State-Specific Prevalence of Adult Tobacco Product Use and Cigarette Smoking Cessation Behaviors, United States, 2018-2019.

Introduction: Increasing quitting among people who smoke cigarettes is the quickest approach to reducing tobacco-related disease and death. Methods: We analyzed data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey for 137,471 adult self-respondents from all 50 US states and the District of Columbia to estimate state-specific prevalence of current tobacco product use, interest in quitting smoking, past-year quit attempts, recent successful cessation (past-year quit lasting ≥6 months), receipt of advice to quit smoking from a medical doctor, and use of cessation medications and/or counseling to quit. Results: Prevalence of current any-tobacco use (use every day or some days) ranged from 10.2% in California to 29.0% in West Virginia. The percentage of adults who currently smoked cigarettes and were interested in quitting ranged from 68.2% in Alabama to 87.5% in Connecticut; made a past-year quit attempt ranged from 44.1% in Tennessee to 62.8% in Rhode Island; reported recent successful cessation ranged from 4.6% in West Virginia and Wisconsin to 10.8% in South Dakota; received advice to quit from a medical doctor ranged from 63.3% in Colorado to 86.9% in Rhode Island; and used medications and/or counseling to quit ranged from 25.5% in Nevada to 50.1% in Massachusetts. Several states with the highest cigarette smoking prevalence reported the lowest prevalence of interest in quitting, quit attempts, receipt of advice to quit, and use of counseling and/or medication, and the highest prevalence of e-cigarette, smokeless tobacco, and cigar use. Conclusion: Adults who smoke struggle with smoking cessation and could benefit from additional intervention.

Patient-Centered Communication (PCC) scale: Psychometric analysis and validation of a health survey measure.

INTRODUCTION: Patient-centered communication (PCC) is one important component of patient-centered care and seen as a goal for most clinical encounters. Previous research has shown that higher PCC is related to an increase in healthy behaviors and less morbidity, among other outcomes. Given its importance, the National Cancer Institute (NCI) commissioned a monograph in 2007 to synthesize the existing literature on PCC and determine measurement objectives and strategies for measuring this construct, with a particular focus on cancer survivors. Based on this effort, a seven-item PCC scale was included on the Health Information National Trends Survey (HINTS), a probability-based survey of the US adult population. This study used HINTS data collected in 2018 to evaluate the psychometric properties of the PCC scale for the general US adult population including measures of reliability and validity. RESULTS: Through an exploratory factor analysis, the seven-item PCC scale was shown to be unidimensional with good internal consistency (Cronbach's alpha = .92). A confirmatory factor analysis verified the factor structure. Other construct validity metrics included known groups and discriminant validity. Known group comparisons were conducted for several sociodemographic factors and health self-efficacy confirming a priori assumptions. Discriminant validity tests with measures of social support and anxiety/depression showed relatively weak associations. CONCLUSIONS: The psychometric properties of this scale demonstrate its scientific utility for both surveillance research and other smaller-scale studies. Given its association with many health outcomes, it can also be used to better understand the dynamics in a clinical encounter.

Treating Smoking in Cancer Patients: An Essential Component of Cancer Care-The New National Cancer Institute Tobacco Control Monograph.

PURPOSE: Continued smoking after the diagnosis of cancer can markedly worsen oncology treatment side effects, cancer outcomes, cancer mortality, and all-cause mortality. Conversely, mounting evidence demonstrates that smoking cessation by patients with cancer improves outcomes. A cancer diagnosis often serves as a teachable moment, characterized by high motivation to quit. However, too few patients with cancer who smoke are offered evidence-based smoking cessation treatment, and too few engage in such treatment. METHODS AND MATERIALS: The National Cancer Institute commissioned Tobacco Control Monograph 23, Treating Smoking in Cancer Patients: An Essential Component of Cancer Care, to review and synthesize the evidence that clarifies the need to intervene with smoking in cancer care. RESULTS: Although many patients with newly diagnosed cancer who smoke make quit attempts, many of these are unsuccessful, and among those who successfully quit, relapse is common. Indeed, an estimated 12.2% of adults ever diagnosed with cancer reported they currently smoked (National Health Interview Survey, 2020). Patients with cancer who smoke are likely to benefit from smoking cessation treatments, including counseling and US Food and Drug Administration-approved medications, and there are many effective strategies to increase delivery of smoking cessation treatment in cancer care settings. CONCLUSION: Smoking cessation is among the most effective treatment options for improving the likelihood of survival, quality of life, and overall health of patients with cancer who smoke. It is important for cancer care clinicians and patients to realize that it is never too late to quit smoking and that there are clear benefits to doing so, regardless of cancer type.

What does the word healing mean to you? Perceptions of patients with life-limiting illness.

INTRODUCTION: There is a growing consensus that patient-centered care is more effective in treating patients than a strictly biomedical model, where there are known challenges to involving the patient in assessments, treatment goals, and determining preferred outcomes. OBJECTIVES: The current study seeks to integrate patient values and perspectives by exploring how people diagnosed with a life-limiting disease define healing in their own words. METHODS: As a part of a larger study that included cognitive interviewing, we asked the question "what does the word healing mean to you?" Data were collected during face-to-face interviews with patients from three metropolitan healthcare facilities. RESULTS: Thirty participants responded to the question "what does healing mean to you?" Seven themes were identified through the data analysis. These themes include acceptance, feeling better, pain, social support, process, religion/spirituality, and make whole. The feeling better, pain, and process themes have subthemes. SIGNIFICANCE OF RESULTS: Probing to understand patient perspectives and how to provide a holistic approach to care is essential to patient treatment. Patients defined healing in a broader way than how it is typically defined in literature. The patients' definitions provide greater insight into perceptions and expectations regarding the healing process.

Population prevalence and predictors of self-reported exposure to court-ordered, tobacco-related corrective statements.

OBJECTIVE: To describe the population prevalence and predictors of self-reported exposure to court-ordered tobacco-related corrective statements in 2017-2018, when they were first implemented in newspapers and on television. METHODS: Nationally representative data from the 2018 Health Information National Trends Survey were used (n=3504). Frequencies and weighted proportions were calculated for seeing any corrective statement and for each of the five court-ordered corrective statements. Weighted, multivariable logistic regression was used to examine sociodemographic and smoking status predictors of reported exposure to any corrective statement. RESULTS: In 2018, an estimated 40.6% of US adults had seen messages in newspapers or on television in the past 6 months stating that a federal court has ordered tobacco companies to make statements about the dangers of smoking cigarettes. Reported exposure to topic-specific statements ranged from 11.4% (manipulation of cigarette design) to 34.7% (health effects). Those with a high school education were significantly less likely than those with a college degree to report seeing the statements (OR=0.69, CI 0.50 to 0.95) and current smokers were significantly more likely than never smokers to report seeing them (OR=1.68, CI 1.12 to 2.53). CONCLUSIONS: In the first 6 months of corrective statement implementation, an estimated 40.6% of US adults reported at least one exposure to any corrective statement, and current smokers were more likely than never smokers to report exposure. Traditional media channels can be effective for tobacco-related message dissemination; however, they may fail to reach more than half of the adult population without additional targeted communication efforts.

Tobacco Product Use and Cessation Indicators Among Adults - United States, 2018.

Cigarette smoking is the leading cause of preventable disease and death in the United States (1). The prevalence of adult cigarette smoking has declined in recent years to 14.0% in 2017 (2). However, an array of new tobacco products, including e-cigarettes, has entered the U.S. market (3). To assess recent national estimates of tobacco product use among U.S. adults aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute analyzed data from the 2018 National Health Interview Survey (NHIS). In 2018, an estimated 49.1 million U.S. adults (19.7%) reported currently using any tobacco product, including cigarettes (13.7%), cigars (3.9%), e-cigarettes (3.2%), smokeless tobacco (2.4%), and pipes* (1.0%). Most tobacco product users (83.8%) reported using combustible products (cigarettes, cigars, or pipes), and 18.8% reported using two or more tobacco products. The prevalence of any current tobacco product use was higher in males; adults aged ≤65 years; non-Hispanic American Indian/Alaska Natives; those with a General Educational Development certificate (GED); those with an annual household income <$35,000; lesbian, gay, or bisexual adults; uninsured adults; those with a disability or limitation; and those with serious psychological distress. The prevalence of e-cigarette and smokeless tobacco use increased during 2017-2018. During 2009-2018, there were significant increases in all three cigarette cessation indicators (quit attempts, recent cessation, and quit ratio). Implementing comprehensive population-based interventions in coordination with regulation of the manufacturing, marketing, and distribution of all tobacco products can reduce tobacco-related disease and death in the United States (1,4).

Vital Signs: Tobacco Product Use Among Middle and High School Students - United States, 2011-2018.

INTRODUCTION: Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco product use begins during youth and young adulthood. METHODS: CDC, the Food and Drug Administration, and the National Cancer Institute analyzed data from the 2011-2018 National Youth Tobacco Surveys to estimate tobacco product use among U.S. middle and high school students. Prevalence estimates of current (past 30-day) use of seven tobacco products were assessed; differences over time were analyzed using multivariable regression (2011-2018) or t-test (2017-2018). RESULTS: In 2018, current use of any tobacco product was reported by 27.1% of high school students (4.04 million) and 7.2% of middle school students (840,000); electronic cigarettes (e-cigarettes) were the most commonly used product among high school (20.8%; 3.05 million) and middle school (4.9%; 570,000) students. Use of any tobacco product overall did not change significantly during 2011-2018 among either school level. During 2017-2018, current use of any tobacco product increased 38.3% (from 19.6% to 27.1%) among high school students and 28.6% (from 5.6% to 7.2%) among middle school students; e-cigarette use increased 77.8% (from 11.7% to 20.8%) among high school students and 48.5% (from 3.3% to 4.9%) among middle school students. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: A considerable increase in e-cigarette use among U.S. youths, coupled with no change in use of other tobacco products during 2017-2018, has erased recent progress in reducing overall tobacco product use among youths. The sustained implementation of comprehensive tobacco control strategies, in coordination with Food and Drug Administration regulation of tobacco products, can prevent and reduce the use of all forms of tobacco products among U.S. youths.

Item Development and Performance of Tobacco Product and Regulation Perception Items for the Health Information National Trends Survey.

INTRODUCTION: Emerging tobacco products have become increasingly popular, and the US Food and Drug Administration extended its authority to all products meeting the definition of a tobacco product in 2016. These changes may lead to shifts in public perceptions about tobacco products and regulation, and national surveys are attempting to assess these perceptions at the population level. This article describes the item development and cognitive interviewing of the tobacco product and regulation perception items included in two tobacco-focused cycles of the Health Information National Trends Survey (HINTS-FDA), referred to as HINTS-FDA. METHODS: Cognitive interviewing was used to investigate how respondents comprehended and responded to tobacco product and regulation perception items. Adult participants (n = 20) were selected purposively to oversample current tobacco users and were interviewed in two iterative rounds. Weighted descriptive statistics from the fielded HINTS-FDA surveys (N = 5474) were also calculated. RESULTS: Items were generally interpreted as intended, and participants meaningfully discriminated between tobacco products when assessing addiction perceptions. Response selection issues involved inconsistent reporting among participants with little knowledge or ambivalent opinions about either government regulation or tobacco products and ingredients, which resolved when a "don't know" response option was included in the survey. The fielded survey found that a non-negligible proportion of the population do not have clear perceptions of emerging tobacco products or government regulation. CONCLUSIONS: A "don't know" response option is helpful for items assessing many emerging tobacco products but presents several analytic challenges that should be carefully considered. Multiple items assessing specific tobacco product and regulation perception items are warranted in future surveys. IMPLICATIONS: The findings from this study can serve as a foundation for future surveys that assess constructs related to emerging tobacco products, harm perceptions across multiple tobacco products, and tobacco-related government regulatory activities. The data provide unique insight into item-specific motivation for selecting a "don't know" response option for tobacco survey items.

Risks and rewards of using prepaid vs. postpaid incentive checks on a survey of physicians.

BACKGROUND: Survey researchers use monetary incentives as a strategy to motivate physicians' survey participation. Experiments from general population surveys demonstrate that prepaid incentives increase response rates and lower survey administration costs relative to postpaid incentives. Experiments comparing these two incentive strategies have rarely been attempted with physician samples. METHODS: A nationally representative sample of oncologists was recruited to participate in the National Survey of Precision Medicine in Cancer Treatment. To determine the optimal strategy for survey incentives, sample members were randomly assigned to receive a $50 prepaid incentive check or a $50 promised (postpaid) incentive check. Outcome measures for this incentives experiment include cooperation rates, speed of response, check-cashing behavior, and comparison of hypothetical costs for different incentive strategies. RESULTS: Cooperation rates were considerably higher for sample members in the prepaid condition (41%) than in the postpaid condition (29%). Similar differences in cooperation rates were seen for physicians when stratified by region, size of the physician's metropolitan statistical area, specialty, and gender by age. Survey responders in the prepaid condition responded earlier in the field period than those in the postpaid condition, thus requiring fewer contacts. In the prepaid group, 84% of sample members who responded with a completed survey cashed the incentive check and only 6% of nonresponders cashed the check. In the postpaid condition, 72% of survey responders cashed the check; nonresponders were not given a check. The relatively higher cooperation rates and earlier response of the responders in the prepaid condition was associated with a 30% cost savings for the prepaid condition compared to the postpaid incentive condition. CONCLUSIONS: The results of this study suggest that the rewards of offering physicians a prepaid incentive check outweigh the possible risks of nonresponders cashing the check. The relative cost benefit of this strategy is likely to vary depending on the amount of the incentive relative to the costs of additional contact attempts to nonresponders.

State-Specific Prevalence of Tobacco Product Use Among Adults - United States, 2014-2015.

Despite recent declines in cigarette smoking prevalence, the tobacco product landscape has shifted to include emerging tobacco products* (1,2). Previous research has documented adult use of smokeless tobacco and cigarettes by state (3); however, state-specific data on other tobacco products are limited. To assess tobacco product use in the 50 U.S. states and the District of Columbia (DC), CDC and the National Cancer Institute analyzed self-reported use of six tobacco product types: cigarettes, cigars, regular pipes, water pipes, electronic cigarettes (e-cigarettes), and smokeless tobacco products among adults aged ≥18 years using data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Prevalence of ever-use of any tobacco product ranged from 27.0% (Utah) to 55.4% (Wyoming). Current (every day or some days) use of any tobacco product ranged from 10.2% (California) to 27.7% (Wyoming). Cigarettes were the most common currently used tobacco product in all states and DC. Among current cigarette smokers, the proportion who currently used one or more other tobacco products ranged from 11.5% (Delaware) to 32.3% (Oregon). Differences in tobacco product use across states underscore the importance of implementing proven population-level strategies to reduce tobacco use and expanding these strategies to cover all forms of tobacco marketed in the United States. Such strategies could include comprehensive smoke-free policies, tobacco product price increases, anti-tobacco mass media campaigns, and barrier-free access to clinical smoking cessation resources (1,4).

Use of Next-Generation Sequencing Tests to Guide Cancer Treatment: Results From a Nationally Representative Survey of Oncologists in the United States.

Purpose: There are no nationally representative data on oncologists' use of next-generation sequencing (NGS) testing in practice. The purpose of this study was to investigate how oncologists in the United States use NGS tests to evaluate patients with cancer and to inform treatment recommendations. Methods: The study used data from the National Survey of Precision Medicine in Cancer Treatment, which was mailed to a nationally representative sample of oncologists in 2017 (N = 1,281; cooperation rate = 38%). Weighted percentages were calculated to describe NGS test use. Multivariable modeling was conducted to assess the association of test use with oncologist practice characteristics. Results: Overall, 75.6% of oncologists reported using NGS tests to guide treatment decisions. Of these oncologists, 34.0% used them often to guide treatment decisions for patients with advanced refractory disease, 29.1% to determine eligibility for clinical trials, and 17.5% to decide on off-label use of Food and Drug Administration-approved drugs. NGS test results informed treatment recommendations often for 26.8%, sometimes for 52.4%, and never or rarely for 20.8% of oncologists. Oncologists younger than 50 years of age, holding a faculty appointment, having genomics training, seeing more than 50 unique patients per month, and having access to a molecular tumor board were more likely to use NGS tests. Conclusion: In 2017, most oncologists in the United States were using NGS tests to guide treatment decisions for their patients. More research is needed to establish the clinical usefulness of these tests, to develop evidence-based clinical guidelines for their use in practice, and to ensure that patients who can benefit from these new technologies receive appropriate testing and treatment.

An Exploration of Changes in the Measurement of Mammography in the National Health Interview Survey.

Background: Using the National Health Interview Survey (NHIS), we examined the effect of question wording on estimates of past-year mammography among racially/ethnically diverse women ages 40-49 and 50-74 without a history of breast cancer.Methods: Data from one-part ("Have you had a mammogram during the past 12 months?") and two-part ("Have you ever had a mammogram"; "When did you have your most recent mammogram?") mammography history questions administered in the 2008, 2011, and 2013 NHIS were analyzed. χ2 tests provided estimates of changes in mammography when question wording was either the same (two-part question) or differed (two-part question followed by one-part question) in the two survey years compared. Crosstabulations and regression models assessed the type, extent, and correlates of inconsistent responses to the two questions in 2013.Results: Reports of past-year mammography were slightly higher in years when the one-part question was asked than when the two-part question was asked. Nearly 10% of women provided inconsistent responses to the two questions asked in 2013. Black women ages 50 to 74 [adjusted OR (aOR), 1.50; 95% confidence interval (CI), 1.16-1.93] and women ages 40-49 in poor health (aOR, 2.22; 95% CI, 1.09-4.52) had higher odds of inconsistent responses; women without a usual source of care had lower odds (40-49: aOR, 0.42; 95% CI, 0.21-0.85; 50-74: aOR, 0.42; 95% CI, 0.24-0.74).Conclusions: Self-reports of mammography are sensitive to question wording. Researchers should use equivalent questions that have been designed to minimize response biases such as telescoping and social desirability.Impact: Trend analyses relying on differently worded questions may be misleading and conceal disparities. Cancer Epidemiol Biomarkers Prev; 26(11); 1611-8. ©2017 AACR.

Life perceptions of patients receiving palliative care and experiencing psycho-social-spiritual healing.

BACKGROUND: It is important to identify, from the patients' perspectives, the different factors that contribute toward psycho-social-spiritual healing. METHODS: This was a qualitative study that took place at a large research center, an underserved clinic, and a community hospital. We used a needs assessment questionnaire and open-ended questions to assess the constituents of psycho-social-spiritual healing: (I) how previous life experiences affected patients' present situations in dealing with their illnesses; (II) barriers to palliative care, and (III) benefits of palliative care. RESULTS: Of a total of 30 participants from 3 different study sites, 24 (80%) were receiving inpatient or outpatient palliative care at a research center. Thirteen (43%) participants were female, 10 (33%) were Black/African American, and 16 (53%) reported being on disability. While the initial shock of the diagnosis made participants feel unprepared for their illnesses, many looked to role models, previous work experiences, and spiritual as well as religious support as sources of strength and coping mechanisms. Barriers to palliative care were identified as either external (lack of proper resources) or internal (symptom barriers and perceived self-limitations). The feeling of "being seen/being heard" was perceived by many participants as the most beneficial aspect of palliative care. CONCLUSIONS: The needs assessment questionnaire and open-ended questions presented in this study may be used in clinical settings to better help patients achieve psycho-social-spiritual healing through palliative care and to help clinicians learn about the person behind the patient.

Understanding Spanish-Language Response in a National Health Communication Survey: Implications for Health Communication Research.

Spanish-speaking Latinos account for 13% of the U.S. population yet are chronically under-represented in national surveys; additionally, the response quality suffers from low literacy rates and translation challenges. These are the same issues that health communicators face when understanding how best to communicate important health information to Latinos. The Health Information National Trends Survey (HINTS) offers a unique opportunity to understand the health communication landscape and information needs of the U.S. POPULATION: We describe the challenges in recruiting Spanish-speaking HINTS respondents and strategies used to improve rates and quality of responses among Spanish-speaking Latinos. Cognitive interviewing techniques helped to better understand how Spanish-speaking Latinos were interpreting the survey questions, and the extent to which these interpretations matched English-speaking respondents' interpretations. Some Spanish-speaking respondents had difficulty with the questions because of a lack of access to health care. Additionally, Spanish-speaking respondents had a particularly hard time answering questions that were presented in a grid format. We describe the cognitive interview process, and consider the impact of format changes on Spanish-speaking people's responses and response quality. We discuss challenges that remain in understanding health information needs of non-English-speakers.

Semantic Assessment of the Barkin Index of Maternal Functioning in a Medically Underserved Obstetric Population.

PURPOSE: This study aims to evaluate the fitness of the Barkin Index of Maternal Functioning (BIMF) for postpartum functional assessment in a low-income obstetric population in medically underserved, Central Georgia (USA). DESIGN AND METHODS: Cognitive interviewing, a best practices approach to instrument development and validation, was performed on 24 new mothers. FINDINGS: The BIMF was comprehensible to this population of disadvantaged women. PRACTICE IMPLICATIONS: The BIMF has broad appeal due to its comprehensibility, patient-centered assessment style, and psychometric profile. Method of questionnaire administration and characteristics of the study and/or patient population should routinely be considered when implementing any type of self-reported health screening.

Cognitive testing of tobacco use items for administration to patients with cancer and cancer survivors in clinical research.

BACKGROUND: To the authors' knowledge, there are currently no standardized measures of tobacco use and secondhand smoke exposure in patients diagnosed with cancer, and this gap hinders the conduct of studies examining the impact of tobacco on cancer treatment outcomes. The objective of the current study was to evaluate and refine questionnaire items proposed by an expert task force to assess tobacco use. METHODS: Trained interviewers conducted cognitive testing with cancer patients aged ≥21 years with a history of tobacco use and a cancer diagnosis of any stage and organ site who were recruited at the National Institutes of Health Clinical Center in Bethesda, Maryland. Iterative rounds of testing and item modification were conducted to identify and resolve cognitive issues (comprehension, memory retrieval, decision/judgment, and response mapping) and instrument navigation issues until no items warranted further significant modification. RESULTS: Thirty participants (6 current cigarette smokers, 1 current cigar smoker, and 23 former cigarette smokers) were enrolled from September 2014 to February 2015. The majority of items functioned well. However, qualitative testing identified wording ambiguities related to cancer diagnosis and treatment trajectory, such as "treatment" and "surgery"; difficulties with lifetime recall; errors in estimating quantities; and difficulties with instrument navigation. Revisions to item wording, format, order, response options, and instructions resulted in a questionnaire that demonstrated navigational ease as well as good question comprehension and response accuracy. CONCLUSIONS: The Cancer Patient Tobacco Use Questionnaire (C-TUQ) can be used as a standardized item set to accelerate the investigation of tobacco use in the cancer setting. Cancer 2016;122:1728-34. © 2016 American Cancer Society.

Linguistic validation of the Spanish version of the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).

PURPOSE: The U.S. NCI's PRO-CTCAE is a library of self-report items for assessing symptomatic adverse events in cancer clinical trials from the patient perspective. The aim of this study was to translate and linguistically validate a Spanish version. METHODS: PRO-CTCAE's 124 items were translated from English into Spanish using multiple forward and back translations. Native Spanish speakers undergoing cancer treatment were enrolled at six cancer treatment sites. Participants each completed approximately 50 items and were then interviewed using cognitive probes. The interviews were analyzed at the item level by linguistic themes, and responses were examined for evidence of equivalence to English. Items for which ≥20 % of participants experienced difficulties were reviewed, and phrasing was revised and then retested in subsequent interviews. Items where <20 % of respondents experienced difficulties were also reviewed and were considered for rephrasing and retesting. RESULTS: One hundred nine participants from diverse Spanish-speaking countries were enrolled (77 in Round 1 and 32 in Round 2). A majority of items were well comprehended in Round 1. Two items presented difficulties in ≥20 % of participants and were revised/retested without further difficulties. Two items presented difficulties in <20 %, and when retested exhibited no further difficulties. Two items presented difficulties in <20 %, but were not revised due to lack of alternatives. Sixteen items presented difficulties in ≤12 % and were not revised because difficulties were minor. CONCLUSIONS: The Spanish PRO-CTCAE has been developed and refined for use in Spanish-speaking populations, with high levels of comprehension and equivalence to the English PRO-CTCAE. TRIAL REGISTRATION: ClinicalTrials.gov:NCT01436240.

Sources of Interactional Problems in a Survey of Racial/Ethnic Discrimination.

Cross-cultural variability in respondent processing of survey questions may bias results from multiethnic samples. We analyzed behavior codes, which identify difficulties in the interactions of respondents and interviewers, from a discrimination module contained within a field test of the 2007 California Health Interview Survey. In all, 553 (English) telephone interviews yielded 13,999 interactions involving 22 items. Multilevel logistic regression modeling revealed that respondent age and several item characteristics (response format, customized questions, length, and first item with new response format), but not race/ethnicity, were associated with interactional problems. These findings suggest that item function within a multi-cultural, albeit English language, survey may be largely influenced by question features, as opposed to respondent characteristics such as race/ethnicity.

Physicians' personal beliefs about weight-related care and their associations with care delivery: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians.

BACKGROUND: Overweight and obesity are major health risks in the United States (US) and primary care physicians (PCPs) are uniquely positioned to address them. However, their personal beliefs about weight-related care may influence their delivery of care. METHODS: A nationally representative sample of 2022 physicians completed the National Survey of Energy Balance-Related Care among Primary Care Physicians. Physicians responded to questions regarding their beliefs and clinical practices associated with weight control including assessment, counselling, referral and follow-up for diet, physical activity, and weight. Multivariate logistic regression was used to examine associations between physician characteristics and personal beliefs, and associations between personal beliefs and care delivery, adjusting for specialty, age, gender, race, region, urban/rural location, and patient population. RESULTS: Most physicians feel a responsibility (97%) to promote weight-related care, but over half (53%) have concerns about their effectiveness and almost two-thirds feel they lack effective strategies to help patients (63%). Demographics and medical specialty were associated with beliefs (female, Asian-American, Midwest and Southern location, and internal medicine physicians were more likely to have stronger positive beliefs about weight-related care). Personal beliefs about weight-related care were associated with the likelihood of its delivery. However, two practices, regular BMI assessment and referring patients for further evaluation and management, were less related to PCP beliefs than were other care practices. CONCLUSIONS: PCPs' beliefs may be important to their practice of weight-related care. Training in behavioural counselling, and providing physician's tools and resources may help to address their concerns about helping patients with weight-related care.