Snus use and rejection in the USA

OBJECTIVE: To determine whether snus might become a strategy for reducing the harm associated with cigarette smoking in the USA as appears to be the case in Sweden, we examined receptivity to snus use in two cities with the greatest exposure to the major brands. METHODS: A dual frame, telephone survey and a brief mail survey were conducted in 2011 and 2012 in Indianapolis, Indiana and Dallas/Fort Worth Texas. Over 5000 adults completed surveys. Trial, ever use, current use and reasons for using or quitting snus after trial were measured. RESULTS: Among male smokers, 29.9% had ever tried snus (CI 22.7 to 38.1) and 4.2% were current users (CI 1.6 to 10.7). Among female smokers, 8.5% ever tried snus (CI 4.4 to 15.7) and current use was unknown. Current use was virtually absent among former smokers and never smokers. A major predictor of any level of snus use was current use of conventional smokeless tobacco. Those who tried and gave up snus cited curiosity (41.3%) and the fact that it was available at low or no cost (30%) as reasons for trial; reasons for not continuing included preferring another form of tobacco (75.1%) and disliking the mouth feel (34.6%). Almost all current snus users indicated that they were trying to cut down on cigarettes, but few (3.9%) were using it to quit smoking entirely. CONCLUSIONS: The low rate of adoption of snus suggests that neither the hopes nor the fears surrounding this new product are likely to be realised in the USA with the current marketing patterns

Doctor-Patient Communication by Email: Trends, Determinants, and Effects of Digital Disparities on Email Use and the Association between Email Use and Quality of Communication in Health Care

The use of email and other Information and Communication Technologies (ICT) in health care has grown considerably over the last two decades, in part, due to widespread claims that electronically mediated communication between providers and patients promotes increased access to quality communication and quality health care. The access and usage of Internet, email, and other ICT, however, has been associated with unequal opportunities that lead to a “digital divide,” based on age, gender, education, income, race and ethnicity, and geographic location. To better understand how and whether electronically mediated communication between providers and patients may contribute to a digital divide, this dissertation sought: (i) to examine trends in email use in doctor-patient communication from 2003 to 2014; (ii) to identify the determinants of email use in doctor-patient communication and changes in those determinants over time; (iii) to examine the role of and extent to which a person’s capability for email and Internet communication mediates the relationship between email use and individual characteristics associated with the digital divide, including age, gender, education, income, race and ethnicity, and geographic location; and (iv) to examine the effects of email use on the perceived quality of doctor-patient communication. This study used publicly available data from four rounds of the Health Information National Trends Surveys (2003, 2007, 2011, 2014), a nationally representative survey funded by the National Cancer Institute which asked respondents about their health, experiences in obtaining health care, and their use of health information technology. The results show that email use in doctor-patient communication increased from 7.6% in 2003 to 28.3% in 2014. The key findings show disparities in email use in doctor-patient communication related to patients’ education, income, region, and urban versus rural residence that have persisted over the study period. Stronger personal capability for email and Internet communication was also associated with increased email use. The quality of doctor-patient communication rating increased with age, better self-rated health, having a primary care provider, and with better experience searching for health information; however, using email to communicate with doctor was only significantly associated with quality rating in 2003 and 2011, but, contrary to expectations, the association was negative, as the use of email decreased likelihood of high-quality rating. This research is the first to comprehensively examine national trends in email use in doctor-patient communication, and the effects of that use on the quality of doctor-patient communication, over a period of one decade. The implications of study findings for research, policy, and practice are discussed, and recommendations are proposed to improve the effectiveness of email use in doctor-patient communication

U.S. Physicians’ Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability

More than thirty years since the enactment of the Americans with Disabilities Act (ADA), people with disability continue to experience health care disparities. The ADA mandates that patients with disability receive reasonable accommodations. In our survey of 714 US physicians in outpatient practices, 35.8 percent reported knowing little or nothing about their legal responsibilities under the ADA, 71.2 percent answered incorrectly about who determines reasonable accommodations, 20.5 percent did not correctly identify who pays for these accommodations, and 68.4 felt that they were at risk for ADA lawsuits. Physicians who felt that lack of formal education or training was a moderate or large barrier to caring for patients with disability were more likely to report little or no knowledge of their responsibilities under the law and were more likely to believe that they were at risk for an ADA lawsuit. To achieve equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians and make health care delivery systems more accessible and accommodating