A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act

Background: Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. Aim: The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles. Method: A scoping review was conducted where the research team searched United States academic literature from 1990 through February 2020 in PubMed, Medline, and CINAHL using general subject headings for disability, mental illness, and Pap testing. Results: Thirty-two articles met inclusion criteria. More barriers than facilitators were mentioned in articles. Barriers and facilitators are organized into three groups according to social ecological model and include individual (e.g., socioeconomic status, anxiety, education), interpersonal (e.g., family, living environment), and organizational factors (health care provider training, health care system). Participant’s race/ethnicity were often reported but minoritized populations were often not the focus of articles. Conclusions: More articles discussed the difficulties that women with disabilities and women with serious mental illnesses face with receiving a Pap test than facilitators to Pap testing. Additional research should focus on the intersectionality race/ethnicity and women with disabilities and women with serious mental illnesses in relation to Pap testing

Milankovitch frequencies in tephra records at volcanic arcs: The relation of kyr-scale cyclic variations in volcanism to global climate changes

Highlights The increase in volcanic activity after the last glacial maximum observed on Iceland has led to one of the most fascinating hypothesis in science in the last decades: that deglaciation may force volcanism. We: - Re-analyzed four longer tephra records with the same statistical method and demonstrated that all contain the ∼41 kyr and ∼100 kyr Millankovitch periodicities. - The frequency spectra of the tephra and δ18O records are significantly correlated supporting the hypothesis that orbital-driven global climate changes interact with the volcanic eruption frequency regionally and globally. - However, the simultaneous analysis of the four best-characterized tephra records shows that correlations and associated time lags suffer from a number of uncertainties including the nature and quality of tephra time series, a wide range in geographic latitudes and geological settings, as well as applied statistical methods Therefore more precise tephra time series (preservation and age optimized) from different regions (glaciated versus non-glaciated) and geological settings (island arcs, continental arcs, intraplate) are needed together with standardized statistical analysis to decipher the impact of these factors on a global perspective of how climate may control volcanism. Abstract The increase in volcanic activity after the last glacial maximum observed on Iceland has led to one of the most fascinating hypothesis in science in the last decades: that deglaciation may force volcanism. Consequently, tephrostratigraphic records of sufficient length that cover multiple glacial cycles have been used to test whether such relationships hold systematically through the Quaternary. Here we review such tephra records that have been linked with climate proxy records such as δ18O in marine sediments, which is a measure of sea-level change and which is thought to be orbitally forced, as it exhibits the characteristic Milankovitch periodicities of precession (∼23 kyr), obliquity (∼41 kyr) and eccentricity (∼100 kyr). Statistical analyses have identified these periodicities also in long tephra records from different latitudes and geotectonic settings, as well as in compiled semi-global records. These studies detect Milankovitch periods in their tephra record, and also a phase shift relative to the δ18O record in such that periods of increased eruption frequencies coincide with the deglaciation period at the glacial/interglacial transition when ice and water loads on the lithosphere change most rapidly. However, there are also disparities in results and interpretations, which may be attributable to the different methods of analysis applied by the studies. We have therefore re-analyzed the four best-characterized tephra records by the same methods. We distinguish between analysis in the frequency domain, a novel approach, and analysis in the time domain, which has been used in previous studies. Analysis in the frequency domain identifies harmonic frequencies that arise from the binary nature of the tephra records and complicate the identification of primary frequencies. However, we show that all four records show spectral density peaks near the main Milankovitch periodicities of 41 and 100 kyr, and that they produce meaningful and significant statistical correlations with each other and the global δ18O record but not with random time series. Although the time-domain correlations with δ18O roughly confirm phase shifts implying peak volcanism during deglaciation, correlation coefficients arising from very noisy records are generally too low for precise constraints on the relative timing. These deficiencies presently hamper the recognition of the physical mechanisms through which global climate changes affect volcanism at both, high-latitude glaciated regions and low-latitude non-glaciated regions

Recruiting Women to a Mobile Health Smoking Cessation Trial: Low- and No-Cost Strategies

Background: Successful recruitment of participants to mobile health (mHealth) studies presents unique challenges over in-person studies. It is important to identify recruitment strategies that maximize the limited recruitment resources available to researchers. Objective: The objective of this study was to describe a case study of a unique recruitment process used in a recent mHealth software app designed to increase smoking cessation among weight-concerned women smokers. The See Me Smoke-Free app was deployed to the Google Play Store (Alphabet, Inc., Google, LLC), where potential participants could download the app and enroll in the study. Users were invited in-app to participate in the study, with no in-person contact. The recruitment activities relied primarily on earned (free) and social media. Methods: To determine the relationship between recruitment activities and participant enrollment, the researchers explored trends in earned and social media activity in relation to app installations, examined social media messaging in relation to reach or impressions, and described app users’ self-reported referral source. The researchers collected and descriptively analyzed data regarding recruitment activities, social media audience, and app use during the 18-week recruitment period (March 30, 2015-July 31, 2015). Data were collected and aggregated from internal staff activity tracking documents and from Web-based data analytics software such as SumAll, Facebook Insights (Facebook, Inc.), and Google Analytics (Alphabet, Inc., Google, LLC). Results: Media coverage was documented across 75 publications and radio or television broadcasts, 35 of which were local, 39 national, and 1 international. The research team made 30 Facebook posts and 49 tweets, yielding 1821 reaches and 6336 impressions, respectively. From March 30, 2015 to July 31, 2015, 289 unique users downloaded the app, and 151 participants enrolled in the study. Conclusions: Research identifying effective online recruitment methods for mHealth studies remains minimal, and findings are inconsistent. We demonstrated how earned media can be leveraged to recruit women to an mHealth smoking cessation trial at low cost. Using earned media and leveraging social media allowed us to enroll 3 times the number of participants that we anticipated enrolling. The cost of earned media resides in the staff time required to manage it, particularly the regular interaction with social media. We recommend communication and cooperation with university public affairs and social media offices, as well as affiliate programs in journalism and communications, so that earned media can be used as a recruitment strategy for mHealth behavior change interventions. However, press releases are not always picked up by the media and should not be considered as a stand-alone method of recruitment. Careful consideration of an intervention’s broad appeal and how that translates into potential media interest is needed when including earned media as part of a comprehensive recruitment plan for mHealth research

See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity

Background: This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors—exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions. Objective: The objective of our study is to evaluate the feasibility of an mHealth app for women designed to simultaneously address smoking, diet, and physical activity behaviors. The objectives are supported by three specific aims: (1) develop guided imagery content, user interface, and resources to reduce weight concern, and increase body image and self-efficacy for behavior change among women smokers, (2) program a prototype of the app that contains all the necessary elements of text, graphics, multimedia and interactive features, and (3) evaluate the feasibility, acceptability, and preliminary efficacy of the app with women smokers. Methods: We created the program content and designed the prototype application for use on the Android platform in collaboration with 9 participants in multiple focus groups and in-depth interviews. We programmed and tested the application’s usability with 6 participants in preparation for an open, pre- and posttest trial. Currently, we are testing the feasibility and acceptability of the application, evaluating the relationship of program use to tobacco cessation, dietary behaviors, and physical activity, and assessing consumer satisfaction with approximately 70 women smokers with Android-based smart phones. Results: The study was started January 1, 2014. The app was launched and feasibility testing began in April 1, 2015. Participants were enrolled from April 1-June 30, 2015. During that time, the app was downloaded over 350 times using no paid advertising. Participants were required to use the app “most days” for 30 days or they would be dropped from the study. We enrolled 151 participants. Of those, 78 were dropped or withdrew from the study, leaving 73 participants. We have completed the 30-day assessment, with a 92% response rate. The 90-day assessment is ongoing. During the final phase of the study, we will be conducting data analyses and disseminating study findings via presentations and publications. Feasibility will be demonstrated by successful participant retention and a high level of app use. We will examine individual metrics (eg, duration of use, number of screens viewed, change in usage patterns over time) and engagement with interactive activities (eg, activity tracking). Conclusions: We will aggregate these data into composite exposure scores that combine number of visits and overall duration to calculate correlations between outcome and measures of program exposure and engagement. Finally, we will compare app use between participants and non-participants using Google Analytics

100- kyr cyclicity in volcanic ash emplacement: evidence from a 1.1 Myr tephra record from the NW Pacific

It is a longstanding observation that the frequency of volcanism periodically changes at times of global climate change. The existence of causal links between volcanism and Earth's climate remains highly controversial, partly because most related studies only cover one glacial cycle. Longer records are available from marine sediment profiles in which the distribution of tephras records frequency changes of explosive arc volcanism with high resolution and time precision. Here we show that tephras of IODP Hole U1437B (northwest Pacific) record a cyclicity of explosive volcanism within the last 1.1 Myr. A spectral analysis of the dataset yields a statistically significant spectral peak at the similar to 100 kyr period, which dominates the global climate cycles since the Middle Pleistocene. A time-domain analysis of the entire eruption and delta O-18 record of benthic foraminifera as climate/sea level proxy shows that volcanism peaks after the glacial maximum and similar to 13 +/- 2 kyr before the delta O-18 minimum right at the glacial/interglacial transition. The correlation is especially good for the last 0.7 Myr. For the period 0.7-1.1 Ma, during the Middle Pleistocene Transition (MPT), the correlation is weaker, since the 100 kyr periodicity in the delta O-18 record diminishes, while the tephra record maintains its strong 100 kyr periodicity

100- kyr cyclicity in volcanic ash emplacement: evidence from a 1.1 Myr tephra record from the NW Pacific

It is a longstanding observation that the frequency of volcanism periodically changes at times of global climate change. The existence of causal links between volcanism and Earth’s climate remains highly controversial, partly because most related studies only cover one glacial cycle. Longer records are available from marine sediment profiles in which the distribution of tephras records frequency changes of explosive arc volcanism with high resolution and time precision. Here we show that tephras of IODP Hole U1437B (northwest Pacific) record a cyclicity of explosive volcanism within the last 1.1 Myr. A spectral analysis of the dataset yields a statistically significant spectral peak at the ~100 kyr period, which dominates the global climate cycles since the Middle Pleistocene. A time-domain analysis of the entire eruption and δ18O record of benthic foraminifera as climate/sea level proxy shows that volcanism peaks after the glacial maximum and ∼13 ± 2 kyr before the δ18O minimum right at the glacial/interglacial transition. The correlation is especially good for the last 0.7 Myr. For the period 0.7–1.1 Ma, during the Middle Pleistocene Transition (MPT), the correlation is weaker, since the 100 kyr periodicity in the δ18O record diminishes, while the tephra record maintains its strong 100 kyr periodicity

A Scoping Review of Health Research with Racially/Ethnically Minoritized Adults with Intellectual and Developmental Disabilities

Living with intersectional identities, having a disability, and being a member of a racial or ethnic minoritized group in the U.S., contributes to marginalization that may result in health disparities and health inequities. The purpose of this scoping review is to describe health research regarding adult racial/ethnic minoritized individuals in the U.S with intellectual and developmental disabilities (I/DD). Eight electronic databases were searched to identify literature on the topic published since 2000. Of the 5,229 records, 35 articles were included in the review. Eligible studies included research conducted in the U.S., published in English, and research focused on adults with I/DD with race and/or ethnicity information. The 35 articles included racial/ethnic minoritized individuals who were Black, Latinx/Hispanic, American Indian, and Asian. Twenty-nine of the 35 articles identified health disparities experienced by adults with I/DD from racial/ethnic minoritized groups. Many health disparities were demonstrated in the articles, where adult racial/ ethnic minoritized individuals with I/DD fared worse compared to White adults with I/DD. Additionally, four articles describe differences in health experiences by those from racial or ethnic minoritized backgrounds. Results of this scoping review highlight the need for research that incorporates intentional inclusion of racial/ethnic minoritized people with I/DD and include novel methodologies that allow for the contributions of historically marginalized voices. Future research with an intersectionality approach is recommended to promote equity