Emil Chiauzzi

My Student Body: A High-Risk Drinking Prevention Web Site for College Students

The authors investigated the efficacy of an interactive Web site, MyStudentBody.com:Alcohol (MSB:Alcohol) that offers a brief, tailored intervention to help heavy drinking college students reduce their alcohol use. They conducted a randomized, controlled clinical trial to compare the intervention with an alcohol education Web site at baseline, postintervention, and 3-month follow-up. Students were assessed on various drinking measures and their readiness to change their drinking habits. The intervention was especially effective for women and persistent binge drinkers. Compared with women who used the control Web site, women who used the intervention significantly reduced their peak and total consumption during special occasions and also reported significantly fewer negative consequences related to drinking. In addition, persistent heavy binge drinkers in the experimental group experienced a more rapid decrease in average consumption and peak consumption compared with those in the control group. The authors judged MSB:Alcohol a useful intervention for reaching important subgroups of college binge drinkers.

Patient-centered activity monitoring in the self-management of chronic health conditions.

BackgroundAs activity tracking devices become smaller, cheaper, and more consumer-accessible, they will be used more extensively across a wide variety of contexts. The expansion of activity tracking and personal data collection offers the potential for patient engagement in the management of chronic diseases. Consumer wearable devices for activity tracking have shown promise in post-surgery recovery in cardiac patients, pulmonary rehabilitation, and activity counseling in diabetic patients, among others. Unfortunately, the data generated by wearable devices is seldom integrated into programmatic self-management chronic disease regimens. In addition, there is lack of evidence supporting sustained use or effects on health outcomes, as studies have primarily focused on establishing the feasibility of monitoring activity and the association of measured activity with short-term benefits.DiscussionMonitoring devices can make a direct and real-time impact on self-management, but the validity and reliability of measurements need to be established. In order for patients to become engaged in wearable data gathering, key patient-centered issues relating to usefulness in care, motivation, the safety and privacy of information, and clinical integration need to be addressed. Because the successful usage of wearables requires an ability to comprehend and utilize personal health data, the user experience should account for individual differences in numeracy skills and apply evidence-based behavioral science principles to promote continued engagement.SummaryActivity monitoring has the potential to engage patients as advocates in their personalized care, as well as offer health care providers real world assessments of their patients’ daily activity patterns. This potential will be realized as the voice of the chronic disease patients is accounted for in the design of devices, measurements are validated against existing clinical assessments, devices become part of the treatment ‘prescription’, behavior change programs are used to engage patients in self-management, and best practices for clinical integration are defined.

A Randomized Trial of a Web-based Intervention to Improve Migraine Self-Management and Coping

Objective.— To test the clinical efficacy of a web‐based intervention designed to increase patient self‐efficacy to perform headache self‐management activities and symptom management strategies, and reduce migraine‐related psychological distress.

Risk behaviors and drug use: a latent class analysis of heavy episodic drinking in first-year college students

Examining individual characteristics may not yield an understanding of the complex array of factors that affect college student alcohol use. Utilizing a latent class analysis, the present study investigated an alcohol and drug use database of first-year college students at 89 U.S. colleges and universities (N = 21,945). These data were collected between December, 2010 and September, 2011. This study identified: (1) classes based on alcohol consumption, alcohol-related behaviors, and past-year use of illegal drugs and nonmedical use of prescriptions medications (NMUPM); (2) demographic covariates of these classes; and (3) differential social norms awareness, perceived harmfulness of illegal drugs and NMUPM, and protective strategies. Four classes were identified: (1) Low Risk Drinking/Low Prevalence Drug Use (Class 1); (2) Lower Intake Drinking/Moderate Prevalence Drug Use (Class 2); (3) Moderate Risk Drinking/Moderate Prevalence Drug Use (Class 3); and (4) High Risk Drinking/High Prevalence Drug Use (Class 4). Classes differed in self-reported typical week drinking, estimated peak blood alcohol content over the past 2 weeks, high-risk alcohol use, negative alcohol-related consequences, driving under the influence or riding with drinking drivers, alcohol-related protective behaviors, and past-year substance use. Of particular interest was the identification of a latent class (Class 2) composed primarily of females with a relatively low alcohol intake, but with a high probability of past-year other substance use. This group reported negative alcohol-related consequences despite their relatively low intake. To our knowledge, this is the first latent class analysis of college student alcohol use that includes a drug use indicator and compares social norms awareness, harmfulness perceptions, and alcohol-related protective behaviors between classes.

Participatory Research With an Online Drug Forum: A Survey of User Characteristics, Information Sharing, and Harm Reduction Views

Visitors to a popular online drug forum completed an online survey between November 2011 and January 2012, which covered (1) demographic characteristics, (2) substance use (including nonmedical prescription opioid use), (3) forum activity, and (4) harm reduction beliefs. The study sample (N = 897) primarily included Caucasian males in their twenties from the United States, the United Kingdom, Australia, and Canada. The practice of harm reduction was overwhelmingly endorsed by participants. Current nonmedical prescription opioid users reported more activity in forums and past substance abuse treatment. The studys implications and limitations are noted and future research is suggested.

A Survey of 100 Community Colleges on Student Substance Use, Programming, and Collaborations

Abstract Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.

Mediators and moderators of chronic pain outcomes in an online self-management program.

Objectives:Little is known about the moderators and mediators of change in online pain interventions based on cognitive-behavior therapy (CBT). We hypothesized that the effects of painACTION.com, an online pain self-management program, on pain-related outcomes would be mediated by changes in depression, anxiety, and stress, as well as the use of coping strategies. We also examined potential moderators of change. Methods:First, the efficacy of painACTION.com and moderators of the intervention effects were evaluated using a pooled sample from previous back, neuropathic, and arthritis pain studies. Next, we explored whether the intervention effect on the primary outcomes, pain severity, and patient global impression of change (PGIC), was mediated by coping strategies or emotional functioning. Results:Compared with controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up. There were no clear moderators of intervention effects. Changes in emotional factors, particularly stress levels, mediated the relationship between the intervention and outcome (pain severity) over time. Discussion:This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors, and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain.

Identifying Primary Care Skills and Competencies in Opioid Risk Management.

Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of pain. The objective of this study was to identify which skills and competencies are most critical for PCPs in order to effectively manage opioid risk in patients treated for chronic pain. Methods: We conducted 1‐hour interviews with 16 nationally known experts in primary care, pain management, and addiction. Eight were trained as PCPs, and 8 were trained as specialists. Their responses were collated and then presented online to the participants for independent sorting and rating. These data were analyzed using an online concept mapping program, which offers an innovative method of summarizing and prioritizing qualitative data. Results: Based on this analysis, items were organized into 10 clusters representing the most critical categories of skills (the “best fit” for these data). The cluster that received the highest average statement rating was “How to Manage Pain Patients With Comorbid Conditions.” Follow‐up analyses indicated that specialists rated this cluster, and 5 others, significantly higher than the PCPs, suggesting that the specialists perceive these competencies as more important in opioid risk management. Discussion: Using a relatively small sample and cost‐effective technique (ie, concept mapping), key PCP competencies can be identified for potential inclusion in continuing education and training in opioid risk management.

Communicating laboratory test results for rheumatoid factor: what do patients and physicians want?

Objective This study aimed to explore patient and physician perspectives on current laboratory test reporting practices and to elicit ideas for improvement. Methods Two independent studies were conducted. The first solicited members of an online physician community for opinions on current laboratory test reporting practices and possible improvements. The second addressed the same topic, but solicited patient feedback, and included an evaluation of a mock laboratory test report for the rheumatoid factor blood test. Results Both physicians and patients expressed a desire for patient-friendly information on laboratory reports. Physicians expressed a need for education for patients around false-positive and false-negative results within laboratory reports, while patients sought context around the meaning of results, relevance to other tests, and follow-up steps. Conclusion Physicians and patients see value in enhancing laboratory test reports to improve communication. While reports should include the context that patients value, they should also contain cautionary interpretation emphasized by physicians. Patient consultation on improving laboratory reports may help improve such patient-focused communication and promote greater patient understanding of health information, thereby increasing patient participation in their own health care and improving outcomes. Practice implications Laboratory reports are typically designed by experts. Including patients in laboratory report design may facilitate communication and improve outcomes through better patient engagement.

New approach for analyzing self-reporting of insomnia symptoms reveals a high rate of comorbid insomnia across a wide spectrum of chronic diseases

BACKGROUND Insomnia is increasingly recognized to be comorbid with one or more medical conditions. This study used an online research platform to characterize insomnia across different mental and physical conditions. METHODS A custom cross-sectional survey was fielded online to 31,208 users of the patient community PatientsLikeMe. The survey queried members on National Sleep Foundation-defined insomnia risk (waking up feeling unrefreshed, difficulty falling asleep, waking in the middle of the night, or waking too early). RESULTS Complete results were obtained from 5256 patients with 11 comorbid conditions. Seventy-six percent of US-based respondents were at risk for insomnia. Patients who reported difficulty falling asleep were found to have nearly twice the odds of self-reporting insomnia (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.5-2.1) when compared to those who do not have difficulty falling asleep, whereas those who reported waking during the night or waking up unrefreshed were no more likely (OR: 1.025 and 1.032, respectively) to report that they suffered from insomnia than those who did not experience these issues. Although insomnia was self-reported as severe or very severe across most conditions, few respondents had actually been diagnosed with insomnia by a physician. After adjustment for age and gender, there was an independent and strong effect of primary condition severity on insomnia risk, and those with severe epilepsy (0.93), depressive disorders (0.92), and fibromyalgia (0.92) occupied the highest risk probabilities. CONCLUSIONS The high rate of severity and frequency of insomnia across a multitude of mental and physical conditions reveals an opportunity for better disease management through enhanced insomnia awareness.