Diana D. McDonnell

Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials.

BACKGROUND The effects of Web- and computer-based smoking cessation programs are inconsistent in randomized controlled trials (RCTs). We evaluated those effects using a meta-analysis. METHODS We searched MEDLINE (PubMed), EMBASE, and the Cochrane Review in August 2008. Two evaluators independently selected and reviewed eligible studies. RESULTS Of 287 articles searched, 22 RCTs, which included 29 549 participants with 16 050 enrolled in Web- or computer-based smoking cessation program groups and 13 499 enrolled in control groups, were included in the final analyses. In a random-effects meta-analysis of all 22 trials, the intervention group had a significant effect on smoking cessation (relative risk [RR], 1.44; 95% confidence interval [CI], 1.27-1.64). Similar findings were observed in 9 trials using a Web-based intervention (RR, 1.40; 95% CI, 1.13-1.72) and in 13 trials using a computer-based intervention (RR, 1.48; 95% CI, 1.25-1.76). Subgroup analyses revealed similar findings for different levels of methodological rigor, stand-alone vs supplemental interventions, type of abstinence rates employed, and duration of follow-up period, but not for adolescent populations (RR, 1.08; 95% CI, 0.59-1.98). CONCLUSION The meta-analysis of RCTs indicates that there is sufficient clinical evidence to support the use of Web- and computer-based smoking cessation programs for adult smokers.

Mobile Phone Use and Risk of Tumors: A Meta-Analysis

PURPOSE Case-control studies have reported inconsistent findings regarding the association between mobile phone use and tumor risk. We investigated these associations using a meta-analysis. METHODS We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library in August 2008. Two evaluators independently reviewed and selected articles based on predetermined selection criteria. RESULTS Of 465 articles meeting our initial criteria, 23 case-control studies, which involved 37,916 participants (12,344 patient cases and 25,572 controls), were included in the final analyses. Compared with never or rarely having used a mobile phone, the odds ratio for overall use was 0.98 for malignant and benign tumors (95% CI, 0.89 to 1.07) in a random-effects meta-analysis of all 23 studies. However, a significant positive association (harmful effect) was observed in a random-effects meta-analysis of eight studies using blinding, whereas a significant negative association (protective effect) was observed in a fixed-effects meta-analysis of 15 studies not using blinding. Mobile phone use of 10 years or longer was associated with a risk of tumors in 13 studies reporting this association (odds ratio = 1.18; 95% CI, 1.04 to 1.34). Further, these findings were also observed in the subgroup analyses by methodologic quality of study. Blinding and methodologic quality of study were strongly associated with the research group. CONCLUSION The current study found that there is possible evidence linking mobile phone use to an increased risk of tumors from a meta-analysis of low-biased case-control studies. Prospective cohort studies providing a higher level of evidence are needed.

Relationships between Household Smoking Restrictions and Intention to Quit Smoking among Korean American Male Smokers in California

This cross-sectional study examined the relationships between household smoking restrictions and intentions to quit smoking among Korean American male smokers in California. We used data from the California Korean American Tobacco Use Survey (CKATUS), which was conducted in 2004 using computer-assisted telephone interviewing. Among the 2,545 respondents who participated in the CKATUS, the 387 male smokers who answered a question assessing their intention to quit smoking were included in the final analyses. In univariable analyses, smokers who reported having household smoking restrictions were more likely to intend to quit smoking as compared with those who did not (P<0.01). Other independent correlates of having an intention to quit smoking were being less than 50 yr of age, having spent more than 50% of ones life in the US, being assimilated, and having other smokers in the household. In a multiple logistic regression analysis, the significant correlates of having an intention to quit smoking were household smoking restrictions (complete or partial restriction vs. no restriction on smoking; odds ratio, 2.54; 95% confidence interval, 1.22-5.28) and absence of other smokers in the household. In conclusion, smoking restrictions in the household are associated with an intention to quit smoking among Korean American male smokers in California.

Cancer coverage in a mainstream and Korean American online newspaper: lessons for community intervention.

OBJECTIVE Korean Americans have higher incidence of stomach, liver, and cervical cancer than most groups in CA, USA, and generally lower rates of cancer screening. To better target community interventions, we evaluated the cancer content in a leading Korean American newspaper, the Korea Daily, compared to a mainstream newspaper from the same metropolitan area, the Los Angeles (LA) Times. METHODS Using the online versions of each newspaper for the year 2006, we counted articles mentioning cancer and evaluated the content in a random sample of 300 articles from each newspaper. Articles were categorized by relevance of cancer content and topic(s) covered. RESULTS Although the LA Times had a higher proportion of articles mentioning cancer, the Korea Daily had more articles that primarily focused on cancer and addressed specific types of cancer. Articles in the Korea Daily were more likely to discuss prevention, while those in the LA Times more often focused on people, politics, or research. CONCLUSIONS Smaller, ethnic newspapers may be more amenable to messages about prevention and appropriate places to target community-focused interventions. PRACTICE IMPLICATIONS Health practitioners should consider submitting articles to ethnic newspapers and forming partnerships with journalists to cultivate this potential.

Online smoking cessation program for Korean Americans: Randomized trial to test effects of incentives for program completion and interim surveys.

INTRODUCTION Smoking is prevalent among Korean American men. Quitting is Winning, an Internet-based, cognitive-behavioral smoking cessation program, was developed using community-based participatory research principles. METHODS A randomized controlled trial was used to evaluate whether participants were more likely to complete the program and quit smoking at 6-months of follow-up with additional reinforcement. The main outcomes were the proportion of participants who completed the online program and the proportion who quit smoking for at least 30days, 26weeks after enrollment, among those randomized into the high-reinforcement (HR) condition compared with those in the low-reinforcement (LR) condition. RESULTS The study achieved a final enrollment of 403 participants including 56 women. Program completion was greater for the HR as compared to the LR condition (17% vs. 10%, p=.035). There was no significant difference in 30-day smoking cessation (intent-to-treat [ITT]) between the HR and LR conditions (9% vs. 8%, ns). Smoking cessation was greater among program completers as compared to those who did not complete the program (28% vs. 5%, p<.001). CONCLUSIONS The addition of interim surveys and financial incentives for interim survey completion and program completion significantly increased the likelihood of program completion. Moreover, program completers were significantly more likely to quit smoking. Although smoking cessation rates did not significantly differ between the HR and LR conditions, the results suggest that future studies should explore the efficacy of larger financial incentives for program completion (Clinical Trial #NCT02584127).

Seniors' and People with Disabilities' Experiences with Mandatory Medicaid Managed Care in California: Populations to Target for Additional Support during Transitions

Abstract:With more states moving people with disabilities and complex care needs into managed care, it is important to target beneficiaries for additional anticipated support before specific needs arise. In a survey of 1,521 seniors and people with disabilities in California who moved into Medicaid managed care six-16 months previously, the majority reported neutral or positive experiences with managed care continuity, access, and quality, compared with fee-for-service. Beneficiaries most likely to have negative experiences included those with poor self-rated health, functional impairment, cognitive impairment, frequent ED visits, and claims for back / osteoarthritis and cancer. Those with no specialty visits and those who had been continuously enrolled in Medicaid longer term before the transition also were more likely to report negative experiences. These populations can be targeted for assistance by health plans and Medicaid agencies. More specialty visits and longer time in Medicaid managed care also seems to improve beneficiaries’ experiences.

Erratum: Correction of References

To the Editor: We found an error in our published article: Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Relationships between household smoking restrictions and intention to quit smoking among Korean American male smokers in California. J Korean Med Sci 2010; 25: 245-50. The published references on pages 249-250 are identical with pages 238-239. It was a mistake that occurred during the editing process of references by the editorial staff. We have attached a corrected version of the references of the above article. Corrected References 1. Levy DT, Romano E, Mumford EA. Recent trends in home and work smoking bans. Tob Control 2004; 13: 258-63. 2. Pizacani BA, Martin DP, Stark MJ, Koepsell TD, Thompson B, Diehr P. Household smoking bans: which households have them and do they work? Prev Med 2003; 36: 99-107. 3. Blackburn C, Spencer N, Bonas S, Coe C, Dolan A, Moy R. Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey. BMJ 2003; 327: 257. 4. Halterman JS, Fagnano M, Conn KM, Szilagyi PG. Do parents of urban children with persistent asthma ban smoking in their homes and cars? Ambul Pediatr 2006; 6: 115-9. 5. Wamboldt FS, Balkissoon RC, Rankin AE, Szefler SJ, Hammond SK, Glasgow RE, Dickinson WP. Correlates of household smoking bans in low-income families of children with and without asthma. Fam Process 2008; 47: 81-94. 6. Shelley D, Yerneni R, Hung D, Das D, Fahs M. The relative effect of household and workplace smoking restriction on health status among Chinese Americans living in New York City. J Urban Health 2007; 84: 360-71. 7. Pizacani BA, Martin DP, Stark MJ, Koepsell TD, Thompson B, Diehr P. A prospective study of household smoking bans and subsequent cessation related behaviour: the role of stage of change. Tob Control 2004; 13: 23-8. 8. Borland R, Yong HH, Cummings KM, Hyland A, Anderson S, Fong GT. Determinants and consequences of smoke-free homes: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006; 15: 42-50. 9. California Health Interview Survey (2007). CHIS 2005 Adult Public Use File, Release1 [computer file], UCLA Center for Health Policy Research, Los Angeles, CA. 10. Carr K, Beers M, Kassebaum T, Chen MS Jr. California Korean American Tobacco Use Survey-2004. Sacramento, CA: Department of Health Services, 2005. 11. Merriam-Websters Online Dictionary. Available at: http://www.merriam-ebster.com/dictionary/acculturation. 12. Pizacani BA, Martin DP, Stark MJ, Koepsell TD, Thompson B, Diehr P. Longitudinal study of household smoking ban adoption among households with at least one smoker: Associated factors, barriers, and smoker support. Nicotine Tob Res 2008; 10: 533-40. 13. Siahpush M, McNeill A, Borland R, Fong GT. Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006; 15 Suppl 3: iii71-5. 14. Abdullah AS, Ho LM, Kwan YH, Cheung WL, McGhee SM, Chan WH. Promoting smoking cessation among the elderly: what are the predictors of intention to quit and successful quitting? J Aging Health 2006; 18: 552-64. 15. Abdullah AS, Yam HK. Intention to quit smoking, attempts to quit, and successful quitting among Hong Kong Chinese smokers: population prevalence and predictors. Am J Health Promot 2005; 19: 346-54. 16. OECD. OECD Health Data 2001. Available at: http://stats.oecd.org/wbos/Index.aspx?DatasetCode=HEALTH 17. Fava JL, Velicer WF, Prochaska JO. Applying the transtheoretical model to a representative sample of smokers. Addict Behav 1995; 20: 189-203.