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Masks and other non-pharmaceutical interventions can complement vaccines and treatments as a part of multilayered mitigation to reduce the burden of COVID-19 in high-risk settings like surges. Although N95s provide greater protection than cloth and procedure masks against airborne infectious illnesses, few people used N95s historically, potentially due to lack of familiarity and cost. The study was designed to examine the feasibility of distributing N95s during a COVID-19 surge. A follow-up survey summarized mask behavior. The investigators aimed to distribute 2,500 N95s to 500 adults in 5-packs with informational handouts at community locations during the COVID-19 Omicron BA.1 surge in New Orleans, Louisiana. A 1-month follow-up survey assessed utilization, safety perceptions, social diffusion of awareness of N95s, and purchase intentions. The investigators successfully distributed all 2,500 N95s during the peak of the BA.1 surge (December 13, 2021 to January 17, 2022). At 1-month follow-up, 96.7% of participants had tried an N95. They utilized an average of 3.42 (68.4%) of the five N95s, felt safer wearing N95s (Ps< 0.0001), discussed N95s with others (80.4%), and would wear N95s again if free (87.9%). Future utilization intentions were price sensitive. Communities will readily use public health tools like N95s when at risk and offered for free with useful information. Cost was identified as a key barrier to sustained utilization. Findings have immediate public policy implications for reducing national, regional, and organizational surges. The research provides an illustrative example of the importance of behavioral science in responding to public health crises.When given free high-quality N95 masks during the COVID-19 Omicron BA.1 surge, community members utilized them at a high rate, felt safer, discussed N95s with others, planned to buy more, and reported cost as a critical barrier to sustained utilization.Masks are a part of a comprehensive approach to reducing the burden of COVID-19 surges. High-quality masks, called N95 masks in the USA, provide better protection than cloth or blue procedure masks. Most people have not used N95s due to a lack of familiarity or cost. We tested a program to distribute N95s to the community during a COVID-19 surge. Specifically, we gave 2,500 N95s to 500 adults in 5-packs with informational handouts during the COVID-19 Omicron BA.1 surge in New Orleans, Louisiana. We requested recipients complete a 1-month follow-up survey. Overall, we were successful in distributing all 2,500 N95s during the peak of the winter 2021–2022 surge. By 1-month follow-up, nearly all recipients had tried an N95 and had used nearly 70% of the total given. They felt safer, discussed the masks with others, and would wear them again if free. Cost was a key barrier to using N95s in the future. After our study, the USA federal government implemented a program to distribute free N95s, but there are no policy plans to distribute free N95s during future winter surges or in response to vaccine-evading variants. Free N95 distribution programs would be popular and reduce the burden of COVID-19.Graphical Abstract

Schizotypy is marked by negative symptoms including blunted affect, social isolation, and social anhedonia. Contemporary personality theory suggests that maladaptive shame regulation may disrupt interpersonal function across personality disorders. We hypothesized that “affect shame”—a conditioned response of shame evoked by openly expressing emotions would co-occur with interpersonal deficits in schizotypy. As hypothesized, affect shame was associated with interpersonal deficits (r= 0.17, p< 0.001), physical anhedonia (r= 0.13, p= 0.001), and social anhedonia (r= 0.17, p= 0.001). The observed findings were upheld in analyses controlling for demographic characteristics, depression symptom severity, and neuroticism and were maintained consistently across sensitivity analyses. Findings suggest that shame related to emotional expression is related to interpersonal deficits in schizotypy and have implications for our understanding of the etiology and treatment of this disorder.

Tobacco use is a leading preventable cause of early mortality and is prevalent among adults with mental health diagnoses, especially in the southern USA. Increasing cessation resources in outpatient mental health care and targeting individuals most receptive to changing their behavior may improve cessation. Drawing on the transtheoretical model, our goals were to develop an educational video about the Louisiana Tobacco Quitline and evaluate its acceptability. We designed the video with knowledge derived from Louisiana-specific data (2016 Louisiana Adult Tobacco Survey, N= 6,469) and stakeholder feedback. Bivariate associations between demographic/tobacco-use characteristics and participants’ stage of quitting (preparation phase vs. nonpreparation phase) were conducted, which informed design elements of the video. Four stakeholder advisory board meetings involving current smokers, mental health clinicians, and public health advocates convened to provide iterative feedback on the intervention. Our stakeholder advisory board (n= 10) and external stakeholders (n= 20) evaluated intervention acceptability. We found that 17.9% of Louisiana adults were current smokers, with 46.9% of them in the preparation phase of quitting. Using insights from data and stakeholders, we succeeded in producing a 2-min video about the Louisiana Tobacco Quitline which incorporated three themes identified as important by stakeholders: positivity, relatability, and approachability. Supporting acceptability, 96.7% of stakeholders rated the video as helpful and engaging. This study demonstrates the acceptability of combining theory, existing data, and iterative stakeholder feedback to develop a quitline educational video. Future research should examine whether the video can be used to reduce tobacco use.We analyzed national data and partnered with community members who smoke to create a positive, relatable, and approachable video about a smoking cessation helpline.

“Scenario planned provides a useful framework for scientists proposing and implementing new projects during the COVID-19 pandemic and other uncertain events.”

The DASS-21 is a public domain instrument that is commonly used to evaluate depression and anxiety in psychiatric and community populations; however, the factor structure of the measure has not previously been examined in oncologic settings. Given that the psychometric properties of measures of distress may be compromised in the context of symptoms related to cancer and its treatment, the present study evaluated the psychometric properties of the DASS-21 Depression and Anxiety scales in cancer patients (n= 376) as compared to noncancer control participants (n= 207). Cancer patients ranged in age from 21 to 84 years (mean = 58.3, standard deviation = 10.4) and noncancer control participants ranged in age from 18 to 81 years (mean = 45.0, standard deviation = 11.7). Multiple group confirmatory factor analysis supported the structural invariance of the DASS-21 Depression and Anxiety scales across groups; the factor variance/covariance invariance model was the best fit to the data. Cronbach’s coefficient alpha values demonstrated acceptable internal consistency reliability across the total sample as well as within subgroups of cancer patients and noncancer control participants. Expected relationships of DASS-21 Depression and Anxiety scale scores to measures of suicidal ideation, quality of life, self-rated health, and depressed mood supported construct validity. These results support the psychometric properties of the DASS-21 Depression and Anxiety scales when measuring psychological distress in cancer patients.

IMPORTANCE: Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE: To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS: Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS: Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES: The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS: Data from 38 oncologists (19 randomized to intervention) and 265 patients (130 intervention) were analyzed. In fully adjusted models, the intervention resulted in clinically and statistically significant improvements in the primary physician-patient communication end point (adjusted intervention effect, 0.34; 95% CI, 0.06-0.62; P = .02). Differences in secondary outcomes were not statistically significant. CONCLUSIONS AND RELEVANCE: A combined intervention that included oncologist communication training and coaching for patients with advanced cancer was effective in improving patient-centered communication but did not affect secondary outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01485627

IMPORTANCE: Patients with advanced cancer often report expectations for survival that differ from their oncologists’ expectations. Whether patients know that their survival expectations differ from those of their oncologists remains unknown. This distinction is important because knowingly expressing differences of opinion is important for shared decision making, whereas patients not knowing that their understanding differs from that of their treating physician is a potential marker of inadequate communication. OBJECTIVE: To describe the prevalence, distribution, and proportion of prognostic discordance that is due to patients’ knowingly vs unknowingly expressing an opinion that differs from that of their oncologist. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted at academic and community oncology practices in Rochester, New York, and Sacramento, California. The sample comprises 236 patients with advanced cancer and their 38 oncologists who participated in a randomized trial of an intervention to improve clinical communication. Participants were enrolled from August 2012 to June 2014 and followed up until October 2015. MAIN OUTCOMES AND MEASURES: We ascertained discordance by comparing patient and oncologist ratings of 2-year survival probability. For discordant pairs, we determined whether patients knew that their opinions differed from those of their oncologists by asking the patients to report how they believed their oncologists rated their 2-year survival. RESULTS: Among the 236 patients (mean [SD] age, 64.5 [11.4] years; 54% female), 161 patient-oncologist survival prognosis ratings (68%; 95% CI, 62%-75%) were discordant. Discordance was substantially more common among nonwhite patients compared with white patients (95% [95% CI, 86%-100%] vs 65% [95% CI, 58%-73%], respectively; P = .03). Among 161 discordant patients, 144 (89%) did not know that their opinions differed from that of their oncologists and nearly all of them (155 of 161 [96%]) were more optimistic than their oncologists. CONCLUSIONS AND RELEVANCE: In this study, patient-oncologist discordance about survival prognosis was common and patients rarely knew that their opinions differed from those of their oncologists.

This pilot study employed a moderated mediation framework to examine whether negative expectations of interpersonal relationships explained the relationship between experiential avoidance and interpersonal problems. University students (N=159) completed measures of experiential avoidance, negative perceptions and expectations of interpersonal relationships (e.g., hostility, attachment anxiety), and interpersonal problems (e.g., coldness, social avoidance, dominating tendencies, and vindictiveness). Attachment anxiety explained the relationship between experiential avoidance and interpersonal problems involving coldness and social avoidance, with a stronger relationship at high levels of experiential avoidance. In addition, hostility explained the relationship between experiential avoidance and interpersonal problems involving dominant and vindictive tendencies. Moreover, experiential avoidance interacted with attachment anxiety and hostility to predict higher levels of interpersonal problems as evidenced by stronger indirect associations among participants reporting higher levels of experiential avoidance. Results of this pilot study provide a preliminary empirical model that integrates the literatures on experiential avoidance and interpersonal problems.

Personality is relatively stable in adulthood but could change in response to life transitions, such as caring for a spouse with a terminal illness. Using a case–control design, spousal caregivers (n= 31) of patients with terminal lung cancer completed the NEO Five-Factor Inventory (NEO-FFI) twice, 1.5 years apart, before and after the patient’s death. A demographically matched sample of community controls (n= 93) completed the NEO-FFI on a similar time frame. Based on research and theory, we hypothesized that bereaved caregivers would experience greater changes than controls in interpersonal facets of extraversion (sociability), agreeableness (prosocial and nonantagonistic), and conscientiousness (dependability). Consistent with hypotheses, bereaved caregivers experienced an increase in interpersonal orientation, becoming more sociable, prosocial, and dependable (Cohen’s d= .48–.67), though there were no changes in nonantagonism. Changes were not observed in controls (ds = .11). These initial findings underscore the need for more research on the effect of life transitions on personality.

The ability to delay gratification and wait for larger long-term rewards is crucial for maximizing outcomes in commonly valued areas of living such as career, health, and relationships. Past research suggests that emotional distress impairs this ability to delay gratification. Research also indicates that persons who exhibit higher levels of experiential avoidance, the tendency to negatively evaluate and avoid emotion and cognition, tend to report higher levels of distress. There is limited research to date on the direct or indirect relationships between experiential avoidance and delay of gratification. The current study was designed to assess these relationships in order to integrate findings from the literature on experiential avoidance and delay of gratification. Two hundred and two university students provided ratings of their experiential avoidance, depression, anger, and delay of gratification. Results indicated these variables were moderately and significantly correlated. Path analysis suggested that experiential avoidance has a direct relationship with delay of gratification, and an indirect relationship through higher depression and anger. These findings suggest that acceptance-based behavior therapies that reduce experiential avoidance and distress may potentially enhance delay of gratification.