(VIDEO) Household Chemicals and Prostate Health: Serum Prostate Specific Antigen Levels and Urinary Benzophenone-3, Bisphenol A, and Triclosan Levels in Males: NHANES 2005-2010

Background: Exposure to environmental phenols (e.g., bisphenol A, benzophenone-3, and triclosan) is widespread in the population. Many of these chemicals have been shown to have adverse effects on reproductive organs and hormones, both in vitro and in vivo. Objective: This study aimed to (1) provide descriptive information about prostate specific antigen levels and (2) examine the association of bisphenol A (BPA), benzophenone-3 (BP-3), and triclosan (TCS) with serum prostate specific antigen (PSA) levels in male participants (ages 40+ years) in the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Methods: Geometric and weighted means, chi-square tests, and logistic regressions were used to provide descriptive information about PSA distribution in these male participants. Multivariable logistic regression was used to estimate associations between serum PSA level risk classification for prostate cancer (high and low) and levels of log-transformed and creatinine adjusted urinary BPA, BP-3, and TCS, in male participants. (Preliminary) Results: BP-3 was associated with significantly higher likelihood of higher prostate specific antigen levels and prostatic cancer in males. (Preliminary) Conclusions: To the researcher\u27s knowledge, this is the first study to produce a report on the distribution of PSA in the USA from NHANES. It also is novel in its report of an association of BP-3 with serum PSA in males. However, because of the limitations inherent to the cross-sectional study design, further studies are needed to confirm and elucidate on our findings

Smoking cessation support for pregnant women: role of mobile technology.

BACKGROUND: Smoking during pregnancy has deleterious health effects for the fetus and mother. Given the high risks associated with smoking in pregnancy, smoking cessation programs that are designed specifically for pregnant smokers are needed. This paper summarizes the current landscape of mHealth cessation programs aimed at pregnant smokers and where available reviews evidence to support their use. METHODS: A search strategy was conducted in June-August 2015 to identify mHealth programs with at least one component or activity that was explicitly directed at smoking cessation assistance for pregnant women. The search for text messaging programs and applications included keyword searches within public health and medical databases of peer-reviewed literature, Google Play/iTunes stores, and gray literature via Google. RESULTS: Five unique short message service programs and two mobile applications were identified and reviewed. Little evidence was identified to support their use. Common tools and features identified included the ability to set your quit date, ability to track smoking status, ability to get help during cravings, referral to quitline, and tailored content for the individual participant. The theoretical approach utilized was varied, and approximately half of the programs included pregnancy-related content, in addition to cessation content. With one exception, the mHealth programs identified were found to have low enrollment. CONCLUSION: Globally, there are a handful of applications and text-based mHealth programs available for pregnant smokers. Future studies are needed that examine the efficacy of such programs, as well as strategies to best promote enrollment

Quit4baby: Results From a Pilot Test of a Mobile Smoking Cessation Program for Pregnant Women

Background: Text messaging programs have been shown to be effective in helping adult smokers quit smoking. This study describes the results of a pilot test of Quit4baby, a smoking cessation text messaging program for pregnant smokers that was adapted from Text2quit. Objective: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program. Methods: Pregnant women enrolled in Text4baby and who were current smokers or had quit within the last 4 weeks (N=20) were enrolled in Quit4baby. Those under age 18, not pregnant, not current smokers, those using nicotine replacement therapy and those not interested in participating were ineligible. Participants were surveyed at baseline and at 2 and 4 weeks post-enrollment. Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive. Conclusions: The pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for pregnancy smoking cessation

A qualitative analysis of smokers’ perceptions about lung cancer screening

Background In 2013, the US Preventive Services Task Force (USPSTF) began recommending lung cancer screening for high risk smokers aged 55–80 years using low-dose computed tomography (CT) scan. In light of these updated recommendations, there is a need to understand smokers’ knowledge of and experiences with lung cancer screening in order to inform the design of patient education and tobacco cessation programs. The purpose of this study is to describe results of a qualitative study examining smokers’ perceptions around lung cancer screening tests. Methods In 2009, prior to the release of the updated USPSTF recommendations, we conducted 12 120-min, gender-specific focus groups with 105 current smokers in Charlotte, North Carolina and Cincinnati, Ohio. Focus group facilitators asked participants about their experience with three lung cancer screening tests, including CT scan, chest x-ray, and sputum cytology. Focus group transcripts were transcribed and qualitatively analyzed using constant comparative methods. Results Participants were 41–67 years-old, with a mean smoking history of 38.9 pack-years. Overall, 34.3% would meet the USPSTF’s current eligibility criteria for screening. Most participants were unaware of all three lung cancer screening tests. The few participants who had been screened recalled limited information about the test. Nevertheless, many participants expressed a strong desire to pursue lung cancer screening. Using the social ecological model for health promotion, we identified potential barriers to lung cancer screening at the 1) health care system level (cost of procedure, confusion around results), 2) cultural level (fatalistic beliefs, distrust of medical system), and 3) individual level (lack of knowledge, denial of risk, concerns about the procedure). Although this study was conducted prior to the updated USPSTF recommendations, these findings provide a baseline for future studies examining smokers’ perceptions of lung cancer screening. Conclusion We recommend clear and patient-friendly educational tools to improve patient understanding of screening risks and benefits and the use of best practices to help smokers quit. Further qualitative studies are needed to assess changes in smokers’ perceptions as lung cancer screening with CT scan becomes more widely used in community practice

Quit4baby: Results from a pilot test of a mobile smoking cessation program for pregnant women

Background: Text messaging (short message service, SMS) programs have been shown to be effective in helping adult smokers quit smoking. This study describes the results of a pilot test of Quit4baby, a smoking cessation text messaging program for pregnant smokers that was adapted from Text2quit. Objective: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program. Methods: Pregnant women enrolled in Text4baby and who were current smokers or had quit within the last 4 weeks (n=20) were enrolled in Quit4baby. Those under the age of 18, not pregnant, not current smokers, those using nicotine replacement therapy, and those not interested in participating were ineligible. Participants were surveyed at baseline and at 2 and 4 weeks postenrollment. Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive. Conclusions: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy

Integrating stages of change models to cast new vision on interventions to improve global retinoblastoma and childhood cancer outcomes

Background: Retinoblastoma, the most common intraocular tumor globally, represents a curable cancer when diagnosed early and treated promptly. Delay to diagnosis, lag time prior to treatment initiation, and abandonment of treatment including upfront treatment refusal, represent stark causes of high retinoblastoma mortality rates in low- and middle- income settings, particularly regions in Africa. While a health delivery-based approach has been a historic focus of retinoblastoma treatments globally and is essential to quality care, this is necessary but not adequate. Retinoblastoma is a compelling disease model to illustrate the potential insights afforded in theory-informed approaches to improve outcomes that integrate public health and oncology perspectives, prioritizing both health service delivery and social efficacy for cure. Discussion: Given that barriers to appropriate and timely diagnosis and treatment represent main contributors to mortality in children with retinoblastoma in resource-limited settings such as certain areas in Africa, an important priority is to overcome barriers to cure that may be predominantly socially influenced, alongside health delivery-based improvements. While Stages of Change models have been effectively utilized in cancer screening programs within settings of economic and cultural barriers, this application of health behavior theory has been limited to cancer screening rather than a comprehensive framework for treatment completion. Using retinoblastoma as a case example, we propose applying stage-based intervention models in critical stages of care, such as the Precaution Adoption Process Model to decrease delay to diagnosis and a Transtheoretical Model to increase treatment completion rates in resource-limited settings. Summary: Stage-based theories recognize that improved cure and survival outcomes will require supportive strategies to progress households, communities, and social and economic institutions from being unaware and unengaged to committed and sustained in their respective roles. Applying a stage-based model lens to programmatic interventions in resource-limited settings has potential for visible improvement in outcomes for children with retinoblastoma and other cancers

A content analysis of electronic health record (EHR) functionality to support tobacco treatment

Government regulations have created new incentives for health systems to implement changes in electronic health records (EHRs) to reduce tobacco use among patients. The purpose of this study is to conduct a content analysis of EHR modifications aimed at supporting tobacco cessation and to document these modifications using a 5 A\u27s framework (i.e., Ask, Advise, Assess, Assist, Arrange). Fourteen trials were identified that met inclusion criteria. A content analysis of EHR functionality in these trials was conducted by two independent reviewers between February and June 2015. For “Ask,” all trials provided for the documentation of smoking status in the EHR. For “Advise,” 35.7 % of EHRs provided functionality related to helping a clinician provide advice to quit. For “Assess,” more than half (57.1 %) of EHRs included a feature to document a patient\u27s willingness to quit. For “Assist,” EHRs offered features for medication prescribing (78.6 %), providing educational materials to patients (57.1 %), referring a patient to the quitline (50.0 %), referring a patient to a tobacco treatment specialist (42.9 %), and documenting the provision of counseling (35.7 %). Finally, for “Arrange,” EHRs supported the following up of patients (35.7 %) and allowed tobacco treatment specialists to “pass back” patient notes to primary care providers (28.6 %). Studies that have modified EHRs for tobacco treatment have done so across the steps in the 5 As model, with most modifications occurring to support documenting smoking status (Ask) and assisting with medication prescribing (Assist). As health systems attempt to comply with Meaningful Use regulations, an understanding of the range of EHR modifications to support tobacco treatment is warranted

Smoking cessation support for pregnant women: role of mobile technology

Background: Smoking during pregnancy has deleterious health effects for the fetus and mother. Given the high risks associated with smoking in pregnancy, smoking cessation programs that are designed specifically for pregnant smokers are needed. This paper summarizes the current landscape of mHealth cessation programs aimed at pregnant smokers and where available reviews evidence to support their use. Methods: A search strategy was conducted in June–August 2015 to identify mHealth programs with at least one component or activity that was explicitly directed at smoking cessation assistance for pregnant women. The search for text messaging programs and applications included keyword searches within public health and medical databases of peer-reviewed literature, Google Play/iTunes stores, and gray literature via Google. Results: Five unique short message service programs and two mobile applications were identified and reviewed. Little evidence was identified to support their use. Common tools and features identified included the ability to set your quit date, ability to track smoking status, ability to get help during cravings, referral to quitline, and tailored content for the individual participant. The theoretical approach utilized was varied, and approximately half of the programs included pregnancy-related content, in addition to cessation content. With one exception, the mHealth programs identified were found to have low enrollment. Conclusion:Globally, there are a handful of applications and text-based mHealth programs available for pregnant smokers. Future studies are needed that examine the efficacy of such programs, as well as strategies to best promote enrollment

A content analysis of Electronic Health Record (EHR) functionality to support tobacco treatment

Background: The adoption of Electronic Health Records (EHRs) in healthcare settings is an opportunity for promoting smoking cessation. EHR functionality related to smoking cessation has potential to shape clinician behavior and standardize best practices. Previous studies have not systematically examined the characteristics of EHRs related to smoking cessation. Objectives: The purpose of this study is to review the published literature that describes EHR modifications aimed at supporting cessation and to document the prevalence of EHR functionality using a 5 A’s framework (Ask, Advise, Assess, Assist, Arrange). Methods: A literature review was conducted and 18 published studies covering 14 unique EHRs were identified. A content analysis for EHR functionality related to tobacco treatment was conducted by two independent coders. Results: For functionality related to Ask, 100% of EHRs allowed for the documentation of smoking status, in some cases, prompted by an alert (42.8%). Others allowed for the documentation of cigarettes smoked per day (28.6%), tobacco type (35.7%), and previous quit attempts (21.4%). For Advise, 35.7% of EHRs provided functionality helping a clinician provide advice to quit. For Assess, more than half of EHRs included a feature to document a patient’s willingness to quit. For Assist, EHRs provided several features, sometimes grouped together in an order set and/or with the presence of an alert. The vast majority provided medication prescribing functionality (78.6%). About half included a feature to refer a patient to the quitline (50.0%), to a tobacco treatment specialist (42.8%), or to educational materials (57.1%). Finally, for Arrange, EHRs helped by scheduling follow-up visits (35.7%) or by linking specialists back to primary care providers (28.6%). Conclusions: Studies that have attempted to modify EHRs for tobacco treatment purposes have included modifications across the steps in the 5 A’s model, with most supporting documentation of smoking status (Ask) and assisting with medication prescribing (Assist). Future studies need to examine the relationship between the presence of specific EHR functionality and smoking cessation outcomes