Publications by authors named "Richard P Moser"

126 Publications

Behavioral Research in Cancer Prevention and Control: Emerging Challenges and Opportunities.

J Natl Cancer Inst 2021 Jul 7. Epub 2021 Jul 7.

Chief, Health Communication and Informatics Research Branch, National Cancer Institute.

It is estimated that behaviors such as poor diet, alcohol consumption, tobacco use, sedentary behavior, and excessive ultraviolet exposure account for nearly half of all cancer morbidity and mortality. Accordingly, the behavioral, social, and communication sciences have been important contributors to cancer prevention and control research, with methodological advances and implementation science helping to produce optimally effective interventions. To sustain these contributions, it is vital to adapt to the contemporary context. Efforts must consider ancillary effects of the 2019 coronavirus disease pandemic, profound changes in the information environment and public understanding of and trust in science, renewed attention to structural racism and social determinants of health, and the rapidly increasing population of cancer survivors. Within this context, it is essential to accelerate reductions in tobacco use across all population subgroups; consider new models of energy balance (diet, physical activity, sedentary behavior); increase awareness of alcohol as a risk factor for cancer, and identify better communication practices in the context of cancer-related decisions such as screening and genetic testing. Successful integration of behavioral research and cancer prevention depends on working globally and seamlessly across disciplines, taking a multilevel approach where possible. Methodological and analytic approaches should be emphasized in research training programs and should employ new and underutilized data sources and technologies. As the leadership core of the National Cancer Institute's Behavioral Research Program, we reflect on these challenges and opportunities and consider implications for the next phase of behavioral research in cancer prevention and control.
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http://dx.doi.org/10.1093/jnci/djab139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344826PMC
July 2021

Predictors of Patient-Centered Communication among U.S. Adults: Analysis of the 2017-2018 Health Information National Trends Survey (HINTS).

J Health Commun 2021 01 1;26(1):57-64. Epub 2021 Mar 1.

Behavioral Research Program, Health Communication and Informatics Research Branch, National Cancer Institute, Rockville, MD USA.

An essential component of patient-centered care is the communication between patients and their providers, which can affect patients' health outcomes A cancer care model, developed by Epstein and Street, includes a multi-dimensional patient-centered communication (PCC) framework with six functions: foster healing relationships, exchange information, respond to emotions, manage uncertainty, make decisions, and enable patient self-management. Seven domains that describe the functions were included on the Health Information National Trends Survey (HINTS) to assess PCC. We examined the association between sociodemographic and health-related factors and PCC as well as how U.S. adults, by different age groups, ranked different domains of PCC.Nationally representative data (n = 5,738) from 2017 to 2018 HINTS were merged to examine predictors of PCC among U.S. adults. Weighted statistics describe the study sample and prevalence for ratings of PCC domains. A multivariate linear regression model was computed to assess associations among predictors and PCC.Participants rated their communication with doctors in the last year with an overall mean of 80 out of 100. Older age, those reporting excellent health, and those with higher confidence in taking care of one's health predicted better PCC. Individuals who reported being non-Hispanic Asian and having lower household income were associated with poorer communication. Participants' lowest rating of PCC concentrated on providers dealing with their emotional needs.Findings suggest that many patients do not feel that their providers adequately manage, communicate, nor respond to their emotional needs. Future efforts should enhance interpersonal exchanges among sub-populations who report poorer communication with providers during clinical visits.
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http://dx.doi.org/10.1080/10810730.2021.1878400DOI Listing
January 2021

Trust in Health Information Sources among Underserved and Vulnerable Populations in the U.S.

J Health Care Poor Underserved 2020 ;31(3):1471-1487

The purpose of this study was to examine trust in health information sources among underserved and vulnerable populations. Data (N=8,759) were from the Health Information National Trends Survey. Differences were assessed across the following subgroups: ethnoracial minorities, immigrants, rural residence, people with limited English proficiency, and sexual minorities. Trust was highest for doctors, followed by government, family/friends, charities, and religious organizations. In adjusted regression models, trusting health information from charitable and religious organizations was higher in ethnoracial minorities and immigrants. Individuals with limited English proficiency also had higher trust in religious organizations compared with those fluent in English. Trusting health information from doctors was lower among individuals with limited English proficiency. There was evidence in support of additive and multiplicative intersectional frameworks for understanding trust in vulnerable and underserved populations; however, the extent to which differences in trust explain disparities in health behaviors and outcomes should be examined.
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http://dx.doi.org/10.1353/hpu.2020.0106DOI Listing
September 2021

Perceptions of cancer as a death sentence: Tracking trends in public perceptions from 2008 to 2017.

Psychooncology 2021 04 4;30(4):511-519. Epub 2020 Dec 4.

Behavioral Research Program, National Cancer Institute (Retired), Honolulu, Hawaii, USA.

Objective: There has been steady progress in reducing cancer mortality in the United States; however, this progress hasn't been evenly distributed across regions. This paper assesses trends in cancer mortality salience (CMS), that is, agreeing that getting cancer is a death sentence, over time in the United States and examines correlates of CMS.

Methods: Data from three administrations of the Health Information National Trends Survey (HINTS), gathered in 2008, 2013, and 2017, were merged, resulting in a total sample of 10,063 respondents. Trends in changes in CMS over time were examined as well as maps of the distribution of CMS in the United States. A logistic regression model was conducted, regressing CMS on a set of sociodemographic, psychological, health-related, and environmental predictors.

Results: The aggregated percentage of US adults who agreed with the CMS statement changed over time and was modified by age. Geographic distribution of agreement with CMS was inconsistent across the United States. In the adjusted logistic model, perceived health (worse health), cancer prevention, fatalism, and confusion, and cancer status (no cancer) were all significantly associated with CMS. There was also a significant interaction between survey year and age.

Conclusion: Despite recent information that cancer mortality rates are decreasing, most US adults still see cancer as a death sentence and this is especially an issue in certain subgroups. These findings have ramifications for groups of people who may be at risk for developing cancer given their attitudes and beliefs that there isn't much they can do to prevent or control it.
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http://dx.doi.org/10.1002/pon.5596DOI Listing
April 2021

Associations of Prostate-Specific Antigen (PSA) Testing in the US Population: Results from a National Cross-Sectional Survey.

J Community Health 2021 04 16;46(2):389-398. Epub 2020 Oct 16.

Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.

Prostate-specific antigen (PSA) testing is one of the standard screening methods for prostate cancer (PC); however, a high proportion of men with abnormal PSA findings lack evidence for PC and may undergo unnecessary treatment. Furthermore, little is known about the prevalence of PSA testing for US men, after the US Preventive Services Task Force (USPSTF) recommended against routine PSA screening in 2012. Our objectives were to: (1) examine the self-reported patterns of PSA testing following a change in the USPSTF prostate cancer screening recommendations and (2) to determine the associated socio-demographic factors. Data were from the 2010 and 2015 National Health Interview Surveys. Men were ages ≥ 40 years and responded to the question "Ever had a PSA test?". Multivariable logistic regression was used to examine PSA testing prevalence in 2010 and 2015, and their associated socio-demographic factors. The analytic sample contained 15,372 men. A majority (75.2%) identified as non-Hispanic (NHW) and 14.2% were foreign-born. Those surveyed in 2015 were less likely to report ever having had a PSA test when compared to those in 2010. Compared to US-born and older NHW men, PSA testing was statistically significantly lower among foreign-born men and men belonging to all other racial categories. Fewer men reported PSA testing following the USPSTF 2012 recommendations. Associated socio-demographic factors included nativity, age, race/ethnicity, educational attainment and type of health insurance. Further studies are required to elucidate our findings and their health implications for the US native and foreign-born population.
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http://dx.doi.org/10.1007/s10900-020-00923-8DOI Listing
April 2021

Patient Reports of Involvement in Health Care Decisions: Falling Short of Healthy People 2020 Objectives.

J Health Commun 2020 06 31;25(6):484-489. Epub 2020 Aug 31.

Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, Maryland, USA.

The Healthy People 2020 (HP 2020) initiative delineates objectives for improving population health in the United States. The National Cancer Institute's Health Information National Trends Survey (HINTS) has served as an important data source for tracking several HP 2020 Health Communication and Health Information Technology objectives, including patient perceptions of involvement in health-care decisions. We analyzed data from six cross-sectional administrations of HINTS (2008 to 2017; N = 25,410) to assess progress toward the HP 2020 objective of increasing the proportion of persons reporting that their health-care providers always involved them in decisions about their health care. In each survey year, just over half the population (range = 51.6 to 54.6) reported that their health-care providers always involved them in health-care decisions; the observed percentages over a 10-year period remained below the HP 2020 goal of 56.8% and did not show significant improvement. Results show a lack of progress toward this HP 2020 goal despite increased attention to patient engagement in health care over the last several decades.
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http://dx.doi.org/10.1080/10810730.2020.1806413DOI Listing
June 2020

Characterizing the US Population by Patterns of Mobile Health Use for Health and Behavioral Tracking: Analysis of the National Cancer Institute's Health Information National Trends Survey Data.

J Med Internet Res 2020 05 14;22(5):e16299. Epub 2020 May 14.

Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, United States.

Background: Multiple types of mobile health (mHealth) technologies are available, such as smartphone health apps, fitness trackers, and digital medical devices. However, despite their availability, some individuals do not own, do not realize they own, or own but do not use these technologies. Others may use mHealth devices, but their use varies in tracking health, behaviors, and goals. Examining patterns of mHealth use at the population level can advance our understanding of technology use for health and behavioral tracking. Moreover, investigating sociodemographic and health-related correlates of these patterns can provide direction to researchers about how to target mHealth interventions for diverse audiences.

Objective: The aim of this study was to identify patterns of mHealth use for health and behavioral tracking in the US adult population and to characterize the population according to those patterns.

Methods: We combined data from the 2017 and 2018 National Cancer Institute Health Information National Trends Survey (N=6789) to characterize respondents according to 5 mutually exclusive reported patterns of mHealth use for health and behavioral tracking: (1) mHealth nonowners and nonusers report not owning or using devices to track health, behaviors, or goals; (2) supertrackers track health or behaviors and goals using a smartphone or tablet plus other devices (eg, Fitbit); (3) app trackers use only a smartphone or tablet; (4) device trackers use only nonsmartphone or nontablet devices and do not track goals; and (5) nontrackers report having smartphone or tablet health apps but do not track health, behaviors, or goals.

Results: Being in the mHealth nonowners and nonusers category (vs all mHealth owners and users) is associated with males, older age, lower income, and not being a health information seeker. Among mHealth owners and users, characteristics of device trackers and supertrackers were most distinctive. Compared with supertrackers, device trackers have higher odds of being male (odds ratio [OR] 2.22, 95% CI 1.55-3.19), older age (vs 18-34 years; 50-64 years: OR 2.83, 95% CI 1.52-5.30; 65+ years: OR 6.28, 95% CI 3.35-11.79), have an annual household income of US $20,000 to US $49,999 (vs US $75,000+: OR 2.31, 95% CI 1.36-3.91), and have a chronic condition (OR 1.69, 95% CI 1.14-2.49). Device trackers also have higher odds of not being health information seekers than supertrackers (OR 2.98, 95% CI 1.66-5.33).

Conclusions: Findings revealed distinctive sociodemographic and health-related characteristics of the population by pattern of mHealth use, with notable contrasts between those who do and do not use devices to track goals. Several characteristics of individuals who track health or behaviors but not goals (device trackers) are similar to those of mHealth nonowners and nonusers. Our results suggest patterns of mHealth use may inform how to target mHealth interventions to enhance reach and facilitate healthy behaviors.
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http://dx.doi.org/10.2196/16299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256752PMC
May 2020

Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study.

Gynecol Oncol 2020 01 21;156(1):131-139. Epub 2019 Nov 21.

Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, 10065, USA. Electronic address:

Background: Risk-reducing salpingo-oophorectomy (RRSO) and ovarian cancer screening (OCS) are management options for women at increased risk of ovarian cancer. Long-term effects of these interventions on quality of life (QOL) are not well understood.

Methods: GOG-0199 is a prospective cohort study of women at increased ovarian cancer risk who chose either RRSO or OCS as their risk management intervention. At study entry, 6, 12, 24 and 60 months of follow-up, participants completed the QOL questionnaire, which included the Medical Outcome Study Short Form-36, the Impact of Events Scales, the Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory, the Functional Assessment of Cancer Therapy - Endocrine Subscale, and the Sexual Activity Questionnaire. QOL measures were compared between the RRSO and OCS cohort at baseline and over time.

Results: Five-hundred-sixty-two participants in the RRSO cohort and 1,010 in the OCS completed the baseline and at least one follow-up questionnaire. At baseline, participants selecting RRSO reported lower health-related QOL (HRQOL), greater ovarian cancer-related stress, greater anxiety, and more depressive symptomatology, which improved during follow-up, especially for ovarian cancer-related stress. Screening was not found to adversely impact HRQOL. Hormone-related menopausal symptoms worsened and sexual functioning declined during follow-up in both cohorts, but more so among participants who underwent RRSO.

Conclusions: HRQOL improved after surgery among women who chose RRSO and remained stable among participants undergoing screening. The adverse effects of RRSO and screening on short-term and long-term sexual activity and sexual functioning warrant consideration in the decision-making process for high-risk women.
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http://dx.doi.org/10.1016/j.ygyno.2019.10.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980744PMC
January 2020

Online Health Information Seeking Among US Adults: Measuring Progress Toward a Healthy People 2020 Objective.

Public Health Rep 2019 Nov/Dec;134(6):617-625. Epub 2019 Sep 12.

Division of Cancer Control and Population Sciences, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA.

Objective: During the past decade, the availability of health information online has increased dramatically. We assessed progress toward the Healthy People 2020 (HP2020) health communication and health information technology objective of increasing the proportion of health information seekers who easily access health information online.

Methods: We used data from 4 administrations of the Health Information National Trends Survey (HINTS 2008-2017) (N = 18 103). We conducted multivariable logistic regression analysis to evaluate trends over time in experiences with accessing health information and to examine differences by sociodemographic variables (sex, age, race/ethnicity, education, income, metropolitan status) separately for those who used the internet (vs other information sources) during their most recent search for health information.

Results: Among US adults who looked for health information and used the internet for their most recent search, the percentage who reported accessing health information without frustration was stable during the study period (from 37.2% in 2008 to 38.5% in 2017). Accessing information online without frustration was significantly and independently associated with age 35-49 (vs age 18-34) (odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.03 -1.73), non-Hispanic black (vs non-Hispanic white) race/ethnicity (OR = 2.15; 95% CI, 1.55-2.97), and annual household income <$20 000 (vs >$75 000) (OR = 0.66; 95% CI, 0.47-0.93). The percentage of adults who used an information source other than the internet and reported accessing health information online without frustration ranged from 31.3% in 2008 to 42.7% in 2017. Survey year 2017 (vs 2008) (OR = 1.61; 95% CI, 1.09-2.35) and high school graduate education (vs college graduate) (OR = 0.69; 95% CI, 0.49-0.97) were significantly and independently associated with accessing health information without frustration from sources other than the internet.

Conclusions: The percentage of online health information seekers reporting easily accessing health information did not meet the HP2020 objective. Continued efforts are needed to enable easy access to online health information among diverse populations.
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http://dx.doi.org/10.1177/0033354919874074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832079PMC
February 2020

A divalent siRNA chemical scaffold for potent and sustained modulation of gene expression throughout the central nervous system.

Nat Biotechnol 2019 08 2;37(8):884-894. Epub 2019 Aug 2.

RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, MA, USA.

Sustained silencing of gene expression throughout the brain using small interfering RNAs (siRNAs) has not been achieved. Here we describe an siRNA architecture, divalent siRNA (di-siRNA), that supports potent, sustained gene silencing in the central nervous system (CNS) of mice and nonhuman primates following a single injection into the cerebrospinal fluid. Di-siRNAs are composed of two fully chemically modified, phosphorothioate-containing siRNAs connected by a linker. In mice, di-siRNAs induced the potent silencing of huntingtin, the causative gene in Huntington's disease, reducing messenger RNA and protein throughout the brain. Silencing persisted for at least 6 months, with the degree of gene silencing correlating to levels of guide strand tissue accumulation. In cynomolgus macaques, a bolus injection of di-siRNA showed substantial distribution and robust silencing throughout the brain and spinal cord without detectable toxicity and with minimal off-target effects. This siRNA design may enable RNA interference-based gene silencing in the CNS for the treatment of neurological disorders.
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http://dx.doi.org/10.1038/s41587-019-0205-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879195PMC
August 2019

Sociodemographic correlates of cancer fatalism and the moderating role of religiosity: Results from a nationally-representative survey.

J Prev Interv Community 2020 Jan-Mar;48(1):29-46. Epub 2019 Jul 11.

Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA.

In general, it has been found that cancer fatalism is negatively associated with important cancer prevention and control behaviors, whereas religiosity is positively associated with these behaviors. Yet, the notion that religiosity gives rise to fatalistic beliefs that may discourage health behaviors is deeply ingrained in the public health literature. In addition, racial/ethnic group membership is associated with higher reports of cancer fatalism, though this association may be confounded by socioeconomic status (SES). A better understanding of the relationships between racial/ethnic group membership, SES, and religiosity may contribute to the development of effective interventions to address cancer fatalism and improve health behaviors. In this study, we examined associations between racial/ethnic group membership, SES, and cancer fatalism as the outcome. In addition, we tested whether religiosity (as measured by religious service attendance) moderated these relationships.
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http://dx.doi.org/10.1080/10852352.2019.1617521DOI Listing
July 2021

Tracking Healthy People 2020 Internet, Broadband, and Mobile Device Access Goals: An Update Using Data From the Health Information National Trends Survey.

J Med Internet Res 2019 06 24;21(6):e13300. Epub 2019 Jun 24.

National Cancer Institute, National Institutes of Health, Rockville, MD, United States.

Background: As the year 2020 approaches, there is a need to evaluate progress toward the United States government's Healthy People 2020 (HP2020) health information technology and communication objectives to establish baselines upon which Healthy People 2030 objectives can be based.

Objective: The aim of this study was to use the National Cancer Institute's (NCI) Health Information National Trends Survey (HINTS) to benchmark progress toward HP2020 goals related to increasing internet access using broadband, and to assess the state of the digital divide for various sociodemographic groups.

Methods: We merged and analyzed data from 8 administrations of HINTS (2003-2017). Descriptive statistics were generated, and predicted marginals were calculated using interaction terms between survey year and selected sociodemographic variables of interest, including age, sex, race and ethnicity, income, education, and geography (rural versus urban), to test for differential change over time.

Results: The number of users having access to the internet increased between 2003 and 2014 (63.15% [3982/6358] to 83.41% [2802/3629]); it remained relatively steady from 2014 to 2017 (81.15% [2533/3283]). Broadband access increased between 2003 and 2011 (from 32.83% [1031/3352] to 77.87% [3375/4405]), but has been declining since (55.93% [1364/2487] in 2017). Access via cellular network increased between 2008 and 2017 (from 6.86% [240/4405] to 65.43% [1436/2489]). Statistically significant disparities in overall internet access were noted in the predicted marginals for age, sex, race and ethnicity, income, and education; for age, sex, income, and geography for broadband access; and for age and sex for cellular network.

Conclusions: The targets set forth in HP2020 were met for overall internet access and for internet access via cellular network; however, the target was not met for internet access via broadband. Furthermore, although the digital divide persisted by sociodemographic characteristics, the magnitude of many disparities in access decreased over time.
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http://dx.doi.org/10.2196/13300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613328PMC
June 2019

Cancer Symptom Recognition and Anticipated Delays in Seeking Care Among U.S. Adults.

Am J Prev Med 2019 07 23;57(1):e1-e9. Epub 2019 May 23.

Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.

Introduction: Early stage diagnosis strongly predicts cancer survival. Recognition of potential symptoms of cancer may improve survival by reducing time to seeking care.

Methods: Telephone interviews with a population-representative sample of English-speaking adults (aged ≥50 years) in the U.S. (N=1,425) were conducted in 2014 using an instrument adapted from the International Cancer Benchmarking Partnership Awareness and Beliefs about Cancer survey. Anticipated time to seeking care for four cancer symptoms (persistent cough, rectal bleeding, mole changes, and breast changes) was assessed, and delay was defined as waiting >2 weeks. Recognition of symptoms as potential cancer signs was assessed dichotomously. Multivariate logistic regression models were used to assess associations between symptom recognition and anticipated delay, adjusting for demographics, cancer experience, self-reported health, and healthcare access. Analyses were weighted and conducted in 2017.

Results: Symptom recognition varied but was relatively high across all symptoms (76.9%-95.5%). Anticipated delay varied by symptom and was highest for persistent cough (41.2%) and lowest for rectal bleeding (9.1%). For rectal bleeding (AOR=2.65, 95% CI=1.31, 5.36) and mole changes (AOR=3.30, 95% CI=1.48, 7.33), anticipated delay was more likely among individuals who did not recognize the symptom as a warning sign. Adults with lower education levels (p<0.05) and African Americans (p<0.05) were less likely to delay for some symptoms.

Conclusions: Lack of symptom recognition was associated with anticipated delay in seeking care for some cancer symptoms. Differences in recognition and delays by symptom could be driven partly by screening messaging or by ambiguity and functional impact of each symptom.
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http://dx.doi.org/10.1016/j.amepre.2019.02.021DOI Listing
July 2019

Consensus-Building efforts to identify best tools for screening and assessment for supportive services in oncology.

Disabil Rehabil 2020 07 19;42(15):2178-2185. Epub 2019 Feb 19.

ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.

To build consensus around an optimal patient-reported outcome measure of cancer symptoms and patient needs to facilitate patient-provider communication and trigger referrals to supportive services. The Grid-Enabled Measures platform was used to crowdsource and facilitate collaboration to achieve consensus. Respondents were invited to nominate and independently rate the usefulness of measures that: (1) have been actively used at a healthcare institution, (2) have a multiple choice or yes/no type format, (3) are applicable to adults with cancer, (4) are patient-reported, and 5) have psychometric data if possible. Discussion boards within the GEM workspace allowed respondents to identify barriers to implementing patient assessment and referral systems. 166 individuals from various disciplines from 25 organizations participated. Six instruments were nominated, and 553 rating surveys were submitted. The three most highly-rated overall instruments were the Distress Thermometer, the James Supportive Case Screening, and the Functional Assessment of Cancer Therapy-General. Participants noted that wide-scale implementation of this process requires both identifying problems and providing clinicians with algorithms to facilitate appropriate referrals. Consensus reported three most highly-related measures as optimal for comprehensive screening and identification for referral by assessing multiple domains of functioning and quality of life.Implications for RehabilitationGaining consensus on the best patient reported outcome measures is an important step towards improving access to cancer rehabilitation services.A consensus agreed on several measures to use for cancer rehabilitation screening. Functional Assessment of Cancer Therapy-General, National Comprehensive Cancer. Network Distress Thermometer and the James Instrument.The selected measures do not put undue burden on clinicians and patients.
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http://dx.doi.org/10.1080/09638288.2018.1555621DOI Listing
July 2020

National Trends in Human Papillomavirus Awareness and Knowledge of Human Papillomavirus-Related Cancers.

Am J Prev Med 2019 04 14;56(4):e117-e123. Epub 2019 Feb 14.

Behavioral Research Program, National Cancer Institute, Bethesda, Maryland.

Introduction: The President's Cancer Panel released a report in 2014 calling for communication strategies to promote the human papillomavirus vaccine among males and females. The purpose of this study was to (1) estimate changes in human papillomavirus awareness and knowledge of human papillomavirus-related cancers from 2014 to 2017 using a nationally representative survey of adults in the U.S. and (2) identify differences in population subgroups that showed significant changes in human papillomavirus awareness and knowledge of human papillomavirus-related cancers.

Methods: Data were from the Health Information National Trends Survey (2014 and 2017 surveys). Health Information National Trends Survey is a cross-sectional, nationally representative survey of non-institutionalized adults (aged ≥18 years) in the U.S. Human papillomavirus awareness was assessed with one item indicating aware or never heard of human papillomavirus. Human papillomavirus-related cancer knowledge was assessed with four items asking if human papillomavirus can cause cervical, anal, oral, or penile cancer (responses coded yes/no or not sure).

Results: The majority (64%, SE=1.4) were aware of human papillomavirus. Awareness was higher among females and the vaccine-eligible subpopulation. No change in awareness was observed. Knowledge of cervical cancer was high (78%), but low for anal (26%); oral (30%); and penile (30%) cancers. Cervical cancer knowledge significantly increased among females, and anal cancer knowledge increased among college graduates and non-vaccine eligible subgroups. No other increases in human papillomavirus-related cancer knowledge were observed.

Conclusions: The general public was moderately aware of human papillomavirus, but associated human papillomavirus with cervical cancer. Knowledge of non-cervical human papillomavirus-related cancers is low, even among vaccine-eligible subgroups. Public health education is needed to raise awareness of non-cervical human papillomavirus-related cancers.
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http://dx.doi.org/10.1016/j.amepre.2018.11.005DOI Listing
April 2019

Adeno-Associated Virus Neutralizing Antibodies in Large Animals and Their Impact on Brain Intraparenchymal Gene Transfer.

Mol Ther Methods Clin Dev 2018 Dec 4;11:65-72. Epub 2018 Oct 4.

Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester, MA 01605, USA.

Pre-existing neutralizing antibody (NAb) against adeno-associated virus (AAV) commonly found in primates is a major host barrier that can severely compromise gene transfer by AAV vectors. To achieve proof-of-concept success in clinical development of recombinant AAV (rAAV)-based gene therapy, it is crucial to consider the potential interference of NAb and to enroll serologically compatible study subjects. In this study, we report a large AAV NAb dataset comprising multiple large animal species and AAV serotypes and compare two NAb assays based on or transduction inhibition, respectively. Together with previously published AAV seroepidemiology studies, these data can serve as a reference for selecting suitable serotypes, study subjects of large animal species, and potentially human patients for rAAV treatment. In addition, we modeled the intrathalamus rAAV9 delivery in the presence of circulating anti-AAV9 NAb generated by either pre-immunization or passive transfer of NAb-positive large animal serum to mice. The data showed that circulating NAb may not be the sole determinant to inhibit brain transduction. Other aspects of pre-existing AAV immunity following natural infection or rAAV administration may be further studied to establish a more accurate inclusion criterion for clinical studies employing intraparenchymal rAAV9 injections.
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http://dx.doi.org/10.1016/j.omtm.2018.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205343PMC
December 2018

Tobacco Use Among Adults by Sexual Orientation: Findings from the Population Assessment of Tobacco and Health Study.

LGBT Health 2018 01;5(1):33-44

1 Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, Maryland.

Purpose: The aim of this study was to characterize lifetime tobacco use across two measures of sexual orientation and six types of tobacco products.

Methods: We conducted a cross-sectional analysis of the Population Assessment of Tobacco and Health (Wave 1, 2013-2014, USA) to estimate the prevalence of tobacco use (cigarettes, e-cigarettes, cigars, pipes, hookah, and smokeless) stratified by gender (men/women), age (< 25/≥ 25 years old), and sexual orientation. Sexual orientation was operationalized as sexual identity and sexual attraction.

Results: Younger lesbian/gay and bisexual women had higher relative odds of experimental use of all six tobacco products compared to heterosexual women, whereas lesbian/gay and bisexual women in both age groups had higher odds of regular use of cigarettes, e-cigarettes, cigars, and hookah than heterosexual women. Younger gay men (but not older gay men) had higher relative odds of experimental and regular use of cigarettes compared to heterosexual men. Older gay men had higher odds of experimental e-cigarette and hookah use, but lower odds of regular cigar and experimental/regular smokeless tobacco use. Measures of sexual orientation identity and sexual attraction resulted in similar estimates of tobacco use with noted differences in those who identified as "something else," as well as among those who indicated asexual attraction.

Conclusion: Our findings reflect a complex relationship between sexual orientation and tobacco use. Gender-based and product-specific approaches to tobacco prevention and control efforts are needed to address the high use of tobacco among sexual minority women.
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http://dx.doi.org/10.1089/lgbt.2017.0175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802250PMC
January 2018

Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis.

J Med Internet Res 2017 06 2;19(6):e188. Epub 2017 Jun 2.

Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States.

Background: In the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC.

Objective: The aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public's use of ePHRs varies across subpopulations, including those with MCC.

Methods: This study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models.

Results: Those with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03).

Conclusions: We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC.
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http://dx.doi.org/10.2196/jmir.7417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473948PMC
June 2017

A Nonresponse Bias Analysis of the Health Information National Trends Survey (HINTS).

J Health Commun 2017 07 30;22(7):545-553. Epub 2017 May 30.

b Behavioral Research Program, Division of Cancer Control and Population Sciences , National Cancer Institute, National Institutes of Health , Bethesda , Maryland , USA.

We conducted a nonresponse bias analysis of the Health Information National Trends Survey (HINTS) 4, Cycles 1 and 3, collected in 2011 and 2013, respectively, using three analysis methods: comparison of response rates for subgroups, comparison of estimates with weighting adjustments and external benchmarks, and level-of-effort analysis. Areas with higher concentrations of low socioeconomic status, higher concentrations of young households, and higher concentrations of minority and Hispanic populations had lower response rates. Estimates of health information seeking behavior were higher in HINTS compared to the National Health Interview Survey (NHIS). The HINTS estimate of doctors always explaining things in a way that the patient understands was not significantly different from the same estimate from the Medical Expenditure Panel Survey (MEPS); however, the HINTS estimate of health professionals always spending enough time with the patient was significantly lower than the same estimate from MEPS. A level-of-effort analysis found that those who respond later in the survey field period were less likely to have looked for information about health in the past 12 months, but found only small differences between early and late respondents for the majority of estimates examined. There is some evidence that estimates from HINTS could be biased toward finding higher levels of health information seeking.
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http://dx.doi.org/10.1080/10810730.2017.1324539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6114127PMC
July 2017

Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience.

World Neurosurg 2017 Aug 17;104:407-410. Epub 2017 May 17.

Solidarity Bridge, Evanston, Illinois, USA; Rosalind Franklin Medical School, Rush University Medical Center, Chicago, Illinois, USA.

Background: The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting.

Methods: In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness.

Results: Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount.

Conclusion: The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery.
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http://dx.doi.org/10.1016/j.wneu.2017.05.046DOI Listing
August 2017

Public use of electronic personal health information: Measuring progress of the Healthy People 2020 Objectives.

Health Policy Technol 2017 Mar 20;6(1):33-39. Epub 2016 Aug 20.

Department of Psychiatry, Brigham and Women's Hospital, Boston, MA.

Use of the internet for seeking and managing health information in the U.S., Europe, and emerging and developing nations is growing. Recent global trends indicate more interactive uses of the internet including online communication with providers. In the U.S., The Healthy People 2020 (HP2020) initiative was created by the Department of Health and Human Services to provide 10-year goals for improving the health of American citizens. Two goals of HP2020 were to increase the proportion of individuals who use the Internet to keep track of their personal health information (PHI) online and to increase the proportion of individuals who use the internet to communicate with their healthcare provider. In the present study, we use data from the seven administrations of the Health Information National Trends Survey (HINTS) to assess progress towards these goals. These data were analyzed using descriptive, bivariate, and logistic regression analytic techniques. Results of this study suggested that the HP2020 target of having 15.7% of individuals manage their PHI online by 2020 has already been exceeded (28.1%); similarly, the goal for proportion of individuals communicating with their provider using the internet (15.0%) was exceeded by 2014 (29.7%). While progress towards these goals was positive in all sociodemographic groups for both goals, differences in the rate of progress were seen by gender, race/ethnicity, income, and education, but not by age group. The rapidly increasing proportion of individuals globally who use the internet to manage their health information provides unique opportunities for patient-centered health information technology interventions.
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http://dx.doi.org/10.1016/j.hlpt.2016.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415302PMC
March 2017

Susceptibility to Food Advertisements and Sugar-Sweetened Beverage Intake in Non-Hispanic Black and Non-Hispanic White Adolescents.

J Community Health 2017 Aug;42(4):748-756

National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850-9761, USA.

Obesity among adolescents in the United States has risen by 16% in the past 30 years. One important contributing factor may be the increased consumption of sugar sweetened beverages (SSBs), which is encouraged by advertisements for unhealthy foods and drinks that are targeted to adolescents. The purpose of this analysis was to determine the association between susceptibility to food and drink advertisements and sugar-sweetened beverage (SSB) consumption in non-Hispanic black (NHB) and non-Hispanic white (NHW) adolescents and to examine if BMI is associated with SSB consumption. Data were obtained from 765 NHB and NHW of ages 14-17 who were surveyed in the Family Life, Activity, Sun, Health, and Eating study sponsored by the National Cancer Institute. Two weighted adjusted logistic regression models were conducted. The first examined the associations of advertisement susceptibility, race, and BMI with SSB consumption. The second examined the associations of race and BMI with advertisement susceptibility. Adolescents with high advertisement susceptibility were more likely to consume at least one SSB daily (OR 1.73, 95% CI 1.21, 2.47). Additionally, non-Hispanic blacks were more likely to consume at least one SSB daily (OR 1.75, 95% CI 1.08, 2.85) and more likely to be highly susceptible to advertisements (OR 1.72, 95% CI 1.19, 2.48) than non-Hispanic whites. No significant associations were found between BMI and advertising susceptibility or BMI and daily SSB consumption. One approach to addressing the consumption of SSBs may be to reduce advertising that markets unhealthy food and beverages to adolescents and minorities.
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http://dx.doi.org/10.1007/s10900-016-0313-4DOI Listing
August 2017

Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study.

Gynecol Oncol 2017 04 10;145(1):122-129. Epub 2017 Feb 10.

Center for Health Policy Research, University of California, Irvine, Irvine, CA 92697, United States. Electronic address:

Objectives: Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated.

Methods: Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS.

Results: Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p<0.0001), more likely to carry deleterious BRCA1/2 mutations (p<0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as >50%, both higher than objective risk estimates.

Conclusions: Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
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http://dx.doi.org/10.1016/j.ygyno.2017.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359045PMC
April 2017

Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States.

J Rural Health 2018 02 11;34 Suppl 1:s30-s38. Epub 2017 Jan 11.

Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Purpose: The increase in use of health information technologies (HIT) presents new opportunities for patient engagement and self-management. Patients in rural areas stand to benefit especially from increased access to health care tools and electronic communication with providers. We assessed the adoption of 4 HIT tools over time by rural or urban residency.

Methods: Analyses were conducted using data from 7 iterations of the National Cancer Institute's Health Information National Trends Survey (HINTS; 2003-2014). Rural/urban residency was based on the USDA's 2003 Rural-Urban Continuum Codes. Outcomes of interest included managing personal health information online; whether providers maintain electronic health records (EHRs); e-mailing health care providers; and purchasing medicine online. Bivariate analyses and logistic regression were used to assess relationships between geography and outcomes, controlling for sociodemographic characteristics.

Findings: In total, 6,043 (17.6%, weighted) of the 33,749 respondents across the 7 administrations of HINTS lived in rural areas. Rural participants were less likely to report regular access to Internet (OR = 0.70, 95% CI = 0.61-0.80). Rural respondents were neither more nor less likely to report that their health care providers maintained EHRs than were urban respondents; however, they had decreased odds of managing personal health information online (OR = 0.59, 95% CI = 0.40-0.78) and e-mailing health care providers (OR = 0.62, 95% CI = 0.49-0.77).

Conclusions: The digital divide between rural and urban residents extends to HIT. Additional investigation is needed to determine whether the decreased use of HIT may be due to lack of Internet connectivity or awareness of these tools.
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http://dx.doi.org/10.1111/jrh.12228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505819PMC
February 2018

Progress on Broadband Access to the Internet and Use of Mobile Devices in the United States.

Public Health Rep 2017 Jan/Feb;132(1):27-31. Epub 2016 Dec 9.

2 Health Communication and Informatics Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.

Healthy People 2020 (HP2020) aims to improve population health outcomes through several objectives, including health communication and health information technology. We used 7 administrations of the Health Information National Trends Survey to examine HP2020 goals toward access to the Internet through broadband and mobile devices (N = 34 080). We conducted descriptive analyses and obtained predicted marginals, also known as model-adjusted risks, to estimate the association between demographic characteristics and use of mobile devices. The HP2020 target (7.7% of the US population) for accessing the Internet through a cellular network was surpassed in 2014 (59.7%), but the HP2020 target (83.2%) for broadband access fell short (63.8%). Sex and age were associated with accessing the Internet through a cellular network throughout the years (Wald F test, P <.05). The increase in the percentage of people accessing the Internet through mobile devices presents an opportunity for technology-based health interventions that should be explored.
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http://dx.doi.org/10.1177/0033354916679365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298494PMC
July 2017

Rationale, Procedures, and Response Rates for the 2015 Administration of NCI's Health Information National Trends Survey: HINTS-FDA 2015.

J Health Commun 2016 12 28;21(12):1269-1275. Epub 2016 Nov 28.

a Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences , National Cancer Institute, National Institutes of Health , Bethesda , Maryland , USA.

The National Cancer Institute (NCI) developed the Health Information National Trends Survey (HINTS) to monitor population trends in cancer communication practices, information preferences, health risk behaviors, attitudes, and cancer knowledge. The U.S. Food and Drug Administration (FDA) recognized HINTS as a unique data resource for informing its health communication endeavors and partnered with NCI to field HINTS-FDA 2015. HINTS-FDA 2015 was a self-administered paper instrument sent by mail May 29 to September 8, 2015, using a random probability-based sample of U.S. postal addresses stratified by county-level smoking rates, with an oversampling of high and medium-high smoking strata to increase the yield of current smokers responding to the survey. The response rate for HINTS-FDA 2015 was 33% (N = 3,738). The yield of current smokers (n = 495) was lower than expected, but the sampling strategy achieved the goal of obtaining more former smokers (n = 1,132). Public-use HINTS-FDA 2015 data and supporting documentation have been available for download and secondary data analyses since June 2016 at http://hints.cancer.gov . NCI and FDA encourage the use of HINTS-FDA for health communication research and practice related to tobacco-related communications, public knowledge, and behaviors as well as beliefs and actions related to medical products and dietary supplements.
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http://dx.doi.org/10.1080/10810730.2016.1242672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5141516PMC
December 2016

Trends in cancer survivors' experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS).

J Cancer Surviv 2016 12 19;10(6):1067-1077. Epub 2016 May 19.

Improving Health Systems, Patient-Centered Outcomes Research Institute, Washington, DC, USA.

Purpose: Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, and exchanging information, represent a central aspect of survivors' care experience that has not been systematically investigated.

Methods: Nationally representative data from four administrations of the Health Information National Trends Survey (HINTS) was merged with combined replicate weights using the jackknife replication method. Linear and logistic regression models were used to assess (1) characteristics of cancer survivors (N = 1794) who report suboptimal patient-centered communication and (2) whether survivors' patient-centered communication experience changed from 2007 to 2013.

Results: One third to one half of survivors report suboptimal patient-centered communication, particularly on core functions of providers helping manage uncertainty (48 %) and responding to emotions (49 %). In a fully adjusted linear regression model, survivors with more education (Wald F = 2.84, p = .04), without a usual source of care (Wald F = 11.59, p < .001), and in poorer health (Wald F = 9.08, p < .001) were more likely to report less patient-centered communication. Although ratings of patient-centered communication improved over time (p trend = .04), this trend did not remain significant in fully adjusted models.

Conclusions: Despite increased attention to survivorship, many survivors continue to report suboptimal communication with their health care providers.

Implications For Cancer Survivors: Survivorship communication should include managing uncertainty about future risk and address survivors' emotional needs. Efforts to improve patient-centered communication should focus on survivors without a usual source of care and in poorer health.
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http://dx.doi.org/10.1007/s11764-016-0550-7DOI Listing
December 2016

Advancing Cancer Prevention and Behavior Theory in the Era of Big Data.

J Cancer Prev 2016 Sep 30;21(3):201-206. Epub 2016 Sep 30.

National Cancer Institute, Rockville, MD, USA.

The era of "Big Data" presents opportunities to substantively address cancer prevention and control issues by improving health behaviors and refining theoretical models designed to understand and intervene in those behaviors. Yet, the terms "model" and "Big Data" have been used rather loosely, and clarification of these terms is required to advance the science in this area. The objectives of this paper are to discuss conceptual definitions of the terms "model" and "Big Data", as well as examine the promises and challenges of Big Data to advance cancer prevention and control research using behavioral theories. Specific recommendations for harnessing Big Data for cancer prevention and control are offered.
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http://dx.doi.org/10.15430/JCP.2016.21.3.201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051595PMC
September 2016

10-Pound Weight Loss and Lower Abdominal Pain.

Mil Med 2016 08;181(8):724-5

Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.

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http://dx.doi.org/10.7205/MILMED-D-16-00070DOI Listing
August 2016
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