An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial.

This study tested the preliminary effectiveness of an electronic health record (EHR)-automated population health management (PHM) intervention for smoking cessation among adult patients of a federally qualified health center in Chicago. Participants (N = 190; 64.7% women, 82.1% African American/Black, 8.4% Hispanic/Latino) were self-identified as smokers, as documented in the EHR, who completed the baseline survey of a longitudinal "needs assessment of health behaviors to strengthen health programs and services." Four weeks later, participants were randomly assigned to the PHM intervention (N = 97) or enhanced usual care (EUC; N = 93). PHM participants were mailed a single-page self-determination theory (SDT)-informed letter that encouraged smoking cessation or reduction as an initial step. The letter also addressed low health literacy and low income. PHM participants also received automated text messages on days 1, 5, 8, 11, and 20 after the mailed letter. Two weeks after mailing, participants were called by the Illinois Tobacco Quitline. EUC participants were e-referred following a usual practice. Participants reached by the quitline were offered behavioral counseling and nicotine replacement therapy. Outcome assessments were conducted at weeks 6, 14, and 28 after the mailed letter. Primary outcomes were treatment engagement, utilization, and self-reported smoking cessation. In the PHM arm, 25.8% of participants engaged in treatment, 21.6% used treatment, and 16.3% were abstinent at 28 weeks. This contrasts with no quitline engagement among EUC participants, and a 6.4% abstinence rate. A PHM approach that can reach all patients who smoke and address unique barriers for low-income individuals may be a critical supplement to clinic-based care.

Electronic nicotine delivery systems: use, knowledge, and attitudes among diverse college students.

ObjectiveThe purpose of this study was to examine Electronic Nicotine Delivery Systems (ENDS) use among nonusers in diverse college students. Participants: Participants were college students enrolled at a Hispanic-Serving University in Chicago, IL, USA in December 2017. Methods: An online survey was administered using questions about ENDS-use behaviors, device characteristics, and knowledge of their own device, and ENDS attitudes. ENDS attitudes included questions about health, susceptibility, and quit characteristics. Results: The prevalence rate of ENDS use was 7%, and 39% of ENDS users identified all device characteristics. Nonusers categorize ENDS as a healthier alternative to cigarettes and as quit devices. Finally, cigarette use, age, health factor, and social proximity are correlated with ENDS susceptibility. Conclusions: These ENDS users lack awareness of their devices and tobacco use plays a key role in ENDS susceptibility. Future studies should continue to study the role ENDS has in dependence and cigarette use.

A Cluster Analysis of Risk Factors for Cancer across EU Countries: Health Policy Recommendations for Prevention.

Cancer burden in the European Union (EU) is increasing and has stimulated the European Commission (EC) to develop strategies for cancer control. A common "one size fits all" prevention policy may not be effective in reducing cancer morbidity and mortality. The goal of this paper is to show that EU member states are not homogenous in terms of their exposure to risk factors for cancer (i.e., lifestyle, socio-economic status (SES), air pollution, and vaccination). Data from a variety of sources including Eurostat, the UNESCO Institute for Statistics, the European Health Interview Survey, Eurobarometer, and the European Environment Agency were merged across years 2013-2015 and used to develop a cluster analysis. This work identified four patterns of cancer prevention behaviors in the EU thus making it possible to group EU members states into four distinct country clusters including: sports-engaged countries, tobacco and pollutant exposed nations, unhealthy lifestyle countries, and a stimulant-enjoying cluster of countries. This paper finds that there is a need for closer collaboration among EU countries belonging to the same cluster in order to share best practices regarding health policy measures that might improve cancer control interventions locally and across the EU.

Building Cross-Institutional Collaborative Infrastructure and Processes: Early Lessons From the Chicago Cancer Health Equity Collaborative.

BACKGROUND: Addressing cancer health disparities requires a multitiered, comprehensive approach. The Chicago Cancer Health Equity Collaborative (ChicagoCHEC) was established as a tri-institutional partnership to advance cancer health equity through scientific discovery, education, and community engagement. OBJECTIVES: Large-scale partnerships rarely document the challenges encountered when establishing processes and operations in the formative years of engagement. We outline selected lessons learned from the first three years of ChicagoCHEC in hopes that future collaborations may be better poised to hit the ground running and create the needed infrastructure for a strong, effective, and sustainable partnership. LESSONS LEARNED: Unifying a diverse group of stakeholders under a shared mission is imperative. A shared governance structure, in which all individuals understand the aims of partnership and can facilitate progress, is crucial for success. Ongoing monitoring of collaborative processes should occur and attention should be given to the optimization of communications. CONCLUSIONS: Large-scale collaborative research and education projects across institutions can be challenging, particularly when establishing a working infrastructure and aligning priorities. However, the benefit of establishing key processes in the early years of the collaborative process can lead to high-quality research output, impact, and a sustainable partnership.

Adaptation of a Proactive Smoking Cessation Intervention to Increase Tobacco Quitline Use by LGBT Smokers.

PURPOSE: The study purpose was to evaluate the content of a proactive population health management intervention aimed at promoting uptake of smoking cessation treatments offered by the Illinois Tobacco Quitline (ITQL) among lesbian, gay, bisexual, and transgender (LGBT)-identified smokers. METHODS: This study represents a partnership between a community-based health center and university researchers. As part of the study, focus groups and in-depth interviews were conducted with LGBT smokers (N = 30). First, we conducted focus groups to obtain feedback on the readability, acceptability, and motivational salience of a targeted and nontargeteed proactive outreach letter. After revisions, a series of in-depth interviews were conducted to evaluate finalized materials. Focus groups and interviews were systematically analyzed. RESULTS: Based on feedback, the revised intervention letter was rated more positively than the initial version, with 80% of participants indicating that they found the information in the letter to be useful. Further, more participants reported that the letter would motivate them to accept a call from a quitline counselor compared with the initial version (47.6% vs. 60.0%, respectively). In the final iteration, 60% of participants preferred the targeted letter, 30% preferred the non-targeted letter, and 10% had no preference. In the first iteration, outreach text messages were rated as unacceptable or completely unacceptable by 54% of participants. The revised text messages and protocols were seen as unacceptable by only 10% of participants. CONCLUSIONS: The development and testing of population-based and cost-effective interventions is critical to the reduction of LGBT smoking disparities. The study protocol and intervention materials were well-received by participants. In a future study, we will evaluate the efficacy of the intervention in increasing use of the quitline among LGBT smokers.

Unhealthy behavior clustering and mental health status in United States college students.

Objective: Examine the association of health risk behavior clusters with mental health status among US college students. Participants: 105,781 US college students who completed the Spring 2011 National College Health Assessment. Methods: We utilized the latent class analysis to determine clustering of health risk behaviors (alcohol binge drinking, cigarette/marijuana use, insufficient physical activity, and fruit/vegetable consumption), and chi-square and ANOVA analyses to examine associations between the class membership and mental health (mental health diagnoses, psychological symptoms, and self-injurious thoughts/behaviors). Results: Three classes were identified with differing rates of binge drinking, substance use, and insufficient physical activity but similar rates of insufficient fruit/vegetable consumption. Students classified with the highest rates of binge drinking and cigarette/marijuana use had the highest rates across all mental health variables compared to other classes. Conclusions: Students who reported engaging in multiple health risk behaviors, especially high alcohol and cigarette/marijuana use, were also more likely to report poorer mental health.

Institutional Alliances to Reduce Cancer Disparities in Chicago.

A partnership formed between Northeastern Illinois University (NEIU) and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University sought to address well-documented cancer health disparities in Chicago by developing a collaborative research, training, and educational infrastructure between a minority-serving institution and a National Cancer Institute designated comprehensive cancer center. With a critical examination of partnership documentation and outputs, we describe the partnership's community-engaged approaches, challenges, and lessons learned. Northeastern Illinois University and the Lurie Cancer Center engaged in a yearlong partnership-building phase, identified interdisciplinary research teams, formed a governance structure, and identified collective aims. Partnership outcomes included funded inter-institutional research projects, new curriculum, and an annual research trainee program. Significant challenges faced included uncertain fiscal climate, widespread turnover, and dissimilar institutional demands. Lessons learned from this minority serving institution and comprehensive cancer center partnership may be useful for bridging distinct academic communities in the pursuit of ameliorating health disparities.

A latent class analysis of cancer risk behaviors among U.S. college students.

OBJECTIVE: The purpose of this study is to understand how cancer risk behaviors cluster in U.S. college students and vary by race and ethnicity. METHODS: Using the fall 2010 wave of the National College Health Assessment (NCHA), we conducted a latent class analysis (LCA) to evaluate the clustering of cancer risk behaviors/conditions: tobacco use, physical inactivity, unhealthy diet, alcohol binge drinking, and overweight/obesity. The identified clusters were then examined separately by students' self-reported race and ethnicity. RESULTS: Among 30,093 college students surveyed, results show a high prevalence of unhealthy diet as defined by insufficient fruit and vegetable intake (>95%) and physical inactivity (>60%). The LCA identified behavioral clustering for the entire sample and distinct clustering among Black and American Indian students. CONCLUSIONS: Cancer risk behaviors/conditions appear to cluster among college students differentially by race. Understanding how risk behaviors cluster in young adults can lend insight to racial disparities in cancer through adulthood. Health behavior interventions focused on modifying multiple risk behaviors and tailored to students' racial group could potentially have a much larger effect on cancer prevention than those targeting any single behavior.

Do state expenditures on tobacco control programs decrease use of tobacco products among college students?

The objective of this paper is to investigate the effects of state tobacco control program expenditures on individual-level tobacco use behaviors among young adults. Data come from the 1997, 1999 and 2001 waves of the Harvard School of Public Health College Alcohol Study (CAS). Our findings indicate that a higher level of state spending on tobacco control programs in the prior year is associated with a statistically significant increase in the probability that current daily smokers report at least one attempt to quit smoking in the past year. We also find evidence that higher state expenditures on tobacco control programs in the prior year are associated with reductions in the prevalence of daily smoking and 30-day cigar use among college students. We do not find any statistically significant association between state tobacco control program expenditures and the number of attempts to quit smoking among those with at least one attempt, or on the prevalence of smokeless tobacco use in the past month.