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Pollak, Kathryn IIonka

Overview:

Smoking cessation, health disparities, and patient-provider communication.

Positions:

Professor in Community and Family Medicine

Community and Family Medicine, Prevention Research
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1996

Ph.D. — University of Houston

Grants:

Optimizing a standalone text messaging-based weight loss intervention

Administered By
Duke Global Health Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
February 01, 2017
End Date
January 31, 2021

Addressing Tobacco Use Disparities through an Innovative Mobile Phone Intervention: The textto4gosmokelesstobacco

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
August 01, 2015
End Date
July 31, 2018

Duke KURe Program

Administered By
Obstetrics and Gynecology, Urogynecology
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
August 01, 2013
End Date
July 31, 2018

Impact of a PCRC-Supported Legacy Intervention in Pediatric Palliative Care

Administered By
Duke Cancer Institute
AwardedBy
Vanderbilt University
Role
Principal Investigator
Start Date
September 26, 2014
End Date
June 30, 2018

Refinement and Expansion of the Palliative Care Research Cooperative Group

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Site PI
Start Date
September 28, 2013
End Date
June 30, 2018

SMS scheduled gradual reduction text messages to help pregnant smokers quit

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 15, 2013
End Date
June 30, 2018

Improving Communication Between Cancer Patients and Oncologists Using Patient Feedback on Actual Conversations and the ABIM Maintenance of Certification

Administered By
Duke Cancer Institute
AwardedBy
Dana Farber Cancer Institute
Role
Principal Investigator
Start Date
September 01, 2016
End Date
August 31, 2017

HIV cure studies: risk, risk perception, and ethics

Administered By
Social Science Research Institute
AwardedBy
Harvard University
Role
Co-Principal Investigator
Start Date
August 01, 2015
End Date
July 31, 2017

Translation of a Lung Cancer Palliative Care Intervention for Clinical Practice

Administered By
Duke Cancer Institute
AwardedBy
City of Hope
Role
Principal Investigator
Start Date
September 28, 2014
End Date
June 30, 2017

A Woman's Health Nurse Practitioner (WHNP) program at Duke University School of Nursing

Administered By
School of Nursing
AwardedBy
Health Resources and Service Administration
Role
Participating Faculty Member
Start Date
July 01, 2014
End Date
June 30, 2017

TRIADIC EXPECTATIONS: DECISION-MAKING IN ADVANCED CANCER

Administered By
Medicine, General Internal Medicine
AwardedBy
National Palliative Care Research Center
Role
Significant Contributor
Start Date
July 01, 2014
End Date
June 30, 2017

PAPNavigator STTR (Fast-Track)

Administered By
Duke Cancer Institute
AwardedBy
Vivor, LLC
Role
Co Investigator
Start Date
September 09, 2016
End Date
March 08, 2017

Improving Communication Between Cancer Patients and Oncologists Using Patient Feedback on Actual Conversations and the ABIM Maintenance of Certification

Administered By
Duke Cancer Institute
AwardedBy
Dana Farber Cancer Institute
Role
Principal Investigator
Start Date
September 01, 2015
End Date
August 31, 2016

Teen CHAT:Improving physician communication with adolescents about healthy weight

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 15, 2009
End Date
June 30, 2016

Communication in Oncologist Patient Encounters: A Patient Intervention

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
June 01, 2009
End Date
April 30, 2016

OB CHAT

Administered By
Duke Cancer Institute
AwardedBy
People Designs
Role
Principal Investigator
Start Date
September 05, 2013
End Date
December 31, 2014

En Pareja: A Latino couples intervention to help expectant fathers quit smoking

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 01, 2008
End Date
July 31, 2014

Smoking Resumption-Prevention in Postpartum Women

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
April 15, 2008
End Date
March 31, 2014

Obesity as a Barrier to Patient-Physician Communication

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
June 01, 2006
End Date
May 31, 2010

Hypertension Improvement Project (HIP)

Administered By
Medicine, Nephrology
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
February 20, 2004
End Date
January 31, 2010

Race effects in oncologists' end-of-life communication

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 2006
End Date
June 30, 2009

Enhancing patient-oncologist communication

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
May 01, 2003
End Date
March 31, 2009

Testing Pharmacological Therapies for Pregnant Smokers

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
May 01, 2002
End Date
April 30, 2008

Partner Assisted Interventions For Pregnant Smokers

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 26, 1997
End Date
December 30, 2003

Recruiting Teen Smokers Into A Self-Help Quit Program

Administered By
Psychiatry & Behavioral Sciences, General Psychiatry
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
January 15, 1999
End Date
December 31, 2002
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Publications:

Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial.

Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return).We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum.Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences (36% [95% confidence interval [CI]: 29-43] vs.35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%).Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking.Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.

Authors
Pollak, KI; Fish, LJ; Lyna, P; Peterson, BL; Myers, ER; Gao, X; Swamy, GK; Brown-Johnson, A; Whitecar, P; Bilheimer, AK; Pletsch, PK
MLA Citation
Pollak, KI, Fish, LJ, Lyna, P, Peterson, BL, Myers, ER, Gao, X, Swamy, GK, Brown-Johnson, A, Whitecar, P, Bilheimer, AK, and Pletsch, PK. "Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial." Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 18.10 (October 2016): 1960-1966.
PMID
27091830
Source
epmc
Published In
Nicotine and Tobacco Research (OUP)
Volume
18
Issue
10
Publish Date
2016
Start Page
1960
End Page
1966
DOI
10.1093/ntr/ntw108

Teaching primary care physicians the 5 A's for discussing weight with overweight and obese adolescents.

We developed an online intervention to teach physicians both MI (addressed in outcomes paper) and the 5 A's (Ask, Advise, Assess, Assist, and Arrange) when discussing weight with overweight/obese adolescents.We audio recorded 527 encounters between adolescents and physicians and coded the 5 A's during weight/BMI discussions. Half of physicians were randomized to receive a tailored, intervention that included their own audio-recorded clips. To examine arm differences, we used multilevel linear mixed-effects models for sum of 5 A's and generalized estimating equations (GEE) models with a logit link for each of the A's separately.Intervention arm physicians used more A's than control physicians (estimated difference=0.6; 95%CI(0.2,1.0);p=0.001). Intervention physicians used Assess (p=0.004), Assist (p=0.001) and Arrange (p=0.02) more when compared to control arm physicians.An online intervention increased physicians' use of the 5 A's when discussing weight with overweight adolescents. These results are promising as the online intervention improved performance for the three A's that are infrequently used (Assess, Assist, and Arrange) yet have the most impact.A tailored online program can increase physicians' use of the 5 A's behavioral counseling approach in clinical practice with adolescents.

Authors
Pollak, KI; Tulsky, JA; Bravender, T; Østbye, T; Lyna, P; Dolor, RJ; Coffman, CJ; Bilheimer, A; Lin, P-H; Farrell, D; Bodner, ME; Alexander, SC
MLA Citation
Pollak, KI, Tulsky, JA, Bravender, T, Østbye, T, Lyna, P, Dolor, RJ, Coffman, CJ, Bilheimer, A, Lin, P-H, Farrell, D, Bodner, ME, and Alexander, SC. "Teaching primary care physicians the 5 A's for discussing weight with overweight and obese adolescents." Patient education and counseling 99.10 (October 2016): 1620-1625.
PMID
27228899
Source
epmc
Published In
Patient Education and Counseling
Volume
99
Issue
10
Publish Date
2016
Start Page
1620
End Page
1625
DOI
10.1016/j.pec.2016.05.007

Unintended Effects of a Smoking Cessation Intervention on Latino Fathers' Binge Drinking In Early Postpartum.

Authors
Noonan, D; Lyna, P; Fish, LJ; Bilheimer, AK; Gordon, KC; Roberson, P; Gonzalez, A; Pollak, KI
MLA Citation
Noonan, D, Lyna, P, Fish, LJ, Bilheimer, AK, Gordon, KC, Roberson, P, Gonzalez, A, and Pollak, KI. "Unintended Effects of a Smoking Cessation Intervention on Latino Fathers' Binge Drinking In Early Postpartum." Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 50.4 (August 2016): 622-627.
PMID
26868270
Source
epmc
Published In
Annals of Behavioral Medicine
Volume
50
Issue
4
Publish Date
2016
Start Page
622
End Page
627
DOI
10.1007/s12160-016-9781-0

Teaching Physicians Motivational Interviewing for Discussing Weight With Overweight Adolescents.

We tested whether an online intervention combined with a patient feedback report improved physicians' use of motivational interviewing (MI) techniques when discussing weight with overweight and obese adolescents.We randomized 46 pediatricians and family physicians and audio recorded 527 patient encounters. Half of the physicians received an individually tailored, online intervention. Then, all physicians received a summary report detailing patient's weight-related behaviors. We coded MI techniques and used multilevel linear mixed-effects models to examine arm differences. We assessed patients' motivation to change and perceived empathy after encounter.We found arm differences in the Intervention Phase and the Summary Report Phase: Empathy (p < .001), MI Spirit (p < .001), open questions (p = .02), and MI consistent behaviors (p = .04). Across all three phases (Baseline, Intervention, and Summary Report), when physicians had higher Empathy scores, patients were more motivated to change diet (p = .03) and physical activity (p = .03). In addition, patients rated physicians as more empathic when physicians used more MI consistent techniques (p = .02).An individually tailored, online intervention coupled with a Summary Report improved physicians' use of MI, which improved the patient experience.

Authors
Pollak, KI; Coffman, CJ; Tulsky, JA; Alexander, SC; Østbye, T; Farrell, D; Lyna, P; Dolor, RJ; Bilheimer, A; Lin, P-H; Bodner, ME; Bravender, TD
MLA Citation
Pollak, KI, Coffman, CJ, Tulsky, JA, Alexander, SC, Østbye, T, Farrell, D, Lyna, P, Dolor, RJ, Bilheimer, A, Lin, P-H, Bodner, ME, and Bravender, TD. "Teaching Physicians Motivational Interviewing for Discussing Weight With Overweight Adolescents." The Journal of adolescent health : official publication of the Society for Adolescent Medicine 59.1 (July 2016): 96-103.
PMID
27155958
Source
epmc
Published In
Journal of Adolescent Health
Volume
59
Issue
1
Publish Date
2016
Start Page
96
End Page
103
DOI
10.1016/j.jadohealth.2016.03.026

Feasibility and Smokers' Evaluation of Self-Generated Text Messages to Promote Quitting.

Cigarette smoking is a leading cause of preventable mortality. Mobile technologies, including text messaging, provide opportunities to promote quitting. Many text messaging-based cessation interventions contain content created by experts. However, smokers may be best persuaded by receipt of text messages they created based on their reasons for quitting, assisted or not by a motivational facilitator. This study assessed the feasibility and participants' evaluation of two ways to self-generate smoking cessation messages delivered via cell-phone.We enrolled smokers (N = 24) and randomized them to: (1) behavioral counseling assistance plus self-generated messages, or (2) self-generated messages only. Both groups wrote: (1) their reasons for wanting to quit and then (2) text messages related to their reason(s) for quitting, Messages were delivered as text messages as well as with a link to verbatim self-recorded audio message for 10 days. At follow-up, participants evaluated the intervention.Participants composed and recorded messages and evaluated them and the intervention favorably. The counseling+message group wrote an average of 7.66 (SD = 4.86) text messages while the message-only wrote an average of 6.66 (SD = 2.93) messages. Most participants felt that the messages were of appropriate length, including the frequency and timing of message delivery.It is feasible for smokers to self-generate motivational text and audio messages concerning reasons for quitting, even among smokers without an immediate desire to quit. Participants evaluated the messages and intervention favorably. Future research should test self-generated messages in larger trials of self- versus expert-generated message.This study assessed the feasibility and participants' evaluation of two ways to self-generate smoking cessation messages delivered via cell-phone. It is feasible for smokers to self-generate motivational text and audio messages concerning reasons for quitting, even among smokers without an immediate desire to quit. Participants evaluated the messages and intervention favorable. Future research should test self-generated messages in larger trials of self- versus expert-generated messages.

Authors
Shaw, RJ; Pollak, K; Zullig, LL; Bennett, G; Hawkins, K; Lipkus, I
MLA Citation
Shaw, RJ, Pollak, K, Zullig, LL, Bennett, G, Hawkins, K, and Lipkus, I. "Feasibility and Smokers' Evaluation of Self-Generated Text Messages to Promote Quitting." Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 18.5 (May 2016): 1206-1209.
PMID
26647104
Source
epmc
Published In
Nicotine and Tobacco Research (OUP)
Volume
18
Issue
5
Publish Date
2016
Start Page
1206
End Page
1209
DOI
10.1093/ntr/ntv268

Not all participatory styles are created equal.

Authors
Pollak, KI
MLA Citation
Pollak, KI. "Not all participatory styles are created equal." Patient education and counseling 99.3 (March 2016): 480-.
PMID
26738435
Source
epmc
Published In
Patient Education and Counseling
Volume
99
Issue
3
Publish Date
2016
Start Page
480
DOI
10.1016/j.pec.2015.12.002

Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices.

Studies indicate needed improvement in clinician communication and patient satisfaction. Motivational interviewing (MI) helps promote patient behavior change and improves satisfaction. In this pilot study, we tested a coaching intervention to teach MI to all clinic staff to improve clinician and patient satisfaction.We included four clinics (n=29 staff members). In the intervention clinics (one primary care and one pediatric obesity-focused), we trained all clinic staff in MI through meetings as a group seven times, directly observing clinicians in practice 4-10 times, and providing real-time feedback on MI techniques. In all clinics, we assessed patient satisfaction via anonymous surveys and also assessed clinician burnout and self-rated MI skills.Clinicians in the intervention clinics reported improvements in burnout scores, self-rated MI skills, and perceived cohesion whereas clinicians in the control clinic reported worse scores. Patient satisfaction improved in the intervention clinics more than in the control clinics.This is the first study to find some benefit of training an entire clinic staff in MI via a coaching model.It might help to train staff in MI to improve clinician satisfaction, team cohesion, perceived skills, and patient satisfaction.

Authors
Pollak, KI; Nagy, P; Bigger, J; Bilheimer, A; Lyna, P; Gao, X; Lancaster, M; Watkins, RC; Johnson, F; Batish, S; Skelton, JA; Armstrong, S
MLA Citation
Pollak, KI, Nagy, P, Bigger, J, Bilheimer, A, Lyna, P, Gao, X, Lancaster, M, Watkins, RC, Johnson, F, Batish, S, Skelton, JA, and Armstrong, S. "Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices." Patient education and counseling 99.2 (February 2016): 300-303.
PMID
26320822
Source
epmc
Published In
Patient Education and Counseling
Volume
99
Issue
2
Publish Date
2016
Start Page
300
End Page
303
DOI
10.1016/j.pec.2015.08.013

Identifying types of sex conversations in adolescent health maintenance visits.

Background Physician-adolescent sexuality discussions are a recommended element in health maintenance visits, but such discussions - if they occur at all - probably vary by adolescents' characteristics and situations, and physicians' personal beliefs and training. However, little is known about the form and content of physician-adolescent sexuality discussions during health maintenance visits.We evaluated 245 physician-adolescent sexuality conversations. Using latent class analysis, we identified conversation types based on 13 sexually related topics, which occurred in at least 10% of all conversations.We found four discrete types of sexuality conversations, which differed in terms of emphasis, topics addressed as part of the sexual history and risk assessment, and topics addressed in anticipatory guidance. Inquiry about partnered sexual experience was typical across all conversation types, as well as over half including discussions about body development and protective behaviours. In all four types of conversation, sexuality discussions were typically embedded in a sequence of psychosocial and behavioural topics recommended for health maintenance visits.The presence of sexuality conversations in the majority of these visits suggests that physicians consider sexuality to be an important issue and part of their responsibility in caring for their adolescent patients. However, the substantial variability in the types of sexuality conversations, particularly the notable omissions of many key topics, supports the importance of teaching sexual health interview skills in medical school and residency, and as part of continuing medical education and quality improvement.

Authors
Alexander, SC; Christ, SL; Fortenberry, JD; Pollak, KI; Østbye, T; Bravender, T; Shields, CG
MLA Citation
Alexander, SC, Christ, SL, Fortenberry, JD, Pollak, KI, Østbye, T, Bravender, T, and Shields, CG. "Identifying types of sex conversations in adolescent health maintenance visits." Sexual health 13.1 (February 2016): 22-28.
PMID
26370470
Source
epmc
Published In
Sexual Health
Volume
13
Issue
1
Publish Date
2016
Start Page
22
End Page
28
DOI
10.1071/sh15080

Studying physician-adolescent patient communication in community-based practices: recruitment challenges and solutions.

Practice-based studies are needed to assess how physicians communicate health messages about weight to overweight/obese adolescent patients, but successful recruitment to such studies is challenging. This paper describes challenges, solutions, and lessons learned to recruit physicians and adolescents to the Teen Communicating Health Analyzing Talk (CHAT) study, a randomized controlled trial of a communication skills intervention for primary care physicians to enhance communication about weight with overweight/obese adolescents.A "peer-to-peer" approach was used to recruit physicians, including the use of "clinic champions" who liaised between study leaders and physicians. Consistent rapport and cooperative working relationships with physicians and clinic staff were developed and maintained. Adolescent clinic files were reviewed (HIPAA waiver) to assess eligibility. Parents could elect to opt-out for their children. To encourage enrollment, confidentiality of audio recordings was emphasized, and financial incentives were offered to all participants.We recruited 49 physicians and audio-recorded 391 of their overweight/obese adolescents' visits. Recruitment challenges included 1) physician reticence to participate; 2) variability in clinic operating procedures; 3) variability in adolescent accrual rates; 4) clinic open access scheduling; and 5) establishing communication with parents and adolescents. Key solutions included the use of a "clinic champion" to help recruit physicians, pro-active, consistent communication with clinic staff, and adapting calling times to reach parents and adolescents.Recruiting physicians and adolescents to audio-recorded, practice-based health communication studies can be successful. Anticipated challenges to recruiting can be met with advanced planning; however, optimal solutions to challenges evolve as recruitment progresses.

Authors
Bodner, ME; Bilheimer, A; Gao, X; Lyna, P; Alexander, SC; Dolor, RJ; Østbye, T; Bravender, T; Tulsky, JA; Graves, S; Irons, A; Pollak, KI
MLA Citation
Bodner, ME, Bilheimer, A, Gao, X, Lyna, P, Alexander, SC, Dolor, RJ, Østbye, T, Bravender, T, Tulsky, JA, Graves, S, Irons, A, and Pollak, KI. "Studying physician-adolescent patient communication in community-based practices: recruitment challenges and solutions." International journal of adolescent medicine and health (November 13, 2015).
PMID
26565534
Source
epmc
Published In
International journal of adolescent medicine and health
Publish Date
2015

The Effect of Parental Presence on Weight-Related Discussions Between Physicians and Their Overweight Adolescent Patients.

Authors
Østbye, T; Lyna, P; Bodner, ME; Alexander, SC; Coffman, C; Tulsky, JA; Dolor, R; Pollak, K
MLA Citation
Østbye, T, Lyna, P, Bodner, ME, Alexander, SC, Coffman, C, Tulsky, JA, Dolor, R, and Pollak, K. "The Effect of Parental Presence on Weight-Related Discussions Between Physicians and Their Overweight Adolescent Patients." Clinical pediatrics 54.12 (October 2015): 1218-1220.
PMID
25575503
Source
epmc
Published In
Clinical Pediatrics
Volume
54
Issue
12
Publish Date
2015
Start Page
1218
End Page
1220
DOI
10.1177/0009922814566027

Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers.

Patients often struggle to express their emotional concerns to their oncology providers and may therefore experience unmet needs. This paper describes the development and implementation of an online program that teaches patients how to communicate their emotions to their oncology providers.The intervention was developed by a multidisciplinary team consisting of palliative care physicians, psychologists, and an intervention software developer and included input from patients. It incorporated elements of Social Cognitive Theory and validated cognitive behavioral strategies for communication skills training. Strategies to increase intervention adherence were implemented midway through the study.The intervention consists of four interactive, online modules to teach patients strategies for expressing emotional concerns to their providers and asking for support. In addition to skill-building, the intervention was designed to raise patients' expectations that expressing emotional concerns to providers would be helpful, to enhance their self-efficacy for doing so, and to help them overcome barriers to having these conversations. After implementing strategies to improve adherence, usage rates increased from 47 to 64 %.This intervention addresses an unmet educational need for patients with advanced cancer. Strategies to increase adherence led to improvements in usage rates in this population of older patients. We are currently evaluating the intervention in a randomized clinical trial to determine its efficacy in increasing patient expression of emotional concerns and requests for support. If successful, this intervention could serve as a model for future online patient education programs.

Authors
Porter, LS; Pollak, KI; Farrell, D; Cooper, M; Arnold, RM; Jeffreys, AS; Tulsky, JA
MLA Citation
Porter, LS, Pollak, KI, Farrell, D, Cooper, M, Arnold, RM, Jeffreys, AS, and Tulsky, JA. "Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23.10 (October 2015): 2907-2916.
PMID
25701437
Source
epmc
Published In
Supportive Care in Cancer
Volume
23
Issue
10
Publish Date
2015
Start Page
2907
End Page
2916
DOI
10.1007/s00520-015-2656-2

Relationships among spousal communication, self-efficacy, and motivation among expectant Latino fathers who smoke.

Cigarette smoking is a prevalent problem among Latinos, yet little is known about what factors motivate them to quit smoking or make them feel more confident that they can. Given cultural emphases on familial bonds among Latinos (e.g., familismo), it is possible that communication processes among Latino spouses play an important role. The present study tested a mechanistic model in which perceived spousal constructive communication patterns predicted changes in level of motivation for smoking cessation through changes in self-efficacy among Latino expectant fathers.Latino males (n = 173) and their pregnant partners participated in a couple-based intervention targeting males' smoking. Couples completed self-report measures of constructive communication, self-efficacy (male partners only), and motivation to quit (male partners only) at 4 time points throughout the intervention.Higher levels of perceived constructive communication among Latino male partners predicted subsequent increases in male partners' self-efficacy and, to a lesser degree, motivation to quit smoking; however, self-efficacy did not mediate associations between constructive communication and motivation to quit smoking. Furthermore, positive relationships with communication were only significant at measurements taken after completion of the intervention. Female partners' level of perceived constructive communication did not predict male partners' outcomes.These results provide preliminary evidence to support the utility of couple-based interventions for Latino men who smoke. Findings also suggest that perceptions of communication processes among Latino partners (particularly male partners) may be an important target for interventions aimed at increasing desire and perceived ability to quit smoking among Latino men. (PsycINFO Database Record

Authors
Khaddouma, A; Gordon, KC; Fish, LJ; Bilheimer, A; Gonzalez, A; Pollak, KI
MLA Citation
Khaddouma, A, Gordon, KC, Fish, LJ, Bilheimer, A, Gonzalez, A, and Pollak, KI. "Relationships among spousal communication, self-efficacy, and motivation among expectant Latino fathers who smoke." Health psychology : official journal of the Division of Health Psychology, American Psychological Association 34.10 (October 2015): 1038-1042.
PMID
25844907
Source
epmc
Published In
Health Psychology
Volume
34
Issue
10
Publish Date
2015
Start Page
1038
End Page
1042
DOI
10.1037/hea0000224

What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?

A number of observational studies and clinical trials have shown that physical activity after a diagnosis of prostate cancer is associated with a decrease in disease progression and an increase in survival, and that specific exercises reduce morbidity from prostate cancer treatments. However, providers need more guidance on what types of physical activity to recommend to patients across different disease states and treatments in prostate cancer, and when and how to initiate the discussion. In addition to evaluating important studies showing benefits of physical activity in patients with prostate cancer, this review suggests some evidence-based methods for incorporating physical activity interventions into clinical practice.

Authors
Ramalingam, S; Pollak, KI; Zullig, LL; Harrison, MR
MLA Citation
Ramalingam, S, Pollak, KI, Zullig, LL, and Harrison, MR. "What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?." Oncology (Williston Park, N.Y.) 29.9 (September 1, 2015). (Review)
Source
scopus
Published In
Oncology
Volume
29
Issue
9
Publish Date
2015

What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?

A number of observational studies and clinical trials have shown that physical activity after a diagnosis of prostate cancer is associated with a decrease in disease progression and an increase in survival, and that specific exercises reduce morbidity from prostate cancer treatments. However, providers need more guidance on what types of physical activity to recommend to patients across different disease states and treatments in prostate cancer, and when and how to initiate the discussion. In addition to evaluating important studies showing benefits of physical activity in patients with prostate cancer, this review suggests some evidence-based methods for incorporating physical activity interventions into clinical practice.

Authors
Ramalingam, S; Pollak, KI; Zullig, LL; Harrison, MR
MLA Citation
Ramalingam, S, Pollak, KI, Zullig, LL, and Harrison, MR. "What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?." Oncology (Williston Park, N.Y.) 29.9 (September 2015): 680-694.
PMID
26384805
Source
epmc
Published In
Oncology
Volume
29
Issue
9
Publish Date
2015
Start Page
680
End Page
694

Patient and Caregiver Opinions of Motivational Interviewing Techniques In Role-Played Palliative Care Conversations: A Pilot Study.

Although many have examined the role of motivational interviewing (MI) in diverse health care encounters, no one has explored whether patients and caregivers facing serious illnesses identify specific MI techniques as helpful.The aim of this pilot study was to describe how patients and caregivers perceived MI techniques in palliative care role-play encounters.About 21 patients and caregivers participated in a role-play encounter where we asked the participant to act out being ambivalent or reluctant regarding the goals of care decision. The participant met with either an MI-trained physician or a physician who was not trained in MI (usual care). After the simulated encounter, we conducted cognitive interviews ("think-aloud" protocol) asking participants to identify "helpful" or "unhelpful" things physicians said. Participants also completed a perceived empathy instrument as a fidelity test of the MI training of the physician.Qualitative analyses revealed that participants independently identified the following helpful communication elements that are consistent with core MI techniques: reflection and validation of values, support of autonomy and flexibility, and open questions acting as catalysts for discussion. Participants rated the MI-trained physician slightly higher on the perceived empathy scale.This pilot study represents the first exploration of patient and caregiver perceptions of helpful techniques in palliative care conversations. Use of MI techniques shows promise for improving palliative care discussions.

Authors
Pollak, KI; Jones, J; Lum, HD; De La Cruz, S; Felton, S; Gill, A; Kutner, JS
MLA Citation
Pollak, KI, Jones, J, Lum, HD, De La Cruz, S, Felton, S, Gill, A, and Kutner, JS. "Patient and Caregiver Opinions of Motivational Interviewing Techniques In Role-Played Palliative Care Conversations: A Pilot Study." Journal of pain and symptom management 50.1 (July 2015): 91-98.
PMID
25701055
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
50
Issue
1
Publish Date
2015
Start Page
91
End Page
98
DOI
10.1016/j.jpainsymman.2015.02.003

Predictors of pregnant quitters' intention to return to smoking postpartum.

Although many pregnant women quit smoking, most return to smoking postpartum. Returning to smoking is strongly related to women's stated intention about smoking during pregnancy. We examined factors related to women's intention to return to smoking to improve intervention trials.We report cross-sectional baseline data from a randomized controlled trial to prevent postpartum return to smoking. Women (n = 382; 98% consent rate) were English-speaking women who smoked at least 100 cigarettes in their lifetimes and at least 5 cigarettes a day prior to becoming pregnant. We fit logistic regression models to test whether women's intention to return to smoking was associated with demographic and smoking factors such as race, parity, and smoker self-identity.Forty-three percent of women had a strong intention of returning to smoking. Factors independently associated with intending to return to smoking were: stating they did not want to be currently pregnant (OR = 2.1, CI = 1.1-3.9), reporting being abstinent for fewer days (OR = 0.8, CI = 0.7-0.9), being less concerned about the harmful effects of smoking to themselves (OR = 1.6, CI = 0.9-2.8), viewing quit as temporary (OR = 2.1, CI = 1.2-3.6), and self-identifying selves as smokers (OR = 8.7, CI = 5.0-15.2).Although some factors related to intention to return to smoking were unchangeable, it might be possible to attempt to change women's attribution of why they quit to be more permanent and to have them change their self-identity to be a "nonsmoker" from a "smoker who is not currently smoking." Helping women have stronger intentions to stay quit could promote less return to smoking postpartum.

Authors
Pollak, KI; Fish, LJ; Lyna, P; Peterson, BL; Swamy, GK; Levine, MD
MLA Citation
Pollak, KI, Fish, LJ, Lyna, P, Peterson, BL, Swamy, GK, and Levine, MD. "Predictors of pregnant quitters' intention to return to smoking postpartum." Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 17.6 (June 2015): 742-745.
PMID
25542912
Source
epmc
Published In
Nicotine and Tobacco Research (OUP)
Volume
17
Issue
6
Publish Date
2015
Start Page
742
End Page
745
DOI
10.1093/ntr/ntu270

A brief relaxation intervention for pain delivered by palliative care physicians: A pilot study.

Authors
Pollak, KI; Lyna, P; Bilheimer, A; Porter, LS
MLA Citation
Pollak, KI, Lyna, P, Bilheimer, A, and Porter, LS. "A brief relaxation intervention for pain delivered by palliative care physicians: A pilot study." Palliative medicine 29.6 (June 2015): 569-570.
PMID
25680379
Source
epmc
Published In
Palliative Medicine
Volume
29
Issue
6
Publish Date
2015
Start Page
569
End Page
570
DOI
10.1177/0269216315570410

Disclosure of Sexual Intercourse by Teenagers: Agreement Between Telephone Survey Responses and Annual Visit Disclosures.

Physicians can help guide teenagers in their emerging sexuality; however, teens rarely inform physicians about their sexual activity.We audio-recorded annual visits between 365 teenagers and 49 physicians. Before the recorded visit, the teens were asked in a confidential telephone survey whether they had ever engaged in sexual intercourse. Recordings were coded for teenage disclosures about previous sexual intercourse. We measured agreement between telephone survey responses and annual visit disclosures, and examined factors associated with agreement between the two.Fifty-six teenagers (15%) reported previous sexual intercourse in either the telephone survey or to their physician. Among those who reported sexual intercourse, 57% shared this information to both the telephone survey and their physician (κ = .72, confidence interval = 0.63-0.82).Although a slight majority of teenagers disclosed their sexual activity to both the telephone survey and their doctor, a significant number disclosed to just one source.

Authors
Alexander, SC; Fortenberry, JD; Pollak, KI; Østbye, T; Bravender, T; Tulsky, JA; Dolor, R; Shields, CG
MLA Citation
Alexander, SC, Fortenberry, JD, Pollak, KI, Østbye, T, Bravender, T, Tulsky, JA, Dolor, R, and Shields, CG. "Disclosure of Sexual Intercourse by Teenagers: Agreement Between Telephone Survey Responses and Annual Visit Disclosures." Clinical pediatrics 54.6 (June 2015): 529-533.
PMID
25857726
Source
epmc
Published In
Clinical Pediatrics
Volume
54
Issue
6
Publish Date
2015
Start Page
529
End Page
533
DOI
10.1177/0009922815580074

Comparison of native light daily smokers and light daily smokers who were former heavy smokers.

INTRODUCTION: An increasing proportion of daily smokers are light smokers (≤10 cigarettes per day). Some light smokers have never smoked more than 10 cigarettes per day (native light smokers) and others smoked at higher levels but have cut down (converted light smokers). It is important that we expand our understanding of these distinct subgroups of light smokers in order to develop effective interventions. METHODS: Data for this report come from a larger sample of smokers who completed a cross-sectional survey administered through an online panel survey service. The sample of 522 light smokers included 256 native light smokers and 266 as converted light smokers. The goal of the analysis was to examine demographic, smoking, and psychosocial factors that differentiate between native and converted light smokers. RESULTS: Multivariable logistic regression results showed 4 variables that differentiated between native and converted light smokers. Native light smokers were more likely to be Black than White, smoke fewer cigarettes per day, smoked fewer total years, and had higher perceived risk of heart disease than converted light smokers. CONCLUSIONS: Native and converted light smokers are similar in many ways and also differ on some important characteristics. Further exploration of group difference is needed and could help to inform for cessation strategies for daily light smokers.

Authors
Fish, LJ; Pollak, KI; Scheuermann, TS; Cox, LS; Mathur, C; Ahluwalia, JS
MLA Citation
Fish, LJ, Pollak, KI, Scheuermann, TS, Cox, LS, Mathur, C, and Ahluwalia, JS. "Comparison of native light daily smokers and light daily smokers who were former heavy smokers." Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 17.5 (May 2015): 546-551.
PMID
25180075
Source
epmc
Published In
Nicotine and Tobacco Research (OUP)
Volume
17
Issue
5
Publish Date
2015
Start Page
546
End Page
551
DOI
10.1093/ntr/ntu169

Cost-related health literacy: a key component of high-quality cancer care.

Authors
Zafar, SY; Ubel, PA; Tulsky, JA; Pollak, KI
MLA Citation
Zafar, SY, Ubel, PA, Tulsky, JA, and Pollak, KI. "Cost-related health literacy: a key component of high-quality cancer care." Journal of oncology practice 11.3 (May 2015): 171-173.
PMID
25829522
Source
epmc
Published In
Journal of Oncology Practice
Volume
11
Issue
3
Publish Date
2015
Start Page
171
End Page
173
DOI
10.1200/jop.2015.004408

Learning what is in the “secret sauce” of MI that is essential for teaching busy clinicians

Authors
Pollak, K
MLA Citation
Pollak, K. "Learning what is in the “secret sauce” of MI that is essential for teaching busy clinicians." Patient Education and Counseling 98.4 (April 2015): 399-400.
Source
crossref
Published In
Patient Education and Counseling
Volume
98
Issue
4
Publish Date
2015
Start Page
399
End Page
400
DOI
10.1016/j.pec.2015.02.001

Efficacy of a couple-based randomized controlled trial to help Latino fathers quit smoking during pregnancy and postpartum: the Parejas trial.

Although many Latinos in the United States smoke, they receive assistance to quit less often than non-Latinos. To address this disparity, we recruited Latino couples into a randomized controlled trial and provided a smoking cessation program during a teachable moment, when men's partners were pregnant.We compared two interventions: (i) written materials plus nicotine replacement therapy (NRT) to (ii) materials, NRT, and couple-based counseling that addressed smoking cessation and couples communication. We recruited 348 expectant fathers who smoked via their pregnant partners from county health departments. Our primary outcome was 7-day point prevalence smoking abstinence and was collected from November 2010 through April 2013 and analyzed in February 2014.We found high rates of cessation but no arm differences in smoking rates at the end of pregnancy (0.31 vs. 0.30, materials only vs. counseling, respectively) and 12 months after randomization (postpartum: 0.39 vs. 0.38). We found high quit rates among nondaily smokers but no arm differences (0.43 vs. 0.46 in pregnancy and 0.52 vs. 0.48 postpartum). Among daily smokers, we found lower quit rates with no arm differences but effects favoring the intervention arm (0.13 vs. 0.16 in pregnancy and 0.17 vs. 0.24 postpartum).A less intensive intervention promoted cessation equal to more intensive counseling. Postpartum might be a more powerful time to promote cessation among Latino men.Less intensive interventions when delivered during teachable moments for Latino men could result in a high smoking cessation rate and could reduce disparities.

Authors
Pollak, KI; Lyna, P; Bilheimer, AK; Gordon, KC; Peterson, BL; Gao, X; Swamy, GK; Denman, S; Gonzalez, A; Rocha, P; Fish, LJ
MLA Citation
Pollak, KI, Lyna, P, Bilheimer, AK, Gordon, KC, Peterson, BL, Gao, X, Swamy, GK, Denman, S, Gonzalez, A, Rocha, P, and Fish, LJ. "Efficacy of a couple-based randomized controlled trial to help Latino fathers quit smoking during pregnancy and postpartum: the Parejas trial." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 24.2 (February 2015): 379-385.
PMID
25406226
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
24
Issue
2
Publish Date
2015
Start Page
379
End Page
385
DOI
10.1158/1055-9965.epi-14-0841

Relationships among spousal communication, self-efficacy, and motivation among expectant Latino fathers who smoke

© 2015 American Psychological Association.Objective: Cigarette smoking is a prevalent problem among Latinos, yet little is known about what factors motivate them to quit smoking or make them feel more confident that they can. Given cultural emphases on familial bonds among Latinos (e.g., familismo), it is possible that communication processes among Latino spouses play an important role. The present study tested a mechanistic model in which perceived spousal constructive communication patterns predicted changes in level of motivation for smoking cessation through changes in self-efficacy among Latino expectant fathers. Methods: Latino males (n = 173) and their pregnant partners participated in a couple-based intervention targeting males' smoking. Couples completed self-report measures of constructive communication, self-efficacy (male partners only), and motivation to quit (male partners only) at 4 time points throughout the intervention. Results: Higher levels of perceived constructive communication among Latino male partners predicted subsequent increases in male partners' self-efficacy and, to a lesser degree, motivation to quit smoking; however, self-efficacy did not mediate associations between constructive communication and motivation to quit smoking. Furthermore, positive relationships with communication were only significant at measurements taken after completion of the intervention. Female partners' level of perceived constructive communication did not predict male partners' outcomes. Conclusion: These results provide preliminary evidence to support the utility of couple-based interventions for Latino men who smoke. Findings also suggest that perceptions of communication processes among Latino partners (particularly male partners) may be an important target for interventions aimed at increasing desire and perceived ability to quit smoking among Latino men.

Authors
Khaddouma, A; Gordon, KC; Fish, LJ; Bilheimer, A; Gonzalez, A; Pollak, KI
MLA Citation
Khaddouma, A, Gordon, KC, Fish, LJ, Bilheimer, A, Gonzalez, A, and Pollak, KI. "Relationships among spousal communication, self-efficacy, and motivation among expectant Latino fathers who smoke." Health Psychology 34.10 (2015): 1038-1042.
Source
scival
Published In
Health Psychology
Volume
34
Issue
10
Publish Date
2015
Start Page
1038
End Page
1042

Physicians Use of Inclusive Sexual Orientation Language During Teenage Annual Visits.

Physicians are encouraged to use inclusive language regarding sexuality in order to help all adolescent patients feel accepted. Non-inclusive language by physicians may influence relationships with adolescent patients, especially those with still-developing sexual identities. The aim of this study was to identify patterns of physicians' use of inclusive and non-inclusive language when discussing sexuality.A total of 393 conversations between 393 adolescents and 49 physicians from 11 clinics located throughout the Raleigh-Durham, North Carolina, area were audio recorded. Conversations were coded for the use of inclusive talk (language use that avoids the use of specific gender, sex, or sexual orientation language), direct non-inclusive talk (language use that assumes the teenager is heterosexual or exclusively engages in heterosexual sexual activity), and indirect non-inclusive talk (language use that frames talk heterosexually but does not pre-identify the adolescent as heterosexual).Nearly two-thirds (63%, 245) of the visits contained some sexuality talk. Inclusive talk rarely occurred (3.3%) while non-inclusive language was predominant (48.1% direct and 48.6% indirect). There were no significant differences in language use by gender, age, adolescent race, or visit length. These non-significant findings suggest that all adolescents regardless of race, gender, or age are receiving non-inclusive sexuality talk from their providers.Physicians are missing opportunities to create safe environments for teenagers to discuss sexuality. The examples of inclusive talk from this study may provide potentially useful ways to teach providers how to begin sexuality discussions, focusing on sexual attraction or asking about friends' sexual behavior, and maintain these discussions.

Authors
Alexander, SC; Fortenberry, JD; Pollak, KI; Bravender, T; Østbye, T; Shields, CG
MLA Citation
Alexander, SC, Fortenberry, JD, Pollak, KI, Bravender, T, Østbye, T, and Shields, CG. "Physicians Use of Inclusive Sexual Orientation Language During Teenage Annual Visits." LGBT health 1.4 (December 2014): 283-291.
PMID
26789857
Source
epmc
Published In
LGBT health
Volume
1
Issue
4
Publish Date
2014
Start Page
283
End Page
291
DOI
10.1089/lgbt.2014.0035

Weight-related SMS texts promoting appropriate pregnancy weight gain: A pilot study

© 2014 Elsevier Ireland Ltd.Objectives: Excessive gestational weight gain (GWG) puts women and children at risk of obesity. We piloted an SMS-texting intervention to promote healthy GWG among overweight and obese women. Methods: We recruited 35 women and randomized them in a 2:1 fashion to: a tailored SMS-texting intervention (Preg CHAT) vs. a generic texting intervention (Txt4baby). Preg CHAT texts provided personalized feedback based on women's intake of sweetened beverages, fruits and vegetables, fast food, daily steps taken, and weight. We abstracted women's weights from charts and surveyed women at baseline and 32 weeks gestation. Results: Few women refused the study; many (30%) did not complete the study, however. Of those in the Preg CHAT arm, 86% responded to texts, and 80% said they would recommend this program to a friend. For women who completed the surveys (. n=. 23), those in the Preg CHAT arm had a mean gain of 6 less pounds than women in the Txt4Baby arm (95% CI -15.9, 4.0; p=. 0.24). Conclusions: This pilot study shows feasibility, acceptability, and potential efficacy of a low-intensity and disseminable intervention to help overweight and obese women reduce GWG. Practice implications: An SMS texting program might help overweight women reduce excessive GWG.

Authors
Pollak, KI; Alexander, SC; Bennett, G; Lyna, P; Coffman, CJ; Bilheimer, A; Farrell, D; Bodner, ME; Swamy, GK; Østbye, T
MLA Citation
Pollak, KI, Alexander, SC, Bennett, G, Lyna, P, Coffman, CJ, Bilheimer, A, Farrell, D, Bodner, ME, Swamy, GK, and Østbye, T. "Weight-related SMS texts promoting appropriate pregnancy weight gain: A pilot study." Patient Education and Counseling 97.2 (November 1, 2014): 256-260.
Source
scopus
Published In
Patient Education and Counseling
Volume
97
Issue
2
Publish Date
2014
Start Page
256
End Page
260
DOI
10.1016/j.pec.2014.07.030

Weight-related SMS texts promoting appropriate pregnancy weight gain: a pilot study.

Excessive gestational weight gain (GWG) puts women and children at risk of obesity. We piloted an SMS-texting intervention to promote healthy GWG among overweight and obese women.We recruited 35 women and randomized them in a 2:1 fashion to: a tailored SMS-texting intervention (Preg CHAT) vs. a generic texting intervention (Txt4baby). Preg CHAT texts provided personalized feedback based on women's intake of sweetened beverages, fruits and vegetables, fast food, daily steps taken, and weight. We abstracted women's weights from charts and surveyed women at baseline and 32 weeks gestation.Few women refused the study; many (30%) did not complete the study, however. Of those in the Preg CHAT arm, 86% responded to texts, and 80% said they would recommend this program to a friend. For women who completed the surveys (n=23), those in the Preg CHAT arm had a mean gain of 6 less pounds than women in the Txt4Baby arm (95% CI -15.9, 4.0; p=0.24).This pilot study shows feasibility, acceptability, and potential efficacy of a low-intensity and disseminable intervention to help overweight and obese women reduce GWG.An SMS texting program might help overweight women reduce excessive GWG.

Authors
Pollak, KI; Alexander, SC; Bennett, G; Lyna, P; Coffman, CJ; Bilheimer, A; Farrell, D; Bodner, ME; Swamy, GK; Østbye, T
MLA Citation
Pollak, KI, Alexander, SC, Bennett, G, Lyna, P, Coffman, CJ, Bilheimer, A, Farrell, D, Bodner, ME, Swamy, GK, and Østbye, T. "Weight-related SMS texts promoting appropriate pregnancy weight gain: a pilot study." Patient education and counseling 97.2 (November 2014): 256-260.
PMID
25153313
Source
epmc
Published In
Patient Education and Counseling
Volume
97
Issue
2
Publish Date
2014
Start Page
256
End Page
260
DOI
10.1016/j.pec.2014.07.030

Physicians' assurances of confidentiality and time spent alone with adolescents during primary care visits.

Authors
Bravender, T; Lyna, P; Tulsky, JA; Ostbye, T; Alexander, SC; Dolor, RJ; Coffman, CJ; Lin, P-H; Pollak, KI
MLA Citation
Bravender, T, Lyna, P, Tulsky, JA, Ostbye, T, Alexander, SC, Dolor, RJ, Coffman, CJ, Lin, P-H, and Pollak, KI. "Physicians' assurances of confidentiality and time spent alone with adolescents during primary care visits." Clinical pediatrics 53.11 (October 2014): 1094-1097.
PMID
24322956
Source
epmc
Published In
Clinical Pediatrics
Volume
53
Issue
11
Publish Date
2014
Start Page
1094
End Page
1097
DOI
10.1177/0009922813512022

Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents.

Physicians' use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown.We coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time.Physicians used more MI consistent techniques with female patients (p=0.06) and with heavier patients (p=0.02). Physicians with prior MI training also used more MI consistent techniques (p=0.04) and asked more open-ended questions (p=0.05). Pediatricians had a higher MI Spirit score than family physicians (p=0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p=0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p=0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p=0.02).Physicians' weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time.Physicians might consider using MI techniques more and attempt to use these equally with all adolescents.

Authors
Pollak, KI; Coffman, CJ; Alexander, SC; Østbye, T; Lyna, P; Tulsky, JA; Bilheimer, A; Dolor, RJ; Lin, P-H; Bodner, ME; Bravender, T
MLA Citation
Pollak, KI, Coffman, CJ, Alexander, SC, Østbye, T, Lyna, P, Tulsky, JA, Bilheimer, A, Dolor, RJ, Lin, P-H, Bodner, ME, and Bravender, T. "Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents." Patient education and counseling 96.3 (September 2014): 327-332.
PMID
25130793
Source
epmc
Published In
Patient Education and Counseling
Volume
96
Issue
3
Publish Date
2014
Start Page
327
End Page
332
DOI
10.1016/j.pec.2014.07.025

IMPROVING ADHERENCE TO A WEB-BASED INTERVENTION TO HELP ADVANCED CANCER PATIENTS EXPRESS EMOTIONAL CONCERNS

Authors
Pollak, KI; Porter, LS; Farrell, D; Lowman, SG; Jeffreys, A; Tulsky, JA
MLA Citation
Pollak, KI, Porter, LS, Farrell, D, Lowman, SG, Jeffreys, A, and Tulsky, JA. "IMPROVING ADHERENCE TO A WEB-BASED INTERVENTION TO HELP ADVANCED CANCER PATIENTS EXPRESS EMOTIONAL CONCERNS." ANNALS OF BEHAVIORAL MEDICINE 47 (April 2014): S98-S98.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
47
Publish Date
2014
Start Page
S98
End Page
S98

Sexuality talk during adolescent health maintenance visits.

IMPORTANCE: Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality. OBJECTIVE: To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents. DESIGN, SETTING, AND PARTICIPANTS: Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53% female; 40% white; 47% African American) and 49 physicians (82% pediatricians; 84% white; 65% female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area. MAIN OUTCOMES AND MEASURES: Total time per visit during which sexuality issues were discussed. RESULTS One hundred sixty-five (65%) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35% 0 seconds; 30% 1-35 seconds; and 35% ≥ 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or ≥ 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR] = 2.58; 95% CI, 1.53-4.36), older patients (OR = 1.37; 95% CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95% CI, 2.58-7.28), African American adolescents (OR = 1.58; 95% CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95% CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95% CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation. CONCLUSIONS AND RELEVANCE: Our study may be the first to directly observe sexuality talk between physicians and adolescents. We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01040975.

Authors
Alexander, SC; Fortenberry, JD; Pollak, KI; Bravender, T; Davis, JK; Ostbye, T; Tulsky, JA; Dolor, RJ; Shields, CG
MLA Citation
Alexander, SC, Fortenberry, JD, Pollak, KI, Bravender, T, Davis, JK, Ostbye, T, Tulsky, JA, Dolor, RJ, and Shields, CG. "Sexuality talk during adolescent health maintenance visits." JAMA Pediatr 168.2 (February 2014): 163-169.
PMID
24378686
Source
pubmed
Published In
JAMA Pediatrics
Volume
168
Issue
2
Publish Date
2014
Start Page
163
End Page
169
DOI
10.1001/jamapediatrics.2013.4338

The impact of physician weight discussion on weight loss in US adults

Problem The increasing prevalence of overweight and obesity in the United States and worldwide is at epidemic levels. Physicians may play a vital role in addressing this epidemic. We aimed to examine the association of a physician's discussion of patients' weight status with self-reported weight loss. We hypothesized that physician discussion of patients' being overweight is associated with increased weight loss in patients with overweight and obesity. Methods Data analysis of participants (n = 5054) in the National Health and Nutritional Examination Survey (NHANES) in 2005-2008 the main outcome was rates of self-reported weight loss and the association with physicians' discussion of their patients' weight status. Results Overweight and obese participants were significantly more likely to report a 5% weight loss in the past year if their doctor had told them they were overweight (adjusted OR (AOR) 1.88; 95% CI 1.45-2.44; AOR 1.79; 95% CI 1.30-2.46, respectively). Conclusions Physicians' direct discussion of their patients' weight status is associated with clinically significant patient weight loss and may be a targetable intervention. Further studies are needed to determine if increasing physician discussion of patients' weight status leads to significant weight loss. © 2013 Asian Oceanian Association for the Study of Obesity.

Authors
Pool, AC; Kraschnewski, JL; Cover, LA; Lehman, EB; Stuckey, HL; Hwang, KO; Pollak, KI; Sciamanna, CN
MLA Citation
Pool, AC, Kraschnewski, JL, Cover, LA, Lehman, EB, Stuckey, HL, Hwang, KO, Pollak, KI, and Sciamanna, CN. "The impact of physician weight discussion on weight loss in US adults." Obesity Research and Clinical Practice 8.2 (January 1, 2014).
Source
scopus
Published In
Obesity Research & Clinical Practice
Volume
8
Issue
2
Publish Date
2014
DOI
10.1016/j.orcp.2013.03.003

Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents

Objective: Physicians' use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown. Methods: We coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time. Results: Physicians used more MI consistent techniques with female patients (p= 0.06) and with heavier patients (p= 0.02). Physicians with prior MI training also used more MI consistent techniques (p= 0.04) and asked more open-ended questions (p= 0.05). Pediatricians had a higher MI Spirit score than family physicians (p= 0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p= 0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p= 0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p= 0.02). Conclusion: Physicians' weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time. Practice implications: Physicians might consider using MI techniques more and attempt to use these equally with all adolescents. © 2014 Elsevier Ireland Ltd.

Authors
Pollak, KI; Coffman, CJ; Alexander, SC; Østbye, T; Lyna, P; Tulsky, JA; Bilheimer, A; Dolor, RJ; Lin, PH; Bodner, ME; Bravender, T
MLA Citation
Pollak, KI, Coffman, CJ, Alexander, SC, Østbye, T, Lyna, P, Tulsky, JA, Bilheimer, A, Dolor, RJ, Lin, PH, Bodner, ME, and Bravender, T. "Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents." Patient Education and Counseling 96.3 (January 1, 2014): 327-332.
Source
scopus
Published In
Patient Education and Counseling
Volume
96
Issue
3
Publish Date
2014
Start Page
327
End Page
332
DOI
10.1016/j.pec.2014.07.025

Accuracy and congruence of patient and physician weight-related discussions: from project CHAT (Communicating Health: Analyzing Talk).

OBJECTIVE: Primary care providers should counsel overweight patients to lose weight. Rates of self-reported, weight-related counseling vary, perhaps because of self-report bias. We assessed the accuracy and congruence of weight-related discussions among patients and physicians during audio-recorded encounters. METHODS: We audio-recorded encounters between physicians (n = 40) and their overweight/obese patients (n = 461) at 5 community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. RESULTS: Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters containing weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%), but when weight was not discussed, patients and physicians were more inaccurate and incongruent (patients, 36%; physicians, 44%; 28% congruence). Physicians who were less comfortable discussing weight were more likely to misreport that weight was discussed (odds ratio, 4.5; 95% confidence interval, 1.88-10.75). White physicians with African American patients were more likely to report accurately no discussion about weight than white physicians with white patients (odds ratio, 0.30; 95% confidence interval, 0.13-0.69). CONCLUSION: Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed but not when recordings indicated no weight discussions. Physicians' overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions.

Authors
Bodner, ME; Dolor, RJ; Ostbye, T; Lyna, P; Alexander, SC; Tulsky, JA; Pollak, KI
MLA Citation
Bodner, ME, Dolor, RJ, Ostbye, T, Lyna, P, Alexander, SC, Tulsky, JA, and Pollak, KI. "Accuracy and congruence of patient and physician weight-related discussions: from project CHAT (Communicating Health: Analyzing Talk)." J Am Board Fam Med 27.1 (January 2014): 70-77.
PMID
24390888
Source
pubmed
Published In
Journal of the American Board of Family Medicine : JABFM
Volume
27
Issue
1
Publish Date
2014
Start Page
70
End Page
77
DOI
10.3122/jabfm.2014.01.130110

Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding.

With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients' health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.

Authors
Haga, SB; Mills, R; Pollak, KI; Rehder, C; Buchanan, AH; Lipkus, IM; Crow, JH; Datto, M
MLA Citation
Haga, SB, Mills, R, Pollak, KI, Rehder, C, Buchanan, AH, Lipkus, IM, Crow, JH, and Datto, M. "Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding." Genome medicine 6.7 (January 2014): 58-.
PMID
25473429
Source
epmc
Published In
Genome Medicine: medicine in the post-genomic era
Volume
6
Issue
7
Publish Date
2014
Start Page
58
DOI
10.1186/s13073-014-0058-6

Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight

Objective: To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician-adolescent communication about healthy weight. Methods: Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys. Results: Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54. min to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients. Conclusion: The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner. Practice implications: If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated. © 2013 Elsevier Ireland Ltd.

Authors
Bravender, T; Tulsky, JA; Farrell, D; Alexander, SC; Østbye, T; Lyna, P; Dolor, RJ; Coffman, CJ; Bilheimer, A; Lin, PH; Pollak, KI
MLA Citation
Bravender, T, Tulsky, JA, Farrell, D, Alexander, SC, Østbye, T, Lyna, P, Dolor, RJ, Coffman, CJ, Bilheimer, A, Lin, PH, and Pollak, KI. "Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight." Patient Education and Counseling 93.3 (December 1, 2013): 525-531.
Source
scopus
Published In
Patient Education and Counseling
Volume
93
Issue
3
Publish Date
2013
Start Page
525
End Page
531
DOI
10.1016/j.pec.2013.08.017

Physician communication styles in initial consultations for hematological cancer

Objective: To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations. Methods: Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists. Results: Physicians frequently "broadcasted" information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients' goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation. Conclusions: Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation. Practice implications: Techniques such as open-ended questions, affirmations of patients' expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations. © 2013 Elsevier Ireland Ltd.

Authors
Chhabra, KR; Pollak, KI; Lee, SJ; Back, AL; Goldman, RE; Tulsky, JA
MLA Citation
Chhabra, KR, Pollak, KI, Lee, SJ, Back, AL, Goldman, RE, and Tulsky, JA. "Physician communication styles in initial consultations for hematological cancer." Patient Education and Counseling 93.3 (December 1, 2013): 573-578.
Source
scopus
Published In
Patient Education and Counseling
Volume
93
Issue
3
Publish Date
2013
Start Page
573
End Page
578
DOI
10.1016/j.pec.2013.08.023

Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight.

OBJECTIVE: To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician-adolescent communication about healthy weight. METHODS: Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys. RESULTS: Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54min to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients. CONCLUSION: The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner. PRACTICE IMPLICATIONS: If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated.

Authors
Bravender, T; Tulsky, JA; Farrell, D; Alexander, SC; Østbye, T; Lyna, P; Dolor, RJ; Coffman, CJ; Bilheimer, A; Lin, P-H; Pollak, KI
MLA Citation
Bravender, T, Tulsky, JA, Farrell, D, Alexander, SC, Østbye, T, Lyna, P, Dolor, RJ, Coffman, CJ, Bilheimer, A, Lin, P-H, and Pollak, KI. "Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight." Patient Educ Couns 93.3 (December 2013): 525-531.
PMID
24021419
Source
pubmed
Published In
Patient Education and Counseling
Volume
93
Issue
3
Publish Date
2013
Start Page
525
End Page
531
DOI
10.1016/j.pec.2013.08.017

Physician communication styles in initial consultations for hematological cancer.

OBJECTIVE: To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations. METHODS: Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists. RESULTS: Physicians frequently "broadcasted" information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients' goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation. CONCLUSIONS: Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation. PRACTICE IMPLICATIONS: Techniques such as open-ended questions, affirmations of patients' expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations.

Authors
Chhabra, KR; Pollak, KI; Lee, SJ; Back, AL; Goldman, RE; Tulsky, JA
MLA Citation
Chhabra, KR, Pollak, KI, Lee, SJ, Back, AL, Goldman, RE, and Tulsky, JA. "Physician communication styles in initial consultations for hematological cancer." Patient Educ Couns 93.3 (December 2013): 573-578.
PMID
24035463
Source
pubmed
Published In
Patient Education and Counseling
Volume
93
Issue
3
Publish Date
2013
Start Page
573
End Page
578
DOI
10.1016/j.pec.2013.08.023

The influence of a physician and patient intervention program on dietary intake.

BACKGROUND: Efficient dietary interventions for patients with hypertension in clinical settings are needed. OBJECTIVE: To assess the separate and combined influence of a physician intervention (MD-I) and a patient intervention (PT-I) on dietary intakes of patients with hypertension. DESIGN: A nested 2×2 design, randomized controlled trial conducted over 18 months. PARTICIPANTS: A total of 32 physicians and 574 outpatients with hypertension. INTERVENTION: MD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification. PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension (DASH) eating pattern, reduce sodium intake, manage weight, increase exercise, and moderate alcohol intake. MAIN OUTCOME MEASURES: Dietary intakes were measured by the Block Food Frequency Questionnaire. Concordance with the DASH dietary pattern was estimated by a DASH score. STATISTICAL ANALYSES: The main effects of MD-I and PT-I, and their interaction, were evaluated using analysis of covariance. RESULTS: After 6 months of intervention, MD-I participants significantly increased intakes of potassium, fruits, juices, and carbohydrate; decreased intake of fat; and improved overall dietary quality as measured by the Healthy Eating Index. PT-I intervention resulted in increased intakes of carbohydrate, protein, fiber, calcium, potassium, fruits and fruit juices, vegetables, dairy and Healthy Eating Index score, and decreased intakes in fat, saturated fat, cholesterol, sodium, sweets, and added fats/oils/sweets. In addition, PT-I improved overall DASH concordance score. The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months. At 18 months, most changes reversed back toward baseline levels, including the DASH score. CONCLUSIONS: Both MD-I and PT-I improved eating patterns at 6 months with some sustained effects at 18 months. Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines, only the PT-I intervention was effective in improving the overall DASH concordance score. This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies. Furthermore, this study emphasizes the importance of collaborations among physicians, registered dietitians and other dietetics practitioners, and lay health advisors while assisting patients to make healthy behavior changes.

Authors
Lin, P-H; Yancy, WS; Pollak, KI; Dolor, RJ; Marcello, J; Samsa, GP; Batch, BC; Svetkey, LP
MLA Citation
Lin, P-H, Yancy, WS, Pollak, KI, Dolor, RJ, Marcello, J, Samsa, GP, Batch, BC, and Svetkey, LP. "The influence of a physician and patient intervention program on dietary intake." J Acad Nutr Diet 113.11 (November 2013): 1465-1475.
PMID
23999279
Source
pubmed
Published In
Journal of the Academy of Nutrition and Dietetics
Volume
113
Issue
11
Publish Date
2013
Start Page
1465
End Page
1475
DOI
10.1016/j.jand.2013.06.343

A pilot study testing SMS text delivered scheduled gradual reduction to pregnant smokers.

INTRODUCTION: Smoking during pregnancy causes multiple perinatal complications; yet, the smoking rate among pregnant women has remained relatively stagnant. Most interventions to help pregnant smokers quit or reduce their smoking are not easily disseminable. Innovative and disseminable interventions are needed. METHODS: We recruited 31 pregnant smokers in their second trimester from prenatal clinics. We assessed feasibility, acceptability, and preliminary efficacy of an SMS text-based intervention in a 2-arm design. We compared SMS-delivered support messages to an intervention that provided support messages plus a scheduled gradual reduction (SGR) to help women reduce their smoking more than 3 weeks. We sent women in the SGR arm "alert texts" at times to instruct them to smoke. We asked women not to smoke unless they received an alert text. RESULTS: Most women (86%) reported reading most or all of the texts. Women in both arms rated the program as helpful (M = 6, SD = 1 vs. M = 5, SD = 2, SGR vs. support only, respectively). Women in the SGR arm had a higher rate of biochemically validated 7-day point prevalence at the end of pregnancy 13.4% versus 7.5%. Of those still smoking, women reduced their smoking substantially with more reduction in the SGR arm (SGR arm: M = 16, SD = 11 vs. support messages only: M = 12, SD = 7). CONCLUSIONS: We developed an easily disseminable intervention that could possibly promote cessation and reduction among pregnant women with SMS texting ability. Women in this pilot were enthusiastic about the program, particularly those in the SGR arm. This program needs further examination.

Authors
Pollak, KI; Lyna, P; Bilheimer, A; Farrell, D; Gao, X; Swamy, GK; Fish, LJ
MLA Citation
Pollak, KI, Lyna, P, Bilheimer, A, Farrell, D, Gao, X, Swamy, GK, and Fish, LJ. "A pilot study testing SMS text delivered scheduled gradual reduction to pregnant smokers." Nicotine Tob Res 15.10 (October 2013): 1773-1776.
PMID
23569007
Source
pubmed
Published In
Nicotine and Tobacco Research (OUP)
Volume
15
Issue
10
Publish Date
2013
Start Page
1773
End Page
1776
DOI
10.1093/ntr/ntt045

The epidemiology of weight counseling for adults in the United States: a case of positive deviance.

Weight counseling for adults is uncommonly performed by primary-care providers (PCPs), despite recommendations. In order to design effective primary-care interventions, a full understanding of the epidemiology of weight counseling in primary care is needed. Our objective was to measure the frequency of weight counseling at the level of the PCP. We performed a cross-sectional study of 21 220 US adult outpatient primary-care visits with 954 PCPs in 2007-2008, using data from the National Ambulatory Medical Care Survey (NAMCS). Most (58%) PCPs performed no weight counseling during any patient visits. A total of 85 (8.9%) PCPs provided 52% of all weight counseling and were categorized as 'positive deviant' (PD) physicians. Patients seeing PD physicians were older, less likely to be female and more likely to have hypertension, diabetes and obesity. Adjusting for patient characteristics strengthened the association between PD status and receipt of weight counseling during visits (adjusted odds ratio=13.2 (95% confidence interval 11.5-15.7)). In conclusion, a minority of PCPs provide the majority of primary-care weight counseling in the United States. Studies of these PCPs may help to identify practical methods to increase weight counseling in primary-care settings.

Authors
Kraschnewski, JL; Sciamanna, CN; Pollak, KI; Stuckey, HL; Sherwood, NE
MLA Citation
Kraschnewski, JL, Sciamanna, CN, Pollak, KI, Stuckey, HL, and Sherwood, NE. "The epidemiology of weight counseling for adults in the United States: a case of positive deviance." Int J Obes (Lond) 37.5 (May 2013): 751-753.
PMID
22777541
Source
pubmed
Published In
International Journal of Obesity
Volume
37
Issue
5
Publish Date
2013
Start Page
751
End Page
753
DOI
10.1038/ijo.2012.113

Smoking is bad for babies: obstetric care providers' use of best practice smoking cessation counseling techniques.

PURPOSE: To use direct observations of first prenatal visits to describe obstetric providers' adherence to the evidence-based clinical practice guideline for smoking cessation counseling recommended by the American College of Obstetricians and Gynecologists, the 5 A's (Ask, Advice, Assess, Assist, and Arrange). DESIGN: Observational study using audio recordings of first obstetric visits. SETTING: An urban academic hospital-based clinic. PARTICIPANTS: Obstetric care providers and pregnant women attending their first obstetric visit. METHOD: First obstetric visits were audio recorded. Visits were identified in which patients reported smoking, and discussions were analyzed for obstetric providers' use of the 5 A's in smoking cessation counseling. RESULTS: Obstetric providers asked about smoking in 98% of the 116 visits analyzed, but used 3 or more of the 5 A's in only 21% (24) of visits. In no visits did providers use all 5 A's. In 54% of the visits, providers gave patients information about smoking, most commonly about risks associated with perinatal smoking. CONCLUSION: Few obstetric care providers performed the recommended 5 A's smoking cessation counseling with their pregnant smokers. Effective and innovative methods are needed to improve obstetric providers' use of the 5 A's.

Authors
Chang, JC; Alexander, SC; Holland, CL; Arnold, RM; Landsittel, D; Tulsky, JA; Pollak, KI
MLA Citation
Chang, JC, Alexander, SC, Holland, CL, Arnold, RM, Landsittel, D, Tulsky, JA, and Pollak, KI. "Smoking is bad for babies: obstetric care providers' use of best practice smoking cessation counseling techniques." Am J Health Promot 27.3 (January 2013): 170-176.
PMID
23286593
Source
pubmed
Published In
American Journal of Health Promotion
Volume
27
Issue
3
Publish Date
2013
Start Page
170
End Page
176
DOI
10.4278/ajhp.110624-QUAL-265

The Influence of a Physician and Patient Intervention Program on Dietary Intake

Background: Efficient dietary interventions for patients with hypertension in clinical settings are needed. Objective: To assess the separate and combined influence of a physician intervention (MD-I) and a patient intervention (PT-I) on dietary intakes of patients with hypertension. Design: A nested 2×2 design, randomized controlled trial conducted over 18 months. Participants: A total of 32 physicians and 574 outpatients with hypertension. Intervention: MD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification. PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension (DASH) eating pattern, reduce sodium intake, manage weight, increase exercise, and moderate alcohol intake. Main outcome measures: Dietary intakes were measured by the Block Food Frequency Questionnaire. Concordance with the DASH dietary pattern was estimated by a DASH score. Statistical analyses: The main effects of MD-I and PT-I, and their interaction, were evaluated using analysis of covariance. Results: After 6 months of intervention, MD-I participants significantly increased intakes of potassium, fruits, juices, and carbohydrate; decreased intake of fat; and improved overall dietary quality as measured by the Healthy Eating Index. PT-I intervention resulted in increased intakes of carbohydrate, protein, fiber, calcium, potassium, fruits and fruit juices, vegetables, dairy and Healthy Eating Index score, and decreased intakes in fat, saturated fat, cholesterol, sodium, sweets, and added fats/oils/sweets. In addition, PT-I improved overall DASH concordance score. The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months. At 18 months, most changes reversed back toward baseline levels, including the DASH score. Conclusions: Both MD-I and PT-I improved eating patterns at 6 months with some sustained effects at 18 months. Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines, only the PT-I intervention was effective in improving the overall DASH concordance score. This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies. Furthermore, this study emphasizes the importance of collaborations among physicians, registered dietitians and other dietetics practitioners, and lay health advisors while assisting patients to make healthy behavior changes. © 2013 Academy of Nutrition and Dietetics.

Authors
Lin, PH; Yancy, WS; Pollak, KI; Dolor, RJ; Marcello, J; Samsa, GP; Batch, BC; Svetkey, LP
MLA Citation
Lin, PH, Yancy, WS, Pollak, KI, Dolor, RJ, Marcello, J, Samsa, GP, Batch, BC, and Svetkey, LP. "The Influence of a Physician and Patient Intervention Program on Dietary Intake." Journal of the Academy of Nutrition and Dietetics 113.11 (2013): 1465-1475.
Source
scival
Published In
Journal of the Academy of Nutrition and Dietetics
Volume
113
Issue
11
Publish Date
2013
Start Page
1465
End Page
1475
DOI
10.1016/j.jand.2013.06.343

The impact of physician weight discussion on weight loss in US adults

Problem: The increasing prevalence of overweight and obesity in the United States and worldwide is at epidemic levels. Physicians may play a vital role in addressing this epidemic. We aimed to examine the association of a physician's discussion of patients' weight status with self-reported weight loss. We hypothesized that physician discussion of patients' being overweight is associated with increased weight loss in patients with overweight and obesity. Methods: Data analysis of participants (n = 5054) in the National Health and Nutritional Examination Survey (NHANES) in 2005-2008. The main outcome was rates of self-reported weight loss and the association with physicians' discussion of their patients' weight status. Results: Overweight and obese participants were significantly more likely to report a 5% weight loss in the past year if their doctor had told them they were overweight (adjusted OR (AOR) 1.88; 95% CI 1.45-2.44; AOR 1.79; 95% CI 1.30-2.46, respectively). Conclusions: Physicians' direct discussion of their patients' weight status is associated with clinically significant patient weight loss and may be a targetable intervention. Further studies are needed to determine if increasing physician discussion of patients' weight status leads to significant weight loss. © 2013 Asian Oceanian Association for the Study of Obesity.

Authors
Pool, AC; Kraschnewski, JL; Cover, LA; Lehman, EB; Stuckey, HL; Hwang, KO; Pollak, KI; Sciamanna, CN
MLA Citation
Pool, AC, Kraschnewski, JL, Cover, LA, Lehman, EB, Stuckey, HL, Hwang, KO, Pollak, KI, and Sciamanna, CN. "The impact of physician weight discussion on weight loss in US adults." Obesity Research and Clinical Practice (2013).
PMID
24743008
Source
scival
Published In
Obesity Research & Clinical Practice
Publish Date
2013
DOI
10.1016/j.orcp.2013.03.003

The epidemiology of weight counseling for adults in the United States: A case of positive deviance

Weight counseling for adults is uncommonly performed by primary-care providers (PCPs), despite recommendations. In order to design effective primary-care interventions, a full understanding of the epidemiology of weight counseling in primary care is needed. Our objective was to measure the frequency of weight counseling at the level of the PCP. We performed a cross-sectional study of 21 220 US adult outpatient primary-care visits with 954 PCPs in 2007-2008, using data from the National Ambulatory Medical Care Survey (NAMCS). Most (58%) PCPs performed no weight counseling during any patient visits. A total of 85 (8.9%) PCPs provided 52% of all weight counseling and were categorized as 'positive deviant' (PD) physicians. Patients seeing PD physicians were older, less likely to be female and more likely to have hypertension, diabetes and obesity. Adjusting for patient characteristics strengthened the association between PD status and receipt of weight counseling during visits (adjusted odds ratio=13.2 (95% confidence interval 11.5-15.7)). In conclusion, a minority of PCPs provide the majority of primary-care weight counseling in the United States. Studies of these PCPs may help to identify practical methods to increase weight counseling in primary-care settings. © 2013 Macmillan Publishers Limited.

Authors
Kraschnewski, JL; Sciamanna, CN; Pollak, KI; Stuckey, HL; Sherwood, NE
MLA Citation
Kraschnewski, JL, Sciamanna, CN, Pollak, KI, Stuckey, HL, and Sherwood, NE. "The epidemiology of weight counseling for adults in the United States: A case of positive deviance." International Journal of Obesity 37.5 (2013): 751-753.
Source
scival
Published In
International Journal of Obesity
Volume
37
Issue
5
Publish Date
2013
Start Page
751
End Page
753
DOI
10.1038/ijo.2012.113

Can physicians accurately predict which patients will lose weight, improve nutrition and increase physical activity?

BACKGROUND: Physician counselling may help patients increase physical activity, improve nutrition and lose weight. However, physicians have low outcome expectations that patients will change. The aims are to describe the accuracy of physicians' outcome expectations about whether patients will follow weight loss, nutrition and physical activity recommendations. The relationships between physician outcome expectations and patient motivation and confidence also are assessed. METHODS: This was an observational study that audio recorded encounters between 40 primary care physicians and 461 of their overweight or obese patients. We surveyed physicians to assess outcome expectations that patients will lose weight, improve nutrition and increase physical activity after counselling. We assessed actual patient change in behaviours from baseline to 3 months after the encounter and changes in motivation and confidence from baseline to immediately post-encounter. RESULTS: Right after the visit, ~55% of the time physicians were optimistic that their individual patients would improve. Physicians were not very accurate about which patients actually would improve weight, nutrition and physical activity. More patients had higher confidence to lose weight when physicians thought that patients would be likely to follow their weight loss recommendations. CONCLUSIONS: Physicians are moderately optimistic that patients will follow their weight loss, nutrition and physical activity recommendations. Patients might perceive physicians' confidence in them and thus feel more confident themselves. Physicians, however, are not very accurate in predicting which patients will or will not change behaviours. Their optimism, although helpful for patient confidence, might make physicians less receptive to learning effective counselling techniques.

Authors
Pollak, KI; Coffman, CJ; Alexander, SC; Tulsky, JA; Lyna, P; Dolor, RJ; Cox, ME; Brouwer, RJN; Bodner, ME; Østbye, T
MLA Citation
Pollak, KI, Coffman, CJ, Alexander, SC, Tulsky, JA, Lyna, P, Dolor, RJ, Cox, ME, Brouwer, RJN, Bodner, ME, and Østbye, T. "Can physicians accurately predict which patients will lose weight, improve nutrition and increase physical activity?." Fam Pract 29.5 (October 2012): 553-560.
PMID
22315467
Source
pubmed
Published In
Family Practice
Volume
29
Issue
5
Publish Date
2012
Start Page
553
End Page
560
DOI
10.1093/fampra/cms004

ACCURACY AND CONGRUENCY OF PATIENT AND PHYSICIAN PERCEPTIONS OF WEIGHT-RELATED DISCUSSIONS: PROJECT CHAT

Authors
Bodner, ME; Dolor, RJ; Ostbye, T; Lyna, P; Coffman, CJ; Alexander, SC; Tulsky, JA; Pollak, KI
MLA Citation
Bodner, ME, Dolor, RJ, Ostbye, T, Lyna, P, Coffman, CJ, Alexander, SC, Tulsky, JA, and Pollak, KI. "ACCURACY AND CONGRUENCY OF PATIENT AND PHYSICIAN PERCEPTIONS OF WEIGHT-RELATED DISCUSSIONS: PROJECT CHAT." ANNALS OF BEHAVIORAL MEDICINE 43 (April 2012): S238-S238.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
43
Publish Date
2012
Start Page
S238
End Page
S238

The influence of physician communication style on overweight patients' perceptions of length of encounter and physician being rushed.

BACKGROUND AND OBJECTIVES: Little is known about how patients and physicians perceive time and the extent to which they perceive the physician being rushed during encounters. One aim of this paper is to examine whether patient and physician characteristics and physician communication influence patient perception of the duration of the encounter and their perception of physicians being rushed. Another aim is to examine the relationship between patient and physician perceptions of physicians feeling rushed. METHODS: We audiorecorded 461 encounters of overweight or obese patients with 40 primary care physicians and included 320 encounters in which weight was discussed. We calculated time spent with physician and coded all communication about weight using the Motivational Interview Treatment Integrity scale (MITI). Patients completed post-visit questionnaires in which they reported the estimated duration of the encounter and how rushed they thought the physician was during the encounter. Physicians reported how rushed they felt. RESULTS: Patients estimated encounters to be longer than they actually were by an average of 2.6 minutes (SD=11.0). When physicians used reflective statements when discussing weight, patients estimated the encounter to be shorter than when physicians did not use reflective statements (1.17 versus 4.56 minutes more than actual duration). Whites perceived the encounter as shorter than African Americans (1.45 versus 4.28 minutes more than actual duration). Physicians felt rushed in 66% of visits; however, most patients did not perceive this. Internists were perceived to be more rushed than family physicians. CONCLUSIONS: There is wide variation in patients' ability to estimate the length of time they spend with their physician. Some physician and patient characteristics were related to patient perceptions of the length of the encounter. Reflective statements might lead patients to perceive encounters as shorter. Physicians, especially family physicians, appear able to conceal that they are feeling rushed.

Authors
Gulbrandsen, P; Østbye, T; Lyna, P; Dolor, RJ; Tulsky, JA; Alexander, SC; Pollak, KI
MLA Citation
Gulbrandsen, P, Østbye, T, Lyna, P, Dolor, RJ, Tulsky, JA, Alexander, SC, and Pollak, KI. "The influence of physician communication style on overweight patients' perceptions of length of encounter and physician being rushed." Fam Med 44.3 (March 2012): 183-188.
PMID
22399481
Source
pubmed
Published In
Family medicine
Volume
44
Issue
3
Publish Date
2012
Start Page
183
End Page
188

Effects of counseling techniques on patients' weight-related attitudes and behaviors in a primary care clinic.

OBJECTIVE: Examine primary care physicians' use of counseling techniques when treating overweight and obese patients and the association with mediators of behavior change as well as change in nutrition, exercise, and weight loss attempts. METHODS: We audio recorded office encounters between 40 physicians and 461 patients. Encounters were coded for physician use of selected counseling techniques using the Motivational Interviewing Treatment Integrity (MITI) scale. Patient motivation and confidence as well as Fat and Fiber Diet score (1-4), Framingham physical activity questionnaire (MET-minutes), and weight loss attempts (yes/no) were assessed by surveys. Generalized linear models were fit, including physician, patient, and visit level covariates. RESULTS: Patients whose physicians were rated higher in empathy improved their Fat and Fiber intake 0.18 units (95% CI 0, 0.4). When physicians used "MI consistent" techniques, patients reported higher confidence to improve nutrition (OR 2.57, 95% CI 1.2, 5.7). CONCLUSION: When physicians used counseling techniques consistent with MI principles, some of their patients' weight-related attitudes and behaviors improved. PRACTICE IMPLICATIONS: Physicians may not be able to employ formal MI during a clinic visit. However, use of counseling techniques consistent with MI principles, such as expression of empathy, may improve patients' weight-related attitudes and behaviors.

Authors
Cox, ME; Yancy, WS; Coffman, CJ; Ostbye, T; Tulsky, JA; Alexander, SC; Brouwer, RJN; Dolor, RJ; Pollak, KI
MLA Citation
Cox, ME, Yancy, WS, Coffman, CJ, Ostbye, T, Tulsky, JA, Alexander, SC, Brouwer, RJN, Dolor, RJ, and Pollak, KI. "Effects of counseling techniques on patients' weight-related attitudes and behaviors in a primary care clinic." Patient Educ Couns 85.3 (December 2011): 363-368.
PMID
21316897
Source
pubmed
Published In
Patient Education and Counseling
Volume
85
Issue
3
Publish Date
2011
Start Page
363
End Page
368
DOI
10.1016/j.pec.2011.01.024

Predictors of weight loss communication in primary care encounters.

OBJECTIVE: Evidence suggests that physicians' use of motivational interviewing (MI) techniques helps patients lose weight. We assessed patient, physician, relationship, and systems predictors of length of weight-loss discussions and whether physicians' used MI techniques. METHODS: Forty primary care physicians and 461 of their overweight or obese patients were audio recorded and surveyed. RESULTS: Weight-related topics were commonly discussed (nutrition 78%, physical activity 82%, and BMI/weight 72%). Use of MI techniques was low. A multivariable linear mixed model was fit to time spent discussing weight, adjusting for patient clustering within physician. More time was spent with obese patients (p=.0002), by African American physicians (p=.03), family physicians (p=.02), and physicians who believed patients were embarrassed to discuss weight (p=.05). Female physicians were more likely to use MI techniques (p=.02); African American physicians were more likely to use MI-inconsistent techniques (p<.001). CONCLUSION: Primary care physicians routinely counsel about weight and are likely to spend more time with obese than with overweight patients. Internists spend less time on weight. Patient and systems factors do not seem to influence physicians' use MI techniques. PRACTICE IMPLICATIONS: All physicians, particularly, male and African American physicians, could increase their use of MI techniques to promote more weight loss among patients.

Authors
Pollak, KI; Coffman, CJ; Alexander, SC; Manusov, JRE; Ostbye, T; Tulsky, JA; Lyna, P; Esoimeme, I; Brouwer, RJN; Dolor, RJ
MLA Citation
Pollak, KI, Coffman, CJ, Alexander, SC, Manusov, JRE, Ostbye, T, Tulsky, JA, Lyna, P, Esoimeme, I, Brouwer, RJN, and Dolor, RJ. "Predictors of weight loss communication in primary care encounters." Patient Educ Couns 85.3 (December 2011): e175-e182.
PMID
21474267
Source
pubmed
Published In
Patient Education and Counseling
Volume
85
Issue
3
Publish Date
2011
Start Page
e175
End Page
e182
DOI
10.1016/j.pec.2011.03.001

Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial.

BACKGROUND: Quality cancer care requires addressing patients' emotions, which oncologists infrequently do. Multiday courses can teach oncologists skills to handle emotion; however, such workshops are long and costly. OBJECTIVE: To test whether a brief, computerized intervention improves oncologist responses to patient expressions of negative emotion. DESIGN: Randomized, controlled, parallel-group trial stratified by site, sex, and oncologic specialty. Oncologists were randomly assigned to receive a communication lecture or the lecture plus a tailored CD-ROM. (ClinicalTrials.gov registration number: NCT00276627) SETTING: Oncology clinics at a comprehensive cancer center and Veterans Affairs Medical Center in Durham, North Carolina, and a comprehensive cancer center in Pittsburgh, Pennsylvania. PARTICIPANTS: 48 medical, gynecologic, and radiation oncologists and 264 patients with advanced cancer. INTERVENTION: Oncologists were randomly assigned in a 1:1 ratio to receive an interactive CD-ROM about responding to patients' negative emotions. The CD-ROM included tailored feedback on the oncologists' own recorded conversations. MEASUREMENTS: Postintervention audio recordings were used to identify the number of empathic statements and responses to patients' expressions of negative emotion. Surveys evaluated patients' trust in their oncologists and perceptions of their oncologists' communication skills. RESULTS: Oncologists in the intervention group used more empathic statements (relative risk, 1.9 [95% CI, 1.1 to 3.3]; P = 0.024) and were more likely to respond to negative emotions empathically (odds ratio, 2.1 [CI, 1.1 to 4.2]; P = 0.028) than control oncologists. Patients of intervention oncologists reported greater trust in their oncologists than did patients of control oncologists (estimated mean difference, 0.1 [CI, 0.0 to 0.2]; P = 0.036). There was no significant difference in perceptions of communication skills. LIMITATIONS: Long-term effects were not examined. The findings may not be generalizable outside of academic medical centers. CONCLUSION: A brief computerized intervention improves how oncologists respond to patients' expressions of negative emotions. PRIMARY FUNDING SOURCE: National Cancer Institute.

Authors
Tulsky, JA; Arnold, RM; Alexander, SC; Olsen, MK; Jeffreys, AS; Rodriguez, KL; Skinner, CS; Farrell, D; Abernethy, AP; Pollak, KI
MLA Citation
Tulsky, JA, Arnold, RM, Alexander, SC, Olsen, MK, Jeffreys, AS, Rodriguez, KL, Skinner, CS, Farrell, D, Abernethy, AP, and Pollak, KI. "Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial." Ann Intern Med 155.9 (November 1, 2011): 593-601.
PMID
22041948
Source
pubmed
Published In
Annals of internal medicine
Volume
155
Issue
9
Publish Date
2011
Start Page
593
End Page
601
DOI
10.7326/0003-4819-155-9-201111010-00007

Physician empathy and listening: associations with patient satisfaction and autonomy.

PURPOSE: Motivational Interviewing (MI) is used to help patients change their behaviors. We sought to determine if physician use of specific MI techniques increases patient satisfaction with the physician and perceived autonomy. METHODS: We audio-recorded preventive and chronic care encounters between 40 primary care physicians and 320 of their overweight or obese patients. We coded use of MI techniques (eg, empathy, reflective listening). We assessed patient satisfaction and how much the patient felt the physician supported him or her to change. Generalized estimating equation models with logit links were used to examine associations between MI techniques and patient perceived autonomy and satisfaction. RESULTS: Patients whose physicians were rated as more empathic had higher rates of high satisfaction than patients whose physicians were less empathic (29% vs 11%; P = .004). Patients whose physicians made any reflective statements had higher rates of high autonomy support than those whose physicians did not (46% vs 30%; P = .006). CONCLUSIONS: When physicians used reflective statements, patients were more likely to perceive high autonomy support. When physicians were empathic, patients were more likely to report high satisfaction with the physician. These results suggest that physician training in MI techniques could potentially improve patient perceptions and outcomes.

Authors
Pollak, KI; Alexander, SC; Tulsky, JA; Lyna, P; Coffman, CJ; Dolor, RJ; Gulbrandsen, P; Ostbye, T
MLA Citation
Pollak, KI, Alexander, SC, Tulsky, JA, Lyna, P, Coffman, CJ, Dolor, RJ, Gulbrandsen, P, and Ostbye, T. "Physician empathy and listening: associations with patient satisfaction and autonomy." J Am Board Fam Med 24.6 (November 2011): 665-672.
PMID
22086809
Source
pubmed
Published In
Journal of the American Board of Family Medicine : JABFM
Volume
24
Issue
6
Publish Date
2011
Start Page
665
End Page
672
DOI
10.3122/jabfm.2011.06.110025

Effect of patient and patient-oncologist relationship characteristics on communication about health-related quality of life.

OBJECTIVE: To test the effects of patient and patient-oncologist relationship factors on the time spent communicating about health-related quality of life (HRQOL) during outpatient clinic encounters between oncologists and their patients with advanced cancer. METHODS: Using mixed methods, we coded for duration of HRQOL talk in a subset of audio-recorded conversations from the Study of Communication in Oncologist-Patient Encounters (SCOPE) Trial. Multivariable linear regression modeling was used to investigate the relationship between duration of HRQOL talk and gender concordance, race concordance, patient education status, patient marital status, and length of the patient-oncologist relationship (i.e. number of previous visits). RESULTS: Sixty-six encounters were analyzed that involved 63 patients and 34 oncologists. Patients were more likely to be female (51%), white (86%), married (78%), and possess a college or more advanced degree (33%). Most oncologists were male (82%) and white (82%). Mean ages were 58.8 years for patients and 44.9 years for oncologists. Regression results showed that the number of a patient's previous visits with their oncologist was significantly associated with a longer duration of HRQOL talk during their audio-recorded clinic visit. The remaining independent variables, gender concordance, race concordance, patient education status, and patient marital status were not significant predictors of duration of HRQOL talk. CONCLUSIONS: Our findings suggest that length of the patient-oncologist relationship is related to duration of HRQOL talk. Improvements in HRQOL communication may best be achieved through efforts directed at those in earlier stages of the doctor-patient relationship.

Authors
Rodriguez, KL; Bayliss, NK; Alexander, SC; Jeffreys, AS; Olsen, MK; Pollak, KI; Garrigues, SK; Tulsky, JA; Arnold, RM
MLA Citation
Rodriguez, KL, Bayliss, NK, Alexander, SC, Jeffreys, AS, Olsen, MK, Pollak, KI, Garrigues, SK, Tulsky, JA, and Arnold, RM. "Effect of patient and patient-oncologist relationship characteristics on communication about health-related quality of life." Psychooncology 20.9 (September 2011): 935-942.
PMID
20737643
Source
pubmed
Published In
Psycho-Oncology
Volume
20
Issue
9
Publish Date
2011
Start Page
935
End Page
942
DOI
10.1002/pon.1829

Incorporating MI techniques into physician counseling.

Authors
Pollak, KI
MLA Citation
Pollak, KI. "Incorporating MI techniques into physician counseling." Patient Educ Couns 84.1 (July 2011): 1-2.
PMID
21571483
Source
pubmed
Published In
Patient Education and Counseling
Volume
84
Issue
1
Publish Date
2011
Start Page
1
End Page
2
DOI
10.1016/j.pec.2011.04.026

Applying motivational interviewing techniques to palliative care communication.

Palliative care relies heavily on communication. Although some guidelines do address difficult communication, less is known about how to handle conversations with patients who express ambivalence or resistance to such care. Clinicians also struggle with how to support patient autonomy when they disagree with patient choices. Motivational Interviewing (MI) techniques may help address these responses. Specifically, MI techniques such as reflective statements and summarizing can help reduce a patient's resistance, resolve patient ambivalence, and support patient autonomy. Not all the MI techniques are applicable, however, in part because palliative care clinicians do not guide patients to make particular choices but, instead, help patients make choices that are consistent with patient values. Some elements from MI can be used to improve the quality and efficacy of palliative care conversations.

Authors
Pollak, KI; Childers, JW; Arnold, RM
MLA Citation
Pollak, KI, Childers, JW, and Arnold, RM. "Applying motivational interviewing techniques to palliative care communication." J Palliat Med 14.5 (May 2011): 587-592.
PMID
21291329
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
14
Issue
5
Publish Date
2011
Start Page
587
End Page
592
DOI
10.1089/jpm.2010.0495

Weight-loss talks: What works (and what doesn't)

Authors
Alexander, SC; Cox, ME; Jr, YWS; Turer, CB; Lyna, P; Ostbye, T; Dolor, RJ; Tulsky, JA; Pollak, KI
MLA Citation
Alexander, SC, Cox, ME, Jr, YWS, Turer, CB, Lyna, P, Ostbye, T, Dolor, RJ, Tulsky, JA, and Pollak, KI. "Weight-loss talks: What works (and what doesn't)." JOURNAL OF FAMILY PRACTICE 60.4 (April 2011): 213-+.
PMID
26048291
Source
wos-lite
Published In
Journal of Family Practice
Volume
60
Issue
4
Publish Date
2011
Start Page
213
End Page
+

Do the five A's work when physicians counsel about weight loss?

BACKGROUND AND OBJECTIVES: More than two thirds of Americans are overweight or obese. Physician counseling may help patients lose weight; however, physicians perceive these discussions as somewhat futile and time-consuming. An effective and efficient tool for smoking cessation is the Five A's (Ask, Advise, Assess, Assist, and Arrange). We studied the effectiveness of the Five A's in weight-loss counseling. METHODS: We audiorecorded primary care encounters between 40 physicians and 461 of their overweight or obese patients. All were told the study was about preventive health, not weight specifically. Encounters were coded for physician use of the Five A's. Patients' motivation and confidence were assessed before and immediately after the encounter. Three months later, we assessed patient change in dietary fat intake, exercise, and weight. RESULTS: Generalized linear models were fit adjusting for patient clustering within physician. Physicians used at least one of the Five A's often (83%). Physicians routinely Ask and Advise patients to lose weight; however, they rarely Assess, Assist, or Arrange. Assist and Arrange were related to diet improvement, whereas Advise was associated with increases in motivation and confidence to change dietary fat intake and confidence to lose weight. CONCLUSIONS: Similar to smoking cessation counseling, physicians routinely Asked and Advised patients to lose weight; however, they rarely Assessed, Assisted, or Arranged. Given the potential impact of using all of these counseling tools on changing patient behavior, physicians should be encouraged to increase their use of the Five A's when counseling patients to lose weight.

Authors
Alexander, SC; Cox, ME; Boling Turer, CL; Lyna, P; Østbye, T; Tulsky, JA; Dolor, RJ; Pollak, KI
MLA Citation
Alexander, SC, Cox, ME, Boling Turer, CL, Lyna, P, Østbye, T, Tulsky, JA, Dolor, RJ, and Pollak, KI. "Do the five A's work when physicians counsel about weight loss?." Fam Med 43.3 (March 2011): 179-184.
PMID
21380950
Source
pubmed
Published In
Family medicine
Volume
43
Issue
3
Publish Date
2011
Start Page
179
End Page
184

Physician characteristics as predictors of blood pressure control in patients enrolled in the hypertension improvement project (HIP).

The authors sought to examine the relationship between physician characteristics and patient blood pressure (BP) in participants enrolled in the Hypertension Improvement Project (HIP). In this cross-sectional study using baseline data of HIP participants, the authors used multiple linear regression to examine how patient BP was related to physician characteristics, including experience, practice patterns, and clinic load. Patients had significantly lower systolic BP (SBP) (-0.2 mm Hg for every 1% increase, P=.008) and diastolic BP (DBP) (-0.1 mm Hg for every 1% increase, P=.0007) when seen by physicians with a higher percentage of patients with hypertension. Patients had significantly higher SBP (0.8 mm Hg for every 1% increase, P=.002) when seen by physicians with a higher number of total clinic visits per day. Patients had significantly lower DBP (-4.4 mm Hg decrease, P=.0002) when seen by physicians with inpatient duties. Physician's volume of patients with hypertension was related to better BP control. However, two indicators of a busy practice had conflicting relationships with BP control. Given the increasing time demands on physicians, future research should examine how physicians with a busy practice are able to successfully address BP in their patients.

Authors
Corsino, L; Yancy, WS; Samsa, GP; Dolor, RJ; Pollak, KI; Lin, P-H; Svetkey, LP
MLA Citation
Corsino, L, Yancy, WS, Samsa, GP, Dolor, RJ, Pollak, KI, Lin, P-H, and Svetkey, LP. "Physician characteristics as predictors of blood pressure control in patients enrolled in the hypertension improvement project (HIP)." J Clin Hypertens (Greenwich) 13.2 (February 2011): 106-111.
PMID
21272198
Source
pubmed
Published In
Journal of Clinical Hypertension
Volume
13
Issue
2
Publish Date
2011
Start Page
106
End Page
111
DOI
10.1111/j.1751-7176.2010.00385.x

Smoking prevalence in early pregnancy: comparison of self-report and anonymous urine cotinine testing.

OBJECTIVE: Societal pressures against smoking during pregnancy may lead to a reduction in disclosure of smoking status. The objective of this study was to compare prevalence of smoking at prenatal intake by self-report with anonymous biochemical validation. METHODS: Women receiving care at the Duke Obstetrics Clinic from February 2005 through January 2006 were eligible for evaluation. Self-reported smoking and urine samples were obtained anonymously at prenatal intake. The NicCheck™ I semi-quantitative dipstick was used to detect urinary nicotine, cotinine, and 3-hydroxycotinine. The difference, with 95% confidence interval, between the proportions of smokers by self-report and urine testing was calculated for (1) high-positive vs. low-positive and negative results combined and (2) any positive vs. negative results. RESULTS: Among 297 subjects, self-reported smoking was 18.2 vs. 14.8% for low-positive and negative results combined with an absolute difference of 3.4%, [-2.9%, 9.6%]. When comparing self-report with any positive result (43.1%), the absolute difference was 24.9%, [17.4%, 32.1%]. CONCLUSIONS: Our findings suggest that most pregnant women disclose their smoking and many nonsmokers may have significant second-hand exposure. Universal urinary cotinine screening of pregnant women could aid in appropriately counseling women about second-hand exposure as well as monitoring women at high risk for adverse pregnancy outcomes.

Authors
Swamy, GK; Reddick, KLB; Brouwer, RJN; Pollak, KI; Myers, ER
MLA Citation
Swamy, GK, Reddick, KLB, Brouwer, RJN, Pollak, KI, and Myers, ER. "Smoking prevalence in early pregnancy: comparison of self-report and anonymous urine cotinine testing." J Matern Fetal Neonatal Med 24.1 (January 2011): 86-90.
PMID
20384470
Source
pubmed
Published In
Journal of Maternal-Fetal and Neonatal Medicine (Informa)
Volume
24
Issue
1
Publish Date
2011
Start Page
86
End Page
90
DOI
10.3109/14767051003758887

How do non-physician clinicians respond to advanced cancer patients' negative expressions of emotions?

PURPOSE: Patients with advanced cancer often experience negative emotion; clinicians' empathic responses can alleviate patient distress. Much is known about how physicians respond to patient emotion; less is known about non-physician clinicians. Given that oncology care is increasingly provided by an interdisciplinary team, it is important to know more about how patients with advanced cancer express emotions to non-physician clinicians (NPCs) and how NPCs respond to those empathic opportunities. METHOD: We audio recorded conversations between non-physician clinicians and patients with advanced cancer. We analyzed 45 conversations between patients and oncology physician assistants, nurse practitioners, and nurse clinicians in which patients or their loved ones expressed at least one negative emotion to the NPC (i.e., an empathic opportunity). Empathic opportunities were coded three ways: type of emotion (anger, sadness, or fear), severity of emotion (least, moderate, or most severe), and NPC response to emotion (not empathic, on-topic medical response, and empathic response). RESULTS: We identified 103 empathic opportunities presented to 25 different NPCs during 45 visits. Approximately half of the empathic opportunities contained anger (53%), followed by sadness (25%) and fear (21%). The majority of emotions expressed were moderately severe (73%), followed by most severe (16%), and least severe (12%). The severity of emotions presented was not found to be statistically different between types of NPCs. NPCs responded to empathic opportunities with empathic statements 30% of the time. Additionally, 40% of the time, NPCs responded to empathic opportunities with on-topic, medical explanations and 30% of the responses were not empathic. CONCLUSION: Patients expressed emotional concerns to NPCs typically in the form of anger; most emotions were moderately severe, with no statistical differences among types of NPC. On average, NPCs responded to patient emotion with empathic language only 30% of the time. A better understanding of NPC-patient interactions can contribute to improved communication training for NPCs and, ultimately, to higher quality patient care in cancer.

Authors
Alexander, SC; Pollak, KI; Morgan, PA; Strand, J; Abernethy, AP; Jeffreys, AS; Arnold, RM; Olsen, M; Rodriguez, KL; Garrigues, SK; Manusov, JRE; Tulsky, JA
MLA Citation
Alexander, SC, Pollak, KI, Morgan, PA, Strand, J, Abernethy, AP, Jeffreys, AS, Arnold, RM, Olsen, M, Rodriguez, KL, Garrigues, SK, Manusov, JRE, and Tulsky, JA. "How do non-physician clinicians respond to advanced cancer patients' negative expressions of emotions?." Support Care Cancer 19.1 (January 2011): 155-159.
PMID
20820814
Source
pubmed
Published In
Supportive Care in Cancer
Volume
19
Issue
1
Publish Date
2011
Start Page
155
End Page
159
DOI
10.1007/s00520-010-0996-5

What are physicians' and patients' beliefs about diet, weight, exercise, and smoking cessation counseling?

Authors
Dolor, RJ; Østbye, T; Lyna, P; Coffman, CJ; Alexander, SC; Tulsky, JA; Brouwer, RJN; Esoimeme, I; Pollak, KI
MLA Citation
Dolor, RJ, Østbye, T, Lyna, P, Coffman, CJ, Alexander, SC, Tulsky, JA, Brouwer, RJN, Esoimeme, I, and Pollak, KI. "What are physicians' and patients' beliefs about diet, weight, exercise, and smoking cessation counseling?." Prev Med 51.5 (November 2010): 440-442. (Letter)
PMID
20692283
Source
pubmed
Published In
Preventive Medicine
Volume
51
Issue
5
Publish Date
2010
Start Page
440
End Page
442
DOI
10.1016/j.ypmed.2010.07.023

Do patient attributes predict oncologist empathic responses and patient perceptions of empathy?

PURPOSE: Most patients with advanced cancer experience negative emotion. When patients express emotions, oncologists rarely respond empathically. Oncologists may respond more empathically to some patients, and patients may perceive different levels of empathy and trust given past documentation of disparities in cancer care. METHODS: We audio-recorded 264 outpatient encounters between oncologists and patients with advanced cancer at three sites. We examined whether patient gender, age, race, marital status, education, economic security, and length of relationship with oncologist were related to oncologist empathic responses to patient's negative emotion and patient's perceptions of oncologist empathy and trust. RESULTS: Half (51%) of the patients expressed a negative emotion. Oncologists sometimes responded with empathy (29%). Oncologists were equally empathic with all patients, except they were more empathic with patients with low economic security compared with those reporting high economic security (p = .002). Patients with low economic security viewed oncologists as more empathic (p = .06) compared with those with moderate security. Married patients also viewed oncologists as more empathic (p = .04). Patients who knew their oncologist for more than a year had more trust than patients who knew their oncologists for less time (p = .02). CONCLUSIONS: Oncologists, in general, did not respond empathically to patient's negative emotion, and did this equally for most patients. Oncologists responded more empathically to patients who were less economically advantaged. In turn, patients with lower economic security perceived more empathy. Although oncologists need more education in responding empathically, they may not need to correct many biases in care.

Authors
Pollak, KI; Arnold, R; Alexander, SC; Jeffreys, AS; Olsen, MK; Abernethy, AP; Rodriguez, KL; Tulsky, JA
MLA Citation
Pollak, KI, Arnold, R, Alexander, SC, Jeffreys, AS, Olsen, MK, Abernethy, AP, Rodriguez, KL, and Tulsky, JA. "Do patient attributes predict oncologist empathic responses and patient perceptions of empathy?." Support Care Cancer 18.11 (November 2010): 1405-1411.
PMID
19838742
Source
pubmed
Published In
Supportive Care in Cancer
Volume
18
Issue
11
Publish Date
2010
Start Page
1405
End Page
1411
DOI
10.1007/s00520-009-0762-8

Physician communication techniques and weight loss in adults: Project CHAT.

BACKGROUND: Physicians are encouraged to counsel overweight and obese patients to lose weight. PURPOSE: It was examined whether discussing weight and use of motivational interviewing techniques (e.g., collaborating, reflective listening) while discussing weight predicted weight loss 3 months after the encounter. METHODS: Forty primary care physicians and 461 of their overweight or obese patient visits were audio recorded between December 2006 and June 2008. Patient actual weight at the encounter and 3 months after the encounter (n=426); whether weight was discussed; physicians' use of motivational interviewing techniques; and patient, physician, and visit covariates (e.g., race, age, specialty) were assessed. This was an observational study and data were analyzed in April 2009. RESULTS: No differences in weight loss were found between patients whose physicians discussed weight or did not. Patients whose physicians used motivational interviewing-consistent techniques during weight-related discussions lost weight 3 months post-encounter; those whose physician used motivational interviewing-inconsistent techniques gained or maintained weight. The estimated difference in weight change between patients whose physician had a higher global motivational interviewing-Spirit score (e.g., collaborated with patient) and those whose physician had a lower score was 1.6 kg (95% CI=-2.9, -0.3, p=0.02). The same was true for patients whose physician used reflective statements: 0.9 kg (95% CI=-1.8, -0.1, p=0.03). Similarly, patients whose physicians expressed only motivational interviewing-consistent behaviors had a difference in weight change of 1.1 kg (95% CI=-2.3, 0.1, p=0.07) compared to those whose physician expressed only motivational interviewing-inconsistent behaviors (e.g., judging, confronting). CONCLUSIONS: In this observational study, use of motivational interviewing techniques during weight loss discussions predicted patient weight loss.

Authors
Pollak, KI; Alexander, SC; Coffman, CJ; Tulsky, JA; Lyna, P; Dolor, RJ; James, IE; Brouwer, RJN; Manusov, JRE; Østbye, T
MLA Citation
Pollak, KI, Alexander, SC, Coffman, CJ, Tulsky, JA, Lyna, P, Dolor, RJ, James, IE, Brouwer, RJN, Manusov, JRE, and Østbye, T. "Physician communication techniques and weight loss in adults: Project CHAT." Am J Prev Med 39.4 (October 2010): 321-328.
PMID
20837282
Source
pubmed
Published In
American Journal of Preventive Medicine
Volume
39
Issue
4
Publish Date
2010
Start Page
321
End Page
328
DOI
10.1016/j.amepre.2010.06.005

How oncologists and their patients with advanced cancer communicate about health-related quality of life.

OBJECTIVE: To describe the content and frequency of communication about health-related quality of life (HRQOL) during outpatient encounters between oncologists and their patients with advanced cancer. METHODS: We coded for HRQOL talk in a subset of audio-recorded conversations (each previously found to contain prognostic talk by the oncologist) from the Study of Communication in Oncologist-Patient Encounters Trial, a randomized controlled trial conducted from 2003 to 2008 in two large US academic medical centers and one Veterans Affairs Medical Center. RESULTS: Seventy-three encounters involved 70 patients and 37 oncologists. Patients were more likely to be female (53%), White (86%), married (78%), and possessing some college education (62%). Most oncologists were male (78%) and White (78%). Mean ages were 59 years for patients and 44 years for oncologists. Every encounter included some talk about HRQOL and HRQOL discussions made up, on average, 25% of the visit time. HRQOL segments described symptoms (50%), general HRQOL (27%), and the following concerns: physical (27%), functional (22%), psychological (9%), social (7%), spiritual (1%), and other (28%). Topics included treatment (56%), disease (14%), and testing (3%), and conversations focused on past (44%), present (68%), and future HRQOL (59%). CONCLUSIONS: HRQOL discussions between oncologists and patients are common, but the emphasis is often on treatment (e.g. side effects) and symptoms (e.g. pain) even in patients with advanced disease. Given the often intense emotional experience of patients with advanced cancer, oncologists may need to pay more attention to psychological, social, and spiritual HRQOL concerns.

Authors
Rodriguez, KL; Bayliss, N; Alexander, SC; Jeffreys, AS; Olsen, MK; Pollak, KI; Kennifer, SL; Tulsky, JA; Arnold, RM
MLA Citation
Rodriguez, KL, Bayliss, N, Alexander, SC, Jeffreys, AS, Olsen, MK, Pollak, KI, Kennifer, SL, Tulsky, JA, and Arnold, RM. "How oncologists and their patients with advanced cancer communicate about health-related quality of life." Psychooncology 19.5 (May 2010): 490-499.
PMID
19449348
Source
pubmed
Published In
Psycho-Oncology
Volume
19
Issue
5
Publish Date
2010
Start Page
490
End Page
499
DOI
10.1002/pon.1579

CAN PHYSICIANS PREDICT WHICH PATIENTS WILL IMPROVE NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT?

Authors
Pollak, KI; Coffman, CJ; Alexander, SC; Tulsky, JA; Dolor, RJ; Lyna, P; Cox, ME; Esoimeme, I; Brouwer, RN; Osbye, T
MLA Citation
Pollak, KI, Coffman, CJ, Alexander, SC, Tulsky, JA, Dolor, RJ, Lyna, P, Cox, ME, Esoimeme, I, Brouwer, RN, and Osbye, T. "CAN PHYSICIANS PREDICT WHICH PATIENTS WILL IMPROVE NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT?." ANNALS OF BEHAVIORAL MEDICINE 39 (April 2010): 142-142.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
39
Publish Date
2010
Start Page
142
End Page
142

Can metaphors and analogies improve communication with seriously ill patients?

OBJECTIVE: It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. DESIGN: Cross-sectional observational study of audio-recorded conversations between patients and physicians. SETTING: Three outpatient oncology practices. PATIENTS: Ninety-four patients with advanced cancer and 52 physicians. INTERVENTION: None. MAIN OUTCOME MEASURES: Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. RESULTS: In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p < 0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p < 0.001). Physicians who used more metaphors elicited better patient ratings of communication (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p < 0.001). CONCLUSIONS: The use of metaphors and analogies may enhance physicians' ability to communicate.

Authors
Casarett, D; Pickard, A; Fishman, JM; Alexander, SC; Arnold, RM; Pollak, KI; Tulsky, JA
MLA Citation
Casarett, D, Pickard, A, Fishman, JM, Alexander, SC, Arnold, RM, Pollak, KI, and Tulsky, JA. "Can metaphors and analogies improve communication with seriously ill patients?." J Palliat Med 13.3 (March 2010): 255-260.
Website
http://hdl.handle.net/10161/3369
PMID
19922170
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
13
Issue
3
Publish Date
2010
Start Page
255
End Page
260
DOI
10.1089/jpm.2009.0221

Oncologist patient-centered communication with patients with advanced cancer: exploring whether race or socioeconomic status matter.

Authors
Pollak, KI; Alexander, SC; Grambow, SC; Tulsky, JA
MLA Citation
Pollak, KI, Alexander, SC, Grambow, SC, and Tulsky, JA. "Oncologist patient-centered communication with patients with advanced cancer: exploring whether race or socioeconomic status matter." Palliat Med 24.1 (January 2010): 96-98. (Letter)
PMID
19910397
Source
pubmed
Published In
Palliative Medicine
Volume
24
Issue
1
Publish Date
2010
Start Page
96
End Page
98
DOI
10.1177/0269216309348179

Comparing oncologist, nurse, and physician assistant attitudes toward discussions of negative emotions with patients.

PURPOSE: Although research shows that empathic communication improves patient outcomes, physicians often fail to respond empathically to patients. Nurses and physician assistants (PAs) may be able to help fill the need for empathic communication. Our study compares the attitudes of oncologists, nurses, and PAs toward communication with patients who demonstrate negative emotions. METHODS: We analyzed surveys from 48 oncologists, 26 PAs, and 22 nurses who participated in the Studying Communication in Oncologist-Patient Encounters trial. Surveys included previously validated items that examined attitudes toward communication with patients about emotion. RESULTS: The mean age of oncology physicians was higher (49 years) than that of PAs (40 years) or nurses (43 years), and 19% of physicians, 81% of PAs, and 100% of nurses were female. Race, years of oncology experience, and previous communication training were similar across provider types. Most nurses (82%) and PAs (68%) described themselves as having a socioemotional orientation, while most oncologists (70%) reported a technological/scientific orientation (p < .0001). PAs and nurses indicated more comfort with psychosocial talk than did oncologists (p < .0001). Discomfort with disclosing uncertainty and provider confidence and expectations when addressing patient concerns were similar across provider types. CONCLUSIONS: PAs and nurses were more oriented toward socioemotional aspects of medicine and were more comfortable with psychosocial talk than were oncologists. Future studies should examine whether these differences are attributable to other factors, including gender, and whether nurses and PAs are more likely than physicians to demonstrate empathic behaviors when patients express negative emotions.

Authors
Morgan, PA; de Oliveira, JS; Alexander, SC; Pollak, KI; Jeffreys, AS; Olsen, MK; Arnold, RM; Abernethy, AP; Rodriguez, KL; Tulsky, JA
MLA Citation
Morgan, PA, de Oliveira, JS, Alexander, SC, Pollak, KI, Jeffreys, AS, Olsen, MK, Arnold, RM, Abernethy, AP, Rodriguez, KL, and Tulsky, JA. "Comparing oncologist, nurse, and physician assistant attitudes toward discussions of negative emotions with patients." J Physician Assist Educ 21.3 (2010): 13-17.
PMID
21141405
Source
pubmed
Published In
The Journal of Physician Assistant Education
Volume
21
Issue
3
Publish Date
2010
Start Page
13
End Page
17

Is pregnancy a teachable moment for smoking cessation among US Latino expectant fathers? A pilot study.

OBJECTIVE: Pregnancy may be a time when US Latino expectant fathers consider quitting smoking. A 'teachable moment' is theorized to increase motivation to change a behavior through increased risk perceptions, emotional responses, and changes in self-image. DESIGN: We recruited 30 Spanish-speaking expectant fathers through their pregnant partners. We assessed expectant fathers' diet, exercise, and smoking and teachable moment constructs (risk perceptions, emotional responses, and self-image).We also tested correlations between teachable moment constructs and motivation to change behaviors. RESULTS: Latino expectant fathers had high-risk perceptions that their smoking harmed the pregnancy (M=4.4, SD=0.5 on five-point scale) and strong emotional responses about their smoking during pregnancy (M=3.9, SD=1.1). They also felt it was their role to make the pregnancy healthy (M=4.4, SD=0.8). They felt less strongly that their diet and exercise affected the pregnancy. The teachable moment constructs for smoking were strongly correlated with motivation to quit smoking; the same was not true for diet and exercise. CONCLUSIONS: Latino expectant fathers seem aware that their smoking could harm the pregnancy but seem less concerned about the effect of their diet and exercise on the pregnancy. Pregnancy may be a time to help Latino expectant fathers quit smoking.

Authors
Pollak, KI; Denman, S; Gordon, KC; Lyna, P; Rocha, P; Brouwer, RN; Fish, L; Baucom, DH
MLA Citation
Pollak, KI, Denman, S, Gordon, KC, Lyna, P, Rocha, P, Brouwer, RN, Fish, L, and Baucom, DH. "Is pregnancy a teachable moment for smoking cessation among US Latino expectant fathers? A pilot study." Ethn Health 15.1 (2010): 47-59.
PMID
20013439
Source
pubmed
Published In
Ethnicity & Health
Volume
15
Issue
1
Publish Date
2010
Start Page
47
End Page
59
DOI
10.1080/13557850903398293

Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients.

Despite widely publicized hypertension treatment guidelines for physicians and lifestyle recommendations for patients, blood pressure control rates remain low. In community-based primary care clinics, we performed a nested, 2 x 2 randomized, controlled trial of physician intervention versus control and/or patient intervention versus control. Physician intervention included internet-based training, self-monitoring, and quarterly feedback reports. Patient intervention included 20 weekly group sessions followed by 12 monthly telephone counseling contacts and focused on weight loss, Dietary Approaches to Stop Hypertension dietary pattern, exercise, and reduced sodium intake. The primary outcome was change in systolic blood pressure at 6 months. Eight primary care practices (32 physicians) were randomized to physician intervention or control groups. Within those practices, 574 patients were randomized to patient intervention or control groups. Patient mean age was 60 years, 61% were women, and 37% were black. Blood pressure data were available for 91% of patients at 6 months. The main effect of physician intervention on systolic blood pressure at 6 months, adjusted for baseline pressure, was 0.3 mm Hg (95% CI: 1.5 to 2.2; P=0.72). The main effect of the patient intervention was 2.6 mm Hg (95% CI: 4.4 to 0.7; P=0.01). The interaction of the 2 interventions was significant (P=0.03); the largest impact was observed with the combination of physician and patient intervention (9.7 +/- 12.7 mm Hg). Differences between treatment groups did not persist at 18 months. Combined physician and patient interventions lowers blood pressure; future research should focus on enhancing effectiveness and sustainability of these interventions.

Authors
Svetkey, LP; Pollak, KI; Yancy, WS; Dolor, RJ; Batch, BC; Samsa, G; Matchar, DB; Lin, P-H
MLA Citation
Svetkey, LP, Pollak, KI, Yancy, WS, Dolor, RJ, Batch, BC, Samsa, G, Matchar, DB, and Lin, P-H. "Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients." Hypertension 54.6 (December 2009): 1226-1233.
PMID
19920081
Source
pubmed
Published In
Hypertension
Volume
54
Issue
6
Publish Date
2009
Start Page
1226
End Page
1233
DOI
10.1161/HYPERTENSIONAHA.109.134874

Is pregnancy a teachable moment for smoking cessation among US Latino expectant fathers? A pilot study.

Objective. Pregnancy may be a time when US Latino expectant fathers consider quitting smoking. A 'teachable moment' is theorized to increase motivation to change a behavior through increased risk perceptions, emotional responses, and changes in self-image. Design. We recruited 30 Spanish-speaking expectant fathers through their pregnant partners. We assessed expectant fathers' diet, exercise, and smoking and teachable moment constructs (risk perceptions, emotional responses, and self-image). We also tested correlations between teachable moment constructs and motivation to change behaviors. Results. Latino expectant fathers had high-risk perceptions that their smoking harmed the pregnancy (M=4.4, SD=0.5 on five-point scale) and strong emotional responses about their smoking during pregnancy (M=3.9, SD=1.1). They also felt it was their role to make the pregnancy healthy (M=4.4, SD=0.8). They felt less strongly that their diet and exercise affected the pregnancy. The teachable moment constructs for smoking were strongly correlated with motivation to quit smoking; the same was not true for diet and exercise. Conclusions. Latino expectant fathers seem aware that their smoking could harm the pregnancy but seem less concerned about the effect of their diet and exercise on the pregnancy. Pregnancy may be a time to help Latino expectant fathers quit smoking.

Authors
Pollak, KI; Denman, S; Gordon, KC; Lyna, P; Rocha, P; Brouwer, RN; Fish, L; Baucom, DH
MLA Citation
Pollak, KI, Denman, S, Gordon, KC, Lyna, P, Rocha, P, Brouwer, RN, Fish, L, and Baucom, DH. "Is pregnancy a teachable moment for smoking cessation among US Latino expectant fathers? A pilot study." Ethnicity & health (December 2009): 1-13. (Academic Article)
Source
manual
Published In
Ethnicity & Health
Publish Date
2009
Start Page
1
End Page
13

Hypertension Improvement Project (HIP): Randomized Trial of Quality Improvement for Physicians and Lifestyle Modification for Patients

Authors
Svetkey, LP; Pollak, KI; Yancy, WS; Dolor, RJ; Batch, BC; Samsa, G; Matchar, DB; Lin, P-H
MLA Citation
Svetkey, LP, Pollak, KI, Yancy, WS, Dolor, RJ, Batch, BC, Samsa, G, Matchar, DB, and Lin, P-H. "Hypertension Improvement Project (HIP): Randomized Trial of Quality Improvement for Physicians and Lifestyle Modification for Patients." November 3, 2009.
Source
wos-lite
Published In
Circulation
Volume
120
Issue
18
Publish Date
2009
Start Page
S474
End Page
S474

Use of and reactions to a tailored CD-ROM designed to enhance oncologist-patient communication: the SCOPE trial intervention.

OBJECTIVE: Assess use of and reactions to an interactive, tailored CD-ROM to enhance oncologist-patient communication. METHODS: Participating oncologists (n=48) agreed to have patient interactions audio recorded, be randomly assigned to receive/not receive a CD-ROM, have CD-ROM usage monitored (intervention group) and complete a follow-up survey. RESULTS: Twenty-one of 24 in the intervention group reported using the CD-ROM. Median usage minutes were 63.8. At follow-up, oncologists rated the CD-ROM from 1 ("none" or "not at all helpful") to 5 ("a great deal" or "very helpful"). Mean responses were: 3.1 and 3.0 for 2 items assessing perceived impact on communications, 3.8-4.0 for 6 items assessing perceived helpfulness, 3.0 and 3.10 for 2 items assessing impact on affecting oncologists' communication with patients and assistance with challenging conversations, respectively, and 3.6 for whether using the CD-ROM was worth their time. Self-report of how much oncologists had used the covered skills before and after intervention showed a perceived increase (2.8 before and 3.2 after). CONCLUSIONS: Findings suggest the tailored interactive CD-ROM has promise for use and acceptance among oncologists. PRACTICE IMPLICATIONS: If ultimately found effective in changing oncologist's communication with patients, the CD-ROM's widespread dissemination should be explored.

Authors
Skinner, CS; Pollak, KI; Farrell, D; Olsen, MK; Jeffreys, AS; Tulsky, JA
MLA Citation
Skinner, CS, Pollak, KI, Farrell, D, Olsen, MK, Jeffreys, AS, and Tulsky, JA. "Use of and reactions to a tailored CD-ROM designed to enhance oncologist-patient communication: the SCOPE trial intervention." Patient Educ Couns 77.1 (October 2009): 90-96.
PMID
19321287
Source
pubmed
Published In
Patient Education and Counseling
Volume
77
Issue
1
Publish Date
2009
Start Page
90
End Page
96
DOI
10.1016/j.pec.2009.02.010

Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trial.

OBJECTIVE: The purpose of this study was to determine the contribution of randomization to nicotine replacement therapy (NRT), sociodemographic and psychosocial factors, and pregnancy and medical history to serious perinatal adverse events among pregnant smokers. STUDY DESIGN: We performed a retrospective review of all medical records for participants in the Baby Steps Trial. Data that were abstracted from 157 records were combined with baseline characteristics for logistic regression modeling of serious adverse events and adjusted for covariates. RESULTS: Serious adverse events occurred in 17% (9/52 pregnancies) and 31% (33/105 pregnancies) of participants in the control and NRT arms, respectively. Black race, adverse pregnancy history, and use of analgesic medication during pregnancy were significant predictors (P = .02, .04, and .01, respectively). Remaining covariates, which included randomization to NRT, were not statistically significant. CONCLUSION: Although race, poor pregnancy history, and use of analgesics were associated with serious adverse events, randomization to NRT during pregnancy was not a significant factor. Further research is needed to examine the safety of analgesic medications during pregnancy.

Authors
Swamy, GK; Roelands, JJ; Peterson, BL; Fish, LJ; Oncken, CA; Pletsch, PK; Myers, ER; Whitecar, PW; Pollak, KI
MLA Citation
Swamy, GK, Roelands, JJ, Peterson, BL, Fish, LJ, Oncken, CA, Pletsch, PK, Myers, ER, Whitecar, PW, and Pollak, KI. "Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trial." Am J Obstet Gynecol 201.4 (October 2009): 354.e1-354.e7.
PMID
19664750
Source
pubmed
Published In
American Journal of Obstetrics & Gynecology
Volume
201
Issue
4
Publish Date
2009
Start Page
354.e1
End Page
354.e7
DOI
10.1016/j.ajog.2009.06.006

Primary care physicians' discussions of weight-related topics with overweight and obese adolescents: results from the Teen CHAT Pilot study.

Physicians should counsel overweight adolescents about nutrition and exercise. We audio recorded 30 physician-adolescent encounters. Female, older, normal-weight physicians and pediatricians were more Motivational Interviewing (MI) adherent. When physicians used MI skills, patients increased exercise, lost weight, and reduced screen time. Physicians should use MI techniques to help adolescents change.

Authors
Pollak, KI; Alexander, SC; Østbye, T; Lyna, P; Tulsky, JA; Dolor, RJ; Coffman, C; Namenek Brouwer, RJ; Esoimeme, I; Manusov, JRE; Bravender, T
MLA Citation
Pollak, KI, Alexander, SC, Østbye, T, Lyna, P, Tulsky, JA, Dolor, RJ, Coffman, C, Namenek Brouwer, RJ, Esoimeme, I, Manusov, JRE, and Bravender, T. "Primary care physicians' discussions of weight-related topics with overweight and obese adolescents: results from the Teen CHAT Pilot study." J Adolesc Health 45.2 (August 2009): 205-207.
PMID
19628149
Source
pubmed
Published In
Journal of Adolescent Health
Volume
45
Issue
2
Publish Date
2009
Start Page
205
End Page
207
DOI
10.1016/j.jadohealth.2009.01.002

Negative emotions in cancer care: do oncologists' responses depend on severity and type of emotion?

OBJECTIVE: To examine how type and severity of patients' negative emotions influence oncologists' responses and subsequent conversations. METHODS: We analyzed 264 audio-recorded conversations between advanced cancer patients and their oncologists. Conversations were coded for patients' expressions of negative emotion, which were categorized by type of emotion and severity. Oncologists' responses were coded as using either empathic language or blocking and distancing approaches. RESULTS: Patients presented fear more often than anger or sadness; severity of disclosures was most often moderate. Oncologists responded to 35% of these negative emotional disclosures with empathic language. They were most empathic when patients presented intense emotions. Responding empathically to patients' emotional disclosures lengthened discussions by an average of only 21s. CONCLUSION: Greater response rates to severe emotions suggest oncologists may recognize negative emotions better when patients express them more intensely. Oncologists were least responsive to patient fear and responded with greatest empathy to sadness. PRACTICE IMPLICATIONS: Oncologists may benefit from additional training to recognize negative emotions, even when displayed without intensity. Teaching cancer patients to better articulate their emotional concerns may also enhance patient-oncologist communication.

Authors
Kennifer, SL; Alexander, SC; Pollak, KI; Jeffreys, AS; Olsen, MK; Rodriguez, KL; Arnold, RM; Tulsky, JA
MLA Citation
Kennifer, SL, Alexander, SC, Pollak, KI, Jeffreys, AS, Olsen, MK, Rodriguez, KL, Arnold, RM, and Tulsky, JA. "Negative emotions in cancer care: do oncologists' responses depend on severity and type of emotion?." Patient Educ Couns 76.1 (July 2009): 51-56.
PMID
19041211
Source
pubmed
Published In
Patient Education and Counseling
Volume
76
Issue
1
Publish Date
2009
Start Page
51
End Page
56
DOI
10.1016/j.pec.2008.10.003

Adherence to nicotine replacement therapy among pregnant smokers.

INTRODUCTION: This secondary analysis examined the association between adherence to nicotine replacement therapy (NRT) and smoking cessation among pregnant smokers enrolled in Baby Steps, an open-label randomized controlled trial testing cognitive-behavioral therapy (CBT) versus CBT plus NRT. METHOD: The analysis included only women who received NRT for whom we had complete data (N = 104). Data came from daily calendars created from recordings of counseling sessions and from telephone surveys at baseline and 38 weeks gestation. RESULTS: Overall, 29% of the 104 women used NRT for the recommended 6 weeks and 41% used NRT as directed in the first 48 hr after a quit attempt. Ordinal logistic regression modeling indicated that using NRT as directed in the first 48 hr and having made a previous quit attempt were the strongest predictors of longer NRT use. Univariate analyses suggested that primigravid women and women who used NRT longer were more likely to report quitting at 38 weeks gestation. DISCUSSION: Findings indicated that adherence to NRT is low among pregnant smokers, but adherence was a predictor of cessation. Future trials should emphasize adherence, particularly more days on NRT, to promote cessation during pregnancy.

Authors
Fish, LJ; Peterson, BL; Namenek Brouwer, RJ; Lyna, P; Oncken, CA; Swamy, GK; Myers, ER; Pletsch, PK; Pollak, KI
MLA Citation
Fish, LJ, Peterson, BL, Namenek Brouwer, RJ, Lyna, P, Oncken, CA, Swamy, GK, Myers, ER, Pletsch, PK, and Pollak, KI. "Adherence to nicotine replacement therapy among pregnant smokers." Nicotine Tob Res 11.5 (May 2009): 514-518.
PMID
19351783
Source
pubmed
Published In
Nicotine and Tobacco Research (OUP)
Volume
11
Issue
5
Publish Date
2009
Start Page
514
End Page
518
DOI
10.1093/ntr/ntp032

Family physicians as team leaders: "time" to share the care.

A major contributor to shortfalls in delivery of recommended health care services is lack of physician time. On the basis of recommendations from national clinical care guidelines for preventive services and chronic disease management, and including the time needed for acute concerns, sufficiently addressing the needs of a standard patient panel of 2,500 would require 21.7 hours per day. The problem of insufficient time indicates that primary care requires broad, fundamental changes. The creation of primary care teams that include members such as physician assistants, nurse practitioners, dietitians, health educators, and lay coaches is important to meeting patients' primary care needs.

Authors
Yarnall, KSH; Østbye, T; Krause, KM; Pollak, KI; Gradison, M; Michener, JL
MLA Citation
Yarnall, KSH, Østbye, T, Krause, KM, Pollak, KI, Gradison, M, and Michener, JL. "Family physicians as team leaders: "time" to share the care." Prev Chronic Dis 6.2 (April 2009): A59-.
PMID
19289002
Source
pubmed
Published In
Preventing Chronic Diseases: Public health research, practice, and policy
Volume
6
Issue
2
Publish Date
2009
Start Page
A59

Hypertension Improvement Project (HIP): study protocol and implementation challenges.

BACKGROUND: Hypertension affects 29% of the adult U.S. population and is a leading cause of heart disease, stroke, and kidney failure. Despite numerous effective treatments, only 53% of people with hypertension are at goal blood pressure. The chronic care model suggests that blood pressure control can be achieved by improving how patients and physicians address patient self-care. METHODS AND DESIGN: This paper describes the protocol of a nested 2 x 2 randomized controlled trial to test the separate and combined effects on systolic blood pressure of a behavioral intervention for patients and a quality improvement-type intervention for physicians. Primary care practices were randomly assigned to the physician intervention or to the physician control condition. Physician randomization occurred at the clinic level. The physician intervention included training and performance monitoring. The training comprised 2 internet-based modules detailing both the JNC-7 hypertension guidelines and lifestyle modifications for hypertension. Performance data were collected for 18 months, and feedback was provided to physicians every 3 months. Patient participants in both intervention and control clinics were individually randomized to the patient intervention or to usual care. The patient intervention consisted of a 6-month behavioral intervention conducted by trained interventionists in 20 group sessions, followed by 12 monthly phone contacts by community health advisors. Follow-up measurements were performed at 6 and 18 months. The primary outcome was the mean change in systolic blood pressure at 6 months. Secondary outcomes were diastolic blood pressure and the proportion of patients with adequate blood pressure control at 6 and 18 months. DISCUSSION: Overall, 8 practices (4 per treatment group), 32 physicians (4 per practice; 16 per treatment group), and 574 patients (289 control and 285 intervention) were enrolled. Baseline characteristics of patients and providers and the challenges faced during study implementation are presented. The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model. The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately, so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local resources. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00201136.

Authors
Dolor, RJ; Yancy, WS; Owen, WF; Matchar, DB; Samsa, GP; Pollak, KI; Lin, P-H; Ard, JD; Prempeh, M; McGuire, HL; Batch, BC; Fan, W; Svetkey, LP
MLA Citation
Dolor, RJ, Yancy, WS, Owen, WF, Matchar, DB, Samsa, GP, Pollak, KI, Lin, P-H, Ard, JD, Prempeh, M, McGuire, HL, Batch, BC, Fan, W, and Svetkey, LP. "Hypertension Improvement Project (HIP): study protocol and implementation challenges. (Published online)" Trials 10 (February 26, 2009): 13-.
PMID
19245692
Source
pubmed
Published In
Trials
Volume
10
Publish Date
2009
Start Page
13
DOI
10.1186/1745-6215-10-13

Estimated time spent on preventive services by primary care physicians.

BACKGROUND: Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. METHODS: We analyzed a large dataset of primary care (family and internal medicine) visits using the National Ambulatory Medical Care Survey (2001-4); analyses were conducted 2007-8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. RESULTS: Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively). New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA), cholesterol, Papanicolaou (Pap) smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence") services, tobacco cessation and Pap smear (in preventive visits), and one "B" rated ("at least fair evidence") service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness"), PSA and exercise counseling. CONCLUSION: Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

Authors
Pollak, KI; Krause, KM; Yarnall, KSH; Gradison, M; Michener, JL; Østbye, T
MLA Citation
Pollak, KI, Krause, KM, Yarnall, KSH, Gradison, M, Michener, JL, and Østbye, T. "Estimated time spent on preventive services by primary care physicians. (Published online)" BMC Health Serv Res 8 (December 1, 2008): 245-.
PMID
19046443
Source
pubmed
Published In
BMC Health Services Research
Volume
8
Publish Date
2008
Start Page
245
DOI
10.1186/1472-6963-8-245

Patient-oncologist communication in advanced cancer: predictors of patient perception of prognosis.

GOALS OF WORK: Advanced cancer patients' perceptions of prognosis, which are often overly optimistic compared to oncologist estimates, influence treatment preferences. The predictors of patients' perceptions and the effect of oncologist communication on patient understanding are unclear. This study was designed to identify the communication factors that influence patient-oncologist concordance about chance of cure. MATERIALS AND METHODS: We analyzed audiorecorded encounters between 51 oncologists and 141 advanced cancer patients with good (n = 69) or poor (n = 72) concordance about chance of cure. Encounters were coded for communication factors that might influence oncologist-patient concordance, including oncologist statements of optimism and pessimism. MAIN RESULTS: Oncologists made more statements of optimism (mean = 3.3 per encounter) than statements of pessimism (mean = 1.2 per encounter). When oncologists made at least one statement of pessimism, patients were more likely to agree with their oncologist's estimated chance of cure (OR = 2.59, 95%CI = 1.31-5.12). Statements of optimism and uncertainty were not associated with an increased likelihood that patients would agree or disagree with their oncologists about chance of cure. CONCLUSIONS: Communication of pessimistic information to patients with advanced cancer increases the likelihood that patients will report concordant prognostic estimates. Communication of optimistic information does not have any direct effect. The best communication strategy to maximize patient knowledge for informed decision making while remaining sensitive to patients' emotional needs may be to emphasize optimistic aspects of prognosis while also consciously and clearly communicating pessimistic aspects of prognosis.

Authors
Robinson, TM; Alexander, SC; Hays, M; Jeffreys, AS; Olsen, MK; Rodriguez, KL; Pollak, KI; Abernethy, AP; Arnold, R; Tulsky, JA
MLA Citation
Robinson, TM, Alexander, SC, Hays, M, Jeffreys, AS, Olsen, MK, Rodriguez, KL, Pollak, KI, Abernethy, AP, Arnold, R, and Tulsky, JA. "Patient-oncologist communication in advanced cancer: predictors of patient perception of prognosis." Support Care Cancer 16.9 (September 2008): 1049-1057.
PMID
18196288
Source
pubmed
Published In
Supportive Care in Cancer
Volume
16
Issue
9
Publish Date
2008
Start Page
1049
End Page
1057
DOI
10.1007/s00520-007-0372-2

"What concerns me is..." Expression of emotion by advanced cancer patients during outpatient visits.

OBJECTIVE: Cancer patients have high levels of distress, yet oncologists often do not recognize patients' concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists. MATERIALS AND METHODS: As part of the Studying Communication in Oncologist-Patient Encounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content. RESULTS: Patients verbally expressed negative emotion in 17% of the visits. The most commonly used words were: "concern," "scared," "worried," "depressed," and "nervous." Types of emotion expressed were: anxiety (46%), fear (25%), depression (12%), anger (9%), and other (8%). Topics about which emotion was expressed were: symptoms and functional concerns (66%), medical diagnoses and treatments (54%), social issues (14%), and the health care system (9%). Although all patients had terminal cancer, they expressed negative emotion overtly related to death and dying only 2% of the time. CONCLUSIONS: Patients infrequently expressed negative emotion to their oncologists. When they did, they typically expressed anxiety and fear, indicating concern about the future. When patients use emotionally expressive words such as those we described, oncologists should respond empathically, allowing patients to express their distress and concerns more fully.

Authors
Anderson, WG; Alexander, SC; Rodriguez, KL; Jeffreys, AS; Olsen, MK; Pollak, KI; Tulsky, JA; Arnold, RM
MLA Citation
Anderson, WG, Alexander, SC, Rodriguez, KL, Jeffreys, AS, Olsen, MK, Pollak, KI, Tulsky, JA, and Arnold, RM. ""What concerns me is.." Expression of emotion by advanced cancer patients during outpatient visits." Support Care Cancer 16.7 (July 2008): 803-811.
PMID
17960430
Source
pubmed
Published In
Supportive Care in Cancer
Volume
16
Issue
7
Publish Date
2008
Start Page
803
End Page
811
DOI
10.1007/s00520-007-0350-8

Understanding the role of cancer worry in creating a "teachable moment" for multiple risk factor reduction.

The manuscript examines the influence of contextual factors on whether and for whom a colon polyp diagnosis might be a teachable moment, as indicated by engagement with a proactively delivered intervention. Baseline and 8-month follow-up data were analyzed from a two-site behavioral intervention trial with patients in Massachusetts and North Carolina, USA who had recently undergone polypectomy for pre-cancerous colon polyps and were randomized to a behavior change intervention condition (N=591). Intervention "buy-in" was used as an indicator of response consistent with the polyp identification serving as a teachable moment. Cancer worry, personal risk, health-related self-identity and other sociodemographic factors were tested to predict intervention buy-in. As predicted, those who were most worried about colon cancer were most likely to engage in the intervention. One indicator of personal risk, number of risk behaviors, was significantly and negatively associated with buy-in. Predictors of intervention buy-in and cancer worry were not consistent. We recommend that expanded measures of affect and health-related self-identity should be considered in future research to understand the motivational potential of health events for increasing engagement in effective behavior change interventions.

Authors
McBride, CM; Puleo, E; Pollak, KI; Clipp, EC; Woolford, S; Emmons, KM
MLA Citation
McBride, CM, Puleo, E, Pollak, KI, Clipp, EC, Woolford, S, and Emmons, KM. "Understanding the role of cancer worry in creating a "teachable moment" for multiple risk factor reduction." Soc Sci Med 66.3 (February 2008): 790-800.
PMID
18037204
Source
pubmed
Published In
Social Science & Medicine
Volume
66
Issue
3
Publish Date
2008
Start Page
790
End Page
800
DOI
10.1016/j.socscimed.2007.10.014

Olfactory and gustatory sensory changes to tobacco smoke in pregnant smokers.

Models of smoking behavior change include addiction, social, and behavioral concepts. The purpose of this study was to explore the prevalence of two biologic factors, olfactory and gustatory responses to tobacco smoke, as potentially powerful contributors to smoking behavior change among pregnant women. Data were obtained from 209 pregnant smokers. The majority of women reported olfactory (62%) and gustatory (53%) aversions to tobacco. Aversions first appeared during the first trimester of pregnancy. Women who experienced olfactory aversions were more likely also to experience gustatory aversions. Olfactory aversions were associated with women smoking less. Aversions to tobacco smoke are common among pregnant smokers, are associated with women smoking less, and could help explain pregnant women's smoking patterns.

Authors
Pletsch, PK; Pollak, KI; Peterson, BL; Park, J; Oncken, CA; Swamy, GK; Lyna, P
MLA Citation
Pletsch, PK, Pollak, KI, Peterson, BL, Park, J, Oncken, CA, Swamy, GK, and Lyna, P. "Olfactory and gustatory sensory changes to tobacco smoke in pregnant smokers." Res Nurs Health 31.1 (February 2008): 31-41.
PMID
18161772
Source
pubmed
Published In
Research in Nursing & Health
Volume
31
Issue
1
Publish Date
2008
Start Page
31
End Page
41
DOI
10.1002/nur.20229

Primary care physicians' discussions of weight-related topics with overweight adolescents: Results from the teen chat pilot study

Authors
Pollak, KI; Bravender, T; Alexander, SC; Ostbye, T; Lyna, P; Dolor, R; Coffman, C; Brouwer, RJN; Esoimeme, I; Manusov, JRE; Tulsky, JA
MLA Citation
Pollak, KI, Bravender, T, Alexander, SC, Ostbye, T, Lyna, P, Dolor, R, Coffman, C, Brouwer, RJN, Esoimeme, I, Manusov, JRE, and Tulsky, JA. "Primary care physicians' discussions of weight-related topics with overweight adolescents: Results from the teen chat pilot study." JOURNAL OF ADOLESCENT HEALTH 42.2 (February 2008): S37-S38.
Source
wos-lite
Published In
Journal of Adolescent Health
Volume
42
Issue
2
Publish Date
2008
Start Page
S37
End Page
S38

Evaluating a stage model in predicting monolingual spanish-speaking latinas' cervical cancer screening practices: The role of psychosocial and cultural predictors

The goals of this study are to evaluate (a) the effectiveness of a stage model in predicting Latinas' self-report of obtaining a Pap test and (b) the unique role of psychosocial/cultural factors in predicting progress toward behavior change. One-on-one structured interviews with monolingual Spanish-speaking Latinas (n = 190) were conducted. Most participants (85%) intended to obtain a Pap smear within 1 year; therefore, staging women based on intention was not possible. Moreover, results from the polychotomous hierarchical logistic regression suggest that psychosocial and cultural factors were independent predictors of Pap test history. A stage model may not be appropriate for predicting Pap test screening among Latinas. Results suggest that unique cultural, psychosocial, and demographic factors may inhibit cervical cancer screening practices. Clinicians may need to tailor messages on these cultural and psychosocial factors to increase Pap testing among Latinas. © 2008 by SOPHE.

Authors
Arredondo, EM; Pollak, K; Costanzo, PR
MLA Citation
Arredondo, EM, Pollak, K, and Costanzo, PR. "Evaluating a stage model in predicting monolingual spanish-speaking latinas' cervical cancer screening practices: The role of psychosocial and cultural predictors." Health Education and Behavior 35.6 (2008): 791-805.
PMID
17652618
Source
scival
Published In
Health Education & Behavior
Volume
35
Issue
6
Publish Date
2008
Start Page
791
End Page
805
DOI
10.1177/1090198107303250

Oncologist communication about emotion during visits with patients with advanced cancer.

INTRODUCTION: Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses. PATIENTS AND METHODS: We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care. RESULTS: In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female oncologists had the most empathic opportunities (P = .03). Younger oncologists (P = .02) and those who rated their orientation as more socioemotional than technical (P = .03) were more likely to respond with empathic statements. CONCLUSION: Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, oncologists may need training to encourage patients to express emotions and to respond empathically to patients' emotions.

Authors
Pollak, KI; Arnold, RM; Jeffreys, AS; Alexander, SC; Olsen, MK; Abernethy, AP; Sugg Skinner, C; Rodriguez, KL; Tulsky, JA
MLA Citation
Pollak, KI, Arnold, RM, Jeffreys, AS, Alexander, SC, Olsen, MK, Abernethy, AP, Sugg Skinner, C, Rodriguez, KL, and Tulsky, JA. "Oncologist communication about emotion during visits with patients with advanced cancer." J Clin Oncol 25.36 (December 20, 2007): 5748-5752.
PMID
18089870
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
25
Issue
36
Publish Date
2007
Start Page
5748
End Page
5752
DOI
10.1200/JCO.2007.12.4180

Empathy goes a long way in weight loss discussions.

PURPOSE: This study explores how weight-related topics are discussed between physicians and their overweight and obese female patients. METHODS: We surveyed and audio-recorded preventive health and chronic care visits with 25 overweight and obese female patients. We coded both for quantity (content and time) of weight-related discussions and quality (adherence to Motivational Interviewing [MI] techniques). We then tested correlations of these measures with patients' reported attempts to lose weight, change diet, and change exercise patterns 1 month after the visit. RESULTS: Weight was routinely addressed (19 of 25 encounters). Patients usually initiated the topic (67% of time). Physicians' use of MI techniques resulted in patients attempting to lose weight and changing their exercise patterns. CONCLUSION: Physicians may benefit from MI training to help patients lose weight.

Authors
Pollak, KI; Østbye, T; Alexander, SC; Gradison, M; Bastian, LA; Brouwer, RJN; Lyna, P
MLA Citation
Pollak, KI, Østbye, T, Alexander, SC, Gradison, M, Bastian, LA, Brouwer, RJN, and Lyna, P. "Empathy goes a long way in weight loss discussions." J Fam Pract 56.12 (December 2007): 1031-1036.
PMID
18053443
Source
pubmed
Published In
Journal of Family Practice
Volume
56
Issue
12
Publish Date
2007
Start Page
1031
End Page
1036

Nicotine replacement and behavioral therapy for smoking cessation in pregnancy.

BACKGROUND: This study examines whether adding nicotine replacement therapy (NRT) to cognitive-behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation. METHODS: An open-label randomized trial (Baby Steps, n=181) of CBT-only versus CBT+NRT (choice of patch, gum, or lozenge; 1:2 randomization) was used. Data were collected from 2003 through 2005; analyses were conducted in 2006 and 2007. Outcomes were biochemically validated self-reported smoking status at 7 weeks post-randomization, 38 weeks gestation, and 3 months postpartum. RESULTS: Women in the CBT+NRT arm were almost three times more likely than women in the CBT-only arm to have biochemically validated cessation at both pregnancy time points (after 7 weeks: 24% vs 8%, p=0.02; at 38 weeks gestation: 18% vs 7%, p=0.04), but not at 3 months postpartum (20% vs 14%, p=0.55). Recruitment was suspended early by an Independent Data and Safety Monitoring Board when an interim analysis found a higher rate of negative birth outcomes in the CBT+NRT arm than in the CBT-only arm. In the final analysis, the difference between the arms in rate of negative birth outcomes was 0.09 (p=0.26), when adjusted for previous history of preterm birth. CONCLUSIONS: The addition of NRT to CBT promoted smoking cessation in pregnant women. This effect did not persist postpartum. More data are needed to determine safety parameters and to confirm the efficacy of NRT use during pregnancy.

Authors
Pollak, KI; Oncken, CA; Lipkus, IM; Lyna, P; Swamy, GK; Pletsch, PK; Peterson, BL; Heine, RP; Brouwer, RJN; Fish, L; Myers, ER
MLA Citation
Pollak, KI, Oncken, CA, Lipkus, IM, Lyna, P, Swamy, GK, Pletsch, PK, Peterson, BL, Heine, RP, Brouwer, RJN, Fish, L, and Myers, ER. "Nicotine replacement and behavioral therapy for smoking cessation in pregnancy." Am J Prev Med 33.4 (October 2007): 297-305.
PMID
17888856
Source
pubmed
Published In
American Journal of Preventive Medicine
Volume
33
Issue
4
Publish Date
2007
Start Page
297
End Page
305
DOI
10.1016/j.amepre.2007.05.006

Physicians' beliefs about discussing obesity: results from focus groups.

PURPOSE: Physicians are expected to discuss weight loss with overweight and obese patients. Physicians' beliefs, outcome expectancies, and strategies for addressing weight with patients have not been examined. DESIGN: Two focus groups of family physicians and internists included questions about obesity and how physicians discuss weight loss with patients. SETTING/SUBJECTS: Family physicians (n = 11) and internists (n = 6) from Duke University Medical Center's Department of Community and Family Medicine and Department of Medicine. ANALYSIS: Qualitative analysis approach using grounded theory methodology. RESULTS: Physicians' responses centered on five key themes: (1) responsibility, (2) barriers, (3) target populations, (4) introducing topic, and (5) ways to talk about obesity. CONCLUSION: Physicians have many barriers related to discussing weight loss with patients. Given the obesity epidemic, the need to understand how to have these discussions, when to have these discussions, and with whom to have these discussions becomes paramount to providing effective care for patients with obesity. Limited physician training in weight-loss counseling explains why physicians find it challenging to discuss obesity with patients.

Authors
Alexander, SC; Ostbye, T; Pollak, KI; Gradison, M; Bastian, LA; Brouwer, RJN
MLA Citation
Alexander, SC, Ostbye, T, Pollak, KI, Gradison, M, Bastian, LA, and Brouwer, RJN. "Physicians' beliefs about discussing obesity: results from focus groups." Am J Health Promot 21.6 (July 2007): 498-500.
PMID
17674636
Source
pubmed
Published In
American journal of health promotion : AJHP
Volume
21
Issue
6
Publish Date
2007
Start Page
498
End Page
500

Studying communication in oncologist-patient encounters: the SCOPE Trial.

STUDY OBJECTIVE: Most oncologists have not received adequate training in physician-patient communication, and existing effective courses tend to be time and resource intensive. We are developing and testing a tailored CD-ROM educational intervention that includes feedback on oncologists' own audio-recorded conversations with their advanced cancer patients. In this report, we describe the study methods and identify challenges to implementation and how these were overcome. STUDY DESIGN: A three-phase, randomized, controlled trial. In Phase 1, we audio-recorded oncologist-patient clinic encounters. In Phase 2, oncologists were randomly assigned to a communication CD-ROM intervention or control. Phase 3 consisted of audio-recording all participating oncologists conversing with a new sample of patients, two to 12 months after the intervention, to assess its effectiveness. SETTING: Oncology clinics at Duke University Medical Center (DUMC) and the Durham Veterans Affairs Medical Center (DVAMC) in Durham, NC, and the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, PA. PARTICIPANTS: Medical, radiation and gynecological oncologists and their patients with advanced cancer. INTERVENTION: A tailored CD-ROM that contains an interactive educational interface with reference materials and video-clips of model conversations, along with the oncologists' own Phase 1 audio-recorded conversations. CONCLUSION: We present challenges and solutions to oncologist recruitment, identifying appropriate patients with advanced cancer, adapting to clinic flow, and developing a self-administered communications intervention.

Authors
Koropchak, CM; Pollak, KI; Arnold, RM; Alexander, SC; Skinner, CS; Olsen, MK; Jeffreys, AS; Rodriguez, KL; Abernethy, AP; Tulsky, JA
MLA Citation
Koropchak, CM, Pollak, KI, Arnold, RM, Alexander, SC, Skinner, CS, Olsen, MK, Jeffreys, AS, Rodriguez, KL, Abernethy, AP, and Tulsky, JA. "Studying communication in oncologist-patient encounters: the SCOPE Trial." Palliat Med 20.8 (December 2006): 813-819.
PMID
17148536
Source
pubmed
Published In
Palliative Medicine
Volume
20
Issue
8
Publish Date
2006
Start Page
813
End Page
819
DOI
10.1177/0269216306070657

Rated helpfulness and partner-reported smoking cessation support across the pregnancy-postpartum continuum.

Support interventions have not changed smoking cessation rates significantly. The pregnancy-postpartum continuum presents a unique opportunity to examine patterns of support. Expectant couples (N = 477) were surveyed twice during pregnancy and 3 times postpartum. Partners reported positive and negative smoking-specific support; women reported the helpfulness of partner support. Linear trends suggest that women viewed support as more helpful during pregnancy than during postpartum. Partners' provision of positive support across the continuum depended on their smoking; provision of negative support depended on women's smoking. Partners who smoked provided lower levels of both positive and negative support, especially postpartum. Women who smoked throughout the pregnancy perceived their partner's negative support as helpful. Implications are that partners who smoke may need help staying engaged in the support process. Partners may provide negative support in response to women's smoking cues. Women who are struggling with cessation may not view negative support as negative.

Authors
Pollak, KI; Baucom, DH; Peterson, BL; Stanton, S; McBride, CM
MLA Citation
Pollak, KI, Baucom, DH, Peterson, BL, Stanton, S, and McBride, CM. "Rated helpfulness and partner-reported smoking cessation support across the pregnancy-postpartum continuum." Health Psychol 25.6 (November 2006): 762-770.
PMID
17100504
Source
pubmed
Published In
Health Psychology
Volume
25
Issue
6
Publish Date
2006
Start Page
762
End Page
770
DOI
10.1037/0278-6133.25.6.762

Couples' reports of support for smoking cessation predicting women's late pregnancy cessation.

PURPOSE: Although social support has been linked to smoking cessation, no studies have examined whether social support predicts women's late pregnancy cessation. Further, few have included reports from both support recipients and providers. DESIGN: Longitudinal. SUBJECTS: Pregnant couples (n = 394) reported support for cessation in early (13-20 weeks) and late (28 weeks) pregnancy. MEASURES: Different measures of couples' support were tested for predicting women's late pregnancy, cessation. Measures of couples' support that were calculated included: summative (added women's and male partners' support scores, possible range 2-10), difference (subtracted the lower score from the higher, possible range 0-4), strong link (used higher positive or lower negative score, possible range 1-5), weak link (lower positive or higher negative score, possible range 1-5), and female and male reports alone (possible ranges 1-5). Covariate-adjusted odds ratios for the association of these various measures of couples' support with women's late pregnancy cessation were calculated. RESULTS: Of the 12 scores (6 positive, 6 negative), only summative (p = .03) and weak link (p = .05) for positive support predicted women's quitting. CONCLUSION: Neither women's nor male partners' reports alone predicted women's cessation; only when both scores were considered, either by adding the scores or by taking the lower score, was the positive support score predictive. Future studies of social support should include support recipients' and providers' perspectives.

Authors
Pollak, KI; Baucom, DH; Palmer, CA; Peterson, BL; Ostbye, T; Stanton, S
MLA Citation
Pollak, KI, Baucom, DH, Palmer, CA, Peterson, BL, Ostbye, T, and Stanton, S. "Couples' reports of support for smoking cessation predicting women's late pregnancy cessation." Am J Health Promot 21.2 (November 2006): 90-96.
PMID
17152247
Source
pubmed
Published In
American journal of health promotion : AJHP
Volume
21
Issue
2
Publish Date
2006
Start Page
90
End Page
96

Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication.

BACKGROUND: Electronic mail (email) has the potential to improve communication between physicians and patients. METHODS: We conducted two research studies in a family practice setting: 1) a brief, anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email, and 2) a randomized, controlled pilot study to assess the feasibility of providing health education via email to family practice patients. RESULTS: Sixty-eight percent of patients used email, and the majority of those (80%) were interested in using email to communicate with the clinic. The majority also reported that their email address changed less frequently than their home address (65%, n = 173) or telephone number (68%, n = 181). Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians. When evaluating email initiated by the clinic, 26% of otherwise eligible patients could not participate because they lacked email access; those people were more likely to be black and to be insured through Medicaid. Twenty-four subjects agreed to participate, but one-third failed to return the required consent form by mail. All participants who received the intervention emails said they would like to receive health education emails in the future. CONCLUSION: Our survey results show that patients are interested in email communication with the family practice clinic. Our feasibility study also illustrates important challenges in physician-initiated electronic communication. The 'digital divide' - decreased access to electronic technologies in lower income groups - is an ethical concern in the use of email for patient-physician communication.

Authors
Virji, A; Yarnall, KSH; Krause, KM; Pollak, KI; Scannell, MA; Gradison, M; Østbye, T
MLA Citation
Virji, A, Yarnall, KSH, Krause, KM, Pollak, KI, Scannell, MA, Gradison, M, and Østbye, T. "Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication. (Published online)" BMC Med 4 (August 15, 2006): 18-.
PMID
16911780
Source
pubmed
Published In
BMC Medicine
Volume
4
Publish Date
2006
Start Page
18
DOI
10.1186/1741-7015-4-18

The impact of health status on physicians' intentions to offer cancer screening to older women.

BACKGROUND: Screening for breast and cervical cancer reduces disease-specific mortality, but high rates of comorbidity and disability among elderly persons may alter the risks and benefits of screening. METHODS: We performed a mail survey of primary care physicians to estimate the impact of health status on physicians' intentions to offer cancer screening to older women. Respondents were asked to read a scenario about an older woman. Each scenario patient was one of three ages (70, 80, or 90) and had one of three levels of comorbidity and disability. Respondents were asked to estimate the likelihood of offering screening with mammography and Pap smear to these patients on a 5-point Likert scale. A logistic regression compared those physicians somewhat or very likely to offer screening with those less likely to do so. Further analyses examined the characteristics of physicians likely to "overscreen" the frailest older women (<5 years median life expectancy) or "underscreen" the healthiest (>10 years median life expectancy). RESULTS: Respondents returned 2003 completed surveys (37.4%). Controlling for age and prior screening, higher levels of comorbidity and disability were associated with a significantly lower likelihood of offering screening for both mammography and Pap smear. Nonetheless, a substantial percentage (30.7%) of physicians indicated a high likelihood of offering a frail 90-year-old woman a mammogram, and 13.4% would offer her a Pap smear. In general, overscreening was more common than underscreening. Female gender was associated with "overscreening" with mammography, whereas male gender and lack of board certification predicted "underscreening." Lack of board certification was associated with "overscreening" with Pap smear. CONCLUSIONS: In addition to age, primary care physicians consider health status in deciding to offer cancer screening to older women. Education and guidelines for cancer screening should more explicitly address the risks of overscreening among frail older women.

Authors
Heflin, MT; Pollak, KI; Kuchibhatla, MN; Branch, LG; Oddone, EZ
MLA Citation
Heflin, MT, Pollak, KI, Kuchibhatla, MN, Branch, LG, and Oddone, EZ. "The impact of health status on physicians' intentions to offer cancer screening to older women." J Gerontol A Biol Sci Med Sci 61.8 (August 2006): 844-850.
PMID
16912103
Source
pubmed
Published In
Journals of Gerontology: Series A
Volume
61
Issue
8
Publish Date
2006
Start Page
844
End Page
850

Challenges and solutions for recruiting pregnant smokers into a nicotine replacement therapy trial.

Improvements in smoking cessation interventions for pregnant smokers are needed. One major step is to examine the potential effectiveness of nicotine replacement therapy (NRT). The potential benefits of providing pregnant women with NRT to help them quit smoking are still unknown; early interventions to test the effectiveness and efficacy are vital to advancing the field. This paper describes recruitment efforts for a multiclinic trial to test the effectiveness of NRT use in addition to behavioral therapy in promoting cessation during pregnancy. The biggest challenge is recruiting sufficient numbers of pregnant women. This paper discusses specific obstacles for recruitment and solutions. Knowing the potential pitfalls to recruiting pregnant women into these trials can lead to better studies and thus improved outcomes.

Authors
Pollak, KI; Oncken, CA; Lipkus, IM; Peterson, BL; Swamy, GK; Pletsch, PK; Lyna, P; Namenek Brouwer, RJ; Fish, LJ; Myers, ER
MLA Citation
Pollak, KI, Oncken, CA, Lipkus, IM, Peterson, BL, Swamy, GK, Pletsch, PK, Lyna, P, Namenek Brouwer, RJ, Fish, LJ, and Myers, ER. "Challenges and solutions for recruiting pregnant smokers into a nicotine replacement therapy trial." Nicotine Tob Res 8.4 (August 2006): 547-554.
PMID
16920652
Source
pubmed
Published In
Nicotine and Tobacco Research (OUP)
Volume
8
Issue
4
Publish Date
2006
Start Page
547
End Page
554
DOI
10.1080/14622200600789882

Gender differences in adolescent smoking: mediator and moderator effects of self-generated expected smoking outcomes.

PURPOSE: To examine relations among gender, self-generated smoking-outcome expectancies, and smoking in adolescents. METHODS: Students from one all-girls' (n=350; 53%) and one all-boys' (n=315; 47%) Catholic high school participated. Analyses included binary and ordinal logistic regression. RESULTS: For boys, smoking behavior was associated with buzz (odds radio [OR] = 1.92, 95% confidence interval [CI]: 1.31-2.83, p < .001), pleasure (OR = 1.47, 95% CI: 1.01-2.16, p = .044), taste/smell (OR = 2.17, 95% CI: 1.12-4.19, p = .022), stimulation (OR = 3.69, 95% CI: 1.32-10.28, p = .013), and exercise/sport impairment (OR = 2.84, 95% CI: 1.68-4.81, p < .001). Among girls, weight control (OR = 0.22, 95% CI: 0.13-0.36, p < .001), negative aesthetics (OR = 0.42, 95% CI: 0.28-0.64, p < .001), addiction (OR = 0.39, 95% CI: 0.28-0.55, p < .001), and negative mood (OR = 0.44, 95% CI 0.20-0.97, p = .041) predicted smoking. Buzz (beta = 2.88, p = .004) mediated the gender-smoking relationship. Moderators included negative social (beta = -0.45, p = .021) and enhance self-esteem (beta = -1.07, p = .024). CONCLUSION: Interventions might benefit from tailoring on gender differences in smoking-outcome expectancies.

Authors
Vidrine, JI; Anderson, CB; Pollak, KI; Wetter, DW
MLA Citation
Vidrine, JI, Anderson, CB, Pollak, KI, and Wetter, DW. "Gender differences in adolescent smoking: mediator and moderator effects of self-generated expected smoking outcomes." Am J Health Promot 20.6 (July 2006): 383-387.
PMID
16871816
Source
pubmed
Published In
American journal of health promotion : AJHP
Volume
20
Issue
6
Publish Date
2006
Start Page
383
End Page
387

Understanding health behavior change among couples: an interdependence and communal coping approach.

Marriage is a ubiquitous social status that consistently is linked to health. Despite this, there has been very little theory development or related research on the extent to which couple members are jointly motivated to and actively engage in health-enhancing behaviors. In this paper we propose an integrative model, based on interdependence theory and communal coping perspectives, that explicitly considers dyadic processes as determinants of couple behavior. Our integrated model applies these constructs to consider how couple dynamics might influence adoption of risk-reducing health habits. Accordingly, we suggest that the couple's interdependence can transform motivation from doing what is in the best interest of the self (person-centered), to doing even selfless actions that are best for the continuation of the relationship (relationship-centered). In turn, this transformation can lead to enhanced motivation for the couple to cope communally or act cooperatively in adopting health-enhancing behavior change. Implications for research related to couples and health behavior change are also highlighted.

Authors
Lewis, MA; McBride, CM; Pollak, KI; Puleo, E; Butterfield, RM; Emmons, KM
MLA Citation
Lewis, MA, McBride, CM, Pollak, KI, Puleo, E, Butterfield, RM, and Emmons, KM. "Understanding health behavior change among couples: an interdependence and communal coping approach." Soc Sci Med 62.6 (March 2006): 1369-1380.
PMID
16146666
Source
pubmed
Published In
Social Science & Medicine
Volume
62
Issue
6
Publish Date
2006
Start Page
1369
End Page
1380
DOI
10.1016/j.socscimed.2005.08.006

Recruiting teen smokers in shopping malls to a smoking-cessation program using the foot-in-the-door technique

Persuading teen smokers to volunteer for smoking-cessation programs is a challenging yet understudied problem. As a method of dealing with this problem, we used and tested a foot-in-the-door (FITD) approach. Teen smokers were intercepted at malls and were assigned randomly to request compliance with a small behavior request of either (a) answering a few questions (light FITD) or (b) answering the same questions and a few additional ones, plus watching a short video about the effects of nicotine (heavy FITD). Participants were then called back by telephone several weeks later and asked to comply with a large behavior request of joining a cessation program that involved the use of self-help materials and telephone counseling. Although no differences were found in responses from the light and heavy groups, consent to enter the program was obtained from 12% of the pooled qualified intercepts and their parents (for those under 18 years). This recruitment rate was considered good, given that this is one of the only reported studies that recruited teen smokers from the general population to cessation programs. © 2006 Blackwell Publishing, Inc.

Authors
Bloom, PN; McBride, CM; Pollak, KI; Schwartz-Bloom, RD; Lipkus, IM
MLA Citation
Bloom, PN, McBride, CM, Pollak, KI, Schwartz-Bloom, RD, and Lipkus, IM. "Recruiting teen smokers in shopping malls to a smoking-cessation program using the foot-in-the-door technique." Journal of Applied Social Psychology 36.5 (2006): 1129-1144.
Source
scival
Published In
Journal of Applied Social Psychology
Volume
36
Issue
5
Publish Date
2006
Start Page
1129
End Page
1144
DOI
10.1111/j.0021-9029.2006.00034.x

Comparison of self-reported smoking status and anonymous urinary cotinine testing in pregnancy

Authors
Bursey-Reddick, K; Swamy, GK; Brouwer, RN; Pollak, KI; Myers, ER; Investigators, BS
MLA Citation
Bursey-Reddick, K, Swamy, GK, Brouwer, RN, Pollak, KI, Myers, ER, and Investigators, BS. "Comparison of self-reported smoking status and anonymous urinary cotinine testing in pregnancy." December 2005.
Source
wos-lite
Published In
American Journal of Obstetrics & Gynecology
Volume
193
Issue
6
Publish Date
2005
Start Page
S107
End Page
S107
DOI
10.1016/j.ajog.2005.10.372

Race/ethnicity, smoking status, and self-generated expected outcomes from smoking among adolescents.

Racial/ethnic differences in adolescent smoking suggest that different factors may motivate smoking among various racial/ethnic groups. This study examined relations among race/ethnicity, self-generated smoking outcome expectancies, and smoking status. Our findings noted that current smoking was highest among Hispanics, whereas African Americans and Asians were least likely to ever smoke. African Americans were most likely to experiment but least likely to smoke currently. Five expectancies differed significantly by race/ethnicity: reduce tension, image, negative aesthetics, addiction, and cost. However, none were significant mediators or moderators. Racial/ethnic groups most susceptible to smoking initiation and with the highest rates of current smoking should be targeted for prevention and cessation. Research is needed to examine more thoroughly racial/ethnic differences in expectancies.

Authors
Irvin Vidrine, J; Anderson, CB; Pollak, KI; Wetter, DW
MLA Citation
Irvin Vidrine, J, Anderson, CB, Pollak, KI, and Wetter, DW. "Race/ethnicity, smoking status, and self-generated expected outcomes from smoking among adolescents." Cancer Control 12 Suppl 2 (November 2005): 51-57.
PMID
16327751
Source
pubmed
Published In
Cancer control : journal of the Moffitt Cancer Center
Volume
12 Suppl 2
Publish Date
2005
Start Page
51
End Page
57

Project PREVENT: a randomized trial to reduce multiple behavioral risk factors for colon cancer.

BACKGROUND: This report examines the outcome data for Project PREVENT, a two-site randomized control trial designed to reduce behavioral risk factors for colorectal cancer among individuals who have been diagnosed with adenomatous colon polyps. METHODS: The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone, and were randomized to either Usual Care (UC) or the PREVENT intervention, which was designed to target multiple risk factors. The intervention consisted of a telephone-delivered intervention plus tailored materials, and focused on the six primary behavioral risk factors for colorectal cancer, including red meat consumption, fruit and vegetable intake, multivitamin intake, alcohol, smoking, and physical inactivity. RESULTS: Participation in the PREVENT intervention was associated with a significantly greater reduction in prevalence of multiple risk factors for colorectal cancer compared with UC. Only about one third of UC participants dropped any risk factors during the study period, compared with almost half of the PREVENT participants. PREVENT participants were also significantly more likely to change more than one behavior than UC participants. CONCLUSIONS: The PREVENT intervention was effective in helping patients change multiple risk factors. These results provide further support that more comprehensive interventions that move beyond emphasis on a single risk factor are acceptable to patient populations, can result in improvements, and are cost effective.

Authors
Emmons, KM; McBride, CM; Puleo, E; Pollak, KI; Clipp, E; Kuntz, K; Marcus, BH; Napolitano, M; Onken, J; Farraye, F; Fletcher, R
MLA Citation
Emmons, KM, McBride, CM, Puleo, E, Pollak, KI, Clipp, E, Kuntz, K, Marcus, BH, Napolitano, M, Onken, J, Farraye, F, and Fletcher, R. "Project PREVENT: a randomized trial to reduce multiple behavioral risk factors for colon cancer." Cancer Epidemiol Biomarkers Prev 14.6 (June 2005): 1453-1459.
PMID
15941955
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
14
Issue
6
Publish Date
2005
Start Page
1453
End Page
1459
DOI
10.1158/1055-9965.EPI-04-0620

Prevalence and predictors of multiple behavioral risk factors for colon cancer.

OBJECTIVES: This paper examines the prevalence of behavioral risk factors for colorectal cancer (CRC) (e.g., red meat consumption, fruit and vegetable intake, multivitamin intake, alcohol, smoking, and physical inactivity), co-occurrence among these behaviors, and motivation for change among patients at increased risk. METHODS: The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone. RESULTS: Sixty-six percent of participants had not been diagnosed with polyps before. Fifty-eight percent of the sample had red meat as a risk factor, 63% had fruit and vegetable consumption as a risk factor, 54% did not take a daily multivitamin, and 44% had physical activity as a risk factor. In contrast, only 9% of the sample had alcohol consumption as a risk factor and only 14% were current smokers. The prevalence of the six individual risk factors was combined into an overall multiple risk factor score (MRF). The average number of risk factors was 2.43. Men, those with a high school education or below, those reporting fair or poor health status, and those with less self-efficacy about risk factor change had more risk factors. CONCLUSIONS: There is a need for multiple risk factor interventions that capitalize on natural intersections among intra- and interpersonal factors that maintain them.

Authors
Emmons, KM; McBride, CM; Puleo, E; Pollak, KI; Marcus, BH; Napolitano, M; Clipp, E; Onken, J; Farraye, FA; Fletcher, R
MLA Citation
Emmons, KM, McBride, CM, Puleo, E, Pollak, KI, Marcus, BH, Napolitano, M, Clipp, E, Onken, J, Farraye, FA, and Fletcher, R. "Prevalence and predictors of multiple behavioral risk factors for colon cancer." Prev Med 40.5 (May 2005): 527-534.
PMID
15749134
Source
pubmed
Published In
Preventive Medicine
Volume
40
Issue
5
Publish Date
2005
Start Page
527
End Page
534
DOI
10.1016/j.ypmed.2004.10.001

Is there time for management of patients with chronic diseases in primary care?

PURPOSE: Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause. METHODS: We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions. The result was compared with time available for patient care for the average primary care physician. RESULTS: Eight hundred twenty-eight hours per year, or 3.5 hours a day, were required to provide care for the top 10 chronic diseases, provided the disease is stable and in good control. We recalculated this estimate based on increased time requirements for uncontrolled disease. Estimated time required increased by a factor of 3. Applying this factor to all 10 diseases, time demands increased to 2,484 hours, or 10.6 hours a day. CONCLUSIONS: Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.

Authors
Østbye, T; Yarnall, KSH; Krause, KM; Pollak, KI; Gradison, M; Michener, JL
MLA Citation
Østbye, T, Yarnall, KSH, Krause, KM, Pollak, KI, Gradison, M, and Michener, JL. "Is there time for management of patients with chronic diseases in primary care?." Ann Fam Med 3.3 (May 2005): 209-214.
PMID
15928223
Source
pubmed
Published In
Annals of family medicine
Volume
3
Issue
3
Publish Date
2005
Start Page
209
End Page
214
DOI
10.1370/afm.310

Assessing attitudinal ambivalence towards smoking and its association with desire to quit among teen smokers

Most smokers have some conflicting thoughts and feelings about their smoking; that is, they feel ambivalent. Whether felt ambivalence can be adequately measured and then used to predict the desire to quit among teen smokers has yet to be explored. Hence, among 402 teen smokers involved in a smoking cessation intervention, we first examined the psychometric properties of an eight-item ambivalence scale via exploratory and confirmatory analyses. After excluding one item, the scale was internally consistent and formed a single factor. We also report on whether felt ambivalence towards smoking assessed at baseline and at four and eight months post-baseline was related to the desire to quit in cross-sectional and prospective analyses. In all cross-sectional and prospective analyses, smokers who felt increasingly ambivalent reported a stronger desire to quit. These results suggest that ambivalence might be a useful construct to explore further and experimentally induce to assess its effects on desire to quit. © 2005 Taylor & Francis Group Ltd.

Authors
Lipkus, IM; Pollak, KI; McBride, CM; Schwartz-Bloom, R; Lyna, P; Bloom, PN
MLA Citation
Lipkus, IM, Pollak, KI, McBride, CM, Schwartz-Bloom, R, Lyna, P, and Bloom, PN. "Assessing attitudinal ambivalence towards smoking and its association with desire to quit among teen smokers." Psychology and Health 20.3 (2005): 373-387.
Source
scival
Published In
Psychology and Health
Volume
20
Issue
3
Publish Date
2005
Start Page
373
End Page
387
DOI
10.1080/08870440512331333988

Prenatal and postpartum smoking abstinence a partner-assisted approach.

BACKGROUND: A partner's provision of support and smoking status has been consistently associated with women's likelihood of smoking cessation during pregnancy and relapse in postpartum. DESIGN: A three-group randomized controlled intervention trial was conducted in 1996 to 2001, with 583 women and their partners randomized to usual care (UC), woman-only (WO), or partner-assisted (PA) intervention. Follow-ups occurred at 28 weeks of pregnancy, and 2-, 6-, and 12-months postpartum. SETTING: Womack Army Medical Center (WAMC) at Fort Bragg in Fayetteville, North Carolina. INTERVENTION: Women in the UC condition received provider advice to quit and a self-help guide. The WO condition received UC components plus a late-pregnancy relapse prevention kit (booklet and gift items) and six counseling calls (three in pregnancy and three postpartum) initiated by a health advisor. Women in the PA condition received the WO intervention, and their partners received telephone counseling and a support guide emphasizing skills to help the woman build and maintain her confidence to quit smoking. Partners who smoked also received cessation aids and related counseling. MAIN OUTCOME MEASURE: Seven-day self-reported abstinence from smoking at each follow-up. RESULTS: Intent-to-treat analyses showed no significant differences by condition in women's reports of abstinence at any follow-up. In late pregnancy, more partners were abstinent in the PA condition (15%) than in the UC condition (5%), p =0.02. CONCLUSIONS: Partner-assisted smoking-cessation interventions need further refinement. Influencing young couples' support patterns may require more intensive and conjoint intervention. Partners who smoke could benefit from support for their cessation efforts.

Authors
McBride, CM; Baucom, DH; Peterson, BL; Pollak, KI; Palmer, C; Westman, E; Lyna, P
MLA Citation
McBride, CM, Baucom, DH, Peterson, BL, Pollak, KI, Palmer, C, Westman, E, and Lyna, P. "Prenatal and postpartum smoking abstinence a partner-assisted approach." Am J Prev Med 27.3 (October 2004): 232-238.
PMID
15450636
Source
pubmed
Published In
American Journal of Preventive Medicine
Volume
27
Issue
3
Publish Date
2004
Start Page
232
End Page
238
DOI
10.1016/j.amepre.2004.06.005

A randomized trial comparing the effects of self-help materials and proactive telephone counseling on teen smoking cessation.

We conducted a 2-arm randomized trial to test the efficacy of self-help materials with or without proactive telephone counseling to increase cessation among teen smokers. Teen smokers (N = 402) recruited from 11 shopping malls and 1 amusement park in the southeastern United States were randomized to 1 of 2 groups: written self-help material plus video; or written self-help material, video, and telephone counseling. Cessation rates based on 7-day point-prevalent abstinence for the self-help and counseling arms were 11% and 16%, respectively (p = .25), at 4 months postbaseline and 19% and 21%, respectively (p = .80), at 8 months postbaseline. Sustained abstinence, reflecting 7-day abstinence at both time points, in the self-help and counseling arms was 7% and 9% (p = .59). Results suggest that minimal self-help cessation approaches that target youth have comparable success to that shown among adult smokers. However, refinements in telephone-counseling approaches may be needed to achieve the success observed in adult populations.

Authors
Lipkus, IM; McBride, CM; Pollak, KI; Schwartz-Bloom, RD; Tilson, E; Bloom, PN
MLA Citation
Lipkus, IM, McBride, CM, Pollak, KI, Schwartz-Bloom, RD, Tilson, E, and Bloom, PN. "A randomized trial comparing the effects of self-help materials and proactive telephone counseling on teen smoking cessation." Health Psychol 23.4 (July 2004): 397-406.
PMID
15264976
Source
pubmed
Published In
Health Psychology
Volume
23
Issue
4
Publish Date
2004
Start Page
397
End Page
406
DOI
10.1037/0278-6133.23.4.397

Modifying attributions of colorectal cancer risk.

We report how a four-group risk communication intervention targeted to individuals in the carpentry trade affected their perceived causes (i.e., attributions) for increased colorectal cancer (CRC) risk. The intervention varied the amount of information presented on CRC risk factors and whether participants received tailored feedback on their risk factors. In baseline and 3-month follow-up telephone surveys, carpenters (N = 860) reported their perceived absolute and comparative CRC risks, perceived causes for increased CRC risk, and knowledge of CRC risk factors. At follow-up, neither the type or amount of information provided, nor the use of tailoring, appreciably and consistently affected whether participants mentioned their specific risk factor (e.g., lifestyle, occupational) emphasized in their intervention information. Furthermore, attributions did not affect CRC risk perceptions. These results suggest that participants do not integrate sufficiently CRC risk factor information into their conceptualizations of CRC risk, and that more effective methods are needed to contextualize risk factors information to achieve the goal of modifying CRC risk perceptions.

Authors
Lipkus, IM; Skinner, CS; Green, LSG; Dement, J; Samsa, GP; Ransohoff, D
MLA Citation
Lipkus, IM, Skinner, CS, Green, LSG, Dement, J, Samsa, GP, and Ransohoff, D. "Modifying attributions of colorectal cancer risk." Cancer Epidemiol Biomarkers Prev 13.4 (April 2004): 560-566.
PMID
15066920
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
13
Issue
4
Publish Date
2004
Start Page
560
End Page
566

The impact of health status on primary care physicians' intentions to offer colorectal cancer screening to older adults.

Authors
Heflin, MT; Kuchibhatla, MN; Pollak, KI
MLA Citation
Heflin, MT, Kuchibhatla, MN, and Pollak, KI. "The impact of health status on primary care physicians' intentions to offer colorectal cancer screening to older adults." April 2004.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
52
Issue
4
Publish Date
2004
Start Page
S112
End Page
S113

Age-related vulnerabilities of older adults with colon adenomas: evidence from Project Prevent.

BACKGROUND: This report addresses the interface between cancer and aging in the context of colorectal carcinoma (CRC), the second leading cause of cancer death in the U.S. overall and the first leading cause among individuals age > or = 75 years. Because polyp risk increases with age, interventions to prevent recurrent polyps among older adults likely would reduce CRC morbidity and mortality. METHODS: Data for this study derive from Project Prevent, a multisite, randomized controlled trial designed to reduce behavioral risk factors for CRC among 1247 adults who underwent the removal of > or = 1 adenomatous colon polyps. Middle-aged and older patients were compared on key cognitive-behavioral mechanisms associated with CRC risk and established age-related factors associated with adverse health outcomes. Relations between cognitive-behavioral mechanisms and age-related vulnerability factors identified subgroups of older polyp patients that may have an enhanced risk for CRC. RESULTS: Compared with middle-aged patients, older patients were less concerned about developing CRC, less motivated to reduce their risk, and less confident that their behavior change efforts would succeed. As expected, they also reported more age-related physical, social, and economic vulnerabilities, as expected. Evidence for enhanced CRC risk was found for older patients with multiple comorbid conditions, low social support for change, and perceptions of income inadequacy. CONCLUSIONS: The presence of age-related vulnerability factors may enhance the risk of CRC among older cancer patients by creating barriers to behavioral change. Efforts to reduce the cancer burden in older populations will require attention beyond early detection and surveillance to interventions that account for the unique physical and psychosocial characteristics of older adults.

Authors
Clipp, EC; Carver, EH; Pollak, KI; Puleo, E; Emmons, KM; Onken, J; Farraye, FA; McBride, CM
MLA Citation
Clipp, EC, Carver, EH, Pollak, KI, Puleo, E, Emmons, KM, Onken, J, Farraye, FA, and McBride, CM. "Age-related vulnerabilities of older adults with colon adenomas: evidence from Project Prevent." Cancer 100.5 (March 1, 2004): 1085-1094.
PMID
14983506
Source
pubmed
Published In
Cancer
Volume
100
Issue
5
Publish Date
2004
Start Page
1085
End Page
1094
DOI
10.1002/cncr.20082

Interpretation of genetic risk feedback among African American smokers with low socioeconomic status.

The authors report on factors related to interpretation of feedback on genetic susceptibility to lung cancer among 371 African American smokers receiving care in a community health clinic, with a focus on whether smokers were interpreting feedback consistent with a defensive processing or an accuracy orientation. Smokers were given feedback on the absence (indicating increased risk) or presence (indicating average risk) of the gene for the mu isoform of glutathione S-transferase. Smokers who were told they were at higher risk were more likely to inaccurately recall the result than those deemed at average risk. Smokers who inaccurately recalled the result, regardless of risk status, were most likely to misinterpret the meaning of the result. Perceived lung cancer risks and worries were not associated with comprehension of the test result. The authors suggest additional research is needed to develop more effective strategies for communicating genetic risk feedback to motivate smoking cessation.

Authors
Lipkus, IM; McBride, CM; Pollak, KI; Lyna, P; Bepler, G
MLA Citation
Lipkus, IM, McBride, CM, Pollak, KI, Lyna, P, and Bepler, G. "Interpretation of genetic risk feedback among African American smokers with low socioeconomic status." Health Psychol 23.2 (March 2004): 178-188.
PMID
15008663
Source
pubmed
Published In
Health Psychology
Volume
23
Issue
2
Publish Date
2004
Start Page
178
End Page
188
DOI
10.1037/0278-6133.23.2.178

Accuracy of self-reports of fecal occult blood tests and test results among individuals in the carpentry trade.

BACKGROUND: Inaccuracy in self-reports of colorectal cancer (CRC) screening procedures (e.g., over- or underreporting) may interfere with individuals adhering to appropriate screening intervals, and can blur the true effects of physician recommendations to screen and the effects of interventions designed to promote screening. We assessed accuracy of self-report of having a fecal occult blood test (FOBT) within a 1-year window based on receipt of FOBT kits among individuals aged 50 and older in the carpentry trade (N = 658) who were off-schedule for having had a FOBT. METHOD: Indices of evaluating accuracy of self-reports (concordance, specificity, false-positive and false-negative rates) were calculated relative to receipt of a mailed FOBT. Among those who mailed a completed FOBT, we assessed accuracy of reporting the test result. RESULTS: Participants underestimated having performed a FOBT (false-negative rate of 44%). Accuracy was unrelated to perceptions of getting or worrying about CRC or family history. Self-reports of having a negative FOBT result more consistently matched the laboratory result (specificity 98%) than having a positive test result (sensitivity 63%). CONCLUSIONS: Contrary to other findings, participants under- rather than over reported FOBT screening. Results suggest greater efforts are needed to enhance accurate recall of FOBT screening.

Authors
Lipkus, IM; Samsa, GP; Dement, J; Skinner, CS; Green, LSG; Pompeii, L; Ransohoff, DF
MLA Citation
Lipkus, IM, Samsa, GP, Dement, J, Skinner, CS, Green, LSG, Pompeii, L, and Ransohoff, DF. "Accuracy of self-reports of fecal occult blood tests and test results among individuals in the carpentry trade." Prev Med 37.5 (November 2003): 513-519.
PMID
14572436
Source
pubmed
Published In
Preventive Medicine
Volume
37
Issue
5
Publish Date
2003
Start Page
513
End Page
519

Weight and smoking cessation among low-income African Americans.

BACKGROUND: Concerns about weight gain have been a commonly cited barrier to cessation among white, affluent, female populations, but less is known about this relationship among minority smokers and those with low incomes. Although smoking cessation is strongly encouraged for this population, it often leads to weight gain. Cultural differences in weight standards and the high prevalence of weight-related health conditions (e.g., hypertension and diabetes) may influence concerns about smoking cessation-related weight gain. METHODS: A secondary analysis of low-income African-American smokers (n=367) from a randomized intervention trial was conducted to explore the association of weight concerns with comorbidities and smoking cessation. RESULTS: Less than one quarter of participants were considered concerned about weight, defined as having high general concern about weight and high expectation of post-cessation weight gain. Those for whom weight gain could be riskiest--obese participants--were least concerned about gaining weight. Further, weight concerns were not associated with successful smoking cessation, quit attempts, confidence in quitting, or desire or readiness to quit. CONCLUSIONS: Because post-cessation weight gain may be a serious health threat for this population, but weight gain was not a concern for these smokers, smoking-cessation interventions for low-income African-American smokers may need to incorporate weight-gain education and prevention.

Authors
Pollak, KI; Namenek Brouwer, RJ; Lyna, P; Taiwo, B; McBride, CM
MLA Citation
Pollak, KI, Namenek Brouwer, RJ, Lyna, P, Taiwo, B, and McBride, CM. "Weight and smoking cessation among low-income African Americans." Am J Prev Med 25.2 (August 2003): 136-139.
PMID
12880881
Source
pubmed
Published In
American Journal of Preventive Medicine
Volume
25
Issue
2
Publish Date
2003
Start Page
136
End Page
139

Primary care residents' characteristics and motives for providing differential medical treatment of cervical cancer screening.

BACKGROUND: Cervical cancer screening rates in the United States are sub-optimal. Physician factors likely contribute to these lower rates. Previous studies provide inconclusive evidence about the association between physician characteristics and the likelihood of addressing cervical cancer. This report assesses potential mechanisms that explain why certain providers do not address cervical cancer screening. METHODS: One hundred primary care residents from various specialties were asked to indicate the preventive topics they would address with a hypothetical white female in her early 20s, who was portrayed as living a "high risk" lifestyle, and visiting her provider only for acute care reasons. RESULTS: Among the provider characteristics assessed, only residents' ethnicity was associated with the likelihood of and time spent addressing cervical cancer screening. In particular, Asian-American residents were least likely to address cervical cancer, while African-American residents were most likely. A mediation analyses revealed that perceived barriers for addressing cervical cancer accounted for this difference. CONCLUSIONS: Study results suggest that there may be cultural factors among health care providers that may account for differential referral and treatment practices. Findings from this study may help identify factors that explain why cervical cancer screening rates are not higher.

Authors
Arredondo, EM; Pollak, KI; Costanzo, P; McNeilly, M; Myers, E
MLA Citation
Arredondo, EM, Pollak, KI, Costanzo, P, McNeilly, M, and Myers, E. "Primary care residents' characteristics and motives for providing differential medical treatment of cervical cancer screening." J Natl Med Assoc 95.7 (July 2003): 576-584.
PMID
12911255
Source
pubmed
Published In
Journal of the National Medical Association
Volume
95
Issue
7
Publish Date
2003
Start Page
576
End Page
584

Primary care: is there enough time for prevention?

OBJECTIVES: We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. METHODS: We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population. RESULTS: To fully satisfy the USPSTF recommendations, 1773 hours of a physician's annual time, or 7.4 hours per working day, is needed for the provision of preventive services. CONCLUSIONS: Time constraints limit the ability of physicians to comply with preventive services recommendations.

Authors
Yarnall, KSH; Pollak, KI; Østbye, T; Krause, KM; Michener, JL
MLA Citation
Yarnall, KSH, Pollak, KI, Østbye, T, Krause, KM, and Michener, JL. "Primary care: is there enough time for prevention?." Am J Public Health 93.4 (April 2003): 635-641.
PMID
12660210
Source
pubmed
Published In
American journal of public health
Volume
93
Issue
4
Publish Date
2003
Start Page
635
End Page
641

Primary care residents' characteristics and motives for providing differential medical treatment of cervical cancer screening

Background: Cervical cancer screening rates in the United States are sub-optimal. Physician factors likely contribute to these lower rates. Previous studies provide inconclusive evidence about the association between physician characteristics and the likelihood of addressing cervical cancer. This report assesses potential mechanisms that explain why certain providers do not address cervical cancer screening, Methods: One hundred primary care residents from various specialties were asked to indicate the preventive topics they would address with a hypothetical white female in her early 20s, who was portrayed as living a "high risk" lifestyle, and visiting her provider only for acute care reasons. Results: Among the provider characteristics assessed, only residents' ethnicity was associated with the likelihood of and time spent addressing cervical cancer screening. In particular, Asian-American residents were least likely to address cervical cancer, while African-American residents were most likely. A mediation analyses revealed that perceived barriers for addressing cervical cancer accounted for this difference. Conclusions: Study results suggest that there may be cultural factors among health care providers that may account for differential referral and treatment practices. Findings from this study may help identify factors that explain why cervical cancer screening rates are not higher.

Authors
Arredondo, EM; Pollak, KI; Costanzo, P; McNeilly, M; Myers, E
MLA Citation
Arredondo, EM, Pollak, KI, Costanzo, P, McNeilly, M, and Myers, E. "Primary care residents' characteristics and motives for providing differential medical treatment of cervical cancer screening." Journal of the National Medical Association 95.7 (2003): 577-584.
Source
scival
Published In
Journal of the National Medical Association
Volume
95
Issue
7
Publish Date
2003
Start Page
577
End Page
584

Distress and motivation for smoking cessation among lung cancer patients' relatives who smoke.

BACKGROUND: Heightened distress at the time of a loved one's lung cancer diagnosis may motivate relatives to quit smoking or could undermine cessation. METHODS: Relatives of new lung cancer patients at Duke were surveyed by telephone to assess diagnosis-related depression, distress, and motivation for smoking cessation. RESULTS: Relatives who reported above average avoidant and intrusive thinking patterns, depressive symptoms or worry were more likely to report that the patient's diagnosis increased their intentions to quit than the less distressed. CONCLUSIONS: Interventions are needed that encourage smoking cessation as a strategy for adaptively coping with a loved ones' lung cancer diagnosis.

Authors
McBride, CM; Pollak, KI; Garst, J; Keefe, F; Lyna, P; Fish, L; Hood, L
MLA Citation
McBride, CM, Pollak, KI, Garst, J, Keefe, F, Lyna, P, Fish, L, and Hood, L. "Distress and motivation for smoking cessation among lung cancer patients' relatives who smoke." J Cancer Educ 18.3 (2003): 150-156.
PMID
14512262
Source
pubmed
Published In
Journal of Cancer Education
Volume
18
Issue
3
Publish Date
2003
Start Page
150
End Page
156
DOI
10.1207/S15430154JCE1803_08

Reported cessation advice given to African Americans by health care providers in a community health clinic.

Physician smoking cessation advice has been shown to be effective in encouraging patients to attempt cessation. Few studies have examined factors associated with patient-reported physician advice in an inner city community health clinic. Smokers identified via chart review and provider referral met with a study "smoking specialist." Eligible participants self-identified as African American, smoked at least 1 cigarette per day in the prior 7 days, were 18 or older, had access to a telephone, and agreed to consider blood testing for genetic susceptibility to lung cancer. Of the 869 smokers identified, 487 were eligible and completed a brief in-person and a more extensive follow-up telephone survey within one week after their visit. Patient reports of smoking cessation advice by providers were regressed on patient demographic, smoking, health, and social support variables. Seventy percent of participants reported that they had been advised to quit smoking. Smokers who were older, did not smoke menthol cigarettes, were in poorer health, and who had a regular health care provider were most likely to report having received advice. Patients in this community health setting reported high rates of provider advice to quit smoking. Yet, even in this optimal condition, young healthy smokers did not report receiving advice, even when they were ready to quit smoking. Providers may need additional training and prompting to counsel young healthy smokers about the importance of cessation.

Authors
Pollak, KI; Taiwo, B; Lyna, P; Baldwin, M; Lipkus, IM; Bepler, G; McBride, CM
MLA Citation
Pollak, KI, Taiwo, B, Lyna, P, Baldwin, M, Lipkus, IM, Bepler, G, and McBride, CM. "Reported cessation advice given to African Americans by health care providers in a community health clinic." J Community Health 27.6 (December 2002): 381-393.
PMID
12458781
Source
pubmed
Published In
Journal of Community Health
Volume
27
Issue
6
Publish Date
2002
Start Page
381
End Page
393

Women's reports of smoking cessation advice during reproductive health visits and subsequent smoking cessation.

OBJECTIVE: To examine associations of women's characteristics with reports of provider advice to quit smoking and smoking cessation 1 year after a reproductive health visit. STUDY DESIGN: Prospective survey. METHODS: As part of a randomized smoking cessation trial, 432 women smokers completed telephone surveys 1 month and 1 year after their reproductive health visit. Most women were white (85%) with a mean age of 36 years. RESULTS: Women more likely to report their provider advised them to quit smoking were white rather than another race (adjusted risk ratio, [RR] = 1.4, confidence interval [CI] = 1.14-1.64), employed versus unemployed (RR = 1.3, CI = 1.04-1.49), engaged in safer versus riskier sexual practices (RR = 1.3, CI = 1.09-1.54), were more rather than less ready to quit (RR = 1.3, Cl = 1.08-1.44), and saw family physicians versus gynecologists (RR = 1.3, CI = 1.12-1.41). Reported provider advice to quit smoking was not associated with subsequent cessation. Women were more likely to have quit smoking by the 1-year follow-up if at baseline they reported an annual Papanicolaou test in the prior 3 years (RR = 1.6, Cl = 1.02-2.26), were more rather than less ready to quit smoking (RR = 2.0, CI = 1.36-2.62), and were less rather than more dependent on nicotine (RR = 0.7, CI = 0.59-0.84). CONCLUSIONS: Provider advice to quit is being directed to women who are most likely to quit and contributes little in explaining subsequent cessation. Providers may not be giving enough cessation advice to minority women, those not considering cessation, and those not prevention oriented. Interventions and system improvements are needed to increase providers' counseling of smokers who are unmotivated and from racial/ethnic minorities.

Authors
Pollak, KI; McBride, CM; Scholes, D; Grothaus, LC; Civic, D; Curry, SJ
MLA Citation
Pollak, KI, McBride, CM, Scholes, D, Grothaus, LC, Civic, D, and Curry, SJ. "Women's reports of smoking cessation advice during reproductive health visits and subsequent smoking cessation." Am J Manag Care 8.10 (October 2002): 837-844.
PMID
12395952
Source
pubmed
Published In
American Journal of Managed Care
Volume
8
Issue
10
Publish Date
2002
Start Page
837
End Page
844

Relations between self-generated positive and negative expected smoking outcomes and smoking behavior: an exploratory study among adolescents.

The expected outcomes of drug use figure prominently in models of drug motivation. This report presents the relations between self-generated expected outcomes of smoking and smoking behavior in 674 adolescents. Expected outcomes of smoking were related to current smoking, experimentation, and susceptibility among never-smokers, even after controlling for key correlates of smoking behavior, including gender, grade, ethnicity, and peer smoking. Although more negative than positive smoking outcomes were accessible from memory, more positive than negative expected outcomes were correlated with smoking behavior. Both the content and number of self-generated expected outcomes provided unique associative information. In sum, greater elaboration of smoking-related memory networks, as well as the specific content of those networks, appear to be associated with smoking behavior.

Authors
Anderson, CB; Pollak, KI; Wetter, DW
MLA Citation
Anderson, CB, Pollak, KI, and Wetter, DW. "Relations between self-generated positive and negative expected smoking outcomes and smoking behavior: an exploratory study among adolescents." Psychol Addict Behav 16.3 (September 2002): 196-204.
PMID
12236454
Source
pubmed
Published In
Psychology of Addictive Behaviors
Volume
16
Issue
3
Publish Date
2002
Start Page
196
End Page
204

Perceptions of patients' self-efficacy for managing pain and lung cancer symptoms: correspondence between patients and family caregivers.

This study examined the degree of correspondence between lung cancer patients and their family caregivers in their perceptions of the patients' self-efficacy for managing pain and other symptoms of lung cancer, and the association of this correspondence to demographic, disease, and psychosocial variables. Thirty patients who were newly diagnosed with lung cancer and their primary family caregivers completed telephone interviews assessing the patient's symptoms, the patient's self-efficacy for managing symptoms, the quality of the relationship between the patient and caregiver, patient and caregiver psychological distress, and caregiver strain. Although patients and their caregivers showed a moderate degree of agreement in their perceptions of the patient's self-efficacy for managing pain and other symptoms, there was considerable variability in the degree of congruence. Factors that contributed to lower levels of congruence included low patient-rated self-efficacy, female gender of the patient, high patient psychological distress, and high caregiver strain. Caregivers were about evenly split in their tendency to overestimate versus underestimate the patient's self-efficacy. A poorer quality of relationship between the caregiver and the patient (as rated by the patient), high levels of patient-rated symptoms, and high levels of caregiver strain were associated with caregivers overestimating patient self-efficacy.

Authors
Porter, LS; Keefe, FJ; McBride, CM; Pollak, K; Fish, L; Garst, J
MLA Citation
Porter, LS, Keefe, FJ, McBride, CM, Pollak, K, Fish, L, and Garst, J. "Perceptions of patients' self-efficacy for managing pain and lung cancer symptoms: correspondence between patients and family caregivers." Pain 98.1-2 (July 2002): 169-178.
PMID
12098629
Source
pubmed
Published In
PAIN
Volume
98
Issue
1-2
Publish Date
2002
Start Page
169
End Page
178

Factors associated with patient-recalled smoking cessation advice in a low-income clinic.

It is recommended that providers advise cessation to their patients who smoke. However, patients' reports of cessation advice indicate disparities based on patients' race, gender, age, and smoking level. Providers' reports do not corroborate these disparities. We investigated whether smokers who receive their care in a community health center recalled their providers advising them to quit smoking when their providers documented such advice. We examined 219 patient-provider dyads to assess factors associated with lack of agreement between providers' documentation and patient recall. Patients were asked to recall any provider advice to quit smoking in the post 2 years. After every visit, providers completed a form to record the content of the visit. Most of the patients were African American, married, and uninsured. Sixty-eight percent of the dyads agreed in their documentation/recall. Patient race was the only factor associated with lack of agreement; African-American patients were more likely than white patients to provide discrepant reports. Although this study can not disentangle the racial difference in patient-provider recall/documentation, results may indicate an important area in which health disparities exist. Future studies should address the dynamics of patient-provider communication about smoking cessation, especially in populations that include ethnically diverse patients.

Authors
Pollak, KI; Yarnall, KSH; Rimer, BK; Lipkus, I; Lyna, PR
MLA Citation
Pollak, KI, Yarnall, KSH, Rimer, BK, Lipkus, I, and Lyna, PR. "Factors associated with patient-recalled smoking cessation advice in a low-income clinic." J Natl Med Assoc 94.5 (May 2002): 354-363.
PMID
12069216
Source
pubmed
Published In
Journal of the National Medical Association
Volume
94
Issue
5
Publish Date
2002
Start Page
354
End Page
363

Exploring the association between perceived risks of smoking and benefits to quitting: who does not see the link?

This report explored associations between different measures of smokers' perceived risks of smoking and benefits to quitting and the extent to which these associations varied by demographic and other characteristics for 144 smokers. We hypothesized greater perceived risk of smoking would be associated with greater perceived benefits to quitting and would be strongest among smokers who were concerned about health effects of smoking and motivated to quit. Results indicated smokers' perceived themselves at risk for lung cancer regardless if they continued or quit smoking and was strongest for smokers who were older and minimized the importance of reducing lung cancer risk. There was a weak correlation between perceived risk for lung cancer when compared to nonsmokers and perception that quitting smoking would reduce lung cancer risk and was weakest for African Americans, lighters smokers, and smokers with higher intrinsic relative to extrinsic motivation for cessation. In conclusion, these subgroup differences in the relationship between perceptions of risks and benefits could be important to consider to increase the relevance and motivational potency of smoking cessation interventions.

Authors
Lyna, P; McBride, C; Samsa, G; Pollak, KI
MLA Citation
Lyna, P, McBride, C, Samsa, G, and Pollak, KI. "Exploring the association between perceived risks of smoking and benefits to quitting: who does not see the link?." Addict Behav 27.2 (March 2002): 293-307.
PMID
11817769
Source
pubmed
Published In
Addictive Behaviors
Volume
27
Issue
2
Publish Date
2002
Start Page
293
End Page
307

Influence of stereotyping in smoking cessation counseling by primary care residents.

This study examined racial differences in primary care residents' rates of addressing smoking cessation. We expected residents to have higher rates of addressing cessation with White female patients as compared with African-American or Hispanic female patients, due, in part, to residents having higher outcome expectancies, self-efficacy, lower barriers, and less reliance on stereotypes. Residents (N = 90) were an average of 31 years old; two-thirds were White internal medicine residents. Residents viewed a video of a lower-middle class White, African-American, or Hispanic female interacting with her physician about stomach pain. Results indicate that residents were very likely to address smoking cessation, regardless of patients' race. Compared to residents assigned to an ethnic minority patient, residents assigned to the White patient were less likely to believe the patient would follow their advice (P < .03) and also perceived more barriers to address smoking cessation (P < .04). Reliance on the stereotype of Whites mediated the racial difference in outcome expectancies. Implications are that residents may be relying on stereotypes when they assess lower-middle class White female patients' receptivity to smoking cessation advice. Future research on the role of stereotyping in medical settings is warranted.

Authors
Pollak, KI; Arredondo, EM; Yarnall, KSH; Lipkus, I; Myers, E; McNeilly, M; Costanzo, P
MLA Citation
Pollak, KI, Arredondo, EM, Yarnall, KSH, Lipkus, I, Myers, E, McNeilly, M, and Costanzo, P. "Influence of stereotyping in smoking cessation counseling by primary care residents." Ethn Dis 12.4 (2002): 578-585.
PMID
12477145
Source
pubmed
Published In
Ethnicity & disease
Volume
12
Issue
4
Publish Date
2002
Start Page
578
End Page
585

Gender differences in the processes of change for condom use: patterns across stages of change in crack cocaine users.

Interventions to increase condom use in crack users have had mixed results. For interventions to achieve greater success, the mechanisms of behavior change in this population need to be understood. One mechanism, the processes of change, was examined across stages of change for condom use. Results from the analysis of variance for males and females revealed that stage of change was associated with different levels of three experiential processes: consciousness raising, social liberation and self-reevaluation. However, these analyses found that male and females seem to have different patterns of behavioral process use. Specifically, females in the preparation stage were different from those in precontemplation, whereas this difference was not pronounced in males. In general, people had high levels of experimental processes in every stage of change. The patterns of behavior process use mimicked patterns found for other behaviors with a linear increase across the stages of change. This may indicate that for maintaining condom use, more emotional and behavioral activities are required throughout the process of acquisition and maintenance than are necessary for other health-related activities. Implications of this research are that interventions for increasing condom use in drug users may target behavioral steps differently for males and females.

Authors
Timpson, SC; Pollak, KI; Bowen, AM; Williams, ML; Ross, MW; McCoy, CB; McCoy, HV
MLA Citation
Timpson, SC, Pollak, KI, Bowen, AM, Williams, ML, Ross, MW, McCoy, CB, and McCoy, HV. "Gender differences in the processes of change for condom use: patterns across stages of change in crack cocaine users." Health Educ Res 16.5 (October 2001): 541-553.
PMID
11675802
Source
pubmed
Published In
Health Education Research
Volume
16
Issue
5
Publish Date
2001
Start Page
541
End Page
553

How do residents prioritize smoking cessation for young "high-risk" women? Factors associated with addressing smoking cessation.

BACKGROUND: Sixty-seven percent of physicians report advising their smoking patients to quit. Primary care residents' priorities for preventive health for a young "high-risk" female are unknown. Factors related to residents addressing smoking also need examining. METHODS: One hundred residents completed a survey about preventive health issues for a woman in her 20s "who leads a high-risk lifestyle." Residents indicated which topics they would address, and the likelihood that they would address each of 12 relevant preventive health topics, their outcome expectancies that the patient would follow their advice on each topic, their confidence that they could address the topic, and perceived barriers for addressing the topic. RESULTS: Residents listed STD prevention most frequently. Drug use and smoking cessation were second and third most frequently listed. Residents who believed that the patient would follow their advice were more likely to list smoking cessation than residents who had lower outcome expectancies for that patient. Higher barriers were negatively related to addressing smoking cessation. CONCLUSIONS: When time is not a barrier, residents are likely to address smoking cessation. Teaching residents how to incorporate this subject into their clinical practice is needed. Raising residents' outcome expectancies may increase their likelihood of addressing smoking cessation.

Authors
Pollak, KI; Arredondo, EM; Yarnall, KS; Lipkus, I; Myers, E; McNeilly, M; Costanzo, P
MLA Citation
Pollak, KI, Arredondo, EM, Yarnall, KS, Lipkus, I, Myers, E, McNeilly, M, and Costanzo, P. "How do residents prioritize smoking cessation for young "high-risk" women? Factors associated with addressing smoking cessation." Prev Med 33.4 (October 2001): 292-299.
PMID
11570833
Source
pubmed
Published In
Preventive Medicine
Volume
33
Issue
4
Publish Date
2001
Start Page
292
End Page
299
DOI
10.1006/pmed.2001.0884

Reasons for quitting smoking among low-income African American smokers.

The psychometric characteristics of the Reasons For Quitting scale (RFQ) were assessed among a sample of African American smokers with low income (N=487). The intrinsic and extrinsic scales and their respective subscales were replicated. As hypothesized, higher levels of motivation were associated significantly, in patterns that supported the measure's construct validity, with advanced stage of readiness to quit smoking, greater perceived vulnerability to health effects of smoking, and greater social support for cessation. On the basis of the present study, the RFQ might best predict short-term cessation among older and female smokers. Refinement of the RFQ is needed to assess intrinsic motivators other than health concerns and to identify salient motivators for young and male smokers.

Authors
McBride, CM; Pollak, KI; Bepler, G; Lyna, P; Lipkus, IM; Samsa, GP
MLA Citation
McBride, CM, Pollak, KI, Bepler, G, Lyna, P, Lipkus, IM, and Samsa, GP. "Reasons for quitting smoking among low-income African American smokers." Health Psychol 20.5 (September 2001): 334-340.
PMID
11570647
Source
pubmed
Published In
Health Psychology
Volume
20
Issue
5
Publish Date
2001
Start Page
334
End Page
340

Women's perceived and partners' reported support for smoking cessation during pregnancy.

Studies of the influence of social support on successful smoking cessation have been based on the smoker's perceptions only. In this pilot study of 58 couples, pregnant women who had smoked in the 30 days before pregnancy and their partners reported the positive and negative support for cessation they had received (women) or provided (partners). Mean levels of the women's and partners' perceptions of support were compared, and correlations of the two reports were analyzed while controlling for the effect of the couple's smoking status. Women's and partners' reports were similar except partners reported wanting the women to stop smoking more than women perceived. Women's and partners' perceived negative support were moderately correlated (r approximately equal to .48, p approximately equal to .001). Partner-reported positive support also was associated with women's perceived negative support (r approximately equal to .30, p approximately equal to .03). These relationships remained signif cant after controllingfor partners' and women's smoking status. Generally, partners reported giving more positive and less negative support than women perceived. Results suggest the need for further examination of couples' perceptions of support and the impact on smoking cessation during pregnancy.

Authors
Pollak, KI; McBride, CM; Curry, SJ; Lando, H; Pirie, PL; Grothaus, LC
MLA Citation
Pollak, KI, McBride, CM, Curry, SJ, Lando, H, Pirie, PL, and Grothaus, LC. "Women's perceived and partners' reported support for smoking cessation during pregnancy." Ann Behav Med 23.3 (2001): 208-214.
PMID
11495221
Source
pubmed
Published In
Annals of Behavioral Medicine
Volume
23
Issue
3
Publish Date
2001
Start Page
208
End Page
214

Relationships among breast cancer perceived absolute risk, comparative risk, and worries.

When trying to predict breast cancer screening, it may be important to understand the relationships between perceived breast cancer risks and worries about getting breast cancer. This study examines the extent to which women's worries about breast cancer correlate with perceptions of both absolute (assessment of own) and comparative (self versus other) 10-year and lifetime risks. As part of a larger randomized intervention trial concerning hormone replacement therapy, 581 women participated in a telephone baseline survey to assess their perceptions of breast cancer risks and worries. Worries about getting breast cancer in the next 10 years and in one's lifetime were related positively to both absolute and comparative 10-year and lifetime risks. The magnitude of these relationships did not differ by time frame. Worry about breast cancer is a function of both how a woman views her own risk and how she compares her risk with that of other women. Some practitioners may encourage women to get screened for breast cancer by using emotional appeals, such as heightening women's worries about breast cancer by using risk information. Our data suggest that they should give careful consideration how best to combine, if at all, information about absolute and comparative risks. For example, if the motivation to screen is based on a sequential assessment of risk beginning with comparative and then absolute risk, creating communications that heighten perceived risk on both of these risk dimensions may be needed to evoke sufficient worry to initiate breast cancer screening.

Authors
Lipkus, IM; Kuchibhatla, M; McBride, CM; Bosworth, HB; Pollak, KI; Siegler, IC; Rimer, BK
MLA Citation
Lipkus, IM, Kuchibhatla, M, McBride, CM, Bosworth, HB, Pollak, KI, Siegler, IC, and Rimer, BK. "Relationships among breast cancer perceived absolute risk, comparative risk, and worries." Cancer Epidemiol Biomarkers Prev 9.9 (September 2000): 973-975.
PMID
11008917
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
9
Issue
9
Publish Date
2000
Start Page
973
End Page
975

Success attributions for stopping smoking during pregnancy, self- efficacy, and postpartum maintenance

Relapse prevention has focused on failure, not success attributions. This study of 392 privately insured women who stopped smoking during pregnancy found that the stability dimension of success attributions for pregnancy smoking cessation predicted abstinence at all postpartum time points (i.e., 6 weeks and 3, 6, and 12 months); for 277 women who continued abstinence to 6 weeks postpartum, the 6-week postpartum stability attribution predicted later time points, as did 6-week self-efficacy. Internality predicted smoking at the next time point only, and controllability was not a predictor. More than 50% said the baby was the reason for pregnancy smoking cessation, and 6-week abstinence; stability and internality ratings varied but not controllability. An exploratory test of the relation of self-efficacy and success attributions indicated that self-efficacy fully mediated the effect of stability. Success attributions may merit more attention.

Authors
Mullen, PD; Pollak, KI; Kok, G
MLA Citation
Mullen, PD, Pollak, KI, and Kok, G. "Success attributions for stopping smoking during pregnancy, self- efficacy, and postpartum maintenance." Psychology of Addictive Behaviors 13.3 (1999): 198-206.
Source
scival
Published In
Psychology of Addictive Behaviors
Volume
13
Issue
3
Publish Date
1999
Start Page
198
End Page
206
DOI
10.1037/0893-164X.13.3.198

Causal relationships of processes of change and decisional balance: stage-specific models for smoking.

This study, a secondary analysis of prospective data of smokers, tested whether the causal relationships between the processes of change and decisional balance of the transtheoretical model of change (TTM) are stage-specific. It was expected that for smokers in the contemplation stage, higher levels of experiential processing cause the cons of smoking to become more important and the pros of smoking to become less important. In other words, the level of experiential process use was expected to causally influence decisional balance (pros minus cons) for people in the contemplation stage. For ex-smokers in the action stage, when the cons outweigh the pros (cons become more important while pros become less important), they should increase their behavioral process use: decisional balance was expected to causally influence use of behavioral processes. Cross-lagged panels were analyzed using structural equation modeling. Results indicate that experiential process use has causal predominance over decisional balance for smokers in the contemplation stage. For those in the action stage, however, neither decisional balance nor behavioral process had apparent causal predominance. Mean-level invariance indicates that the contemplation and action stages are different. Further analysis investigated smokers who progressed from contemplation to either preparation or action or from preparation to action. For these smokers who had progressed toward action, decisional balance did causally influence use of behavioral processes. This evidence provides support for the use of the TTM as the basis for planning interventions that target specific stage-dependent causal mechanisms.

Authors
Pollak, KI; Carbonari, JP; DiClemente, CC; Niemann, YF; Mullen, PD
MLA Citation
Pollak, KI, Carbonari, JP, DiClemente, CC, Niemann, YF, and Mullen, PD. "Causal relationships of processes of change and decisional balance: stage-specific models for smoking." Addict Behav 23.4 (July 1998): 437-448.
PMID
9698973
Source
pubmed
Published In
Addictive Behaviors
Volume
23
Issue
4
Publish Date
1998
Start Page
437
End Page
448

Prenatal smoking cessation counseling by Texas obstetricians.

BACKGROUND: Smoking during pregnancy causes 20 to 30 percent of low birthweight and 10 percent of infant mortality in the United States. Brief counseling can reduce rates of smoking. The study objectives were to describe Texas obstetricians' pregnancy smoking cessation counseling activity and to identify attributes associated with consistent, effective counseling. METHODS: A survey was mailed to a random sample of Texas obstetricians. RESULTS: A response rate of 44 percent (n = 204) was attained. A counseling coverage-effectiveness index was created based on the percentage of smokers counseled and use of specific techniques. Almost all respondents reported asking about smoking; fewer, however, reported counseling smokers. Physicians with low index scores, indicating inconsistent coverage, ineffective counseling, or both were dissatisfied with their current counseling, did not perceive counseling to decrease smoking, were not aware of the risks of smoking, and were unfamiliar with expert reports and recommendations for prenatal care. CONCLUSIONS: Obstetricians who are not reached by expert reports and guidelines from groups outside their specialty or who do not perceive the seriousness of maternal smoking are less likely to counsel consistently and to use the most effective techniques. Continuing medical education at local, state, and national levels should be directed toward increasing knowledge and skills about smoking cessation counseling of pregnant women.

Authors
Mullen, PD; Pollak, KI; Titus, JP; Sockrider, MM; Moy, JG
MLA Citation
Mullen, PD, Pollak, KI, Titus, JP, Sockrider, MM, and Moy, JG. "Prenatal smoking cessation counseling by Texas obstetricians." Birth 25.1 (March 1998): 25-31.
PMID
9534502
Source
pubmed
Published In
Birth
Volume
25
Issue
1
Publish Date
1998
Start Page
25
End Page
31

Effects of physical context on stereotyping of Mexican American males

Based on Trope's (1986) model of perception, the effects of physical context on stereotyping and willingness to affiliate with Mexican American males were examined. In this two-part study, the effect of context alone was explored by showing a stilled video frame of a library room and a crime scene without people in them. Results indicated that the context affected expectations of the type of people who might be seen in those contexts. In the second study, the interaction of context and stereotyping was examined by placing two Mexican American males (one of whom was "stereotypical") in scholar, crime, and neutral contexts. Results reveal an interaction between context and target stereotyping whereby physical context did not affect stereotyping except when the target could not be easily categorized by ethnicity alone. Discussion centers on contributions of these studies to the literature on context, stereotyping of Mexican Americans, and future research.

Authors
Niemann, YF; Pollak, KI; Rogers, S; O'Connor, E
MLA Citation
Niemann, YF, Pollak, KI, Rogers, S, and O'Connor, E. "Effects of physical context on stereotyping of Mexican American males." Hispanic Journal of Behavioral Sciences 20.3 (1998): 349-362.
Source
scival
Published In
Hispanic Journal of Behavioral Sciences
Volume
20
Issue
3
Publish Date
1998
Start Page
349
End Page
362

Black and white tokens in academia: A difference of chronic versus acute distinctiveness

Token status effects, also called distinctiveness, include feelings of racial/gender awareness, representativeness, and accountability. In this multimethod three-part research, it is argued that Black students in a predominantly White university feel chronically distinctive, whereas White students may feel acutely distinctive when they are in the numerical minority. However, this acute distinctiveness is situation specific. First a pilot study confirmed that Black and White females differ in their reports of distinctiveness. Study 1 showed that Black students feel chronically distinctive and that they are often "solos" in classrooms. Study 2 tried to separate race and solo status effects on distinctiveness by experimentally manipulating group solo status. Results indicate a main effect for solo status and also a main effect for race on feelings of distinctiveness across solo conditions. Applications of this research for the token literature and for distinctiveness theory are discussed.

Authors
Pollak, KI; Niemann, YF
MLA Citation
Pollak, KI, and Niemann, YF. "Black and white tokens in academia: A difference of chronic versus acute distinctiveness." Journal of Applied Social Psychology 28.11 (1998): 954-972.
Source
scival
Published In
Journal of Applied Social Psychology
Volume
28
Issue
11
Publish Date
1998
Start Page
954
End Page
972

An exploration of the effects of partner smoking, type of social support, and stress on postpartum smoking in married women who stopped smoking during pregnancy

Partner smoking, general social support, partner support for quitting, and stress were examined in a sample of 72 pregnant women who spontaneously quit smoking and had a steady partner. Women whose partners provided them with general social support but smoked were more likely to return to smoking than women whose partners provided them with general social support and did not smoke. General social support, partner support for quitting, and stress were not associated with postpartum return to smoking. Emotional social support from the partner was related to perceived stress both in pregnancy and postpartum. Contributions of this study include development of an intervention that educates partners about the influence of their smoking on new mothers' maintenance and a description of the psychosocial environment of pregnant spontaneous quitters.

Authors
Pollak, KI; Mullen, PD
MLA Citation
Pollak, KI, and Mullen, PD. "An exploration of the effects of partner smoking, type of social support, and stress on postpartum smoking in married women who stopped smoking during pregnancy." Psychology of Addictive Behaviors 11.3 (1997): 182-189.
Source
scival
Published In
Psychology of Addictive Behaviors
Volume
11
Issue
3
Publish Date
1997
Start Page
182
End Page
189
DOI
10.1037/0893-164X.11.3.182
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