Provider satisfaction with an inpatient tobacco treatment program: results from an inpatient provider survey

Background: Hospitalization offers an optimal environment for ensuring that patients receive evidence-based treatment. An inpatient tobacco treatment program can deliver interventions broadly, but minimal research has examined the impacts of a consult program on inpatient providers. The Nicotine Dependence Program at the University of North Carolina has provided an inpatient tobacco treatment consult service since 2010. Objective: The program sought feedback from inpatient providers to examine factors that prompted tobacco treatment consult orders, the impact on provider counseling behavior, provider satisfaction, and suggested program improvements. Design: Providers who had ordered a tobacco treatment consult received an online anonymous survey. Setting: The University of North Carolina Hospital is an academic medical facility with 803 beds and over 37,000 inpatient admissions annually from all 100 counties in North Carolina. Approximately 20% of these inpatients report current use of any tobacco product. Patients/participants: Medical providers who ordered inpatient tobacco treatment consults from July 2012 to June 2013 (n=265) received the survey, with 118 providers responding (44.5% response rate). Results: Almost all providers reported being satisfied with the consult program and believed it was effective. Key factors in provider satisfaction included ease of accessing the service, saving provider time, and offering patients evidence-based tobacco use treatment. The consult program increased the likelihood of providers prescribing tobacco cessation medications at discharge, as well as following up at post-discharge appointments. Conclusion: This is some of the first research to show provider satisfaction, program usage, and outcomes with an inpatient tobacco treatment program and demonstrates the important impact of implementing tobacco treatment services within hospitals

Provider satisfaction with an inpatient tobacco treatment program: Results from an inpatient provider survey

Background: Hospitalization offers an optimal environment for ensuring that patients receive evidence-based treatment. An inpatient tobacco treatment program can deliver interventions broadly, but minimal research has examined the impacts of a consult program on inpatient providers. The Nicotine Dependence Program at the University of North Carolina has provided an inpatient tobacco treatment consult service since 2010. Objective: The program sought feedback from inpatient providers to examine factors that prompted tobacco treatment consult orders, the impact on provider counseling behavior, provider satisfaction, and suggested program improvements. Design: Providers who had ordered a tobacco treatment consult received an online anonymous survey. Setting: The University of North Carolina Hospital is an academic medical facility with 803 beds and over 37,000 inpatient admissions annually from all 100 counties in North Carolina. Approximately 20% of these inpatients report current use of any tobacco product. Patients/participants: Medical providers who ordered inpatient tobacco treatment consults from July 2012 to June 2013 (n=265) received the survey, with 118 providers responding (44.5% response rate). Results: Almost all providers reported being satisfied with the consult program and believed it was effective. Key factors in provider satisfaction included ease of accessing the service, saving provider time, and offering patients evidence-based tobacco use treatment. The consult program increased the likelihood of providers prescribing tobacco cessation medications at discharge, as well as following up at post-discharge appointments. Conclusion: This is some of the first research to show provider satisfaction, program usage, and outcomes with an inpatient tobacco treatment program and demonstrates the important impact of implementing tobacco treatment services within hospitals

Case Study: Use of Electronic Nicotine Delivery Systems (ENDS) By a Pregnant Woman

Introduction: The use of electronic nicotine delivery systems (ENDS) such as electronic cigarettes, vapour cigarettes, and vapour/hookah pens is rapidly increasing. The effectiveness of ENDS for smoking cessation and their safety, particularly amongst pregnant women, is largely unknown. Some women who use tobacco products in pregnancy, such as the one described in this case study, switch to ENDS assuming they are a safer alternative to smoking traditional cigarettes. Many obstetric providers do not screen for ENDS use and may miss an opportunity to counsel their patients about ENDS usage, side effects, or alternatives. Case Description: Motivated by concern for her baby's health, a 28-year-old patient reduced consumption of traditional cigarettes and began using ENDS shortly after learning she was pregnant. Her obstetric team did not screen for ENDS use and was unaware that she had started using ENDS. During the postpartum period, her providers ordered a tobacco cessation consult and the tobacco treatment specialist (TTS) discovered the patient's ENDS use as well as her desire to quit. Conclusions: In the absence of consistent screening by providers and a lack of safety data regarding ENDS use during pregnancy, women are often given little guidance in deciphering the potential risks and benefits of ENDS use. In this case, the patient turned to ENDS because she thought it was safer than smoking tobacco cigarettes and was unaware that there is limited research on ENDS safety. This case highlights the importance of updating clinical screening tools to include ENDS and the need for further research investigating the safety of ENDS use during pregnancy

Disparities in the Use of assisted Reproductive Technologies after Breast Cancer: a Population-Based Study

PURPOSE: Equitable access to oncofertility services is a key component of cancer survivorship care, but factors affecting access and use remain understudied. METHODS: to describe disparities in assisted reproductive technology (ART) use among women with breast cancer in California, we conducted a population-based cohort study using linked oncology, ART, and demographic data. We identified women age 18-45 years diagnosed with invasive breast cancer between 2000 and 2015. The primary outcome was ART use-including oocyte/embryo cryopreservation or embryo transfer-after cancer diagnosis. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to identify factors associated with ART use. RESULTS: Among 36,468 women with invasive breast cancer, 206 (0.56%) used ART. Women significantly less likely to use ART were age 36-45 years at diagnosis (vs. 18-35 years: PR = 0.17, 95% CI 0.13-0.22); non-Hispanic Black or Hispanic (vs. non-Hispanic White: PR = 0.31, 95% CI 0.21-0.46); had at least one child (vs. no children: adjusted PR [aPR] = 0.39, 95% CI 0.25-0.60); or lived in non-urban areas (vs. urban: aPR = 0.28, 95% CI 0.10-0.75), whereas women more likely to use ART lived in high-SES areas (vs. low-/middle-SES areas: aPR = 2.93, 95% CI 2.04-4.20) or had private insurance (vs. public/other insurance: aPR = 2.95, 95% CI 1.59-5.49). CONCLUSION: Women with breast cancer who are socially or economically disadvantaged, or who already had a child, are substantially less likely to use ART after diagnosis. The implementation of policies or programs targeting more equitable access to fertility services for women with cancer is warranted

Youth source of acquisition for E-Cigarettes

As rates of traditional cigarette smoking have decreased among youth over the past several years, rates of e-cigarette use have increased. Little evidence exists on how youth obtain e-cigarettes. We used data from middle and high school students under the age of 18 who reported using an e-cigarette in the past 30 days from the 2017 North Carolina Youth Tobacco Survey (n = 640). We used chi-square tests and multivariable logistic regressions to examine correlates of access and place of acquisition. Over half (51.5%) of youth report acquiring e-cigarettes from a friend. Youth in 12th grade had higher odds of acquiring e-cigarettes from a vape shop (aOR: 2.54, 95% CI: 1.25, 5.15) or retail outlet (aOR: 2.40, 95% CI: 1.18, 4.90) than youth in middle school. Compared to non-Hispanic white youth, Hispanic youth had lower odds of acquiring e-cigarettes from a vape shop (aOR: 0.42, 95% CI: 0.20, 0.87). Youth living with someone who uses e-cigarettes, compared to those who did not, had higher odds of acquiring e-cigarettes from a family member (aOR: 3.95, 95% CI: 1.94, 8.05). Finally, current smokers had higher odds of acquiring e-cigarettes from a retail outlet (aOR: 3.28, 95% CI: 1.88, 5.70) and lower odds of acquiring e-cigarettes from a friend (aOR: 0.53, 95% CI: 0.36, 0.77). Youth primarily reported obtaining e-cigarettes from a friend. Living with someone who uses e-cigarettes may be a risk factor for acquiring e-cigarettes from family members. Identifying sources of e-cigarette acquisition will help inform interventions preventing youth e-cigarette access

Vaping cannabis among adolescents: Prevalence and associations with tobacco use from a cross-sectional study in the USA

Objective Previous research suggests that some adolescents are using e-cigarette devices to vaporise ('vaping') cannabis in the form of hash oil, tetrahydrocannabinol (THC) wax or oil, or dried cannabis buds or leaves. However, it is unclear how adolescents who vape cannabis use other tobacco products. This study examined the extent to which adolescents reported ever vaping cannabis and investigated how demographic variables and tobacco behaviours were associated with use. Design We used cross-sectional data from adolescents (total response rate 64.5%) who participated in the 2017 North Carolina Youth Tobacco Survey. SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Setting North Carolina, USA. Participants Adolescents in high school (n=2835). Primary outcome and measure Adolescents were asked to indicate whether they had ever used an e-cigarette device with marijuana, THC or hash oil, or THC wax. Results Approximately 1 in 10 high school students reported ever vaping cannabis in the overall sample (9.6%). In multivariable models, adolescents who reported using cigars (adjusted OR (aOR) 3.76, 95% CI 2.33 to 6.07), waterpipe (aOR 2.32, 95% CI 1.37 to 3.93) or e-cigarettes (aOR 3.18, 95% CI 2.38 to 4.25) in the past 30 days had higher odds of reporting ever vaping cannabis compared with their counterparts. There was no significant association between use of smokeless tobacco (aOR 0.89, 95% CI 0.42 to 1.91) or use of cigarettes (aOR 1.27, 95% CI 0.71 to 2.29) in the past 30 days and odds of reporting ever vaping cannabis. Conclusions These findings provide evidence that large numbers of high school students who use tobacco products have vaped cannabis. As tobacco control policies - such as communication campaigns or smoke-free laws - increasingly focus on e-cigarettes, attention to understanding how adolescents use e-cigarettes to vape substances other than nicotine is essential

Social Media Use for Cancer Support Among Young Adults with Cancer

Purpose: Social media can facilitate peer support among young adults with cancer; however, information is needed about what social media are used, by whom, and how to inform resource and intervention recommendations. Methods: In December 2021, we conducted an online survey with 396 young adults with cancer, ages 18–39, with any diagnosis ages 15–39. Participants reported their social media use to connect with other young adults with cancer, including frequency of use, type of support, and affect (positive to negative) when using to connect with cancer peers. Results: Participants were on average 31 years old (SD = 5.2), with an average age of 27 at diagnosis (63.4% male, 62.1% non-Hispanic White). Almost all (97.5%) reported using social media to connect with other young adults with cancer. Many (48.0%) used three or more social media platforms for cancer support, including Facebook (44.4%), YouTube (43.6%), Instagram (43.4%), Snapchat (36.9%), and Twitter (36.9%). Daily use for cancer support was common (32.9%–60.9%) among those who used social media, particularly among those who were younger; are not transgender; live in urban areas; or had brain, gynecologic, or testicular cancers. Across social media platforms, young adults with cancer reported seeking and sharing emotional support (88.9%), informational support (84.1%), and making connections (81.3%). Conclusion: Young adults with cancer use social media to connect with cancer peers for support. Commonly used existing social media (e.g., Facebook, YouTube, Instagram) should be prioritized in interventions to reach young adults who desire more age-appropriate resources to improve their psychosocial health

Time to cancer treatment and reproductive outcomes after fertility preservation among adolescent and young adult women with cancer

Background: Fertility preservation (FP) may be underused after cancer diagnosis because of uncertainty around delays to cancer treatment and subsequent reproductive success. Methods: Women aged 15 to 39 years diagnosed with cancer between 2004 and 2015 were identified from the North Carolina Central Cancer Registry. Use of assisted reproductive technology (ART) after cancer diagnosis between 2004 and 2018 (including FP) was assessed through linkage to the Society for Assisted Reproductive Technology. Linear regression was used to examine time to cancer treatment among women who did (n = 95) or did not (n = 469) use FP. Modified Poisson regression was used to estimate risk ratios (RRs) and 95% CIs for pregnancy and birth based on timing of ART initiation relative to cancer treatment (n = 18 initiated before treatment for FP vs n = 26 initiated after treatment without FP). Results: The median time to cancer treatment was 9 to 33 days longer among women who used FP compared with women who did not, matched on clinical factors. Women who initiated ART before cancer treatment may be more likely to have a live birth given pregnancy compared with women who initiated ART after cancer treatment (age-adjusted RR, 1.47; 95% CI, 0.98-2.23), though this may be affected by the more frequent use of gestational carriers in the former group (47% vs 20% of transfer cycles, respectively). Conclusions: FP delayed gonadotoxic cancer treatment by up to 4.5 weeks, a delay that would not be expected to alter prognosis for many women. Further study of the use of gestational carriers in cancer populations is warranted to better understand its effect on reproductive outcomes

With or without force? : European public opinion on democracy promotion

A Large part of the education provided at colleges and universities of today requires for thestudent to be more independent in their studies. This demands that the physical space,where the students choose to study, is designed in a way that can encourage and supportlearning. It seems as though that many of the learning spaces of today don’t always meetthe students’ needs. The university library at the University of Umeå is currently planningto design new learning spaces for the students. The aim of this study is to examine how thephysical learning space can be designed to engage and encourage the students in theirlearning process. Based on literature describing learning spaces we have initially identified three mainareas to examine- Learning, Information Technology and Learning space design. Theseareas are all important features in the design of new learning spaces. With informationdrawn from that literature we conducted an empirical study at the library of the Universityof Umeå. The empirical study was carried out through observations and focus groupinterviews. To give us more insight about the students’ thoughts about the learning spacewe also compared our findings with a survey conducted by the library personnel in 2008and 2010. The result of our study shows that there are some areas to be improved in theexisting learning space. The students are working more collaboratively which requiresmore group areas. Our study also shows that flexibility, more student interaction and asocial and engaging environment are all important features in the design of new learningspaces