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A45 Background. Cervical cancer screening with the Pap test is well integrated into the U.S. health care system and widely accepted by women. However, recent advances in cervical cancer etiology, specifically the identification of human... more
A45 Background. Cervical cancer screening with the Pap test is well integrated into the U.S. health care system and widely accepted by women. However, recent advances in cervical cancer etiology, specifically the identification of human papillomavirus (HPV) as a necessary cause, are changing clinical perspectives on what tests (HPV DNA vs. cervical cytology) should be used for screening. Also, results support using a vaccine to prevent transmission of certain carcinogenic HPV types. The changing landscape of technologies used to prevent and detect cervical cancer offers new options to women and health care providers. It is therefore critical that women have accurate knowledge about the HPV-cervical cancer link in order to make appropriate, evidence-based health care choices. Data available from special populations (university students and women attending colposcopy clinics) suggest that women know little about HPV. Less is known about HPV awareness among older women and women with average risk for developing cervical cancer. Assessment of the public9s knowledge of HPV in nationally representative samples was identified as a high-priority research aim in 1999 by the Centers for Disease Control and Prevention, but has yet to be achieved. Objectives. To assess factors associated with U.S. women9s awareness of human papillomavirus (HPV) and knowledge about its link to cervical cancer. Methods. Analyzed cross-sectional data from women ages 18 to 75 years of age responding to the 2005 Health Information National Trends Survey (n = 3,076). Results. Among the 40% of women (n = 1,248) who had ever heard about HPV,
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The US Food and Drug Administration's (FDA) Center for Tobacco Products (CTP) funds a wide range of research studies. Methods development and modeling research (MDMR) are 2 areas of interest, as they can help advance tobacco... more
The US Food and Drug Administration's (FDA) Center for Tobacco Products (CTP) funds a wide range of research studies. Methods development and modeling research (MDMR) are 2 areas of interest, as they can help advance tobacco regulatory science (TRS) by fostering data synthesis and exploration of complex relationships. Our analyses of the CTP portfolio found that 13% of publications focused on MDMR, and the most commonly addressed CTP priority research domains were knowledge, attitudes, and behaviors, and toxicity and carcinogenicity. MDMR publications were cited by 1,186 publications, 5 FDA proposed rules and guidance documents, and 3 dockets. MDMR publications are characterized as foundational research and help build the evidence base that informs policy. While MDMR represents a small portion of the CTP research portfolio, they have made important contributions to advancing TRS and informing regulatory actions.
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Multilevel interventions can be uniquely effective at addressing minority health and health disparities, but they pose substantial methodological, data analytic, and assessment challenges that must be considered when designing and... more
Multilevel interventions can be uniquely effective at addressing minority health and health disparities, but they pose substantial methodological, data analytic, and assessment challenges that must be considered when designing and applying interventions and assessment.To facilitate the adoption of multilevel interventions to reduce health disparities, we outline areas of need in filling existing operational challenges to the design and assessment of multilevel interventions. We discuss areas of development that address overarching constructs inherent in multilevel interventions, with a particular focus on their application to minority health and health disparities. Our approach will prove useful to researchers, as it allows them to integrate information related to health disparities research into the framework of broader constructs with which they are familiar.We urge researchers to prioritize building transdisciplinary teams and the skills needed to overcome the challenges in designing and assessing multilevel interventions, as even small contributions can accelerate progress toward improving minority health and reducing health disparities. To make substantial progress, however, a concerted and strategic effort, including work to advance analytic techniques and measures, is needed.
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IntroductionThis study explores how the emergence of FDA-funded Tobacco Regulatory Science (TRS) research complements and perhaps influenced the direction of tobacco research supported by NIH.Aims and MethodsNew NIH- and FDA-funded... more
IntroductionThis study explores how the emergence of FDA-funded Tobacco Regulatory Science (TRS) research complements and perhaps influenced the direction of tobacco research supported by NIH.Aims and MethodsNew NIH- and FDA-funded tobacco projects awarded in fiscal years (FY) 2011–2020 were identified using internal NIH databases of awarded grants. Project abstracts and research aims were coded by the authors to characterize research domains and tobacco products studied.ResultsBetween FY 2011 and 2020, NIH funded 1032 and FDA funded 322 new tobacco projects. For the years and grant activity codes studied, the number of new NIH tobacco projects declined while FDA’s increased; combined the number of new projects held steady. Much of NIH research included smoking combustibles (43.7%). The most common products in FDA research were cigarettes (74.8%) and e-cigarettes/ENDS (48.1%). Most NIH (58.6%) and FDA (67.7%) projects included research on the determinants of tobacco use. Another area of apparent overlap was health effects (29.5% NIH and 30.1% FDA). Projects unique to NIH included treatment interventions (33.3%), disease pathology/progression (17.8%) and neurobiology (18.9%). A minority of both NIH and FDA projects included populations particularly vulnerable to tobacco product use.ConclusionsIn total, support for new tobacco research supported by NIH and FDA combined remained steady for the time period covered, though there was a concomitant decline in NIH tobacco projects with the increase in FDA-funded TRS projects for the activity codes studied. Despite the apparent overlap in some areas, both NIH and FDA support research that is unique to their respective missions.ImplicationsNIH continues to support tobacco research that falls within and outside of FDA’s regulatory authorities. This research still is needed not only to bolster the evidence base for regulatory decisions at the national and state levels, but also to advance a comprehensive scientific agenda that can inform multiple levels of influence on tobacco control, use and addiction. It will be important to continue monitoring FDA-funded TRS and NIH-funded tobacco research portfolios to ensure that the level of support for and focus of the research is sufficient to address the burden of tobacco-related morbidity and mortality.
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Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with... more
Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with youth in May 2021: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter and YouTube. Nine of the 11 sites prohibitedpaid advertisingfor tobacco products. However, only three of them clearly prohibitedsponsored content(ie, social influencers) that promotes tobacco. Six platforms restricted content thatsells tobacco productsand three tried toprohibit underage accessto content that promotes or sells tobacco products. Although most platform policies prohibited paid tobacco advertising, few addressed more novel strategies, such as sponsored/influencer content and few had age-gating to prevent youth access. There is a pressing need to regulate tobacco promotion on social media platforms.
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Introduction This study explores how the emergence of FDA-funded Tobacco Regulatory Science (TRS) research complements and perhaps influenced the direction of tobacco research supported by NIH. Aims and Methods New NIH- and FDA-funded... more
Introduction This study explores how the emergence of FDA-funded Tobacco Regulatory Science (TRS) research complements and perhaps influenced the direction of tobacco research supported by NIH. Aims and Methods New NIH- and FDA-funded tobacco projects awarded in fiscal years (FY) 2011–2020 were identified using internal NIH databases of awarded grants. Project abstracts and research aims were coded by the authors to characterize research domains and tobacco products studied. Results Between FY 2011 and 2020, NIH funded 1032 and FDA funded 322 new tobacco projects. For the years and grant activity codes studied, the number of new NIH tobacco projects declined while FDA’s increased; combined the number of new projects held steady. Much of NIH research included smoking combustibles (43.7%). The most common products in FDA research were cigarettes (74.8%) and e-cigarettes/ENDS (48.1%). Most NIH (58.6%) and FDA (67.7%) projects included research on the determinants of tobacco use. Anothe...
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ObjectivesWe examine adolescent receipt of tobacco coupons and subsequent tobacco use.MethodsData were from the Population Assessment of Tobacco and Health (PATH) Study (2013–2015). We identified correlates of coupon receipt at Wave 1... more
ObjectivesWe examine adolescent receipt of tobacco coupons and subsequent tobacco use.MethodsData were from the Population Assessment of Tobacco and Health (PATH) Study (2013–2015). We identified correlates of coupon receipt at Wave 1 (youth sample age 12–17 ; n = 13 651) including demographics, additional vulnerability factors that may place youth at risk of tobacco use and correlates of coupon receipt by channel. We examined associations of Wave 1 coupon receipt with Wave 2 tobacco use using weighted multivariable models.ResultsOverall, 7.6% of US youth received tobacco coupons in the 6 months before Wave 1. Coupon recipients were more likely to be women, living outside urban areas, living with a tobacco user, current and former (vs never) tobacco users, having high internalising mental health symptoms and having a favourite tobacco advertisement. Coupons were received primarily through direct mail (56%), product packs (28%) and online (25%). Never tobacco users at Wave 1 who rece...
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IntroductionYoung adulthood (aged 18–24) is a crucial period in the development of long-term tobacco use patterns. Tobacco advertising and promotion lead to the initiation and continuation of smoking among young adults. We examined... more
IntroductionYoung adulthood (aged 18–24) is a crucial period in the development of long-term tobacco use patterns. Tobacco advertising and promotion lead to the initiation and continuation of smoking among young adults. We examined whether vulnerability factors moderated the association between tobacco advertisement liking and tobacco use in the United States.MethodsAnalyses were conducted among 9109 US young adults in the nationally representative Population Assessment of Tobacco and Health (PATH) Study wave 1 (2013–14). Participants viewed 20 randomly selected sets of tobacco advertisements (five each for cigarettes, e-cigarettes, cigars, and smokeless tobacco) and indicated whether they liked each ad. The outcome variables were past 30-day cigarette, e-cigarette, cigar, and smokeless tobacco use. Covariates included tobacco advertisement liking, age, sex, race or ethnicity, sexual orientation, education, poverty level, military service, and internalizing and externalizing mental ...
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An extensive body of intervention research to promote breast and cervical cancer screening has accumulated over the last three decades, but its coverage and comprehensiveness have not been assessed. We evaluated published reports of these... more
An extensive body of intervention research to promote breast and cervical cancer screening has accumulated over the last three decades, but its coverage and comprehensiveness have not been assessed. We evaluated published reports of these interventions and propose a framework of critical elements for authors and researchers to use when contributing to this literature. We identified all articles describing breast and cervical cancer screening interventions published between January 1960 and May 1997 in the United States and abstracted specified critical elements in the broad areas of: (a) needs assessment; (b) intervention study design; and (c) analysis methods and study outcomes from each article using a template developed for that purpose. Fifty-eight studies met our criteria for inclusion. Thirty-eight focused exclusively on breast cancer screening, 7 promoted cervical cancer screening, and 13 were designed to promote screening for both cancers. The amount of detail reported varie...
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Research Design, Family Medicine, Breast Cancer, Medicine, Population, and 13 moreHumans, Needs Assessment, United States, Female, Pubmed, Psychological Intervention, Cervical Cancer, Reproducibility of Results, Guidance and Counseling Intervention Programs, Breast Neoplasms, Uterine Cervical Neoplasms, mass Screening, and Medical and Health Sciences
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This study examines mammography-enhancing intervention studies that focus on women in groups with historically lower rates of mammography use than the general population. These groups consist of women who are disproportionately older,... more
This study examines mammography-enhancing intervention studies that focus on women in groups with historically lower rates of mammography use than the general population. These groups consist of women who are disproportionately older, poorer, of racial-ethnic minorities, have lower levels of formal education, and live in rural areas. We refer to them as diverse populations. The purpose of this report is to determine which types of mammography-enhancing interventions are most effective for these diverse populations. For this report, United States and international studies with concurrent controls that reported actual receipt of mammograms (usually based on self-report) as an outcome were eligible for inclusion. Intervention effects were measured by differences in intervention and control group screening rates postintervention and were weighted to reflect the certainty of each study's contribution. These effects differed significantly (Q = 218, 34 df), and the variation between st...
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Health Promotion, Poverty, Global Health, Biomarkers, Medicine, and 15 moreHumans, Minority Groups, Female, Regression Analysis, Confidence intervals, Incidence, Mammography, Intervention Studies, Aged, Middle Aged, Educational Status, Case Control Studies, Breast Neoplasms, mass Screening, and Medical and Health Sciences
Despite the consistent and strong association of social class with health status, the extent to which racial/ethnic disparities in cancer screening reflect social class is rarely addressed. We hypothesized that the use of cancer screening... more
Despite the consistent and strong association of social class with health status, the extent to which racial/ethnic disparities in cancer screening reflect social class is rarely addressed. We hypothesized that the use of cancer screening is positively correlated with social class for black, white and Hispanic Americans. Data from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements were compared for each racial/ethnic group by income, education, age, and gender. For each racial/ethnic group, individuals with less education or income are less likely to be screened. Although specific subgroups increased their use of screening modalities between 1987 and 1992, older black Americans who were poor or had less education reported less screening than similar older white Americans. Although social class is a powerful explanatory variable for younger Americans, racial disparities in cancer screening persist among older black Americans.
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Demography, Medicine, Social Class, Humans, Female, and 15 moreMale, Confidence intervals, Mammography, African Americans, Aged, Middle Aged, Public health systems and services research, Ethnic Group, Educational Status, European Continental Ancestry Group, Colorectal Neoplasms, Breast Neoplasms, Sigmoidoscopy, mass Screening, and Population surveillance
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Algorithms, Medicine, Social Class, California, Humans, and 13 moreFemale, Mammography, Aged, Middle Aged, Adult, Public health systems and services research, Multilevel Analysis, European Continental Ancestry Group, Urban Population, Health Services Accessibility, Breast Neoplasms, Early detection of cancer, and mass Screening
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▪ The hard work of public health officials, physicians, and disease advocacy groups to educate Americans about the importance of early detection has resulted in uptake of screening tests at levels equivalent to or higher than in... more
▪ The hard work of public health officials, physicians, and disease advocacy groups to educate Americans about the importance of early detection has resulted in uptake of screening tests at levels equivalent to or higher than in countries with organized cancer screening programs. However, the societal costs of high screening rates are larger in the United States than in other countries, including higher prices for screening, more unnecessary testing, and inefficiencies in delivery, especially in small practices. Further, screening rates are not evenly distributed across population groups, and the national expenditure on clinical and community research to promote cancer screening among individuals has not been matched by research efforts that focus on policy or clinical systems to increase screening widely throughout the population. We identify opportunities for organizational change that improve access to use, improve quality, and promote cost effectiveness in cancer screening del...
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Health Planning, Forecasting, Public Health, Medicine, Humans, and 12 moreUnited States, Total Quality Management, Public health systems and services research, Cost Benefit Analysis, Neoplasms, Organizational Survival and Efficiency, Cost of Illness, Health Services Accessibility, Patient selection, mass Screening, Referral and consultation, and Population surveillance
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The purpose of this study is to describe the focus and comprehensiveness of domains measured in e-cigarette research. A portfolio analysis of National Institutes of Health grants focusing on e-cigarette research and funded between the... more
The purpose of this study is to describe the focus and comprehensiveness of domains measured in e-cigarette research. A portfolio analysis of National Institutes of Health grants focusing on e-cigarette research and funded between the fiscal years 2007 and 2015 was conducted. Grant proposals were retrieved using a government database and coded using the Host-Agent-Vector-Environment (HAVE) model as a framework to characterise the measures proposed. Eighty-one projects met the criteria for inclusion in the analysis. The primary HAVE focus most commonly found was Host (73%), followed by Agent (21%), Vector (6%) and Environment (0%). Intrapersonal measures and use trajectories were the most common measures in studies that include Host measures (n=59 and n=51, respectively). Product composition was the most common area of measurement in Agent studies (n=24), whereas Marketing (n=21) was the most common (n=21) area of Vector measurement. When Environment measures were examined as seconda...
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For close to two decades, scientific experts have disagreed about the age at when to start and stop breast cancer screening, the schedule on which tests should occur and the effectiveness of different screening modalities. Despite these... more
For close to two decades, scientific experts have disagreed about the age at when to start and stop breast cancer screening, the schedule on which tests should occur and the effectiveness of different screening modalities. Despite these controversies, most experts agree that screening has been effective in reducing breast cancer mortality. While much is known about factors influencing women to get screened, little information is available about physicians' current breast cancer screening practices. This study explores the characteristics of four types of primary care physicians (family practice, general medicine, internal medicine and obstetrics/gynecology) and how their beliefs and practices are associated with breast cancer screening using the National Survey of Primary Care Physicians' Recommendations and Practice for Breast, Cervical, Colorectal and Lung Cancer Screening. The survey, fielded September 2006-May 2007, included questions about physician and practice charact...
This session, Reaching Subgroups at Greatest Risk with New Medical Technologies: Learning from the Human Papillomavirus (HPV) Vaccine, will use the HPV vaccine as a case study for examining factors that influence adoption of new medical... more
This session, Reaching Subgroups at Greatest Risk with New Medical Technologies: Learning from the Human Papillomavirus (HPV) Vaccine, will use the HPV vaccine as a case study for examining factors that influence adoption of new medical technologies among underserved groups. We will review current surveillance data on awareness and use of the HPV vaccine across subgroups at greatest risk of cervical cancer, with a special emphasis on racial and ethnic minorities and the uninsured. The session will highlight factors influencing vaccine uptake, including interest, financing and access. HPV vaccine promotion and payment policies will be described. Proposed presentations: 1) Systematic review of HPV vaccine initiation and completion: surveillance data from national and local studies. (15 minutes) 2) HPV vaccination in the Indian Health Service. (15 minutes) 3) Knowledge of HPV: differences across at-risk groups. (15 minutes) 4) Interest in the HPV vaccine and the potential role of finan...
Background: News media are an important information source about new healthcare technologies for individuals, healthcare providers, and policymakers. Content and framing of information has the power to shape public discourse and influence... more
Background: News media are an important information source about new healthcare technologies for individuals, healthcare providers, and policymakers. Content and framing of information has the power to shape public discourse and influence attitudes and medical decisions. Most media analyses have focused on newspapers; however, television, especially local, is where most Americans report getting news about health issues. Little is known about coverage differences by delivery channel. Objectives: This paper compares the content and quality of print and television coverage on the approval of the human papillomavirus (HPV) vaccine. Methods: We examined all HPV-related articles published in U.S. newspapers archived by Factiva, a database of 10,000 news sources, all national network stories, and a random sample of local stories that aired on 70 stations in 26 U.S. markets from September 2005 to December 2006. Key messages of the media campaign conducted by the vaccine's maker, Merck, ...
Although screening mammography may contribute to decreases in breast cancer mortality in a population, it may also increase the risk of false positives, anxiety, and unnecessary and costly medical procedures in individuals. We report... more
Although screening mammography may contribute to decreases in breast cancer mortality in a population, it may also increase the risk of false positives, anxiety, and unnecessary and costly medical procedures in individuals. We report trends in self-reported non-normal screening mammography results, lumpectomies, and breast cancer in a representative sample of California women. Data were obtained from the 2001, 2005, and 2009 cross-sectional California Health Interview Surveys (CHIS) and weighted to the California population. CHIS employed a multistage sampling design to administer telephone surveys in 6 languages. Our study sample was restricted to women 40 years and older who reported a screening mammogram in the past 2 years. Sample sizes were 13,974 in 2001, 12,069 in 2005, and 15,552 in 2009. Women reporting non-normal results were asked whether they had an operation to remove the lump and, if so, whether the lump was confirmed as malignant. Between 2001 and 2009, the percent of California women who reported having been diagnosed with breast cancer was relatively stable. For each of the three age groups studied, the percentage of non-normal mammography results increased and the percentages of lumpectomies decreased and, for every woman reporting a diagnosis of breast cancer, three women reported a lumpectomy that turned out not to be cancer. This ratio was greater for younger women and less for older women. Despite relatively constant rates of breast cancer diagnosis from 2001 to 2009, the percentage of non-normal mammography results increased and lumpectomies declined.
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Since 2003, U.S. Preventive Services Task Force guidelines recommend against Pap testing for women without a cervix following a hysterectomy and those aged >65 years. Few population-based studies have investigated factors associated... more
Since 2003, U.S. Preventive Services Task Force guidelines recommend against Pap testing for women without a cervix following a hysterectomy and those aged >65 years. Few population-based studies have investigated factors associated with overuse of Pap testing in the U.S. To evaluate patient characteristics associated with overuse of Pap testing. A cross-sectional study was conducted using data from the 2010 National Health Interview Survey (NHIS) for women aged ≥30 years. NHIS is a nationally representative survey that employs a random, stratified, multi-stage cluster sampling design. In 2010, the NHIS administered a Cancer Control Supplement with questions on cervical cancer screening and hysterectomy status. Conducted in 2011-2013, all analyses account for the stratification and clustering of data within the complex NHIS survey design. Multivariate logistic regression models were used in all analyses. Among women who have undergone a hysterectomy, younger age, Hispanic and bla...
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Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences... more
Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences crossing socio-ecological levels. It is often difficult for research to accurately represent and address the complexities of the real world, and traditional methodological approaches are generally inadequate for this task. Systems science methods, expressly designed to study complex systems, can be effectively employed for an improved understanding about dissemination and implementation of evidence-based interventions. The aims of this study were to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity. Case examples of three systems science methods-system dynamics modeling, agent-based modeling, and network analysis-are used to illustrate how each method...
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Decision Making, Prostate Cancer, Preventive medicine, Shared decision making, Humans, and 11 moreUnited States, Male, Health information, Aged, Middle Aged, Public health systems and services research, Curriculum and Pedagogy, Educational Status, Health surveys, Preventive, and Prostate Specific Antigen
Barriers to cancer screening may change over time as screening becomes more widespread. Using 1987, 1992, and 2000 National Health Interview Survey data, we examined population-wide trends in barriers to Pap, mammography, and colorectal... more
Barriers to cancer screening may change over time as screening becomes more widespread. Using 1987, 1992, and 2000 National Health Interview Survey data, we examined population-wide trends in barriers to Pap, mammography, and colorectal screening (n =66,452). Lack of awareness was the most common barrier for all screening tests; it decreased by 13.5 percentage points for mammography and by 4.6 percentage points for colorectal screening, but increased by 3.0 percentage points for Pap test from 1987 to 2000. Decreases in not recommended by a doctor were observed for mammography (from 20.5% to 3.7%) and colorectal screening (from 22.3% to 14.2%). Examination of trends in barriers among sociodemographic and health care access subgroups revealed disparities for each screening test. Although population-wide progress has been made in reducing barriers to screening, lack of awareness, and not recommended by a doctor remain important barriers, especially among traditionally underserved populations.
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Utilization of mammography has increased steadily since the early 1990s. It is now important to expand the attention given to obtaining repeat examination. This study examines the prevalence and cross-sectional correlates of repeat... more
Utilization of mammography has increased steadily since the early 1990s. It is now important to expand the attention given to obtaining repeat examination. This study examines the prevalence and cross-sectional correlates of repeat mammography, among women aged 55-79, using a 12-month (N = 3,502) and a 24-month interval (N = 3,491). Data were from the Year 2000 Cancer Control Module of the National Health Interview Survey (NHIS-CCM). The NHIS-CCM asked about the most recent mammogram and the total number of mammograms over the prior 6 years. An algorithm estimated repeat mammography for the two intervals. Prevalence estimates were 49% for the 12-month interval, and 64.1% for the 24-month interval. Correlates of lower likelihood of repeat mammography for both indicators were: no regular source of care, having public or no health insurance, less than a college education, household income less than $45K, not being married, current or never smoking, age 65-79, and lower absolute risk of breast cancer (Gail Model score). A substantial percentage of women do not receive repeat mammography. The correlates of repeat mammography were similar to those often found for ever-had and recent mammography. There is probably some imprecision in the prevalence estimates due to the nature of NHIS-CCM questions. Issues pertinent to the definition of repeat examination are addressed.