scholarly journals Implementation of Ask-Advise-Connect in a safety net healthcare system: quitline treatment engagement and smoking cessation outcomes

2018 ◽  
Vol 10 (1) ◽  
pp. 163-167 ◽  
Author(s):  
Bárbara Piñeiro ◽  
Damon J Vidrine ◽  
David W Wetter ◽  
Diana S Hoover ◽  
Summer G Frank-Pearce ◽  
...  
Keyword(s):  
Low Income ◽  
Standard Care ◽  
Smoking Status ◽  
Large Population ◽  
Treatment Engagement ◽  
Safety Net ◽  
Population Based ◽  
Self Report ◽  
Tobacco Treatment ◽  
Care Outcomes

Abstract Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.

scholarly journals Association between socioeconomic status and self-reported, tested and diagnosed COVID-19 status during the first wave in the Northern Netherlands: a general population-based cohort from 49 474 adults

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e048020
Author(s):  
Yinjie Zhu ◽  
Ming-Jie Duan ◽  
Hermien H. Dijk ◽  
Roel D. Freriks ◽  
Louise H. Dekker ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
General Population ◽  
Low Income ◽  
Smoking Status ◽  
Sleep Time ◽  
Population Based ◽  
Lifestyle Factors ◽  
Self Report ◽  
Low Education ◽  
Tv Watching

ObjectivesStudies in clinical settings showed a potential relationship between socioeconomic status (SES) and lifestyle factors with COVID-19, but it is still unknown whether this holds in the general population. In this study, we investigated the associations of SES with self-reported, tested and diagnosed COVID-19 status in the general population.Design, setting, participants and outcome measuresParticipants were 49 474 men and women (46±12 years) residing in the Northern Netherlands from the Lifelines cohort study. SES indicators and lifestyle factors (i.e., smoking status, physical activity, alcohol intake, diet quality, sleep time and TV watching time) were assessed by questionnaire from the Lifelines Biobank. Self-reported, tested and diagnosed COVID-19 status was obtained from the Lifelines COVID-19 questionnaire.ResultsThere were 4711 participants who self-reported having had a COVID-19 infection, 2883 participants tested for COVID-19, and 123 positive cases were diagnosed in this study population. After adjustment for age, sex, lifestyle factors, body mass index and ethnicity, we found that participants with low education or low income were less likely to self-report a COVID-19 infection (OR [95% CI]: low education 0.78 [0.71 to 0.86]; low income 0.86 [0.79 to 0.93]) and be tested for COVID-19 (OR [95% CI]: low education 0.58 [0.52 to 0.66]; low income 0.86 [0.78 to 0.95]) compared with high education or high income groups, respectively.ConclusionOur findings suggest that the low SES group was the most vulnerable population to self-reported and tested COVID-19 status in the general population.

scholarly journals Association of smoking and cancer with the risk of venous thromboembolism: the Scandinavian Thrombosis and Cancer cohort

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Benedikte Paulsen ◽  
Olga V. Gran ◽  
Marianne T. Severinsen ◽  
Jens Hammerstrøm ◽  
Søren R. Kristensen ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Smoking Status ◽  
Large Population ◽  
Population Based ◽  
Cancer Site ◽  
Established Risk Factor ◽  
Increased Risk ◽  
Active Cancer

AbstractSmoking is a well-established risk factor for cancer, and cancer patients have a high risk of venous thromboembolism (VTE). Conflicting results have been reported on the association between smoking and risk of VTE, and the effect of smoking on VTE-risk in subjects with cancer is scarcely studied. We aimed to investigate the association between smoking and VTE in subjects with and without cancer in a large population-based cohort. The Scandinavian Thrombosis and Cancer (STAC) cohort included 144,952 participants followed from 1993–1997 to 2008–2012. Information on smoking habits was derived from self-administered questionnaires. Active cancer was defined as the first two years following the date of cancer diagnosis. Former smokers (n = 35,890) and those with missing information on smoking status (n = 3680) at baseline were excluded. During a mean follow up of 11 years, 10,181 participants were diagnosed with cancer, and 1611 developed incident VTE, of which 214 were cancer-related. Smoking was associated with a 50% increased risk of VTE (HR 1.49, 95% CI 1.12–1.98) in cancer patients, whereas no association was found in cancer-free subjects (HR 1.07, 95% CI 0.96–1.20). In cancer patients, the risk of VTE among smokers remained unchanged after adjustment for cancer site and metastasis. Stratified analyses showed that smoking was a risk factor for VTE among those with smoking-related and advanced cancers. In conclusion, smoking was associated with increased VTE risk in subjects with active cancer, but not in those without cancer. Our findings imply a biological interaction between cancer and smoking on the risk of VTE.

scholarly journals Population-based estimates of post-acute sequelae of SARS-CoV-2 infection (PASC) prevalence and characteristics: A cross-sectional study

2021 ◽  
Author(s):  
Jana L. Hirschtick ◽  
Andrea R. Titus ◽  
Elizabeth Slocum ◽  
Laura E. Power ◽  
Robert E. Hirschtick ◽  
...  
Keyword(s):  
Low Income ◽  
Smoking Status ◽  
Prevalence Ratio ◽  
Population Based ◽  
Outcome Data ◽  
Cross Sectional Survey ◽  
Annual Household Income ◽  
Cross Sectional ◽  
Persistent Symptoms ◽  
Initial Symptoms

AbstractImportanceEmerging evidence suggests many people have persistent symptoms after acute COVID-19 illness.ObjectiveTo estimate the prevalence and correlates of persistent COVID-19 symptoms 30 and 60 days post onset using a population-based sample.Design & SettingThe Michigan COVID-19 Recovery Surveillance Study is a population-based cross-sectional survey of a probability sample of adults with confirmed COVID-19 in the Michigan Disease Surveillance System (MDSS). Respondents completed a survey online or via telephone in English, Spanish, or Arabic between June - December 2020.ParticipantsLiving non-institutionalized adults (aged 18+) in MDSS with COVID-19 onset through mid-April 2020 were eligible for selection (n=28,000). Among 2,000 adults selected, 629 completed the survey. We excluded 79 cases during data collection due to ineligibility, 6 asymptomatic cases, 7 proxy reports, and 24 cases missing outcome data, resulting in a sample size of 593. The sample was predominantly female (56.1%), aged 45 and older (68.2%), and Non-Hispanic White (46.3%) or Black (34.8%).ExposuresDemographic (age, sex, race/ethnicity, and annual household income) and clinical factors (smoking status, body mass index, diagnosed comorbidities, and illness severity).Main outcomes and MeasuresWe defined post-acute sequelae of SARS-CoV-2 infection (PASC) as persistent symptoms 30+ days (30-day COVID-19) or 60+ days (60-day COVID-19) post COVID-19 onset.Results30- and 60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among respondents reporting mild symptoms (29.2% and 24.5%) and non-hospitalized respondents (43.7% and 26.9%, respectively). Low income was statistically significantly associated with 30-day COVID-19 in adjusted models. Respondents reporting very severe (vs. mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 (Adjusted Prevalence Ratio [aPR] 2.25, 95% CI 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19 (aPR 1.71, 95% 1.02-2.88). Hospitalized (vs. non-hospitalized) respondents had about 40% higher prevalence of both 30-day (aPR 1.37, 95% CI 1.12-1.69) and 60-day COVID-19 (aPR 1.40, 95% CI 1.02-1.93).Conclusions and RelevancePASC is highly prevalent among cases with severe initial symptoms, and, to a lesser extent, cases with mild and moderate symptoms.

scholarly journals T-ACE and predictors of self-reported alcohol use during pregnancy in a large, population-based urban cohort

2014 ◽  
Vol 3 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Matthew Hicks ◽  
Suzanne C. Tough ◽  
David Johnston ◽  
Jodi Siever ◽  
Margaret Clarke ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Alcohol Use ◽  
Large Population ◽  
First Trimester ◽  
Population Based ◽  
Poor Mental Health ◽  
Self Report ◽  
History Of ◽  
The Relationship

Hicks, M., Tough, S., Johnston, D., Siever, J., Clarke, M., Sauve, R., Brant, R., & Lyon, A. (2014). T-ACE and predictors of self-reported alcohol use during pregnancy in a large, population-based urban cohort. The International Journal Of Alcohol And Drug Research, 3(1), 51-61. doi:10.7895/ijadr.v3i1.117Aims: To determine 1) the relationship between T-ACE score and maternal self-reported alcohol use prior to and during pregnancy, and 2) the relationship between T-ACE score and maternal demographics, mental health and life circumstances.Design: Prospective, population-based cohort study.Setting: Three urban maternity clinics in Calgary, Canada.Participants: 1,929 pregnant women attended by family physicians at low-risk maternity clinics.Measures: Women completed three standardized questionnaires over the telephone in the first and third trimesters and eight weeks post-delivery, including the T-ACE and questions about drug and alcohol use, demographics, mental health and life circumstances.Findings: 43.6% of subjects had a positive T-ACE score at intake (score 2 or greater). A positive T-ACE score was predictive of alcohol use throughout pregnancy, although most women reported no alcohol after the first trimester (93.1%). Multivariate analysis indicated that a positive T-ACE score was significantly associated with being less than 30 years of age; being Caucasian; smoking during pregnancy; having an income of less than $80,000 per annum; having a history of depression; having a history of alcohol use and binge drinking during a previous pregnancy; lower social support; and poor network orientation.Conclusions: There was a positive association between the T-ACE score and maternal self-report of alcohol use, poor mental health and poor social support. Routine use of the T-ACE to assess for risk of an alcohol-exposed pregnancy may also help identify women with complex needs who could benefit from additional prenatal support.

scholarly journals Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study

2021 ◽  
Author(s):  
Antonio Leidi ◽  
Flora Koegler ◽  
Roxane Dumont ◽  
Richard Dubos ◽  
Maria-Eugenia Zaballa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Smoking Status ◽  
Large Population ◽  
Population Based ◽  
Matched Cohort ◽  
Igg Antibodies ◽  
Matched Cohort Study ◽  
Pandemic Wave

Importance: Serological assays detecting specific IgG antibodies generated against the Spike protein following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection are being widely deployed in research studies and clinical practice. However, the duration and the effectiveness of the protection conferred by the immune response against future infection remains to be assessed in a large population. Objective: To estimate the incidence of newly acquired SARS-CoV-2 infections in seropositive individuals from a population-based sample as compared to seronegative controls. Design: Retrospective longitudinal propensity-score matched cohort study. Setting: A seroprevalence survey including a population-based representative sample of the population from the canton of Geneva (Switzerland) was conducted between April and June 2020, immediately after the first pandemic wave. Each individual included in the seroprevalence survey was linked to a state centralized registry compiling virologically confirmed SARS-CoV-2 infections since the beginning of the pandemic. Participants: Participants aged twelve years old and over, who developed anti-spike IgG antibodies were matched one-to-two to seronegative controls, using a propensity-score including age, gender, immunodeficiency, body mass index, smoking status and education level. Exposure: SARS-CoV-2 seropositivity. Main outcomes and measures: Our primary outcome was virologically confirmed SARS-CoV-2 infections which occurred from serological status assessment in April-June 2020 to the end of the second pandemic wave (January 2021). Additionally, incidence of infections, rate of testing and proportion of positive tests were analysed. Results: Among 8344 serosurvey participants, 498 seropositive individuals were selected and matched with 996 seronegative controls. After a mean follow-up of 35.6 (Standard Deviation, SD: 3.2) weeks, 7 out of 498 (1.4%) seropositive subjects had a positive SARS-CoV-2 test, of which 5 (1.0%) were considered as reinfections. By contrast, infection rate was significantly higher in seronegative individuals (15.5%, 154/996) during a similar mean follow-up of 34.7 (SD 3.2) weeks, corresponding to a 94% (95%CI 86% to 98%, P<0.001) reduction in the hazard of having a positive SARS-CoV-2 test for seropositive subjects. Conclusions and relevance: Seroconversion after SARS-CoV-2 infection confers protection to successive viral contamination lasting at least 8 months. These findings could help global health authorities establishing priority for vaccine allocation.

scholarly journals The impact of Mendelian sleep and circadian genetic variants in a population setting

2022 ◽  
Author(s):  
Michael N Weedon ◽  
Samuel E Jones ◽  
Jacqueline Lane ◽  
Jiwon Lee ◽  
Hanna M Ollila ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Rare Variants ◽  
Sequence Data ◽  
Large Population ◽  
Population Based ◽  
Self Report ◽  
Uk Biobank ◽  
Sleep Phase ◽  
Sleep Timing ◽  
The Impact

Rare variants in ten genes have been reported to cause Mendelian sleep conditions characterised by extreme sleep duration or timing. These include familial natural short sleep (ADRB1, DEC2/BHLHE41, GRM1 and NPSR1), advanced sleep phase (PER2, PER3, CRY2, CSNK1D and TIMELESS) and delayed sleep phase (CRY1). The association of variants of these genes with extreme sleep conditions were usually based on clinically ascertained families, and their effects when identified in the population are unknown. We aimed to determine the effects of these variants on sleep traits in large population-based cohorts. We performed genetic association analysis of variants previously reported to be causal for Mendelian sleep and circadian conditions. Analyses were performed using 191,929 individuals with data on sleep and whole-exome or genome-sequence data from 4 population-based studies: UK Biobank, FINRISK, Health-2000-2001, and the Multi-Ethnic Study of Atherosclerosis (MESA). We identified sleep disorders from self-report, hospital and primary care data. We estimated sleep duration and timing measures from self-report and accelerometery data. We identified carriers for 10 out of 12 previously reported pathogenic variants for 8 of the 10 genes. They ranged in frequency from 1 individual with the variant in CSNK1D to 1,574 individuals with a reported variant in the PER3 gene in the UK Biobank. We found no association of any of these variants with extreme sleep or circadian phenotypes. Using sleep timing as a proxy measure for sleep phase, only PER3 and CRY1 variants demonstrated association with earlier and later sleep timing, respectively; however, the magnitude of effect was smaller than previously reported (sleep midpoint ~7 mins earlier and ~5 mins later, respectively). We also performed burden tests of protein truncating (PTVs) or rare missense variants for the 10 genes. Only PTVs in PER2 and PER3 were associated with a relevant trait (for example, 64 individuals with a PTV in PER2 had an odds ratio of 4.4 for being "definitely a morning person", P=4x10-8; and had a 57-minute earlier midpoint sleep, P=5x10-7). Our results indicate that previously reported variants for Mendelian sleep and circadian conditions are often not highly penetrant when ascertained incidentally from the general population.

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