Background
The Cancer Health Awareness through screeNinG and Education (CHANGE) initiative delivers cancer awareness education with an emphasis on modifiable risk factors and navigation to screening ...for prostate, breast, and colorectal cancers to residents of public housing communities who experience significant negative social determinants of health.
Methods
Residents of five communities participated. Community advisory board members were recruited and provided feedback to local environmental change projects, recruitment, and community engagement at each site. At each site, four education sessions were provided by trained facilitators on cancer risk factors and etiology, racial disparities, eligibility for cancer screening, and participation in clinical trials. Attendance, knowledge, attitudes and beliefs about cancer, and height, weight, and waist circumference were measured at baseline and 1‐week post‐CHANGE sessions.
Results
90 residents (60% 65 and older years old, 33% male, 60% High School education, 93% AA) participated in the program. 95% completed post‐intervention evaluation. Participants were eligible for breast (n = 12), prostate (n = 15), and colorectal screening (n = 25) based on American Cancer Society guidelines, and 22 for tobacco cessation; 21 participants accepted navigation assistance for these services. At post‐test, participants significantly increased in knowledge and behaviors around obesity/overweight risk for cancer, nutrition, and physical activity. Colorectal, prostate, and breast cancer knowledge scores also increased, but were not significant.
Conclusions
CHANGE participants demonstrated improved health knowledge and intentions to improve their modifiable health behaviors. Participants reported being motivated and confident in seeking preventive care and satisfaction with community engagement efforts. Replication of this project in similar communities may improve knowledge and health equity among underserved populations.
Background: Smoking rates have declined over the last half-century, however, e-cigarette use has more than tripled in the recent years. Tobacco-risk education and tobacco-free policies are critical ...policy instruments to help prevent youth tobacco use. This study evaluates the impact of these policies on youth cigarette and e-cigarette use. Methods: Data from the 2013/2015 Georgia Youth Tobacco Survey (GYTS) is used to test for statistical differences in tobacco use status across school-based tobacco control policies and estimate their impact on cigarette and e-cigarette use. Data includes 5,285 participants representing 2013 middle school (n=2,099), 2013 high school (n=1,775), and 2015 high school (n=1,411). Current cigarette and e-cigarette use is measured as having used them in the past month. Students were asked if their school has a tobacco-free policy and if they were taught in classes about why they should not use tobacco. Multivariate logistic regression and Chi-squared tests are used to analyze data. Results: The use of cigarettes among high school students has decreased, however the use of e-cigarettes has increased. Strong statistical associations exist between tobacco-use behavior and tobacco-control policies, however, these associations were not consistent across all cohorts. Smoking disparities exist where males, White and Hispanic students smoked at much higher rates. Conclusions: The rise of e-cigarette popularity may have significant health effects and become a gateway to smoking cigarettes. The positive impact of tobacco-free policies on youth cigarette use is counter-intuitive and may be the result of adoption of tobacco-free policies by the schools where tobacco use is of a significant concern, hence, higher smoking rates. Future research should examine the effects of these policies, their enforcement, and length of existence in detail to provide more evidence into the effectiveness of these policies.
Mental health insurance laws are intended to improve access to needed treatments and prevent discrimination in coverage for mental health conditions and other medical conditions.
The aim was to ...estimate the impact of these policies on mental health treatment utilization in a nationally representative longitudinal sample of youth followed through adulthood.
We used data from the 1997 National Longitudinal Survey of Youth and the Mental Health Insurance Laws data set. We specified a zero-inflated negative binomial regression model to estimate the relationship between mental health treatment utilization and law exposure while controlling for other explanatory variables.
We found that the number of mental health treatment visits declined as cumulative exposure to mental health insurance legislation increased; a 10 unit (or 10.3%) increase in the law exposure strength resulted in a 4% decline in the number of mental health visits. We also found that state mental health insurance laws are associated with reducing mental health treatments and disparities within at-risk subgroups.
Prolonged exposure to comprehensive mental health laws across a person's childhood and adolescence may reduce the demand for mental health visitations in adulthood, hence, reducing the burden on the payors and consumers. Further, as the exposure to the mental health law strengthened, the gap between at-risk subgroups was narrowed or eliminated at the highest policy exposure levels.
A sound understanding of the potency of tobacco control policies is key to tobacco prevention. This study exploits a Smoothed Instrumental Variables Quantile Regression estimator to gauge the ...effectiveness of these policies while addressing major methodological and data limitations plaguing the previous literature. Specifically, smoke-free indoor air laws and tobacco control expenditures are examined in a single framework, which has the promise of accounting for potential complementarities thereof. Further, endogeneity of price (a proxy for tax policy) and other tobacco control policies is addressed through a unique set of instruments while allowing for differential impacts across the conditional distribution of cigarette consumption. Finally, our use of the nationally representative individual-level price and consumption data is essential to precise estimation of price elasticities and policy effects. Results indicate that ignoring price and policy endogeneity leads to inconsistent estimates. Further, tobacco control expenditures appear to be effective only for relatively more addicted smokers. Meanwhile, state-level smoke-free indoor laws, whose primary goal is to reduce exposure to second-hand smoke, do not affect cigarette use among smokers. In contrast, tax policy appears to be most potent for less addicted individuals. Therefore, optimal policy responses should combine tobacco control expenditures with sin taxes.
In order to meet the communication needs of individuals who use Augmentative and Alternative Communication (AAC) devices, communication partners are often responsible for the programming of the AAC ...devices. However, the prolonged learning time and operational demands of AAC devices are often barriers to an efficient use of time during a therapy session. We developed a prototype app for iPad, called Speech-to-Symbol that decreases the programming time by finding pictures stored in the app using speech-to-text technology. We compared our solution to the TalkTablet app during AAC sessions with children with different communication disabilities. The aims of this study were 1) to compare the time to program both apps, 2) to identify the type of vocabulary used, and 3) to assess the usability of the two apps. Results showed that the reduced operational demands of our Speech-to-Symbols app allow communication partners to expose children to a larger and more diverse vocabulary. In addition, the communication partners gave our Speech-to-Symbols app a higher usability rating. Implications for clinical and educational settings and directions for future research are also discussed.
The Government of Turkey has initiated a series of major health reforms in 2003 with an objective of increasing access to health care services and improving efficiency of public and private ...hospitals. This study attempts to understand the technical efficiency of public and private hospitals in Turkey to better guide hospital reform.
We use data from 1079 public and private hospitals and translog stochastic production frontier was adopted to estimate technical inefficiency of hospitals.
Results indicate that there is no statistically significant difference in the degree of inefficiency of hospitals by geographic location or its level of economic development. Efficiency scores vary significantly across hospital types with Ministry of Health (MoH) General Hospitals being the most efficient followed by MoH teaching hospitals. Better performance of MoH hospitals may be due to successful implementation of 2003 health reforms in Turkey, which intended to improve resource utilization within and across MoH hospitals. Among MoH hospital types, integrated county hospitals were the least efficient. Since the hospital outcome measure did not include the value of medical training, efficiency scores of university hospitals became relatively low. Wide variability of efficiency scores of private general hospitals implies the existence of both highly efficient and inefficient hospitals in the private sector.
Efficiency differences of various hospital types can be leveraged to guide future reforms by emphasizing the strengths of general hospitals and improving the referral system from county hospitals to general hospitals. Encouraging resource sharing across hospitals, as being done by the 2011 reforms, should further improve hospital efficiency. Promoting private hospitals may not necessarily be efficiency enhancing due to high variability of private hospitals in terms of efficiency scores. Similarly, implementation of common productivity standards and quality control measures are likely to improve hospital technical efficiency scores further.
This study analyzed deployment-related exposures and risk of Persian Gulf War Illness (GWI) in women veterans from the Veterans Affairs (VA) Cooperative Studies Program 585 Gulf War Era Cohort and ...Biorepository (GWECB CSP#585).
We examined the associations between GW deployment-related exposures and case definitions for GWI in deployed GW women. Multivariate regression analyses controlling for demographic outcomes were performed.
Surveys were obtained from 202 GW deployed women veterans. Self-reported exposure to smoke from oil well fires as well as chemical and biological warfare were the only exposures significantly associated with the Center for Disease Control and Prevention (CDC) GWI criteria. Seventy-nine women were excluded from the rest of the analyses as they met Kansas GW illness exclusion criteria. Eligible women who self-reported deployment-related exposure to smoke from oil wells, pyridostigmine bromide (PB) pills, pesticide cream, pesticide treated uniforms, and insect baits were significantly more likely to meet the Kansas GWI criteria (n = 123) than those unexposed and exposures were related to Kansas symptom subdomain endorsements.
These results suggest that women GW veterans reporting deployment related exposures of pesticide, oil well fire and PB pills are significantly more likely to meet the Kansas GWI criteria in this national cohort of GW women suggesting its utility in future studies. In addition, based on these results it appears that women exposed to particular toxicants during the war may benefit from more targeted treatment strategies dependent upon the mechanism of exposure of their toxicant induced outcomes.
Health literacy and patient web portals Coughlin, Steven S.; Stewart, Jessica L.; Young, Lufei ...
International journal of medical informatics (Shannon, Ireland),
20/May , Volume:
113
Journal Article
Peer reviewed
•There is limited evidence about the association between health literacy and use of patient web portals in patients with chronic illnesses.•Qualitative studies and studies with a cross-sectional, ...cohort, or pre-/post-test study design have shown that persons with limited health literacy are less likely to use patient web portals, although not all studies have found an association.•Several opportunities exist to improve the usability and acceptability of web portals for patients with limited health literacy including enhancements in the design of the portals, patient and provider education and training, and engagement of proxies such as caregivers and close family members.•Studies are needed of use of web portals and adherence with prescribed medications and other forms of treatment by patients with varying levels of health literacy.
There is limited evidence about the association between health literacy and use of patient web portals in patients with chronic illnesses. The objective of this review was to learn more about health literacy and use of patient web portals.
Bibliographic searches were conducted in PubMed and CINAHL using relevant MeSH search terms and Boolean algebra commands.
Qualitative studies and studies with a cross-sectional, cohort, or pre-/post-test design have shown that persons with limited health literacy are less likely to use patient web portals, although there is inconsistency in the association across studies.
The conflicting findings may be partially due to racial and ethnic differences in health literacy or level of comfort in sharing private health information using mobile technologies. Several opportunities exist to improve the usability and acceptability of web portals for patients with limited health literacy including enhancements in the design of the portals, patient and provider education and training, and engagement of proxies such as caregivers and close family members.
Emergency Department (ED) utilization accounts for a large portion of healthcare services in the US. Disturbance of circadian rhythms may affect mental and behavioral health (MBH) conditions, which ...could result in increased ED visits and subsequent hospitalizations, thus potentially inducing staffing shortages and increasing ED wait time. Predicting the burden of ED admissions helps to better plan care at the EDs and provides significant benefits. This study investigates if increased ED visits for MBH conditions are associated with seasonality and changes in daylight savings time.
Using ED encounter data from a large academic medical center, we have examined univariate and multivariate associations between ED visits for MBH conditions and the annual time periods during which MBH conditions are more elevated due to changes in the seasons. We hypothesize that ED visits for MBH conditions increase within the 2-week period following the daylight savings time changes.
Increased MBH ED visits were observed in certain seasons. This was especially true for non-bipolar depressive illness. We saw no significant changes in MBH visits as associated with changes in the daylight savings time.
Data do not provide conclusive evidence of a uniform seasonal increase in ED visits for MBH conditions. Variation in ED MBH visits may be due to secular trends, such as socioeconomic factors. Future research should explore contemporaneous associations between time-driven events and MBH ED visits. It will allow for greater understanding of challenges regarding psychiatric patients and opportunities for improvement.
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