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Biomedical subjects

Adam O Goldstein

Publications and source records attributed to Adam O Goldstein.

11 recordsLinked to original sources

Messaging Strategies for Tobacco Prevention and Cessation Among People with Depression: A Scoping Review.

INTRODUCTION: Depression is strongly associated with higher tobacco use and lower quit rate; few communication campaigns have been designed with these mental health factors in mind. This scoping review compiles existing research on tobacco prevention and cessation messaging involving people with depression to identify gaps and opportunities for future message development. METHODS: Sources included PubMed, PsycINFO, Scopus, Academic Search Premier, and ProQuest Central (November - December 2024). The 55 studies included examined tobacco prevention or cessation messages and measured depression, depressive symptoms, or mental health as a primary outcome or analytic covariate. Study characteristics, target population, delivery format, message content, theoretical frameworks, outcomes, and gaps were extracted. RESULTS: RCTs made up half (51%) of the included studies, and most (78%) were conducted in the U.S. Nearly half (46%) required participants to have a mental health condition. Interventions most often used interactive (65.5%) or text-based (47.3%) communication and focused on tobacco cessation (89%) rather than vaping (9%). Common outcomes included feasibility or acceptability (37.7%) and point prevalence abstinence (37.7%). Mental health-specific messages showed mixed effectiveness. CONCLUSIONS: Despite progress in integrating mental health into tobacco messaging, targeted interventions for people with depression remain limited. Few studies tested long-term outcomes or used biochemical verification; many relied on untargeted generalized messaging.

Journal Article↗

Policies to increase influenza and pneumococcal immunizations in chronically ill and institutionalized settings.

BACKGROUND: The objective of this study was to understand better the status of and ways to improve dissemination of influenza and pneumococcal standing-order vaccination policies to at-risk adults in health care institutions. METHODS: A statewide sample of 5 different types of institutions serving at-risk elderly persons in North Carolina was surveyed. A 45-question telephone survey was administered to infection control nurses or facility directors at 267 (86% response rate) health care facilities involved in direct patient care. RESULTS: A majority of respondents reported that influenza (81%) and pneumococcal (59%) diseases were important to their facility, and 63% stated that the influenza vaccine was very effective versus 47% for pneumococcal. Except nursing homes, few facilities reported adoption of standing-order policies to vaccinate routinely the at-risk adults. Over 70% of respondents stated that their facilities might consider adopting standing-order policies for influenza and pneumococcal disease. A majority of respondents also supported a state law that requires such vaccines for high-risk patients unless contraindicated or the patient refuses. CONCLUSIONS: Respondents across diverse health care institutions appear interested in adopting standing-order policies to increase influenza and pneumococcal vaccination rates and are more likely to do so if provided with appropriate administrative and/or financial support for implementation.

Ambulatory Care Facilities↗

Recognizing the value of community involvement by AHC faculty: a case study.

Physicians seek connections to their communities. Some health care and academic leaders believe that facilitating the creation of more such community connections is one way to reverse the trend of waning social and political legitimacy for the U.S. medical profession. For academic health centers (AHCs), such connections can maintain local and state support crucial to their long-term success. Multiple barriers exist to such involvement, especially for physicians in AHCs, where work done beyond direct patient care, administration, and research rarely contributes to the tenure and promotion process. The authors present a case study to show how one department in an AHC, beginning in the late 1990s, has been overcoming these barriers to incorporate the scholarship of community engagement into its mission and structure. The case study incorporates theoretical underpinnings to crystallize the following lessons that the department has learned so far: (1) If academic departments wish community service to be a central part of their mission, they need ways to institutionalize community engagement within organizational structures. (2) Community engagement can be scholarly. (3) If faculty members are to be recognized for their service activities, measures are necessary to determine what constitutes "excellence" and "scholarship" in community service. (4) Scholarship of community engagement goes beyond performing service activities in the community.

Academic Medical Centers↗

Policies and practices for improving influenza immunization rates among healthcare workers.

OBJECTIVE: To determine the attitudes, policies, and barriers for requiring annual versus voluntary influenza vaccinations for the staff of healthcare institutions in North Carolina. METHODS: Five different types of institutions serving at-risk elderly populations throughout North Carolina were chosen for study, including hospitals, home health agencies, nursing homes, dialysis centers, and assisted living facilities. Infection control managers completed a 45-question telephone survey on policies for annual influenza vaccinations for employees, incentives to encourage immunizations, support for mandatory influenza vaccinations for workers, barriers to employee vaccinations, and support for a state law to mandate influenza immunizations for employees with patient care contact. RESULTS: Of 312 institutions, 268 (86%) participated in the study. Only 38% of institutions reported having formal written employee influenza vaccination policies, and only 2% actually mandated annual employee vaccinations. Reported barriers to increasing healthcare worker annual influenza vaccinations included "fear of side effects" and "perceived ineffectiveness of the flu vaccine." Almost half of the respondents would support mandating influenza vaccinations for all healthcare workers with direct patient contact. CONCLUSION: A state-wide survey of the receptivity, policies, and implications of mandated employee influenza vaccinations among healthcare institutions serving the elderly in North Carolina found written policies uncommon and most of the mechanisms used to increase vaccinations voluntary. Efforts should be tailored to individuals, institutions, and healthcare systems to dramatically increase employee immunization rates.

Attitude of Health Personnel↗

The North Carolina Youth Empowerment Study (NCYES): a participatory research study examining the impact of youth empowerment for tobacco use prevention.

This article describes the North Carolina Youth Empowerment Study (NC YES), a 3-year participatory evaluation of youth programs addressing tobacco use prevention. The study goals of NC YES were to (1) convene an advisory board comprised of lay youths and adults in a participatory research process, (2) document the characteristics of youth programs for tobacco use prevention and control in North Carolina, and (3) track the role of youth involvement in initiating and implementing 100% tobacco-free policies in local school districts. The NC YES Statewide Advisory Board helped guide the evaluation process, reviewed study protocols and data collection instruments, and helped interpret preliminary findings. Both quantitative and qualitative methods(e.g., telephone interviews and written questionnaires) were used to gather data from youth and adult leaders to achieve these aims. Lessons learned about the process of conducting participatory evaluation approaches and summary findings about the role of youths in policy advocacy efforts are presented.

Adolescent↗

Passage of 100% tobacco-free school policies in 14 North Carolina school districts.

Though comprehensive tobacco-free school policies constitute an important component of state tobacco control efforts, little research exists about their adoption process. In the past two years, efforts occurred in North Carolina to increase the number of school districts adopting 100% tobacco-free school policies. As part of the North Carolina Youth Empowerment Study (NC-YES), researchers developed a school tobacco policy interview guide to conduct interviews with 40 key people (e.g., school board member, principal, etc.) in each of 14 school districts that adopted a 100% tobacco-free school policy by the end of 2001. Results showed seven districts adopted their school policy in the past two years. Seven themes emerged: 1) Catalysts: Local adult and youth "champions" facilitated policy change; 2) Process of Adoption: Most school policies were adopted with an administrator or other adult initiating the change, but youth involvement increased in recent years; 3) Methods of Adoption: Advocates personalized health concerns by focusing on children and role modeling by adults; 4) Political Leadership: Governors of North Carolina, through letters to school districts and a policy summit, played an important role in stimulating policy change; 5) Barriers to Adoption: Concerns expressed before policy adoption, about teacher attrition or inability to enforce the policy, did not occur as feared; 6) Enforcement Issues: A key to policy enforcement involved being consistent, supportive, and firm; and 7) Economics of Tobacco Farming/Manufacturing: Though a local tobacco economy did little to influence policy adoption, districts that adopted policies were not located in counties with heavy tobacco production. Public health advocates may use this information to encourage school districts to adopt 100% tobacco-free school policies.

Adult↗

State legislators' beliefs about legislation that restricts youth access to tobacco products.

Better understanding of the cognitive framework for decision making among legislators is important for advocacy of health-promoting legislation. In 1994, the authors surveyed state legislators from North Carolina, Texas, and Vermont concerning their beliefs and intentions related to voting for a hypothetical measure to enforce legislation preventing the sale of tobacco to minors, using scales based on the theory of planned behavior. Attitude (importance), subjective norm (whether most people important to you would say you should or should not vote for the law), perceived behavioral control (ability to cast one's vote for the law), and home state were independently and significantly related to intention to vote for the law's enforcement. The results, including descriptive data concerning individual beliefs, suggest specific public health strategies to increase legislative support for passing legislation to restrict youth tobacco sales and, more generally, a framework for studying policy making and advocacy.

Adolescent↗

Smoking cessation in pregnancy: a review of postpartum relapse prevention strategies.

OBJECTIVE: Review and examine existing research, current strategies, and directions for future research on smoking cessation relapse and relapse prevention in pregnancy and postpartum. METHODS: A MEDLINE/PubMed search in 2002 and 2003 for articles containing the key words "smoking," "pregnancy," "cessation," and "cessation relapse prevention" and references of retrieved papers yielded a review of more than 500 articles. Only 14 of these addressed program-based strategies to increase cessation among pregnant women through relapse prevention programs. CONCLUSION: Although there is much information on the rationale and strategies for smoking cessation for pregnant women, fewer studies exist on how to prevent relapse. Maintaining and accelerating progress in cessation during pregnancy and postpartum requires more research that focuses on relapse prevention and cessation. Programs should incorporate stresses particular to postpartum women, should be part of routine health care, and should involve the woman's social support network, including her partner, to maximize effectiveness.

Decision Making↗

Community service by North Carolina family physicians.

BACKGROUND: Community service is an integral part of American society. Although Family Medicine advocates community service through community medicine, few data exist on family physicians' involvement in voluntary community service activities or roles as community advocates. METHODS: A questionnaire was mailed to 489 North Carolina family physicians, including a 20% random sample of those in community practice and all statewide faculty physicians. The survey assessed types and amount of volunteer activity, attitudes toward volunteer work, and factors that support or inhibit participation in community service. RESULTS: The overall response rate was 54%. Most respondents reported strong interests in community service before medical school and residency, yet few reported any relevant training during medical education. More than 85% of faculty and community practice family physicians reported participating in volunteer service in the previous year (70.8 mean hours for faculty vs 45.5 mean hours for community practice; P = .06). Family physicians also reported a wide variety of lifetime volunteer activities (mean number of different faculty physician activities 20.8 vs mean number of different community practice physician activities 16.7, P = .00). Less than 50% of both physician groups reported that their practice or program publicly supports those performing community service. CONCLUSIONS: The great majority of family physicians in North Carolina regularly participate in one or more volunteer community service activities, frequently without organizational recognition. Data about the scope of service expected by communities and provided by physicians may assist the discipline in clarifying the place of volunteer community service in medical education, promotion guidelines and practice.

Adult↗