Cancer-Related Direct-To-Consumer Advertising - A Study of its Antecedents, Influence on Patient Information Seeking Behaviors, and Contingent Effects

Direct-to-consumer advertising (DTCA) of prescription medications and healthcare facilities has generated much debate over the potential benefits and adverse consequences for the public at large, patients, clinician-patient relationships, and the overall healthcare system. This dissertation is aimed at contributing to this debate through studying the impact of DTCA in the context of cancer treatment. Study 1 assessed the reliability and validity of three candidate measures of patient-reported exposure to cancer-related DTCA across seven criteria. The study found that all three measures performed well in terms of convergent, nomological, discriminant, and face validity. Findings from this study offer support for utilizing these survey measures in future studies targeting cancer patients. Next, Study 2 examined the prevalence and correlates of cancer-related DTCA exposure in a sample of patients in Pennsylvania diagnosed with breast, prostate, or colorectal cancers. On average, patients reported modest exposure to such DTCA (median exposure was once per week). Significant correlates of exposure included cancer type, age, stage of disease, and ethnicity. Study 3 investigated the relationships between DTCA exposure and subsequent information seeking behaviors. The analyses detected a significant association between DTCA exposure and cancer patients\u27 subsequent information engagement with their clinicians at one-year follow-up. Exposure to DTCA was marginally significant in predicting information seeking from non-clinician (lay media and interpersonal) sources. Based on the Integrative Model of Behavioral Prediction, a focused analysis showed a significant indirect path between DTCA exposure and subsequent information seeking from non-clinician sources, mediated through attitudes and intention to seek from these sources. Study 4 was guided by the Structural Influence Model of Communication to explore disparities in health information seeking behaviors arising from DTCA exposure. The study found that the associations between DTCA exposure and active information seeking behaviors were not moderated by patients\u27 age, educational level, race/ethnicity, or cancer type. To conclude, these studies would likely inform the ongoing debate and future research regarding the impact of cancer-related DTCA exposure on communication outcomes and disparities

The Use of Substances Other Than Nicotine in Electronic Cigarettes Among College Students

Introduction: Electronic cigarettes (e-cigarettes) have grown in popularity, especially among youth and young adults. Although e-cigarettes were originally intended to vaporize a liquid mixture containing nicotine, there appears to be an increasing trend in other substance use in e-cigarettes (OSUE). Materials and methods: Cross-sectional data from 1542 undergraduate college student e-cigarette users from a large Midwestern university were collected via online survey to assess prevalence of e-cigarette use, reasons for use, perceived harm, and prevalence and predictors of OSUE. Results: Nearly 7% (6.94%) reported using an e-cigarette to vaporize and inhale a substance other than nicotine. Current tobacco cigarette smokers were significantly more likely to report OSUE (51.0%) as compared with never (33.7%) and former (15.4%) smokers. Among respondents reporting OSUE, the primary reason for e-cigarette use was “safer than cigarettes” (21.7%), followed by “experimentation” (18.9%) and “friends use” (17.0%). Most (77.9%) reported using cannabis or some derivative of cannabis in an e-cigarette. Binomial logistic regression found that women were less likely to report OSUE by a factor of 0.60, former tobacco cigarette smokers as compared with never smokers were more likely to report OSUE by a factor of 1.87, and e-cigarette users who reported using e-cigarettes for “cool or trendy” reasons were more likely to report OSUE by a factor of 2.89. Discussion: Little is known regarding the health effects of cannabis and cannabis derivatives delivered through e-cigarettes. Concern may also be warranted regarding the potential dangers of this young population using substances more dangerous than cannabis in e-cigarettes. Knowledge is limited regarding the public health impact of vaping cannabis or other illicit substances among college student populations. This study stresses the need for continued research regarding the vaping of cannabis and other illicit substances among college students

Fundamentos e aplicações da metodologia de ensaios não destrutivos com células bacterianas

Os Ensaios Não Destrutivos (END) são determinantes para a fiabilidade de materiais cuja integridade é de extrema importância. A técnica de Ensaios Não Destrutivos com células bacterianas (CB) tem demonstrado viabilidade para deteção de defeitos superficiais, com espessuras e profundidades inferiores a 5 μm em vários materiais de engenharia. O conhecimento adquirido sobre esta técnica já é significativo mas alguns aspetos necessitam de mais desenvolvimentos, como a interação bactéria-defeito e a viabilidade da técnica para condições de superfície diferentes das já ensaiadas. O objetivo deste trabalho é alargar a técnica a uma maior gama de materiais de engenharia com condições de superfície diferentes, assim como, desenvolver o conhecimento sobre a interação bactéria-defeito. A bactéria Rhodococcus erythropolis foi usada na inspeção de vários materiais como Alumínio Liga 1100, Estanho, Ouro, Prata, INCONEL 9095, Aço revestido com Nickel, Cobre revestido com Ouro, Alumínio revestido com Cobre, Polímero com nano tubos de carbono, entre outros, e com condições de superfície diferentes como superfícies anodizadas e revestidas. Foram também caracterizados os campos magnéticos de dois equipamentos desenvolvidos para esta técnica de Ensaios Não Destrutivos. Os resultados experimentais mostraram que a utilização de campos magnéticos contribui positivamente para a deteção de defeitos e que provetes com revestimentos superficiais diferentes revelam resultados diferentes apesar de terem o mesmo material base

Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system.

It is unclear whether use of electronic nicotine delivery systems (ENDS) precedes cigarette smoking initiation, relapse, and/or quitting. Healthcare systems with electronic health records (EHRs) provide unique data to examine ENDS use and changes in smoking. We examined the incidence of ENDS use (2012-2015) based on clinician documentation and tested whether EHR documented ENDS use is associated with twelve-month changes in patient smoking status using a matched retrospective cohort design. The sample was Kaiser Permanente Northern California (KPNC) patients aged ≥12 with documented ENDS use (N = 7926); 57% were current smokers, 35% former smokers, and 8% never-smokers. ENDS documentation incidence peaked in 2014 for current and former smokers and in 2015 for never-smokers. We matched patients with documented ENDS use to KPNC patients without documented ENDS use (N = 7926) on age, sex, race/ethnicity, and smoking status. Documented ENDS use predicted the likelihood of smoking in the following year. Among current smokers, ENDS use was associated with greater odds of quitting smoking (OR = 1.17, 95%CI = 1.05-1.31). Among former smokers, ENDS use was associated with greater odds of smoking relapse (OR = 1.53, 95%CI = 1.22-1.92). Among never-smokers, ENDS use was associated with greater odds of initiating smoking (OR = 7.41, 95%CI = 3.14-17.5). The overall number of current smokers at 12 months was slightly higher among patients with (N = 3931) versus without (N = 3850) documented ENDS use. Results support both potential harm reduction of ENDS use (quitting combustibles among current smokers) and potential for harm (relapse to combustibles among former smokers, initiation for never-smokers)

Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system.

It is unclear whether use of electronic nicotine delivery systems (ENDS) precedes cigarette smoking initiation, relapse, and/or quitting. Healthcare systems with electronic health records (EHRs) provide unique data to examine ENDS use and changes in smoking. We examined the incidence of ENDS use (2012-2015) based on clinician documentation and tested whether EHR documented ENDS use is associated with twelve-month changes in patient smoking status using a matched retrospective cohort design. The sample was Kaiser Permanente Northern California (KPNC) patients aged ≥12 with documented ENDS use (N = 7926); 57% were current smokers, 35% former smokers, and 8% never-smokers. ENDS documentation incidence peaked in 2014 for current and former smokers and in 2015 for never-smokers. We matched patients with documented ENDS use to KPNC patients without documented ENDS use (N = 7926) on age, sex, race/ethnicity, and smoking status. Documented ENDS use predicted the likelihood of smoking in the following year. Among current smokers, ENDS use was associated with greater odds of quitting smoking (OR = 1.17, 95%CI = 1.05-1.31). Among former smokers, ENDS use was associated with greater odds of smoking relapse (OR = 1.53, 95%CI = 1.22-1.92). Among never-smokers, ENDS use was associated with greater odds of initiating smoking (OR = 7.41, 95%CI = 3.14-17.5). The overall number of current smokers at 12 months was slightly higher among patients with (N = 3931) versus without (N = 3850) documented ENDS use. Results support both potential harm reduction of ENDS use (quitting combustibles among current smokers) and potential for harm (relapse to combustibles among former smokers, initiation for never-smokers)

Smoking Protective and Risk Factors Among Transgender and Gender-Expansive Individuals (Project SPRING): Qualitative Study Using Digital Photovoice

BackgroundTransgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults. ObjectiveThis study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars. MethodsWe conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants’ photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors. ResultsWe identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes. ConclusionsThe findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals

Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults.

Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N=9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006-2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p<0.0001), particularly among adults aged 18-24 and 25-44. Most prevalent were "e-cig," "electronic cigarettes", and "vape," with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word "vape", and less likely to have "e-cig" and "electronic cigarette" than records of adults (ps<0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes

Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults.

Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N=9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006-2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p<0.0001), particularly among adults aged 18-24 and 25-44. Most prevalent were "e-cig," "electronic cigarettes", and "vape," with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word "vape", and less likely to have "e-cig" and "electronic cigarette" than records of adults (ps<0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes