Faculty Bibliography

Knowledge of nutrition among breast cancer patients is insufficient, despite their motivation to seek valid information about healthy food choices. This study examines the feasibility of nutrition education workshops for cancer survivors, to inform the design of a multi-center intervention. Fifty-nine female English-speaking breast cancer patients, who had completed treatment, were enrolled. Participants were randomized to the intervention or control group. The intervention group attended six nutrition education sessions, and the control group received brochures. Measurements were done at baseline and 3-month follow-up and included the Assessment Instrument for Breast Cancer (NLit-BCa), fruit/vegetable and general health literacy screeners. Height and weight were measured. Changes in nutrition literacy, health literacy, and food intake from baseline to follow-up (within-group change) were calculated for both groups (effect sizes were reported as Cohen's d). Participants were mostly white, with a mean age of 58 years, BMI of 31.6 kg/m2, and had college degrees. Follow-up rates were high (89% = control and 77% = intervention group). At baseline, participants scored high for most NLit-BCa assessment components except food portions in both groups. At the 3-month follow-up, effect sizes (d) on the NLit-BCa ranged from -0.5 to 0.16. The study met its recruitment goals within 6 months. Focus groups indicated that (a) attending six sessions was acceptable, (b) patients found social/emotional support, (c) improvements should include information for special diets and booster sessions. This pilot study suggests that the intervention was acceptable and that scaling up of this intervention is feasible and could provide benefit to breast cancer survivors.

The transtheoretical model and the stages of change are often used to adapt treatment to the individual client. The aims of this study were to review the stages of change and popular measures of change readiness in psychotherapy and to conduct a meta-analysis of the relation between readiness measures and psychotherapy outcomes. We report data from 76 studies, encompassing 25,917 patients. Moderate-sized effects (d = 0.41) were found for the association among multiple disorders, including substance and alcohol use, eating disorders, and mood disorders. Outcomes were a function of the pretreatment stage of change; that is, the farther a patient along the stages, the better the treatment outcomes. This review added 37 studies to the data reported in 2010, further strengthening the link between readiness and therapy outcomes. The article concludes with limitations of the research, diversity considerations, and therapeutic practices for stage matching in psychotherapy specifically and behavioral health more generally.

Persons with mental health diagnoses use tobacco at alarming rates, yet misperceptions remain about the effect of quitting on mental health outcomes. This article examines the relationship between tobacco cessation and changes in severity of mental illness. Participants were N = 577 veterans with a history of mental health treatment enrolled in a tobacco cessation study. The effects of abstinence and time on Behavior and Symptom Identification Scale-24 summary scores and subscales were examined. Abstinence at both 2 and 6 months post-baseline was related (p < .0001) to lower Behavior and Symptom Identification Scale-24 summary scores and improvement on three Behavior and Symptom Identification Scale-24 subscales. Providers should recommend and provide tobacco treatment to all mental health patients to improve their physical and mental health functioning.

INTRODUCTION/BACKGROUND:Veterans with a mental health diagnosis have high rates of tobacco use but encounter low rates of treatment from providers. This study tested whether a proactive tobacco treatment approach increases treatment engagement and abstinence rates in Department of Veterans Affairs mental health patients. STUDY DESIGN/METHODS:RCT. SETTING/PARTICIPANTS/METHODS:The study was performed from 2013 to 2017 and analyses were conducted in 2017. Investigators used the electronic medical record at four Veterans Administration facilities to identify patients documented as current smokers and who had a mental health clinic visit in the past 12 months. INTERVENTION/METHODS:Patients were mailed an introductory letter and baseline survey. Survey respondents were enrolled and randomized to intervention (n=969) or control (n=969). Control participants received a list of usual Veterans Administration smoking services. Intervention participants received a motivational outreach call, multisession telephone counseling, and assistance with obtaining nicotine replacement therapy. MAIN OUTCOME MEASURES/METHODS:Participants completed surveys at baseline, 6 months, and 12 months after randomization. The primary outcome was self-reported 7-day abstinence from cigarettes at 12-month follow-up. Secondary outcomes included use of cessation treatment, self-reported 7-day abstinence at 6-month follow-up, and 6-month prolonged abstinence at 12-month follow-up. RESULTS:At 12 months, intervention participants were more likely to report using telephone counseling (19% vs 3%, OR=7.34, 95% CI=4.59, 11.74), nicotine replacement therapy (47% vs 35%, OR=1.63, 95% CI=1.31, 2.03), or both counseling and nicotine replacement therapy (16% vs 2%, OR=11.93, 95% CI=6.34, 22.47). Intervention participants were more likely to report 7-day abstinence (19% vs 14%, OR=1.50, 95% CI=1.12, 2.01) and prolonged 6-month abstinence (16% vs 9%, OR=1.87, 95% CI=1.34, 2.61). After adjusting for non-ignorable missingness at follow-up, the intervention effects on 7-day and prolonged abstinence remained significant (p<0.05). CONCLUSIONS:Proactive outreach was more effective than usual Veterans Administration care at increasing treatment engagement and long-term abstinence in mental health patients. TRIAL REGISTRATION/BACKGROUND:This study is registered at www.clinicaltrials.gov NCT01737281.

OBJECTIVES: We conducted two parallel studies evaluating the effectiveness of proactive and reactive engagement approaches to telephone treatment for smoking cessation. METHODS: Patients who smoked and were interested in quitting were referred to this study and were eligible if they were current smokers and had an address and a telephone number. The data were collected at 35 Department of Veterans Affairs (VA) sites, part of four VA medical centres in both California and Nevada. In study 1, participants received multisession counselling from the California Smokers' Helpline (quitline). In study 2, they received self-help materials only. Patients were randomly assigned by week to either proactive or reactive engagement, and primary care staff were blind to this assignment. Providers gave brief advice and referred them via the electronic health record to a tobacco co-ordinator. All patients were offered cessation medications. OUTCOME: Using complete case analysis, in study 1 (quitline), patients in the proactive condition were more likely than those in the reactive condition to report abstinence at 6 months (21.0% vs 16.4%, p=0.03). No difference was found between conditions in study 2 (self-help) (16.9% vs 16.5%, p=0.88). Proactive outreach resulted in increased use of cessation medications in both the quitline (70.1% vs 57.6%, p<0.0001) and the self-help studies (74.5% vs 48.2%, p<0.0001). CONCLUSION: Proactive outreach with quitline intervention was associated with greater long-term abstinence. Both studies resulted in high rates of medication use. Sites should use a proactive outreach approach and provide counselling whenever possible. TRIAL REGISTRATION NUMBER: NCT00123682.

Background: Veterans with a mental health diagnosis have high rates of tobacco use, but encounter low rates of treatment and referrals from providers and limited treatment approaches addressing their unique barriers to cessation. This study aimed to determine whether an intensive proactive tobacco treatment approach increases treatment engagement and long-term abstinence rates in Department of Veterans Affairs (VA) mental health patients compared to visit-based usual tobacco care. Methods: The study used a randomized controlled trial design. Investigators used the electronic medical record at four VA facilities to identify patients documented as current smokers and who had a mental health clinic visit in the past 12 months. Patients were sent an introductory letter and baseline survey. Survey respondents were randomized to intervention (n=969) or control (n=969). Control participants received a list of usual VA smoking services. Intervention participants received a motivational outreach call, multi-session telephone counseling, and assistance with obtaining nicotine replacement therapy (NRT). Participants completed telephone surveys at 6 and 12 months to assess use of treatment, 7-day abstinence and prolonged 6-month abstinence. The primary outcome was self-reported 7-day abstinence from smoking at 12-month follow-up. Secondary outcomes included use of cessation treatment, self-reported 7-day abstinence at 6-month follow-up, and 6-month prolonged abstinence at 12-month follow-up. Mailed saliva samples were collected to verify self-reported 7-day abstinence at 12 months. Results: At 12 months, Intervention participants were more likely to report using telephone counseling (19% vs 3%, OR=7.34, 95%CI=4.59-11.74), NRT (47% vs 35%, OR=1.63, 95%CI=1.31-2.03) or both counseling and NRT (16% vs 2%, OR=11.93, 95%CI=6.34-22.47) compared to Control patients with access to usual care. Intervention participants were more likelyto report 7-day abstinence (19% vs. 14%, OR=1.50, 95%CI=1.12-2.01) and prolonged 6-month abstinence (16% vs 9%, OR=1.87, 95%CI=1.34-2.61). After adjusting for non-ignorable missingness at follow-up, the intervention effects on 7-day and prolonged abstinence remained significant (p<.05). Conclusions: Proactive tobacco treatment was more effective than usual VA care at increasing treatment engagement and long-term abstinence in mental health patients

BACKGROUND:Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. OBJECTIVE:The objective of this study was to explore behaviors and perceptions about mobile phone-based apps for health among individuals with chronic conditions. METHODS:Data were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. RESULTS:Among participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity. CONCLUSIONS:Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools.

BACKGROUND:Many men who have sex with men (MSM) use apps to connect with and meet other MSM. Given that these apps are often used to arrange sexual encounters, it is possible that apps may be suitable venues for messages and initiatives related to HIV prevention such as those to increase HIV testing rates among this population. OBJECTIVE:The purpose of this study was to assess willingness to use a new app for reminders of when to be tested for HIV infection among a sample of MSM in London who use apps to arrange sexual encounters. METHODS:Broadcast advertisements targeted users of a popular social-networking app for MSM in London. Advertisements directed users to a Web-based survey of sexual behaviors and sexual health needs. Willingness to use apps for reminders of when to be tested for HIV was assessed. In addition, participants responded to items assessing recent sexual behaviors, substance use, and demographic characteristics. Exploratory analyses were undertaken to examine differences in willingness to use an app by demographic and behavioral characteristics. RESULTS:Broadcast advertisements yielded a sample of 169 HIV-negative MSM. Overall, two-thirds (108/169, 63.9%) reported willingness to use an app to remind them when to be tested for HIV. There were no significant differences in willingness to use these apps based on demographic characteristics, but MSM who reported recent binge drinking and recent club drug use more frequently reported willingness to use this app compared to their nonusing counterparts. CONCLUSIONS:MSM in this sample are willing to use a new app for HIV testing reminders. Given the high levels of willingness to use them, these types of apps should be developed, evaluated, and made available for this population.