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Objective: Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September-October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N= 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966-0.998) and commitment score (aOR = 0.987, 95% CI: 0.976-0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550-6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.

IntroductionHow to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening.Methods and analysisIn partnership with healthcare teams, we developed 'e-assist: Colon Health', a patient-targeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient-physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50-75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patient-perceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians.Ethics and disseminationAll trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action.Trial registration numberNCT02798224; Pre-results.

PurposeTechnology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases.MethodsTwelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey.ResultsIn 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%).ConclusionsMany patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated.

Objectives. We estimated how many deaths would be averted if the entire population of Virginia experienced the mortality rates of the 5 most affluent counties or cities. Methods. Using census data and vital statistics for the years 1990 through 2006, we applied the mortality rates of the 5 counties/cities with the highest median household income to the populations of all counties and cities in the state. Results. If the mortality rates of the reference population had applied to the entire state, 24.3% of deaths in Virginia from 1990 through 2006 (range=21.8%-28.1%) would not have occurred. An annual mean of 12954 deaths would have been averted (range=10548-14569), totaling 220211 deaths from 1990 through 2006. In some of the most disadvantaged areas of the state, nearly half of deaths would have been averted. Conclusions. Favorable conditions that exist in areas with high household incomes exert a major influence on mortality rates. The corollary--that health suffers when society is exposed to economic stresses--is especially timely amid the current recession. Further research must clarify the extent to which individual-level factors (e.g., earnings, education, race, health insurance) and community characteristics can improve health outcomes. (Am J Public Health. 2010;100:750-755. doi:10.2105/AJPH.2009.165142)

Objective Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September–October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N = 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966–0.998) and commitment score (aOR = 0.987, 95% CI: 0.976–0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550–6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors. [ABSTRACT FROM AUTHOR]

Introduction How to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening. Methods and analysis In partnership with healthcare teams, we developed 'e-assist: Colon Health', a patienttargeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient-physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50-75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patientperceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians. Ethics and dissemination All trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action. [ABSTRACT FROM AUTHOR]