Publications by authors named "Steven Sutton"

137 Publications

A randomized wait-list controlled trial of a social support intervention for caregivers of patients with primary malignant brain tumor.

BMC Health Serv Res 2021 Apr 17;21(1):360. Epub 2021 Apr 17.

Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.

Background: Informal family caregivers constitute an important and increasingly demanding role in the cancer healthcare system. This is especially true for caregivers of patients with primary malignant brain tumors based on the rapid progression of disease, including physical and cognitive debilitation. Informal social network resources such as friends and family can provide social support to caregivers, which lowers caregiver burden and improves overall quality of life. However, barriers to obtaining needed social support exist for caregivers. To address this need, our team developed and is assessing a multi-component caregiver support intervention that uses a blend of technology and personal contact to improve caregiver social support.

Methods: We are currently conducting a prospective, longitudinal 2-group randomized controlled trial which compares caregivers who receive the intervention to a wait-list control group. Only caregivers directly receive the intervention, but the patient-caregiver dyads are enrolled so we can assess outcomes in both. The 8-week intervention consists of two components: (1) The electronic Social Network Assessment Program, a web-based tool to visualize existing social support resources and provide a tailored list of additional resources; and (2) Caregiver Navigation, including weekly phone sessions with a Caregiver Navigator to address caregiver social support needs. Outcomes are assessed by questionnaires completed by the caregiver (baseline, 4-week, 8-week) and the cancer patient (baseline, and 8-week). At 8 weeks, caregivers in the wait-list condition may opt into the intervention. Our primary outcome is caregiver well-being; we also explore patient well-being and caregiver and patient health care utilization.

Discussion: This protocol describes a study testing a novel social support intervention that pairs a web-based social network visualization tool and resource list (eSNAP) with personalized caregiver navigation. This intervention is responsive to a family-centered model of care and calls for clinical and research priorities focused on informal caregiving research.

Trial Registration: clinicaltrials.gov , Registration number: NCT04268979 ; Date of registration: February 10, 2020, retrospectively registered.
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http://dx.doi.org/10.1186/s12913-021-06372-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052543PMC
April 2021

A Bayesian transition model for missing longitudinal binary outcomes and an application to a smoking cessation study.

Stat Modelling 2020 Jun 4;20(3):310-338. Epub 2019 Mar 4.

Department of Health Outcomes and Behaviour, Moffitt Cancer Center, Tampa, FL, USA.

Smoking cessation intervention studies often produce data on smoking status at discrete follow-up assessments, often with missing data in different amounts at each assessment. Smoking status in these studies is a dynamic process with individuals transitioning from smoking to abstinent, as well as abstinent to smoking, at different times during the intervention. Directly assessing transitions provides an opportunity to answer important questions like 'Does the proposed intervention help smokers remain abstinent or quit smoking more effectively than other interventions?' In this article, we model changes in smoking status and examine how interventions and other covariates affect the transitions. We propose a Bayesian approach for fitting the transition model to the observed data and impute missing outcomes based on a logistic model, which accounts for both missing at random (MAR) and missing not at random (MNAR) mechanisms. The proposed Bayesian approach treats missing data as additional unknown quantities and samples them from their posterior distributions. The performance of the proposed method is investigated through simulation studies and illustrated by data from a randomized controlled trial of smoking cessation interventions. Finally, posterior predictive checking and log pseudo marginal likelihood (LPML) are used to assess model assumptions and perform model comparisons, respectively.
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http://dx.doi.org/10.1177/1471082x18821489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043653PMC
June 2020

Abstinence-related motivational engagement for smoking cessation: Longitudinal patterns and predictive validity.

PLoS One 2021 4;16(3):e0247867. Epub 2021 Mar 4.

Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America.

The Abstinence-Related Motivational Engagement (ARME) scale was developed to assess motivation to remain abstinent after a smoking cessation attempt. The ARME demonstrated reliability and validity among a small sample of ex-smokers. This study expands the psychometric evaluation of the ARME and tests the ARME as a predictor of smoking status among a sample of participants quitting smoking. The parent trial tested the efficacy of a self-help smoking cessation intervention (N = 1874), with assessments every 6 months. Internal consistency and factor structure of the ARME was evaluated at each assessment to confirm use of the measure as designed. Discriminant validity was assessed by comparing the ARME to the Situation-specific Abstinence Self-Efficacy (SSE) scale via inter-correlations and prediction of future smoking status. Finally, the trajectories of both the ARME and SSE were compared among continuous abstainers and continuous smokers. A single-factor structure was observed at each assessment. Cronbach's alphas ranged from 0.88-0.91 for the total sample. Correlations between the ARME and the SSE ranged from 0.38-0.47 (ps <0.001) among smokers; and from 0.09-0.15 (most ps > 0.05) among abstainers. Among current smokers, the ARME and SSE were independent positive predictors of subsequent abstinence (AORs 1.28-2.29, ps <0.001). For those currently abstinent, only the SSE predicted subsequent abstinence (AORs 1.69-2.60, ps <0.05). GEE analyses showed different trajectories for the two measures, as well as between abstainers and smokers. In conclusion, the ARME is a reliable, valid measure with unique predictive utility for current smokers and a distinct trajectory among those who have successfully quit.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247867PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932153PMC
March 2021

Smoking Cessation Using Wearable Sensors: Protocol for a Microrandomized Trial.

JMIR Res Protoc 2021 Feb 24;10(2):e22877. Epub 2021 Feb 24.

Moffitt Cancer Center, Tampa, FL, United States.

Background: Cigarette smoking has numerous health consequences and is the leading cause of morbidity and mortality in the United States. Mindfulness has the ability to enhance resilience to stressors and can strengthen an individual's ability to deal with discomfort, which may be particularly useful when managing withdrawal and craving to smoke.

Objective: This study aims to evaluate feasibility results from an intervention that provides real-time, real-world mindfulness strategies to a sample of racially and ethnically diverse smokers making a quit attempt.

Methods: This study uses a microrandomized trial design to deliver mindfulness-based strategies in real time to individuals attempting to quit smoking. Data will be collected via wearable sensors, a study smartphone, and questionnaires filled out during the in-person study visits.

Results: Recruitment is complete, and data management is ongoing.

Conclusions: The data collected during this feasibility trial will provide preliminary findings about whether mindfulness strategies delivered in real time are a useful quit smoking aid that warrants additional investigation.

Trial Registration: Clinicaltrials.gov NCT03404596; https://clinicaltrials.gov/ct2/show/NCT03404596.

International Registered Report Identifier (irrid): DERR1-10.2196/22877.
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http://dx.doi.org/10.2196/22877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946584PMC
February 2021

Augmented Reality for Smoking Cessation: Development and Usability Study.

JMIR Mhealth Uhealth 2020 12 31;8(12):e21643. Epub 2020 Dec 31.

Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States.

Background: The recent widespread availability of augmented reality via smartphone offers an opportunity to translate cue exposure therapy for smoking cessation from the laboratory to the real world. Despite significant reductions in the smoking rates in the last decade, approximately 13.7% of the adults in the United States continue to smoke. Smoking-related cue exposure has demonstrated promise as an adjuvant therapy in the laboratory, but practical limitations have prevented its success in the real world. Augmented reality technology presents an innovative approach to overcome these limitations.

Objective: The aim of this study was to develop a smartphone app that presents smoking-related augmented reality images for cue exposure. Smokers provided feedback on the images and reported on the perceived urge to smoke, qualities of reality/coexistence, and general feedback about quality and functioning. The feedback was used to refine the augmented reality images within the app.

Methods: In collaboration with an augmented reality design company, we developed 6 smoking-related images (cigarette, lighter, ashtray, lit cigarette in ashtray, etc) and 6 neutral images similar in size or complexity for comparison (pen, eraser, notebook, soda bottle with droplets, etc). Ten smokers completed a survey of demographic characteristics, smoking history and behavior, dependence on nicotine, motivation to quit smoking, and familiarity with augmented reality technology. Then, participants viewed each augmented reality image and provided ratings on 10-point Likert scales for urge to smoke and reality/coexistence of the image into the scene. Participants were also queried with open-ended questions regarding the features of the images.

Results: Of the 10 participants, 5 (50%) had experienced augmented reality prior to the laboratory visit, but only 4 of those 5 participants used augmented reality at least weekly. Although the sample was small (N=10), smokers reported significantly higher urge to smoke after viewing the smoking-related augmented reality images (median 4.58, SD 3.49) versus the neutral images (median 1.42, SD 3.01) (Z=-2.14, P=.03; d=0.70). The average reality and coexistence ratings of the images did not differ between smoking-related and neutral images (all P>.29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting).

Conclusions: All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed.
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http://dx.doi.org/10.2196/21643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808889PMC
December 2020

Testing Augmented Reality for Eliciting Cue-Provoked Urges to Smoke: Toward Moving Cue-Exposure Into the Real World.

Nicotine Tob Res 2021 May;23(5):861-865

Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.

Background: Cue exposure for extinguishing conditioned urges to smoking cues has been promising in the laboratory, but difficult to implement in natural environments. The recent availability of augmented reality (AR) via smartphone provides an opportunity to overcome this limitation. Testing the ability of AR to elicit cue-provoked urges to smoke (ie, cue reactivity [CR]) is the first step to systemically testing the efficacy of AR for cue exposure therapy.

Objectives: To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues.

Methods: A 2 × 2 within-subject design comparing cue content (smoking vs. neutral) and presentation modality (AR vs. in vivo) on urge response. Seventeen smokers viewed six smoking-related and six neutral cues via AR smartphone app and also six smoking and six neutral in vivo cues. Participants rated their urge to smoke and reality/co-existence of the cue.

Results: Average urge to smoke was higher following smoking-related AR images (Median = 7.50) than neutral images (Median = 3.33) (Z = -3.44; p = .001; d = 1.37). Similarly, average urge ratings for in vivo smoking-related cues (Median = 8.12) were higher than for neutral cues (Median = 2.12) (Z = -3.44; p = .001; d = 1.64). Also, greater CR was observed for in vivo cues than for AR cues (Z = -2.67, p = .008; d = .36). AR cues were generally perceived as being realistic and well-integrated.

Conclusions: CR was demonstrated with very large effect sizes in response to AR smoking cues, although slightly smaller than with in vivo smoking cues. This satisfies the first criterion for the potential use of AR for exposure therapy.

Implications: This study introduces AR as a novel modality for presenting smoking-related stimuli to provoke cue reactivity, and ultimately to conduct extinction-based therapy. AR cues presented via a smartphone have the advantage over other modes of cue presentation (pictures, virtual reality, in vivo, etc.) of being easily transportable, affordable, and realistic, and they can be inserted in a smokers' natural environment rather than being limited to laboratory and clinic settings. These AR features may overcome the generalizability barriers of other methods, thus increasing clinical utility for cue exposure therapies.
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http://dx.doi.org/10.1093/ntr/ntaa259DOI Listing
May 2021

Development of a mindfulness-based treatment for smoking cessation and the modification of alcohol use: A protocol for a randomized controlled trial and pilot study findings.

Contemp Clin Trials 2021 Jan 14;100:106218. Epub 2020 Nov 14.

Moffitt Cancer Center, USA; University of South Florida, USA. Electronic address:

The combined use of cigarettes and alcohol is associated with an increased risk of morbidity and mortality. Yet, efficacious interventions that address both behaviors concurrently are lacking. Smoking cessation and alcohol modification not only garner health benefits, but there is also value in addressing alcohol use in the context of smoking cessation to reduce the risk for smoking relapse. In this paper we describe the development of mindfulness-based relapse prevention for smoking cessation and alcohol modification (MBRP-SA) and pilot study findings (Phase 1). Next, details regarding the methods and design of an ongoing, randomized controlled trial, Project RISE (Phase 2), are described. MBRP-SA is a group-based intervention that consists of eight weekly treatment sessions. Results from the Phase 1 pilot study (N = 21 enrolled) indicated that participants planned to use the skills learned in their everyday activities and to address their smoking and alcohol goals. Based on the progression of Phase 1 cohorts, modifications were made to the inclusion/exclusion criteria and recruitment methods that will be implemented in Phase 2. Phase 2 will assess the feasibility and acceptability of MBRP-SA, delivered via live online groups, as a primary treatment option for smoking cessation and alcohol use modification.
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http://dx.doi.org/10.1016/j.cct.2020.106218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887009PMC
January 2021

Facilitating smoking cessation using reduced nicotine cigarettes: Intervention development and RCT study design.

Contemp Clin Trials 2020 Nov 8;98:106172. Epub 2020 Oct 8.

Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States of America; Department of Psychology, University of South Florida, Tampa, FL, United States of America. Electronic address:

Smoking cigarettes with substantially lower nicotine than conventional cigarettes prior to a quit attempt may reduce the reinforcing effects of smoking, which could facilitate smoking cessation through extinction learning. This paper describes the development of a smoking cessation intervention designed to optimize extinction processes using reduced nicotine cigarettes, as well as the design and methods for an ongoing randomized controlled trial (RCT) to evaluate this intervention. Qualitative methods and pilot testing were conducted to develop the novel facilitated extinction (FE) intervention, with a key focus on maximizing opportunities for extinction learning during a five-week pre-quit period. The primary aims of the RCT are to test the effects of the FE intervention versus a standard (cognitive-behavioral) intervention, while also comparing two nicotine reduction schedules for providing very low nicotine content (VLNC) cigarettes. The efficacy of the intervention is currently being evaluated with treatment-seeking smokers (n = 208) randomly assigned to one of four conditions crossing FE versus standard intervention with immediate versus gradual transition to VLNC cigarettes.
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http://dx.doi.org/10.1016/j.cct.2020.106172DOI Listing
November 2020

Oncologists' experiences caring for LGBTQ patients with cancer: Qualitative analysis of items on a national survey.

Patient Educ Couns 2021 Apr 22;104(4):871-876. Epub 2020 Sep 22.

Departments of Obstetrics and Gynecology and Population Health, New York University Grossman School of Medicine, New York, NY, USA; Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA. Electronic address:

Objectives: Sexual and gender minority (SGM) individuals experience cancer-related health disparities and reduced quality of cancer care compared to the general population in part due to a lack of knowledgeable providers. This study explored oncologists' experiences and perspectives in providing patient-centered care for SGM individuals with cancer.

Methods: We conducted a qualitative analysis of oncologists' responses to four open-ended items on a national survey eliciting their experiences, reservations, and suggestions in treating SGM patients.

Results: Over 50 % of the 149 respondents of the national survey responded to at least one open-ended item. Many oncologists reported positive experiences reflecting personal growth and affirmative care practices, such as open, non-judgmental communication, compassion, competence, and supporting patients' identity. There was a notable lack of experience with transgender patients in particular. Lack of knowledge, interpersonal communication concerns (e.g., fear of offending patients), and microaggressions ("don't ask, don't tell") were identified as barriers to providing affirming care.

Conclusions: Oncologists recognize their knowledge deficits and need strategies to overcome communication barriers and microaggressions among the cancer care team to provide SGM-affirming care.

Practice Implications: Curricula are needed to train oncologists in SGM healthcare needs and affirming communication skills to facilitate patient-centered care for SGM individuals with cancer.
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http://dx.doi.org/10.1016/j.pec.2020.09.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982350PMC
April 2021

Preventing smoking relapse in patients with cancer: A randomized controlled trial.

Cancer 2020 Dec 9;126(23):5165-5172. Epub 2020 Sep 9.

Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.

Background: Abstaining from smoking after a cancer diagnosis is critical to mitigating the risk of multiple adverse health outcomes. Although many patients with cancer attempt to quit smoking, the majority relapse. The current randomized controlled trial evaluated the efficacy of adapting an evidence-based smoking relapse prevention (SRP) intervention for patients with cancer.

Methods: The trial enrolled 412 patients newly diagnosed with cancer who had recently quit smoking. Participants were randomized to usual care (UC) or SRP. Participants in the UC group received the institution's standard of care for treating tobacco use. Participants in the SRP group in addition received a targeted educational DVD plus a validated self-help intervention for preventing smoking relapse. The primary outcome was smoking abstinence at 2 months, 6 months, and 12 months.

Results: Abstinence rates for participants in the SRP and UC groups were 75% versus 71% at 2 months and 69% versus 64% at 6 months (Ps > .20). At 12 months, abstinence rates among survivors were 68% for those in the SRP group and 63% for those in the UC group (P = .38). Post hoc analyses revealed that across 2 months and 6 months, patients who were married/partnered were more likely to be abstinent after SRP than UC (P = .03).

Conclusions: A smoking relapse prevention intervention did not reduce relapse rates overall, but did appear to have benefited those participants who had the social support of a partner. Future work is needed to extend this effect to the larger population of patients.
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http://dx.doi.org/10.1002/cncr.33162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771373PMC
December 2020

Comparing Methods of Recruiting Spanish-Preferring Smokers in the United States: Findings from a Randomized Controlled Trial.

J Med Internet Res 2020 08 14;22(8):e19389. Epub 2020 Aug 14.

Tobacco Research & Intervention Program, Department of Health Outcomes & Behavior, Moffitt Cancer Center & Research Institute, Tampa, FL, United States.

Background: There is a pressing need to address the unacceptable disparities and underrepresentation of racial and ethnic minority groups, including Hispanics or Latinxs, in smoking cessation trials.

Objective: Given the lack of research on recruitment strategies for this population, this study aims to assess effective recruitment methods based on enrollment and cost.

Methods: Recruitment and enrollment data were collected from a nationwide randomized controlled trial (RCT) of a Spanish-language smoking cessation intervention (N=1417). The effectiveness of each recruitment strategy was evaluated by computing the cost per participant (CPP), which is the ratio of direct cost over the number enrolled. More effective strategies yielded lower CPPs. Demographic and smoking-related characteristics of participants recruited via the two most effective strategies were also compared (n=1307).

Results: Facebook was the most effective method (CPP=US $74.12), followed by TV advertisements (CPP=US $191.31), whereas public bus interior card advertising was the least effective method (CPP=US $642.50). Participants recruited via Facebook had lower average age (P=.008) and had spent fewer years in the United States (P<.001). Among the participants recruited via Facebook, a greater percentage of individuals had at least a high school education (P<.001) and an annual income above US $10,000 (P<.001). In addition, a greater percentage of individuals were employed (P<.001) and foreign born (P=.003). In terms of subethnicity, among the subjects recruited via Facebook, a lower percentage of individuals were of Mexican origin (P<.001) and a greater percentage of individuals were of Central American (P=.02), South American (P=.01), and Cuban (P<.001) origin.

Conclusions: Facebook was the most effective method for recruiting Hispanic or Latinx smokers in the United States for this RCT. However, using multiple methods was necessary to recruit a more diverse sample of Spanish-preferring Hispanic or Latinx smokers.
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http://dx.doi.org/10.2196/19389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455877PMC
August 2020

A survey of oncology advanced practice providers' knowledge and attitudes towards sexual and gender minorities with cancer.

J Clin Nurs 2020 Aug 11;29(15-16):2953-2966. Epub 2020 May 11.

H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.

Aims And Objectives: To evaluate the knowledge and attitudes towards sexual and gender minority (SGM) oncology patients' needs among advanced practice providers (APPs).

Background: SGM individuals experience health disparities, in part due to lack of access to knowledgeable providers. Despite the important role of APPs in cancer care, less is known about their attitudes and knowledge towards SGM cancer patients.

Design: Cross-sectional study.

Methods: A survey of APPs at a National Cancer Institute-Designated Comprehensive Cancer Center assessed self-reported demographics, attitudes, knowledge and postsurvey confidence in knowledge of SGM oncology patient needs. Reporting of this study adheres to STROBE guidelines.

Results: Knowledge of health needs was low with an average of 2.56 (SD = 1.27) items answered correctly out of 6. The majority of APPs self-reported being comfortable treating SGM patients (93.6% and 87.2%, respectively), but less confident in knowledge of their health needs (68.0% and 53.8%, respectively). Although less than half of APPs believed education should be mandatory (44.9%), 79.5% were interested in education about SGMs' unique health needs. Political affiliation, medical specialty, licensure, and having SGM friends or family were associated with various attitude items, but not knowledge. Moderation analyses indicated that APPs who had greater overall knowledge scores were more likely to agree, on average, that knowing sexual orientation, gender identity and sex assigned at birth are important to providing quality oncology care.

Conclusion: APPs report being comfortable providing care for SGMs with cancer, but knowledge gaps remain that may inhibit the quality of care provided. Given the interest in education, results would support the development of SGM-related healthcare training for oncology APPs.

Relevance To Clinical Practice: Targeted education for providers during training and continuing education is likely to improve the provision of quality care for SGMs with cancer.
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http://dx.doi.org/10.1111/jocn.15302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771380PMC
August 2020

Use of biomarker testing in lung cancer among Puerto Rico and Florida Physicians: Results of a comparative study.

J Clin Pathw 2019 Oct;5(8):33-40

Departments of OB-GYN, Population Health and Center for Medical Ethics, New York University School of Medicine, New York, NY.

Background: Lung cancer biomarker-driven therapies are the gold standard of treatment and recent studies suggest a higher prevalence of specific targetable biomarkers among Hispanic/Latinos (H/L) than Non-Hispanic Whites (NHW). The study aimed (1) to identify Florida (FL) and Puerto Rico (PR) physicians' knowledge and perceived value of newer genomic data regarding race/ethnicity in relation to optimal lung cancer treatment and survival; and (2) to identify modifiable practice barriers both across and within each location regarding biomarker testing in lung cancer.

Methods: A 25-item survey was administered to a stratified random sample of physicians in FL and PR (medical oncologists, radiation oncologists, pulmonologists, and pathologists). Questions targeted domains of biomarker knowledge, attitudes toward testing, barriers, and practice behaviors regarding lung cancer biomarker testing.

Results: The response rate was 45%. Participants identified guiding treatment decisions (82%) and personalizing treatments for patients (78%) as key benefits to mutation testing. PR physicians were more likely (p=0.022) to believe H/L had an elevated incidence of targetable epidermal growth factor receptor () mutations compared to NHW. They also perceived lack of appropriate testing resources as a primary barrier compared to FL physicians (43.6% vs. 20.6%, p<0.001), whereas FL physicians identified mutation tests not conducted routinely as part of patient diagnosis as a primary barrier (43.1% vs 24.2%, p= 0.008).

Conclusions: Practice behaviors differed by specialty and between locations, and differences were noted concerning physician's preferences for ordering mutation testing, indicating a clear need for education among physicians in both locations.

Impact: Educating physicians regarding biomarker testing is imperative to improve patient care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953751PMC
October 2019

Pharmacologic Characterization of JNJ-42226314, [1-(4-Fluorophenyl)indol-5-yl]-[3-[4-(thiazole-2-carbonyl)piperazin-1-yl]azetidin-1-yl]methanone, a Reversible, Selective, and Potent Monoacylglycerol Lipase Inhibitor.

J Pharmacol Exp Ther 2020 03 9;372(3):339-353. Epub 2019 Dec 9.

Janssen Research & Development, LLC, San Diego, California.

The serine hydrolase monoacylglycerol lipase (MAGL) is the rate-limiting enzyme responsible for the degradation of the endocannabinoid 2-arachidonoylglycerol (2-AG) into arachidonic acid and glycerol. Inhibition of 2-AG degradation leads to elevation of 2-AG, the most abundant endogenous agonist of the cannabinoid receptors (CBs) CB1 and CB2. Activation of these receptors has demonstrated beneficial effects on mood, appetite, pain, and inflammation. Therefore, MAGL inhibitors have the potential to produce therapeutic effects in a vast array of complex human diseases. The present report describes the pharmacologic characterization of [1-(4-fluorophenyl)indol-5-yl]-[3-[4-(thiazole-2-carbonyl)piperazin-1-yl]azetidin-1-yl]methanone (JNJ-42226314), a reversible and highly selective MAGL inhibitor. JNJ-42226314 inhibits MAGL in a competitive mode with respect to the 2-AG substrate. In rodent brain, the compound time- and dose-dependently bound to MAGL, indirectly led to CB1 occupancy by raising 2-AG levels, and raised norepinephrine levels in cortex. In vivo, the compound exhibited antinociceptive efficacy in both the rat complete Freund's adjuvant-induced radiant heat hypersensitivity and chronic constriction injury-induced cold hypersensitivity models of inflammatory and neuropathic pain, respectively. Though 30 mg/kg induced hippocampal synaptic depression, altered sleep onset, and decreased electroencephalogram gamma power, 3 mg/kg still provided approximately 80% enzyme occupancy, significantly increased 2-AG and norepinephrine levels, and produced neuropathic antinociception without synaptic depression or decreased gamma power. Thus, it is anticipated that the profile exhibited by this compound will allow for precise modulation of 2-AG levels in vivo, supporting potential therapeutic application in several central nervous system disorders. SIGNIFICANCE STATEMENT: Potentiation of endocannabinoid signaling activity via inhibition of the serine hydrolase monoacylglycerol lipase (MAGL) is an appealing strategy in the development of treatments for several disorders, including ones related to mood, pain, and inflammation. [1-(4-Fluorophenyl)indol-5-yl]-[3-[4-(thiazole-2-carbonyl)piperazin-1-yl]azetidin-1-yl]methanone is presented in this report to be a novel, potent, selective, and reversible noncovalent MAGL inhibitor that demonstrates dose-dependent enhancement of the major endocannabinoid 2-arachidonoylglycerol as well as efficacy in models of neuropathic and inflammatory pain.
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http://dx.doi.org/10.1124/jpet.119.262139DOI Listing
March 2020

A randomized controlled trial of a smoking cessation self-help intervention for Spanish-speaking Hispanic/Latinx smokers: Study design and baseline characteristics.

Contemp Clin Trials 2019 10 29;85:105836. Epub 2019 Aug 29.

H. Lee Moffitt Cancer Center, Tampa, FL, USA; University of South Florida, USA. Electronic address:

Although the current smoking prevalence among Hispanics/Latinxs (10%) is lower than in non-Hispanic whites (15%), higher prevalence is observed among certain subgroups (e.g., Puerto Rican males, 19%). Hispanic/Latinx smokers face unique challenges such as lower awareness and acceptability of nicotine replacement aids, lower prevalence of using counseling or medication, and receiving less advice to quit by their health care providers. Despite these barriers to smoking cessation, few interventions specifically targeted to Hispanic/Latinx smokers have been developed and evaluated. This paper summarizes the design, methods, analysis plan, and sample baseline characteristics of an ongoing randomized controlled trial to assess the efficacy of a Spanish-language self-help smoking cessation intervention among Hispanics/Latinxs. Current smokers who prefer health education materials in Spanish were randomized to one of two conditions. The usual care group received a standard smoking cessation booklet developed by the National Cancer Institute. The intervention group received 10 booklets, 9 pamphlets and a booklet for family and friends mailed monthly over 18 months. All participants complete self-report surveys every 6 months over 2 years. Smoking abstinence is biochemically verified at 12- and 24-month follow-up. A total of 2387 smokers were screened, 2056 were eligible and 1417 were enrolled in the study. The primary outcome is self-reported 7-day point prevalence abstinence. If the intervention is deemed efficacious, it has potential to have a large public health impact with respect to reducing smoking rates and smoking related morbidity and mortality among a large underserved minority population.
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http://dx.doi.org/10.1016/j.cct.2019.105836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815731PMC
October 2019

Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans.

Patient Educ Couns 2020 02 18;103(2):385-391. Epub 2019 Aug 18.

Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA.

Objectives: Individuals with limited health literacy often experience suboptimal health outcomes. This study examined the frequency of limited health literacy and demographic and psychosocial factors associated with limited health literacy in a sample of older Black Americans.

Methods: Participants (n = 330) enrolled in a community-based intervention to promote colorectal cancer (CRC) screening completed baseline surveys assessing health literacy with the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test, CRC awareness, cancer fatalism, Preventive Health Model (PHM) constructs, and demographics.

Results: Approximately 52% of participants had limited health literacy, the REALM-R score was 5.4 (SD = 2.7). Univariable correlates of limited health literacy were gender, employment, income, prior screening, cancer fatalism, CRC awareness, and PHM constructs (religious beliefs, salience/coherence, perceived susceptibility). Multivariable correlates of limited health literacy were male gender (OR = 2.3, CI = 1.4-3.8), unable to work (OR = 2.8, CI = 1.3-6.1), lower household income (OR = 3.0, CI = 1.6, 5.5), and higher PHM religious beliefs (OR = 1.1, CI = 1.0-1.2).

Conclusion: Limited health literacy was associated with multiple complex factors. Interventions should incorporate patient health literacy and low-literacy materials that can be delivered through multiple channels.

Practice Implications: Future studies are needed to understand the role of health literacy in an individual's health behavior and the provision of effective healthcare.
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http://dx.doi.org/10.1016/j.pec.2019.08.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012696PMC
February 2020

Gut Microbiome: Profound Implications for Diet and Disease.

Nutrients 2019 Jul 16;11(7). Epub 2019 Jul 16.

Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME 04103, USA.

The gut microbiome plays an important role in human health and influences the development of chronic diseases ranging from metabolic disease to gastrointestinal disorders and colorectal cancer. Of increasing prevalence in Western societies, these conditions carry a high burden of care. Dietary patterns and environmental factors have a profound effect on shaping gut microbiota in real time. Diverse populations of intestinal bacteria mediate their beneficial effects through the fermentation of dietary fiber to produce short-chain fatty acids, endogenous signals with important roles in lipid homeostasis and reducing inflammation. Recent progress shows that an individual's starting microbial profile is a key determinant in predicting their response to intervention with live probiotics. The gut microbiota is complex and challenging to characterize. Enterotypes have been proposed using metrics such as alpha species diversity, the ratio of Firmicutes to Bacteroidetes phyla, and the relative abundance of beneficial genera (e.g., , ) versus facultative anaerobes (), pro-inflammatory , or nonbacterial microbes. Microbiota composition and relative populations of bacterial species are linked to physiologic health along different axes. We review the role of diet quality, carbohydrate intake, fermentable FODMAPs, and prebiotic fiber in maintaining healthy gut flora. The implications are discussed for various conditions including obesity, diabetes, irritable bowel syndrome, inflammatory bowel disease, depression, and cardiovascular disease.
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http://dx.doi.org/10.3390/nu11071613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682904PMC
July 2019

Does smoking abstinence predict cancer patients' quality of life over time?

Psychooncology 2019 08 2;28(8):1702-1711. Epub 2019 Jul 2.

Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.

Objective: Smoking cessation improves quality of life (QOL) in the general population. However, there is limited information on the role of smoking status on QOL among cancer patients. Moreover, previous studies tended to analyze smoking status dichotomously and at a single point in time, potentially reducing the strength of the relation between smoking cessation and QOL. This study examined the association of smoking abstinence and QOL over time, including depression, pain, and fatigue in patients with a wide variety of cancers.

Methods: Participants were 332 cancer patients (eg, gynecologic, breast, thoracic, head and neck, and genitourinary) who had been abstinent for at least 24 hours. Days abstinent and QOL were assessed at baseline and 2, 6, and 12 months later. Latent growth curve models examined if days abstinent was associated with QOL at each assessment. Baseline demographics (eg, sex and income) and smoking history variables (eg, nicotine dependence) were used as time-invariant covariates.

Results: The final model for each QOL component had good-to-excellent fit. More days abstinent was associated with lower depression at all follow-ups and with lower fatigue at 12 months but was not associated with pain.

Conclusions: QOL was better among patients who quit smoking for longer periods. Findings suggest different timelines, with smoking abstinence most immediately associated with lower depression, followed by lower fatigue. Although pain decreased over time, it was not associated with length of smoking abstinence. Results reinforce the relationship between sustained smoking cessation and QOL, which should be communicated to patients.
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http://dx.doi.org/10.1002/pon.5145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691965PMC
August 2019

A culturally and linguistically salient pilot intervention to promote colorectal cancer screening among Latinos receiving care in a Federally Qualified Health Center.

Health Educ Res 2019 06;34(3):310-320

Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.

Despite established benefits, colorectal cancer (CRC) screening is underutilized among Latinos/Hispanics. We conducted a pilot 2-arm randomized controlled trial evaluating efficacy of two intervention conditions on CRC screening uptake among Latinos receiving care in community clinics. Participants (N = 76) were aged 50-75, most were foreign-born, preferred to receive their health information in Spanish, and not up-to-date with CRC screening. Participants were randomized to either a culturally linguistically targeted Spanish-language fotonovela booklet and DVD intervention plus fecal immunochemical test [FIT] (the LCARES, Latinos Colorectal Cancer Awareness, Research, Education and Screening intervention group); or a non-targeted intervention that included a standard Spanish-language booklet plus FIT (comparison group). Measures assessed socio-demographic variables, health literacy, CRC screening behavior, awareness and beliefs. Overall, FIT uptake was 87%, exceeding the National Colorectal Cancer Roundtable's goal of 80% by 2018. The LCARES intervention group had higher FIT uptake than did the comparison group (90% versus 83%), albeit not statistically significant (P = 0.379). The LCARES intervention group was associated with greater increases in CRC awareness (P = 0.046) and susceptibility (P = 0.013). In contrast, cancer worry increased more in the comparison group (P = 0.045). Providing educational materials and a FIT kit to Spanish-language preferring Latinos receiving care in community clinics is a promising strategy to bolster CRC screening uptake to meet national targets.
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http://dx.doi.org/10.1093/her/cyz010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868960PMC
June 2019

National Survey of Oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers: Attitudes, Knowledge, and Practice Behaviors About LGBTQ Patients With Cancer.

J Clin Oncol 2019 03 16;37(7):547-558. Epub 2019 Jan 16.

2 New York University School of Medicine, New York, NY.

Purpose: To identify potential gaps in attitudes, knowledge, and institutional practices toward lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients, a national survey of oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers was conducted to measure these attributes related to LGBTQ patients and desire for future training and education.

Methods: A random sample of 450 oncologists from 45 cancer centers was selected from the American Medical Association's Physician Masterfile to complete a survey measuring attitudes and knowledge about LGBTQ health and institutional practices. Results were quantified using descriptive and stratified analyses and by a novel attitude summary measure.

Results: Of the 149 respondents, there was high agreement (65.8%) regarding the importance of knowing the gender identity of patients, which was contrasted by low agreement (39.6%) regarding the importance of knowing sexual orientation. There was high interest in receiving education regarding the unique health needs of LGBTQ patients (70.4%), and knowledge questions yielded high percentages of "neutral" and "do not know or prefer not to answer" responses. After completing the survey, there was a significant decrease ( P < .001) in confidence in knowledge of health needs for LGB (53.1% agreed they were confident during survey assessment v 38.9% postsurvey) and transgender patients (36.9% v 19.5% postsurvey). Stratified analyses revealed some but limited influence on attitudes and knowledge by having LGBTQ friends and/or family members, political affiliation, oncology specialty, years since graduation, and respondents' region of the country.

Conclusion: This was the first nationwide study, to our knowledge, of oncologists assessing attitudes, knowledge, and institutional practices of LGBTQ patients with cancer. Overall, there was limited knowledge about LGBTQ health and cancer needs but a high interest in receiving education regarding this community.
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http://dx.doi.org/10.1200/JCO.18.00551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553841PMC
March 2019

Vaping characteristics and expectancies are associated with smoking cessation propensity among dual users of combustible and electronic cigarettes.

Addiction 2019 05 13;114(5):896-906. Epub 2019 Feb 13.

Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.

Background And Aims: Most e-cigarette users who also smoke combustible cigarettes (dual users) begin vaping to quit smoking, yet only a subset succeeds. We hypothesized that reinforcing characteristics of e-cigarettes (vaping reinforcement) would positively predict smoking cessation propensity (SCP) among dual users.

Design: Secondary analysis of cross-sectional baseline data from dual users in an ongoing smoking cessation trial. Exploratory and confirmatory factor analysis (EFA and CFA) created latent variables for vaping reinforcement and SCP. A structural equation modeling (SEM) approach was used to test the hypothesis.

Setting: United States.

Participants: A national sample of dual users of combustible and electronic cigarettes who smoke and vape at least once per week (n = 2896) were enrolled (63% male; mean age = 29.9 years) into a randomized controlled trial in which they would receive either smoking cessation materials or no smoking cessation materials.

Measurements: Vaping reinforcement was indexed by vaping frequency (days/week vaping, times/day vaping, puffs/e-cigarette use), e-cigarette characteristics [numbers of modifications and tobacco or non-tobacco flavors, nicotine content (mg) and positive e-cigarette expectancies]. SCP was measured by items of confidence, commitment to being smoke-free, cessation motivation (contemplation ladder), change in cigarettes per day since beginning e-cigarette use and negative smoking expectancies.

Findings: Four factors emerged from the EFA: vaping propensity (vaping frequency, positive expectancies), vaping enthusiasm (e-cigarette modifications, using non-tobacco flavors, puffs per use), nicotine/tobacco flavor (nicotine strength, tobacco flavors) and SCP (negative expectancies about smoking, motivation to quit smoking, reduction in smoking). A CFA upheld the exploratory factor structure [root mean square error of approximation (RMSEA) = 0.046, CFI = 0.91]. An SEM with the three vaping latent variables directly predicting SCP had good model fit (RMSEA = 0.030, CFI = 0.97) with a positive relationship of vaping propensity (0.509, P < 0.001), and small negative relationships of vaping enthusiasm (-0.158, P = 0.014) and nicotine/tobacco flavor (-0.230, P < 0.001).

Conclusions: Among e-cigarette users who also smoke combustible cigarettes, frequent vaping combined with positive e-cigarette expectancies appears to predict greater smoking cessation propensity. However, vaping enthusiasm (measured by e-cigarette modifications, using non-tobacco flavors and puffs per use), higher nicotine content and use of tobacco flavored solution may reduce cessation propensity.
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http://dx.doi.org/10.1111/add.14551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629519PMC
May 2019

Behind closed doors: How advanced cancer couples communicate at home.

J Psychosoc Oncol 2019 Mar-Apr;37(2):228-241. Epub 2018 Oct 29.

d University of Utah , Salt Lake City , Utah , USA.

Objective: Describe communication between patients with advanced cancer and their spouse/partner caregivers.

Design: Prospective observational study.

Sample: 83 advanced cancer patient-spouse caregiver couples.

Methods: Couples completed surveys and recorded naturalistic communication for one day. Descriptive analysis was performed on self-report and observational communication data.

Findings: Both patients and caregivers self-reported high likelihood of engaging in positive interactions. The majority of observed communication was logistical or social small-talk. Cancer and relationship talk was highly skewed; many couples had no talk in these domains.

Conclusion: This study is one of the first to assess continuous naturalistic observation of communication in the homes of couples coping with advanced cancer. We found that routine aspects of daily life continue even when couples are facing important challenges. Implications for Psychosocial Providers: There appear to be few naturalistic cues encouraging couples to discuss potentially difficult topics. More work is needed to determine appropriate levels of communication.
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http://dx.doi.org/10.1080/07347332.2018.1508535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771241PMC
February 2020

Long-term outcomes from a self-help smoking cessation randomized controlled trial.

Psychol Addict Behav 2018 Nov 4;32(7):710-714. Epub 2018 Oct 4.

Department of Health Outcomes and Behavior.

There is a need for effective smoking cessation interventions that can be disseminated easily in health care and other settings. We previously reported that an extended self-help intervention comprising intensive repeated mailings over 18 months improved abstinence rates through 6 months beyond the end of the intervention when compared to both a reduced version of the self-help materials and a traditional self-help booklet. This report extends the follow-up for an additional 6 months (30-months postbaseline) to examine long-term maintenance of the intervention effect. We hypothesized that the previously observed "dose-response" effect of treatment intensity would be maintained. Participants were randomized to Traditional Self-Help (TSH, = 638), Standard Repeated Mailings (SRM, = 614), or Intensive Repeated Mailings (IRM, = 622). TSH received an existing self-help smoking cessation booklet. SRM received 8 cessation booklets mailed over 12 months. IRM received monthly mailings of 10 booklets and additional material to enhance social support over 18 months. Follow-up assessments occurred every 6 months through 30 months. Data were collected 2010-2013 and analyzed 2014-2017. At 1 year posttreatment, there was a linear dose effect with the highest abstinence rates observed in IRM (33%), followed by SRM (29%), and then TSH (23%; = .002). Paired comparisons indicated that IRM was superior to TSH ( = .002). Results revealed a robust intervention effect for the intensive self-help intervention that was maintained 12 months after treatment completion. This further supports extended self-help as a low-cost intervention for smoking cessation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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http://dx.doi.org/10.1037/adb0000401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6242763PMC
November 2018

Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination.

Prev Med 2018 11 13;116:143-149. Epub 2018 Sep 13.

Moffitt Cancer Center & Research Institute, Division of Population Science, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612, United States; Moffitt Cancer Center & Research Institute, Center for Immunization and Infection Research in Cancer, 12902 Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States. Electronic address:

HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08-1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02-12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20-2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08-8.43), daily patient load (<20 vs. 20-24: aOR = 9.05;95%CI = 2.72-30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11-8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities.
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http://dx.doi.org/10.1016/j.ypmed.2018.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260815PMC
November 2018

Educating Hispanic Women about Cervical Cancer Prevention: Feasibility of a Promotora-Led Charla Intervention in a Farmworker Community.

Ethn Dis 2018 12;28(3):169-176. Epub 2018 Jul 12.

Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.

Hispanic women suffer disproportionately from cervical cancer incidence and mortality compared with non-Hispanic Whites in the United States. Peer-led health education and coaching via charlas (talking circles) may improve cervical cancer screening and early detection rates among specific sub-groups such as farmworker communities. This pilot study sought to collect preliminary evaluation data about the feasibility of implementing a promotora-led cervical cancer education intervention among women from a farmworker community. The study took place between April 2014 and November 2014. Created based on an established network (Tampa Bay Community Cancer Network, TBCCN), in partnership with a local farmworker organization (Farmworkers Self-Help, Inc.), the project entailed refinement of a curriculum guide including Spanish-language educational resources (teaching cards). Social Cognitive Theory and the Health Belief Model provided the conceptual framework for the study. Six women from the farmworker community helped to refine the intervention and were trained as promotoras. They successfully delivered the program via charlas to a total of 60 participants who completed baseline and post-intervention measures on knowledge (cervical cancer/HPV), beliefs, self-efficacy, and intentions. Findings demonstrated gains in knowledge and self-efficacy among charla participants (P<.0001), and support the promise of a community-driven intervention that is delivered by promotoras who use their cultural knowledge and trustworthiness to educate women about cancer screening practices. Results also add to the literature on the use of a charla approach for cancer prevention education within a farmworker community to prompt discussions about health. Future research should evaluate peer-led programs on a larger scale and among other at-risk groups in other community settings.
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http://dx.doi.org/10.18865/ed.28.3.169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051510PMC
October 2019

Understanding Cancer Worry Among Patients in a Community Clinic-Based Colorectal Cancer Screening Intervention Study.

Nurs Res 2018 Jul/Aug;67(4):275-285

Shannon M. Christy, PhD, is Assistant Professor, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis. At the time this manuscript was prepared and submitted, Dr. Christy was a Postdoctoral Fellow, Division of Population Science, Moffitt Cancer Center, and Postdoctoral Fellow, Morsani College of Medicine, University of South Florida, Tampa, Florida. Alyssa Schmidt, MPH, PA-C, is Physician Assistant at WVP Boulder Creek Family Medicine, Salem, Oregon. At the time the research was conducted, she was a Research Coordinator, Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Hsiao-Lan Wang, PhD, RN, CMSRN, ACSM EP-C, is Associate Professor, College of Nursing, University of South Florida, Tampa, Florida. Steven K. Sutton, PhD, is Assistant Member, Division of Quantitative Science, Moffitt Cancer Center, and Assistant Professor, Morsani College of Medicine, University of South Florida, Tampa, Florida. Stacy N. Davis, PhD, MPH, is Instructor, Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey. At the time the research was conducted, Dr. Davis was a Postdoctoral Fellow, Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Enmanuel Chavarria, PhD, CHES, is Assistant Professor, University of Texas Health Science Center at Houston School of Public Health, Brownsville. At the time the research was conducted, Dr. Chavarria was a Postdoctoral Fellow, Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Rania Abdulla, MA, is Research Program Administrator, Division of Population Science, Moffitt Cancer Center, Tampa, Florida. Gwendolyn P. Quinn, PhD, is Liva Wan Endowed Chair and Vice-Chair of Research, and Professor, Department of Ob-Gyn, New York University School of Medicine, New York. At the time the research was conducted, Dr. Quinn was a Senior Member, Division of Population Science, Moffitt Cancer Center, and Professor, Morsani College of Medicine, University of South Florida, Tampa, Florida. Susan T. Vadaparampil, PhD, MPH, is Senior Member, Division of Population Science, Moffitt Cancer Center, and Professor, Morsani College of Medicine, University of South Florida, Tampa, Florida. Ida Schultz, LPN, is Office Manager, Premier Community HealthCare Group, Inc., Dade City, Florida. Richard Roetzheim, MD, MSPH, is Physician, Division of Population Science, Moffitt Cancer Center, and Professor and Chair, Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida. David Shibata, MD, FACS, FASCRS, is Scheinberg Endowed Chair in Surgery and Professor, Surgeon-in-Chief, and Chair of the Department of Surgery, University of Tennessee Health Science Center, and Deputy Director, University of Tennessee West Cancer Center, Memphis. At the time this research was conducted, Dr. Shibata was Senior Member and Chief of the Section of Colorectal Oncology, Moffitt Cancer Center, and Professor of Surgery and Oncology, Morsani College of Medicine, University of South Florida, Tampa, Florida. Cathy D. Meade, PhD, RN, FAAN, is Senior Member, Division of Population Science, Moffitt Cancer Center, and Professor, Morsani College of Medicine, University of South Florida, Tampa, Florida. Clement K. Gwede, PhD, MPH, RN, FAAN, is Senior Member, Division of Population Science, Moffitt Cancer Center, and Professor, Morsani College of Medicine, University of South Florida, Tampa, Florida.

Background: To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals.

Objectives: The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry.

Methods: Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models.

Results: Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single).

Discussion: Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.
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http://dx.doi.org/10.1097/NNR.0000000000000275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023767PMC
February 2019

Associations between the smoking-relatedness of a cancer type, cessation attitudes and beliefs, and future abstinence among recent quitters.

Psychooncology 2018 09 14;27(9):2104-2110. Epub 2018 Jun 14.

Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.

Objective: Smoking after a diagnosis of cancer can negatively impact treatment outcomes and quality of life. It is important that patients quit smoking and remain abstinent regardless of cancer type. Some cancer types (eg, lung) have stronger links to smoking as a cause than do others (eg, colorectal). The aims of this study were to (1) assess associations between smoking-relatedness of the cancer type with beliefs and attitudes concerning smoking abstinence (eg, confidence, self-efficacy), and (2) assess these variables as predictors of future abstinence.

Methods: In this secondary analysis, cancer patients (N = 357) who quit smoking within the previous 90 days were assigned a code of 3, 2, or 1 according to the cancer type's level of smoking-relatedness: Very related (n = 134, thoracic and head and neck), Somewhat related (n = 93, acute myeloid leukemia, bladder, cervix, colorectal, esophageal, kidney, liver, pancreas, and stomach), and Unlikely related (n = 137, all other cancer types).

Results: Smoking-relatedness was positively associated with plan to stay smoke-free, maximum confidence in being smoke-free in 6 months, higher abstinence self-efficacy, and lower expected difficulty in staying smoke-free. Each of the 4 beliefs and attitude variables predicted abstinence 2 months later. Smoking-relatedness also predicted abstinence in a univariate model, but not in a multivariable model with the belief and attitude variables. Using backwards stepwise procedures, the final model included plan to stay smoke-free, confidence in being smoke-free, and abstinence self-efficacy.

Conclusion: These results are consistent with our conceptualization of cessation motivation differing by smoking-relatedness of the cancer type and predicting future abstinence.
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http://dx.doi.org/10.1002/pon.4774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156937PMC
September 2018

Childbearing across borders: Fertility and parenthood attitudes and decisions among breast cancer survivors in USA and Portugal.

Breast 2018 Aug 16;40:16-22. Epub 2018 Apr 16.

Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; Department of Ob-Gyn, NYU Langone Medical Center, NY, NY 10016, USA.

Objective: To compare fertility and childbearing attitudes and decisions of Portuguese and American female reproductive aged breast cancer survivors.

Methods: This was a cross-sectional study of 102 young breast cancer survivors (59 from Portugal and 43 from USA). Demographic, clinical and reproductive information were collected. Fertility and parenthood attitudes and decisions were assessed through a self-report questionnaire devised specifically for the study.

Results: Fertility issues became very important after the diagnosis for most of the women (51%). Few differences existed between USA and Portuguese participants. USA participants were more likely to undergo FP (23% USA vs Portugal 5%, p = 0.01). Portuguese women were more dissatisfied with their physician's explanations about fertility (Portugal: 23% vs USA: 3%; p = 0.01). Overall, women relied on their oncologist for fertility information (70%); only Portuguese women discussed fertility with their family medicine physician (11%). Overall, women showed positive attitudes towards motherhood. Portuguese women were more likely to report their partners placed more value on the family after their illness (Portuguese agree: 55% vs USA agree: 14%; p < 0.001).

Conclusions: Fertility and childbearing after breast cancer are important issues regardless of culture, background or country's heath care system. Overall, few differences across the USA and Portuguese samples were found on fertility and childbearing attitudes and decisions.
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http://dx.doi.org/10.1016/j.breast.2018.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045956PMC
August 2018

Culturally Competent Care for Sexual and Gender Minority Patients at National Cancer Institute-Designated Comprehensive Cancer Centers.

LGBT Health 2018 04 15;5(3):203-211. Epub 2018 Mar 15.

7 Department of Obstetrics and Gynecology, New York University School of Medicine , New York, New York.

Purpose: This study sought to identify the policies and guidelines regarding culturally competent care of sexual and gender minority (SGM) cancer patients and survivors at National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers.

Methods: This study used an in-depth interview qualitative approach. Semistructured interviews were conducted via telephone with representatives from 21 of the 45 NCI-Designated Comprehensive Cancer Centers in 2015. Verbatim transcripts were created from the audiotapes for content analysis.

Results: Two main themes were identified as follows: (1) patient-focused experiences and support and (2) organization-focused development activities. Most of the cancer centers in this study had an advisory committee to assist with SGM policies and guidelines. Despite the existence of these committees, the majority of centers did not have explicit policies, guidelines, or routine practices addressing the following issues: the collection and integration of sexual orientation and gender identity information in the medical record, gender-neutral language on patient forms, patient educational materials with SGM-specific health concerns, SGM-specific support for cancer survivors, or required SGM-specific cultural competency trainings for medical and nonmedical staff.

Conclusion: In general, the cancer centers in this study lacked institutional policies, guidelines, and practices focused on patient-centered cancer care for SGM populations. Coordinated efforts are needed to systemically improve patient-centered cancer care for these populations.
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http://dx.doi.org/10.1089/lgbt.2017.0217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905865PMC
April 2018