Unmet needs for home and community-based services among persons with disabilities in Massachusetts.

BACKGROUND: Home and community-based services (HCBS) are vital to the health and well-being of persons with disabilities. However, no previous population-based studies have examined the prevalence of unmet needs for HCBS among working-age persons with disabilities. The purpose of this report is to document the prevalence of unmet need for HCBS among a representative sample of working-age persons with disabilities in Massachusetts. METHODS: Data from the 2007 Massachusetts Survey of Unmet Needs of Adults with Disabilities were analyzed. HCBS included in-home help, case-management, information, access to medical care, physical and occupational therapy, prescription drugs, meals, assistive technology, home adaptation, transportation, need for assistance with activities of daily living and instrumental activities of daily living (IADL) services. RESULTS: The prevalence of unmet need for HCBS was high, with more than two-thirds of respondents reporting at least 1 unmet need and more than 1 in 4 respondents reporting 4 or more unmet needs. The most prevalent unmet need included the need for information for disability-related services and legal rights, need for primary, specialty, and mental health care, case management services and the unmet need for IADL services. The unmet needs for HCBS were categorized into unmet needs relating to access to information and services and those relating to in-home supports. CONCLUSIONS: The study findings support the need to broaden the scope of HCBS for working-age persons with disabilities and to implement community-based programs such as improving access to information for services and benefits and enhancing access to in-home supports.

A randomized trial comparing mail versus in-office distribution of the CAHPS Clinician and Group Survey.

OBJECTIVE: To assess the effect of survey distribution protocol (mail versus handout) on data quality and measurement of patient care experiences. DATA SOURCES/STUDY SETTING: Multisite randomized trial of survey distribution protocols. Analytic sample included 2,477 patients of 15 clinicians at three practice sites in New York State. DATA COLLECTION/EXTRACTION METHODS: Mail and handout distribution modes were alternated weekly at each site for 6 weeks. PRINCIPAL FINDINGS: Handout protocols yielded an incomplete distribution rate (74 percent) and lower overall response rates (40 percent versus 58 percent) compared with mail. Handout distribution rates decreased over time and resulted in more favorable survey scores compared with mailed surveys. There were significant mode-physician interaction effects, indicating that data cannot simply be pooled and adjusted for mode. CONCLUSIONS: In-office survey distribution has the potential to bias measurement and comparison of physicians and sites on patient care experiences. Incomplete distribution rates observed in-office, together with between-office differences in distribution rates and declining rates over time suggest staff may be burdened by the process and selective in their choice of patients. Further testing with a larger physician and site sample is important to definitively establish the potential role for in-office distribution in obtaining reliable, valid assessment of patient care experiences.

Surveillance indicators for potential reduced exposure products (PREPs): developing survey items to measure awareness.

BACKGROUND: Over the past decade, tobacco companies have introduced cigarettes and smokeless tobacco products (known as Potential Reduced Exposure Products, PREPs) with purportedly lower levels of some toxins than conventional cigarettes and smokeless products. It is essential that public health agencies monitor awareness, interest, use, and perceptions of these products so that their impact on population health can be detected at the earliest stages. METHODS: This paper reviews and critiques existing strategies for measuring awareness of PREPs from 16 published and unpublished studies. From these measures, we developed new surveillance items and subjected them to two rounds of cognitive testing, a common and accepted method for evaluating questionnaire wording. RESULTS: Our review suggests that high levels of awareness of PREPs reported in some studies are likely to be inaccurate. Two likely sources of inaccuracy in awareness measures were identified: 1) the tendency of respondents to misclassify "no additive" and "natural" cigarettes as PREPs and 2) the tendency of respondents to mistakenly report awareness as a result of confusion between PREPs brands and similarly named familiar products, for example, Eclipse chewing gum and Accord automobiles. CONCLUSION: After evaluating new measures with cognitive interviews, we conclude that as of winter 2006, awareness of reduced exposure products among U.S. smokers was likely to be between 1% and 8%, with the higher estimates for some products occurring in test markets. Recommended measurement strategies for future surveys are presented.

Receptivity to Taboka and Camel Snus in a U.S. test market.

INTRODUCTION: The two largest U.S. cigarette manufacturers introduced Swedish-style low-nitrosamine smokeless tobacco (snus) to several U.S. test markets in summer 2006. Since then, snus brands and test markets have proliferated. METHODS: This article assesses consumer response by analyzing data from the 2006 and 2007 Indiana Adult Tobacco Survey (IATS), a statewide telephone survey of 3,544 adults. During those years, the IATS included questions on awareness and trial of Camel Snus and Taboka. Analyses examined rates and predictors of awareness and trial statewide, and within the central Indiana test market. RESULTS: Nineteen percent of Indiana adults were aware of either Taboka or Camel Snus in 2006 and 2007. Estimates are larger (29%) for central Indiana and larger still (70%) for central Indiana smokers. Trial of snus, however, was very low (1.5% statewide), except among male smokers in central Indiana, 20% of whom are estimated to have tried it. Multivariate analyses showed that trial was more likely among men than women (odds ratio [OR] 13.85), residents of central Indiana than those farther from Indianapolis (OR 2.96), recipients than nonrecipients of tobacco promotions (OR 6.08), and those believing that smokeless tobacco is less harmful than cigarettes compared with those who believe it is equally or more harmful (OR 3.86). DISCUSSION: Results from this study suggest substantial initial interest in the new products among male smokers in this test market, especially those who receive promotional mailings from tobacco companies, which often include coupons for free or discounted products.

Impact of corrective health information on consumers' perceptions of "reduced exposure" tobacco products.

OBJECTIVE: To determine whether providing corrective health information can reduce the tendency of consumers to believe that the implied marketing message that two "potentially reduced exposure products" (PREPs) are safer than regular cigarettes. DESIGN: Face-to-face interviews with smokers assigned to one of four conditions, which varied in terms of the presence or absence of health information that qualified claims made in advertising for two PREPs. SUBJECTS: A convenience sample of 177 smokers in Boston area. INTERVENTIONS: Health information detailed the extent to which exposure to toxins and health risks of the brands were unknown. MAIN OUTCOME MEASURES: Respondents' assessments of the health risks and toxicity of the two combustible PREPs, Advance and Eclipse. RESULTS: The health information had a modest but significant effect on ratings of health risk, and reduced perceptions that switching to the new brands would lower a smoker's risk of cancer (OR 0.75; p<0.05). The health information had no effect on perceptions of toxicity. CONCLUSIONS: A small dose of corrective information was effective in tempering smokers' perceptions. A higher dose of public health campaigns would be needed to affect misperceptions likely to follow a full-scale tobacco marketing effort.

Consequences of marketing exceptions in the Master Settlement Agreement: exposure of youth to adult-only tobacco promotions.

The Master Settlement Agreement between a consortium of tobacco companies and 46 states contains many restrictions on tobacco sales and advertising that were designed to reduce youth exposure to tobacco promotions. Most of the restrictions include an exception for "adult-only" facilities. The present study investigated the extent to which youth are being exposed to marketing that is presumably limited to adults. Using data from a statewide random-digit-dialed survey of 3,863 Massachusetts youth aged 12-17 years, we found that about half of all youth in this age group reported seeing cigarettes advertised at events, concerts, bars, or clubs in the past 12 months, and that about 5% of youth in this age group reported being present at a venue where free samples of cigarettes were being distributed. Youth exposed to this marketing were those most at risk for progression to established smoking. To our knowledge, this is the first study to estimate youth exposure to advertisements designed for adult-only venues. In light of the large body of evidence that exposure to tobacco advertising and promotion increases tobacco use among youth, our findings demonstrate the need to close the "adult-only" loophole.