Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100305
Leah M. Marcotte MD, MS , Sara Khor PhD, MASc , Edwin S. Wong PhD , Nkem Akinsoto MSc , E. Sally Lee PhD , Susan Onstad BA , Rachel B. Issaka MD, MAS
Introduction
Patient portals may facilitate breast cancer screening and could be an important factor to address inequities; however, this association is not well characterized. The authors sought to examine this association in a large academic health system to inform interventions to address breast cancer screening inequities.
Methods
The authors conducted a cross-sectional study among Black patients in a large academic health system using logistic regression to examine the association between breast cancer screening and portal use, adjusting for multilevel covariates and interactions. The authors estimated average marginal effects to examine the additive probability of breast cancer screening completion given portal use in the prior 12 months.
Results
In the unadjusted model, portal use was associated with an estimated mean 24.8 percentage points (95% CI=20.7, 29.0) increased likelihood of completing breast cancer screening. In the adjusted model, portal use was associated with an estimated mean 16.2 percentage points (95% CI=11.2, 21.3) increased likelihood for completing breast cancer screening.
Conclusions
Improving portal access and use among racialized groups who face both portal and breast cancer screening inequities could be one strategy to address inequities. These pilot data will inform subsequent community-engaged research to better understand this association and develop and test a portal intervention to facilitate breast cancer screening access among Black patients eligible for screening.
{"title":"A Pilot Analysis of Patient Portal Use and Breast Cancer Screening Among Black Patients in a Large Academic Health System","authors":"Leah M. Marcotte MD, MS , Sara Khor PhD, MASc , Edwin S. Wong PhD , Nkem Akinsoto MSc , E. Sally Lee PhD , Susan Onstad BA , Rachel B. Issaka MD, MAS","doi":"10.1016/j.focus.2024.100305","DOIUrl":"10.1016/j.focus.2024.100305","url":null,"abstract":"<div><h3>Introduction</h3><div>Patient portals may facilitate breast cancer screening and could be an important factor to address inequities; however, this association is not well characterized. The authors sought to examine this association in a large academic health system to inform interventions to address breast cancer screening inequities.</div></div><div><h3>Methods</h3><div>The authors conducted a cross-sectional study among Black patients in a large academic health system using logistic regression to examine the association between breast cancer screening and portal use, adjusting for multilevel covariates and interactions. The authors estimated average marginal effects to examine the additive probability of breast cancer screening completion given portal use in the prior 12 months.</div></div><div><h3>Results</h3><div>In the unadjusted model, portal use was associated with an estimated mean 24.8 percentage points (95% CI=20.7, 29.0) increased likelihood of completing breast cancer screening. In the adjusted model, portal use was associated with an estimated mean 16.2 percentage points (95% CI=11.2, 21.3) increased likelihood for completing breast cancer screening.</div></div><div><h3>Conclusions</h3><div>Improving portal access and use among racialized groups who face both portal and breast cancer screening inequities could be one strategy to address inequities. These pilot data will inform subsequent community-engaged research to better understand this association and develop and test a portal intervention to facilitate breast cancer screening access among Black patients eligible for screening.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100292
Nan Wang PhD , Melanie S. Dove ScD , Cindy V. Valencia PhD , Elisa K. Tong MD
Introduction
People who are covered by Medicaid have a higher smoking prevalence than the general population and are at an increased risk for tobacco-related disease, a major driver of Medicaid costs. California has the largest Medicaid program, called Medi-Cal, whose members also have higher tobacco-use rates and tobacco-related disease. Quitting is beneficial at any age, and health professional advice and assistance are a key indicator of smoking cessation. As Medi-Cal transforms to improve population health and health equity, this study aimed to understand both the prevention and treatment of tobacco-related disease by comparing health professional advice and assistance among all Medi-Cal members with and without chronic disease who smoke.
Methods
Using data from the California Health Interview Survey (2014, 2016–2018), the authors examined 3,517 Medi-Cal current smokers (age ≥18 years) who consulted a health professional and reported about having a chronic disease. The outcomes included receiving advice or assistance from a health professional to quit smoking. Adjusted logistic regression models were conducted to examine the association between chronic disease and the outcomes, including adjusting for frequency of office visits.
Results
Among 1,227,154 Medi-Cal members who smoke, over half (51.9%) of whom had at least 1 chronic disease, approximately half received cessation advice, and less than one third received smoking cessation assistance. Smokers with chronic disease were more likely to receive health professional advice (63.9% vs 33.7%, p<0.001) and assistance (37.7% vs 20.5%, p<0.001) than those without chronic disease. In adjusted models, smokers with chronic disease were almost twice as likely to receive advice (OR=1.97, 95% CI=1.39, 2.78) and 1.5 times as likely to receive assistance (OR=1.50, 95% CI=0.94, 2.38) as those without chronic disease, but the latter was not statistically significant.
Conclusions
Medi-Cal members who smoke have tobacco treatment disparities between those with or without chronic disease, even after adjusting for the number of office visits. Medi-Cal population health strategies for tobacco cessation treatment will need to improve prevention, not just treatment, of tobacco-related disease to reduce the long-term burden on the healthcare system and associated costs.
{"title":"Tobacco Treatment Disparities Among California Medicaid Members With and Without Chronic Disease Who Smoke","authors":"Nan Wang PhD , Melanie S. Dove ScD , Cindy V. Valencia PhD , Elisa K. Tong MD","doi":"10.1016/j.focus.2024.100292","DOIUrl":"10.1016/j.focus.2024.100292","url":null,"abstract":"<div><h3>Introduction</h3><div>People who are covered by Medicaid have a higher smoking prevalence than the general population and are at an increased risk for tobacco-related disease, a major driver of Medicaid costs. California has the largest Medicaid program, called Medi-Cal, whose members also have higher tobacco-use rates and tobacco-related disease. Quitting is beneficial at any age, and health professional advice and assistance are a key indicator of smoking cessation. As Medi-Cal transforms to improve population health and health equity, this study aimed to understand both the prevention and treatment of tobacco-related disease by comparing health professional advice and assistance among all Medi-Cal members with and without chronic disease who smoke.</div></div><div><h3>Methods</h3><div>Using data from the California Health Interview Survey (2014, 2016–2018), the authors examined 3,517 Medi-Cal current smokers (age ≥18 years) who consulted a health professional and reported about having a chronic disease. The outcomes included receiving advice or assistance from a health professional to quit smoking. Adjusted logistic regression models were conducted to examine the association between chronic disease and the outcomes, including adjusting for frequency of office visits.</div></div><div><h3>Results</h3><div>Among 1,227,154 Medi-Cal members who smoke, over half (51.9%) of whom had at least 1 chronic disease, approximately half received cessation advice, and less than one third received smoking cessation assistance. Smokers with chronic disease were more likely to receive health professional advice (63.9% vs 33.7%, <em>p</em><0.001) and assistance (37.7% vs 20.5%, <em>p</em><0.001) than those without chronic disease. In adjusted models, smokers with chronic disease were almost twice as likely to receive advice (OR=1.97, 95% CI=1.39, 2.78) and 1.5 times as likely to receive assistance (OR=1.50, 95% CI=0.94, 2.38) as those without chronic disease, but the latter was not statistically significant.</div></div><div><h3>Conclusions</h3><div>Medi-Cal members who smoke have tobacco treatment disparities between those with or without chronic disease, even after adjusting for the number of office visits. Medi-Cal population health strategies for tobacco cessation treatment will need to improve prevention, not just treatment, of tobacco-related disease to reduce the long-term burden on the healthcare system and associated costs.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100292"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100304
Lisa M. Shook DHPE, MA, MCHES , Bailey House MPH , Christina Bennett Farrell MPH , Rosalyn Stewart MD , Sophie Lanzkron MD, MHS , Allison A. King MD, MPH, PhD , Taniya Varughese MSOT , J.J. Strouse MD, PhD , Marsha Treadwell PhD , Julie Kanter MD
Introduction
Sickle cell disease (SCD) is an inherited blood disorder affecting approximately 100,000 individuals in the U.S. A lack of knowledgeable providers, particularly for adult patients, has led to a significant number of adults without access to high-quality care. Several federal partners collaborated with the Sickle Cell Disease Treatment Demonstration Program (SCDTDP) grantees to develop and test a national Project ECHO telementoring program targeting primary care providers (PCPs).
Methods
Federal partners developed an extensive recruitment and outreach strategy to engage PCPs in the Sickle Cell Disease Training and Mentoring (STAMP) virtual educational (telementoring) program using a multi-pronged recruitment strategy. The SCDTDP grantees created a tailored curriculum of didactic presentations about the management of SCD, especially for PCPs.
Results
STAMP hosted 12 sessions over 6 months. Despite the multi-pronged recruitment strategy and tailored curriculum, there were very few PCPs among the 763 attendees. The majority of attendees were hematologists and other community-based advocates with a vested interest in SCD.
Conclusions
Despite a federal partnership, the STAMP outreach strategy was unsuccessful in recruiting PCPs to participate in a virtual telementoring education program designed to increase access to care for adults with SCD. STAMP's attendee participation and the lack of engagement by PCPs were unable to significantly show an increase in interest or willingness by PCPs to learn to co-manage SCD care with specialists.
{"title":"Challenges of Engaging Primary Care Providers in Specialized Telementoring Education About Sickle Cell Disease for Sickle Cell Specialists: Results from the Sickle Cell Disease Training and Mentoring Program for Primary Care Providers (STAMP) Project ECHO","authors":"Lisa M. Shook DHPE, MA, MCHES , Bailey House MPH , Christina Bennett Farrell MPH , Rosalyn Stewart MD , Sophie Lanzkron MD, MHS , Allison A. King MD, MPH, PhD , Taniya Varughese MSOT , J.J. Strouse MD, PhD , Marsha Treadwell PhD , Julie Kanter MD","doi":"10.1016/j.focus.2024.100304","DOIUrl":"10.1016/j.focus.2024.100304","url":null,"abstract":"<div><h3>Introduction</h3><div>Sickle cell disease (SCD) is an inherited blood disorder affecting approximately 100,000 individuals in the U.S. A lack of knowledgeable providers, particularly for adult patients, has led to a significant number of adults without access to high-quality care. Several federal partners collaborated with the Sickle Cell Disease Treatment Demonstration Program (SCDTDP) grantees to develop and test a national Project ECHO telementoring program targeting primary care providers (PCPs).</div></div><div><h3>Methods</h3><div>Federal partners developed an extensive recruitment and outreach strategy to engage PCPs in the Sickle Cell Disease Training and Mentoring (STAMP) virtual educational (telementoring) program using a multi-pronged recruitment strategy. The SCDTDP grantees created a tailored curriculum of didactic presentations about the management of SCD, especially for PCPs.</div></div><div><h3>Results</h3><div>STAMP hosted 12 sessions over 6 months. Despite the multi-pronged recruitment strategy and tailored curriculum, there were very few PCPs among the 763 attendees. The majority of attendees were hematologists and other community-based advocates with a vested interest in SCD.</div></div><div><h3>Conclusions</h3><div>Despite a federal partnership, the STAMP outreach strategy was unsuccessful in recruiting PCPs to participate in a virtual telementoring education program designed to increase access to care for adults with SCD. STAMP's attendee participation and the lack of engagement by PCPs were unable to significantly show an increase in interest or willingness by PCPs to learn to co-manage SCD care with specialists.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100286
Mohammad Reza Fallah Ghanbari PhDc , Katayoun Jahangiri PhD , Mehdi Safari PhD , Zohreh Ghomian PhD , Mohammad Ali Nekooie PhD
Introduction
Infectious diseases can result in global emergencies and a shortage of resources, leading to ethical and humanitarian challenges. This study aimed to identify the factors that affect the allocation of health resources based on humanitarian principles during infectious disease emergencies.
Methods
This study was conducted using a qualitative approach known as content analysis, and 23 specialists and experts with practical experience and theoretical knowledge in this area were carefully selected to participate in the study. The selection process continued until the principle of data saturation was attained. Data collection was done through in-depth, semi-structured interviews that were conducted from October to December 2023.
Results
Factors affecting resource allocation were categorized into 9 main themes, 25 categories, and 50 subcategories. The extracted themes are: (1) Rules and Regulations; (2) Quality in Allocation; (3) Human Aspects; (4) Epidemic/Pandemic Characteristics; (5) Governance and Policymaking; (6) Emergency Management; (7) Resource Management; (8) Solidarity; (9) Trustworthiness.
Conclusions
During emergencies caused by infectious diseases, resource allocation requires attention to various aspects such as laws, protocols, procedures, organizational structures, and coordination mechanisms. Ethical principles and respect for human aspects are also important.
{"title":"Experts' Views on Factors Influencing Resource Allocation for Infectious Disease Emergencies Based on Humanitarian Principles: A Qualitative Study","authors":"Mohammad Reza Fallah Ghanbari PhDc , Katayoun Jahangiri PhD , Mehdi Safari PhD , Zohreh Ghomian PhD , Mohammad Ali Nekooie PhD","doi":"10.1016/j.focus.2024.100286","DOIUrl":"10.1016/j.focus.2024.100286","url":null,"abstract":"<div><h3>Introduction</h3><div>Infectious diseases can result in global emergencies and a shortage of resources, leading to ethical and humanitarian challenges. This study aimed to identify the factors that affect the allocation of health resources based on humanitarian principles during infectious disease emergencies.</div></div><div><h3>Methods</h3><div>This study was conducted using a qualitative approach known as content analysis, and 23 specialists and experts with practical experience and theoretical knowledge in this area were carefully selected to participate in the study. The selection process continued until the principle of data saturation was attained. Data collection was done through in-depth, semi-structured interviews that were conducted from October to December 2023.</div></div><div><h3>Results</h3><div>Factors affecting resource allocation were categorized into 9 main themes, 25 categories, and 50 subcategories. The extracted themes are: (1) Rules and Regulations; (2) Quality in Allocation; (3) Human Aspects; (4) Epidemic/Pandemic Characteristics; (5) Governance and Policymaking; (6) Emergency Management; (7) Resource Management; (8) Solidarity; (9) Trustworthiness.</div></div><div><h3>Conclusions</h3><div>During emergencies caused by infectious diseases, resource allocation requires attention to various aspects such as laws, protocols, procedures, organizational structures, and coordination mechanisms. Ethical principles and respect for human aspects are also important.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100286"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100293
Katie M. Kirkpatrick MS , Deborah J. Robinson MPH , Sarah J. Hinman MSPH , Jessica L. Kegel MA , Rachel A. Chamberlin PhD , Rory G. McCarthy PhD , Jonathan M. Scott PhD
Introduction
Americans have increased their intake of food away from home, which is lower in quality and higher in calories than food prepared at home. The increase of operations that serve food also impacts the military nutrition environment—including all foods, beverages, and dietary supplements available to the military community—and its role in nutritional fitness.
Methods
As part of a pilot study, 5 military installations used the online Military Nutrition Environment Assessment Tool to evaluate their local food landscape. Each site then developed an intervention to address a specific venue (e.g., dining facility, express) and a key category (food policy, food availability, or behavioral design) through a targeted intervention.
Results
Site teams conducted assessments on a total of 103 venues across 9 venue types. Scores varied widely among and within installations. The overall average Military Nutrition Environment Assessment Tool score was 52%, with individual installation scores ranging from 39% to 69%. The most commonly targeted facility for intervention was the dining facility. In-person feedback sessions revealed that leadership awareness and support are key facilitators to improving the local food environment. Most users agreed or strongly agreed that the Military Nutrition Environment Assessment Tool application was easy to navigate.
Conclusions
Similar to trends in the general public, the military community has more ways to purchase food away from home, so improving food-away-from-home quality in military settings can have a major impact. A review of local military food environments showed areas of success and opportunities for improvement. Given the prevalence of food away from home, providing and promoting nutritious options can help optimize Service Member nutritional fitness.
{"title":"Food-Away-From-Home Options in Local Military Nutrition Environments","authors":"Katie M. Kirkpatrick MS , Deborah J. Robinson MPH , Sarah J. Hinman MSPH , Jessica L. Kegel MA , Rachel A. Chamberlin PhD , Rory G. McCarthy PhD , Jonathan M. Scott PhD","doi":"10.1016/j.focus.2024.100293","DOIUrl":"10.1016/j.focus.2024.100293","url":null,"abstract":"<div><h3>Introduction</h3><div>Americans have increased their intake of food away from home, which is lower in quality and higher in calories than food prepared at home. The increase of operations that serve food also impacts the military nutrition environment—including all foods, beverages, and dietary supplements available to the military community—and its role in nutritional fitness.</div></div><div><h3>Methods</h3><div>As part of a pilot study, 5 military installations used the online Military Nutrition Environment Assessment Tool to evaluate their local food landscape. Each site then developed an intervention to address a specific venue (e.g., dining facility, express) and a key category (food policy, food availability, or behavioral design) through a targeted intervention.</div></div><div><h3>Results</h3><div>Site teams conducted assessments on a total of 103 venues across 9 venue types. Scores varied widely among and within installations. The overall average Military Nutrition Environment Assessment Tool score was 52%, with individual installation scores ranging from 39% to 69%. The most commonly targeted facility for intervention was the dining facility. In-person feedback sessions revealed that leadership awareness and support are key facilitators to improving the local food environment. Most users agreed or strongly agreed that the Military Nutrition Environment Assessment Tool application was easy to navigate.</div></div><div><h3>Conclusions</h3><div>Similar to trends in the general public, the military community has more ways to purchase food away from home, so improving food-away-from-home quality in military settings can have a major impact. A review of local military food environments showed areas of success and opportunities for improvement. Given the prevalence of food away from home, providing and promoting nutritious options can help optimize Service Member nutritional fitness.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100293"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100301
Siran M. Koroukian PhD , Weichuan Dong PhD , Jeffrey M. Albert PhD , Uriel Kim MD, PhD, MBA , Long Vu MS , Kirsten Y. Eom PhD, MPH , Johnie Rose MD, PhD , Gregory S. Cooper MD, MA , Richard S. Hoehn MD , Jennifer Tsui PhD, MPH
Introduction
The authors determined whether certain subgroups of patients with cancer on Ohio Medicaid benefited from the program's expansion to a greater/lesser extent. Study outcomes included stage at diagnosis for screening-amenable cancers (breast [n=1,707 and 2,976], cervical [n=309 and 655], and colorectal [n=927 and 2,009] cancer, before and after expansion, respectively) and time to treatment initiation.
Methods
Using linked data from the 2011–2017 Ohio cancer registry and Medicaid, the authors conducted a robust Poisson regression analysis for stage at diagnosis and Cox regression analysis for time to treatment initiation to obtain the adjusted risk for earlier stage at diagnosis before to after expansion or hazard of shorter time to treatment initiation for each demographic or clinical subgroup after compared with before pre-Medicaid expansion. The authors subsequently calculated the ratio of risk (or hazard) ratios.
Results
The effect of Medicaid expansion on outcomes was mostly similar across subgroups of patients with cancer on Medicaid. However, those who were non-Hispanic Black or of other race had a lower probability of being diagnosed with early-stage breast cancer (ratio of risk ratio=0.85 [95% CI=0.74, 0.98] and ratio of risk ratio=0.72 [95% CI=0.55, 0.95], respectively) than non-Hispanic White women.
Conclusions
These findings point to differences that should be investigated to ensure that the benefits of Medicaid expansion are realized equitably.
{"title":"A Rising Tide Raises All Ships: Was the Effect of Medicaid Expansion on Cancer Outcomes Similar Across Subgroups of Patients With Cancer on Medicaid?","authors":"Siran M. Koroukian PhD , Weichuan Dong PhD , Jeffrey M. Albert PhD , Uriel Kim MD, PhD, MBA , Long Vu MS , Kirsten Y. Eom PhD, MPH , Johnie Rose MD, PhD , Gregory S. Cooper MD, MA , Richard S. Hoehn MD , Jennifer Tsui PhD, MPH","doi":"10.1016/j.focus.2024.100301","DOIUrl":"10.1016/j.focus.2024.100301","url":null,"abstract":"<div><h3>Introduction</h3><div>The authors determined whether certain subgroups of patients with cancer on Ohio Medicaid benefited from the program's expansion to a greater/lesser extent. Study outcomes included stage at diagnosis for screening-amenable cancers (breast [<em>n</em>=1,707 and 2,976], cervical [<em>n</em>=309 and 655], and colorectal [<em>n</em>=927 and 2,009] cancer, before and after expansion, respectively) and time to treatment initiation.</div></div><div><h3>Methods</h3><div>Using linked data from the 2011–2017 Ohio cancer registry and Medicaid, the authors conducted a robust Poisson regression analysis for stage at diagnosis and Cox regression analysis for time to treatment initiation to obtain the adjusted risk for earlier stage at diagnosis before to after expansion or hazard of shorter time to treatment initiation for each demographic or clinical subgroup after compared with before pre-Medicaid expansion. The authors subsequently calculated the ratio of risk (or hazard) ratios.</div></div><div><h3>Results</h3><div>The effect of Medicaid expansion on outcomes was mostly similar across subgroups of patients with cancer on Medicaid. However, those who were non-Hispanic Black or of other race had a lower probability of being diagnosed with early-stage breast cancer (ratio of risk ratio=0.85 [95% CI=0.74, 0.98] and ratio of risk ratio=0.72 [95% CI=0.55, 0.95], respectively) than non-Hispanic White women.</div></div><div><h3>Conclusions</h3><div>These findings point to differences that should be investigated to ensure that the benefits of Medicaid expansion are realized equitably.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100294
Bruce G. Taylor PhD , Kimberly J. Mitchell PhD , Heather A. Turner PhD , Jackie Sheridan-Johnson MPH , Elizabeth A. Mumford PhD
Introduction
Guns were one of the leading causes of death in children and youth aged 0–24 years in the U.S. over the last decade, with large variations by sex, race, region, and income. This paper examines the rates of gun involvement for a group of youth and young adults in the U.S. from ages 10 years to 34 years across major demographic and background factors.
Methods
This is a cross-sectional nationally representative survey of participants recruited through an ongoing national research panel. Completed surveys were collected from 5,311 participants from September 2023 to January 2024.
Results
Lifetime rates for carrying guns were 26.7%, gun violence victimization rates were 9.5%, and gun violence perpetration rates were 3.3%. High levels of past-year involvement with guns and gun violence were observed, with 13.9% carrying guns, gun violence victimization of 2.5%, and gun violence perpetration of 0.9%. Even more concerning, data indicate that 7.6% of the participants reported carrying a gun before age 18 years, 5.2% experienced gun violence victimization, and 1.8% perpetrated gun violence. Gun carrying and violence were higher by demographics, with a statistically significant difference for all demographic subgroups on at least 1 gun outcome.
Conclusions
High levels of exposure to guns and gun violence are experienced among a nationally representative population of young Americans, with rates varying considerably by demographic factors. On the basis of these demographic disparities in gun involvement, more work is needed to address community and other risk and protective factors across different levels of the social ecology, such as structural inequities associated with gun violence.
{"title":"Prevalence of Gun Carrying and Gun Violence Victimization and Perpetration Among a Nationally Representative Sample of U.S. Youth and Young Adults","authors":"Bruce G. Taylor PhD , Kimberly J. Mitchell PhD , Heather A. Turner PhD , Jackie Sheridan-Johnson MPH , Elizabeth A. Mumford PhD","doi":"10.1016/j.focus.2024.100294","DOIUrl":"10.1016/j.focus.2024.100294","url":null,"abstract":"<div><h3>Introduction</h3><div>Guns were one of the leading causes of death in children and youth aged 0–24 years in the U.S. over the last decade, with large variations by sex, race, region, and income. This paper examines the rates of gun involvement for a group of youth and young adults in the U.S. from ages 10 years to 34 years across major demographic and background factors.</div></div><div><h3>Methods</h3><div>This is a cross-sectional nationally representative survey of participants recruited through an ongoing national research panel. Completed surveys were collected from 5,311 participants from September 2023 to January 2024.</div></div><div><h3>Results</h3><div>Lifetime rates for carrying guns were 26.7%, gun violence victimization rates were 9.5%, and gun violence perpetration rates were 3.3%. High levels of past-year involvement with guns and gun violence were observed, with 13.9% carrying guns, gun violence victimization of 2.5%, and gun violence perpetration of 0.9%. Even more concerning, data indicate that 7.6% of the participants reported carrying a gun before age 18 years, 5.2% experienced gun violence victimization, and 1.8% perpetrated gun violence. Gun carrying and violence were higher by demographics, with a statistically significant difference for all demographic subgroups on at least 1 gun outcome.</div></div><div><h3>Conclusions</h3><div>High levels of exposure to guns and gun violence are experienced among a nationally representative population of young Americans, with rates varying considerably by demographic factors. On the basis of these demographic disparities in gun involvement, more work is needed to address community and other risk and protective factors across different levels of the social ecology, such as structural inequities associated with gun violence.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100294"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100308
Shauna R. Goldberg MPH , Linda K. Ko PhD , Li Hsu PhD , Hang Yin MS , Charles Kooperberg PhD , Ulrike Peters PhD, MPH , Andrea N. Burnett-Hartman PhD, MPH
Introduction
Colorectal cancer is increasingly diagnosed in people aged <50 years. New U.S. guidelines recommend screening initiation at age 45 years. Providing personalized risk for colorectal cancer using polygenic risk scores may be an opportunity to engage this younger population in colorectal cancer screening. There is limited research on patient understanding of polygenic risk scores results and use of polygenic risk scores to inform colorectal cancer screening decisions.
Methods
From May 2022 to June 2023, 20 Kaiser Permanente Colorado members aged 46–51 years who had been offered colorectal cancer screening but had never completed it signed consent to provide a saliva sample for colorectal cancer polygenic risk score analysis. After receiving personalized polygenic risk scores for colorectal cancer, participants completed a semistructured interview regarding the understanding of their polygenic risk scores, perceived colorectal cancer risk, and intention to screen. Thematic analysis was conducted using Atlas.ti, Version 8.
Results
Of the 19 participants who successfully completed polygenic risk score–related testing and a semistructured interview, 13 were female, 14 never smoked cigarettes, 6 were Hispanic, and 13 were non-Hispanic White. One participant had high risk for colorectal cancer on the basis of polygenic risk score results. Qualitative interviews showed participants’ understanding of their results, trust in polygenic risk scores, perception of risk for colorectal cancer, plans to complete colorectal cancer screening, intent to share polygenic risk scores with healthcare providers, and concerns about genetic results impacting health care.
Conclusions
Qualitative analyses suggest that participants were interested in and understood their polygenic risk score results. Further study is needed to develop guidelines, effective calls to action, provider engagement, and health education materials on use of polygenic risk scores for health decision making.
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Pub Date : 2025-02-01DOI: 10.1016/j.focus.2024.100296
Shannon Brownlee MSc , Alison N. Huffstetler MD , Joseph Fraiman MD , Kenneth W. Lin MD, MPH
Introduction
Screening colonoscopy is often performed on patients who are younger or older than the ages specified in national guidelines or at shorter intervals than recommended. The annual incidence of harms associated with overuse of screening colonoscopy in the U.S. is not known. This study estimated the incidence of low-value screening colonoscopies annually in the U.S. and the number of preventable harms associated with them.
Methods
The 2018 National Health Interview Survey was used to estimate the number of annual screening colonoscopies. Rates of colonoscopy overuse and serious (bleeding and bowel perforation) and minor harms were drawn from 3 recent systematic reviews.
Results
Approximately 12.4 million screening colonoscopies were completed in the U.S. in 2018. Given the credible range of overuse rates of screening colonoscopy, between 2.1 and 3.2 million low-value colonoscopies occur per year. Applying the credible ranges identified for serious and minor harms secondary to screening colonoscopy resulted in an estimated annual incidence of serious harm from unnecessary colonoscopies ranging from 9,055 to 11,874. The estimate for minor harms ranged from 359,5790 to 1,566,846.
Conclusions
In the U.S., screening colonoscopies are often completed at intervals and in populations that are inconsistent with national recommendations, resulting in unnecessary serious and minor harm. Although individual risk is relatively low, the large number of nonindicated screening colonoscopies results in large numbers of adverse events that are preventable with better adherence to recommendations.
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