Ruth Lederman

The Behavioral Risk Factor Surveillance System questionnaire: its reliability in a statewide sample.

The reliability of the Behavioral Risk Factor Surveillance System questionnaire was assessed in a random sample of adults (n = 122) and a separate sample of Black and Hispanic adults (n = 200) in Massachusetts. The questionnaire was administered twice, 21 to 44 days apart, by telephone (210 completed reinterviews, 65% response rate for second administration). There were no statistically significant differences in the distribution of demographic or risk factor variables across administrations. Individual-level reliability (kappa for categorical variables, correlation for continuous variables) for demographic characteristics was more than 0.80 for White respondents and more than 0.60 for Black and Hispanic respondents. Employment and income were reported less consistently than other variables. Reliability coefficients for behavioral risk factors were generally above 0.70. Exceptions were variables with extreme distributions. These data support the use of the Behavioral Risk Factor Surveillance System questionnaire for surveillance and research.

Process Evaluation of an Integrated Health Promotion/Occupational Health Model in WellWorks-2

Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.

Process Evaluation Results From the Healthy Directions–Small Business Study

The Healthy Directions–Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conductedusing quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.

Results of Employee Involvement in Planning and Implementing the Treatwell 5-a-Day Work-Site Study

When work-site health promotion programs incorporate theories of community organization, it is likely that employee ownership and participation are enhanced. This article reports quantitative indicators of involvement of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of implementation and variables associated with behavior change and work-site support. The results reported here indicate that a greater number of EAB member hours spent on program activities was associated with a greater number of events implemented. Smaller work-site size was associated with greater employee awareness of the program and greater participation in project activities as reported on the employee survey. These results suggest that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.

Process Tracking Results From the Treatwell 5-a-Day Worksite Study

Purpose. To report findings from Treatwell 5-a-Day process tracking. Design. Worksites were randomly assigned to a minimal intervention control, worksite-only condition, or worksite-plus-family condition. Setting. Twenty-two small community health centers in Massachusetts. Subjects. Employees of the community health centers. Intervention. Both intervention conditions included the formation of employee advisory boards; activities such as nutrition discussions and taste tests targeting individual behavior change; and point-of-purchase labeling as an environmental strategy. Worksite-plus-family sites incorporated activities such as family contests, campaigns, and picnics. Measures. Documentation of the number and type of activities for extent of implementation; number of participants in activities for reach; program awareness and participation from the follow-up employee survey (n = 1306, representing 76% [range, 56%–100%] of the sample); change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys (n = 1359, representing 87% [range, 75%–100%] of the sample). Results. A higher number of activities per employee was significantly correlated with greater program awareness (. 68; p = . 006) and greater change in fruit and vegetable consumption (.55; p = .04). Greater participation in activities was significantly correlated with greater awareness (.67; p = .007), higher participation (.61; p = .02), and increase in fruit and vegetable consumption. (.55; p = .04). Conclusions. These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption.

Disparities in Evaluation of Patients With Rectal Bleeding 40 Years and Older

BACKGROUND & AIMS Rectal bleeding is associated with colorectal cancer. We characterized the evaluation of patients aged 40 years and older with rectal bleeding and identified characteristics associated with inadequate evaluation. METHODS We conducted a retrospective review of records of outpatient visits that contained reports of rectal bleeding for patients aged 40 years and older (N = 480). We studied whether patient characteristics affected whether or not they received a colonoscopy examination within 90 days of presentation with rectal bleeding. Patient characteristics included demographics; family history of colon cancer and polyps; and histories of screening colonoscopies, physical examinations, referrals to specialists at the index visit, and communication of laboratory results. Data were collected from medical records, and patient income levels were estimated based on Zip codes. RESULTS Nearly half of the patients presenting with rectal bleeding received colonoscopies (48.1%); 81.7% received the procedure within 90 days. A history of a colonoscopy examination was more likely to be reported in white patients compared with Hispanic or Asian patients (P = .012 and P = .006, respectively), and in high-income compared with low-income patients (P = .022). A family history was more likely to be documented among patients with private insurance than those with Medicaid or Medicare (P = .004). A rectal examination was performed more often for patients who were white or Asian, male, and with high or middle incomes, compared with those who were black, Hispanic, female, or with low incomes (P = .027). White patients were more likely to have their laboratory results communicated to them than black patients (P = .001). CONCLUSIONS Sex, race, ethnicity, patient income, and insurance status were associated with disparities in evaluation of rectal bleeding. There is a need to standardize the evaluation of patients with rectal bleeding.

Elements of External Validity of Tools for Health: An Intervention for Construction Laborers

Purpose. To examine the external validity of an efficacious tailored smoking cessation and nutrition improvement telephone intervention. Design. Comparison of characteristics of participants and nonparticipants (representativeness); examination of the extent of intervention implementation. Setting. Cancer center collaboration with a labor union. Subjects. Unionized construction laborers. Intervention. Tailored feedback report, telephone counseling, and supplementary educational materials focused on smoking cessation and improved nutrition. Measures. Background survey identifying socio-demographic and behavioral characteristics; process evaluation data; and final efficacy survey to determine participant satisfaction. Analysis. Cross-classification and the X2 test of homogeneity were used with categorically measured variables comparing participants and nonparticipants. We compared the means in the two groups for continuously scaled measures using the Student t-test and investigated the multivariable association of the characteristics of participation with a multiple logistic regression. For process data we present frequencies, percentages, and means. Results. Characteristics associated with participation included self-efficacy to change fruit and vegetable consumption (p = .0009) and self-identification with unions problems (p = 0.05). Eighty-six percent of non-smokers and 61% of smokers completed between 1 and 4 counseling sessions. Over one-half of non-smokers (61%) and smokers (53%) completed 4 or more calls and more smokers (34%) than non-smokers (11%) completed the 5+ sessions. Conclusions. These results provide a snapshot of characteristics of construction laborers to whom this intervention can be generalized and indicators of feasibility necessary for translating research into practice.

Evaluation of Fruit and Vegetable Consumption Estimated from the NCI 7-Item Screener

Abstract LEARNING OUTCOME: A Field ScD, Harvard Med Sch, Boston MA.To evaluate bias and correlation of fruit and vegetable intakes estimated from the NCI 7-item screener compared with multiple 24-hr recalls. We compared estimates of fruit and vegetable consumption based on a 7-item frequency questionnaire used to assess baseline and post-intervention intake in NCI-funded trials with average intake across 3 24-hr recalls collected in a single season using the Nutrient Data System (NDS). Total servings of fruit and vegetables on the screener were summed across 6 items, excluding the question on fried potatoes according to NCI 5-A-Day for Better Health guidelines. Among 140 control-site employees in a worksite study selected from 3 ethnic strata (black, Hispanic, white), distribution of fruit and vegetable intakes was positively skewed and ranged from less than half to about 15 servings per day on both instruments. Median intake on the 24-hr recalls was 2.2 servings greater than estimated by the screener (p=0.0001). Median and mean daily intakes were 4.8 and 5.2 (± 2.4) servings, respectively, on the 24 hour recalls; and 2.6 and 3.3 (±2.5) servings, respectively, on the screener. This bias was variable, however, with an inter-quartile range from less than half a serving to more than 3.5 servings per day. The correlation of responses to the two instruments was 0.28 (95% confidence interval 0.12-0.43). To control for skewness in the measures, we also evaluated the bias and correlation in the logarithmic scale. The geometric mean servings were 4.5 for the 24-hour recall and 2.5 for the screener (r=0.24). Daily intakes estimated by the NCI screener were about 2 servings less than our comparison measure, but similar to usual intakes estimated by the 6-item BRFSS brief frequency questionnaire evaluated by others. The higher 24-hr recall estimate is consistent with the NDS algorithm that includes intake from mixed dishes in total fruit and vegetables. Correlations were low relative to those reported by others suggesting limited ability of the screener to rank individuals.

Perceptions of Oncologists About Sharing Clinic Notes with Patients

In a large survey (n = 809) conducted to understand how oncologists differ from nononcologists regarding routinely sharing visit notes with patients, oncologists were less likely to agree patient safety would improve (p = .03) or that patients would be offended after reading notes (p = .01); however, they agreed with nononcologists that sharing notes would lead to less candid documentation (69% vs. 73%; p = .39). Oncologists share a high level of worry about the impact of sharing notes on documentation practices, a concern that will need to be addressed as the practice of sharing visit notes expands to cancer care.

Interactive or static reports to guide clinical interpretation of cancer genomics

Abstract Objective Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation. Materials and Methods We conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians’ genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0–18 and 1–4, respectively, higher score corresponding with improved endpoints). Results One hundred and five physicians at a tertiary cancer center participated (29% participation rate): 67% medical, 20% pediatric, 7% radiation, and 7% surgical oncology; 37% female. Prior to viewing the case-based vignettes, 34% of the physicians reported difficulty making treatment recommendations based on the standard static report. After vignette/report exposure, physicians’ overall comprehension scores did not differ by report type (mean score: interactive 11.6 vs static 10.5, difference = 1.1, 95% CI, −0.3, 2.5, P = .13). However, physicians exposed to the interactive report were more likely to correctly assess sequencing quality (P < .001) and understand when reports needed to be interpreted with caution (eg, low tumor purity; P = .02). Overall satisfaction scores were higher in the interactive group (mean score 2.5 vs 2.1, difference = 0.4, 95% CI, 0.2-0.7, P = .001). Discussion and Conclusion Interactive genomic reports may improve physicians’ ability to accurately assess genomic data and increase report-related satisfaction. Additional research in users’ genomic needs and efforts to integrate interactive reports into electronic health records may facilitate the implementation of precision oncology.