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Few studies have examined the relative effectiveness of reinforcing versus aversive consequences at changing behavior in real-world environments. Real-time sensing devices makes it easier to investigate such questions, offering the potential to improve both intervention outcomes and theory. This research aims to describe the development of a real-time, operant theory-based secondhand smoke (SHS) intervention and compare the efficacy of aversive versus aversive plus reinforcement contingency systems. Indoor air particle monitors were placed in the households of 253 smokers for approximately three months. Participants were assigned to a measurement-only control group (N = 129) or one of the following groups: 1.) aversive only (AO, N = 71), with aversive audio/visual consequences triggered by the detection of elevated air particle measurements, or 2.) aversive plus reinforcement (AP, N = 53), with reinforcing consequences contingent on the absence of SHS added to the AO intervention. Residualized change ANCOVA analysis compared particle concentrations over time and across groups. Post-hoc pairwise comparisons were also performed. After controlling for Baseline, Post-Baseline daily particle counts (F = 6.42, p = 0.002), % of time >15,000 counts (F = 7.72, p < 0.001), and daily particle events (F = 4.04, p = 0.02) significantly differed by study group. Nearly all control versus AO/AP pair-wise comparisons were statistically significant. No significant differences were found for AO versus AP groups. The aversive feedback system reduced SHS, but adding reinforcing consequences did not further improve outcomes. The complexity of real-world environments requires the nuances of these two contingency systems continue to be explored, with this study demonstrating that real-time sensing technology can serve as a platform for such research.

BackgroundPrevious secondhand smoke (SHS) reduction interventions have provided only delayed feedback on reported smoking behaviour, such as coaching, or presenting results from child cotinine assays or air particle counters.DesignThis SHS reduction trial assigned families at random to brief coaching and continuous real-time feedback (intervention) or measurement-only (control) groups.ParticipantsWe enrolled 298 families with a resident tobacco smoker and a child under age 14.InterventionWe installed air particle monitors in all homes. For the intervention homes, immediate light and sound feedback was contingent on elevated indoor particle levels, and up to four coaching sessions used prompts and praise contingent on smoking outdoors. Mean intervention duration was 64 days.MeasuresThe primary outcome was 'particle events' (PEs) which were patterns of air particle concentrations indicative of the occurrence of particle-generating behaviours such as smoking cigarettes or burning candles. Other measures included indoor air nicotine concentrations and participant reports of particle-generating behaviour.ResultsPEs were significantly correlated with air nicotine levels (r=0.60) and reported indoor cigarette smoking (r=0.51). Interrupted time-series analyses showed an immediate intervention effect, with reduced PEs the day following intervention initiation. The trajectory of daily PEs over the intervention period declined significantly faster in intervention homes than in control homes. Pretest to post-test, air nicotine levels, cigarette smoking and e-cigarette use decreased more in intervention homes than in control homes.ConclusionsResults suggest that real-time particle feedback and coaching contingencies reduced PEs generated by cigarette smoking and other sources.Trial registration numberNCT01634334; Post-results.

Health interventions using real-time sensing technology are characterized by intensive longitudinal data, which has the potential to enable nuanced evaluations of individuals' responses to treatment. Existing analytic tools were not developed to capitalize on this opportunity as they typically focus on first-order findings such as changes in the level and/or slope of outcome variables over different intervention phases. This paper introduces an exploratory, Markov-based empirical transition method that offers a more comprehensive assessment of behavioral responses when intensive longitudinal data are available. The procedure projects a univariate time-series into discrete states and empirically determines the probability of transitioning from one state to another. State transition probabilities are summarized separately in phase-specific transition matrices. Comparing transition matrices illuminates intricate, quantifiable differences in behavior between intervention phases. Statistical significance is estimated via bootstrapping techniques. This paper introduces the methodology via three case studies from a secondhand smoke reduction trial utilizing real-time air particle sensors. Analysis enabled the identification of complex phenomena such as avoidance and escape behavior in response to punitive contingencies for tobacco use. Additionally, the largest changes in behavior dynamics were associated with the introduction of behavioral feedback. The Markov approach's ability to elucidate subtle behavioral details has not typically been feasible with standard methodologies, mainly due to historical limitations associated with infrequent repeated measures. These results suggest that the evaluation of intervention effects in data-intensive single-case designs can be enhanced, providing rich information that can ultimately be used to develop interventions uniquely tailored to specific individuals.

ObjectivesPreventive health services are important for child development, and parents play a key role in facilitating access to services. This study examined how parents' reasons for not having a usual source of care were associated with their children's receipt of preventive services.MethodsWe used pooled data from the 2011-2014 National Health Interview Survey (n = 34 843 participants). Parents' reasons for not having a usual source of care were framed within the Penchansky and Thomas model of access and measured through 3 dichotomous indicators: financial barriers (affordability), attitudes and beliefs about health care (acceptability), and all other nonfinancial barriers (accessibility, accommodation, and availability). We used multivariable logistic regression models to test associations between parental barriers and children's receipt of past-year well-child care visits and influenza vaccinations, controlling for other child, family, and contextual factors.ResultsIn 2014, 14.3% (weighted percentage) of children had at least 1 parent without a usual source of care. Children of parents without a usual source of care because they "don't need a doctor and/or haven't had any problems" or they "don't like, trust, or believe in doctors" had 35% lower odds of receiving well-child care (adjusted odds ratio = 0.65; 95% CI, 0.56-0.74) and 23% lower odds of receiving influenza vaccination (adjusted odds ratio = 0.77; 95% CI, 0.69-0.86) than children of parents without those attitudes and beliefs about health care. Financial and other nonfinancial parental barriers were not associated with children's receipt of preventive services. Results were independent of several factors relevant to children's access to preventive health care, including whether the child had a usual source of care.ConclusionsParents' attitudes and beliefs about having a usual source of care were strongly associated with their children's receipt of recommended preventive health services. Rates of receipt of child preventive services may be improved by addressing parents' attitudes and beliefs about having a usual source of care. Future studies should assess causes of these associations.

Children are at risk for adverse health outcomes from occupant-controllable indoor airborne contaminants in their homes. Data are needed to design residential interventions for reducing low-income children's pollutant exposure. Using customized air quality monitors, we continuously measured fine particle counts (0.5 to 2.5 microns) over a week in living areas of predominantly low-income households in San Diego, California, with at least one child (under age 14) and at least one cigarette smoker. We performed retrospective interviews on home characteristics, and particle source and ventilation activities occurring during the week of monitoring. We explored the relationship between weekly mean particle counts and interview responses using graphical visualization and multivariable linear regression (base sample n = 262; complete cases n = 193). We found associations of higher weekly mean particle counts with reports of indoor smoking of cigarettes or marijuana, as well as with frying food, using candles or incense, and house cleaning. Lower particle levels were associated with larger homes. We did not observe an association between lower mean particle counts and reports of opening windows, using kitchen exhaust fans, or other ventilation activities. Our findings about sources of fine airborne particles and their mitigation can inform future studies that investigate more effective feedback on residential indoor-air-quality and better strategies for reducing occupant exposures.

While previous reviews found a positive association between pre‐existing cancer diagnosis and COVID‐19‐related death, most early studies did not distinguish long‐term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher‐quality evidence on risk of COVID‐19‐related death for people with recent/active cancer (compared to people without) in the pre‐COVID‐19‐vaccination period. We searched the WHO COVID‐19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk‐of‐bias assessment was based on the Newcastle‐Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse‐variance random‐effects models. Random‐effects meta‐regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID‐19‐related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36‐1.61, I2 = 0; people with COVID‐19: aOR = 1.58, 95% CI: 1.41‐1.77, I2 = 0.58; inpatients with COVID‐19: aOR = 1.66, 95% CI: 1.34‐2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4‐4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68‐2.68, I2 = 0.43), and for metastatic cancers. Meta‐regression suggested risk of COVID‐19‐related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37‐1.75) at 1 year and aOR = 0.98 (95% CI: 0.80‐1.20) at 5 years post‐cancer diagnosis/treatment. In conclusion, before COVID‐19‐vaccination, risk of COVID‐19‐related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment. [ABSTRACT FROM AUTHOR]

Objectives Population-based recruitment of a cohort of women who are currently pregnant or who may become pregnant in a given timeframe presents challenges unique to identifying pregnancy status or the likelihood of future pregnancy. Little is known about the performance of individual eligibility items on pregnancy screeners although they are critical to participant recruitment. This paper examined the patterns and respondent characteristics of key pregnancy screener items used in a large national study. Methods Cross-sectional analyses were conducted. Descriptive statistics and multivariable logistic regression models were used to examine nonresponse patterns to three questions (currently pregnant, trying to get pregnant and able to get pregnant). The questions were asked of 50,529 women in 17 locations across the US, as part of eligibility screening for the National Children's Study Vanguard Study household-based recruitment. Results Most respondents were willing to provide information about current pregnancy, trying, and able to get pregnant: 99.3% of respondents answered all three questions and 97.4% provided meaningful answers. Nonresponse ranged from 0.3 to 2.5% for individual items. Multivariable logistic regression results identified small but statistically significant differences in nonresponse by respondent age, marital status, race/ethnicity-language, and household-based recruitment group. Conclusions for Practice The high levels of response to pregnancy-related items are impressive considering that the eligibility questions were fairly sensitive, were administered at households, and were not part of a respondent-initiated encounter., Author(s): Suzanne C. Hughes [sup.1] , Carol J. Hogue [sup.2] , Melissa A. Clark [sup.3] , Jessica E. Graber [sup.4] [sup.7] , Elaine D. Eaker [sup.5] [sup.8] , Amy H. [...]

Background This study explores hypotheses linking church attendance to smoking prevalence, cessation, exposure to environmental tobacco smoke (ETS), and household smoking bans among Korean immigrants in California. Methods Data were drawn from telephone interviews with Korean adults (N = 2085) based on a probability sample during 2005–2006 in which 86% of those contacted completed interviews. Results Koreans who reported that they had attended church were less likely to be current smokers and to be exposed to ETS, and more likely to have quit smoking and to have a complete smoking ban than non-attenders after statistical controls for behavioral covariates. Discussion Whether or not participants reported attending church was associated with increased tobacco control practices. Public health interventions may profit by seeking to expand cooperation with religious congregations to facilitate efforts to promote healthy lifestyles among immigrant populations beyond the influences of church attendance.

Simple Summary: Early detection of breast cancer in asymptomatic women through screening is an important strategy in reducing the burden of breast cancer. In current organized breast screening programs, age is the predominant risk factor. Breast cancer risk assessment tools are numerical models that can combine information on various risk factors to estimate the risk of being diagnosed with breast cancer within a certain time period. These tools could be used to offer risk-based screening. This systematic review assessed, using a variety of methods, how accurately breast cancer risk assessment tools can group women eligible for screening within a population, into risk groups, so that each group could potentially be offered a screening protocol with more benefits and less harms compared to current age-based screening. Background: The benefits and harms of breast screening may be better balanced through a risk-stratified approach. We conducted a systematic review assessing the accuracy of questionnaire-based risk assessment tools for this purpose. Methods: Population: asymptomatic women aged ≥40 years; Intervention: questionnaire-based risk assessment tool (incorporating breast density and polygenic risk where available); Comparison: different tool applied to the same population; Primary outcome: breast cancer incidence; Scope: external validation studies identified from databases including Medline and Embase (period 1 January 2008–20 July 2021). We assessed calibration (goodness-of-fit) between expected and observed cancers and compared observed cancer rates by risk group. Risk of bias was assessed with PROBAST. Results: Of 5124 records, 13 were included examining 11 tools across 15 cohorts. The Gail tool was most represented (n = 11), followed by Tyrer-Cuzick (n = 5), BRCAPRO and iCARE-Lit (n = 3). No tool was consistently well-calibrated across multiple studies and breast density or polygenic risk scores did not improve calibration. Most tools identified a risk group with higher rates of observed cancers, but few tools identified lower-risk groups across different settings. All tools demonstrated a high risk of bias. Conclusion: Some risk tools can identify groups of women at higher or lower breast cancer risk, but this is highly dependent on the setting and population. [ABSTRACT FROM AUTHOR]

Previous studies have suggested high rates of HIV infection and other sexually transmitted infections in theU.S.-Mexico border region. However, no information is available on the risk for HIV infection among Mexican adolescents living in this geographic area. This study examines the prevalence of HIV risk practices and psychosocial correlates among 370 high school students in the border city of Tijuana, Mexico, by gender and age group. The results indicate substantial risk for HIV infection among Tijuana youth due to unprotected sexual practices, lifetime rates of pregnancy and sexually transmitted infections, and needle-sharing practices, mostly related to tattooing and body piercing. These findings suggest the need for HIV prevention programs for Tijuana adolescents. These programs must be culturally sensitive and tailored to meet the needs of the different age and gender groups in this region.

Objective: This research identifies social reinforcers within religious institutions associated with alcohol consumption among Korean women in California. Method: Data were drawn from telephone interviews with female adults (N = 591) selected from a random sampling of persons in California with Korean surnames during 2007. Approximately 70% of attempted interviews were completed, with 92% conducted in Korean. Respondents were asked about any lifetime drinking (yes/no), drinking rate (typical number of drinks consumed on drinking days among current drinkers), and messages discouraging 'excessive drinking' from religious leaders or congregants. Bivariable and multivariable regressions were used for analysis. Results: Approximately 70.4% of women reported any lifetime drinking, and drinkers drank a mean (SD) of 1. 10 (1.22) drinks on drinking days. About 30.8% reported any exposure to religious leaders' messages discouraging excessive drinking, and 28.2% reported any exposure to similar messages from congregants. Each congregant's message was statistically significantly associated with a 5.1% lower probability (odds ratio = 0.775, 95% confidence interval [CI]: 0.626, 0.959) of any lifetime drinking. Also, each congregant's message was associated with a 13.8% (B = -0.138; 95% CI: -0.306, 0.029) lower drinking rate, which was statistically significant after adjusting for covariates using a one-tailed test. Exposure to leaders' messages was not statistically significantly associated with any lifetime drinking or drinking rate. Conclusions: Social reinforcement in the form of religious messages may be one mechanism by which religious institutions influence drinking behaviors. For Korean women, messages from congregants had a unique impact beyond the traditional religiosity indicators. These social mechanisms provide public health interventionists with religious pathways to improve drinking behaviors., ALCOHOL CONSUMPTION IS A RISK FACTOR for cirrhosis and cancers of the oropharynx, larynx, esophagus, and liver (Anderson et al., 1993; Blot, 1992; Klatsky et al., 1992; Stinson et al., [...]