Publications by authors named "Greta M Massetti"

54 Publications

Prevalence of Adverse Childhood Experiences (ACEs) and associated health risks and risk behaviors among young women and men in Honduras.

Child Abuse Negl 2021 Feb 19;115:104993. Epub 2021 Feb 19.

Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States.

Background: Adverse Childhood Experiences (ACEs) are potentially traumatic childhood events associated with negative health outcomes. Limited data on ACEs exists from low- and middle-income countries (LMICs). No ACEs studies have been done in Honduras.

Objective: This study assessed the prevalence of ACEs in Honduras and associated health risks and risk behaviors among young adults.

Participants And Setting: Data from the 2017 Honduras Violence Against Children and Youth Survey (VACS) were used. Analyses were restricted to participants ages 18-24 years (n = 2701).

Methods: This study uses nationally representative VACS data to estimate the weighted prevalence of ACEs (physical, emotional, and sexual violence; witnessing violence; parental migration). Logistic regression analyses assessed the relationship between individual ACEs, cumulative ACEs, and health risks and risk behaviors (psychological distress; suicide ideation or self-harm; binge drinking; smoking; drug use; STIs; early pregnancy). Chi-square tests examined differences by sex.

Results: An estimated 77 % of 18-24 year olds in Honduras experienced at least 1 ACE and 39 % experienced 3+ ACEs. Women experienced significantly more sexual, emotional, and physical violence compared to men. Compared to youth with no ACEs, those with 1-2 ACEs and 3+ ACEs had 1.8 and 2.8 increased odds for psychological distress, 2.3 and 6.4 increased odds for suicidal ideation and self-harm, and 1.7 and 1.9 increased odds for smoking, respectively, adjusting for age, education, and food insecurity. Physical violence victimization and witnessing violence in the community were associated with increased odds of all health risks and risk behaviors.

Conclusions: The high prevalence of ACEs and associated negative health risks and risk behaviors in this population support the need for prevention and early intervention for ACEs.
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http://dx.doi.org/10.1016/j.chiabu.2021.104993DOI Listing
February 2021

Adoption of Strategies to Mitigate Transmission of COVID-19 During a Statewide Primary Election - Delaware, September 2020.

MMWR Morb Mortal Wkly Rep 2020 Oct 30;69(43):1571-1575. Epub 2020 Oct 30.

Elections occurring during the coronavirus disease 2019 (COVID-19) pandemic have been affected by notable changes in the methods of voting, the number and type of polling locations, and in-person voting procedures (1). To mitigate transmission of COVID-19 at polling locations, jurisdictions have adopted changes to protocols and procedures, informed by CDC's interim guidance, developed in collaboration with the Election Assistance Commission (2). The driving principle for this guidance is that voting practices with lower infection risk will be those which reduce the number of voters who congregate indoors in polling locations by offering a variety of methods for voting and longer voting periods. The guidance for in-person voting includes considerations for election officials, poll workers, and voters to maintain healthy environments and operations. To assess knowledge and adoption of mitigation strategies, CDC collaborated with the Delaware Department of Health and Social Services and the Delaware State Election Commission on a survey of poll workers who served during the statewide primary election on September 15, 2020. Among 522 eligible poll workers, 93% correctly answered all three survey questions about COVID-19 transmission. Respondents noted that most voters and poll workers wore masks. However, masks were not always worn correctly (i.e., covering both the nose and mouth). Responses suggest that mitigation measures recommended for both poll workers and voters were widely adopted and feasible, but also highlighted gaps in infection prevention control efforts. Strengthening of measures intended to minimize the risk of poll workers acquiring COVID-19 from ill voters, such as additional training and necessary personal protective equipment (PPE), as well as support for alternative voting options for ill voters, are needed. Adherence to mitigation measures is important not only to protect voters but also to protect poll workers, many of whom are older adults, and thus at higher risk for severe COVID-19-associated illness. Enhanced attention to reducing congregation in polling locations, correct mask use, and providing safe voting options for ill voters are critical considerations to minimize risk to voters and poll workers. Evidence from the Delaware election supports the feasibility and acceptability of implementing current CDC guidance for election officials, poll workers, and voters for mitigating COVID-19 transmission at polling locations (2).
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http://dx.doi.org/10.15585/mmwr.mm6943e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641001PMC
October 2020

Adoption of Strategies to Mitigate Transmission of COVID-19 During a Statewide Primary Election - Delaware, September 2020.

MMWR Morb Mortal Wkly Rep 2020 Oct 30;69(43):1571-1575. Epub 2020 Oct 30.

Elections occurring during the coronavirus disease 2019 (COVID-19) pandemic have been affected by notable changes in the methods of voting, the number and type of polling locations, and in-person voting procedures (1). To mitigate transmission of COVID-19 at polling locations, jurisdictions have adopted changes to protocols and procedures, informed by CDC's interim guidance, developed in collaboration with the Election Assistance Commission (2). The driving principle for this guidance is that voting practices with lower infection risk will be those which reduce the number of voters who congregate indoors in polling locations by offering a variety of methods for voting and longer voting periods. The guidance for in-person voting includes considerations for election officials, poll workers, and voters to maintain healthy environments and operations. To assess knowledge and adoption of mitigation strategies, CDC collaborated with the Delaware Department of Health and Social Services and the Delaware State Election Commission on a survey of poll workers who served during the statewide primary election on September 15, 2020. Among 522 eligible poll workers, 93% correctly answered all three survey questions about COVID-19 transmission. Respondents noted that most voters and poll workers wore masks. However, masks were not always worn correctly (i.e., covering both the nose and mouth). Responses suggest that mitigation measures recommended for both poll workers and voters were widely adopted and feasible, but also highlighted gaps in infection prevention control efforts. Strengthening of measures intended to minimize the risk of poll workers acquiring COVID-19 from ill voters, such as additional training and necessary personal protective equipment (PPE), as well as support for alternative voting options for ill voters, are needed. Adherence to mitigation measures is important not only to protect voters but also to protect poll workers, many of whom are older adults, and thus at higher risk for severe COVID-19-associated illness. Enhanced attention to reducing congregation in polling locations, correct mask use, and providing safe voting options for ill voters are critical considerations to minimize risk to voters and poll workers. Evidence from the Delaware election supports the feasibility and acceptability of implementing current CDC guidance for election officials, poll workers, and voters for mitigating COVID-19 transmission at polling locations (2).
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http://dx.doi.org/10.15585/mmwr.mm6943e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641001PMC
October 2020

Emotional violence in childhood and health conditions, risk-taking behaviors, and violence perpetration among young adults in Nigeria.

Child Abuse Negl 2020 Aug 21;106:104510. Epub 2020 May 21.

Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria.

Background: Globally, over 1 billion children are victims of violence against children annually. Studies examining the health consequences of childhood violence have mostly focused on childhood physical violence (PV) and sexual violence (SV). Recent evidence suggests that childhood emotional violence (EV) may also be deleterious to the health and wellbeing of victims.

Objective: This study examines the independent association between EV and some health conditions, risk taking behaviors, and violence perpetration among Nigerian young adults ages 18-24 years.

Participants And Setting: Data from 2014 Nigeria Violence Against Children Survey (n = 4,203), a nationally representative cross-sectional survey of individuals ages 13-24 were used.

Methods: Childhood EV was defined as EV victimization before age 18 perpetrated by a parent, adult caregiver or other adult relative. Logistic regression analyses assessed the association between EV in childhood and mental distress in the past 30 days, ever self-harm behaviors and history of sexually transmitted infections; risk behaviors such as having multiple sex partners in the past 12 months; and ever violence perpetration.

Results: After controlling for study covariates, EV in childhood was associated with mental distress in both males and females, and self-harm behaviors in females; excessive alcohol use and infrequent condom use in males, and multiple sexual partners in females; and PV perpetration in males and SV perpetration in females.

Conclusion: EV in childhood is associated with some health conditions, risk taking behaviors, and violence perpetration. Implementing programs that address all forms of violence in childhood, including EV may benefit children.
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http://dx.doi.org/10.1016/j.chiabu.2020.104510DOI Listing
August 2020

Adolescent Opioid Misuse Attributable to Adverse Childhood Experiences.

J Pediatr 2020 09 11;224:102-109.e3. Epub 2020 May 11.

Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.

Objectives: To estimate the proportion of opioid misuse attributable to adverse childhood experiences (ACEs) among adolescents.

Study Design: A cross-sectional survey was administered to 10 546 seventh-to twelfth-grade students in northeastern Ohio in Spring 2018. Study measures included self-reported lifetime exposure to 10 ACEs and past 30-day use of nonmedical prescription opioid or heroin. Using generalized estimating equations, we evaluated associations between recent opioid misuse, individual ACEs, and cumulative number of ACEs. We calculated population attributable fractions to determine the proportion of adolescents' recent opioid misuse attributable to ACEs.

Results: Nearly 1 in 50 adolescents reported opioid misuse within 30 days (1.9%); approximately 60% of youth experienced ≥1 ACE; 10.2% experienced ≥5 ACEs. Cumulative ACE exposure demonstrated a significant graded relationship with opioid misuse. Compared with youth with zero ACEs, youth with 1 ACE (aOR 1.9, 95% CI, 0.9-3.9), 2 ACEs (aOR, 3.8; 95% CI, 1.9-7.9), 3 ACEs (aOR, 3.7; 95% CI, 2.2-6.5), 4 ACEs (aOR, 5.8; 95% CI, 3.1-11.2), and ≥5 ACEs (aOR, 15.3; 95% CI, 8.8-26.6) had higher odds of recent opioid misuse. The population attributable fraction of recent opioid misuse associated with experiencing ≥1 ACE was 71.6% (95% CI, 59.8-83.5).

Conclusions: There was a significant graded relationship between number of ACEs and recent opioid misuse among adolescents. More than 70% of recent adolescent opioid misuse in our study population was attributable to ACEs. Efforts to decrease opioid misuse could include programmatic, policy, and clinical practice interventions to prevent and mitigate the negative effects of ACEs.
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http://dx.doi.org/10.1016/j.jpeds.2020.05.001DOI Listing
September 2020

Violence victimization and negative health correlates of youth in post-earthquake Haiti: Findings from the cross-sectional violence against children survey.

J Affect Disord 2020 06 23;270:59-64. Epub 2020 Mar 23.

Division of Violence Prevention, Centers for Disease Control and Prevention, USA.

Background: We examined the prevalence of and relationships between violence victimization and negative health correlates of Haitian youth exposed to the 2010 earthquake.

Methods: Participants were randomly selected 13-24 year-old youth (1457 females; 1459 males) living in Haiti following the 2010 earthquake. Data collected via Haiti's 2012 Violence against Children Survey (VACS) were analyzed.

Results: Participants reported violence victimization in the past 12 months (females: 49.93%; males: 41.68%), moderate-to-severe mental distress (females: 76.56%; males: 66.41%), and suicidal ideation (females: 26.79%; males: 8.05%). Compared to participants without experiences of violence, victims of violence had significantly higher mean number of sexual partners (females: 1.99, 95% CI: 1.81-2.16, p = .02; males: 4.33, 95% CI: 3.50-5.16, p = .03), mental distress (females: 80.39%, p = .01; males: 72.95%, p = .002), and suicidal ideation (females: 36.09%, p < .0001; males: 12.02%, p < .0001). Male victims of violence were more likely to have sex without a condom (26.02%, p = .01) and female victims of violence were more likely to report histories of STIs (28.04%, p = .01), when compared to participants without history of violence.

Limitations: Data were collected via self-report. Disaster exposure experiences were not assessed. Analysis was correlational and did not control for potential confounding variables.

Conclusions: Disaster-exposed youth endorsed high levels of violence victimization and negative health correlates. Earthquake survivors who experienced violence were more likely to report negative health correlates. Greater attention to downstream sequelae of natural disasters is needed.
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http://dx.doi.org/10.1016/j.jad.2020.03.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359602PMC
June 2020

Randomized Trial of First-Line Behavioral Intervention to Reduce Need for Medication in Children with ADHD.

J Clin Child Adolesc Psychol 2020 Sep-Oct;49(5):673-687. Epub 2019 Aug 14.

Center for Children and Families, Florida International University.

A study conducted in an analogue summer treatment setting showed that when concurrently receiving behavioral intervention, many children with Attention-Deficit Hyperactivity Disorder (ADHD) did not need medication or maximized responsiveness at very low doses. The present study followed participants in that summer study into the subsequent school year to investigate whether the same pattern would extend to the natural school and home settings. There were 127 unmedicated children with ADHD between the ages of 5 and 13 who were randomly assigned to receive or not receive behavioral consultation (BC) at the start of the school year. Children were evaluated by teachers and parents each week to determine if central nervous system stimulant treatment was needed. Children who received BC were approximately half as likely those who did not (NoBC) to initiate medication use each week at school or home and used lower doses when medicated at school. This produced a 40% reduction in total methylphenidate exposure over the course of the school year. BC and NoBC groups did not significantly differ on end-of-year teacher or parent ratings of behavior, which were positive. Moreover, BC and NoBC groups did not significantly differ in cost of treatment; although children in the BC condition accrued additional costs via the BC, these costs were offset by the associated delay and reduction in medication use. Results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.
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http://dx.doi.org/10.1080/15374416.2019.1630835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018583PMC
January 2021

Addressing gaps in global data on violence against children and adolescents.

Lancet Child Adolesc Health 2019 09 2;3(9):587-589. Epub 2019 Jul 2.

Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

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http://dx.doi.org/10.1016/S2352-4642(19)30187-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688961PMC
September 2019

Prevalence of Violence Victimization and Perpetration Among Persons Aged 13-24 Years - Four Sub-Saharan African Countries, 2013-2015.

MMWR Morb Mortal Wkly Rep 2019 Apr 19;68(15):350-355. Epub 2019 Apr 19.

Violence is a major public health and human rights concern, claiming over 1.3 million lives globally each year (1). Despite the scope of this problem, population-based data on physical and sexual violence perpetration are scarce, particularly in low-income and middle-income countries (2,3). To better understand factors driving both children becoming victims of physical or sexual violence and subsequently (as adults) becoming perpetrators, CDC collaborated with four countries in sub-Saharan Africa (Malawi, Nigeria, Uganda, and Zambia) to conduct national household surveys of persons aged 13-24 years to measure experiences of violence victimization in childhood and subsequent perpetration of physical or sexual violence. Perpetration of physical or sexual violence was prevalent among both males and females, ranging among males from 29.5% in Nigeria to 51.5% in Malawi and among females from 15.3% in Zambia to 28.4% in Uganda. Experiencing physical, sexual, or emotional violence in childhood was the strongest predictor for perpetrating violence; a graded dose-response relationship emerged between the number of types of childhood violence experienced (i.e., physical, sexual, and emotional) and perpetration of violence. Efforts to prevent violence victimization need to begin early, requiring investment in the prevention of childhood violence and interventions to mitigate the negative effects of violence experienced by children.
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http://dx.doi.org/10.15585/mmwr.mm6815a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476058PMC
April 2019

Childhood Violence Is Associated with Forced Sexual Initiation Among Girls and Young Women in Malawi: A Cross-Sectional Survey.

J Pediatr 2019 05 6;208:265-272.e1. Epub 2019 Feb 6.

Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Office of the Global AIDS Coordinator, Washington, DC.

Objective: To describe associations between childhood violence and forced sexual initiation in young Malawian females.

Study Design: We analyzed data from 595 women and girls who were 13-24 years old who ever had sex and participated in Malawi's 2013 Violence Against Children Survey, a nationally representative household survey. We estimated the overall prevalence of forced sexual initiation and identified subgroups with highest prevalences. Using logistic regression, we examined childhood violence and other independent predictors of forced sexual initiation.

Results: The overall prevalence of forced sexual initiation was 38.9% among Malawian girls and young women who ever had sex. More than one-half of those aged 13-17 years at time of survey (52.0%), unmarried (64.6%), or experiencing emotional violence in childhood (56.9%) reported forced sexual initiation. After adjustment, independent predictors of forced sexual initiation included being unmarried (aOR, 3.54; 95% CI, 1.22-10.27) and any emotional violence (aOR, 2.47; 95% CI, 1.45-4.24). Those experiencing emotional violence alone (aOR, 3.04; 95% CI: 1.01-9.12), emotional violence in combination with physical or nonpenetrative sexual violence (aOR, 2.50; 95% CI, 1.23-5.09), and emotional violence in combination with physical and nonpenetrative sexual violence (aOR, 2.61; 95% CI, 1.20-5.67) had an increased independent odds of forced sexual initiation.

Conclusions: Experiences of forced sexual initiation are common among Malawian females. Emotional violence is strongly associated with forced sexual initiation, alone and in combination with other forms of childhood violence. The relationship between emotional violence and forced sexual initiation highlights the importance of comprehensive strategies to prevent childhood violence.
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http://dx.doi.org/10.1016/j.jpeds.2018.12.066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486860PMC
May 2019

Sampling design and methodology of the Violence Against Children and Youth Surveys.

Inj Prev 2019 08 24;25(4):321-327. Epub 2018 Nov 24.

Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Introduction: Globally 1 billion children are exposed to violence every year. The Violence Against Children Surveys (VACS) are nationally representative surveys of males and females ages 13-24 that are intended to measure the burden of sexual, physical and emotional violence experienced in childhood, adolescence and young adulthood. It is important to document the methodological approach and design of the VACS to better understand the national estimates that are produced in each country, which are used to drive violence prevention efforts.

Methods: This study describes the surveys' target population, sampling design, statistical considerations, data collection process, priority violence indicators and data dissemination.

Results: Twenty-four national household surveys have been completed or are being planned in countries across Africa, Asia, the Caribbean, Central and South America, and Eastern Europe. The sample sizes range from 891 to 7912 among females (72%-98% response rate) and 803-2717 among males (66%-98% response rate). Two face-to-face interviews are conducted: a Household and an Individual Questionnaire. A standard set of core priority indicators are generated for each country that range from prevalence of different types of violence, contexts, risk and protective factors, and health consequences. Results are disseminated through various platforms to expand the reach and impact of the survey results.

Conclusion: Data obtained through VACS can inform development and implementation of effective prevention strategies and improve health service provision for all who experience violence. VACS serves as a standardised tool to inform and drive prevention through high-quality, comprehensive data.
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http://dx.doi.org/10.1136/injuryprev-2018-042916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534473PMC
August 2019

Strategies to Prevent Obesity-Related Cancer-Reply.

JAMA 2018 06;319(23):2442-2443

Centers for Disease Control and Prevention, Atlanta, Georgia.

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http://dx.doi.org/10.1001/jama.2018.4952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112148PMC
June 2018

Strategies to Prevent Obesity-Related Cancer-Reply.

JAMA 2018 06;319(23):2442-2443

Centers for Disease Control and Prevention, Atlanta, Georgia.

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http://dx.doi.org/10.1001/jama.2018.4952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112148PMC
June 2018

Primary Care Providers' Intended Use of Decision Aids for Prostate-Specific Antigen Testing for Prostate Cancer Screening.

J Cancer Educ 2019 Aug;34(4):666-670

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-76, Atlanta, GA, 30341, USA.

Decision aids are tools intended to help people weigh the benefits and harms of a health decision. We examined primary care providers' perspective on use of decision aids and explored whether providers' beliefs and interest in use of a decision aid was associated with offering the prostate-specific antigen (PSA) test for early detection of prostate cancer. Data were obtained from 2016 DocStyles, an annual, web-based survey of U.S. healthcare professionals including primary care physicians (n = 1003) and nurse practitioners (n = 253). We found that the majority of primary care providers reported not using (patient) decision aids for prostate cancer screening, but were interested in learning about and incorporating these tools in their practice. Given the potential of decision aids to guide in informed decision-making, there is an opportunity for evaluating existing decision aids for prostate cancer screening for clinical use.
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http://dx.doi.org/10.1007/s13187-018-1353-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158108PMC
August 2019

Weight management and physical activity throughout the cancer care continuum.

CA Cancer J Clin 2018 01 22;68(1):64-89. Epub 2017 Nov 22.

Professor of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX.

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
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http://dx.doi.org/10.3322/caac.21441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766382PMC
January 2018

Stakeholder Research Priorities for Smoking Cessation Interventions within Lung Cancer Screening Programs. An Official American Thoracic Society Research Statement.

Am J Respir Crit Care Med 2017 11;196(9):1202-1212

Rationale: Smoking cessation counseling in conjunction with low-dose computed tomography (LDCT) lung cancer screening is recommended in multiple clinical practice guidelines. The best approach for integrating effective smoking cessation interventions within this setting is unknown.

Objectives: To summarize evidence, identify research gaps, prioritize topics for future research, and propose standardized tools for use in conducting research on smoking cessation interventions within the LDCT lung cancer screening setting.

Methods: The American Thoracic Society convened a multistakeholder committee with expertise in tobacco dependence treatment and/or LDCT screening. During an in-person meeting, evidence was reviewed, research gaps were identified, and key questions were generated for each of three research domains: (1) target population to study; (2) adaptation, development, and testing of interventions; and (3) implementation of interventions with demonstrated efficacy. We also identified standardized measures for use in conducting this research. A larger stakeholder panel then ranked research questions by perceived importance in an online survey. Final prioritization was generated hierarchically on the basis of average rank assigned.

Results: There was little consensus on which questions within the population domain were of highest priority. Within the intervention domain, research to evaluate the effectiveness in the lung cancer screening setting of evidence-based smoking cessation interventions shown to be effective in other contexts was ranked highest. In the implementation domain, stakeholders prioritized understanding strategies to identify and overcome barriers to integrating smoking cessation in lung cancer screening settings.

Conclusions: This statement offers an agenda to stimulate research surrounding the integration and implementation of smoking cessation interventions with LDCT lung cancer screening.
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http://dx.doi.org/10.1164/rccm.201709-1858STDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072613PMC
November 2017

Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity - United States, 2005-2014.

MMWR Morb Mortal Wkly Rep 2017 Oct 3;66(39):1052-1058. Epub 2017 Oct 3.

Background: Overweight and obesity are associated with increased risk of at least 13 different types of cancer.

Methods: Data from the United States Cancer Statistics for 2014 were used to assess incidence rates, and data from 2005 to 2014 were used to assess trends for cancers associated with overweight and obesity (adenocarcinoma of the esophagus; cancers of the breast [in postmenopausal women], colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid; meningioma; and multiple myeloma) by sex, age, race/ethnicity, state, geographic region, and cancer site. Because screening for colorectal cancer can reduce colorectal cancer incidence through detection of precancerous polyps before they become cancerous, trends with and without colorectal cancer were analyzed.

Results: In 2014, approximately 631,000 persons in the United States received a diagnosis of a cancer associated with overweight and obesity, representing 40% of all cancers diagnosed. Overweight- and obesity-related cancer incidence rates were higher among older persons (ages ≥50 years) than younger persons; higher among females than males; and higher among non-Hispanic black and non-Hispanic white adults compared with other groups. Incidence rates for overweight- and obesity-related cancers during 2005-2014 varied by age, cancer site, and state. Excluding colorectal cancer, incidence rates increased significantly among persons aged 20-74 years; decreased among those aged ≥75 years; increased in 32 states; and were stable in 16 states and the District of Columbia.

Conclusions: The burden of overweight- and obesity-related cancer is high in the United States. Incidence rates of overweight- and obesity-related cancers except colorectal cancer have increased in some age groups and states.

Implications For Public Health Practice: The burden of overweight- and obesity-related cancers might be reduced through efforts to prevent and control overweight and obesity. Comprehensive cancer control strategies, including use of evidence-based interventions to promote healthy weight, could help decrease the incidence of these cancers in the United States.
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http://dx.doi.org/10.15585/mmwr.mm6639e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720881PMC
October 2017

Excessive Weight Gain, Obesity, and Cancer: Opportunities for Clinical Intervention.

JAMA 2017 Nov;318(20):1975-1976

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

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http://dx.doi.org/10.1001/jama.2017.15519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712448PMC
November 2017

Healthcare Access and Cancer Screening Among Victims of Intimate Partner Violence.

J Womens Health (Larchmt) 2018 05 7;27(5):607-614. Epub 2017 Sep 7.

1 Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .

Background: Intimate partner violence (IPV) victims often experience substantial and persistent mental and physical health problems, including increased risk for chronic disease and barriers to healthcare access. This study investigated the association between IPV and cancer screening.

Materials And Methods: Behavioral Risk Factor Surveillance System data from the eight states and one U.S. territory that administered the optional IPV module in 2006 were analyzed to examine demographic characteristics, health behaviors, health status, healthcare coverage, use of health services, and cancer screening among men and women who reported IPV victimization compared with those among men and women who did not. IPV victimization included physical violence, threats, and sexual violence.

Results: In the nine jurisdictions that administered the IPV module, 23.6% of women and 11.3% of men experienced IPV. Fewer women and men reporting IPV victimization had health insurance, a personal doctor or healthcare provider, or regular checkups within the past 2 years than nonvictims. More male and female IPV victims were current tobacco users and engaged in binge drinking in the past month. IPV victims of both sexes also had poorer health status, lower life satisfaction, less social and emotional support, and more days with poor physical and mental health in the past month than nonvictims. IPV victimization was associated with lower rates of mammography and colorectal cancer screening but not cervical cancer screening in women and was not associated with colorectal cancer screening in men. In multivariable logistic regression results presented as adjusted proportions controlling for demographics, health status, and healthcare access, only the association with mammography screening remained significant, and the magnitude of this association was modest.

Conclusions: There were consistent differences between IPV victims and nonvictims in nearly every measure of healthcare access, health status, and preventive service use. Much of this association seems explained by population characteristics associated with both IPV and lower use of preventive service use, including differences in demographic characteristics, health status, and healthcare access. Healthcare providers could take steps to identify populations at high risk for lack of access or use of preventive services and IPV victimization.
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http://dx.doi.org/10.1089/jwh.2017.6402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842092PMC
May 2018

Cancer Prevention During Early Adulthood: Highlights From a Meeting of Experts.

Am J Prev Med 2017 Sep;53(3S1):S5-S13

Philip R. Lee Institute for Health Policy Studies and Adolescent and Young Adult Health National Resource Center, University of California San Francisco, San Francisco, California.

Using a life course approach, the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control and the National Association of Chronic Disease Directors co-hosted a 2-day meeting with 15 multidisciplinary experts to consider evidence linking factors in early adulthood to subsequent cancer risk and strategies for putting that evidence into practice to reduce cancer incidence. This paper provides an overview of key themes from those meeting discussions, drawing attention to the influence that early adulthood can have on lifetime cancer risk and potential strategies for intervention during this phase of life. A number of social, behavioral, and environmental factors during early adulthood influence cancer risk, including dietary patterns, physical inactivity, medical conditions (e.g., obesity, diabetes, viral infections), circadian rhythm disruption, chronic stress, and targeted marketing of cancer-causing products (e.g., tobacco, alcohol). Suggestions for translating research into practice are framed in the context of the four strategic directions of the National Prevention Strategy: building healthy and safe community environments; expanding quality preventive services in clinical and community settings; empowering people to make healthy choices; and eliminating health disparities. Promising strategies for prevention among young adults include collaborating with a variety of community sectors as well as mobilizing young adults to serve as advocates for change. Young adults are a heterogeneous demographic group, and targeted efforts are needed to address the unique needs of population subgroups that are often underserved and under-represented in research studies.
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http://dx.doi.org/10.1016/j.amepre.2017.04.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890433PMC
September 2017

Mental Health Problems and Cancer Risk Factors Among Young Adults.

Am J Prev Med 2017 Sep;53(3S1):S30-S39

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: Chronic mental health problems often emerge in young adulthood, when adults begin to develop lifelong health behaviors and access preventive health services. The associations between mental health problems and modifiable cancer risk factors in young adulthood are not well understood.

Methods: In 2016, the authors analyzed 2014 Behavioral Risk Factor Surveillance System data on demographic characteristics, health service access and use, health status, and cancer risk factors (tobacco use, alcohol use, overweight or obesity, physical activity, and sleep) for 90,821 young adults aged 18-39 years with mental health problems (depressive disorder or frequent mental distress) compared to other young adults.

Results: Mental health problems were associated with white race; less than a high school education; lower income; being out of work or unable to work; being uninsured (for men only); poor health; previous diagnosis of asthma, skin cancer, or diabetes; and not having a recent checkup. After controlling for demographic characteristics, health service use, and health status, mental health problems among young adults were associated with smoking, binge drinking, inadequate sleep, having no leisure time physical activity, and being overweight or obese (among women only). Cervical cancer screening was not associated with mental health problems after controlling for demographic characteristics, health service use, and health status.

Conclusions: Mental health problems in young adulthood were associated with potentially modifiable factors and behaviors that increase risk for cancer. Efforts to prevent cancer and promote health must attend to mental health disparities to meet the needs of young adults.
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http://dx.doi.org/10.1016/j.amepre.2017.04.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584599PMC
September 2017

Prostate-specific antigen screening: An update of physician beliefs and practices.

Prev Med 2017 Oct 6;103:66-69. Epub 2017 Aug 6.

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA. Electronic address:

PSA testing for early detection of prostate cancer decreased dramatically following the 2012 PSA screening recommendation against routine screening of asymptomatic men. In an assessment of the screening behaviors of primary care providers, the majority (61%) of family medicine and internal medicine practitioners who responded to a 2016 DocStyles online survey (608 of 1003) recommended prostate-specific antigen (PSA) testing based on individual risk or other factors, rather than routinely screening all men for prostate cancer.
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http://dx.doi.org/10.1016/j.ypmed.2017.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737769PMC
October 2017

Invasive Cancer Incidence, 2004-2013, and Deaths, 2006-2015, in Nonmetropolitan and Metropolitan Counties - United States.

MMWR Surveill Summ 2017 07 7;66(14):1-13. Epub 2017 Jul 7.

National Center for Chronic Disease Prevention and Health Promotion, CDC.

Problem/condition: Previous reports have shown that persons living in nonmetropolitan (rural or urban) areas in the United States have higher death rates from all cancers combined than persons living in metropolitan areas. Disparities might vary by cancer type and between occurrence and death from the disease. This report provides a comprehensive assessment of cancer incidence and deaths by cancer type in nonmetropolitan and metropolitan counties.

Reporting Period: 2004-2015.

Description Of System: Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2009-2013 and trends in annual age-adjusted incidence rates for 2004-2013. Cancer mortality data from the National Vital Statistics System were used to calculate average annual age-adjusted death rates for 2011-2015 and trends in annual age-adjusted death rates for 2006-2015. For 5-year average annual rates, counties were classified into four categories (nonmetropolitan rural, nonmetropolitan urban, metropolitan with population <1 million, and metropolitan with population ≥1 million). For the trend analysis, which used annual rates, these categories were combined into two categories (nonmetropolitan and metropolitan). Rates by county classification were examined by sex, age, race/ethnicity, U.S. census region, and cancer site. Trends in rates were examined by county classification and cancer site.

Results: During the most recent 5-year period for which data were available, nonmetropolitan rural areas had lower average annual age-adjusted cancer incidence rates for all anatomic cancer sites combined but higher death rates than metropolitan areas. During 2006-2015, the annual age-adjusted death rates for all cancer sites combined decreased at a slower pace in nonmetropolitan areas (-1.0% per year) than in metropolitan areas (-1.6% per year), increasing the differences in these rates. In contrast, annual age-adjusted incidence rates for all cancer sites combined decreased approximately 1% per year during 2004-2013 both in nonmetropolitan and metropolitan counties.

Interpretation: This report provides the first comprehensive description of cancer incidence and mortality in nonmetropolitan and metropolitan counties in the United States. Nonmetropolitan rural counties had higher incidence of and deaths from several cancers related to tobacco use and cancers that can be prevented by screening. Differences between nonmetropolitan and metropolitan counties in cancer incidence might reflect differences in risk factors such as cigarette smoking, obesity, and physical inactivity, whereas differences in cancer death rates might reflect disparities in access to health care and timely diagnosis and treatment.

Public Health Action: Many cancer cases and deaths could be prevented, and public health programs can use evidence-based strategies from the U.S. Preventive Services Task Force and Advisory Committee for Immunization Practices (ACIP) to support cancer prevention and control. The U.S. Preventive Services Task Force recommends population-based screening for colorectal, female breast, and cervical cancers among adults at average risk for these cancers and for lung cancer among adults at high risk; screening adults for tobacco use and excessive alcohol use, offering counseling and interventions as needed; and using low-dose aspirin to prevent colorectal cancer among adults considered to be at high risk for cardiovascular disease based on specific criteria. ACIP recommends vaccination against cancer-related infectious diseases including human papillomavirus and hepatitis B virus. The Guide to Community Preventive Services describes program and policy interventions proven to increase cancer screening and vaccination rates and to prevent tobacco use, excessive alcohol use, obesity, and physical inactivity.
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http://dx.doi.org/10.15585/mmwr.ss6614a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879727PMC
July 2017

CDC's Public Health Surveillance of Cancer.

Prev Chronic Dis 2017 05 18;14:E39. Epub 2017 May 18.

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Routine data collection efforts are a necessary, often underappreciated, component of nearly all cancer research and prevention efforts. Public health cancer surveillance data are crucial for identifying needs, planning interventions, directing public health resources, and evaluating the overall effectiveness of initiatives aimed at preventing or treating cancer and its negative health consequences. As the nation's health protection agency, the Centers for Disease Control and Prevention (CDC) provides resources for disease surveillance systems to help protect our nation against expensive and dangerous health threats, including cancer. Therefore, public health surveillance is a core function of CDC. In this article we briefly describe CDC's approach to cancer surveillance in our public health programs and other federal initiatives to monitor cancer-related outcomes. We also describe our premier cancer incidence surveillance system, the National Program of Cancer Registries, and discuss uses and applications of the program's critical cancer data.
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http://dx.doi.org/10.5888/pcd14.160480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437769PMC
May 2017

Leading Causes of Death in Nonmetropolitan and Metropolitan Areas- United States, 1999-2014.

MMWR Surveill Summ 2017 Jan 13;66(1):1-8. Epub 2017 Jan 13.

Center for Surveillance, Epidemiology, and Laboratory Services, CDC.

Problem/condition: Higher rates of death in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas have been described but not systematically assessed.

Period Covered: 1999-2014 DESCRIPTION OF SYSTEM: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate age-adjusted death rates and potentially excess deaths for nonmetropolitan and metropolitan areas for the five leading causes of death. Age-adjusted death rates included all ages and were adjusted to the 2000 U.S. standard population by the direct method. Potentially excess deaths are defined as deaths among persons aged <80 years that exceed the numbers that would be expected if the death rates of states with the lowest rates (i.e., benchmark states) occurred across all states. (Benchmark states were the three states with the lowest rates for each cause during 2008-2010.) Potentially excess deaths were calculated separately for nonmetropolitan and metropolitan areas. Data are presented for the United States and the 10 U.S. Department of Health and Human Services public health regions.

Results: Across the United States, nonmetropolitan areas experienced higher age-adjusted death rates than metropolitan areas. The percentages of potentially excess deaths among persons aged <80 years from the five leading causes were higher in nonmetropolitan areas than in metropolitan areas. For example, approximately half of deaths from unintentional injury and chronic lower respiratory disease in nonmetropolitan areas were potentially excess deaths, compared with 39.2% and 30.9%, respectively, in metropolitan areas. Potentially excess deaths also differed among and within public health regions; within regions, nonmetropolitan areas tended to have higher percentages of potentially excess deaths than metropolitan areas.

Interpretation: Compared with metropolitan areas, nonmetropolitan areas have higher age-adjusted death rates and greater percentages of potentially excess deaths from the five leading causes of death, nationally and across public health regions.

Public Health Action: Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas.
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http://dx.doi.org/10.15585/mmwr.ss6601a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829895PMC
January 2017

Disparities in the Context of Opportunities for Cancer Prevention in Early Life.

Pediatrics 2016 Nov;138(Suppl 1):S65-S77

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Persistent health disparities are a major contributor to disproportionate burden of cancer for some populations. Health disparities in cancer incidence and mortality may reflect differences in exposures to risk factors early in life. Understanding the distribution of exposures to early life risk and protective factors for cancer across different populations can shed light on opportunities to promote health equity at earlier developmental stages. Disparities may differentially influence risk for cancer during early life and create opportunities to promote health equity. Potential risk and protective factors for cancer in early life reveal patterns of disparities in their exposure. These disparities in exposures can manifest in downstream disparities in risk for cancer. These risk and protective factors include adverse childhood experiences; maternal alcohol consumption in pregnancy; childhood obesity; high or low birth weight; benzene exposure; use of assisted reproductive technologies; pesticide and insecticide exposure; isolated cryptorchidism; early pubertal timing; exposure to radiation; exposure to tobacco in utero and in early life; allergies, asthma, and atopy; and early exposure to infection. Disparities on the basis of racial and ethnic minority status, economic disadvantage, disability status, sex, geography, and nation of origin can occur in these risk and protective factors. Vulnerable populations experience disproportionally greater exposure to risk factors in early life. Addressing disparities in risk factors in early life can advance opportunities for prevention, promote health equity, and possibly reduce risk for subsequent development of cancer.
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http://dx.doi.org/10.1542/peds.2015-4268JDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161109PMC
November 2016

Foreword: Cancer Prevention Can Start Early and Last a Lifetime.

Pediatrics 2016 11;138(Suppl 1):S1-S2

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

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http://dx.doi.org/10.1542/peds.2015-4268BDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821225PMC
November 2016

CDC Grand Rounds: Family History and Genomics as Tools for Cancer Prevention and Control.

MMWR Morb Mortal Wkly Rep 2016 Nov 25;65(46):1291-1294. Epub 2016 Nov 25.

Although many efforts in cancer prevention and control have routinely focused on behavioral risk factors, such as tobacco use, or on the early detection of cancer, such as colorectal cancer screening, advances in genetic testing have created new opportunities for cancer prevention through evaluation of family history and identification of cancer-causing inherited mutations. Through the collection and evaluation of a family cancer history by a trained health care provider, patients and families at increased risk for a hereditary cancer syndrome can be identified, referred for genetic counseling and testing, and make informed decisions about options for cancer risk reduction (1). Although hereditary cancers make up a small proportion of all cancers, the number of affected persons can be large, and the level of risk among affected persons is high. Two hereditary cancer syndromes for which public health professionals have worked to reduce the burden of morbidity and mortality are hereditary breast and ovarian cancer syndrome (HBOC) and Lynch syndrome.
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http://dx.doi.org/10.15585/mmwr.mm6546a3DOI Listing
November 2016

Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality - United States, 2004-2013.

MMWR Morb Mortal Wkly Rep 2016 Nov 11;65(44):1212-1218. Epub 2016 Nov 11.

Background: Tobacco use causes at least 12 types of cancer and is the leading preventable cause of cancer.

Methods: Data from the United States Cancer Statistics dataset for 2004-2013 were used to assess incidence and death rates and trends for cancers that can be caused by tobacco use (tobacco-related cancers: oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; cervix; and acute myeloid leukemia) by sex, age, race, ethnicity, state, county-level poverty and educational attainment, and cancer site.

Results: Each year during 2009-2013, on average, 660,000 persons in the United States received a diagnosis of a tobacco-related cancer, and 343,000 persons died from these cancers. Tobacco-related cancer incidence and death rates were higher among men than women; highest among black men and women; higher in counties with low proportion of college graduates or high level of poverty; lowest in the West; and differed two-fold among states. During 2004-2013, incidence of tobacco-related cancer decreased 1.3% per year and mortality decreased 1.6% per year, with decreases observed across most groups, but not at the same rate.

Conclusions: Tobacco-related cancer declined during 2004-2013. However, the burden remains high, and disparities persist among certain groups with higher rates or slower declines in rates.

Implications For Public Health Practice: The burden of tobacco-related cancers can be reduced through efforts to prevent and control tobacco use and other comprehensive cancer control efforts focused on reducing cancer risk, detecting cancer early, improving cancer treatments, helping more persons survive cancer, improving cancer survivors' quality of life, and better assisting communities disproportionately impacted by cancer.
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http://dx.doi.org/10.15585/mmwr.mm6544a3DOI Listing
November 2016

Methodological and Design Considerations in Evaluating the Impact of Prevention Programs on Violence and Related Health Outcomes.

Prev Sci 2016 10;17(7):779-84

University of Chicago, Chicago, Illinois, USA.

Drawing on research that has identified specific predictors and trajectories of risk for violence and related negative outcomes, a multitude of small- and large-scale preventive interventions for specific risk behaviors have been developed, implemented, and evaluated. One of the principal challenges of these approaches is that a number of separate problem-specific programs targeting different risk areas have emerged. However, as many negative health behaviors such as substance abuse and violence share a multitude of risk factors, many programs target identical risk factors. There are opportunities to understand whether evidence-based programs can be leveraged for potential effects across a spectrum of outcomes and over time. Some recent work has documented longitudinal effects of evidence-based interventions on generalized outcomes. This work has potential for advancing our understanding of the effectiveness of promising and evidence-based prevention strategies. However, conducting longitudinal follow-up of established interventions presents a number of methodological and design challenges. To answer some of these questions, the Centers for Disease Control and Prevention convened a panel of multidisciplinary experts to discuss opportunities to take advantage of evaluations of early prevention programs and evaluating multiple long-term outcomes. This special section of the journal Prevention Science includes a series of papers that begin to address the relevant considerations for conducting longitudinal follow-up evaluation research. This collection of papers is intended to inform our understanding of the challenges and strategies for conducting longitudinal follow-up evaluation research that could be used to drive future research endeavors.
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http://dx.doi.org/10.1007/s11121-016-0704-xDOI Listing
October 2016