Addressing COVID-19 Vaccine Hesitancy With Community Distribution of Conversation Cards.

To increase community conversations about COVID-19 vaccine hesitancy, we distributed vaccine cardholders and conversation cards to 6000 newly vaccinated adults at vaccination sites and encouraged them to talk with unvaccinated friends and family members. In 257 onsite exit interviews, we found that cardholders and conversation cards were well liked, and most recipients expected to use them. Follow-up surveys two weeks later showed that 51% of respondents used a card to start a conversation and 41% gave a card to an unvaccinated friend or family member. (Am J Public Health. 2024;114(S1):S87-S91. https://doi.org/10.2105/AJPH.2023.307481).

Outreach to Low-Income Homebound Older Adults to Increase Access to COVID-19 Self-Test Kits, Missouri, 2022.

COVID-19 self-test kits were distributed to low-income, older adults (n = 2532) with their home-delivered or congregate meals in May 2022. Later, a convenience sample (n = 1108) were contacted for follow-up, and 606 (55%) were reached. Among 79% who remembered getting the test, only 34% already had a test kit, but nearly all liked receiving it (91%) and reported they would use or had used it (93%). Partnering with meal-delivery service providers was feasible to increase access to COVID-19 self-tests for low-income older adults. (Am J Public Health. 2024;114(S1):S65-S68. https://doi.org/10.2105/AJPH.2023.307485).

iHeard STL: Development and first year findings from a local surveillance and rapid response system for addressing COVID-19 and other health misinformation.

BACKGROUND: The U.S. Surgeon General and others have emphasized a critical need to address COVID-19 misinformation to protect public health. In St. Louis, MO, we created iHeard STL, a community-level misinformation surveillance and response system. This paper reports methods and findings from its first year of operation. METHODS: We assembled a panel of over 200 community members who answered brief, weekly mobile phone surveys to share information they heard in the last seven days. Based on their responses, we prioritized misinformation threats. Weekly surveillance data, misinformation priorities, and accurate responses to each misinformation threat were shared on a public dashboard and sent to community organizations in weekly alerts. We used logistic regression to estimate odds ratios (ORs) for associations between panel member characteristics and misinformation exposure and belief. RESULTS: In the first year, 214 panel members were enrolled. Weekly survey response rates were high (mean = 88.3% ± 6%). Exposure to a sample of COVID-19 misinformation items did not differ significantly by panel member age category or gender; however, African American panel members had significantly higher reported odds of exposure and belief/uncertain belief in some misinformation items (ORs from 3.4 to 17.1) compared to white panel members. CONCLUSIONS: Our first-year experience suggests that this systematic, community-based approach to assessing and addressing misinformation is feasible, sustainable, and a promising strategy for responding to the threat of health misinformation. In addition, further studies are needed to understand whether structural factors such as medical mistrust underly the observed racial differences in exposure and belief.

Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation.

Background: Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods: Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings: Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98). Interpretation: A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. Trial registration: ClinicalTrials.gov Identifier: NCT03194958. Funding: National Cancer Institute: R01CA201429.

Complexity and clinical significance of drug-drug interactions (DDIs) in oncology: challenging issues in the care of patients regarding cancer-associated thrombosis (CAT).

Cancer patients have an increased risk of developing venous thromboembolic events. Anticoagulation management includes prophylactic or therapeutic doses of low molecular weight heparins (LMWHs) or direct oral anticoagulants (DOACs). However, the management of thrombosis in patients with cancer is complex due to various individual and disease-related factors, including drug-drug interactions (DDIs). Furthermore, DDIs may impact both, cancer and venous thrombosis, treatment effectiveness and safety; their relevance is highlighted by the advances in cancer therapeutics. Given that these new oncology drugs are extensively used, more attention should be given to monitoring potential DDIs to minimize risks. Recognition of DDIs is of utmost importance in an era of rapid developments in cancer treatments and introduction of novel treatments and protocols. When managing cancer-associated thrombosis (CAT), the concomitant use of a DOAC and a moderate or strong modulator (inhibitor or inducer) of CYP3A4 or a P-glycoprotein (P-gp) is most likely to be associated with significant DDIs. Therefore, LMWHs remain the first-line option for the long-term management of CAT under these circumstances and physicians must consider utilizing LMWHs as first line. This review describes the risk of DDIs and their potential impact and outcomes in patients with cancer associated thrombosis (CAT) receiving anticoagulation.

Inpatient primary prophylaxis of cancer-associated thromboembolism (CAT).

PURPOSE: Cancer-associated thrombosis (CAT) increases morbidity and mortality in oncology patients. The risk of CAT is increased with hospitalization for acute medical illness. The goal of this review will be to examine the available evidence for (1) risk assessment and (2) primary thromboprophylaxis, (3) international published guideline recommendations, and (4) future directions to manage oncology patients admitted for an acute medical illness. METHODS: A review was performed for each subject to gather information on the available evidence and recommendations available for oncology patients hospitalized for an acute medical illness. RESULTS: Risk assessments for thrombosis are primarily developed and validated in the general population. There is not a risk assessment that has specifically been developed and validated in oncology patients hospitalized for an acute medical illness. Most evidence for thromboprophylaxis of oncology patients is from sub-group analysis of larger randomized-controlled trials in the general population. Evidence is conflicting and suggests an individualized approach evaluating the risk-benefit of thromboprophylaxis. The strength of recommendations of international guidelines is limited because of the available evidence. Guidelines usually recommend utilizing and/or offering thromboprophylaxis to oncology patients hospitalized for an acute medical illness barring contraindications. Future evidence needs to improve risk assessments and knowledge of the appropriate agent, dose, and duration of thromboprophylaxis if indicated. CONCLUSION: Evidence for risk assessments and primary prophylaxis for oncology patients hospitalized for acute medical illness appears limited, with many research opportunities available to improve understanding on management of this patient population.

Stress, depression, sleep problems and unmet social needs: Baseline characteristics of low-income smokers in a randomized cessation trial.

BACKGROUND: Low-income Americans smoke cigarettes at higher rates and quit less than other groups. METHODS: To increase their engagement in and success using evidence-based cessation methods, we tested two interventions using a 2x2 randomized factorial design: (1) telephone navigation to reduce financial strain and address social needs such as food, rent and utility payment; and (2) a specialized tobacco quitline designed for low-income smokers. From June 2017 to November 2020, we enrolled 1,944 low-income smokers in Missouri, USA, recruited through the Missouri 2-1-1 helpline, into the trial. This paper describes recruitment, key characteristics and life circumstances of this high-risk population. RESULTS: After eligibility screening, 1,944 participants completed baseline and were randomized. Participants were racially diverse (58% African American), poor (51% < $10,000 annual pre-tax household income) and many reported less than high school education (30%). They reported a mean of 2.5 unmet social needs, especially childcare and paying bills, had high rates of stress, depressive symptoms and sleep problems, and most were in fair or poor health. There were few differences between these variables, and no differences between tobacco use and cessation variables, across the four study groups and between participants recruited pre and during the COVID-19 pandemic. CONCLUSIONS: Trial recruitment through the 2-1-1 helpline is feasible for reaching a population of low-income smokers. Low-income smokers face myriad daily challenges beyond quitting smoking. Cessation interventions need to account for and address these life circumstances. TRIAL REGISTRATION: Clinicaltrials.gov NCT03194958.

Cannabidiol: Knowledge, Beliefs, and Experiences of Patients With Cancer.

BACKGROUND: Cannabidiol (CBD) is purported to work for a variety of therapeutic indications. Interest in CBD products has significantly increased as patients with cancer seek ways to improve symptom control and quality of life. OBJECTIVES: The purpose of this study was to explore patients' knowledge of and experience with CBD. METHODS: A panel of oncology nurse practitioners, an oncologist, and oncology pharmacy specialists developed a survey to capture information about patient knowledge and use of CBD. The initial survey was pilot tested and further refined, resulting in the final item survey. The final survey was administered to 100 participants undergoing or having completed cancer treatment and being followed in a supportive oncology care clinic at a large academic medical center. FINDINGS: Most patients learned about CBD through a family member or friend. The majority of patients had never tried CBD. The most common reported indications were pain, anxiety, and nausea. Of those who had not tried CBD, the most common reasons included lack of knowledge about CBD and providers not recommending CBD.

Comparing two approaches to remote biochemical verification of self-reported cessation in very low-income smokers.

Little is known about the acceptability and use of remote biochemical verification of self-reported cessation among low-income and racially diverse smokers. We compared responses to an in-person carbon monoxide breath test and in-home urine cotinine test among 270 adults who reported 7-day continuous abstinence at 6-month follow-up in a community-based randomized cessation trial. Half of participants (50%) reported annual household income below $10,000, one in four (28%) had not completed high school, and 69% were Black or African American. Regardless of whether the two tests were offered separately, sequentially, or as a head-to-head choice, participants were more likely to accept an offer to take the urine test than the breath test (89% vs. 32%), and complete it (46% vs. 13%). The proportion of participants completing the urine test and returning a digital photo of the test result is comparable to several studies completed with less disadvantaged samples. Self-report was confirmed by urine test for 74% of participants with a conclusive test result, although a high percentage (39%) of test results were inconclusive. In-home urine testing appears both acceptable and feasible for many low-income smokers, but challenges with testing technology and response rates currently limit its value to increase confidence in self-reports.

Stretching Impacts Inflammation Resolution in Connective Tissue.

Acute inflammation is accompanied from its outset by the release of specialized pro-resolving mediators (SPMs), including resolvins, that orchestrate the resolution of local inflammation. We showed earlier that, in rats with subcutaneous inflammation of the back induced by carrageenan, stretching for 10 min twice daily reduced inflammation and improved pain, 2 weeks after carrageenan injection. In this study, we hypothesized that stretching of connective tissue activates local pro-resolving mechanisms within the tissue in the acute phase of inflammation. In rats injected with carrageenan and randomized to stretch versus no stretch for 48 h, stretching reduced inflammatory lesion thickness and neutrophil count, and increased resolvin (RvD1) concentrations within lesions. Furthermore, subcutaneous resolvin injection mimicked the effect of stretching. In ex vivo experiments, stretching of connective tissue reduced the migration of neutrophils and increased tissue RvD1 concentration. These results demonstrate a direct mechanical impact of stretching on inflammation-regulation mechanisms within connective tissue.

A review of 2014 cancer drug approvals, with a look at 2015 and beyond.

The number of cancer medications approved by the Food and Drug Administration has risen steadily in recent years. This article provides a concise overview of drugs and indications added to the cancer armamentarium in 2014 and to date in 2015.

Drug monographs: pomalidomide and ponatinib.

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net.