Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care.</p> <p>Methods</p> <p>The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26) and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement.</p> <p>Results</p> <p>Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers.</p> <p>Conclusions</p> <p>Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific staff members, and supported by internal systems that ensure adequate tracking and follow up of smokers. Ongoing staff training and patient self-management techniques are also needed to ease the introduction of new programs and increase their acceptability to smokers.</p

Transition in Occupations of Refugees During Resettlement

Purpose: In 2016, there were 22.5 million refugees worldwide (UNHCR, 2017). California resettled just over 5,000 of those 85,000 (Igielnik & Krogstad, 2017). Limited research has been conducted in the United States (U.S.) focusing on the refugee experience; furthermore, there is a significant gap in research regarding the impact of the refugee experience on the occupations of refugees as they transition to living in the U.S. Smith (2012) explored the adaptation of cultural weaving among Karen refugees to maintain their previous occupations and the impact of daily weaving on their lives within Western culture; however, the study focused only on work occupations. This study sought to capture the experience of refugees and the impact of their transition on a broad array of occupations. Adding to occupational science literature regarding the occupational impact of the refugee experience, as well as aiding in addressing issues of occupational justice (Townsend, & Wilcock, 2004). Methods: This research was a qualitative-descriptive, phenomenological study. Data was collected through semi-structured interviews. Questions were guided by Person-Environment-Occupation model (Law, et al., 1996) and Transitions Theory (Blair, 2000), to address personal and cultural values, environments where occupations are performed, and occupational patterns to identify changes in meaningful occupations due to the refugee process. Participants have legal status as refugees, have been in the U.S. between one and five years, resettled in Northern California, are at least 18 years old and were not required to speak English. As this study aimed to capture a broad experience of transition and limit confounding factors influencing how the participant responded to changes in occupations, participants could be of any ethnicity, country of origin, or gender. Two participants were recruited through snowball sampling. Interviews were audio taped and transcribed. Interviews were coded using Thematic Analysis to generate common themes across cases (Braun & Clarke, 2006). Rigor was strengthened through member checks and peer review. Findings: Through analysis of the interviews, the researchers found five major themes: contextual barriers, internal factors, adaptation, belonging, and transition. The first four themes form a loop and influence each other both positively and negatively and, ultimately, affect engagement in occupations. Transition is the theme that envelops and influences the whole. Using these five themes, the researchers developed the Transition-related Effects on Refugee Occupations (TERO) Model. Key findings include that refugees may experience more meaning and role change/loss in their occupations, rather than adoption of new occupations. Additionally, the researchers found social network to be important for positive occupational engagement throughout country transition. Implications: As occupational therapists, the tendency towards working with refugee populations may be to focus on their transitions to new occupations. However, data from this study indicates that it may be more pertinent to address role and meaning change/loss in current occupations

Transition in Occupations of Refugees During Resettlement

Background: Human displacement is a social problem that has occupational implications. There is a significant gap in the research focusing on the refugee experience and the impact of this experience on their occupations as they transition to living in the US. This study seeks to capture the experience of refugees and the impact of this transition to the US on a broad array of occupations. Method: This research is a qualitative study. Data was collected through semi-structured interviews with two participants who have legal status as refugees living in the US. Results: Thematic analysis generated three themes: (a) contextual barriers to occupation, (b) belonging, and (c) adaptation. Refugees experienced a variety of contextual barriers, both systemic and socio-cultural, that impacted their ability to engage in meaningful occupation leading to a lack of belonging. Refugees adapted to these barriers by adapting their occupations. In addition, the researchers found social networks to be important for positive occupational engagement throughout country transition. Conclusion: This research adds to occupational science literature regarding the occupational impact of the refugee experience, as well as supporting occupational therapists to address issues of occupational deprivation with refugee populations

Transition in Occupations of Refugees During Resettlement

Purpose: In 2016, there were 22.5 million refugees worldwide (UNHCR, 2017). California resettled just over 5,000 of those 85,000 (Igielnik & Krogstad, 2017). Limited research has been conducted in the United States (U.S.) focusing on the refugee experience; furthermore, there is a significant gap in research regarding the impact of the refugee experience on the occupations of refugees as they transition to living in the U.S. Smith (2012) explored the adaptation of cultural weaving among Karen refugees to maintain their previous occupations and the impact of daily weaving on their lives within Western culture; however, the study focused only on work occupations. This study sought to capture the experience of refugees and the impact of their transition on a broad array of occupations. Adding to occupational science literature regarding the occupational impact of the refugee experience, as well as aiding in addressing issues of occupational justice (Townsend, & Wilcock, 2004). Methods: This research was a qualitative-descriptive, phenomenological study. Data was collected through semi-structured interviews. Questions were guided by Person-Environment-Occupation model (Law, et al., 1996) and Transitions Theory (Blair, 2000), to address personal and cultural values, environments where occupations are performed, and occupational patterns to identify changes in meaningful occupations due to the refugee process. Participants have legal status as refugees, have been in the U.S. between one and five years, resettled in Northern California, are at least 18 years old and were not required to speak English. As this study aimed to capture a broad experience of transition and limit confounding factors influencing how the participant responded to changes in occupations, participants could be of any ethnicity, country of origin, or gender. Two participants were recruited through snowball sampling. Interviews were audio taped and transcribed. Interviews were coded using Thematic Analysis to generate common themes across cases (Braun & Clarke, 2006). Rigor was strengthened through member checks and peer review. Findings: Through analysis of the interviews, the researchers found five major themes: contextual barriers, internal factors, adaptation, belonging, and transition. The first four themes form a loop and influence each other both positively and negatively and, ultimately, affect engagement in occupations. Transition is the theme that envelops and influences the whole. Using these five themes, the researchers developed the Transition-related Effects on Refugee Occupations (TERO) Model. Key findings include that refugees may experience more meaning and role change/loss in their occupations, rather than adoption of new occupations. Additionally, the researchers found social network to be important for positive occupational engagement throughout country transition. Implications: As occupational therapists, the tendency towards working with refugee populations may be to focus on their transitions to new occupations. However, data from this study indicates that it may be more pertinent to address role and meaning change/loss in current occupations.https://scholar.dominican.edu/ug-student-posters/1082/thumbnail.jp

The Effectiveness of the Learning to BREATHE Program on Adolescent Emotion Regulation

This study assessed the effectiveness of a mindfulness-based program, Learning to BREATHE, on adolescent emotion regulation. Participants included 216 regular education public high school students with pretest and posttest data participating in the program or instruction-as-usual comparison condition. Program participants reported statistically lower levels of perceived stress and psychosomatic complaints and higher levels of efficacy in affective regulation. Program participants also evidenced statistically larger gains in emotion regulation skills including emotional awareness, access to regulation strategies, and emotional clarity. These findings provide promising evidence of the effectiveness of Learning to BREATHE on the development of key social-emotional learning skills

Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups: Results from a Randomized Web-Based Experiment

Background: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22−1.62), and intention to quit (OR = 1.30, 95% CI = 1.10−1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities

The impact of replacing breakfast grains with meat/meat alternatives: an evaluation of child nutrition policy

Objective: To evaluate the Child and Adult Care Food Program (CACFP) rule that allows a meat/meat alternative to replace the breakfast grain requirement three times per week. Design: A 5-week menu including breakfast, lunch and snack was developed with meat/meat alternative replacing the breakfast grain requirement three times per week. Menu nutrients based on the minimum requirements were compared with reference values representing the Acceptable Macronutrient Distribution Range for fat and a range of reference values representing two-thirds the Dietary Reference Intake for 3-year-olds and 4–5-year-olds. The meal pattern minimum requirements were compared with two-thirds of those recommended by the Dietary Guidelines for Americans (DGA). Setting: Evaluation took place between April and June 2019. Participants: Human subjects were not utilized. Results: The CACFP minimum grain requirement is well below the DGA reference value (0·5–1·5 v. 3·33 ounce-equivalents). Energy (2208·52 kJ) was below the reference values (3126·83–4362·53 kJ). Protein (34·43 g) was above the reference values (9·87–10·81 g). Carbohydrate (76·65 g), fibre (7·46 g) and vitamin E (1·69 mg) were below their reference values of 86·67 g, 10·46–14·60 g and 4–4·76 mg, respectively. Fat (22·57 %) was below the reference range (25–40 %). Conclusions: The CACFP rule which allows a meat/meat alternative to replace the breakfast grain requirement three times per week may result in meal patterns low in energy, carbohydrate, fat, fibre and vitamin E, while providing an excessive amount of protein

Metropolitan Social Environments and Pre-HAART/HAART Era Changes in Mortality Rates (per 10,000 Adult Residents) among Injection Drug Users Living with AIDS

Background Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs) with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents) after highly active antiretroviral therapy (HAART) was developed. Methods This is an ecological cohort study of 86 large US metropolitan areas from 1993–2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents) from 1993–1995 to 2004–2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993–1995 mortality rates to (partially) control for pre-HAART epidemic history and study how other independent variables affected the outcomes. Results In multivariable models, pre-HAART to HAART era increases in ‘hard drug’ arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. Conclusions Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be considered

A multidisciplinary approach to health campaign effectiveness

Campaign costs are rising, making ad execution testing more critical to determine effectiveness prior to media spending. Premarket testing occurs prior to messages’ airing while in-market testing examines message attributes when messages are aired within a real-world setting, where context plays an important role in determining audience response. These types of ad testing provide critical feedback to help develop and deploy campaigns. Due to recent changes in media delivery platforms and audience tobacco use behavior, this study analyzes two nationally representative youth samples, aged 15-21, to examine if pre-market ad testing is an indicator of in-market ad performance for public health campaigns, which rely on persuasive messages to promote or reduce health behaviors rather than selling a product. Using data from the truth® campaign, a national tobacco use prevention campaign targeted to youth and young adults, findings indicate strong associations between pre-market scores and in-market ad performance metrics