Huynh L, Cornwell WD, Tang MS, Simborio H, Huang J, Kosmider B, Rogers TJ, Zhao H, Steinberg MB, Thu Thi Le L, Zhang L, Pham K, Liu C, Wang H. Electronic Cigarettes Induce Mitochondrial DNA Damage and Trigger TLR9 (Toll-Like Receptor 9)-Mediated Atherosclerosis. Arterioscler Thromb Vasc Biol 2020; 41:839-853. [PMID: 33380174 DOI: 10.1161/atvbaha.120.315556] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Electronic cigarette (e-cig) use has recently been implicated in promoting atherosclerosis. In this study, we aimed to investigate the mechanism of e-cig exposure accelerated atherosclerotic lesion development. Approach and Results: Eight-week-old ApoE-/- mice fed normal laboratory diet were exposed to e-cig vapor (ECV) for 2 hours/day, 5 days/week for 16 weeks. We found that ECV exposure significantly induced atherosclerotic lesions as examined by Oil Red O staining and greatly upregulated TLR9 (toll-like receptor 9) expression in classical monocytes and in the atherosclerotic plaques, which the latter was corroborated by enhanced TLR9 expression in human femoral artery atherosclerotic plaques from e-cig smokers. Intriguingly, we found a significant increase of oxidative mitochondria DNA lesion in the plasma of ECV-exposed mice. Administration of TLR9 antagonist before ECV exposure not only alleviated atherosclerosis and the upregulation of TLR9 in plaques but also attenuated the increase of plasma levels of inflammatory cytokines, reduced the plaque accumulation of lipid and macrophages, and decreased the frequency of blood CCR2+ (C-C chemokine receptor type 2) classical monocytes. Surprisingly, we found that cytoplasmic mitochondrial DNA isolated from ECV extract-treated macrophages can enhance TLR9 activation in reporter cells and the induction of inflammatory cytokine could be suppressed by TLR9 inhibitor in macrophages. CONCLUSIONS E-cig increases level of damaged mitochondrial DNA in circulating blood and induces the expression of TLR9, which elevate the expression of proinflammatory cytokines in monocyte/macrophage and consequently lead to atherosclerosis. Our results raise the possibility that intervention of TLR9 activation is a potential pharmacological target of ECV-related inflammation and cardiovascular diseases.
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Affiliation(s)
- Jieliang Li
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ (J.L., L.H., J.H., L.T.T.L., H.W.)
| | - Luong Huynh
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ (J.L., L.H., J.H., L.T.T.L., H.W.)
| | - William D Cornwell
- Department of Physiology (W.D.C.), Temple University School of Medicine, Philadelphia, PA
| | - Moon-Shong Tang
- Department of Environment Medicine, New York University School of Medicine, Tuxedo Park (M.-S.T.)
| | - Hannah Simborio
- Center for Inflammation, Translational and Clinical Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (H.S., B.K., T.J.R.)
| | - Jing Huang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ (J.L., L.H., J.H., L.T.T.L., H.W.)
| | - Beata Kosmider
- Center for Inflammation, Translational and Clinical Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (H.S., B.K., T.J.R.).,Department of Thoracic Medicine and Surgery (B.K.), Temple University School of Medicine, Philadelphia, PA
| | - Thomas J Rogers
- Center for Inflammation, Translational and Clinical Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (H.S., B.K., T.J.R.)
| | - Huaqing Zhao
- Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA
| | - Michael B Steinberg
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (M.B.S.)
| | - Le Thu Thi Le
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ (J.L., L.H., J.H., L.T.T.L., H.W.)
| | - Lanjing Zhang
- Gastrointestinal and Liver Pathology, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey (L.Z.)
| | - Kien Pham
- Department of Pathology, Yale University School of Medicine, New Haven, CT (K.P., C.L.)
| | - Chen Liu
- Department of Pathology, Yale University School of Medicine, New Haven, CT (K.P., C.L.)
| | - He Wang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ (J.L., L.H., J.H., L.T.T.L., H.W.)
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Bover Manderski MT, Black K, Udasin IG, Black TM, Steinberg MB, Giuliano AR, Luft BJ, Harrison D, Crane MA, Moline J, Passannante MR, Ohman Strickland P, Dasaro CR, Lucchini RG, Todd AC, Graber JM. Retrospective Assessment of Risk Factors for Head and Neck Cancer Among World Trade Center General Responders. Front Public Health 2020; 8:488057. [PMID: 33330296 PMCID: PMC7734028 DOI: 10.3389/fpubh.2020.488057] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/04/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: To assess the reliability of a questionnaire designed to reconstruct risk factors for head and neck cancer relative to the 9/11 World Trade Center (WTC) response and over the lifetime. Methods: As part of a nested case-control study, 200 WTC Health Program (WTCHP) General Responder Cohort (GRC) members completed a newly-developed study questionnaire via telephone (with a trained interviewer) or online (self-administered). We assessed agreement between measures of tobacco and alcohol use in our questionnaire results and data collected previously during WTCHP-GRC monitoring visits using Cohens Kappa (κ) and intraclass correlation coefficient (ICC) for categorical and continuous measures, respectively. We compared agreement by disease status, survey mode, and year of WTCHP enrollment. Results: We observed high agreement between measures of lifetime, pre-WTC, and post-WTC smoking prevalence (all κ > 0.85) and smoking duration (all ICC > 0.84). There was moderate agreement between measures of smoking frequency (ICC: 0.61-0.73). Agreement between measures of smoking frequency, but not duration, differed by disease status, and agreement between smoking measures was higher for participants who completed our survey by phone than by web. Among cases, there were no differences based on enrollment in the WTCHP before or after diagnosis. Conclusion: Agreement between measures was generally high, although potential reporting bias and a mode effect that should be considered when interpreting analyses of self-reported data in this population; however differential misclassification appears to be minimal. Our questionnaire may be useful for future studies examining similar behavioral risk factors among disaster-exposed populations.
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Affiliation(s)
- Michelle T. Bover Manderski
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Kathleen Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Iris G. Udasin
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Taylor M. Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Michael B. Steinberg
- Division of General Internal Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
| | - Benjamin J. Luft
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Denise Harrison
- Department of Environmental Medicine, Bellevue Hospital Center/New York University School of Medicine, New York, NY, United States
| | - Michael A. Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jacqueline Moline
- Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY, United States
| | - Marian R. Passannante
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
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Pierce JP, Benmarhnia T, Chen R, White M, Abrams DB, Ambrose BK, Blanco C, Borek N, Choi K, Coleman B, Compton WM, Cummings KM, Delnevo CD, Elton-Marshall T, Goniewicz ML, Gravely S, Fong GT, Hatsukami D, Henrie J, Kasza KA, Kealey S, Kimmel HL, Limpert J, Niaura RS, Ramôa C, Sharma E, Silveira ML, Stanton CA, Steinberg MB, Taylor E, Bansal-Travers M, Trinidad DR, Gardner LD, Hyland A, Soneji S, Messer K. Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16. PLoS One 2020; 15:e0237938. [PMID: 32877429 PMCID: PMC7467279 DOI: 10.1371/journal.pone.0237938] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 04/04/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy. OBJECTIVE To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use. DESIGN Cohort study of US sample, with annual follow-up. PARTICIPANTS US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443). EXPOSURES Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2. ANALYSIS Propensity score matching (PSM) of groups using different methods to quit. OUTCOME MEASURES 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome. RESULTS Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products. LIMITATIONS The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA. CONCLUSION Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.
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Affiliation(s)
- John P. Pierce
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Tarik Benmarhnia
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Ruifeng Chen
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Martha White
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
| | - David B. Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Kelvin Choi
- National Institute for Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Blair Coleman
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey, United States of America
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada
| | - Dorothy Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - James Henrie
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Karin A. Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Sheila Kealey
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Raymond S. Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Carolina Ramôa
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Eva Sharma
- Westat, Rockville, Maryland, United States of America
| | - Marushka L. Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
- Kelly Government Solutions, Rockville, Maryland, United States of America
| | | | - Michael B. Steinberg
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey, United States of America
| | - Ethel Taylor
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Dennis R. Trinidad
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Lisa D. Gardner
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
- Westat, Rockville, Maryland, United States of America
| | - Samir Soneji
- Department of Health Behavior, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Karen Messer
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
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Pham K, Huynh D, Le L, Delitto D, Yang L, Huang J, Kang Y, Steinberg MB, Li J, Zhang L, Liu D, Tang MS, Liu C, Wang H. E-cigarette promotes breast carcinoma progression and lung metastasis: Macrophage-tumor cells crosstalk and the role of CCL5 and VCAM-1. Cancer Lett 2020; 491:132-145. [PMID: 32829009 DOI: 10.1016/j.canlet.2020.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 04/11/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 12/31/2022]
Abstract
Young women represent a target of E-cigarette (E-cig) companies, raising concern for potential connections with breast cancer (BC) that have not yet been elucidated. We hypothesized that E-cig promotes BC development and lung metastasis possibly through BC-monocyte/tumor-associated macrophage (TAM) crosstalk via CCL5 and V-CAM-1 axes. We demonstrated that E-cig promoted the infiltration of circulating monocytes in mammary fat pad (MFP) model. Furthermore, E-cig exposure significantly enhanced BC cell growth in MFP tumor and metastatic lung colonization; immunohistochemical stains illustrated the increase of TAMs infiltration, reduced BC cell apoptosis and increased proliferation index after E-cig exposure. In vitro studies show E-cig vapor condensate (EVC) treatment upregulated protein expressions of CCL5, V-CAM-1, and other pro-tumorigenic factors in BC cells. Mechanistically, co-culture system demonstrated both EVC and macrophages independently stimulated BC cell growth and the migration via CCL5/CCR1/CCR5 axis. During metastasis, E-Cig exposure stimulated BC cell survival via direct interaction with infiltrated macrophages, regulated by VCAM-1 and integrin α4β1. Our findings, for the first time, showed that E-cig promotes BC growth and metastasis. This study highlights the critical role of TAMs via CCL5 and VCAM-1 pathways in E-cig promoted BC tumor development.
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Affiliation(s)
- Kien Pham
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Do Huynh
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Le Le
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Daniel Delitto
- Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lei Yang
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Jing Huang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Yibin Kang
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Michael B Steinberg
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Jieliang Li
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Lanjing Zhang
- Department of Pathology, Immunology & Laboratory Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Dongfang Liu
- Department of Pathology, Immunology & Laboratory Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Moon-Shong Tang
- Department of Environment Medicine, New York University School of Medicine, New York University, Tuxedo Park, NY, USA
| | - Chen Liu
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - He Wang
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; Department of Pathology, Immunology & Laboratory Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
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Doose M, Steinberg MB, Xing CY, Lin Y, Cantor JC, Hong CC, Demissie K, Bandera EV, Tsui J. Abstract D070: Examining medical providers’ involvement in diabetes and hypertension clinical care management of Black breast cancer patients. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-d070] [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
Purpose: Hypertension and diabetes are common comorbidities present at breast cancer diagnosis, which may account for half of the Black-White breast cancer survival disparity. Having a coordinated team of medical providers to manage both breast cancer and comorbidities for patients can improve care quality and outcomes; however, these relationships are understudied. Therefore, we examined 1) type of medical provider involved in diabetes and hypertension clinical care management and 2) whether type of physician team was associated with optimal clinical care management of diabetes and hypertension during breast cancer care. Methods: We used medical and pharmacy records and interview data from the Women’s Circle of Health Follow-Up Study, an ongoing population-based cohort of Black breast cancer survivors. Women with diabetes or hypertension for at least one year prior to breast cancer diagnosis (2012-2016) were included (N=274). Optimal diabetes management was categorized as physician order of HbA1c test, LDL-cholesterol test, and medical attention for nephropathy; and optimal hypertension management was categorized as physician order of lipid screen and prescription for hypertension medications within the 12-months post cancer diagnosis. Visits with any cancer specialist, primary care provider, or medical specialist were examined and then categorized as shared care (visits with both a cancer specialist and primary care physician and/or medical specialist) or cancer specialist only. The likelihood of receiving optimal clinical care management for either diabetes and hypertension during breast cancer care was compared by type of physician team using multivariable binomial regression, adjusting for age and health insurance at diagnosis, cancer stage, and comorbidity type and disease severity. Results: 86% of patients had a primary care visit in the 12-months after diagnosis. Most clinical care for comorbidities were managed by primary care providers (diabetes tests: 65% HbA1c, 88% LDL- cholesterol, 60% microalbuminuria; hypertension: 88% lipid screen, 85% hypertension medications). Half of all measures were ordered within 6 months of diagnosis. Only half (49%) of patients received optimal comorbid clinical care management and 90% received shared care. Patients with shared care were four times more likely to have optimal clinical care management for diabetes and hypertension compared with patients who only saw cancer specialists (aRR: 4.41; 95% CI: 1.57, 12.34). Conclusions: These findings are important in that shared care may promote optimal clinical care management for diabetes and hypertension and lead to reduced mortality and improved outcomes, particularly for racial/ethnic minority patients with a greater burden of chronic conditions. Future research is needed to explore the processes of shared care to determine whether medical providers are performing clinical care independently or if providers are communicating to coordinate patients’ care.
Citation Format: Michelle Doose, Michael B. Steinberg, Cathleen Y. Xing, Yong Lin, Joel C. Cantor, Chi-Chen Hong, Kitaw Demissie, Elisa V. Bandera, Jennifer Tsui. Examining medical providers’ involvement in diabetes and hypertension clinical care management of Black breast cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D070.
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Affiliation(s)
| | | | | | - Yong Lin
- 1Rutgers School of Public Health, Piscataway, NJ, USA,
| | - Joel C. Cantor
- 3Rutgers Center for State Health Policy, New Brunswick, NJ, USA,
| | - Chi-Chen Hong
- 4Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA,
| | | | | | - Jennifer Tsui
- 6Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Kotsen C, Santorelli ML, Bloom EL, Goldstein AO, Ripley-Moffitt C, Steinberg MB, Burke MV, Foulds J. A Narrative Review of Intensive Group Tobacco Treatment: Clinical, Research, and US Policy Recommendations. Nicotine Tob Res 2020; 21:1580-1589. [PMID: 30124924 DOI: 10.1093/ntr/nty162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/14/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Clinical practice guidelines recommend comprehensive treatment for tobacco dependence including pharmacotherapies and behavioral interventions. Group counseling may deliver unique treatment aspects not available with other modalities. This manuscript provides a narrative review of group treatment outcomes from real-world practice settings and complements recent meta-analyses of randomized controlled trials (RCTs). Our primary goals were to determine whether group treatments delivered in these settings have yielded similar quit rates compared to individual treatment and to provide recommendations for best practices and policy. METHODS Group treatment was defined as occurring in a clinical or workplace setting (ie, not provided as part of a research study), led by a professionally trained clinician, and offered weekly over several weeks. English language PubMed articles from January 2000 to July 2017 were searched to identify studies that included outcomes from both group and individual treatment offered in real-world settings. Additional data sources meeting our criteria were also included. Reports not using pharmacotherapy and research studies (eg, RCTs) were excluded. The primary outcome was short-term, carbon monoxide (CO)-validated point prevalence abstinence (4-week postquit date). RESULTS The review included data from 11 observational studies. In all cases, group treatment(s) had higher 4-week CO-validated quit rates (range: 35.5%-67.3%) than individual treatment(s) (range: 18.6%-53.3%). CONCLUSIONS Best practice group treatments for tobacco dependence are generalizable from research to clinical settings and likely to be at least as effective as intensive individual treatment. The added advantages of efficiency and cost-effectiveness can be significant. Group treatment is feasible in various settings with good results. IMPLICATIONS A major barrier to achieving high rates of tobacco abstinence is under-utilization of evidence-based treatment interventions. This review demonstrates the effectiveness and utility of group treatment for tobacco dependence. Based on the available data described in this narrative review in conjunction with existing RCT data, group treatment for tobacco dependence should be established and available in all behavioral health and medical settings. Group tobacco treatment is now one of the mandated reimbursable tobacco treatment formats within the US health care system, creating enormous opportunities for widespread clinical reach. Finally, comprehensive worksite group programs can further extend impact.
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Affiliation(s)
- Chris Kotsen
- Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, RWJ Barnabas Health, Robert Wood Johnson Barnabas Health University Hospital Somerset, Somerville, NJ
| | - Melissa L Santorelli
- Community Health and Wellness Unit, New Jersey Department of Health, State of New Jersey, Trenton, NJ
| | - Erika Litvin Bloom
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam O Goldstein
- Tobacco Intervention Programs, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Carol Ripley-Moffitt
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael B Steinberg
- Rutgers Tobacco Dependence Program, Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Jonathan Foulds
- Population Health and Cancer Control Program, Cancer Institute, College of Medicine, Penn State University, Hershey, PA
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Briganti M, Wackowski OA, Delnevo CD, Brown L, Hastings SE, Singh B, Steinberg MB. Content Analysis of Electronic Nicotine Delivery System Publications in Core Clinical Journals from 2012 to 2018. Int J Environ Res Public Health 2020; 17:E2201. [PMID: 32218306 PMCID: PMC7177383 DOI: 10.3390/ijerph17072201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 02/07/2023]
Abstract
There is no consensus if electronic nicotine delivery systems (ENDS) should be used to reduce harm among the smoking population. Physicians, who represent a trusted source of health communication, are exposed to a range of often conflicting ENDS information and this information may be relayed to patients looking to quit smoking. Previous studies have examined ENDS content of various sources of media but there is a lack of knowledge about ENDS content in medical journals. We analyzed 421 ENDS publications printed between 2012 and 2018 from PubMed's Core Clinical Journal list. Publications were analyzed based on publication type, journal type, study design, geographic focus, theme, terminology, outcomes, and positive/negative statements. The number of ENDS publications grew since 2012, and peaked in 2015. Across all years, negative statements about ENDS outnumbered positive statements, though this difference decreased over time. Over time, negative statements about "toxins and carcinogens" were made less frequently, while negative statements about "gateway effects" and "youth appeal" became more prevalent. UK journals had fewer negative statements relative to US journals. Only 12.6% of publications included guidance for healthcare professionals about ENDS. As published ENDS topics change over time, physicians' communications with patients may be impacted.
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Affiliation(s)
- Michael Briganti
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Leanne Brown
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
| | - Shirin E. Hastings
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
| | - Binu Singh
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA; (M.B.); (O.A.W.); (C.D.D.); (B.S.)
| | - Michael B. Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (L.B.); (S.E.H.)
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Yingst J, Foulds J, Zurlo J, Steinberg MB, Eissenberg T, Du P. Acceptability of electronic nicotine delivery systems (ENDS) among HIV positive smokers. AIDS Care 2019; 32:1224-1228. [PMID: 31698920 DOI: 10.1080/09540121.2019.1687835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Electronic nicotine delivery systems (ENDS) have the potential to help smokers living with HIV/AIDS (PLWHA) to reduce harms from tobacco use. However, little is known about ENDS use among PLWHA. This study's aim was to evaluate the acceptability of two types of ENDS among PLWHA not planning to quit smoking. The study utilized a cross-over design where participants used two ENDS in a random order as smoking substitutes during two use periods separated by 7 days. Exhaled carbon monoxide (CO) was analyzed and participants reported daily cigarette and ENDS use and completed ratings on ENDS acceptability. Participants (n = 17) were a mean age of 49.1 years (SD = 8.8), were 53% white, and 59% male. All participants had controlled HIV disease status. Participants smoked a mean of 16.9 (SD = 7.9) CPD at baseline. Overall, CPD significantly decreased during both ENDS use periods (p < .01) but there were no differences in reduction between the different devices. CO decreased from baseline to follow-up only during the button-activated ENDS use period (p = .03), but there were no differences between ENDS devices. There were no significant differences in ratings of acceptability between ENDS devices. These results suggest that ENDS could be a harm reduction tool for smokers with HIV.
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Affiliation(s)
- Jessica Yingst
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - John Zurlo
- Department of Medicine, Penn State University College of Medicine, Hershey, PA USA
| | - Michael B Steinberg
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA.,Department of Medicine, Penn State University College of Medicine, Hershey, PA USA
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Bover Manderski MT, Black K, Udasin IG, Giuliano AR, Steinberg MB, Ohman Strickland P, Black TM, Dasaro CR, Crane M, Harrison D, Moline J, Luft BJ, Passannante MR, Lucchini RG, Todd AC, Graber JM. Risk factors for head and neck cancer in the World Trade Center Health Program General Responder Cohort: results from a nested case-control study. Occup Environ Med 2019; 76:854-860. [PMID: 31515248 DOI: 10.1136/oemed-2019-105890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Head and neck cancers (HNCs) may be among the health consequences of involvement in the World Trade Center (WTC) response on and after 11 September 2001. We conducted a nested case-control study of WTC Health Program (WTCHP) general responders to examine the effects of WTC exposures and behavioural risk factors on HNC. METHODS We enrolled 64 cases and 136 controls, matched on age, sex and race/ethnicity within risk sets. We assessed tobacco and alcohol use, sexual activity, and occupational exposures prior to, during and after WTC exposure until case diagnosis via questionnaire. We obtained WTC exposure information (duration (first to last day), total days and location of work) from the WTCHP General Responder Data Center. We assessed associations with HNC, and interaction among exposures, using conditional logistic regression. RESULTS Responders in protective services versus other occupations had increased odds (OR: 2.51, 95% CI 1.09 to 5.82) of HNC. Among those in non-protective services occupations, arriving to the WTC effort on versus after 11 September 2001 was significantly associated with HNC (OR: 3.77, 95% CI 1.00 to 14.11). Duration of work was not significantly associated with HNC. Lifetime and post-WTC years of cigarette smoking and post-WTC number of sex partners were positively and significantly associated with HNC, while alcohol consumption was not. CONCLUSIONS These findings suggest opportunities for HNC risk factor mitigation (eg, smoking cessation, human papillomavirus vaccination) and contribute to a risk factor profile which may assist WTCHP clinicians with identifying high-risk responders and improve detection and treatment outcomes in this population.
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Affiliation(s)
- Michelle T Bover Manderski
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kathleen Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Iris G Udasin
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Michael B Steinberg
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Taylor M Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Denise Harrison
- Department of Environmental Medicine, Bellevue Hospital Center, New York City, New York, USA
| | - Jacqueline Moline
- Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Marian R Passannante
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Roberto G Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Judith M Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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Wackowski OA, Giovenco DP, Singh B, Lewis MJ, Steinberg MB, Delnevo CD. Content Analysis of US News Stories About E-Cigarettes in 2015. Nicotine Tob Res 2019; 20:1015-1019. [PMID: 29065205 DOI: 10.1093/ntr/ntx170] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/28/2017] [Indexed: 11/13/2022]
Abstract
Background Coverage of e-cigarettes in the news media may shape public perceptions about them but little is known about such news content. This content analysis characterized discussion of e-cigarettes in leading print and online US news sources in 2015. Methods We searched Access World News and Factiva databases for e-cigarette-related news articles appearing in the top 30 circulating newspapers, 4 newswires, and 4 online news sources in the United States in 2015 (n = 295). Coders identified the presence of various e-cigarette topics (e.g. regulation), and benefit and risk statements. Results Nearly half of articles (45.1%) focused primarily on e-cigarette policy/regulatory issues, although e-cigarette prevalence (21.0%) and health effects (21.7%) were common main topics. Concerns about youth were frequently mentioned, including the rise in youth e-cigarette use (45.4%), gateway to smoking potential (33.9%) and appeal of flavors (22.4%). Youth e-cigarette prevalence was more frequently mentioned than adult prevalence in articles discussing FDA regulation (61% vs. 13.5%, respectively). News articles more frequently discussed potential e-cigarette risks or concerns (80%) than benefits (45.4%), such as smoking harm-reduction. Quoted physicians, researchers, and government representatives were more likely to refer to e-cigarette risks than benefits. Conclusions In 2015, rising rates of e-cigarette use among youth and policy strategies to address e-cigarettes dominated US e-cigarette news stories, leading up to their FDA regulation in 2016. Statements about e-cigarettes' potential risks were frequently attributed to trusted sources such as physicians, and outnumbered claims about their harm-reduction benefits. Such coverage may impact e-cigarette risk perceptions, use intentions and policy support. Implications In the year leading up to the FDA's Deeming Rule, concerns about youth use or potential use were frequently discussed in e-cigarette news. News articles more frequently discussed potential e-cigarette risks/concerns compared to potential harm-reduction benefits relative to tobacco cigarettes. While such coverage may inform the public about potential e-cigarette risks, they may also contribute to increasing perceptions that e-cigarettes are as harmful as tobacco cigarettes. E-cigarette risk and benefit statements were most frequently made by or attributed to researchers and physicians in articles, which is significant given that they may be particularly trusted sources of e-cigarette risk information.
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Affiliation(s)
- Olivia A Wackowski
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Binu Singh
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ
| | - M Jane Lewis
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ
| | - Michael B Steinberg
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Cristine D Delnevo
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ
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Graber JM, Harris G, Black K, Lucchini RG, Giuliano AR, Dasaro CR, Shapiro M, Steinberg MB, Crane MA, Moline JM, Harrison DJ, Luft BJ, Todd AC, Udasin IG. Excess HPV-related head and neck cancer in the world trade center health program general responder cohort. Int J Cancer 2019; 145:1504-1509. [PMID: 30556136 DOI: 10.1002/ijc.32070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/17/2018] [Accepted: 11/28/2018] [Indexed: 01/14/2023]
Abstract
The World Trade Center (WTC) attacks exposed rescue and recovery workers to a complex mix of toxicants, including carcinogens. our study compared site-specific cancer incidence of head and neck cancers (HNC) from 2003 through 2012 among 33,809 consented WTC General Responder Cohort (GRC) members to the New Jersey State Cancer Registry, using standardized incidence ratios (SIRs). HNC grouped using SEER ICD-O-3 codes into HPV-related (oropharyngeal) and non-related (other oral-nasal; laryngeal) tumors based on anatomical site. For the 73 GRC members identified with HNC, proportional hazard regression assessed the relationship between WTC exposure and other socio-demographic characteristics. An overall excess of HNC was not observed (SIR = 1.00, 95% CI: 0.78, 1.25) but excess cancer was seen in the latest observation period (2009-2012: SIR = 1.4; 95% CI: 1.01, 1.89). A similar temporal pattern was seen for HPV-related oropharyngeal cancer and laryngeal cancer, but not for non-HPV-related sites (oral-nasal cancer). HNC was significantly associated with increasing age (8% per year, 95% CI: 5%, 12%), non-Hispanic white ethnic group-ethnicity (hazard ratio (HR) = 3.51, 95 CI: 1.49, 8.27); there was a borderline association with the 9/11 occupation of military/protective services vs. others (HR = 1.83 95% CI: 0.99, 3.38; p = 0.0504). Caution is needed in interpreting these results given the small number of cases, potential for surveillance bias, and long latency for most cancers. Our findings highlight the need to examine the potentially carcinogenic effects of WTC exposure in the context of other strong risk factors, and the need for continued medical monitoring of WTC responders.
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Affiliation(s)
- Judith M Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Gerald Harris
- Rutgers, The State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Kathleen Black
- Clinical Research and Occupational Medicine, Rutgers, The State University of New Jersey, Occupational Health Sciences Institute (EOHSI), Piscataway, NJ, United States
| | - Roberto G Lucchini
- Icahn School of Medicine at Mount Sinai, Environmental Medicine and Public Health, New York City, NY, United States
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Research Institute, Tampa, FL, United States
| | - Christopher R Dasaro
- Icahn School of Medicine at Mount Sinai, Environmental Medicine and Public Health, New York City, NY, United States
| | - Moshe Shapiro
- Icahn School of Medicine at Mount Sinai, Environmental Medicine and Public Health, New York City, NY, United States
| | - Michael B Steinberg
- Division of General Internal Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Michael A Crane
- Icahn School of Medicine at Mount Sinai, Environmental Medicine and Public Health, New York City, NY, United States
| | - Jacqueline M Moline
- Hofstra Northwell School of Medicine at Hofstra University, Occupational Medicine, Epidemiology and Prevention, Hempstead, NY, United States
| | - Denise J Harrison
- Bellevue Hospital Center/New York University School of Medicine, Environmental Medicine, New York City, NY, United States
| | - Benjamin J Luft
- Stony Brook University Medical Center, Department of Medicine, Stony Brook, NY, United States
| | - Andrew C Todd
- Icahn School of Medicine at Mount Sinai Tisch Cancer Institute, Environmental Medicine and Public Health, New York City, NY, United States
| | - Iris G Udasin
- Clinical Research and Occupational Medicine, Rutgers, The State University of New Jersey, Occupational Health Sciences Institute (EOHSI), Piscataway, NJ, United States
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Lewis MJ, Zimmermann MH, Delnevo CD, Steinberg MB. Evaluating receipt of and inability to discontinue tobacco industry direct mail. Tob Control 2018; 27:e65. [PMID: 29588391 DOI: 10.1136/tobaccocontrol-2017-054182] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/21/2018] [Accepted: 03/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- M Jane Lewis
- Center for Tobacco Studies, School of Public Health, Rutgers University, New Brunswick, New Jersey, USA
| | - Mia Hanos Zimmermann
- Center for Tobacco Studies, School of Public Health, Rutgers University, New Brunswick, New Jersey, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, New Brunswick, New Jersey, USA
| | - Michael B Steinberg
- Division of General Internal Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA
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Manderski MTB, Steinberg MB, Rahi KN, Banerjee SC, Delnevo CD. Surveillance of Tobacco Use Among South Asians in the US: Are We Underestimating Prevalence? J Community Health 2018; 41:1140-1145. [PMID: 27470121 DOI: 10.1007/s10900-016-0226-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study employed a randomized split sample survey to assess the accuracy of standard tobacco surveillance measures among South Asians living in the US. 219 South Asian adults completed a web-based survey of "standard" tobacco use questions, as they appear in national surveillance surveys, and half were randomly assigned to also receive questions about South Asian tobacco products. Prevalence of tobacco use was compared by experimental condition, assessed by only the standard questions for the control group (N = 116) and by both standard and South Asian questions for the experimental group (N = 103). Among the experimental group, sensitivity and negative predictive value (NPV) of the standard use definitions were calculated, considering the inclusive definitions as the "gold standard." Prevalence of any tobacco product use was higher among the experimental group, as was prevalence of smokeless tobacco (SLT) use, relative to the control group (34.7 vs. 17.2 % and 21.2 vs. 4.3 %, respectively). 70.6 and 33.3 % of true tobacco users (any product) and SLT users were correctly classified by the respective standard product questions. A majority of gutka, paan with tobacco, and supari with tobacco users (69, 86, and 75 %, respectively) did not otherwise endorse the standard SLT questions. Current tobacco surveillance measures may underestimate the use of tobacco in the South Asian population residing in the US. These results indicate that careful consideration must be given to how tobacco-related questions are presented to minority populations.
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Affiliation(s)
- Michelle T Bover Manderski
- Center for Tobacco Studies, School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
| | - Michael B Steinberg
- Division of General Internal Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Clinical Academic Building (CAB), 125 Paterson Street, Suite 2304, New Brunswick, NJ, 08901, USA
| | - Kimberly N Rahi
- Center for Tobacco Studies, School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
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Singh B, Hrywna M, Wackowski OA, Delnevo CD, Jane Lewis M, Steinberg MB. "Knowledge, recommendation, and beliefs of e-cigarettes among physicians involved in tobacco cessation: A qualitative study". Prev Med Rep 2017; 8:25-29. [PMID: 28831370 PMCID: PMC5555092 DOI: 10.1016/j.pmedr.2017.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 11/24/2022] Open
Abstract
Physicians are rated the most trustworthy source of information for smokers and thus play an increasing role in disseminating information on e-cigarettes to patients. Therefore, it is important to understand what is currently being communicated about e-cigarettes between physicians and patients. This study explored the knowledge, beliefs, communication, and recommendation of e-cigarettes among physicians of various specialties. Semi-structured interviews were conducted in early 2016 with 35 physicians across five different specialties. Interviews were transcribed and coded for the following deductive themes: (1) tobacco cessation recommendation practices, (2) knowledge of e-cigarettes, (3) communication of e-cigarettes with patients, (4) recommendation of e-cigarettes, and (5) general beliefs about e-cigarettes. Physicians across all specialties reported having conversations with patients about e-cigarettes. Conversations were generally prompted by the patient inquiring about e-cigarettes as a cessation method. Overall, physicians felt there was a lack of information on the efficacy and long term health effects but despite lack of evidence, generally did not discourage patients from trying e-cigarettes as a cessation device. Although physicians did not currently recommend e-cigarettes over traditional cessation methods, they were open to recommending e-cigarettes in the future if adequate data became available suggesting effectiveness. Patients are inquiring about e-cigarettes with physicians across various specialties. Future research should continue to study physicians' perceptions/practices given their potential to impact patient behavior and the possibility that such perceptions may change over time in response to the evidence-base on e-cigarettes. Physicians across specialties are having conversations with patients about ecigs. Generally did not discourage patients from trying ecigs as a cessation device. Physicians open to recommending ecigs for cessation in the future. Adolescent use major cause of concern for physicians.
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Affiliation(s)
- Binu Singh
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West Piscataway, NJ 08854, United States
| | - Mary Hrywna
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West Piscataway, NJ 08854, United States
| | - Olivia A Wackowski
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West Piscataway, NJ 08854, United States
| | - Cristine D Delnevo
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West Piscataway, NJ 08854, United States
| | - M Jane Lewis
- Department of Health Education & Behavioral Science, Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West Piscataway, NJ 08854, United States
| | - Michael B Steinberg
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, 125 Paterson Street, New Brunswick, NJ 08901, United States
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Hrywna M, Jane Lewis M, Mukherjea A, Banerjee SC, Steinberg MB, Delnevo CD. Awareness and Use of South Asian Tobacco Products Among South Asians in New Jersey. J Community Health 2016; 41:1122-1129. [PMID: 27256410 PMCID: PMC5083141 DOI: 10.1007/s10900-016-0208-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/21/2022]
Abstract
South Asians are the third largest Asian group in the US and among the fastest growing racial groups in New Jersey. Tobacco consumption among South Asians is characterized by several smoked and smokeless tobacco products indigenous to the Indian subcontinent. However, there is a paucity of research on tobacco use behaviors among South Asians in the US. The goal of this study was to examine the awareness and use of South Asian tobacco products such as bidis, gutkha, paan, paan masala, and zarda as well as other potentially carcinogenic products such as supari, their context of use, and their cultural significance among South Asians living in the US. Eight focus groups were conducted with South Asian adults living in Central New Jersey. Overall, participants were aware of a wide variety of foreign and American tobacco products with older South Asians identifying a greater variety of indigenous products compared to younger South Asians. Hookah was consistently recognized as popular among the younger generation while products such as paan or paan masala were more commonly identified with elders. Use of tobacco-related products such as paan and supari were described as common at social gatherings or after meals. In addition, light or social users of South Asian tobacco products, including products not consistently defined as tobacco, may not report tobacco use on a survey. Better understanding of the use of these products among South Asians and how some may classify tobacco usage can inform future research and public health interventions in these communities.
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Affiliation(s)
- Mary Hrywna
- School of Public Health Rutgers, The State University of New Jersey, 335 George Street, Suite 2100, New Brunswick, NJ, 08901, USA.
| | - M Jane Lewis
- School of Public Health Rutgers, The State University of New Jersey, 335 George Street, Suite 2100, New Brunswick, NJ, 08901, USA
| | - Arnab Mukherjea
- Health Sciences Program, California State University, East Bay, 25800 Carlos Bee Boulevard, Hayward, CA, 94542, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Michael B Steinberg
- Division of General Internal Medicine, Robert Wood Johnson Medical School Rutgers, The State University of New Jersey, Clinical Academic Building (CAB), 125 Paterson Street, Suite 2304, New Brunswick, NJ, 08901, USA
| | - Cristine D Delnevo
- School of Public Health Rutgers, The State University of New Jersey, 335 George Street, Suite 2100, New Brunswick, NJ, 08901, USA
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40
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Affiliation(s)
- Olivia A Wackowski
- From Rutgers School of Public Health, Piscataway, and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Cristine D Delnevo
- From Rutgers School of Public Health, Piscataway, and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael B Steinberg
- From Rutgers School of Public Health, Piscataway, and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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41
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Manne S, Steinberg MB, Delnevo C, Ulpe R, Sorice K. Colorectal Cancer Screening Among Foreign-born South Asians in the Metropolitan New York/New Jersey Region. J Community Health 2016; 40:1075-83. [PMID: 26072261 DOI: 10.1007/s10900-015-0053-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/28/2022]
Abstract
The goal of this study was to examine colorectal cancer (CRC) screening practices and factors associated with CRC screening among foreign-born South Asians living in the metropolitan New York-New Jersey area. Two hundred and eight men and women recruited from community settings in the New York and New Jersey metropolitan area completed a questionnaire that included demographics, CRC screening practices, health care access and practices, attitudes about the health care system, primary care physician support for CRC screening, cultural factors, and attitudes about CRC screening and CRC worry. Almost a third of the sample had not heard of any of CRC screening tests. Approximately 62 % of the sample had never had a CRC screening test and approximately 69 % of the sample was not currently on schedule with regard to CRC screening. When the relative contribution of significant correlates were evaluated, participants who had lived in the US for a longer time, who endorsed more CRC screening benefits, and who endorsed fewer CRC screening barriers were significantly more likely to have had CRC screening in the past. Participants who were more likely to use English in their daily life, who endorsed more CRC screening benefits, and endorsed fewer CRC screening barriers were more likely to be on schedule with regard to CRC screening. In conclusion, awareness of CRC screening and uptake of screening was low in this population of foreign-born South Asians. Interventions to promote CRC screening may benefit from targeting this subgroup of Asian Americans.
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Affiliation(s)
- Sharon Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
| | | | - Cristine Delnevo
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Rajiv Ulpe
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
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Steinberg MB, Akincigil A, Kim EJ, Shallis R, Delnevo CD. Tobacco Smoking as a Risk Factor for Increased Antibiotic Prescription. Am J Prev Med 2016; 50:692-698. [PMID: 26702478 PMCID: PMC5189690 DOI: 10.1016/j.amepre.2015.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/06/2015] [Accepted: 11/11/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Antibiotic resistance is rapidly spreading, affecting millions of people and costing billions of dollars. Potential factors affecting antibiotic prescription, such as tobacco use, could dramatically influence this public health crisis. The study determined the magnitude of impact that tobacco use has on antibiotic prescribing patterns. METHODS Pooled data were analyzed in 2015 from the 2006-2010 National Ambulatory Medical Care Survey, a cross-sectional survey describing use of ambulatory medical services in the U.S. via healthcare provider-patient encounters. Patients aged >18 years with documented tobacco use status diagnosed with an infection were included (i.e., all encounters in the analysis included an infectious diagnosis of interest). The analytic sample included 8,307 visits, representing 294 million visits nationally. RESULTS Half (49.9%) of encounters that included any infection had an antibiotic prescribed. Adjusted odds of receiving antibiotics among current tobacco users was 1.20 (95% CI=1.02, 1.42), and even higher for encounters of respiratory infections (AOR=1.31, 95% CI=1.05, 1.62). Antibiotic prescription rates were lower among patients aged >65 years, those with comorbid asthma or cancer, non-whites, and those covered by Medicaid and higher for primary care physicians. CONCLUSIONS Despite lack of evidence-based rationale, among a national sample of patients with an infectious diagnosis, tobacco users had 20%-30% higher odds of receiving antibiotics than non-tobacco users. This is the first U.S. study to quantify the magnitude of this unsubstantiated practice. Prescribers should understand that tobacco use could be associated with higher antibiotic prescription, which may subsequently increase antimicrobial resistance in the community.
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Affiliation(s)
- Michael B Steinberg
- Rutgers Robert Wood Johnson Medical School, Division of General Internal Medicine, New Brunswick, New Jersey; Rutgers School of Public Health, Department of Health Education and Behavioral Science, New Brunswick, New Jersey; Rutgers Cancer Institute of New Jersey, Population Science Section, New Brunswick, New Jersey.
| | - Ayse Akincigil
- Rutgers School of Social Work, New Brunswick, New Jersey; Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
| | - Eun Jung Kim
- Rutgers Ernest Mario School of Pharmacy, Piscataway, New Jersey
| | - Rory Shallis
- Rutgers Robert Wood Johnson Medical School, Division of General Internal Medicine, New Brunswick, New Jersey
| | - Cristine D Delnevo
- Rutgers School of Public Health, Department of Health Education and Behavioral Science, New Brunswick, New Jersey; Rutgers Cancer Institute of New Jersey, Population Science Section, New Brunswick, New Jersey
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Santorelli ML, Hirshfield KM, Steinberg MB, Rhoads GG, Lin Y, Demissie K. Hormonal therapy for breast cancer and diabetes incidence among postmenopausal women. Ann Epidemiol 2016; 26:436-40. [DOI: 10.1016/j.annepidem.2016.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 03/20/2016] [Accepted: 04/04/2016] [Indexed: 02/03/2023]
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Herrigel DJ, Carroll M, Fanning C, Steinberg MB, Parikh A, Usher M. Interhospital transfer handoff practices among US tertiary care centers: A descriptive survey. J Hosp Med 2016; 11:413-7. [PMID: 27042950 PMCID: PMC5739590 DOI: 10.1002/jhm.2577] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/15/2016] [Accepted: 01/17/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Interhospital transfer is an understudied area within transitions of care. The process by which hospitals accept and transfer patients is not well described. National trends and best practices are unclear. OBJECTIVE To describe the demographics of large transfer centers, to identify common handoff practices, and to describe challenges and notable innovations involving the interhospital transfer handoff process. DESIGN AND PARTICIPANTS A convenience sample of 32 tertiary care centers in the United States was studied. Respondents were typically transfer center directors surveyed by phone. MAIN MEASURES Data regarding transfer center demographics, handoff communication practices, electronic infrastructure, and data sharing were obtained. RESULTS The median number of patients transferred each month per receiving institution was 700 (range, 250-2500); on average, 28% of these patients were transferred to an intensive care unit. Transfer protocols and practices varied by institution. Transfer center coordinators typically had a medical background (78%), and critical care-trained registered nurse was the most prevalent (38%). Common practices included: mandatory recorded 3-way physician-to-physician conversation (84%) and mandatory clinical status updates prior to patient arrival (81%). However, the timeline of clinical status updates was variable. Less frequent transfer practices included: electronic medical record (EMR) cross-talk availability and utilization (23%), real-time transfer center documentation accessibility in the EMR (32%), and referring center clinical documentation available prior to transport (29%). A number of innovative strategies to address challenges involving interhospital handoffs are reported. CONCLUSIONS Interhospital transfer practices vary widely amongst tertiary care centers. Practices that lead to improved patient handoffs and reduced medical errors need additional prospective evaluation. Journal of Hospital Medicine 2016;11:413-417. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Dana J. Herrigel
- Division of Education and General Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Address for correspondence and reprint requests: Dana Herrigel, MD, Rutgers-Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB Room 494, New Brunswick, NJ 08901, Telephone: 732-235-6501, Fax: 732-235-7427,
| | - Madeline Carroll
- Division of General Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Christine Fanning
- Division of General Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael B. Steinberg
- Division of General Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amay Parikh
- Division of Critical Care and Nephrology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael Usher
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Ferreira GS, Steinberg MB. Going Slow May Not Be Best When Quitting Smoking. Ann Intern Med 2016; 164:622-3. [PMID: 26974591 DOI: 10.7326/m16-0362] [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: 11/22/2022] Open
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Abstract
BACKGROUND Young adulthood provides an enormous opportunity to alter trajectories of smoking behaviour for a large public health impact. OBJECTIVE The purpose of this study was to examine correlates of perceived barriers to quitting smoking and reasons to quit in a sample of young adult current and former smokers. METHODS This study used data from the 2011 National Young Adult Health Survey, a random-digit-dial cellphone survey. Participants were US young adult current smokers aged 18-34 (n = 699) and young adults who were either current smokers who had made a quit attempt in the past-year (n = 402) or former smokers (n = 289). Correlates of barriers to quitting smoking and reasons for quitting smoking were assessed using bivariate and multivariable analyses. RESULTS More than half of current smokers identified 'loss of a way to handle stress' (59%) and 'cravings or withdrawal' (52%) as barriers to quitting. Female gender, daily smoking and intention to quit remained significantly associated with endorsing 'loss of a way to handle stress' as a barrier to quitting in multivariable analyses. The two most popular reasons for quitting smoking were physical fitness (64%) and the cost of tobacco (64%). CONCLUSION These findings highlight barriers to cessation and the reasons that young smokers give for quitting. This information may be helpful to physicians as they counsel their young adult patients to quit smoking.
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Affiliation(s)
- Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Daniel A Gundersen
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and
| | - Michael B Steinberg
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ and
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Abstract
This issue provides a clinical overview of smoking cessation, focusing on health consequences of smoking, prevention of smoking-related disease, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.
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Santorelli ML, Steinberg MB, Hirshfield KM, Rhoads GG, Bandera EV, Lin Y, Demissie K. Effects of breast cancer on chronic disease medication adherence among older women. Pharmacoepidemiol Drug Saf 2016; 25:898-907. [PMID: 26875432 DOI: 10.1002/pds.3971] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/13/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to determine the effects of breast cancer on chronic disease medication adherence among older women. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data and a 5% random sample of Medicare enrollees were used. Stage I-III breast cancer patients diagnosed in 2008 and women without cancer were eligible. Three cohorts of medication users 66+ years were identified using diagnosis codes and prescription fill records: diabetes, hypertension, and lipid disorders. For each cohort, breast cancer patients were frequency matched to comparison women by age and geographic area. Medication adherence was measured by the proportion of days covered and medication persistence. RESULTS During the post-baseline period, the percentage of breast cancer patients who were non-adherent was 26.2% for diabetes medication, 28.9% for lipid-lowering medication, and 14.2% for hypertension medication. Breast cancer patients experienced an increased odds of diabetes medication non-adherence [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.07 to 1.95] and were more likely to be non-persistent with diabetes medication (hazard ratio = 1.31; 95%CI: 1.04 to 1.66) relative to women without cancer. The study failed to show a difference between breast cancer and comparison women in the odds of non-adherence to hypertensive (OR = 0.87; 95%CI: 0.71 to 1.05) or lipid-lowering medication (OR = 0. 91; 95%CI: 0.73 to 1.13) with a proportion of days covered threshold of 80%. CONCLUSION Special attention should be given to the coordination of primary care for older breast cancer patients with diabetes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Melissa L Santorelli
- School of Public Health, Department of Epidemiology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | | | - Kim M Hirshfield
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - George G Rhoads
- School of Public Health, Department of Epidemiology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Elisa V Bandera
- School of Public Health, Department of Epidemiology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Yong Lin
- School of Public Health, Department of Biostatistics, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Kitaw Demissie
- School of Public Health, Department of Epidemiology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Delnevo CD, Giovenco DP, Steinberg MB, Villanti AC, Pearson JL, Niaura RS, Abrams DB. Patterns of Electronic Cigarette Use Among Adults in the United States. Nicotine Tob Res 2015; 18:715-9. [PMID: 26525063 DOI: 10.1093/ntr/ntv237] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/05/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Amid increasing rates of electronic cigarette (e-cigarette) use in the United States, there is an urgent need to monitor patterns of use at the population level in order to inform practice, policy and regulation. This article examines how patterns of e-cigarette use among adults differ between users and nonusers of cigarettes using the most current national data. METHODS We analyzed data from the 2014 National Health Interview Survey. We estimated prevalence of ever, current, and daily e-cigarette use and examined how use patterns differed by demographic subgroups and measures of cigarette smoking status that accounted for the recent availability of e-cigarettes in the US marketplace. RESULTS Current e-cigarette use is extremely low among never cigarette smokers (0.4%) and former smokers who quit cigarettes 4 or more years ago (0.8%). Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes (AOR: 4.33 [95% CI: 3.08-6.09]). CONCLUSIONS Extremely low e-cigarette use among never-smokers and longer term former smokers suggest that e-cigarettes neither promote widespread initiation nor relapse among adults. Recognition of the heterogeneity of smokers, including the time since quitting, is critical to draw accurate conclusions about patterns of e-cigarette use at the population level and its potential for public health benefit or harm. IMPLICATIONS Data from 2014 National Health Interview Survey indicate that e-cigarettes have not been attracting adult non-smokers or promoting relapse in longer term former smokers. Moreover, the data are suggestive that some recent quitters may have done so with the assistance of e-cigarettes. Creating measures of smoking status that treat former smokers as a homogenous group is insufficient to assess the epidemiology of e-cigarette use and the potential impact on public health.
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Affiliation(s)
- Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ;
| | - Daniel P Giovenco
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - Michael B Steinberg
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Abstract
INTRODUCTION Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician-patient communication regarding e-cigarettes. METHODS A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient-provider e-cigarette communication, and attitudes towards tobacco harm reduction. RESULTS Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. DISCUSSION Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.
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Affiliation(s)
- Michael B. Steinberg
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Daniel P. Giovenco
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Cristine D. Delnevo
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
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