Publications
Department of Medicine faculty members published more than 3,600 peer-reviewed articles in 2024.
2016
2016
2016
2016
2016
BACKGROUND
Data describing patients' priorities, or main concerns, are essential to inform important decisions in healthcare, including treatment planning, diagnostic testing, and the development of programs to improve access and delivery of care. To date, the majority of studies performed does not account for variability in patients' priorities, and as a consequence may not effectively inform end users. The objective of this study was to examine the value of segmentation analysis as a method to illustrate variability in priorities for treatment of chronic hepatitis C (HCV).
METHODS
We elicited patients' main concerns when considering antiviral therapy for HCV using a Best-Worst Scaling experiment (Case 1) with ten objects. Latent class analysis was used to estimate part-worth utilities and the probability that each respondent belongs to each segment.
RESULTS
In the aggregate, subjects (N = 162) had three main concerns: (1) not being cured; (2) experiencing a lot of side effects; and (3) developing viral resistance to therapy. Segmentation into two groups demonstrated that both groups prioritized the likelihood of cure and coping with side effects, but that only one group (n = 78) was concerned about developing viral resistance to therapy, while subjects in the second group (n = 84) prioritized being able to keep up with their responsibilities. Further segmentation revealed distinct clusters of patients with unique priorities.
CONCLUSIONS
Patients' priorities vary significantly. Preference studies should consider including methods to determine whether distinct clusters of priorities and/or concerns exist in order to accurately inform end users' decision making.
View on PubMed2016
2016
BACKGROUND
Advertising influences people's health behaviors. Tobacco companies have linked tobacco and alcohol in their marketing activities. We examined how depictions of alcohol were placed in lifestyle magazines produced by tobacco companies, and if these references differed depending on if the magazine was oriented towards men, women, or if it was unisex.
METHODS
Content analysis of 6 different tobacco industry lifestyle magazines (73 issues), including 73 magazine covers, 1558 articles, 444 tobacco ads, and 695 non-tobacco ads.
RESULTS
14 of 73 (19%) magazine covers featured alcohol; 581 of 1558 (37%) magazine articles mentioned alcohol; 119 of 444 (27%) tobacco ads showed alcohol images; and 57 of 695 (8%) non-tobacco ads portrayed alcohol. Male-oriented magazines (, , and ) contained the most alcohol references, and the references were mainly beer, mixed drinks, and liquor or spirits. Female-oriented magazines ( and ) contained the fewest alcohol references, and wine and mixed drinks were the major types of alcoholic beverage portrayed. For unisex magazine (), the frequency of alcohol references fell between the male- and female-oriented magazines, and most frequently mentioned mixed drinks.
CONCLUSIONS
Frequent depictions of smoking and drinking in tobacco industry lifestyle magazines might have reinforced norms about paired use of tobacco and alcohol among young adults. The pairing of tobacco and alcohol may particularly target young men. Anti-tobacco interventions need to address the co-use of tobacco and alcohol, change the social acceptability of smoking in any social settings, and tailor alcohol related anti-tobacco messaging by gender.
View on PubMed2016
BACKGROUND
Internalization of HIV-related stigma may inhibit a person's ability to manage HIV disease through adherence to treatment regimens. Studies, mainly with white men, have suggested an association between internalized stigma and suboptimal adherence to antiretroviral therapy (ART). However, there is a scarcity of research with women of different racial/ethnic backgrounds and on mediating mechanisms in the association between internalized stigma and ART adherence.
METHODS
The Women's Interagency HIV Study (WIHS) is a multicenter cohort study. Women living with HIV complete interviewer-administered questionnaires semiannually. Cross-sectional analyses for the current article included 1168 women on ART for whom data on medication adherence were available from their last study visit between April 2013 and March 2014, when the internalized stigma measure was initially introduced.
RESULTS
The association between internalized stigma and self-reported suboptimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, P = 0.009, 95% CI: 0.52 to 0.91), but not for non-Hispanic whites (AOR = 2.15, P = 0.19, 95% CI: 0.69 to 6.73). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and suboptimal adherence in the whole sample, as well as in the subsample of minority participants. In serial mediation models, internalized stigma predicted less-perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted suboptimal medication adherence.
CONCLUSIONS
Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multifaceted interventions addressing both mental health and interpersonal factors, especially for minority women.
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