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Introduction: Although smoking prevalence has recently declined, the smoking prevalence in China remains high. Extensive research has demonstrated ways that social media can assist in quitting smoking. WeChat is the most commonly used social media platform in China but has not been used for smoking cessation. A process evaluation of a novel WeChat-based smoking cessation intervention was conducted to measure its efficacy of content delivery, participant satisfaction, engagement, and likelihood of recommendation to others. Methods: A three-week, three-arm, single-blind randomized control trial was established. WeChat was used to recruit 403 participants and to deliver intervention messages and process evaluation surveys to them. Recruitment advertisements were posted on an official WeChat account and were forwarded to WeChat Moments. Intervention messages were delivered once a day during weekdays, using the WeChat broadcasting messages function, with two messages being sent each time. Process evaluation surveys were organized using Wenjuanwang and were delivered via WeChat. Process assessments were conducted every Friday to assess intervention message receipt, satisfaction level, engagement level, and recommendation to others. The receipt of intervention messages was measured by a self-reported question indicating which messages were read each week. Satisfaction was measured by a five-item Likert scale survey. Engagement was measured by a one-item Likert scale survey. Recommendation to others was measured by one self-reported question. Results: Participants read an average of 4.76 (out of 10), 5.80 (out of 10), and 4.25 (out of 6) messages at week 1, week 2, and week 3, respectively. The second messages were less likely to be read compared to the first messages (52.3% vs. 61.6%, respectively). Moreover, within each single week, the number of participants who read the intervention messages gradually decreases over time. Picture-based intervention messages tended to be less likely to be read than video-based intervention messages. Total program satisfaction scores ranged between 5 and 25, and the overall scores for satisfaction for each week were 21.55, 22.27, and 22.76, respectively. No significant differences were found in all the satisfaction indicators between groups. More than 60% of participants reported being either highly engaged or somewhat engaged each week. In addition, most participants (93.0% at week 1, 95.8% at week 2, and 96.2% at week 3) reported that they were willing to recommend our program to others. Discussion: A WeChat-based smoking cessation intervention for Chinese smokers was implemented and evaluated. For future studies, one should consider sending messages of a higher importance as the first message of a given day. Smokers had a higher rate of reading intervention messages at the beginning part of each week, during which, relatively important messages should be prioritized. One might also consider alternating the topics and formats of the messages for a better engagement of the users in future studies.

Background: Previous studies have shown that smoking tobacco significantly increases both incidence and mortality rates for many diseases. Social media has become one of the most influential platforms for various smoking cessation interventions. However, results from smoking cessation interventions have differed from study to study. Limited studies have summarised cessation outcomes from social media–based interventions. Therefore, the objective of this review is to explore the effectiveness of using social media for smoking cessation. Methods: We searched PubMed, MEDLINE, PsycINFO, and CINAHL for articles between June 2008 and June 2018, and also assessed the references of selected articles. We included studies that used social media as intervention platforms, provided a baseline assessment before the intervention, and provided smoking cessation outcomes after the intervention. Results: We identified 13 original studies that enrolled between 16 and 1698 participants; 7-day Point Prevalence Abstinence (PPA) rate was the most frequently used measure of abstinence, with a range of 7%–75%, regardless of the measurement time, study design, and analysis methods. Social media–based smoking cessation interventions were effective, because (1) smokers reported higher 7-day PPA rates after intervention compared to baseline and (2) smokers reported higher 7-day PPA rates in intervention groups than in control groups. Moreover, at each time point, approximately half of all smokers in studies reporting abstinence were found to be biochemically abstinent. There were no significant differences in the effectiveness of smoking cessation outcomes between those that used existing popular social networking platforms (e.g. Pechmann et al’s studies) and those that used individually designed interactive platforms (e.g. MyLastDip, iQuit system, Quitxt system). Conclusions: This review highlights the effectiveness of social media–based smoking cessation intervention studies. Due to the widespread use of social media, as well as its low cost, we suggest embedding smoking cessation interventions within existing popular social media platforms.

The purpose of this study was to compare the outcomes of 2 self-collection methods to detect cervical human papillomavirus (HPV) DNA with outcomes from a standard clinical method. The standard method samples were collected by a clinician at a routine pelvic examination. Self-samples were taken at home and mailed to the clinical laboratory.The 2 self-collection methods were a tampon-based method and a swab-based method using a commercial device, an Eve Medical HerSwab. All HPV samples were processed by a clinical laboratory using the Food and Drugs Administration approved Roche Cobase HPV method, which specifically identifies HPV 16, HPV 18, and a set of 12 other high-risk subtypes. Patients were recruited from 2 cancer screening clinics 2015 to 2017. All patients signed an informed consent. Screening outcomes, such as prevalence, percent agreement with standard, sensitivity, and specificity, were calculated for each self-collection method. Measures of similarity between self and standard collection outcomes, Cohen's κ, percent concordance, McNemar equivalence, and others were tested statistically.One hundred seventy-four patients were randomized. The prevalence of 1 or more positive HPV high-risk subtypes from the standard clinical specimens was 13.5%. All clinical specimens were sufficient for valid HPV detection. For the tampon method, 15 (27%) of the specimens were insufficient quality. Only 1 (2%) swab specimen was insufficient. Only the swab self-collection method was found to be statistically noninferior to the clinical method. The tampon method had an unacceptably high rate of insufficient quality specimens and also failed the equivalency tests.The swab home collection samples were equivalent to the clinical samples, but the tampon method had an unacceptably high rate of specimens insufficient for HPV detection.

Breast density is known to increase breast cancer risk and decrease mammography screening sensitivity. Breast density notification laws (enacted in 38 states as of September 2020), require physicians to inform women with high breast density of these potential risks. The laws usually require healthcare providers to notify patients of the possibility of using more sensitive supplemental screening tests (e.g., ultrasound). Since the enactment of the laws, there have been controversial debates over i) their implementations due to the potential radiologists bias in breast density classification of mammogram images and ii) the necessity of supplemental screenings for all patients with high breast density. In this study, we formulate a finite-horizon, discrete-time partially observable Markov chain (POMC) to investigate the effectiveness of supplemental screening and the impact of radiologists’ bias on patients’ outcomes. We consider the conditional probability of eventually detecting breast cancer in early states given that the patient develops breast cancer in her lifetime as the primary and the expected number of supplemental tests as the secondary patient’s outcome. Our results indicate that referring patients to a supplemental test solely based on their breast density may not necessarily improve their health outcomes and other risk factors need to be considered when making such referrals. Additionally, average-skilled radiologists’ performances are shown to be comparable with the performance of a perfect radiologist (i.e., 100% accuracy in breast density classification). However, a significant bias in breast density classification (i.e., consistent upgrading or downgrading of breast density classes) can negatively impact a patient’s health outcomes.

Overdiagnosis is defined as the diagnosis of an asymptotic cancer that would not have presented clinically in a patient's lifetime in the absence of screening. Quantifying overdiagnosis is difficult, since it is impossible to distinguish between a cancer that would cause symptoms in the patient lifetime and the ones that would not. In this study, a mathematical framework is developed to estimate the lifetime overdiagnosis and cancer mortality risks associated with cancer screening policies. We also develop an optimization model to extract screening policies with minimum overdiagnosis and lifetime breast cancer mortality risk. The proposed optimization model is highly nonlinear with complex structure. Therefore, we linearize the optimization model by introducing new decision variables and restructuring the equations to solve it optimally. We utilize existing data on breast cancer for average-risk women and evaluated mammography screening policies in terms of their associated lifetime overdiagnosis ...

Introduction: Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Moreover, health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Social media interventions for tobacco cessation may effectively reach both groups. The objective of this study was to evaluate the efficacy of a WeChat-delivered smoking cessation intervention among rural and urban Chinese smokers, and to assess moderating variables that may contribute to differential intervention efficacy. Methods: WeChat was used to recruit smokers into this intervention study between 1 July and 5 August 2019. Participants were randomized to one of three intervention schedules: participants in the Standard Group and the Enhanced Group received 20 smoking-related messages over 2 weeks, whereas participants in the Enhanced Group received an extra 6 oral health-related messages for one week. Participants in the control group received 20 smoking-related messages after the post-intervention assessment. Participants completed questionnaires at baseline and at 4 weeks follow-up. Our primary outcome was smoking cessation stage of change and secondary outcome was 24-h point prevalence abstinence (PPA). Urban and rural areas were based on self-reported living areas. Chi-squared test, Fisher’s exact test, ANOVA test, linear regression, and logistic regression were used for analysis. Results: Overall, 403 participants completed the intervention (233 rural, 107 suburban, 63 urban). Compared to urban participants, rural participants were more likely to have progressed to a later stage of change (β = 0.40, 95% CI: 0.13, 0.67) and to report higher 24-h PPA rates at follow-up (aOR = 3.23, 95% CI: 1.36, 7.68). After stratification by living area, the intervention effects in stage of change and 24-h PPA rate at follow-up were only found in the urban subgroup. Discussion: Smokers who lived in rural areas reported better smoking cessation outcomes compared with urban smokers, however, the efficacy of a WeChat-based smoking cessation intervention was only found for participants living in an urban area. WeChat based smoking cessation interventions should be used to promote smoking cessation in urban, suburban, and rural areas.

Background: The purpose of this randomized trial was to examine the feasibility of using home self-sampling for HPV testing to screen for cervical cancer, as compared to HPV samples obtained by a physician or nurse practitioner during a clinical exam. Methods: Two LSU study sites were used, New Orleans and Shreveport, LA. Stratified, permuted blocks randomization was used to allocate patients to one of two methods of home sampling: a standard tampon inserted and worn for two hours, or an easy-to-use vaginal swab device (HerSwab®). All self- collected and clinical were tested for HPV 16 and 18 subtypes and other high-risk subtypes. Each self-collected sample was compared to the patient's clinical sample using McNemarâ' paired chi-squared test. Tampon and self-collected swab samples were compared using an unpaired chi-squared test. Results: A total of one hundred and seventy-four (174) eligible subjects were recruited. Ninety-five subjects were recruited from Shreveport and 79 from New Orleans. The age of the women subjects ranged from 21 to 69, with a mean age of 47 years. The predominant race was African American, 73%, with 22% white and 5% Asian, mixed race or unknown. Hispanic or Latino ethnicity was reported as 4%. Overall, 66% of home-collected specimens were returned for processing. The percent positive specimens was approximately the same, regardless of specimen source, e.g., clinical (13.5% positive), tampon (14.5% positive) or swab (15% positive). There was no statistical difference between the positive specimen rates of tampon and swab methods. By oversight, 11 clinical specimens were not collected for HPV testing. Six women had a positive self-test, but their clinical test results were not positive. All the clinical samples were sufficient for valid DNA analysis. Only one of the home swab specimens was insufficient, but 15 of the tampon specimens were insufficient. This difference is highly statistically significant, p< 0.0001 by Fisher's exact test. Also, as mentioned above, the return rate was better for the swab method. Fifty-five women answered the satisfaction questionnaire. Participants assigned to the tampon use complained about the procedure verbally to the study nurse, although the formal questionnaire did not reflect this. None reported problems with the swab method. Conclusion: The self-collected HPV specimens were not significantly different from the clinically collected specimens, although the tampon method had more unreturned specimens and significantly more specimens of insufficient quality for testing. Citation Format: Jerry McLarty, Donna Williams, Susan Loyd, Michael Hagensee. Cervical HPV testing with two home self-collection methods compared to a standard clinical-collection method [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B116.

In the United States, about 11% (26,393) of those diagnosed with breast cancer in 2016 will be young or less than 45 years old. Young breast cancer survivors, compared to older cancer survivors, are a disparate group that experience higher incidence of advanced disease, greater mortality, and poorer quality of life, and are often faced with difficulty locating support that meet the unique needs of young women. The Gulf States Young Breast Cancer Survivor Network, composed of three sister networks, formed a partnership aimed at harnessing the power of social media to reach and impact the lives of young women with breast cancer. The collaborative partnership framework and the power of synergy are shown in merging two existing programs and incorporating a third new program.

Human papilloma virus (HPV) is a common virus that can cause genital warts and certain cancers. The HPV vaccine is effective in preventing many HPV-associated diseases, however, vaccination rates suggest many remain unprotected. This study examined successful strategies used by physicians to improve HPV vaccination rates. Providers with above average vaccination rates were identified. A representative from each provider participated in an interview to identify strategies used to boost HPV vaccination. Key strategies in ensuring vaccine completion were reminders, education, standing orders, and scheduling future vaccine appointments at time of first dose. Other successful strategies included coupling the HPV vaccine with adolescent vaccines, administering during well-visits, and recommending the vaccine as protection against cancer and genital warts. Findings suggest successful and widely used methods among high performing providers in Louisiana, the majority of which should be easily reproducible with minimal resources to improve HPV vaccination rates.

Objective . Lack of health insurance is correlated with noncompliance in colorectal cancer screening. Louisiana ranks 48th among all states in residents with health insurance. This paper describes initial results of Louisiana’s first statewide colorectal cancer screening program. Methods . The program enhanced screening capacity of state hospitals by providing fecal immunochemical tests (FITs), colonoscopes, and funded patient navigators. The Social Ecological Model (SEM) was used as the framework for the program. Results . Patient navigators distributed 975 FITs to adults 50 to 64 years (21% men, 78% women).The overall return rate was 66%. There was no association among return rates, race, or gender. Participants who were previously screened (10.7%) were more likely to return their FIT. Discussion . The combination of patient navigation and providing patients with an easy-touse CRC screening option proved to be an effective method that potential colorectal cancer screening programs can deploy in similar populations of un- and under-insured adults.

Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and African American women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays) and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17%, respectively). African American and white women did not differ in distribution of stage of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More African American women experienced delays in diagnosis; however these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities as well as other possible barriers to treatment warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study.

Crustaceans must replace their old exoskeleton with a new, larger one in order to grow and differentiate. During that process a new (preexuvial) cuticle is deposited beneath the old cuticle. Since breakdown products from the old cuticle have been reported to be removed from the old cuticle and transported across the new cuticle and hypodermis into the hemolymph, the preexuvial cuticle is presumed to be permeable. However, it has also been reported that intermolt cuticle is a highly impermeable structure that prevents loss of water and ions from the cuticle to the external environment. This study was designed to determine the timing of any change in the permeability of the cuticle of the blue crab, Callinectes sapidus, from the period just preceding ecdysis through the early postmolt period. To test for any changes in permeability pilot studies were performed on pieces of dorsobranchial cuticle from late premolt (D4) and early postmolt crabs (15 min, 2 h, 12 h and 18 h post-ecdysis) using 3 H2O and an Ussing chamber. Additional permeability studies were done monitoring the movement of p-nitrophenol (pNP) across the cuticle using a more restricted post-exuvial time course (0, 5, 10, 15 and 30 min. postecdysis) as compared to premolt cuticle. Results from these studies as well as wash-out studies using tissues pre-loaded with pNP and staining of 1 h post-molt cuticle with OsO4 suggest that the epicuticle undergoes a transition at or soon after ecdysis that renders it impermeable to water and small molecules. While the precise mechanism for this transition is unknown, it is clear that the resultant alteration in epicuticle permeability during early post-ecdysis allows for the formation of a barrier that prevents osmotic and ionic exchange, allows for the generation of significant hydrostatic pressure, and provides a suitable microenvironment for calcification.

SUMMARY: The resistance of Pseudomonas aeruginosa wild-type, uvr, pol and rec strains to ultraviolet (u.v.) light, X-rays and freezing and thawing was determined. An R plasmid, pPL1, which increased resistance of the wild-type, uvr, and pol but not rec strains to u.v. light, increased the resistance of only rec and pol mutants to X-rays and freezing and thawing. These findings reinforce the idea of DNA as a target in the organism for freeze-thaw stress and suggest that freeze-thaw-induced DNA damage might be similar to that produced by X-rays but different from that produced by u.v. light.