GOOD MORNING, EVERYONE
JOINING IN PERSON AND ONLINE.
THANK YOU SO MUCH POOR BEG HERE.
FOR BEING HERE.
WE WILL GET STARTED.
IF YOU COULD PLEASE TAKE YOUR
SEATS.
WELCOME TO THE "2023 HINTS DATA
USERS CONFERENCE".
WE ARE THRILL ED TO HAVE YOU AT
NIH TO HELP YOU CELEBRATE THE
TRENDS SURVEY.
WE HAVE 419 REGISTERED, 166 IN
PERSON HERE AT NATCHER AND 253
VIEWING ONLINE.
THAT'S MORE THAN IN 2019.
WHEN WE STARTED PLANNING THIS
CONFERENCE WE WERE UNDER
STRICTER DENSITY REQUIREMENTS
DUE TO COVID.
THE ROOM IS QUITE LARGE.
IT'S GOOD WE HAVE EXTRA SPACE
TO ACCOMMODATE A BIT OF
DISTANCING SO FEEL FREE TO DO
THAT.
WE ENCOURAGE QUESTIONS, THOUGH
COMMENTS WON'T BE MONITORED
REGULARLY.
WE WILL TRY TO ANSWER QUESTIONS
ON YOUR BEHALF IF TIME ALLOWS.
IF YOU NEED TECHNICAL
ASSISTANCE EMAIL HERE.
THE OFFICE OF RESEARCH SERVICES
WAS ABLE TO GET THE NATCHER
CAFETERIA OPEN FOR US, SO
PLEASE PATRONIZE IT THE NEXT
FEW DAYS.
LUNCH WILL BE SERVED FROM
11:30-1:30.
WE WILL HAVE HOT STATIONS, GRAB
AND GO SANDWICHES AND SALADS
AND SUSHI AND FOR THE HANDFUL
OF PEOPLE WHO ORDERED BOXED
LUNCHES THOSE WERE CANCELLED
AND YOU WEREN'T CHARGED.
USE THE CAFETERIA.
STAFF AT THE REGISTRATION DESK
CAN ASSIST YOU WITH BOOKING
TAXIS.
IF YOU USE LYFT OR UBER, THE
PICK UP IS AT A KISS AND RIDE
AREA OUTSIDE THE CAMPUS
PERIMETER.
PLEASE CONTACT PEOPLE AT THE
TABLE.
TOMORROW ROOM J HAS BEEN
RESERVED FOR LUGGAGE, IF YOU
NEED TO BRING LUGGAGE WITH YOU
TO THE NATCHER CONFERENCE
CENTER, ALLOW EXTRA TIME FOR
SECURITY AT THE GATEWAY CENTER
IN THE MORNING, BECAUSE YOU
WILL STILL NEED TO GO THROUGH
SECURITY AGAIN AND GET ANOTHER
VISITOR BADGE.
POSTER PRESENTERS ARE
ENCOURAGED TO USE THE POSTERS
IN THE ATRIUM.
AND YOUR POSTERS DO NEED TO BE
REMOVED WHEN THE CONFERENCE
ADJOURNS TOMORROW.
BEFORE WE START I WOULD LIKE TO
EXPRESS GRATITUDE TO EVERYONE.
THE LIST GOES ON AND ON.
IT'S BEEN A HERCULEAN EFFORT BY
A LOT OF PEOPLE.
AND WE REALLY APPRECIATE THEM.
NAMELY ANNA GAYSYNSKY.
OUR ASL INTERPRETERS AND STAFF
AT ICF, INCLUDING BRIAN KEEFE.
THANK YOU SO MUCH TO OUR
CONFERENCE PLANNERS.
NOW I WOULD LIKE TO MAKE A FEW
INTRODUCTORY REMARKS TO GIVE
SOME CONTEXT FOR OUR CONFERENCE.
AS YOU KNOW WE ARE CELEBRATING
20 YEARS SINCE HINTS FIRST
FIELDED IN 2023.
RAISE YOUR HAND IF YOU WERE
INVOLVED IN THAT INAUGURAL IN
2003 OR IF YOU HAVE USED THE
2003 DATA IN YOUR RESEARCH.
GREAT.
IT'S BEEN VERY GRATIFYING FOR
THOSE OF US WHO HAVE WORKED ON
THE SURVEY ALL THIS TIME TO
HAVE SUCH LONG RELATIONSHIPS
WITH OUR DATA USERS AND WE
REMAIN COMMITTED TO SERVING YOU
WELL OVER THE NEXT 20 YEARS.
FOR THOSE OF YOU WHO DON'T KNOW
THE HISTORY OF HINTS.
AT A CANCER RISK COMMUNICATION
IT SORT OF BECAME THE BASIS OF
A MONOGRAPH PUBLISHED IN 1999
THAT OUTLINED PRIORITY AREAS
FOR CANCER COMMUNICATION
SCIENCE.
FOLLOWING THAT WORKSHOP AND THE
PUBLICATION OF THE MONOGRAPH,
CANCER COMMUNICATION WAS
IDENTIFIED AS AN EXTRAORDINARY
OPPORTUNITY FOR INVESTMENT
THREE YEARS IN A ROW IN NCI'S
BYPASS BUDGET.
THAT GAVE RISE TO THE HEALTH
COMMUNICATION AND INFORMATICS
RESEARCH BRANCH WHERE I WORK AT
NCI AND WHERE HINTS IS HOUSED.
OUR BRANCH REMAINS THE ONLY
HEALTH COMMUNICATION RESEARCH
BRANCH AT ALL OF NIH.
SO THE EARLY PLANNING EFFORTS
MORE THAN 20 YEARS AGO AND
EXTRAORDINARY OPPORTUNITY
DESIGNATION WERE IMPETUS FOR
TWO INITIATIVES.
THE CENTERS OF EXCELLENCE AND
CANCER COMMUNICATION RESEARCH,
EXTRAMARITAL FUNDING INITIATIVE
THAT FUNDED P 50 CENTERS AND
OUR NATIONAL TRENDS SURVEY.
WHICH IS WHY WE ARE ALL HERE
TODAY.
AS I SAID, HINTS WAS FIRST
FIELDED IN 2003 AND FIELDED 16
TIMES TO DATE WITH SEVERAL
SPECIAL ITERATIONS INCLUDING
ONE IN PUERTO RICO AND TWO THAT
WERE TOBACCO SPECIFIC AND
FUNDED BY FDA'S CENTER FOR
TOBACCO PRODUCTS.
THE MOST RECENT GENERAL
POPULATION SURVEY WAS FIELDED
IN 2022.
AND NEXT ITERATION IS SLATED
FOR JANUARY 2024.
AT OUR LAST COUNT EARLIER THIS
YEAR THERE HAVE BEEN MORE THAN
800 HINTS PAPERS PUBLISHED IN
PEER-REVIEWED JOURNALS.
SO PLEASE CONGRATULATE
YOURSELVES FOR THAT.
THE HINTS PROGRAM HAS ENJOYED
SUPPORT FROM SEVERAL AGENCIES
AND OFFICES ACROSS THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES AND THE FEDERAL
GOVERNMENT.
NAMELY THE FOOD AND DRUG
ADMINISTRATION'S CENTER FOR
TOBACCO PRODUCTS, HHS, NATIONAL
COORDINATOR FOR INFORMATION
TECHNOLOGY, OR ONC FOR SHORT,
THE FCC AND ODPHP.
HINTS ITEMS ARE ACTUALLY THE
BENCHMARKS FOR SIX OF THE
HEALTHY PEOPLE NOW 2030, IT
USED TO BE HEALTHY PEOPLE 2020.
THE OBJECTIVES RELATED TO
COMPONENTS OF THE AFFORDABLE
CARE ACT.
PROPORTION OF ADULTS OFFERED
ONLINE ACCESS TO THEIR MEDICAL
RECORD.
PROPORTION WHO USE IT FOR
HEALTHCARE DATA AND COMMUNICATE
WITH PROVIDERS.
ITEMS LIKE THAT.
IN ADDITION TO HINTS, NCI'S
RESEARCH BRANCH HAS HELD
SEVERAL MEANINGFUL INITIATIVES
OVER THE LAST 20 YEARS THAT
HAVE BUOYED UP HINTS AND HINTS
SUPPORTED INCLUDING EFFORTS ON
PATIENT-CENTERED COMMUNICATION,
HEALTH LITERACY, VACCINATION
INFORMATION AND MISINFORMATION
AMONG OTHERS.
I HAVE ROBIN VANDER POOL AND MY
COLLEAGUES IN THE RESEARCH
BRANCH TO THANK FOR THESE COOL
ROADMAP SLIDES THAT PLOT OUT
OUR KEY INITIATIVES.
I WANTED TO SHOW YOU THESE TO
GIVE YOU SOME CONTEXT FOR HOW
HINTS FITS WITH OTHER HEALTH
AND CANCER COMMUNICATION
EFFORTS AT NCI.
FOR EXAMPLE, OUR BRANCH HAS LED
SEVERAL FUNDING INITIATIVES
THAT EITHER SOLELY FOCUS ON
CANCER COMMUNICATION OR ADDRESS
IMPORTANT COMMUNICATION
RESEARCH QUESTIONS IN THE
CONTEXT OF OTHER DOMAINS.
EXAMPLES INCLUDE THREE
ISSUANCES OF OUR INNOVATIVE
APPROACHES TO SETTING CANCER
COMMUNICATION IN THE NEW
INFORMATION ECOSYSTEM P.A.R.'S
AND TELEHEALTH RESEARCH CENTERS
OF EXCELLENCE R.F.A. INITIATIVE
THAT WAS RECENTLY FUNDED.
AND HEALTH AND CANCER
COMMUNICATION RESEARCH WILL
CONTINUE TO BE AN IMPORTANT
AREA OF INVESTMENT FOR OUR
DIVISION AND OUR BRANCH IN THE
YEARS TO COME.
IN 2023 OUR DIVISION
ESTABLISHED SIX PRIORITY AREAS
FOR INVESTMENT WHICH OUR BRANCH
AND HINTS HAVE AN IMPORTANT
ROLE TO PLAY, DR. KATRINA
GODDARD WILL ADDRESS IN HER
OPENING REMARKS.
BEFORE I ASK HER TO DO THAT, I
WOULD LIKE TO TAKE A FEW
MINUTES TO HIGHLIGHT SOME OF
THE SURVEY'S ACCOMPLISHMENTS
AND CONTRIBUTIONS.
SO THOSE OF YOU WHO HAVE WORKED
WITH HINTS DATA ARE FAMILIAR
WITH THE PROTOCOLS ON THIS
SLIDE, SO I WON'T GO THROUGH
THEM.
BUT WHAT YOU MAY NOT KNOW IS
SINCE OUR FIRST FIELDING IN
2023, WE HAVE RECEIVED SURVEY
RESPONSES FROM MORE THAN 63,000
U.S. ADULTS.
WHICH I THINK IS PRETTY
IMPRESSIVE.
OUR BROAD OBJECTIVES HAVE
REMAINED CONSISTENT THROUGHOUT
THE SURVEY'S HISTORY.
WITH THE PRIMARY OBJECTIVE
IDENTIFY AND TRACK INFORMATION
SUPPORT NEEDS IN THE POPULATION.
AND THIS ALLOWS TO DOCUMENT
DISPARITIES AND INEQUALITIES
AND FIND OPPORTUNITIES FOR
INTERVENTIONS AND TRY TO SERVE
AS THE GOVERNMENT'S PREMIERE
SURVEILLANCE MECHANISM FOR
HEALTH INFORMATION CONSTRUCTS
INCLUDING THE HEALTHY PEOPLE
2030 BENCHMARKS I MENTIONED
EARLIER AND EXTRAMURAL SUPPORT
AND RESOURCES TO YOU.
WE HOPE WE DO THAT WELL.
RELEASING SECONDARY DATA FOR
PUBLIC HEALTH RESEARCHERS AND
PRACTITIONERS, EXTERNAL
STAKEHOLDERS AND OUR FEDERAL
PARTNERS AND PRODUCING AND
RELEASING POPULATION ESTIMATES
FOR PLANNING PURPOSES.
AND HINTS ALSO OBVIOUSLY
PROVIDES INTRAMURAL SUPPORT AND
RESEARCH OPPORTUNITIES FOR NCI
STAFF AND FELLOWS.
WE THINK THOSE OBJECTIVES ARE
BEING MET BASED ON ENGAGEMENT
AND PRODUCTIVITY.
OUR WEB ANALYTICS TELL US IN
THE LAST SIX YEARS DATA HAS
BEEN DOWNLOADED MORE THAN
33,000 TIMES BY MORE THAN
14,000 UNIQUE USERS.
IN EARLIER 2023 THIS YEAR, OUR
HINTS MANAGEMENT TEAMWORKED
WITH NIH LIBRARIANS TO CONDUCT
A BIBLIOMETRIC ANALYSIS OF
HINTS PUBLICATIONS TO TRY TO
ASSESS THE IMPACT OF OUR HINTS
PROGRAM.
THE RESULTS OF THAT ANALYSIS
POINT TO A NUMBER OF KEY
FINDINGS.
NAMELY THAT HINTS HAS A HIGHER
THAN AVERAGE CITATION IMPACT.
THERE'S A SIZABLE NUMBER OF
RESEARCHERS WORKING WITH DATA
INDEPENDENTLY OTHER THAN THOSE
OF US AT NCI WORKING WITH IT.
AND FACILITATED A LOT OF
WONDERFUL COLLABORATIONS
BETWEEN NCI AND OTHER
ORGANIZATIONS.
SO FOR EXAMPLE, THIS GRAPHIC IS
AN INSTITUTIONAL CO-AUTHOR SHIP
NETWORK THAT EXCLUDES NCI,
SHOWING 403 INSTITUTIONS
AFFILIATED WITH 503 AUTHORS OF
HINTS PUBLICATIONS WHERE NONE
OF THE AUTHORS ON THE
PUBLICATION WERE AFFILIATED
WITH NCI BUT CERTAINLY PEOPLE
WERE WORKING TOGETHER ON THEIR
RESEARCH.
AND THEN THIS ONE IS SHOWING
125 INSTITUTIONS AFFILIATED
WITH AUTHORS OF 170
PUBLICATIONS WHERE AT LEAST ONE
AUTHOR WAS AFFILIATED WITH
SOMEONE AT NCI.
IN TERMS OF CITATION IMPACT FOR
THE GROUP OF PAPERS, THE 650 OR
SO PUBLISHED FROM 2024, SO --
2004 A YEAR AFTER THE SURVEY
CAME OUT, IT WAS CITED TOTAL OF
OVER 12,000.
AVERAGE CITATIONS PER PAPER ARE
29.
I THINK IT'S REALLY IMPRESSIVE
WE HAVE AT LEAST 153 OF OUR
HINTS PUBLICATIONS IN THE TOP
10% OF CITATIONS OVERALL.
THE MOST FREQUENTLY CITED HINTS
STUDIES ARE THOSE THAT ARE
OLDER BECAUSE THEY HAVE HAD
MORE TIME TO BE READ AND CITED
BUT NEVERTHELESS TELL US A LOT
ABOUT THE CONTRIBUTION TO THE
LITERATURE.
TRUST AND USE OF HEALTH
INFORMATION SOURCES AND
DOCUMENTED THE IMPACT OF THE
INTERNET AND ITS IMPLICATIONS
FOR HEALTHCARE PROVIDERS AND
HAS BEEN CITED 999 TIMES, IT'S
PROBABLY 1,000 TIMES AS OF
TODAY.
THESE SLIDES ARE ABOUT A MONTH
OLD NOW.
AND THEN ANOTHER HINTS PAPER
ACHIEVING A REALLY HIGH
CITATION RATE WAS ACTUALLY THE
SECOND HIGHEST FOR HINTS
EXAMINED PREDICTORS OF E-HEALTH
USE AND PROVIDED INSIGHTS ON
THE DIGITAL DIVIDE.
AND OF COURSE THE ORIGINAL
HINTS METHODS PAPER PUBLISHED
BY DAVE NELSON AND NCI
COLLEAGUES HAS BEEN CITED QUITE
FREQUENTLY, I'M SURE MOST OF
YOU HAVE CITED THAT ONE.
OTHER MOST CITED HINTS
PUBLICATIONS ARE HEALTH
LITERACY AND SMOKERS
INFORMATION.
UNREALISTIC BELIEFS ABOUT
CANCER PREVENTION.
I THINK THE FIELD'S RELIANCE ON
THESE PAPERS INDICATES THE ROLE
OF HINTS AS A SURVEILLANCE TOOL
AND BASELINE FOR HEALTH
COMMUNICATION RESEARCH AND
HEALTH BEHAVIOR RESEARCH.
SEVERAL OF OUR PUBLISHED
STUDIES THAT HAVE USED HINTS
DATA ALSO GARNERED SIGNIFICANT
MEDIA ATTENTION AND CONTRIBUTED
TO POLICY AND POLICY
DISCUSSIONS.
AS EVIDENCED BY ALT METRIC
ATTENTION SCORES.
I HOPE ALL OF YOU ARE FAMILIAR
WITH ALTMETRIC, ALL OF THESE I
WILL MENTION ON THIS SLIDE AND
NEXT, ARE IN THE TOP 5% OF
RESEARCH INPUTS SCORED BY
ALTMETRIC BROADLY AND THERE ARE
OTHER STUDIES IN THAT TOP 5% OF
SCORES BUT I DON'T HAVE TIME TO
MENTION THEM ALL.
SO A HINTS PAPER LED BY JEN
TABER AND COLLEAGUES IS WHY
PEOPLE AVOID MEDICAL CARE.
IT GARNERED SIGNIFICANT MEDIA
ATTENTION WITH OVER 76 STORIES
AND 66 NEWS OUTLETS, AND WHO
AND A PAPER LED BY AMANDA GRAM
AND MICHAEL AMATO USED HINTS TO
DOCUMENT 12 MILLION SMOKERS
HAVE LOOKED ONLINE FOR SMOKING
CESSATION HELP ANNUALLY.
AND IT WAS MENTIONED IN 69
STORIES FROM 66 MEDIA OUTLETS
AND SEIDENBERG AND COLLEAGUES I
THINK THIS YEAR USED HINTS TO
LOOK AT ALCOHOL AS A CARCINOGEN
AND IF THAT LINK CONTRIBUTES TO
PEOPLE'S OPINIONS ABOUT POLICY
MEASURES TO PREVENT ALCOHOL USE.
SUK AND COLLEAGUES DOCUMENTED
KNOWLEDGE OF HPV AND THE
RECEIPT OF HPV RECOMMENDATIONS
IN A PAPER IN JAMA PEDIATRIC
THAT'S RESULTED IN 46 NEW
STORIES.
ANTHONY AND COLLEAGUES USED
HINTS TO DOCUMENT WHO ISN'T
USING PATIENT PORTALS AND WHY.
FORD AND COLLEAGUES USED HINTS
ABOUT PERSONAL HEALTH RECORDS
AND PREDICT FUTURE ADOPTION
LEVELS.
I THINK THE PREDICTION OF THESE
FINDINGS AND RESULT IN HIGH
ALTMETRIC ATTENTION SCORES
HINTS IS USED FOR PRACTITIONERS
AND POLICY MAKERS AND THEY HAVE
UTILITY BEYOND JUST ACADEMIC
EFFORTS.
SO KUDOS TO ALL OF YOU WHO ARE
DOING THIS IMPORTANT WORK.
AND THANKS FOR MAKING HINTS
DATA PART OF THE LARGER PUBLIC
INFORMATION ENVIRONMENT.
SO WHAT DO THE NEXT 20 YEARS
HAVE IN STORE?
WE HOPE TO CONTINUE TO NURTURE
OUR ROBUST COMMUNICATION DATA
USER COMMUNITY FOCUSED ON
ANSWERING IMPORTANT HEALTH AND
CANCER COMMUNICATION RESEARCH
QUESTIONS THAT CAN INFORM
PRACTICE.
WE WILL HAVE MORE ABOUT
LONGITUDINAL DATA TOMORROW.
EXPAND DATA LINKAGES,
PRIORITIZE THE NEEDS OF CANCER
SURVIVORS AND CAREGIVERS IN OUR
COLLECTION EFFORTS.
KEEP PACE WITH IMPORTANT
DEVELOPMENTS IN THE
COMMUNICATION AND HEALTH
INFORMATION TECHNOLOGY
LANDSCAPES.
TRYING TO HAVE MORE FOCUS ON
EMERGING SOCIAL MEDIA PLATFORMS
RESPONSES TO ONLINE
MISINFORMATION, CHANGES IN
TELEHEALTH POLICY ET CETERA.
WE HOPE TO CONTINUE TO SUPPORT
OUR FEDERAL PARTNERS IN
TRACKING POLICY IMPLEMENTATION
AND GUIDELINE ADHERENCE AND TO
STAY ON THE CUTTING EDGE OF
SURVEY METHODOLOGY.
WE HAVE A REAL TREAT AFTER
LUNCH WHERE WE WILL HAVE A
PANEL OF DIRECTORS OF FEDERAL
SURVEYS TALKING ABOUT
CHALLENGES AND OPPORTUNITIES
FOR FEDERAL SURVEY RESEARCH.
SO WE HOPE YOU WILL BE HERE
WITH US FOR THE NEXT 20 YEARS.
WE ARE GLAD YOU ARE HERE WITH
US TODAY.
SO NEXT, IT'S MY HONOR TO
INTRODUCE KATRINA GODDARD.
DR. GODDARD IS THE DIRECTOR OF
DIVISION OF CANCER CONTROL AND
POPULATION SCIENCES HERE AT NCI.
THE DIVISION THAT HOUSES HINTS.
DR. GODDARD WAS APPOINTED THE
DIRECTOR OF THE DIVISION OF
CANCER CONTROL AND POPULATION
SCIENCES IN OCTOBER 2021, SO
SHE IS STILL PRETTY NEW TO OUR
DIVISION.
IN THIS POSITION SHE OVERSEES
OUR DIVISION THAT COVERS A WIDE
RANGE OF SCIENTIFIC DOMAINS AND
DISCIPLINES, INCLUDING EPI
BEHAVIORAL SILENCES,
SURVEILLANCE AND STATISTICS,
CANCER SURVIVEORSHIP AND HEALTH
OUTCOMES RESEARCH.
PRIOR TO JOINING NCI SHE WAS A
DISTINGUISHED INVESTIGATOR AND
DIRECTOR OF TRANSLATIONAL AND
APPLIED GENOMICS AT KAISER IN
PORTLAND OREGON.
BIO STATITICIAN.
SHE HAS A BS IN MOLECULAR
BIOLOGY FROM UNIVERSITY OF
WISCONSIN, MADISON.
WELCOME, DR. GODDARD.
>> Katrina Goddard: WELCOME,
EVERYONE.
AND REALLY CONGRATULATIONS TO
EVERYONE HERE WHO HAS TAKEN
PART IN HINTS OVER THE PAST 20
YEARS.
I AM JUST THRILLED TO HAVE THE
OPPORTUNITY TO FOLLICLY'S
REMARKS.
-- FOLLOW KELLY'S REMARKS.
THANK YOU, KELLY FOR GIVING US
THE WONDERFUL LOOK OVER THE
PAST 20 YEARS AND NOW I GET TO
LOOK FORWARD ABOUT HOW HEALTH
COMMUNICATION AND HINTS IN
PARTICULAR IS REALLY GOING TO
BE PART OF THE FUTURE
DIRECTIONS OF THE DIVISION.
AS KELLY MENTIONED WE DEVELOPED
SIX PRIORITY AREAS SINCE I
JOINED NCI.
THIS WAS A PROCESS THAT
INVOLVED OUR ENTIRE RESEARCH
COMMUNITY.
WE HAD A REQUEST FOR
INFORMATION AND RECEIVED NEARLY
400 IDEAS WHAT OUR PRIORITIES
SHOULD BE BETWEEN THE
EXTRAMURAL COMMUNITIES AND
OTHER STAKEHOLDERS AS WELL AS
STAFF IDEAS WE GATHERED
INTERNALLY AT NCI.
SO FROM THOSE 400 IDEAS WE WENT
THROUGH A FACILITATED PROCESS
TO NARROW IT DOWN AND COME UP
WITH THESE SIX PRIORITY AREAS.
THESE SIX AREAS WERE CHOSEN
BECAUSE WE THINK THERE'S AN
OPPORTUNITY RIGHT NOW TO REALLY
ADVANCE THE SCIENCE IN THESE
AREAS.
BECAUSE THESE AREAS BUILD UPON
THE WORK THAT WE HAVE DONE OVER
THE PAST 25 YEARS IN THIS
DIVISION.
AND BECAUSE SOME OF THESE AREAS
REALLY NEED GREATER
COORDINATION FROM THE NCI TO
BUILD INFRASTRUCTURE IN ORDER
TO HELP RESEARCHERS BE ABLE TO
DO THE SCIENCE THAT IS VERY
DIFFICULT TO DO TODAY.
SO THOSE WERE KIND OF THE THREE
REASONS WHY WE CHOSE THESE SIX
PRIORITY AREAS.
I WANT TO TALK ABOUT HOW HINTS
IS REALLY GOING TO BE
CONTRIBUTING TO ALL OF THESE
PRIORITIES, AND HAS CONTRIBUTED.
SO STARTING WITH THE DIGITAL
HEALTH PRIORITY AREA.
I THINK THAT IT IS CLEAR THAT
DIGITAL TECHNOLOGIES ARE HERE
TO STAY AND REALLY INTERESTING
OPPORTUNITY FOR US TO THINK
ABOUT HOW TO USE THESE
TECHNOLOGIES AS PART OF
HEALTHCARE AND AS PART OF
HEALTH COMMUNICATION.
SO THESE ARE JUST SOME EXAMPLES
OF THE RELEVANT HINTS ITEMS
THAT HAVE BEEN ON PAST SURVEYS
FOR HINTS.
SO ONE IS ON YOUR TABLET OR
SMARTPHONE.
DO YOU HAVE ANY SOFTWARE
APPLICATIONS OR APPS FOR HEALTH.
DID YOU RECEIVE CARE FROM A
DOCTOR OR HEALTH PROFESSIONAL
USING TELEHEALTH.
DURING THE PANDEMIC WE SAW A
DRAMATIC INCREASE IN THE USE OF
TELEHEALTH AND I THINK THAT'S A
TECHNOLOGY THAT IS HERE TO STAY
AND SOMETHING THAT WE NEED TO
STUDY HOW TO USE IT MOST
EFFECTIVELY.
OUR NEXT PRIORITY AREA IS
CLIMATE CHANGE.
THIS IS SOMETHING THAT REALLY
IMPACTS HEALTH BEHAVIORS BUT IT
ALSO IMPACTS HOW WE DELIVER
CANCER CARE.
AND SO THIS IS AN EXAMPLE HOW
MUCH DO YOU THINK CLIMATE
CHANGE WILL HARM YOUR HEALTH.
SO TRYING TO UNDERSTAND
ATTITUDES ABOUT CLIMATE CHANGE
ANDITY HEALTH EFFECTS.
MODIFIABLE RISK FACTORS HAS
BEEN PART OF OUR BREAD AND
BUTTER OVER THE PAST 25 YEARS.
A REALLY IMPORTANT AREA OF
RESEARCH IN CANCER, IT
CONTRIBUTES ABOUT 40% OF CANCER
DEATHS ARE FROM KNOWN
MODIFIABLE RISK FACTORS.
SO THIS IS AN AREA THAT WE
STILL NEED TO CONTINUE TO WORK
ON ADDRESSING THESE HEALTH
BEHAVIORS AND MODIFIABLE RISK
FACTORS THAT ARE REALLY MAKING
A SUBSTANTIAL CONTRIBUTION TO
CANCER RISK.
AND SO SOME OF THE ITEMS YOU
CAN SEE HERE, THIS QUESTION HOW
MUCH DO YOU THINK DRINKING
ALCOHOL CAN INCREASE A PERSON'S
CHANCE OF DEVELOPING CANCER WAS
A VERY IMPORTANT QUESTION THAT
LED TO, THAT WAS PUBLISHED IN
THE SEIDENBERG MANUSCRIPT THAT
KELLY WAS TALKING ABOUT.
HEALTH EQUITY IS SOMETHING THAT
WE ALL NEED TO FOCUS ON.
AND THE HEALTH DISPARITIES IN
THIS COUNTRY AND WORLDWIDE ARE
SUBSTANTIAL AND SOMETHING THAT
WE CAN MAKE A DIFFERENCE IN.
SO THIS IS A PRIORITY FOR OUR
DIVISION TO STUDY WAYS THAT WE
CAN REDUCE THESE HEALTH
DISPARITIES.
AND HINTS QUESTIONS HAVE
CONTRIBUTED TO UNDERSTANDING
PEOPLE'S FOOD INSECURITY AND
DISCRIMINATION IN HEALTHCARE
SETTINGS AND HOW THEY HAVE
EXPERIENCED THAT IN THEIR OWN
PERSONAL SITUATION.
HEALTH POLICY IS ONE WAY THAT
WE CAN REALLY TAKE THE RESEARCH
THAT WE ARE DOING AND HELP TO
EMBED EVIDENCE-BASED PRACTICES
INTO FUTURE CARE AND TO MAKE
SURE THAT THE RESEARCH WE DO
CAN BE SUSTAINED AND SCALABLE
NATIONWIDE.
SO SOME OF THE HINTS ITEMS HERE
ARE LOOKING AT EXCESSIVE
ALCOHOL USE AND LOOKING AT
WARNINGS ON CONTAINERS AS
HEALTH POLICY.
AND WHEN YOU ORDER FOOD DO YOU
SEEK CALORIE INFORMATION ON THE
MENU.
SO THESE ARE PARTICULAR POLICY
THAT'S COULD MAKE A DIFFERENCE
IN HEALTH BEHAVIORS.
DATA STRATEGIES IS REALLY
IMPORTANT BECAUSE WE REALLY
NEED TO FIND WAYS TO DO OUR
WORK MORE EFFICIENTLY AND TO
REUSE TO THE MAXIMUM EXTENT
POSSIBLE THE MAXIMUM AMOUNT OF
INFORMATION WE ARE COLLECTING.
I THINK HINTS IS A NICE EXAMPLE
FROM THE STATISTICS KELLY
QUOTED WITH SO MANY
PUBLICATIONS, SO MANY USERS
WERE REALLY LIVING THAT
IMPORTANCE OF DATA STRATEGIES
THROUGH HINTS TO ENSURE THE
DATA IS ACCESSIBLE AND TO
ACCELERATE THE DISCOVERIES.
I ALSO WANT TO TALK ABOUT
NATIONAL CANCER PLAN.
MARTINA JOINED AND WHAT SHE DID
AFTER JOINING NCI WAS TO COME
OUT WITH THE NATION'S NATIONAL
CANCER PLAN.
THIS INVOLVES EVERYONE.
IT'S ALL OF GOVERNMENT, ALL OF
SOCIETY APPROACH TO HOW WE CAN
TACKLE THE ISSUE OF CANCER.
THERE ARE EIGHT PRIORITY AREAS
IN THE NATIONAL CANCER PLAN
LISTED HERE.
IN THE RED TEXT YOU COULD SEE
HOW HINTS IS CONTRIBUTING TO
EACH OF THESE PRIORITY AREAS.
IN TERMS OF PREVENTION OF
CANCER, TRACKING KNOWLEDGE,
ATTITUDES AND BEHAVIORS RELATED
TO CANCER PREVENTION.
DETECTING CANCERS EARLY.
SHARED DECISION MAKING.
AND ADDRESSING CANCER SCREENING.
ELIMINATING INEQUITIES.
LOOKING AT DIFFERENCES IN
ACCESS AND USE TO INFORMATION
TECHNOLOGY.
DELIVERING OPTIMAL CARE.
LOOKING AT PATIENT PROVIDER
COMMUNICATION, CARE
SATISFACTION AND CARE
UTILIZATION.
ENGAGING EVERY PERSON IN
RESEARCH.
IT PROVIDES AN OPPORTUNITY FOR
THOSE WITH CANCER AND AT RISK
FOR CANCER TO PARTICIPATE IN
RESEARCH BY BEING PART OF THE
HINTS SURVEY.
AND MAXIMIZING DATA UTILITY
BECAUSE THIS DATA IS FREELY
AVAILABLE TO THE RESEARCH
COMMUNITY AND REALLY BEING ABLE
TO FACILITATE THOSE
COLLABORATIONS LIKE KELLY
SHOWED IN THE VERY IMPRESSIVE
NETWORK OF COLLABORATIONS THAT
ARE USING HINTS DATA.
SO I WANTED TO END WITH SHOWING
SOME OF THE CANCER
COMMUNICATION-RELATED FUNDING
OPPORTUNITIES.
I HOPE THAT YOU WILL CONSIDER
APPLYING FOR THESE
OPPORTUNITIES.
WE WOULD REALLY LIKE TO
STIMULATE SCIENCE IN THESE
AREAS AND SEE MORE PEOPLE WHO
ARE STUDYING THESE TOPICS.
THERE ARE SEVERAL.
SO STARTING OFF WITH INNOVATIVE
APPROACHES FOR STUDYING CANCER
COMMUNICATION IN THE NEW
INFORMATION ECOSYSTEM.
I THINK EVERYONE IN THIS
AUDIENCE, BOTH IN PERSON AND
VIRTUALLY UNDERSTANDS THE
IMPORTANCE THAT CANCER
COMMUNICATION IS GOING TO HAVE.
IN OUR FUTURE HEALTH OF THE
POPULATION AND THE COVID
PANDEMIC ONLY UNDERLINED AND
UNDERSCORED THAT IMPORTANCE.
LOOKING AT THE
PATIENT-CLINICIAN RELATIONSHIP.
LEVERAGING HEALTH INFORMATION
TECHNOLOGY TO ADDRESS AND
REDUCE HEALTHCARE DISPARITIES.
AND SECONDARY ANALYSES TO
INTEGRATE EXISTING DATA AND
ELUCIDATE CANCER RISK AND
RELATED OUTCOMES.
SO I THINK YOU CAN SEE HOW MANY
OF THESE TOPICS RELATE TO THE
PRIORITIES I JUST MENTIONED AS
WELL.
WE ALSO RECENTLY HAD A NEW
P.A.R. ANNOUNCED ON POPULATION
APPROACHES TO REDUCE
ALCOHOL-RELATED CANCER RISK.
AND AGAIN, THIS WAS PARTIALLY
MOTIVATED BY SOME OF THE DATA
FROM HINTS, SO THAT IS EXCITING.
UNDERSTANDING EXPECTANCIES IN
CANCER-SYMPTOM MANAGEMENT.
AND NOTICE OF SPECIAL INTEREST
ON TELEHEALTH AND CANCER CARE.
SO THANK YOU VERY MUCH FOR
BEING HERE TODAY.
AND REALLY ENJOY THE CONFERENCE.
THANK YOU.
>> Kelly Blake: THANK YOU, DR.
GODDARD FOR THOSE REMARKS.
NOW IT'S MY PLEASURE, HONOR AND
THRILL TO INTRODUCE YOU TO MY
FRIEND MARLENE CAMACHO-RIVERA
WHO IS THE CONFERENCE CHAIR FOR
THIS HINTS MEETING, TO GIVE HER
KEYNOTE ADDRESS TITLED --
SORRY, THE PATH TOWARDS HEALTH
COMMUNICATION EQUITY, A JOURNEY
THROUGH 20 YEARS OF HINTS.
DR. CAMACHO-RIVERA IS AN
ASSISTANT PROFESSOR OF
COMMUNITY HEALTH SCIENCES AT
SUNY DOWNSTATE SCHOOL OF HEALTH.
SHE RECEIVED HER B.S. IN
BIOLOGY AND SOCIETY FROM
CORNELL.
M.P.H. FROM HEALTH POLICY AND
MANAGEMENT FROM TUFTS AND SCM
AND SCD DEGREES IN SOCIAL
EPIDEMIOLOGY FROM THE HARVARD
SCHOOL OF PUBLIC HEALTH AND
POSTDOCTORAL FELLOW AT THE
FEINSTEIN INSTITUTE FOR MEDICAL
RESEARCH NORTH WELL HEALTH.
DR. CAMACHO-RIVERA'S RESEARCH
FOCUSES ON THREE MAIN THEMES.
SOCIAL AND STRUCTURAL
DETERMINANTS OF CHRONIC DISEASE
DISPARITIES.
EXPLORING PATTERNS AND
DETERMINANTS WITHIN GROUP
HETEROGENEITY AND CHRONIC
HEALTH OUTCOMES WITHIN LATINOS
AND DESIGN BETWEEN MULTI-LEVEL
COMMUNITY-ENGAGED INTERVENTIONS
TO MANAGE CHRONIC DISEASE
SELF-MANAGEMENT AMONG NON URBAN
COMMUNITIES WITH NEW HEALTH AND
TECHNOLOGIES.
MARLENE HAS LONG BEEN A HINTS
DATA USER.
HAS CHALLENGED US TO REALLY
FOCUS ON HEALTH EQUITY AND SHE
IS ACTIVELY ENGAGED WITH HINTS
DATA AND OTHER RESEARCH THAT
EXAMINES DETERMINANTS AND
IMPACTS OF CANCER, COVID-19
PANDEMIC, I THINK SHE HAS SOME
FROM NHLBI AT ONE TIME.
HER RESEARCH HAS BEEN FUNDED BY
NCI, ASSOCIATION OF AMERICAN
MEDICAL COLLEGES, NATIONAL
INSTITUTE ON MINORITY HEALTH
AND HEALTH DISPARITIES AND
STONEY WALL HERBERT FUND.
JOIN ME IN WELCOMING OUR
CONFERENCE CHAIR, DR. MARLENE
CAMACHO-RIVERA.
>> Marlene Camacho-Rivera: GOOD
MORNING, EVERYBODY.
WHAT A TREAT AND PLEASURE TO BE
ABLE TO BE HERE IN PERSON TO BE
ABLE TO REALLY HELP US KICKOFF
WHAT I THINK IS GOING TO BE AN
EXCITING AND PRODUCTIVE TWO
DAYS OF EVENTS AND ACTIVITIES
HERE AT THIS CONFERENCE.
I WAS ASKED TO SORT OF THINK
ABOUT HOW WE CAN CONTEXTUALIZE
AND KICKOFF THE THEME IN
THINKING ABOUT 20 YEARS OF
HINTS.
I THOUGHT THROUGH THIS KEYNOTE
IN THE CONTEXT OF THE FACT THAT
AS MANY OF YOU KNOW, LAST WEEK
STARTED THE KICK-OFF TO LATINO
HISPANIC HERITAGE MONTH.
YES, THANK YOU FOR THAT.
SO I WAS REFLECTING BACK ON MY
JOURNEY INTO PUBLIC HEALTH AND
THINKING ABOUT HEALTH EQUITY, I
REALIZED MY PATH IN THE FIELD
OF PUBLIC HEALTH AND HEALTH
EQUITY STARTED WITH MY EARLIEST
LIVED EXPERIENCES BEING THE
DAUGHTER OF IMMIGRANTS, HELPING
MY FAMILY SERVE AS AN
INTERPRETER AND NAVIGATOR IN
ORDER TO ENHANCE THEIR
EFFECTIVE COMMUNICATION AND
RELATIONSHIPS WITH HEALTHCARE
PROVIDERS.
SO AT THE VERY CENTER OF MY
JOURNEY IN PUBLIC HEALTH AND AS
A HEALTH EQUITY RESEARCHER AND
PRACTITIONER IS COMMUNICATION.
IT'S ACTUALLY BEEN SUCH A
PRIVILEGE TO BE ABLE TO WORK
WITH HINTS TO THINK ABOUT HOW
TO CONTEXTUALIZE MY HINTS
EXPERIENCE INTO THE BROADER
FIELD.
I WANT TO TALK A LITTLE BIT
JUST ABOUT HEALTH EQUITY.
AND WE HAVE ALREADY HEARD IT
MENTIONED SEVERAL TIMES HERE
WITHIN THE CONFERENCE.
I'M SURE IT WILL BE A RUNNING
THEME WE WILL BE ABLE TO SEE
AND ESTABLISH OUR OWN
INTERCONNECTIONS AS WE MOVE
THROUGH THESE TWO DAYS.
I REALLY LIKE THIS CDC
FRAMEWORK AND VISUAL ROADMAP
FOR THINKING ABOUT HOW WE CAN
PAVE THE ROAD TO HEALTH EQUITY
AND ADVANCE HEALTH EQUITY.
I WANT TO HIGHLIGHT FOUR KEY
POINTS THAT HAVE ALREADY BEEN
TOUCHED UPON WITHIN THIS
MORNING'S PRESENTERS.
THE FIRST IS ABOUT MEASUREMENT.
HINTS PLAYS AN IMPORTANT ROLE
IN HEALTH COMMUNICATION, HEALTH
INFORMATION SURVEILLANCE
RESEARCH AND CANCER
SURVEILLANCE RESEARCH ALONG
WITH SIERRA MOORE BROADLY.
WE WILL THINK MORE AS AN
EPIDEMIOLOGIST I LIKE GEEKING
OUT THINKING CRITICALLY ABOUT
MEASUREMENT.
WHAT I WANT US TO THINK ABOUT
WITH RESPECT TO HEALTH EQUITY
IS EVERY SINGLE DATA POINT
WITHIN HINTS IS A PERSON, A
PERSON WITH UNIQUE LIVED
EXPERIENCES WHO AGREED TO
PARTICIPATE IN HINTS BECAUSE
THEY WANTED THEIR STORY TOLD.
AND THAT'S SOMETHING THAT IS
INCREDIBLY IMPORTANT FOR HEALTH
EQUITY.
ESPECIALLY AS WE THINK ABOUT
HOW WE AMPLIFY THE STORIES OF
THOSE WHO HAVE BEEN
HISTORICALLY SILENCED.
ESPECIALLY INDIVIDUALS WHO COME
FROM SYSTEMICALLY MARGINALIZED
BACKGROUNDS.
I ALSO WANT US TO THINK ABOUT
HOW WE CAN ADD DEPTH AND
CONTEXT TO THOSE STORIES.
AND AS A SOCIAL EPIDEMIOLOGIST
A LOT OF MY WORK HAS BEEN
BRINGING ATTENTION TO MORE
UPSTREAM STRUCTURAL AND SOCIAL
FACTORS IN TERMS OF THINKING
ABOUT HOW THEY INFLUENCE ACCESS
AND UPTICK OF INFORMATION, AS
WELL AS HEALTH INFORMATION
TECHNOLOGY AND HEALTH
COMMUNICATION INTO BROADER
CONTEXT.
BUT IT'S NOT ENOUGH FOR US TO
THINK ABOUT DATA AND
MEASUREMENT.
DATA FOR THE SAKE OF DATA
DOESN'T REALLY ADVANCE HEALTH
EQUITY AT ALL.
SO REALLY THINKING ABOUT HOW WE
CAN TRANSLATE THE SCIENTIFIC
EVIDENCE UTILIZING HINTS INTO
BOTH ADVANCEMENTS IN PROGRAMS,
CANCER PREVENTION AND CONTROL
PROGRAMS, AGAIN TO ADVANCE
HEALTH EQUITY BROADER ON A
BROADER SCOPE NATIONALLY, AS
WELL AS WITHIN OUR LOCAL
COMMUNITIES.
AND I WILL SPEND JUST A FEW
MINUTES HIGHLIGHTING LOCAL
INITIATIVES LEVERAGING HINTS AS
WELL.
WE HAVE ALREADY HEARD ABOUT
POLICY AND THE REALLY IMPORTANT
ROLE THAT HINTS PLAYS IN
HELPING TO UNDERSTAND AMERICANS
AWARENESS OF POLICIES, WITH
RESPECT TO CANCER INEQUITIES IN
THE FIELDS OF TOBACCO, ALCOHOL,
MENU-LABELING.
BUT OF COURSE THINKING ABOUT
HOW WE CAN UNDERSTAND AND TAKE
THE PULSE OF U.S. ADULTS TO
REALLY BE ABLE TO ADVOCATE FOR
POLICY CHANGE THAT WILL HELP
ADVANCE HEALTH EQUITY.
BUT OF COURSE IT'S IMPORTANT
FOR US TO REALIZE ADVANCEMENT
IN POLICY MEASUREMENT AND
PROGRAMS CAN ONLY TAKE US SO
FAR IF WE ARE NOT INVESTING IN
INFRASTRUCTURE.
INFRASTRUCTURE IS KEY TO
ADVANCING HEALTH EQUITY,
ESPECIALLY, AGAIN, AMONG
COMMUNITIES THAT HAVE BEEN
HISTORICALLY DISINVESTED, AS
WELL AS INDIVIDUALS FROM
SYSTEMICALLY MARGINALIZED
BACKGROUNDS.
AND I WILL HIGHLIGHT THAT AS AN
EARLY CAREER INVESTIGATOR WHO
IS AT AN INSTITUTION NOT
AFFILIATED WITH AN NCI
AFFILIATED CANCER CENTER, HINTS
HAS PLAYED AN IMPORTANT ROLE
MAKING PUBLICLY AVAILABLE DATA
THAT AGAIN WE CAN UTILIZE TO
TRANSLATE INTO PROGRAMS WITHIN
OUR COMMUNITIES IN CENTRAL
BROOKLYN.
SO WE GOT A REALLY GREAT
OVERVIEW OF THE CONTEXT AND
HISTORY OF HINTS, SO I DON'T
WANT TO BELABOR THE POINT TOO
MUCH.
BUT THERE WAS A LOT OF WORK
HAPPENING BEHIND THE SCENES
BEFORE 2003, TEN YEARS IN THE
MAKING I THINK THAT REALLY LED
TO THE IMPETUS AND
ESTABLISHMENT OF HINTS.
THAT WAS EVERYTHING FROM
CHANGES IN HOW WE ACCESS
INFORMATION, LITTLE THINGS
CALLED THE WORLD WIDE WEB.
CHANGES IN TECHNOLOGY AND
ACCESS TO THE FIRST SMARTPHONE.
AND OF COURSE, HOW WE THINK
ABOUT ADVANCEMENTS IN SCIENCE
AND HOW WE CAN COMMUNICATE
ADVANCEMENTS IN SCIENCE,
ESPECIALLY IN FIELDS OF
UNCERTAINTY TO THE GENERAL
PUBLIC.
IT'S NO SURPRISE THIS WAS
HAPPENING RIGHT AROUND THE TIME
WE WERE THINKING OF ADVANCEMENT
IN THE HUMAN GENOME AND
TRANSLATING SOMETHING AS
COMPLEX AS GENOMIC INFORMATION
AND GENETIC INFORMATION TO THE
PUBLIC.
WE CONTINUE TO SEE HOW
ADVANCEMENTS IN SCIENCE AND THE
NEED FOR ADVANCEMENT IN SCIENCE
RESULTING IN RAPID
COMMUNICATION OF EVIDENCE-BASED
INFORMATION, WE HAVE SEEN THAT
WITHIN THE LAST THREE YEARS IN
MOVING THROUGH THE COVID-19
PANDEMIC.
SO WE TALKED A LITTLE BIT
AGAIN, KELLY PRESENTED A REALLY
GREAT OVERVIEW OF THE
ESTABLISHMENT OF HINTS AS A
NATIONAL HEALTH INFORMATION
SURVEILLANCE PROGRAM.
WITHIN THE BROADER CONTEXT OF
SURVEILLANCE RESEARCH, ALONG
WITH SEER AND PLAYING AN
IMPORTANT ROLE REDUCING
HEALTHCARE INEQUITIES.
THE GOALS OF HINTS HAVE BEEN
CONSTANTLY BUT THE WAY HINTS
CONSTANTLY EVOLVES TO MEET
THOSE GOALS WITHIN U.S. ADULTS
IS EXCITING.
THINKING ABOUT IDENTIFYING
PATTERNS AND CHANGES IN HEALTH
INFORMATION ENVIRONMENT,
DOCUMENTING SOURCES OF
COMMUNICATION CHANNELS.
THINKING ABOUT HOW TO ACCESS
AND UPTAKE HEALTH INFORMATION
AND COMMUNICATION INFLUENCE
CANCER DISPARITIES ACROSS THE
CONTINUUM.
AGAIN, THINKING ABOUT
INVESTMENT IN INFRASTRUCTURE
FROM THE VERY BEGINNING, MAKING
SURE THAT HINTS IS PUBLICLY A
FREELY AVAILABLE TO A BROAD
STAKEHOLDER BASE AND PROVIDING
THEM WITH THE TOOLS TO BE ABLE
TO EFFECTIVELY UTILIZE HINTS IS
IMPORTANT.
SO I JUST WANTED TO HIGHLIGHT
THE EARLY HINTS FRAMEWORK,
WHICH AGAIN, REALLY BRAD IS
HERE IN THE ROOM.
I'M SURE HE MIGHT HAVE BEEN
SOME TIME SINCE HE HAS SEEN
THIS PARTICULAR FIGURE.
AGAIN, REALLY THINKING ABOUT
THE FOREFRONT, REALLY THINKING
ABOUT HOW HINTS HAD A
TREMENDOUS AMOUNT OF FOREFRONT
IN THINKING ABOUT NOT JUST THE
IMPORTANCE OF AWARENESS AND
RAISING AWARENESS AROUND HEALTH
INFORMATION AND HEALTH
COMMUNICATION, BUT THINKING OF
HEALTH COMMUNICATION IS
MODIFIED BY SOCIOECONOMIC,
COMMUNITY STRUCTURAL AND
BROADER STRUCTURAL CONTEXT.
OF COURSE THINKING ABOUT HOW
THAT GETS TRANSLATED INTO
HEALTH BEHAVIORS THROUGH
KNOWLEDGE AND ATTITUDES.
AND OF COURSE RECOGNIZING THAT
THERE'S RECIPROCAL
RELATIONSHIP, RIGHT?
THE MORE YOU KNOW, THE MORE YOU
BECOME AWARE, THE MORE
KNOWLEDGE THAT IS GAINED HOW
THAT CAN CONTINUE TO RESULT IN
BEHAVIORAL CHANGE.
THIS WAS A REALLY IMPORTANT
EARLY PUBLICATION FROM HINTS
THAT UTILIZED THE FIRST WAVE OF
HINTS DATA.
AND AGAIN, HIGHLIGHTING THE
NEED FOR CONSIDERATION OF
STRUCTURAL AND SOCIAL CONTEXT
WITH RESPECT TO THINKING ABOUT
COMMUNICATION INEQUALITIES.
THIS PARTICULAR FIGURE, IF YOU
LOOK AT THE FIGURE ON THE RIGHT
SHOWS THE PERCENTAGE THAT POINT
WHO HAD ACCESS TO INTERNET USE
AND AGAIN, REALLY SHOWING THE
IMPORTANCE OF HINTS IN TERMS OF
BEING ABLE TO SET THE STAGE FOR
U.S. ADULTS FOR THE DIGITAL
DIVIDE.
WHAT WE CAN SEE WITHIN THIS
PUBLICATION IS WE KNOW THERE
ARE DISPARITIES AND DISPARITIES
CONTINUE AND PERSIST IN
INTERNET USE ACROSS RACE
ETHNICITY, SOCIOECONOMIC
STATUS, AS WELL AS PLACE-BASED
DISPARITIES.
I WANT TO TALK A LITTLE BIT
ABOUT HOW WE HAVE BEEN ABLE TO
CONTINUE TO MOVE THE NEEDLE
FORWARDMENT A LOT OF MY WORK
HAS BEEN FOCUSED ON THINKING
ABOUT WHAT LIES WITHIN THESE
BROADER DISPARITIES THAT WE
DOCUMENT THROUGH MANY OF OUR
EXISTING WORK WITHIN BROAD
RACIAL AND ETHNIC AND OTHER
PARTICULAR CATEGORIES AND
SOCIAL IDENTITIES.
AND SO, ONE OF THE PAPERS I HAD
THE PLEASURE OF WORKING WITH
KELLY AT HINTS WITH IS TO BE
ABLE TO LOOK AT HETEROGENEITY.
THIS IS THE FIRST TIME TO LOOK
AT LATINO GROUPS TO UNDERSTAND
DISPARITIES AND PATTERNS OF USE.
THIS WAS IN A SPECIAL ISSUE BIO
MARKERS AND PREVENTION.
WE FOUND TRUST AND USES OF
VARIOUS SOURCES OF CANCER
INFORMATION VARIED CONSIDERABLY
27% RADIO 91% OF TRUST IN
DOCTORS, AS THE PRIMARY SOURCE
OF HEALTH INFORMATION.
BUT WE DID FIND ETHNIC
DIFFERENCES BY COUNTRY OF
ORIGIN WITH LATINOS FROM
CARIBBEAN BACKGROUNDS, CUBANS
AND PUERTO RICANS MORE LIKELY
TO TRUST SOURCES FROM PRINT
MEDIA COMPARED TO LATINOS FROM
MEXICAN OR AMERICAN DESCENT AND
WE CONTINUE TO FIND DISPARITIES
BY AGE AND GENDER IDENTITY.
WHAT THIS REALLY POINTED TO IS
THE NEED FOR US TO THINK AGAIN,
BEYOND THESE BROAD DISPARITY
CATEGORIES THAT WE SO OFTEN USE.
AND THINK ABOUT HOW WE CAN
THINK ABOUT THESE FOR CANCER
COMMUNICATION AND PREVENTION.
GETTING MORE SPECIFICITY IN
THESE GROUPS AND REALIZE ONE
SIZE FITS ALL APPROACHES NEVER
WORK OUT AS WE INTENDED.
I WANT TO HIGHLIGHTS THIS
EXISTING WORK BEING DONE ACROSS
OTHER CATEGORIES AS WELL.
THE WORK OF DR. CHRIS WELDON
AND HIS COLLEAGUES, SEXUAL
IDENTITY AND MINORITY
RESPONDENTS WITH RESPECT TO
HINTS WITH RESPECT TO TRUST IN
TOBACCO INFORMATION.
WE WILL TALK ABOUT THE
HINTS-SEER AND IMPORTANT GROUPS
THAT NEED TO HAVE THEIR STORIES
AND EXPERIENCES TOLD.
AS A SOCIAL EPIDEMIOLOGIST I
WAS SO EXCITED I THINK I MIGHT
HAVE HELPED MANIFEST THAT INTO
FRUITION THINKING ABOUT FOR THE
FIRST TIME WE ARE ABLE TO
LEVERAGE EXISTING
ADMINISTRATIVE DATA AND CENSUS
DATA TO BE ABLE TO THINK ABOUT
STRUCTURAL AND SOCIAL CONTEXT
WITHIN HINTS RESPONDENTS.
AND I'M REALLY EXCITED TO
CONTINUE TO SEE THAT.
MOVE FORWARD.
OF COURSE THERE'S OPPORTUNITIES
FOR US TO THINK ABOUT HOW WE
DEVELOP OUR OWN COMMUNITY HINTS
AND BEING ABLE TO UNDERSTAND
SMALL AREA ESTIMATES OF HEALTH
INFORMATION, HEALTH
COMMUNICATION, INEQUALITIES
WITHIN OUR OWN COMMUNITIES.
WE HAVE TALKED A LOT ABOUT HOW
HINTS HAS USED, TO PE ABLE TO
TRANSLATE EVIDENCE INTO
PROGRAMMATIC ACTION.
SO I WON'T BELABOR THIS POINT
WITH RESPECT TO HINTS PLAYING
AN IMPORTANT ROLE IN TERMS OF
TRACKING NATIONAL OBJECTIVES
AROUND HEALTH COMMUNICATION AND
HEALTH INFORMATION TECHNOLOGY,
BOTH WITHIN HEALTHY PEOPLE 2020
AND HEALTHY PEOPLE 2030.
GETTING A PULSE OF ACCESS TO
HEALTH INFORMATION AND
COMMUNICATION WITHIN
DECISION-MAKING CONTEXT.
I WANT TO SPEND A LITTLE TIME
TALKING ABOUT THE POPULATION
HEALTH ASSESSMENT IN CANCER
CATCHMENT AREAS.
THIS WAS MY FIRST DEEP DIVES
USING HINTS.
I WAS FORTUNATE TO BE CO-LEAGUE
FOR MSK CATCHMENT AWARD IN 2016
WITHIN NEW YORK CITY AND WE
DECIDED TO FOCUS ON AREAS IN
CENTRAL BROOKLYN AND
COMMUNITIES IN CENTRAL BROOKLYN
THAT WERE UNDERSERVED BY
MEMORIAL SLOAN KETTERING, THIS
IS IN THE SPIRIT OF
PROGRAMMATIC GOALS OF THIS
SUPPLEMENTAL INITIATIVE TO
ENHANCE LOCAL CAPACITY TO BE
ABLE TO ACQUIRE DATA LEVERAGING
EXISTING QUESTIONS.
SO TRANSLATE THAT INTO HOW WE
CAN BETTER DEVELOP AND
DISSEMINATE CANCER CATCHMENT
ACTIVITIES TO ADDRESS
DISPARITIES WITHIN OUR AREA.
AND OF COURSE A REALLY
IMPORTANT ROLE IN
INFRASTRUCTURE WAS TO BE ABLE
TO FACILITATE COLLABORATIONS
THROUGH SHARED DATA ELEMENTS.
TO BE ABLE TO EXPAND RESEARCH
AGAIN AROUND LOCAL HEALTH
INEQUITIES.
SO THINKING ABOUT HINTS FROM
BOTH LARGE AND SMALL.
SO REALLY UNDERSTANDING THAT
INEQUITIES WITHIN OUR LOCAL
CONTEXT MAY OR MAY IN THE MAP
ONTO WHAT WE ARE SEEING
NATIONALLY.
SO IT'S REALLY IMPORTANT FOR US
TO THINK ABOUT AS WE CONTINUE
TO ADVANCE HEALTH EQUITY IN OUR
OWN COMMUNITIES TO WHAT EXTENT
THE DISPARITIES MIRROR WHAT WE
KNOW WITHIN THE BROADER HINTS
SCIENTIFIC EVIDENCE BASE.
SO THIS WAS A REALLY EXCITING
INITIATIVE TO BE A PART OF AND
THERE WERE TWO CYCLES OF
FUNDING OPPORTUNITIES THAT LED
TO TWO SPECIAL ISSUES.
ONE THAT WAS FOCUSED ON CANCER
EPIDEMIOLOGY BIO MARKERS AND
PREVENTION, WE HIGHLIGHTED
DISPARITIS IN SMARTPHONE USE
WITHIN CENTRAL BROOKLYN
NEIGHBORHOODS AND SPECIAL
SECTION WITHIN THE JOURNAL OF
RURAL HEALTH AND HAVING A
VIRTUAL MEETING IN 2020 TO TALK
ABOUT BEST PRACTICES AND
CONTINUE TO MOVE THESE
COLLABORATIONS FORWARD.
WITHIN NEW YORK CITY THESE
EXIST PART OF OUR NEW YORK CITY
CANCER COLLABORATIVE.
IT LED TO MORE THAN 50
ADDITIONAL PUBLICATIONS JUST
USING LOCAL AND AGGREGATED DATA
AND THOSE PUBLICATIONS CONTINUE
TO GROW.
THINKING ABOUT HOW WE TRANSLATE
EVIDENCE INTO ACTION, THROUGH
EVIDENCE-BASED TAILORED
MULTI-LEVEL PROGRAMS WITHIN OUR
OWN COMMUNITIES.
I WANT TO TALK A LITTLE ABOUT
SOME OF THE ADVANCES.
AGAIN, WE TALKED ABOUT POLICY.
WE HEARD ABOUT THE IMPORTANCE
THAT HINTS PLAYS IN
UNDERSTANDING THE U.S. ADULTS
AWARENESS IN SUPPORT FOR
POLICIES AS WELL AS GUIDELINE
TRACKING.
WE HAVE SOME REALLY EXCITING
PRESENTERS LATER WHO ARE GOING
TO BE PRESENTING ON THIS WORK.
IN TERMS OF THINKING ABOUT
EVERYTHING FROM AWARENESS OF
SPECIFIC HEALTH CONTENT
WARNINGINGS ON ALCOHOL
CONTAINERS IN LOTS OF WORK IN
TOBACCO USE FOR WORK OF
UTILIZATION OF IMAGES AND WORDS
ON TOBACCO PRODUCTS AND SOCIAL
MEDIA.
THERE WILL BE A PRESENTATION
TALKING ABOUT MENU LABELING AND
AWARENESS OF CALORIE
INFORMATION AMONG U.S. ADULTS
AND THINKING ABOUT GOVERNMENT
RECOMMENDATIONS FOR PHYSICAL
ACTIVITY.
AND THESE ARE SOME, AGAIN,
IMPORTANT RECENT PUBLICATIONS
JUST LEVERAGING THE EXISTING
QUESTIONS ON HINTS AROUND
POLICY SUPPORT AND TRACKING
THAT HAVE BEEN DISSEMINATED IN
BROAD AND HIGH IMPACT JOURNALS.
AND HINTS DOES ITS OWN WORK
WITH RESPECT TO PUBLISHING
THEIR OWN BRIEFS TO BE ABLE TO
COMMUNICATE SOME OF THESE KEY
FINDINGS.
SO THIS CAME, THE FIGURE ON THE
RIGHT CAME FROM HINTS BRIEF #50
LOOKING AT AWARENESS AND SUP
FOR THE FOR ADDITIONAL LABELING
THAT UTILIZES BOTH HEALTH AND
WORDS TO SHOW NEGATIVE IMPACTS
OF SMOKING AND OVERWHELMINGLY
SHOWING ADULTS SHOW STRONG
SUPPORT OR SUPPORT FOR
UTILIZATION OF IMAGES AND WORDS
BUT WE KNOW THERE'S DISPARITIES
ACROSS GEOGRAPHICAL CONTEXT AND
WITHIN SOCIOECONOMIC GROUPS AS
WELL.
I LAST WANT TO CLOSE BY TALKING
ABOUT INVESTMENTS IN
INFRASTRUCTURE.
AGAIN, WE CAN'T ADVANCE HEALTH
EQUITY WITHOUT THINKING OF
INFRASTRUCTURE.
I LOVE DR. GODDARD'S
PRESENTATION ABOUT ALL THE
DIFFERENT FUNDING OPPORTUNITIES
AVAILABLE FOR US TO THINK
CREATIVELY UTILIZING HINTS.
I COUNT 17 DATASETS BECAUSE I
COUNT THE DATA LINKAGE PROJECT
THOUGH THAT WAS EXISTING DATA.
THINKING ABOUT NOT JUST MAKING
DATA PUBLICLY AVAILABLE BUT
PROVIDING WEBINARS,
CONFERENCES, TUTORIALS TO
EMPOWER USERS TO THINK ABOUT
UTILIZING HINTS AND HOPEFULLY
PROVIDE FEEDBACK TO THE HINTS
COMMUNITY ABOUT FUTURE
DIRECTIONS AND GROWTH.
WE HAVE SEEN SUCCESS WITH
RESPECT TO THE NUMBER OF
ARTICLES AND PEER-REVIEWED
PUBLICATIONS WHERE I THINK WE
CAN DO MORE IS REALLY
INCORPORATING THE POWER OF
HINTS INTO FEDERALLY FUNDED
RESEARCH.
THINKING ABOUT THE IMPORTANCE
OF SECONDARY DATA AND EXISTING
DATA AND UTILIZING EXISTING
DATA INTO DEVELOPING AND
ADVANCING AND EVALUATING BOTH
INTERVENTIONS TO ENHANCE
EVERYTHING FROM PATIENT
PROVIDER COMMUNICATION TO
ACCESS AND UPTAKE TO TELEHEALTH
USE.
I HAVE DONE WORK ADDRESSING
INFORMATION AND MISINFORMATION
AMONG LATINOS AND HINTS
QUESTIONS HAVE PLAYED AN
IMPORTANT ROLE IN THAT.
CONTINUING TO THINK ABOUT HOW
WE CAN EVOLVE AND UTILIZE HINTS
IN NEW AND EXCITING WAYS AND
FOSTER CROSS COLLABORATION
ACROSS DISCIPLINES TO CONTINUE
TO SUSTAIN THIS WORK THAT'S
BEING DONE AND I WOULD BE
REMISS IF I DIDN'T MENTION THAT
THE MOST IMPORTANT INVESTMENTS
IN INFRASTRUCTURE ARE AMONG
BRINGING MORE HINTS USERS TO
THE TABLE EARLIER IN THE
PIPELINE.
SO REALLY SUPPORTING EARLY
CAREER INVESTIGATORS, STUDENTS.
I WILL GIVE A QUICK SHOUT OUT,
WE HAVE A FEW OF OUR STUDENTS
HERE AT SUNY DOWNSTATE
PRESENTING BECAUSE WE TEACH A
STATISTICS COURSE UTILIZING
HINTS WITHIN THE CLASSROOM.
REALLY THINKING ABOUT WAYS WE
CAN CREATE MORE INCLUSIVE
ENVIRONMENTS, MORE DIVERSE
ENVIRONMENTS FOR HINTS USERS
THAT WILL HELP TO SUSTAIN THIS
IMPORTANT WORK FOR YEARS TO
COME.
I THINK THAT'S IT.
I WANT TO GO AHEAD AND THANK
THE PLANNING COMMITTEE AGAIN,
AND SOME OF MY LONG-STANDING
HINTS COLLABORATORS FOR ALL THE
WORK WE HAVE BEEN DOING AND
WILL CONTINUE TO DO.
THANKS SO MUCH.
>> Kelly Blake: SO THAT WAS
AMAZING.
WE DIDN'T PAY MARLENE TO SAY
THOSE THINGS.
I DIDN'T TELL HER WHAT TO SAY.
TELL HER ANYTHING THAT WENT
INTO HER SLIDES.
THAT WAS ALL HER.
THANK YOU, MARLENE FOR BEING
SUCH A HINTS ADVOCATE AND AVID
HINTS USER AND OUR CONFERENCE
CHAIR.
THAT WAS REALLY GREAT.
SO NOW I'M GOING TO HAVE TO
FIGURE OUT HOW TO GET BACK TO
THE OTHER SLIDES.
JUST ONE MORE.
NEXT I WILL ASK ALL OF THE
PRESENTERS WHO ARE PRESENTING
IN OUR FIRST ORAL PRESENTATION
SESSION TO COME AND SIT AT THE
TABLE AT THE STAGE.
COME TO THE PODIUM TO GIVE YOUR
PRESENTATION, THEN SIT BACK
DOWN AT THE TABLE TO ANSWER
QUESTIONS AT THE END.
OUR MODERATOR FOR THIS SESSION,
I'M SO THRILLED HE IS HERE WITH
US IS DR. BRAD HESSE WHO USED
TO BE THE DIRECTOR OF THE HINTS
PROGRAM AND CHIEF OF THE HEALTH
COMMUNICATION AND INFORMATICS
RESEARCH AT NCI BEFORE HE
RETIRED IN 2019.
BRAD WILL WALK US THROUGH THIS
ORAL PRESENTATION SESSION.
IF THE PRESENTERS CAN COME TO
THE TABLE, WE WILL GET STARTED
WITH OUR FIRST DATA-DRIVEN SET
OF TALKS.
>> Moderator Bradford Hesse:
THANK YOU FOR COMING TODAY AND
BEING PART.
THIS IS INCREDIBLE, FELT LIKE
GOING TO SAN FRANCISCO, GO TO A
COUPLE VINEYARDS AND ALL OF THE
SUDDEN WE HAVE THIS GIGANTIC
INFRASTRUCTURE.
THANK YOU ALL.
I KNOW IN THE EARLY DAYS PART
OF WHAT WE WANTED TO DO WITH
HINTS IS KEEP TRACK OF THE
CHANGING HEALTH ENVIRONMENT.
BACK IN 2002-2003 IT WAS CD
ROMS.
THAT'S HOW OLD IT WAS.
SINCE THEN, OH MY GOSH.
AND THE PANDEMIC, RIGHT?
WE ARE GOING TO BE LOOKING IN A
FEW MINUTES WHAT HAPPENED FROM
THE OFFICES OF NATIONAL HEALTH
COORDINATOR, THEY ARE LOOKING
AT USE OF HEALTH INFORMATION
TECHNOLOGY.
THAT WILL BE OUR FIRST
PRESENTER.
WE WILL WATCH AMAZING TRENDS I
NEVER THOUGHT WE WOULD SEE.
WITH THAT, I WANT TO INTRODUCE
OUR FIRST SPEAKER FROM THE ONC.
SO THIS IS DR. CHELSEA RICHWINE.
HER TOPIC WILL BE ON PROGRESS
AND PERSISTED DISPARITIES IN
PATIENT INFORMATION IN HEALTH
INFORMATION TECHNOLOGY.
>> Chelsea Richwine: THANK YOU
FOR THE INTRODUCTION.
SO ON TREND WITH LOOKING BACK
AT THE LAST 20 YEARS OF HINTS
THIS PRESENTATION IS USING
SEVERAL WAVES OF THE HINTS TO
ASSESS PROGRESS AND PERSISTENT
DISPARITIES IN PATIENT ACCESS
TO ELECTRONIC HEALTH
INFORMATION.
AND BEFORE I DIVE INTO THE
RESULTS, I WANT TO GIVE A
LITTLE BIT OF BACKGROUND AND
IMPORTANCE TO THIS TOPIC.
EXPANDING PATIENT ACCESS TO
ELECTRONIC HEALTH INFORMATION
OR EHI HAS BEEN SHOWN TO HELP
MAKE INDIVIDUALS MAKE MORE
INFORMED DECISIONS ABOUT THEIR
HEALTH AND LEAD TO BETTER
HEALTH OUTCOMES.
TO ACHIEVE THIS GOAL THERE HAVE
BEEN SEVERAL FEDERAL EFFORTS
OVER THE LAST DECADE OR MORE TO
HELP MAKE INFORMED DECISIONS BY
INCREASING PATIENT ACCESS TO
EHI.
PROVIDERS TO ADOPT AND USE
ELECTRONIC HEALTH RECORD
SYSTEMS THAT ENABLE PATIENTS TO
DOWNLOAD AND TRANSIT HEALTH
INFORMATION, THIS IS LARGELY
VIA PATIENT PORTALS.
MORE RECENTLY IN 2020, SOUGHT
TO MAKE EHI MORE EASILY
ACCESSIBLE TO PATIENTS THROUGH
SECURE STANDARDS BASED EPI'S
THAT COULD BE USED TO CREATE
SMARTPHONE HEALTH APPS THAT CAN
HELP PATIENTS ACCESS THEIR
HEALTH INFORMATION.
DESPITE SUBSTANTIAL PROGRESS
OVER THE LAST DECADE IN
EXPANDING PATIENT ACCESS THIS
GROWTH HAS NOT OCCURRED
EQUITABLY.
THERE HAVE BEEN SEVERAL STUDIES
IDENTIFYING DISPARITIES IN
PATIENT ACCESS.
PARTICULARLY THE TWO, SHOW
BLACK AND HISPANIC PATIENTS
HAVE BEEN LESS OFFERED TO
ACCESS THEIR PORTAL COMPARED TO
WHITE INDIVIDUALS.
THIS IS NEGATIVE DOWNSTREAM
IMPLICATIONS IN ACCESS IN THE
USE OF EHI.
LOOKING AT SIX DIFFERENT WAYS
OF THE HINTS.
FROM 2014 TO 2022, EXAMINING
TRENDS ACCESSING PATIENT PORTAL.
THIS IS IMPORTANT BECAUSE WE
LOOK AT THIS IN 2022, WHICH MAY
HAVE INCREASED DEMAND FOR
PATIENT ACCESS TO EHI.
THIS WAS A GOOD OPPORTUNITY TO
LOOK AT THIS LONG TREND AND SEE
HOW MUCH PROGRESS WE HAVE MADE.
OBVIOUSLY DATA FOR THIS STUDY
COME FROM THE HINTS.
RANGING FROM HINTS 4 2014, TO
HINTS 6 IN 2022.
THIS USED QUESTIONS FROM THE
MEDICAL RECORDS QUESTION SET
FOR PATIENTS TO ENGAGE IN THEIR
MEDICAL RECORD OR PATIENT
PORTAL.
HENCEFORTH PATIENT PORTAL.
THE TRENDS OVER THE SIX WAVES
OF THIS STUDY, INDIVIDUALS
REPORTING THEY WERE OFFERED
ACCESS TO THE PORTAL BY THEIR
HEALTHCARE PROVIDER.
THEY WERE ENCOURAGED TO USE THE
PORTAL BY THEIR HEALTHCARE
PROVIDER, WHETHER THEY ACCESSED
IT AT LEAST ONCE IN THE PAST
YEAR, AS WELL AS HOW THEY
ACCESS THEIR PORTAL, THROUGH A
WEBSITE AND HEALTH APP OR BOTH
METHODS HOW THEY USE TO VIEW,
DOWNLOAD, TRANSMIT INFORMATION.
AS WELL AS EASE OF
UNDERSTANDING INFORMATION IN
THE PORTAL.
WE KNOW THE SAMPLE IS
RESTRICTED TO RESPONDENTS WHO
HAD HEALTHCARE VISIT IN THE
LAST 12 YEARS AND THUS HAD
REASON TO ACCESS THEIR PORTAL.
AND ALL THIS USED TO DEVELOP
THE HINTS TEAM.
SO THIS FIRST SLIDE SHOWS THOSE
OFFERED PATIENT PORTAL BY THEIR
HEALTHCARE PROVIDER AND THE
OTHER THOSE WHO HAVE ACCESSED
THEIR PATIENT PORTAL.
ACCESS HAS INCREASED WITH A
COUPLE SIGNIFICANT INCREASES
INDICATED BY THE ASTERISKS HERE.
BUT I REALLY WANT TO CALL
ATTENTION TO THE ACCELERATION
IN GROWTH AND PATIENT ACCESS
BETWEEN 2020 AND 2022 DURING
THOSE PANDEMIC YEARS.
THE SHARE OF INDIVIDUALS
OFFERED A PATIENT PORTAL
INCREASED 24% BETWEEN 2020 AND
2022.
AND THOSE WHO USED INCREASED
FROM 46% TO 86% IN 2022.
WHILE THERE ARE A LOT OF
DIFFERENT REASONS WHY PATIENT
ACCESS MAY HAVE ACCELERATED IN
THE LAST COUPLE YEARS, IT COULD
HAVE BEEN DUE TO INCREASED
DEMAND FOR PATIENT ACCESS
DURING THE PANDEMIC.
SOME OF THE POLICY EFFORTS I
MENTIONED IN THE LAST COUPLE
YEARS.
BUT WE ALSO SAW INCREASED
HEALTHCARE PROVIDER ENGAGEMENT
WHICH MAY HAVE CONTRIBUTED TO
PATIENT ACCESS.
IN OTHER WORDS THERE WAS AN
INCREASE IN INDIVIDUALS
INDICATING THEIR PROVIDER
OFFERED THEM A PORTAL AND
SIGNIFICANT INCREASE IN SHARE
OF PATIENTS THAT THEIR
HEALTHCARE PROVIDER ENCOURAGED
THEM TO USE THE PORTAL.
THIS MAY HAVE CONTRIBUTED TO
THE GROWTH OF ACCESS IN THE
MIDDLE PART OF THE BAR, THE
48-68%.
HOWEVER, WE ALSO SEE AMONG
THOSE OFFERED A PORTAL AND
ENCOURAGED TO USE IT, THERE
WERE STILL SIGNIFICANT
INCREASES IN ACCESS.
AMONG THOSE ENCOURAGED AND WE
ALSO SEE A SIGNIFICANT INCREASE.
THIS REALLY SUGGESTS THAT IN
ADDITION TO INCREASED
HEALTHCARE PROVIDER
ENCOURAGEMENT THERE'S INCREASED
PATIENT ENGAGEMENT, POTENTIALLY
DUE TO INCREASED DEMAND OR
OTHER FACTORS SUCH AS THESE
POLICY EFFORTS I MENTIONED.
SO TO THAT END, ONE OF THE
POLICY EFFORTS I MENTIONED IS
MAKING IT EASIER FOR PATIENTS
TO ACCESS INFORMATION.
ONE WAY IS EXPANDING APP-BASED
ACCESS TO EHI.
WE SEE BETWEEN 2020-2022 ACCESS
TO APP-BASED EHI INCREASED.
WHILE THERE WAS ONLY A SMALL
INCREASE IN APP-ONLY FROM 2016.
THERE WAS SIGNIFICANT INCREASE
USING BOTH AN APP AND A WEBSITE.
TOGETHER SUGGESTS INDIVIDUALS
HAD MORE WAYS TO ACCESS AND MAY
HAVE CONTRIBUTED TO THE
EXPANDED ACCESS WE SEE.
SO OVER THE LAST FEW SLIDES
PAINTED THIS POSITIVE PICTURE
IN EXPANSION IN PATIENT ACCESS.
WE SEE GROWTH IN PATIENT ACCESS
HAS NOT OCCURRED EQUITABLY.
THE DISPARITIES WE SAW IN
STUDIES IN 2020 APPEAR TO
PERSIST IN 2022.
SO IN THIS FIRST SET OF BARS WE
SEE BLACK AND HISPANIC
INDIVIDUALS HAD SIGNIFICANTLY
LOWER RATES OF INDICATING THEY
WERE OFFERED THE OPPORTUNITY TO
ACCESS THEIR PORTAL COMPARED TO
THEIR WHITE COUNTERPARTS.
BLACK AND HISPANIC
SIGNIFICANTLY LOWER RATES OF
BEING ENCOURAGED TO USE A
PORTAL AND SIGNIFICANTLY LOWER
RATES OF ACCESSING A PORTAL.
HOWEVER, AMONG THOSE THAT DID
HAVE AN OPPORTUNITY TO ACCESS
THEIR PORTAL THROUGH THE OFFER,
THERE WERE NO SIGNIFICANT
DIFFERENCES IN ACCESS AMONG
THAT GROUP.
THERE WERE ALSO NO SIGNIFICANT
DIFFERENCES IN ACCESS AMONG
THOSE ENCOURAGED TO USE THEIR
PORTAL.
TAKEN TOGETHER THIS SUGGESTS
ROLE OF OFFER AND ENCOURAGEMENT
MAY BE A DRIVING FORCE IN THE
OVERALL DISPARITIES WE SEE IN
ACCESS.
TO FURTHER DEMONSTRATE WE SAW
NO DIFFERENCES IN USE OR
UNDERSTANDING.
THIS IS SHOWING PATIENT PORTAL
USE FOR DIFFERENT USES LOOK UP
TEST RESULTS, DOWNLOAD, SEND
INFORMATION AND VIEW CLINICAL
NOTES AMONG RACE AND ETHNICITY,
WE SAW NO REAL DIFFERENCES IN
ACCESS AND THE WAYS THEY USE
THEM, COB SIS STENT WITH THE
FINDINGS FROM 2019 AND 2022 AS
WELL.
BLACK AND HISPANIC WERE MORE
LIKELY TO DOWNLOAD THEIR HEALTH
INFORMATION.
TAKING ALL THESE THINGS
TOGETHER, IT'S REALLY MAKES AN
IMPORTANT POINT THAT NOT ONLY
IS THE OFFER IN ACCESSIBILITY
OF PORTALS PLAYING A ROLE.
IT SUGGESTS THE DIFFERENCE IN
PREFERENCES IS NOT DRIVING
DIFFERENCES IN ACCESS.
THERE ARE NO DIFFERENCES IN USE
OR UNDERSTANDING OF INFORMATION.
SO TO HIGHLIGHT THESE KEY
POINTS FROM THE STUDY WE FOUND
THAT INDIVIDUAL REPORTED ACCESS
TO ENGAGEMENT WITH PATIENT
PORTALS EXPANDED SIGNIFICANTLY
BETWEEN 2014 AND 2022.
BUT RACIAL AND ETHNIC
DISPARITIES EXIST.
THERE WERE NO SIGNIFICANT
DIFFERENCES IN THE USE OR
UNDERSTANDING UNDERSTANDING
MEDICAL RECORDS IN THE PORTALS
AMONG THOSE WHO HAD ACCESS
WHICH PROMOTES EFFORTS WOULD
LIKELY BE SUCCESSFUL IN
INCREASING PATIENT ACCESS.
LOOKING FORWARD, I THINK
THERE'S BEEN PRIMARY DATA
SOURCE WITHIN ONC THAT ALLOWS
US TO MONITOR THE IMPACT OF
POLICIES IN THE BEGINNING THAT
ARE DESIGNED TO MAKE IT EASIER
FOR INDIVIDUALS TO ACCESS AND
USE EHI THROUGH VARIETY OF
CHOICES INCLUDING SMARTPHONES
AND APPS.
IN ADDITION TO OTHER SURVEYS WE
HAVE LOOKING AT HOSPITALS AND
PROVIDERS USE OF VHR'S THAT
ENABLE THESE CAPABILITIES HINTS
OFFERS THIS PATIENT PERSPECTIVE
ON PERSONAL EXPERIENCES USING
TECHNOLOGIES TO ACCESS EHI.
THEREFORE ONGOING MEASUREMENT
IS ESSENTIAL FOR CONTINUED
ASSESSMENT AMONG PATIENT ACCESS
OVERALL BUT FOR ALL INDIVIDUALS.
IDENTIFYING AN OPPORTUNITY TO
ACCESS THEIR EHI AND CHOOSING
TO DO SO IS A REALLY CRITICAL
FIRST STEP IN DEVELOPING
SOLUTIONS IN ACHIEVING
EQUITABLE ACCESS AND USE.
THANK YOU.
I'M HAPPY TO ANSWER ANY
QUESTIONS AT THE END OF THE
PRESENTATION.
THIS IS NOT SOMETHING THAT
WOULD COME FROM THE ONC BUT ONE
OF THE POTENTIAL -- ONE OF
THE PAPERS I PUBLISHED LAST
YEAR WAS IMPLEMENTING A
UNIVERSAL ACCESS POLICY.
IT TAKES AWAY GUESSWORK OF
MAKING INDIVIDUAL OFFERS OR
RECOMMENDATION AND JUST SAYING
ANYONE WHO WALKS THROUGH YOUR
DOOR IS OFFERED A PORTAL.
I THINK THIS IS REALLY
IMPORTANT BECAUSE I THINK WHERE
SOMEONE RECEIVES CARE CAN MAKE
A REALLY BIG DIFFERENCE.
SO YOU MIGHT SEE DIFFERENCES IN
OFFERING A PORTAL AND
ENCOURAGING THAT PORTAL AMONG
THOSE WHO HAVE A PRE-EXISTING
RELATIONSHIP WITH A PROVIDER
VERSUS A CLINIC.
SO IMPLEMENTING THIS WOULD TAKE
AWAY THE GUESSWORK AND RELIANCE
ON THE PROVIDER WHO I REALIZE
HAS A LOT OF OTHER TASKS AT
HAND.
IT WOULD BE HELPFUL FOR THEM,
THE ORGANIZATION AND PATIENTS
TO MAKE SURE EVERYBODY HAS THAT
OPPORTUNITY TO ACCESS THEIR
PATIENT INFORMATION, IF THEY
WANT TO.
>> NO BUTTONS, I'M DR. RIVERA
WITH RUTGERS SCHOOL.
THIS IS A GREAT PRESENTATION.
IT'S MORE OF A CURIOSITY WHEN
YOU WERE LOOKING AT THE
DIFFERENCES BETWEEN WHITE,
BLACK AND HISPANIC USERS WHO
WERE OFFERED ACCESS, DID YOU
LOOK AT GEOGRAPHICAL DATA?
WAS THERE ANY, IF YOU HAVEN'T,
I THINK THAT WOULD BE VERY
INTERESTING TO SEE, ARE THERE
SPECIFIC REGIONS WHERE MAYBE
MORE OF AN EFFORT HAS TO BE PUT
INTO REACHING THOSE PROVIDERS
SO THEY ARE ACTUALLY GETTING
EQUAL ACCESS?
>> YEAH, SO THERE WASN'T
GEOGRAPHIC INFORMATION
AVAILABLE BUT THERE WERE
PARTICULARLY IN THE PAST
PAPERS, THIS IS SORT OF AN
UPDATE OF A PAPER I PUBLISHED
AT THE END OF LAST YEAR.
IN THAT ONE WE CONTROLED FOR A
NUMBER OF DIFFERENT THINGS,
INCLUDING WHETHER THE
INDIVIDUAL HAS ACCESS TO THE
INTERNET AS A PROXY.
THERE MIGHT HAVE BEEN AN
URBAN/RURAL SPLIT.
A COUPLE THINGS TO GET AT THAT
ACCESS.
I THINK THE INTERNET ACCESS WAS
A TRICKY ONE.
I THINK I ENDED UP CONTROLLING
FOR IN NUMBER OF INTERNET
ACCESS TYPES.
HAVING BROADBAND AND CELLULAR
AND WI-FI.
I THINK THERE'S A LITTLE BIT OF
MISUNDERSTANDING SOMETIMES, IN
WHICH CASE RESPONDENTS OF WHAT
TYPE OF ACCESS THEY HAVE.
I FOUND THAT CONTROLLING FOR
THE NUMBER WAS ACTUALLY A
BETTER PROXY OF ACCESS THERE.
BUT THAT'S CERTAINLY A REALLY
GOOD POINT THAT GEOGRAPHY AND
WHERE YOU ARE RECEIVING CARE IS
A BIG DRIVER OF THAT.
IT'S AN OPPORTUNITY TO LOOK AT.
THANK YOU.
>> Moderator Bradford Hesse:
ALL RIGHT.
>> Abhishek Henry: HI, I'M
ABHISHEK HENRY, I'M A GRADUATE
STUDENT AT MASTER OF PUBLIC
HEALTH IN EPIDEMIOLOGY AT OHIO
STATE UNIVERSITY.
STARTING OFF WITH SOME
BACKGROUND ON COLORECTAL
CANCER, IT'S THE SECOND LEADING
CAUSE OF CANCER-RELATED DEATHS
AMONG BOTH MEN AND WOMEN.
HOWEVER WE CAN PREVENT THROUGH
EARLY DETECTION.
IN 2021 THE UNITED STATES WITH
A TASK FORCE REDUCED SCREENING
AGE FROM 50 YEARS TO 45 YEARS.
AS AGE DECREASES OTHER MEANS OF
INTERVENTIONS MAY PROVE MORE
BENEFICIAL.
FOR EXAMPLE, 60% OF UNITED
STATES ADULTS REPORTED SEEKING
ONLINE HEALTH INFORMATION.
THIS JUST GOES TO SHOW TARGETED
ONLINE CANCER EDUCATION AND
PREVENTION CAN BE USED FOR
CANCER SCREENING UTILIZATION.
SO DURING THE COVID-19
PANDEMIC, IN-PERSON HEALTHCARE
VISITS WERE HARD TO ACCESS.
HOWEVER, ONLINE MEDICAL RECORDS
AND ONLINE PATIENT PORTALS
COULD HAVE BEEN USED TO BRIDGE
THE GAP BETWEEN PATIENTS AND
PROVIDERS AND INCREASE
HEALTHCARE ACCESS.
PREVIOUS STUDIES HAVE SHOWN
PATIENT PORTALS HAVE INCREASED
PATIENT-PROVIDER COMMUNICATIONS
REGARDING CRC SCREENING.
OUR DESIGN WAS TO EXAMINE THE
IMPACT OF ONLINE MEDICAL.
WE USED THE HINTS 5, CYCLES 2,
3, 4 BETWEEN 2018-2010.
-- -2020.
IT ASSESSES HEALTH
COMMUNICATION, AND HEALTH
RELATED ATTITUDES AND BEHAVIORS.
ADULTS AGE 45-75 WHO
PARTICIPATED IN THE HINTS
DURING THESE SPECIFIED CYCLES,
THIS AGE RANGE WAS CHOSEN TO BE
IN LINE WITH THE
RECOMMENDATIONS BY UNITED
STATES PREVENTIVE SERVICE TASK
FORCE.
AND WHY USE HINTS FOR THE
STUDY, IT INFORMS COMMUNICATION
AND CANCER PREVENTIONMENT OUR
DEPENDENT VARIABLE WAS CRC
SCREEN STATUS.
HAVE YOU EVER HAD A TEST TO
CHECK FOR COLON CANCER.
DICHOTOMIZED AS EVER SCREENED
AND NEVER SCREENED.
HINTS DID NOT PROVIDE OR ASK
THE SPECIFIC AGE TIMEFRAME FOR
WHEN THEY WERE SCREENED.
SO THIS IS WHY IT WAS
DICHOTOMIZED THIS WAY.
OUR INDEPENDENT VARIABLES WERE
SOCIAL DEMOGRAPHICS, MEDICAL
CONDITIONS AND ONLINE MEDICAL
RECORD USE ASSESSED THROUGH
WHETHER THEY ACCESS THEIR
ONLINE MEDICAL RECORDS IN THE
LAST 12 MONTHS ALSO
DICHOTOMIZED WITH YES OR NO.
GOING ONTO STATISTICAL ANALYSIS
WE FIRST APPLIED SURVEY WEIGHTS
USING THE JACK KNIFE
REPLICATION METHOD AND OTHER
FACTORS.
WE THEN CONDUCTED BVARIATE
ANALYSES, CHECK FOR PREDICTORS
AND SIGNIFICANT
ASSOCIATIONSMENT WE WANTED TO
SEE ASSOCIATIONS BETWEEN ONLINE
MEDICAL RECORD USE AND
INDEPENDENT VARIABLES, SO
BIVARIATE WAS USED HERE.
AND CHI-SQUARE TESTS WERE USED
TO ASSESS.
WE DID A MULTI-VARIABLE
LOGISTIC REGRESSION TO ASSESS.
OUR WEIGHTED SAMPLE SIZE WAS
AROUND 257 MILLION PARTICIPANTS.
ON THE RIGHT YOU WILL SEE A
GRAPH THAT SHOWS THE RACIAL
DISTRIBUTION IN OUR STUDY.
MAJORITY WERE NON-HISPANIC
WHITES AROUND 72%.
70% OF PARTICIPANTS REPORTED
PREVIOUS COLORECTAL SCREENINGS.
FOR REFERENCE THE 2021 NATIONAL
HEALTH INTERVIEW SURVEY
REPORTED COLORECTAL SCREENINGS
AT 59% FOR ADULTS 45 YEARS OR
OLDER.
SO OURS HAS A LITTLE BIT MORE
REPORTINGS.
52% OF PARTICIPANTS ALSO
REPORTED ACCESSING THEIR ONLINE
MEDICAL RECORDS AT LEAST ONCE
IN THE LAST PAST YEAR.
MEAN AGE WHERE AVERAGE WAS 59
YEARS AND NEVER SCREENED WAS 52
YEARS.
THESE ARE RESULTS OF THE
BIVARIATE ANALYSES.
THESE MIMIC TODAY'S TRENDS IN
COLORECTAL SCREENING, WE ARE
SEEING HIGHER RATES IN
NON-HISPANIC BLACK AND
NON-HISPANIC WHITE.
THOSE WERE HIGHER EDUCATIONAL
ATTAINMENT AND THOSE WITH
INSURANCE.
WE ALSO FOUND THOSE WITH HIGH
BLOOD PRESSURE TO ALSO HAVE
MORE COLORECTAL CANCER
SCREENING RATES.
THIS IS BIVARIATE ANALYSIS OF
ONLINE MEDICAL RECORD USE.
THOSE WITH INSURANCE, 53% HAD
REPORTED PREVIOUS ACCESSING
THEIR ONLINE MEDICAL RECORDS
WHILE ONLY 20% ACCESSED THEM
WITHIN THE GROUP WITHOUT
INSURANCE.
THIS IS CONTROLLING FOR
CONFOUNDERS.
WE SEE HIGHER ODDS OF COLO
RECTAL SCREENING AMONG NON
HISPANIC AFRICAN AMERICANS
COMPARED TO NON HISPANIC WHITES.
THIS DEMONSTRATES PROMOTION OF
SCREENING AMONG THESE
INDIVIDUALS.
WE SEE GREATER ODDS OF
SCREENING AMONG ONLINE MEDICAL
RECORD USERS.
SHOWING ASSOCIATION OF
COLORECTAL SCREENING AND ONLINE
MEDICAL RECORD USE.
WE ALSO SEE GREATER ODDS AMONG
OLDER INDIVIDUALS.
THOSE WITH HIGHER EDUCATIONAL
ATTAINMENT AND THOSE WITH
INSURANCE.
NOTABLY, YOU COULD SEE THE ODDS
RATIOS ARE QUITE HIGH FOR THE
LAST FEW FACTORS.
SOME STRENGTHS AND LIMITATIONS
FOR OUR STUDY.
IT'S A LARGE DATASET.
SO IT'S QUITE GENERALIZABLE
FINDINGS.
OUR GROUP IS THE FIRST TO FIND
UTILITY AMONG THE GENERAL
POPULATION.
ALSO INTERNET USE AND
TECHNOLOGY HAVE BEEN IDENTIFIED
AS SOCIAL DETERMINANTS OF
HEALTH.
SO OUR STUDY INVESTIGATES THE
BEHAVIOR AND SOCIAL CONTEXTUAL
RELATED INFORMATION BETWEEN
THIS AND SCREENING.
SOME QUICK LIMITATIONS.
OUR STUDY INCLUDED THOSE WHO
ARE AVERAGE RISK AND HIGH RISK
FOR COLORECTAL CANCER.
SO WE ARE TREATING THEM THE
SAME WHEN THEY MIGHT NOT IN
FACT BE.
SO THOSE WITH HIGHER RISK
MIGHT HAVE DIFFERENT SCREENING
GUIDELINES OR DIFFERENT
COMMUNICATION WITH THEIR
PROVIDERS.
WHEN WE DICHOTOMIZE BETWEEN
EVER SCREENED AND NEVER SCREEN
WE ARE ASSUMING THOSE NOT
UP-TO-DATE WITH THEIR
COLORECTAL SCREENING
RECOMMENDATIONS HAVE THE SAME
SCREENING BEHAVIORS AS THOSE
WHO ARE.
SO THERE ARE DIFFERENT KINDS OF
SCREENING TESTS LIKE THE FIT
TEST WHICH IS DONE ANNUALLY OR
A COLONOSCOPY USUALLY DONE
EVERY TEN YEARS.
YOU CAN SEE HOW THOSE WHO ARE
NOT UP-TO-DATE MIGHT BE STILL
CONSIDERED IN EVER SCREEN
CATEGORY.
WE ALSO HAVE SELF-REPORTED COLO
RECTAL SCREENING AND ONLINE
MEDICAL REPORT USE REPORTS.
THERE ARE SOME CAUSALITY
CONCERNS, THE LIMITATION ACROSS
CONCEPTUAL DESIGN AND LIMITED
RACIAL AND ETHNIC DIVERSITY, WE
SAW MAJORITY OF THE POPULATION
WERE NON HISPANIC WHITE SO
GREATER OUTREACH AND SAMPLING
COULD HELP.
WE SAW POSITIVE ASSOCIATION
BETWEEN COLORECTAL SCREENING
AND ONLINE MEDICAL RECORD USE.
SHOWING HOW ONLINE MEDICAL
RECORD UTILITY CAN PROMOTE
SCREENING.
WE STILL SAW DISPARITIES AMONG
SCREENING AND ONLINE MEDICAL
RECORD USE.
THROUGH HIGHER EDUCATIONAL
ATTAINMENT AND INSURANCE STATUS
WE MIGHT BE SEEING HIGHER
ECONOMICALLY SOCIAL STATUS
LEADS TO BETTER OUTCOMES.
WE SAW LOWER ODDS OF COLORECTAL
SCREENING AMONG HISPANICS, NON
HISPANIC ASIAN AND NON HISPANIC
OTHER.
NON HISPANIC AFRICAN AMERICANS
HAD HIGHER ODDS OF SCREENING.
I WANT TO TALK ABOUT MODIFIABLE
AND NON MODIFIABLE FACTORS.
AGE, RACE AND ETHNICITY ARE NON
MODIFIABLE.
ONLINE RECORD USE, EDUCATION
AND INSURANCE ARE MODIFIABLE.
HOWEVER, ONLINE MEDICAL RECORD
USE IS AN ACTIONABLE TARGET
THAT HEALTHCARE PATIENTS AND
SYSTEMS CAN CHANGE TOGETHER.
THEY ARE MORE ACCESSIBLE AND
OPERATIONALIZED AMONG GENERAL
PATIENT POPULATION.
COMPARED TO INFLUENCING
EDUCATION STATUS OR INSURANCE
STATUS.
NOTING TECHNOLOGY AND USE OF
INTERNET ARE SOCIAL
DETERMINANTS OF HEALTH,
PROMOTION OF TECHNOLOGY AND
ONLINE BASED INTERVENTIONS SUCH
AS ONLINE MEDICAL RECORD USE
CAN LEAD TO POSITIVE HEALTH
OUTCOMES.
THANK YOU.
>> COULD IT BE POSSIBLE THOSE
ARE CORRELATED AND NEEDS
FURTHER STUDY.
ASSUMING THERE'S A CAUSAL LINK,
BRINGING BACK TO THE PREVIOUS
PRESENTER, HOW WOULD YOU EXPECT
THAT WOULD RELATE TO FURTHER
DISPARITIES IN PATIENTS WITH
COLO RECTAL CANCER?
AS A PRIOR PRESENTER SHOWED,
MINORITIES ARE LESS LIKELY TO
UTILIZE ONLINE MEDICAL RECORDS
SO THAT COULD POTENTIALLY
FURTHER PERPETUATE DISPARITIES.
>> Abhishek Henry: YEAH, WE ARE
INVOLVED IN ANOTHER STUDY WE
ARE ASSESSING THE FACILITATORS
FOR ONLINE MEDICAL RECORDS AND
PATIENT PORTALS AMONG AFRICAN
AMERICANS AND SPECIFICALLY HOW
THAT MIGHT INFLUENCE THEIR
COLORECTAL CANCER SCREENING
RATES.
THERE ARE DISPARITIES AND
BARRIERS.
SOME RELATE TO OLDER
INDIVIDUALS HAVING TROUBLE
USING TECHNOLOGY.
OR THEY PREFER BEING IN-PERSON
WITH THEIR PROVIDERS RATHER
THAN COMMUNICATING ONLINE.
SO WITHIN DIFFERENT RACIAL
GROUPS WE STILL DO SEE THAT
THOSE DIFFERENCES, I WILL SAY
THAT EVEN AMONG NON-HISPANIC
WHITE INDIVIDUALS, THOSE
LIMITATIONS ARE STILL THERE.
SO OLDER INDIVIDUALS MIGHT NOT
WANT TO USE ONLINE MEDICAL
RECORDS OR TECHNOLOGY JUST
BECAUSE OF THAT GAP IN
KNOWLEDGE FOR TECHNOLOGY USE.
BUT FURTHER STUDIES CAN BE USED
TO INVESTIGATE ONLINE MEDICAL
RECORD USE AGAINST DIFFERENT
SUBGROUPS, SO YEAH.
>> Moderator Bradford Hesse:
ACTUALLY, YOU WERE SETTING UP
OUR NEXT SPEAKER.
SO DR. YINJIAO YE FROM
UNIVERSITY OF RHODE ISLAND,
TALKING A LITTLE ABOUT OLDER
PEOPLE, AND I'M NOW IN THAT
CATEGORY.
SOMETIMES WILL HAVE STRUGGLES
WITH TECHNOLOGY AND NEED HELP
WITH THAT.
SO WE WANT TO TRACK THOSE.
IN HAWAIIAN THERE'S GREAT
RESULT FOR OLDER PEOPLE, KAPUNA.
SO I APPRECIATE THE FACT YOU
ARE REMEMBERING THAT PART OF
THE POPULATION AS WE LOOK NOW
AT HOW TO TRY TO TAKE OUR
INFORMATION ENVIRONMENT AND
SCULPT IN A WAY THAT IS
COMPLETELY ACCESSIBLE BY ALL
GROUPS.
SO THANK YOU FOR PRESENTING AND
IT'S UP TO YOU NOW.
>> THANK YOU.
>> Yinjiao Ye: THANK YOU.
SPEAKING OF THAT GROUP, IN TEN
YEARS I WILL BE IN THAT GROUP.
IT'S AN HONOR TO PRESENT THIS
RESEARCH TO OUR AUDIENCE TODAY.
SO IT IS ABOUT THE GREAT
DIGITAL DIVIDE IN THE
POST-PANDEMIC ERA.
I LOOK AT SEVERAL USES HOW
INFORMATION TECHNOLOGY
INCLUDING ACCESS TO THE
INTERNET, HEALTH RELATED
INTERNET USE, TELEHEALTH VISITS
AND THE USE OF ONLINE MEDICAL
RECORDS.
MAXWELL HUANG FROM NOBLE HIGH
SCHOOL STUDENT.
HE DID THIS RESEARCH.
A FEW PIECES OF INFORMATION
REGARDING WHY WE DID THIS STUDY.
THE FIRST THING THAT CAME TO
MIND IS THAT EVEN THOUGH THE
INTERNET HAS BEEN INVENTED FOR
30 YEARS, AS OF 2021, STILL 7%
OF THE POPULATION OF U.S.
ADULTS DIDN'T USE THE INTERNET.
AND THAT NUMBER BECOMES 25%
AMONG PEOPLE WHO ARE 65 YEARS
OR OLDER.
AND THE SECOND PIECE OF
INFORMATION THAT LEADS TO THE
STUDY IS THE RAPID HEALTHCARE
DIGITALIZATION.
ESPECIALLY DURING THE COVID
PANDEMIC.
JUST AN EXAMPLE, 90% OF
OFFICE-BASED DOCTORS IN THE
U.S. ADOPTED ELECTRONIC HEALTH
RECORDS IN 2021.
80% OF CANCER PATIENTS USE
SOCIAL MEDIA TO CONNECT WITH
THEIR PEERS.
AND 50% OF SMARTPHONE OWNERS
USE HEALTH APPS, AS OF 2021.
AND 39% OF U.S. ADULTS ACCESSED
THEIR ONLINE MEDICAL RECORDS AT
LEAST 1-2 TIMES A YEAR.
AND ONE THIRD OF THE U.S.
ADULTS USE WEARABLE HEALTHCARE
ELECTRONIC DEVICES.
AND THEN FINALLY, 22% OF
AMERICAN ADULTS USE TELEHEALTH.
THAT NUMBER IS UP FROM 11%
BEFORE THE PANDEMIC.
SO IT IS SIGNIFICANT INCREASE
IN HEALTHCARE DIGITALIZATION.
THE THIRD INFORMATION THAT
LEADS TO OUR RESEARCH IS OLDER
ADULTS POPULATION HEALTHCARE,
ESPECIALLY THEIR PERSONAL
HEALTHCARE SPENDING.
IN 2020, THE PERSONAL
HEALTHCARE SPENDING FOR OLDER
ADULTS IN THE U.S. WERE $1.2
TRILLION DOLLARS.
OR IN OTHER WORDS, OLDER ADULTS
USED ABOUT -- I MEAN, LIKE
ONE OLDER ADULT USE 22,356 IN
2020.
THAT NUMBER WAS 2.5 TIMES
HIGHER THAN THE AVERAGE
HEALTHCARE SPENDING BY AVERAGE
WORKING-AGE PERSON.
SO THOSE THREE THINGS REALLY
LED TO OUR INVESTIGATION HOW TO
MITIGATE THIS GRAY DIGITAL
DIVIDE AND REDUCE HEALTHCARE
EXPENDITURES FOR OLDER ADULTS.
SEVERAL SIGNIFICANT FINDINGS IN
THE LITERATURE.
NUMBER ONE IS THERE ARE THREE
LEVELS OF DIGITAL DIVIDE,
INCLUDING PHYSICAL ACCESS,
DIGITAL LITERACY AND BENEFITS
GAINED THROUGH THE USE OF
HEALTH INFORMATION TECHNOLOGY.
THE SECOND IS ABOUT THE
EVIDENCE OF THE GRAY DIGITAL
DIVIDE IN INTERNET ACCESS, AS
WELL AS IN HITU'S.
SO PREVIOUS RESEARCH HAS FOUND
THAT OLDER ADULTS ARE LESS
LIKELY TO USE THE INTERNET AS
WELL AS LESS LIKELY TO USE HIT,
OR HEALTH INFORMATION
TECHNOLOGIES.
AND THEN THERE IS A THEORY
REGARDING THE ADOPTION OF
HEALTHCARE TECHNOLOGY.
THE THEORY IS CALLED UNIFIED
THEORY OF ACCEPTANCE AND USE OF
TECHNOLOGY.
THE EXTENDED VERSION.
THE ABBREVIATION IS UTAUT2.
THIS THEORY PROPOSES, THERE ARE
SEVERAL FACTORS THAT CONTRIBUTE
TO THE ADOPTION OF HEALTH
INFORMATION TECHNOLOGY.
INCLUDING NUMBER ONE
PERFORMANCE EXPECTANCY.
WHICH IS THE EXPECTED BENEFITS
FROM THE USE OF THE TECHNOLOGY.
THE SECOND IS EFFORT EXPECTANCY.
WHICH IS THE EASE, DEGREE HOW
EASY IT IS TO USE THE
TECHNOLOGY.
THE THIRD IS SOCIAL INFLUENCE.
THE FOURTH IS FACILITATING
CONDITIONS.
NUMBER FIVE FACTOR IS HEDONIC
MOTIVATION.
IN OTHER WORDS PEOPLE USE
TECHNOLOGY NOT JUST FOR
INFORMATION BUT ALSO SOMETIMES
THEY USE IT FOR ENTERTAINMENT.
NUMBER SIX FACTOR IS PRICE
VALUE.
WHICH MEANS IF THE TECHNOLOGY
DOESN'T COST MUCH IN TERMS OF
HOW MUCH IT COSTS LIKE MONEY
VALUE.
AND THEN, IT ALSO BRINGS
BENEFITS TO THEIR PERSON.
THEN THE PERSON WILL SEE A
BETTER PRICE VALUE FOR USING
THE TECHNOLOGY THAT WILL LEAD
TO HIGHER LIKELIHOOD OF USING
THE TECHNOLOGY.
THE LAST ONE FACTOR FROM THIS
MODEL IS HABIT OF USING
TECHNOLOGY.
SO ALL THESE FACTORS ARE
LOOKING AT THE INDIVIDUAL'S
CHARACTERISTICS, AS WELL AS
SOCIAL INFLUENCE AND PHYSICAL
ENVIRONMENT FACTORS.
AND THEN, IN OUR RESEARCH WE
FOUND THERE'S SEVERAL GAPS.
EVEN THOUGH THE SIGNIFICANCE OF
FINDINGS IN THE LITERATURE.
THE NUMBER ONE GAP IS THERE WAS
LESS FOCUS ON OLDER ADULTS.
ESPECIALLY THEIR USE OF HEALTH
INFORMATION TECHNOLOGY.
THE SECOND IS THAT THE LIMITED
SCOPE OF HIT USE EXAMINED IN
THE PREVIOUS LITERATURE.
THE THIRD IS THAT THE USE OF
NATIONAL DATA TO EXAMINE THIS
TOPIC.
SO ALL THOSE THREE GAPS LED TO
OUR STUDY OF HOW OLDER ADULTS
USE HEALTH INFORMATION
TECHNOLOGIES.
AND THEN MORE IMPORTANTLY, LIKE
MENTIONED IN THE PREVIOUS
RESEARCH, THE PRESENTATIONS
THAT WE WANT TO TAKE A LOOK AT
THE MODIFIABLE RISK FACTORS.
SO FOR EXAMPLE, EDUCATION.
INCOME COULD BE MODIFIABLE.
AND ALSO HEALTH-RELATED
MOTIVATION.
FOR EXAMPLE, GENERAL HEALTH
STATUS OF OLDER ADULTS.
NOW, OUR RESEARCH HYPOTHESES
ARE BUILT UPON THE LITERATURE
REVIEW.
THE FIRST TWO HYPOTHESES
LOOKING AT TWO LEVELS OF
DIGITAL DIVIDE.
WE DIDN'T EXAMINE THE THIRD
LEVEL OF DIGITAL DIVIDE, WHICH
IS ABOUT BENEFITS GAINED
THROUGH THE USE OF HEALTH
INFORMATION TECHNOLOGIES, DUE
TO THE SCOPE OF THE QUESTIONS
IN THE HINTS DATA.
WE WOULD LIKE TO DO MORE ABOUT
THAT IN THE FUTURE.
BUT FOR NOW WE EXAMINED THE
FIRST OF TWO LEVEL DIGITAL
DIVIDE BETWEEN OLDER ADULTS AND
YOUNGER ADULTS.
THE FIRST ONE IS DIGITAL DIVIDE
IN INTERNET ACCESS.
THE SECOND IS DIGITAL DIVIDE IN
THE USE OF HEALTH INFORMATION
TECHNOLOGIES, INCLUDING
HEALTH-RELATED INTERNET USE,
TELEHEALTH VISITS AND USE OF
ONLINE MEDICAL RECORDS.
THE THIRD SET OF HYPOTHESES
DEAL WITH EDUCATION
MODIFICATION ON THE DIGITAL
DIVIDE.
THE TWO LEVELS OF DIGITAL
DIVIDE.
THE FOURTH SET OF HYPOTHESES
DEALS WITH THE INCOME
MODERATION ON THE DIGITAL
DIVIDE.
THE FINAL RESEARCH HYPOTHESES
IS ABOUT HOW GENERAL HEALTH
STATUS MODIFIES THEIR
SECOND-LEVEL DIGITAL DIVIDE.
ONE THING I WANT TO PROVIDE A
QUICK NOTE ABOUT IS THE LAST
ONE.
WE DIDN'T EXAMINE HOW STATUS
MODIFICATION BECAUSE WE THINK
IT'S MORE RELEVANT TO THE
SECOND LEVEL DIGITAL DIVIDE
WHICH IS THE USE OF H.I.T.
OUR METHODOLOGIES, WE USED THE
HINTS DATA IN CONDUCTED IN 2022
AND OUR MEASURES INCURRED
NUMBER ONE, THE PREDICTOR WHICH
IS AGE GROUP.
SO WE HAVE TWO AGE GROUPS, 65
YEARS AND OLDER, VERSUS YOUNGER
ADULTS.
THE OUTCOMES WE EXAMINED
INCLUDE TWO LEVELS.
NUMBER ONE IS PHYSICAL ACCESS
OR THE FIRST-LEVEL OF DIGITAL
DIVIDE WHICH IS INTERNET ACCESS.
THE SECOND SET OF OUTCOMES IS
H.I.T. USE, RECRUITING THE
THREE TYPES OF H.I.T.'S I
MENTIONED BEFORE.
SO THERE WE LOOK AT MODERATORS
INCLUDING EDUCATION, INCOME AND
GENERAL HEALTH STATUS.
ALL THESE ANALYSIS ARE ADJUSTED
FOR GENDER AND RACE.
AND THEN WE CONDUCTED THE
REGRESSION ANALYSIS BY USING
ACCESS LOGISTIC OR PROCEDURES
DEPENDING WHETHER THE OUTCOMES
ARE CONTINUOUS VARIABLES OR
CATEGORICAL VARIABLES.
OUR RESULTS, THE VERY FIRST
THING WE NOTICED IN THE
ANALYSIS WAS THE GRAY DIGITAL
DIVIDE IN INTERNET ACCESS.
SO THAT SPEAKS TO THE FIRST
LEVEL OF DIGITAL DIVIDE.
SO OLDER ADULTS WERE LESS
LIKELY TO USE THE INTERNET THAN
YOUNGER ADULTS.
SO IN OTHER WORDS, YOUNGER
ADULTS WERE 4.55 TIMES MORE
LIKELY TO USE THE INTERNET THAN
OLDER ADULTS.
SO THAT CONFIRMED OUR FIRST
DIGITAL RESEARCH HYPOTHESES.
THE SECOND IS ABOUT THE SECOND
LEVEL DIGITAL DIVIDE.
SO IN TERMS OF HEALTH-RELATED
INTERNET USE, OLDER ADULTS WERE
LESS LIKELY TO USE THAT.
IN TERMS OF ACCESSING ONLINE
MEDICAL RECORDS, OLDER ADULTS
WERE MUCH LESS LIKELY TO ACCESS
ONLINE MEDICAL RECORDS,
COMPARED TO YOUNGER ADULTS.
IN TERMS OF THE TELEHEALTH
VISIT WE DIDN'T FIND ANY
DIFFERENCE BETWEEN THE TWO AGE
GROUPS.
THEREFORE OUR SECOND HYPOTHESES
WERE, THE SECOND SET OF
HYPOTHESES WERE PARTIALLY
CONFIRMED.
CONTINUING THE RESULTS
REGARDING THE MODIFICATION OF
EDUCATION ON DIGITAL DIVIDE.
EDUCATION WAS A SIGNIFICANT
MODIFIABLE FACTOR IN INTERNET
ACCESS.
SO OUR FIRST HYPOTHESES IN THE
THIRD SET WAS CONFIRMED.
EDUCATION ALSO MODIFIED THREE
H.I.T. USES IN TERMS OF
HEALTH-RELATED INTERNET USE.
ACCESS ONLINE MEDICAL RECORDS
AND TELEHEALTH VISITS.
SO EDUCATION WAS A VERY
CONSISTENT POWERFUL MOTIVATOR
OF INTERNET ACCESS AND H.I.T.
USE EXAMINED IN THE STUDY.
IN TERMS OF MODIFICATION OF
INCOME ON DIGITAL DIVIDE,
INCOME WAS SIGNIFICANTLY
PREDICTING INTERNET ACCESS.
HIGHER INCOME PEOPLE OLDER
ADULTS WERE MORE LIKELY TO
ACCESS INTERNET.
HIGHER-INCOME PEOPLE WERE MORE
LIKELY TO USE H.I.T.'S,
INCLUDING HEALTH-RELATED
INTERNET USE AND ACCESSING
ONLINE MEDICAL RECORDS.
HOWEVER, INCOME DID NOT PREDICT
TELEHEALTH VISITS.
IN OTHER WORDS, BOTH LOW INCOME
AND HIGH INCOME PEOPLE, OLDER
ADULTS, I SHOULD SAY, WERE
EQUALLY LIKELY TO HAVE
TELEHEALTH VISITS.
IN TERMS OF THE MODIFICATION OF
GENERAL STATUS AMONG H.I.T.'S
AMONG OLDER ADULTS, WE FOUND
GENERAL HEALTH STATUS GENERALLY
PREDICTED HEALTH RELATED
INTERNET USE.
THESE DIDN'T PREDICT ACCESSING
ONLINE MEDICAL RECORDS AND
PREDICTED TELEHEALTH VISITS.
WE WILL DISCUSS THE OUTCOME OF
THOSE RESULTS LATER.
OVERALL GRAY DIGITAL DIVIDE
STILL EXISTS DECADES AFTER THE
INVENTION OF THE INTERNET.
NOT JUST IN TERMS OF PHYSICAL
ACCESS BUT ALSO IN TERMS OF USE
OF SOFT H.I.T.'S LIKE
HEALTH-RELATED INTERNET USE AND
USE OF ONLINE MEDICAL RECORDS.
OUR SECOND FINDING WAS
EDUCATION SEEMS TO BE THE MOST
PROMINENT MITIGATOR.
INCOME COMPARED TO EDUCATION IS
MUCH LESS CONSISTENT PREDICTOR
OF DIGITAL DIVIDE.
SO WHAT DOES THIS MEAN FOR
HEALTH POLICIES?
WE ADVOCATE FOR MORE
EDUCATIONAL PROGRAMS,
ESPECIALLY PROGRAMS TARGETING
HEALTH DIGITAL LITERACY SKILLS
FOR OLDER ADULTS.
FOR EXAMPLE, HOW TO SEARCH FOR
HEALTH INFORMATION.
HOW TO SCREEN OUT LESS
TRUSTWORTHY HEALTH INFORMATION.
HOW TO PROCESS INFORMATION, ET
CETERA.
SO THAT'S A VERY IMPORTANT.
THE SECOND IMPLICATION OF OUR
RESEARCH IS THAT WE ADVOCATE
FOR MORE PROGRAMS THAT GIVE
THREE OR SUBSIDIZED DEVICES TO
ADULTS TO ELIMINATE THAT
BARRIER IN ACCESSING THE
INTERNET AND ALSO USE OF
H.I.T.'S AMONG OLDER ADULTS.
THOSE ARE THE MOST IMPORTANT
IMPLICATIONS OF OUR STUDY.
AND THEN SURPRISINGLY GENERAL
STATUS WE THOUGHT THIS WOULD
MOTIVATE PEOPLE TO USE HEALTH
INFORMATION TECHNOLOGIES.
WE DIDN'T FIND THAT IS AS
STRONG AS EDUCATION AND INCOME
MODIFICATION ON DIGITAL DIVIDE.
MORE RESEARCH IS NEEDED FOR
THAT, ONE HIGHLIGHT FROM THIS
IS THAT THEIR OPPOSITE EFFECTS
OF GENERAL HEALTH STATUS.
BETTER HEALTH PREDICTS MORE
INTERNET ACCESS AND ALSO USING
THE INTERNET FOR HEALTH
INFORMATION.
HOWEVER, BETTER HEALTH PREDICTS
LESS USE OF TELEHEALTH VISITS.
I THINK THAT IS REASONABLE
BECAUSE WHEN YOU ACTUALLY
EXPERIENCE A DISEASE OR HAVE
SOME HEALTH CONDITIONS, THEN
YOU ARE MORE MOTIVATED TO LOOK
FOR HEALTHCARE THROUGH
TELEHEALTH VISIT.
THIS IS IN CONTRAST TO SOFT
H.I.T. USE SUCH AS JUST
SEARCHING FOR INFORMATION ON
THE INTERNET.
THE OTHER I WOULD LIKE TO TOUCH
ON IS ABOUT THE INCLUSION OF
EDUCATION AND INCOME INTO THE
PREDICTION OF TECHNOLOGY
ADOPTION, ESPECIALLY AMONG
H.I.T. ADOPTION AMONG OLDER
ADULTS.
SO BECAUSE OF THOSE TWO
POWERFUL CONTRIBUTORS TO
DIGITAL DIVIDE.
THANK YOU.
>> Moderator Bradford Hesse: WE
HAVE TIME FOR JUST ONE
QUESTION, IF ANYONE HAS ONE
FROM THE AUDIENCE.
OTHERWISE WE WILL HAVE TO MOVE
ON.
WE HAVE ONE RIGHT HERE?
>> THANK YOU FOR YOUR
PRESENTATION, I WILL BE QUICK.
CAN YOU SPEAK A LITTLE BIT TO
THE DECISION TO CONTROL FOR
RACE AND GENDER?
WHAT YOUR DECISION WAS FOR
THAT, GIVEN, I KNOW IN BLACK
WOMEN, EDUCATIONAL DOESN'T
REALLY RELATE TO HEALTH.
ANY THOUGHTS ON THAT?
>> Yinjiao Ye: WE LOOKED IN
DETAIL ABOUT THE CONTRIBUTION
OF RACE AND ALSO GENDER IN OUR
RESEARCH.
BUT IF I REMEMBER IT CORRECTLY
RACE IS ALSO A VERY SIGNIFICANT
PREDICTOR OF DIGITAL DIVIDE
HERE IN TERMS OF GENDER, I
THINK THE SAME THING TOO.
PERHAPS GENDER IS MORE POWERFUL
OR STRONGER PREDICTOR.
>> Moderator Bradford Hesse:
ALL RIGHT.
THANK YOU VERY MUCH.
LET'S GO AHEAD AND CHANGE
SPEAKERS.
SO AS WE ARE DOING THAT, JUST A
QUICK COMMENT THAT, OVER THE
ITERATIONS OF HINTS NOW FOR 20
YEARS, THAT AGE DISPARITY HAS
ALWAYS BEEN PREVALENT IN
TECHNOLOGY.
AND IT'S SOMETHING WE HAVE BEEN
WATCHING.
BUT I APPRECIATE THAT WE ARE
GETTING A LITTLE BIT MORE
NUANCED NOW IN OUR ANALYSES,
ESPECIALLY WITH THAT FUNNY BUMP
WE HAD WITH THE PANDEMIC AND
TELEHEALTH BEING USED MORE
FREQUENTLY, NOW BECAUSE PEOPLE
HAVE THE NEED BECAUSE THEY ARE
HOME-BOUND THERE'S SOME
PROGRESSION IN GETTING
TELEHEALTH IMPLEMENTED BUT THE
EDUCATION REQUIREMENTS FOR THAT
ARE SOMETHING WE CAN'T IGNORE.
SO I REALLY APPRECIATE THAT.
AS WE ARE LOOKING NOW AT HEALTH
DISPARITIES WE HAVE LOOKED AT
TRADITIONAL ETHNIC AND RACIAL
DISPARITIES.
WE HAVE LOOKED AT AGE.
AND I'M REALLY HAPPY TO SEE
THAT ELISE ATKINSON WILL BE
PRESENTING ON ANOTHER LEVEL OF
MINORITY GROUPING.
AND SO THEY WILL BE PRESENTING
ON PATTERNS OF TELEHEALTH USE
IN 2022 AMONG U.S. ADULTS BY
SEXUAL ORIENTATION.
>> Elise Atkinson: I'M ELISE
ATKINSON.
I HAVE NOTHING TO DISCLOSE.
MINORITIES EXPERIENCE FINANCIAL
BURDEN, BOTH OF THE APPOINTMENT
ITSELF AND OF OPPORTUNITY COST
THAT COMES FROM MISSING WORK.
TRANSPORTATION, BOTH IN THE
PHYSICAL SENSE AS WELL AS THE
TIME NEEDED AND DISCRIMINATION.
THE CHANCE OF WHICH INCREASES
WITH EACH SUBSEQUENT PERSON.
THESE GEARS DON'T TURN VERY
WELL.
THIS IS A VERY DIFFICULT SYSTEM
TO NAVIGATE.
LUCKILY, TELEHEALTH MINIMIZES
ALL THREE OF THESE BARRIERS.
IT'S NOT QUESTION THAT
MINORITIES HAVE BEEN THE
BIGGEST USERS.
BEFORE 2013 THE NATIONAL
INTERVIEW HEALTH BY GAY AND
BISEXUAL MEN, LATER TO REACH
OUT TO H.I.V. INDIVIDUALS
IMPROVING ACCESS TO CARE AS
WELL AS PATIENT RETENTION.
MORE RECENTLY THE AARP FOUND
THAT SEXUAL MINORITY AND
TRANSGENDER ADULTS AGED 45
YEARS AND UP USED TELEHEALTH AT
GREATER RATES THAN THEIR
COMPATRIOTS.
WITH THE ADVENT OF COVID,
INCREASED FUNDING AND PUBLIC
AWARENESS BROUGHT TELEHEALTH TO
THE MAINSTREAM.
MOVING FORWARD, HOW CAN WE
LEVERAGE THESE INVESTMENTS TO
HELP SEXUAL MINORITIES WHO HAVE
ALREADY BEEN USING THIS
TECHNOLOGY TO MITIGATE BARRIERS
THEMSELVES?
IN ORDER TO DO THIS, IT WOULD
BE HELPFUL TO NOTE PATTERNS AND
PREFERENCES OF THIS COMMUNITY.
WHILE THIS HAS BEEN UNKNOWN,
HINTS 2022 DATA CAN HELP FILL
THIS GAP.
IT SHOULD BE NOTED HOWEVER THAT
TRANSGENDER INDIVIDUALS WERE
NOT ANALYZED IN THE STUDY DUE
TO SMALL NUMBER OF RESPONDENTS.
OF RESPONDENTS WE USE
TELEHEALTH.
QUALITY RATINGS WERE MEASURED
BASED ON THREE ITEMS.
TECHNICAL ISSUES.
IF K WAS EQUIVALENT TO
IN-PERSON CARE, FEELINGS OF
PRIVACY, MODALITY WAS BASED ON
ONE ITEM WITH OPTIONS VIDEO,
PHONE CALL OR BOTH.
SUBJECT OF VISIT WAS OPTIONS
FOR AN ANNUAL VISIT, FOR ACUTE
CARE, FOR CHRONIC CONDITION,
FOR MENTAL HEALTH APPOINTMENT,
OR OTHER.
AND REASONS FOR VISIT WAS BASED
ON ONE ITEM WITH OPTIONS IT WAS
RECOMMENDED BY THE HEALTHCARE
PROVIDER.
IF THEY WANTED ADVICE TO SEE IF
THEY NEEDED TO COME IN PERSON.
TO AVOID INFECTION.
IF IT WAS CONVENIENT.
IF THEY WANTED TO INCLUDE
OTHERS ON THE CALL.
AND OTHER.
THE DATA WAS ANALYZED VIA
PROBIT REGRESSION, PROBABILITY
ESTIMATE OF NORMAL DATA.
THE DATA WAS ANALYZED IN MPLUS
USING THE SQUARES MEAN VARIANCE
ESTIMATOR.
FULL INFORMATION MAXIMUM
LIKELIHOOD WAS USED TO KEEP
RESPONDENTS WHO HAD BLANKS,
THIS CREATED A MORE ACCURATE
ESTIMATION.
COVARIATES INCLUDE, AGE, SEX,
MARITAL STATUS EDUCATION LEVEL
AND RACE/ETHNICITY.
PATIENT HEALTH QUESTIONNAIRE
AND SELF-RATED HEALTH.
THIS IS IMPORTANT AS MINORITIES
SUFFER FROM MINORITY STRESS AND
MAY HAVE WORSE HEALTH STATUSES.
IN ORDER TO ADDRESS
INTERCORRELATIONS FOR DATABASED
ON MULTIPLE ITEMS OR OPTIONS,
SIMULTANEOUS PROBIT REGRESSIONS
WERE DONE FOR QUALITY RATINGS,
THREE SEPARATE ITEMS AND SIX
SIM TANE YUS DONE FOR REASONS
FOR VISIT, ONE ITEM BUT
MULTIPLE OPTIONS COULD BE
SELECTED AND THIS WAS BINARY
DATA.
9% IDENTIFIED AS SEXUAL
MINORITY AND 40% REPORTED USING
TELEHEALTH USE.
LIKE PREVIOUS STUDIES THIS
FOUND THAT SEXUAL MINORITIES
USED TELEHEALTH AT MUCH HIGHER
RATES THAN THEIR COMPATRIOTS.
OVERALL 49% USED TELEHEALTH
COMPARED TO 38% OF
HETEROSEXUALS SO IT'S AN 11%
GAP.
SUBJECT OF VISIT WERE MORE
LIKELY TO BE MENTAL HEALTH
RELATED.
THIS REMAINED EVEN AFTER
CONTROLLING FOR MENTAL HEALTH
STATUS, SUGGESTING THE DUAL
STATUS OF BEING SEXUAL MINORITY
AND HAVING A MENTAL HEALTH
ISSUE PUSHED THESE INDIVIDUALS
ON LEAN TO A MORE PHYSICAL AND
EMOTIONAL DISTANCE, LESS LIKELY
TO BE ACUTE CARE.
SEXUAL MINORITIES REASONS FOR
VISITS WERE MORE LIKELY TO BE
CONVENIENT AND MINIMIZED
EXPOSURE TO ILLNESSES.
THE FINDING OF CONVENIENCE MAY
BE DUE TO FEARS ABOUT
DISCRIMINATION WHILE EXPOSURE
TO ILLNESS MAY BE DUE TO
ATTITUDES TOWARDS COVID.
SEXUAL MINORITIES ARE MORE
LIKELY TO BE LIBERAL AND
POLITICAL LEANING AND ATTITUDES
TOWARD COVID LIBERAL AND
POLITICAL LEANING.
MODALITY AND QUALITY NO
DIFFERENCE THIS. DIFFERS FROM
PAST FINDINGS.
STUDIES WERE MORE TO THE
BEGINNING OF THE PANDEMIC WHERE
LESS MODALITIES MAY HAVE BEEN
AVAILABLE.
SO WITH ALL THIS KNOWLEDGE HOW
CAN WE FACILITATE ACCESS TO
CARE FOR SEXUAL MINORITIES?
FIRSTLY PAYMENT PARITY SHOULD
BE SUPPORTED.
THIS SHOULD ALLOW THE SAME
REIMBURSEMENT RATE FOR
IN-PERSON CARE AS WELL AS TELL
HEALTH.
TELEHEALTH.
ONE MODALITY WAS NOT
SIGNIFICANT.
RACIAL AND SEXUAL MODALITIES
MAY PREFER A SPECIFIC MODALITY.
ALLYSHIP SHOULD BE MADE VISIBLE
IN THE PHYSICAL HEALTHCARE
SPACE AS WELL AS ANY ASSOCIATED
WEBSITES WITH USE OF CODED
VISUALS.
NOW THE GEARS RUN SMOOTHLY,
IT'S A MUCH BETTER SYSTEM.
THIS IS A GOOD STEP TOWARD
KNOWING THE RELATIONSHIP
BETWEEN SEXUAL MINORITIES AND
TELEHEALTH USE.
SOME THINGS REMAIN UNKNOWN.
FOR EXAMPLE, OVERALL
WILLINGNESS TO USE TELEHEALTH.
DO THESE INDIVIDUALS CHOOSE TO
USE TELEHEALTH OR FEEL PUSHED
TO USE IT?
AVAILABLE OPTIONS IN THEIR AREA
AND IDEAL MODALITY ALSO NEED TO
BE LOOKED AT.
AS WELL AS A MORE GRANULAR
ANALYSIS OF DEMOGRAPHIC THAT'S
WILL ELUCIDATE THE RELATIONSHIP
MUCH BETTER.
THANK YOU.
>> Moderator Bradford Hesse:
I'M A FAN OF THE MOVING GEARS.
I LIKE THAT, THAT'S WONDERFUL.
WE HAVE TIME FOR A QUESTION OR
TWO.
>> GREAT PRESENTATION.
THAT WAS VERY IMPORTANT TOPIC
AND I APPRECIATE THE TIMELINESS
OF IT.
I UNDERSTAND WITH RESPECT TO
DATA LIMITATIONS MAY HAVE
SAMPLE SIZE LIMITATIONS MAY
HAVE INFLUENCED THE ABILITY TO
BE ABLE TO LOOK AT IMPORTANCE
OF INTERSECTIONAL IDENTITIES
WITH RESPECT TO SEXUAL
ORIENTATION AS WELL AS MULTIPLE
MARGINALIZATIONS ACROSS
RACE/ETHNICITY.
I WAS CURIOUS YOUR THOUGHTS
MOVING THAT WORK FORWARD TO
LOOK AT INTERSECTIONAL ANALYSES
ACROSS SEXUAL ORIENTATION AND
MINE OR TIESED LINES OF
INDIVIDUALS ESPECIALLY GIVEN
SOME PROPOSED MECHANISMS YOU
TALKED ABOUT WITH RESPECT TO
TELEHEALTH UTILIZATION
DECREASED EXPERIENCES OF
DISCRIMINATION AS WELL AS
STIGMA AND OTHER FORMS OF
MARGINALIZATION WITHIN
HEALTHCARE SETTINGS, THANKS.
>> Elise Atkinson: I PLAN ON
REPLICATING WITH A LARGER
SAMPLE IN THE FUTURE.
I AGREE, CROSS SECTIONS OF
DEMOGRAPHICS AND BOTH GENDER
AND SEXUAL ORIENTATION AS WELL
AS RACIAL IS VERY IMPORTANT TO
KNOW.
I KNOW LESBIAN INDIVIDUALS HAVE
THE HIGHEST RATES OF
VACCINATION DUE TO THEIR HIGH
EDUCATION LEVEL, AS WELL AS
THEIR SOCIOECONOMIC STATUS.
THIS IS A SNAPSHOT BUT MORE
GRANULAR ANALYSIS WILL
DEFINITELY BE USEFUL.
THANK YOU.
>> Moderator Bradford Hesse: WE
HAVE FIVE MINUTES BEFORE LUNCH.
I WOULD LIKE TO TAKE A
PREROGATIVE TO ASK YOU GUYS
SOMETHING RIGHT NOW.
EACH OF YOU BE THINKING ABOUT
THIS.
THIS IS YOUR CHANCE TO TALK
ABOUT THE NEXT 20 YEARS OF
EVENTS.
IN YOUR YEARS OF RESEARCH, YOU
HAVE A LEG UP, YOU SAID YOU
WANT TO WATCH THIS OR THIS,
THINK OF THE ONE OR TWO THINGS
YOU WANT THE HINTS GROUP AND
THIS COMMUNITY TO THINK ABOUT
IN YOUR AREAS OF RESEARCH INTO
THE FUTURE.
AND SO I'M GOING TO START
ACTUALLY WITH DR. RICHWINE.
BECAUSE YOU ARE NEXT TO ME.
>> Chelsea Richwine: OKAY, ON
THE SPOT.
IN THE FUTURE LOOKING AT CLOSER
METHODS OF ACCESS WILL BE
INTERESTING GOING FORWARD.
WE HAVE A COUPLE NEW QUESTIONS
WE ARE JUST ON HINT 6 AND
HOPEFULLY ON HINT 7 THAT GET
MORE INTO, FOR INSTANCE PORTAL
ORGANIZING APPS.
PULLING YOUR INFORMATION FROM
DIFFERENT RECORDS INTO ONE
PLACE.
AND CURRENTLY THERE'S 1% SAYING
THEY WERE DOING THIS.
I AM INTERESTED TO SEE THIS IN
THE FUTURE AND HOW THAT CAN
EXPAND ACCESS OF USE.
>> Moderator Bradford Hesse: I
WAS INTERESTED TO SEE FROM MY
PERCH OVER IN HAWAII, THE
NATIONAL CANCER PROGRAM IS NOW
ANNOUNCING A TOPIC IN THE AREA
OF USING TECHNOLOGY FOR
COORDINATING CARE.
AND I THINK THIS NOTION OF
ORGANIZING DIGITAL INFORMATION
WITH ORGANIZING APPS, THAT KIND
OF THING, SO WE GET AWAY FROM
THIS DIFFUSE BIFURCATED
PIPELINES OF DATA AND
INFORMATION, THAT DOES SEEM
LIKE SOMETHING TO REALLY TAP
INTO FOR THE NEXT TEN YEARS.
THAT'S WONDERFUL.
THANK YOU.
I WILL GO RIGHT NOW, INSTEAD OF
ORDER FROM THE PRESENTATION, WE
WILL GO RIGHT DOWN THE ROW.
DR. YE?
>> Yinjiao Ye: IN TERMS OF
ADDITIONAL TOPICKS IN DIGITAL
DIVIDE, I THINK THE NEXT 20
YEARS I WOULD LIKE TO SEE --
BETWEEN OLDER ADULTS AND
YOUNGER ADULTS.
ESPECIALLY FOR THE PURPOSE OF
REDUCING PERSONAL HEALTHCARE
EXPENDITURE.
SO I THINK THAT'S A VERY FIRST
THING I WOULD LIKE TO SEE AND
THEN DO RESEARCH ABOUT.
AND THE SECOND IS WHETHER, WE
CAN ALSO TAKE A LOOK AT HOW
THEIR SOCIAL CIRCLE, THEIR
FAMILY MEMBERS AND THEIR
FRIENDS CAN HELP THEM TO REALLY
GO ALONG WITH THEIR HEALTHCARE
DIGITALIZATION.
I THINK THAT'S ANOTHER THING
THAT I WOULD LIKE FOR HINTS TO
INCLUDE IN THE FUTURE SURVEYS.
THANK YOU.
>> Moderator Bradford Hesse:
WONDERFUL.
AND I CAN COMMENT ON THAT A
LITTLE BIT.
ONE THING WE HAVE NOTICED IN
PREVIOUS ITERATIONS OF HINTS
AND EXAMINING THE USE OF THIS
TECHNOLOGY, OFTEN, AND THIS
APPLIES SOMETIMES FOR
IMMIGRANTS WHO HAVE ENGLISH AS
A SECOND LANGUAGE AND OLDER
ADULTS HOW MUCH THEY RELY ON
OTHER FAMILY MEMBERS FOR CARE
GIVING AND INFORMATION
REFEREEING.
SO THEY WILL GO DOWN AND GIVE
INFORMATION TO THE ABUELA OR
SOMETHING LIKE THAT.
IT SEEMS THIS NOTION OF LOOKING
AT THAT FAMILY IS IMPORTANT, AS
WE REDUCE OVERALL DEFICITS IN
OLDER PEOPLE'S USE OF
TECHNOLOGY.
AND THANK YOU FOR NEVER SAYING
OKAY, BOOMER, WHEN I DID ALL
THAT STUFF.
SO THAT'S REALLY GOOD.
LET'S MOVE TO THE NEXT ONE.
>> Abhishek Henry: BEING A
SECOND YEAR MASTER STUDENT I
DON'T HAVE TOO MUCH RESEARCH
EXPERIENCE BUT I'M INTERESTED
HOW TECHNOLOGY CAN BE USED TO
PROMOTE HEALTH, I'VE BEEN
INVOLVED WITH THE CANCER
RESEARCH GROUP.
I'M INTERESTED IN SEEING HOW
TECHNOLOGY COULD BE IMPLEMENTED
EVEN HEALTHCARE SETTINGS.
SO I PREVIOUSLY MENTIONED I WAS
IN ANOTHER STUDY LOOKING AT
FACILITATORS AND WE HAVE BEEN
TALKING ABOUT THE PATIENT SIDE
AND HOW WE CAN GET TO USE THEM
BETTER, BUT THE PROVIDER SIDE
WE ARE DOING STUDIES IN
FEDERALLY-QUALIFIED HEALTHCARE
CENTERS AND THERE'S A MIX OF
RESPONSES TO THE PROVIDERS
WHERE THEY MIGHT HAVE DIFFERENT
BARRIERS AND IT MIGHT BE BETTER
WORK TO KEEP TRACK AND MAINTAIN
AN ONLINE MEDICAL RECORD SYSTEM
WHEREAS PROVIDERS SAY IT'S
SOMETHING USEFUL, I THINK THERE
NEEDS TO BE SOME KIND OF
UNDERSTANDING AND COMMON GROUND
OF PUSHING THESE TECHNOLOGY
METHODS TO THEIR PATIENTS TO
HELP COMMUNICATION.
SO THAT'S SOMETHING I'M
INTERESTED IN DOING.
IN HOW MANY, TEN OR 20 YEARS,
I'M NOT SURE.
BUT THAT'S THE NEXT STEP.
>> Moderator Bradford Hesse:
GOOD, YOU ARE JUST AT THE START
OF THIS TRAJECTORY, SO WE WILL
GET YOU BACK.
THAT WILL WORK OUT REALLY WELL.
EMPHASIZING ACROSS THE PANEL
THE NOTION OF THE USE OF
PORTALS TO PROMPT FOR SCREENING.
OFTEN WORKS BEST WHEN THERE ARE
MULTIPLE MODALITIS.
SO A TRIGGER HAPPENS AND THE
PHYSICIAN SENDS A BIRTHDAY CARD
AND SAYS HOW ABOUT THAT
COLORECTAL SCREENING, IT'S
ABOUT TIME, RIGHT?
BUT THERE'S A FOLLOW-UP AT THE
OTHER END AND YOU CAN MAKE YOUR
APPOINTMENT ONLINE, SO THAT
COORDINATION OF THE PROMPT AND
RESPONSE TO MAKE SURE WE GET A
CLOSED LOOP OF THE
COMMUNICATION.
ELISE YOU ARE AHEAD OF THE GAME
BUT SEE IF THERE IS ANYTHING
ELSE YOU LEFT OUT.
>> Elise Atkinson: YEAH, THAT
WAS DUE RELATED TO MY PAPER.
BUT OVERALL, I THINK I
MENTIONED I COULDN'T REALLY
MEASURE TRANSGENDER RESPONDENTS
DUE TO THE SMALL NUMBER.
IF YOU COULD OVER SAMPLE
MINORITIES AND WEIGHT THEM IN
THE END TO BE ACCURATE TO THE
U.S. POPULATION, I THINK THAT
WOULD ALLOW RESEARCHERS LIKE ME
TO GET THE NUMBERS I NEED WHILE
STILL REMAINING TRUE TO THE
OVERALL MAKE-UP OF AMERICA.
>> Moderator Bradford Hesse:
YOU KNOW, IN SOME WAYS I WAS
GOING TO PREDICT THAT'S WHERE
YOU WERE GOING TO GO.
BECAUSE THAT'S SUCH A PROBLEM
IN THESE SURVEYS GETTING
REPRESENTATIVENESS IN CERTAIN
GROUP THAT'S CAN OTHERWISE
FALLOUT SIDE OF THE GRID.
A SPECIAL STUDY CAN SOMETIMES
BE DONE.
I CAN SEE KELLY'S GEARS.
WHAT A WONDERFUL START TO THE
PANELS.
THANK YOU FOR THE WONDERFUL
WORK AND PRESENTATION.
>> Kelly Blake: THANK YOU,
BRAD, FOR MODERATING OUR FIRST
ORAL PRESENTATION SESSION.
IT'S TIME FOR LUNCH, EVERYBODY.
THE CAFETERIA, IF YOU GO
UPSTAIRS TO THE ATRIUM, MAKE A
LEFT, PAST THE ELEVATORS YOU
WILL SEE THE CAFETERIA.
WE HAVE AN HOUR FOR LUNCH.
I THINK THERE ARE TABLES
OUTSIDE.
IT'S A NICE DAY.
OR OF COURSE YOU CAN SIT INSIDE.
PLEASE BE BACK AT 1:00 SHARP
WHEN WE WILL START THE AGENDA
BACK. THANK YOU.
WELCOME BACK
EVERYBODY. WE HAVE A REAL
TREAT HERE THIS AFTERNOON
BEFORE WE JUMP INTO THE REST OF
THE ORAL PRESENTATIONS AND THE
SPECIFIC SESSIONS OF THE
CONFERENCE WE HAVE THIS PANEL
TITLED "CHALLENGES AND
OPPORTUNITIES IN SURVEY
RESEARCH."
AND WE HAVE THE LEADERS OF
MANY OF OUR FEDERAL SURVEYS AND
METHODOLOGIES FROM FEDERAL
SURVEYS HERE TO SPEAK TODAY.
SO I'M GOING TO TELL YOU WHO
THEY ARE AND WHERE THEY ARE
FROM.
AND THEN TURN IT OVER TO THEM
TO INTRODUCE THEMSELVES ON
THEIR WORK BEFORE WE JUMP INTO
SOME MODERATOR QUESTIONS AND
WELCOME YOU GUYS TO ASK
QUESTIONS AS WELL.
ON THE PANEL TODAY WE HAVE DR.
PAUL BEATTY, CHIEF - CENTER FOR
BEHAVIORAL SCIENCE METHODS, U.S.
CENSUS BUREAU, AND PAST
PRESIDENT - AMERICAN
ASSOCIATION FOR PUBLIC
OPINION RESEARCH (AAPOR). AND
WE HAVE MELISA CREAMER, DEPUTY
BRANCH CHIEF AND PROGRAM
OFFICIAL -
EPIDEMIOLOGY RESEARCH BRANCH,
NATIONAL INSTITUTE ON DRUG
ABUSE (THE
POPULATION ASSESSMENT OF
TOBACCO AND HEALTH [PATH]
STUDY)
WE HAVE DR. BRANCH CHIEF -
POPULATION HEALTH SURVEILLANCE
BRANCH,
CENTERS FOR DISEASE CONTROL AND
PREVENTION (BEHAVIORAL RISK
FACTOR
SURVEILLANCE SYSTEM [BRFSS])
AND DR. AARON MAITLAND ALSO
FROM THE CDC. CHIEF - SURVEY
PLANNING AND SPECIAL SURVEYS
BRANCH, NATIONAL CENTER FOR
HEALTH STATISTICS (NATIONAL
HEALTH INTERVIEW
SURVEY [NHIS]).
THIS GO IN THE ORDER OF THE
AGENDA.
>> DR. BEATTY: HELLO EVERYBODY,
I'M PAUL BEATTY, CHIEF - CENTER
FOR BEHAVIORAL SCIENCE METHODS,
U.S.
CENSUS BUREAU, AND PAST
PRESIDENT - AMERICAN
ASSOCIATION FOR PUBLIC
OPINION RESEARCH (AAPOR). AND
SURVEY METHODOLOGIES BY
TRAINING IN FEDERAL SERVICE FOR
30 YEARS. I HAVE BEEN AT CENSUS
FOR NINE YEARS BEFORE THAT I
WAS AT THE -- FOR 21 YEARS.
UNLIKE A LOT OF THE OTHER
PANELISTS, I WORK IN A GROUP
THAT IS NOT PRIMARILY
RESPONSIBLE FOR MAJOR DATA
COLLECTION OPERATION. WE ARE A
METHODS GROUP, WHICH IS IN
CONTACT WITH MOST OF THE OTHER
PARTS OF THE CENSUS BUREAU AND
THE FEDERAL AGENCY AS WELL
ABOUT MAXIMIZING THE QUALITY OF
THE DATA COLLECTION WE DO.
THAT INCLUDES OF COURSE THE
DECENNIAL CENSUS WHICH IS ONE
OF THE MOST VISIBLE THINGS WE
DO BUT THE CENSUS BUREAU IS
ESSENTIALLY A NATIONAL CENTER
FOR DEMOGRAPHIC AND ECONOMIC
STATISTICS. SO MANY OTHER
SURVEYS EITHER DONE DIRECTLY BY
US, OR WE DO ON BEHALF OF THE
FEDERAL AGENCIES COMING INTO
OUR WORLD.
WHAT WE ARE WORKING ON IS
CLOSING THE GAP BETWEEN WHAT
PEOPLE ARE TRYING TO MEASURE,
AND WHAT THEIR MEASURES
ACTUALLY DO. WE DO THAT
THROUGH A COMBINATION OF
METHODS. QUALITATIVE AND
QUANTITATIVE.
MANY OF YOU ARE FAMILIAR WITH
COGNITIVE TESTING. THAT IS
PART OF WHAT WE DO. DISABILITY
TESTING ALSO. NOT ALL
QUALITATIVE. SOUND IS MORE
CORRECTION BASED FOR EXAMPLE,
LIKE -- DATA ANALYSIS AND OTHER
FORMS OF ACCREDITATION.
AND WE DO MORE THAN ADVISE AND
DESIGN. WE ARE ALSO INVOLVED IN
KEY INITIATIVES IN TRYING TO
UNDERSTAND WHAT DATA USERS ARE
EXPECTING FROM US. AND HELPING
TO PRODUCE PRODUCTS THAT BETTER
ALIGN WITH THEIR NEEDS. WHICH
MEANS WE HAVE TO UNDERSTAND
WHAT THEY WANT AND CONSTRUCT
PRODUCTS WITH THAT
UNDERSTANDING IN MY. THAT'S
ENOUGH ABOUT ME.
>> AARON_
>> DR. MAITLAND: AARON
MAITLAND, CHIEF - SURVEY
PLANNING AND SPECIAL SURVEYS
BRANCH, NATIONAL CENTER FOR
HEALTH STATISTICS (NATIONAL
HEALTH INTERVIEW
SURVEY [NHIS]). LIKE KELLY
SAID.
OUR BRANCH OVERSEAS ONE
LONGTIME SURVEY AND ONE SURVEY
PROGRAM THAT HAS BEEN BORN.
YOU SAW SLIDES THIS MORNING
THAT REFER TO THE NIHS, AN
ONGOING SURVEY THAT HAS BEEN
GOING ON SINCE 1957, IT GOES ON
EVERY YEAR. IT'S AN
ADDRESS-BASED SAMPLE. THE
INTERVIEWS ARE DONE IN PERSON
AND BY TELEPHONE. WE DO
INTERVIEWS WITH ABOUT 30,000
SAMPLE ADULTS. AND THEN ABOUT
10,000 PARENTS OR CAREGIVERS OF
SAMPLE CHILDREN. THE MAIN
OBJECTIVE OF THE NHIS IS TO
MONITOR THE OVERALL HEALTH OF
THE UNITED STATES POPULATION.
WE ASK ABROAD RANGE OF HEALTH
TOPICS, HEALTH CONDITIONS,
HEALTH BEHAVIORS, HEALTHCARE
ACCESS, IT'S ABOUT AN HOUR LONG
INTERVIEW OF THE HEALTH OF THE
PEOPLE WE ARE TALKING TO.
MAJOR STRENGTH OF THE SURVEY
IS IT HAS A LARGE SAMPLE SIZE.
SO, IF FOLKS ARE LOOKING TO GET
ESTIMATES OF SUBPOPULATIONS,
THE HIS IS A GOOD SOURCE OF
DATA. THE HIS IS USED TO TRACK
A LOT OF GOALS FOR THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES HEALTHY PEOPLE 2030
GOALS AND WE WORK WITH A LOT OF
CDC PROGRAMS AND NIH PROGRAMS
TO MEASURE THOSE GOALS AND
OTHER RELATED GOALS.
AND WE ALSO HAVE OF COURSE THE
RESEARCH COMMUNITY USES THE HIS
FOR A VARIETY OF DIFFERENT
TOPICS.
EACH YEAR, WE HAVE CONTENT
THAT IS THE SAME EVERY YEAR.
WE ALSO HAVE-- AND RECALL THAT
ANNUAL CORE CONTENT-- WE HAVE
ROTATING CORE CONTENT THAT IS
PART OF OUR CORE TOPICS THAT WE
ARE ASKING ABOUT IN THE NHIS.
BUT THOSE TOPICS ARE ONLY SAY
ONCE EVERY OTHER YEAR OR TWO
OUT OF THREE YEARS.
AND THEN WE ALSO HAVE A COUPLE
OF CATEGORIES OF CONTENT THAT
VERY LITTLE BIT SO WE HAVE
SPONSOR CONTEXT OR WE WORK WITH
CDC PROGRAMS AND NIH AND OTHER
GOVERNMENT AGENCIES TO SPONSOR
TOPICS THAT ARE OF INTEREST TO
VARIOUS PARTS OF THE CDC OR
OTHER PARTS OF THE GOVERNMENT.
AND THAT WHAT WE HAVE WHAT WE
CALL THE "EMERGING CONTENT,"
TOPICS THAT ARE -- THAT HAVE A
TIMELY NATURE TO THEM. SO IF
THERE IS SOME NEW ISSUE THAT
HAS EMERGED. FOR EXAMPLE WE
HAVE INCLUDED NEW QUESTIONS ON
THINGS LIKE OPIOIDS AND PAIN
MANAGEMENT, AND THINGS LIKE
THAT.
SO THAT'S-- ALL ABOUT THE HIS.
WE HAVE A NEW SURVEY SYSTEM
THAT IS JUST GETTING UNDERWAY
THAT IS CALLED THE "RAPID
SURVEY SYSTEM." AND SO FOR THAT
SYSTEM, WE ARE USING ONLINE
COMMERCIAL WEB PANELS TO
COLLECT DATA ON TOPICS THAT ARE
SORT OF TIME SENSITIVE NATURE.
AND IT'S GOT THE NAME "RAPID,"
BECAUSE WE'RE TRYING TO DO ONE
SURVEY EVERY QUARTER. SO, FOR
EXAMPLE IF A SAFETY PROGRAM
COMES TO US WITH A TOPIC THAT
THEY WANT TO PUT ON ONE OF OUR
SURVEYS,
FROM THE TIME WE ARE DESIGNING
THE QUESTIONS,
TO WHEN WE WILL HAVE DATA
AVAILABLE
ON OUR WEBSITE
IS ABOUT SIX MONTHS OF TIME.
SO,
FOR SOME THAT MAY NOT BE THAT
RAPID.
FOR US THAT IS PRETTY RAPID.
THAT IS A NEW SYSTEM
THAT IS GETTING STARTED.
AND WE ARE USING LIKE I SAID
THE COMMERCIAL WEB PANELS
BUT MANY HERE ARE FAMILIAR
WITH ALREADY.
AND KELLY, I THINK YOU WANTED
ME TO SAY A LITTLE ABOUT OUR
CONNECTIONS WITH DATA USERS? GO
AHEAD WITH THAT.
SO WE DON'T HAVE AN ONGOING
CONFERENCE LIKE THIS ONE.
I THINK THIS IS GREAT.
THIS IS A GREAT WAY TO BE IN
TOUCH
WITH EVERYONE WE HAD A DATA
USERS CONFERENCE, NHIS, I DON'T
THINK IT HAS HAD ONE FOR ABOUT
10 YEARS OR SO BUT THAT DATA
USERS CONFERENCE WAS FOR ALL
CDC, ALL NCHS SYSTEMS, AND DATA
SET THAT WE ALL HAVE DATA
PRESENTED THERE.
WE -- A LOT OF
OUR USERS
LIKE I WAS REFERRING TO WITH
OUR SPONSORED CONTENT
OR OTHER CDC PROGRAMS
OR PLACES AT NIH.
SO THEY ARE DATA USERS.
WE ARE CONSTANTLY KEEPING IN
TOUCH WITH THEM
BECAUSE THEY ARE OFTEN
SPONSORING
TOPICS ON THE SURVEY AND WE
WORK WITH THEM
A LOT OF TIMES
TO GET PUBLICATIONS OUT
AND ON THE TOPICS
THAT THEY SPONSOR.
AND
SO THE OTHER
DATA USERS LIKE
RESEARCHERS AT UNIVERSITIES,
AND OTHER PLACES,
WE DON'T REALLY HAVE A
SPECIFIC WAY
TO KEEP IN TOUCH WITH THEM.
SOMETIMES WE DO HAVE SOME
COLLABORATIONS ON OPERATIONS ON
PUBLICATIONS OR SOMETHING LIKE
THAT.
WE HAVE THE DATA USER REQUEST
LINE THAT WE ARE SOMETIMES IN
TOUCH WITH THEM OR RANDOM TOUCH
POINTS WITH THEM.
THAT IS PROBABLY A PLACE
WHERE I THINK HINTS DOES A
MUCH BETTER JOB AT REACHING
THOSE RESEARCHERS THAN WE DO
AND HINTS DOES AN AWESOME JOB
AND DOCUMENTATION TOO.
TRYING TO DOCUMENT EVERYTHING
ON OUR SURVEY ON THE WEBSITE
THAT WE CAN.
MAYBE SOMETIMES
TO OUR DETRIMENT
WHEN WE GET DOCUMENTED A
REALLY LONG,
AND NOBODY WANTS TO READ THEM.
BUT ALL THE DETAILS ARE THERE
ABOUT THE SURVEYS.
SO WE DEFINITELY TRY TO KEEP
OUR DATA USERS INFORMED THAT
WAY.
>> HI EVERYONE I AM MELISA
CREAMER, AT DEPUTY BRANCH CHIEF
AND PROGRAM OFFICIAL -
EPIDEMIOLOGY RESEARCH BRANCH,
NATIONAL INSTITUTE ON DRUG
ABUSE (THE
POPULATION ASSESSMENT OF
TOBACCO AND HEALTH [PATH]
STUDY). I HAVE CODIRECTED STUDY
OF THE HEALTH STUDY A
LONGITUDINAL STUDY OF THE
NATIONALLY REPRESENTED
NONINSTITUTIONALIZED POPULATION
IN THE UNITED STATES ONGOING
SINCE 2013 WHEN THE FIRST WAVE
DATA WERE COLLECTED.
APPROXIMATELY 34,000 YOUTHS AND
ADULTS.
WE PRIMARILY COLLECT DATA ON
TOBACCO USE, HEALTH
EFFECTS AND BEHAVIORS THAT MAY
BE
INFLUENCED BY TOBACCO USE AND
OTHER
ETIOLOGICAL FACTORS IS
ASSOCIATED.
WE CURRENTLY HAVE A SURVEY ON
13 DIFFERENT CLASSES OF TOBACCO
PRODUCTS, INCLUDING CIGARETTES,
E-PRODUCTS,
AND WE RECENTLY ADDED NICOTINE
OR THE NICOTINE -- IN OTHER
TYPES OF CIGAR PRODUCTS SO A
WIDE VARIETY OF PRODUCTS.
I ALSO JUST WANTED TO NOTE
THAT OUR STUDY NOT ONLY COLLECT
DATA
IN A SURVEY FORM.
I CAN TALK LATER
IF WE WANT ABOUT SOME OF THE
CHANGES THAT WERE IMPLEMENTED
DURING COVID.
WE PRIMARILY COLLECT IN PERSON
INTERVIEW DATA, SAMPLING
PROCEDURES AND THEY ARE
FOLLOWED EVERY YEAR.
AND WE HAVE COLLECTED
ANNUAL DATA SINCE LIKE I SAID
2013.
AND BEGINNING AFTER WAVE 4,
WE STARTED EVERY OTHER YEAR
DATA COLLECTION OF THE FULL
SAMPLE. AND IN BETWEEN YEARS,
WE SAMPLED THE USE OR YOUNGER
ADULTS.
WE ALSO COLLECT BIOMARKER DATA.
SO BUYER SPECIMENS ARE
COLLECTED.
URINE HAS BEEN COLLECTED AT
EVERY ANNUAL, OR EVERY MAIN
WAVE OF DATA COLLECTIONS.
SO WHEN THE FULL SAMPLE IS
COLLECTED WE ALSO COLLECT URINE
AND ANALYZE THOSE BIOMARKER
DATA, BEING ABLE TO COLLECT
OBJECTIVE DATA WITH SUBJECTIVE
DATA.
AND OTHER DATA ARE AVAILABLE
TO THE PUBLI RIGHT NOW THROUGH
WAVE 6, PUBLIC USE FILES ARE
AVAILABLE AT NATA, THE NATIONAL
ADDICTION AND HIV ARCHIVE DATA
PROGRAM.
AND,
THE BIOMARKER DATA--
THEY USE FILES BUT IT'S RATHER
EASY TO APPLY AND YOU HAVE TO
HAVE AN IRV AND A RESEARCH
QUESTION A NATURAL THING BUT WE
TRY TO CONNECT WITH OUR DATA
USERS ANNUALLY AT ICPSR
(PHONETIC) UNIVERSITY OF
MICHIGAN.
WE HAVE OFFERED TRADITIONALLY A
PROGRAM REALLY
ON THE DATA
ITSELF AND HOW TO USE THE
DATA,
HOW TO ANALYZE THE DATA.
DATA WORKSHOPS.
AND WE ALSO HAVE ARCHIVED
YOUTUBE VIDEOS OF THE BASICS OF
THE PAST STUDY PROGRAM BECAUSE
WE RECOGNIZE IT CAN BE REALLY
CHALLENGING USE LONGITUDINAL
DATA.
AND HOW DIFFERENT WAYS
IT COULD BE USED, AND THE
VARIOUS WAYS, AND WE TRY TO
REALLY BE INVOLVED WITH THE
SCIENTIFIC COMMUNITY.
THE IMPORTANT PART OF THE PAST
DATA WHICH I FAILED TO MENTION
IN THE BEGINNING, SPONSORED BY
THE CENTER FOR TOBACCO
PRODUCTS, IS A CONTRACT THAT
NAIDA (PHONETIC) ADMINISTERS.
THE MAIN PURPOSE OF THE PAST
STUDY WAS TO BUILD SCIENTIFIC
EVIDENCE FOR THE RULEMAKING AND
REGULATORY PROCESSES THAT CTP
CAN DO AND SO A LOT OF THE
QUESTIONS HAVE BEEN MAINTAINED
OVER TIME AND SOME HAVE BEEN
CHANGED FOR THE MOST PART WE
ARE TRYING TO BUILD SCIENTIFIC
EVIDENCE SO THAT CTP AND
REGULAR TOBACCO PRODUCT IN AN
EFFECTIVE MANNER.
>>
>> GOOD AFTERNOON EVERYONE.
EVERYONE IS TIRED FROM LUNCH. I
AM TIRED FROM LUNCH. I AM DR.
MACHELL TOWN, BRANCH CHIEF -
POPULATION HEALTH SURVEILLANCE
BRANCH,
CENTERS FOR DISEASE CONTROL AND
PREVENTION (BEHAVIORAL RISK
FACTOR
SURVEILLANCE SYSTEM [BRFSS]).
OUR BRANCH OF THE POPULATION
HEALTH SURVEILLANCE BRANCH
WITHIN THE DIVISION OF
PREPARATION HEALTH WITHIN CDC.
WE ARE SYSTEM BASED OF
STATE-BASED SURVEYS. WE HAVE
BEEN IN EXISTENCE 1984. WE EACH
STATED WE COLLECT DATA FOR, WE
COLLECT DATA FOR ALL STATES,
DC, AND THREE US TERRITORIES.
THE SURVEY IS OF ADULTS 18 AND
OLDER. WE COLLECT DATA ON
HEALTH CONDITIONS, RACE
FACTORS, CHRONIC CONDITIONS.
OPIOIDS. OPIOID QUESTIONS. WE
HAVE SOCIAL DETERMINANTS OF
HEALTH QUESTIONS. WE HAVE
ACTIONS TO RAISE QUESTIONS IN
DIFFERENT TYPES OF
HEALTH-RELATED QUESTIONS, AND
ALSO DO PREVENTABLE INFECTIOUS
DISEASE QUESTIONS.
OUR DATA IS COLLECTED
AND THE PARTNERSHIP BETWEEN
OUR OFFICES AND THE STATE
DEPARTMENTS AND ALSO THE CDC
PROGRAMS WE COME TOGETHER, THE
BRFS (PHONETIC) HAS A CORE
STUDY, AND THE STATE DETERMINE
WHICH MODULES THEY ARE GOING TO
COLLECT AND EACH STATE BECAUSE
IT TO COLLECT THE MODULES, WE
CONSIDER OURSELVES 54 SURVEYS
TIMES -- BECAUSE WE DO LANDLINE
AND CELL PHONE ADMINISTRATION.
WE WORK REALLY CLOSELY WITH THE
STATE HEALTH DEPARTMENTS. THEY
ARE THE ONES THAT ACTUALLY
DETERMINE EXACTLY WHAT THE
FINAL QUESTIONNAIRE WILL BE
FOR THEIR PARTICULAR STATE. SO
WE WORK CLOSELY WITH THE CDC
PROGRAMS. AS AARON STATED
BEFORE THEY PROPOSE QUESTIONS
ON THE BRFS, AND THE STATE
HEALTH DEPARTMENT DETERMINES
WHETHER OR NOT THEY WANT TO
ADMINISTER THE QUESTIONS THAT
THE CDC PROGRAMS ACTUALLY
SPONSORED.
AND WE ALSO, WE WORK WITH-- WE
HAVE ADDITIONAL-- WE DO
EMERGING CORE TOPICS AS AARON
SAID THEY DO, ANYTHING THAT
COMES UP, HEALTH BEHAVIORS OR
WHEN COVID CAME OUT WE DID THE
EMERGING QUARTILE, THE
ADMINISTRATION OF THE COVID
SHOT.
SO WE ALSO HAVE A PROJECT
WHERE WE USED THE BRFS DATA TO
CONTINUE TO COLLECT DATA ON
PERSONS WHO HAVE HAD ASTHMA. SO
WE HAVE THE ASTHMA CALLBACK
SURVEY THAT USES A PARTICULAR
DATA. WE HAVE A STANDARDIZED
DATA COLLECTION WERE WITNESS TO
THE SURVEY ON THE LANDLINE AND
CELL PHONE. OUR LANDLINE IS
STRATIFIED BY COUNTIES. WE DO
CENSUS TRACTS, CENSUS BLOCKS.
WE CAN ALSO STRATIFY DIFFERENT
COUNTIES. SO WHEN THE STATE
DETERMINE WHETHER
STRATIFICATION METHOD IS THE
DETERMINE WHETHER OR NOT THEY
WANT TO HAVE JUST THE OVERALL
STATE SAMPLE, OR THEY WANT TO
SAMPLE AT THE GEOGRAPHIC LEVEL.
WE ALSO BY CELL PHONES, WE
SAMPLE BY COUNTIES BY CELL
PHONES WITH THE CELL PHONE
SAMPLE. WE ARE IN THE PROCESS
OF CONTINUING TO LOOK AT OTHER
WAYS IN WHICH WE CAN CONTINUE
TO COLLECT DATA AT THE
STRATIFICATION LEVEL
BY CELL PHONE. WE HAVE HAD A
CONFERENCE EVERY YEAR WHERE WE
SPONSOR THE STATE HEALTH
COORDINATORS THAT COME IN AND
ALSO THE CDC PROGRAMS COME IN
AND WE DO TRAINING ON HOW TO
USE THE BRFS DATA. WE ALSO
HAVE WEBINARS THAT WE HAVE HAD
EVERY MONTH ON THE USE OF THE
DATA AND DIFFERENT PAPERS THAT
ARE ACTUALLY WRITTEN USING BRFS.
WE ALSO WORK WITH DIFFERENT
UNIVERSITIES. ARE USUALLY
PRESENT AT MULTIPLE
UNIVERSITIES AROUND THE COUNTRY
ON DATA. WE ALSO WORK WITH CMS
ON DIFFERENT PROJECTS. ON HOW
THEY CAN USE BRFS DATA, AND
THEY CAN LEVERAGE SOME OF THE
QUESTIONS THAT WE USE.
WE ALSO WORK WITH OTHER
FEDERAL AGENCIES. I WORK WITH
THE OFFICE OF MINORITY HEALTH
ON HOW TO REACH NATIVE AMERICAN
POPULATIONS.
SO WE DO A LOT OF
COLLABORATION WITHIN SOME OF
THE FEDERAL AGENCIES.
>> THANK YOU GUYS FOR THIS
REVIEW OF YOUR SURVEYS AND WHAT
YOU DO. AND I THINK ONE OF THE
MOST COMMON QUESTIONS WE GET
FROM OUR DATA USERS AROUND
RESPONSE RATES. I WOULD LIKE TO
START THERE, SYNTHESIS OF PANEL
ABOUT CHALLENGES. AS WAS
OPPORTUNITIES.
PAUL MAYBE WE CAN START WITH
YOU, JUST GIVING SOME
OVERARCHING REMARKS AND
THOUGHTS ON DECLINING RESPONSE
RATES THE FEDERAL SURVEYS. AND
THAT WILL FOLLOW UP WITH
EVERYBODY IN THE PANEL, GIVING
SIMILAR REMARKS BUT ALSO,
TALKING ABOUT YOU KNOW HOW IN
YOUR SURVEYS YOU ARE ASSESSING
THE RELATIONSHIP BETWEEN
RESPONSE RATE AND NONRESPONSE
BIAS AND DATA QUALITY IN THE
SURVEYS THAT EACH OF YOU LEAD.
>> DR. BEATTY: SURE WELL,
NEWSFLASH. RESPONSE RATES ARE
REALLY BAD. WHEN SOME
REPUTABLE, NATIONAL SURVEYS ARE
GETTING RESPONSE RATE IN SINGLE
DIGITS, THAT IS KIND OF
FRIGHTENING. WHEN I WAS BEING
TRAINED AS THE SURVEY
METHODOLOGIST, WE WOULD NEVER
HAVE ACCEPTED THINGS LIKE THAT
IS LEGITIMATE. THIS IS BEYOND
ANY REALM THAT WE EXPECTED TO
BE WORKING IN. WE HAVE ENTERED
DIFFERENT STAGES OF THINGS.
FORTUNATELY WELL DONE FEDERAL
SERVICE ARE NOT QUITE IN THAT
BALLPARK. MOST OF THE TIME.
AND WE TEND TO GET BETTER
RESPONSE RATE THAN MOST OTHER
PARTS OF THE WORLD ARE DOING
SURVEYS.
AND ACTUALLY I THINK WE REALLY
DO A GOOD JOB MONITORING FOR
RESPONSE BIAS. WHICH IS WHAT WE
ARE REALLY CONCERNED ABOUT.
YOU CAN HAVE AS IT TURNS OUT,
RESPONSE RATE THAT IS NOT VERY
GOOD, AND NOT HAVE A PROBLEM
WITH RESPONSE BIAS. AND THE
OTHER WAY AROUND AS WELL. YOU
CAN HAVE A RELATIVELY HIGH
RESPONSE RATE, BUT NEVERTHELESS
THE BIAS IS NOT IGNORABLE.
SO THE WAY WE HAVE TO BE
MINDFUL OF IS FIRST OF ALL, WE
CAN'T TOTALLY STOP THE DECLINE
IN RESPONSE RATES. WE CAN
CONTINUE TO DO BEST PRACTICES
TO GET PEOPLE TO PARTICIPATE IN
SERVICE AS MUCH AS THEY CAN.
BUT THIS IS THE NEW REALITY.
THE DAYS OF 80% RESPONSE RATE
AS A VIABLE TARGET ARE REALLY
PROBABLY BEHIND US FOREVER.
SO, GIVEN THAT REALITY, HOW
MUCH IS BIAS A PROBLEM?
AND AS IT TURNS OUT IT'S ONLY
A PROBLEM WHEN THE PROPENSITY
TO RESPOND IS RELATED TO THE
THING THAT WE CARE ABOUT
MEASURING. AND IN A LOT OF
THINGS THAT WE ARE CONCERNED
ABOUT, THAT IS NOT GOING TO BE
THE CASE.
THERE ARE CERTAIN VOTER
BEHAVIORS WHERE IT IS NOT TRUE.
YOUR WILLINGNESS TO BE TALKING
ABOUT YOUR VOTER BEHAVIOR IS
DEFINITELY RELATED TO YOUR
ATTITUDES ABOUT CERTAIN
POLITICAL THINGS.
IN HEALTH, NOT ALWAYS SO MUCH.
WE DO HAVE TO MAKE SURE-- AND
WE WILL GET TO THIS LATER --
THE GROUPS THAT ARE HARD TO
FIND, HARDER TO REACH, HARDER
TO CONVINCE THAT THEY SHOULD BE
TALKING WITH US, THAT IS WHERE
A LOT OF OUR INTEREST AND OUR
ATTENTION IS DIRECTED. IT IS
PARTLY A MATTER OF BIAS IN
GENERAL, BUT ALSO MAKING SURE
THAT EVERYBODY THAT WE HAVE AN
INTEREST IN COMMUNICATING IN,
BRINGING THE DATA TO THE TABLE
IS IN FACT REACHED.
>> OKAY.
>> YEAH, I DON'T KNOW IF I HAVE
A LOT TO ADD TO WHAT PAUL SAID.
BUT MAYBE I CAN TALK ABOUT
SPECIFICALLY ABOUT NHIS. WE
DID A REDESIGN OF OUR
QUESTIONNAIRE IN 2019, AND DID
A REDESIGN OF OUR WEIGHTING
PROCEDURES AT THE SAME TIME.
WE DID THE QUESTIONNAIRE
REDESIGN.
THE RESULT OF THAT HAS BEEN
LIKE A CLOSER LOOK AT
NONRESPONSE BIAS EVERY YEAR
WITH THIS PROCESS. WHAT WE
USED TO DO AS WE HAD A BASIC
GEOGRAPHIC ADJUSTMENT PER
NONRESPONSE TO SORT OF TAKE
CARE OF THE DIFFERENT RATES OF
RESPONDING ACROSS THE US.
AND THEN, WE WOULD HAVE AN
AGE/SEX POST STRATIFICATION. WE
DID SOME RESEARCH THAT HELPED
US KIND OF REDESIGN OUR
WEIGHTING; AND THAT GAVE US A
LITTLE BIT MORE COMPLICATED
PROCESS THAT INVOLVED MODELING
USING OUR PAIR DATA AND USING
OTHER SOURCES OF INFORMATION TO
SORT OF MODEL NONRESPONSE IN A
SAMPLE ADULT OR SAMPLE CHILD
LEVEL. AND SO WE HAVE SOME
MULTILEVEL REGRESSION MODELS
THAT SERVE AS PREDICTORS OF
RESPONSE AND WE PUT THAT INTO A
PROPENSITY MODEL, AND ADJUST
FOR THAT NONRESPONSE THAT WAY.
WE'VE GOTTEN A LITTLE BIT MORE
COMPLICATED, OVER THE PAST
COUPLE OF YEARS. WE NOW USE
SORT OF MACHINE LEARNING
METHODS, OR RECURSIVE
PARTITIONING MODELS. AND SO,
THESE MODELS ALLOW US THEY ARE
TREE-BASED MODELS THAT ALLOW US
TO LOOK AT THE INTERACTIONS
BETWEEN VARIOUS PREDICTORS OF
NONRESPONSE AND HOPEFULLY DO A
BETTER JOB OF MODELING THE
NONRESPONSE. THAT GOES INTO OUR
PROPENSITY MODEL NOW.
AND, WE'VE ALSO AS A RESULT OF
REDESIGNING OUR WEIGHTING,
INSTEAD OF USING THE
AGE/SEX/RACE POST
STRATIFICATION WE DO
CALIBRATION THROUGH RAKING.
AND THAT GIVES US SOME MORE--
A LITTLE BIT MORE OF A VARIETY
OF DIFFERENT CELLS THAT WE DID
NOT HAVE BEFORE IN THE
CALIBRATION.
SO WE HAVE THINGS LIKE AGE,
SEX AND RACE STILL. BUT WE
ADDED TO THAT EDUCATIONAL
ATTAINMENT, METROPOLITAN
STATISTICAL AREA STATUS, AND
SO, WHEN WE LOOK AT WHAT REALLY
MAKES OUR ADJUSTMENTS WORK, IN
SPITE OF HOW COMPLICATED THE
NONRESPONSE WEIGHTING METHODS
ARE, IT'S REALLY THE
CALIBRATION THAT MOVES THE
ESTIMATES IN THE RANKING MAKES
A BIG DIFFERENCE.
AND SO, WITH THOSE MODELS,
EVERY YEAR WE HAVE A COUPLE OF
DIFFERENT TYPES OF DATA FILES
THAT WE PRODUCE. WE HAVE WHAT
WE CALL "EARLY RELEASE
ESTIMATES," THAT WERE RELEASED
FOUR TIMES DURING THE YEAR,
EVERY QUARTER AND WE ALSO HAVE
AN ANNUAL DATA FILE THAT IS
RELEASED IN EVERY YEAR WE DO
THE ANNUAL DATA FILE WE ARE
RERUNNING THE NONRESPONSE
WEIGHTING MODELS TO SEE WE ARE
PICKING UP ANY NEW FACTORS. WE
ARE CONSTANTLY LOOKING FOR NEW
DATA SOURCES OUT THERE THAT WE
CAN LINK TO OUR DATA AND SEE IF
THERE IS SOME LEVEL OF
GEOGRAPHY AND SEE IF THEY ARE
PREDICTIVE OF NONRESPONSE THAT
WOULD ADD ANYTHING TO OUR
WEIGHTING. SOMETIMES WE CAN
CHANGE THAT. IT CAN RESULT IN
CHANGES OF WHAT GOES INTO THE
MODEL OVER TIME.
AND THEN, SO WE BASICALLY
STICK WITH THE SAME MODEL FROM
THE ANNUAL FILE. THAT WILL GET
APPLY TO ALL THE QUARTER P
FILES. BUT AT LEAST ONCE A YEAR
WE ARE LOOKING VERY CLOSE THAT
WHETHER ANYTHING SHOULD BE
UPDATING IN THE NONRESPONSE
WEIGHTING MODELS.
WITH THE PANDEMIC HEAD,
(CORRECTION) HIT, WE SAW THERE
WERE THINGS THAT WE NEED TO
ADJUST IN OUR RAKING
PROCEDURES. WHEN THE PANDEMIC
HIT, WE WERE SEEING ONE
VARIABLE THAT SHOWED UP REALLY
STRONGER THAN IT HAD IN THE
PAST, HOUSING TENURE. WE WERE
SEEING WEALTHIER HOUSEHOLDS
SNEAK IN AT A HIGHER RATE THAN
LESS WEALTHY HOUSEHOLD.
WE ADDED THAT TO OUR RANKING
PROCEDURES IN 2020.
BESIDES THE WEIGHTING, WHAT
WE WERE TRYING TO DO TO ADDRESS
RESPONSE RATES, WE START AS AN
IN PERSON SURVEY. AND SO, WE
DON'T HAVE INCENTIVES. REALLY,
I STILL THINK THE STRONGEST
THING YOU CAN DO TO ADDRESS
NONRESPONSE IS NOT CAN
SOMEBODY'S DOOR. THERE'S NOT A
WHOLE LOT ELSE WE CAN
DO THAT IS GOING TO BE
STRONGER THAN THAT. AND SO WE
FOCUSED A LOT OF OUR EFFORTS ON
WHATEVER WE CAN DO TO TRY TO
SUPPORT THE CENSUS FIELD
REPRESENTATIVES IN GOING OUT
AND RECRUITING HOUSEHOLD.
SYMPTOMS THAT MEAN TRYING TO
FIGURE OUT WAYS TO ADDRESS
CONCERNS THAT RESPONDENTS HAVE
THROUGH TRAINING AND THINGS OF
THAT NATURE. OTHER TIMES IT IS
DEVELOPING NEW MATERIALS THAT
THEY CAN USE TO RECRUIT
HOUSEHOLDS. AND SOMETIMES,
IT'S KIND OF CREATING FORUMS
FOR THE FRS TO ENGAGE WITH
THEIR SUPERVISORS AND WITH
THEMSELVES TO TALK ABOUT HOW
THEY CAN ADDRESS THEIR CASELOAD.
BUT THAT IS REALLY THE FOCUS
OF OUR EFFORTS. GIVING THEM THE
SUPPORT THEY NEED.
>> SO AS I SAID OUR STUDY IS
SLIGHTLY DIFFERENT IN SOME OF
THE OTHER SURVEYS. IT IS
LONGITUDINAL. SO ALL WE DO HAVE
RESPONSE RATES, WE HAVE A
REALLY GOOD RETENTION OF OUR
SAMPLE OVER TIME. AND ONE
THING THAT I DID NOT MENTION IN
THE STUDY IS WE REPLENISH THE
SAMPLE TWICE. AND THE PRIMARY
PURPOSE OF REPLENISHING THE
SAMPLE, IT HAPPENED THAT WAY,
2017-18, HAPPENED AGAIN IN WAVE
7, WHICH WAS LAST YEAR IN 2022.
AND THE MAIN PURPOSE OF THAT
IS TO REPLENISH OUR YOUNGEST
DISCIPLINES, SO WE CAN HAVE 12
AND 13-YEAR-OLDS IN OUR STUDY.
AND I WILL SAY THAT OUR
REPLENISHMENT RESPONSE RATES
HAVE GONE DOWN OVER TIME AND WE
ARE NOT QUITE SURE WHY. WE DO
PROVIDE INCENTIVES FOR OUR
PARTICIPANTS. THAT IS A LITTLE
BIT EASIER. I THINK AARON MADE
A GREAT POINT OF BEING AN IN
PERSON SURVEY, PRIMARILY IN
PERSON AND WE DID CHANGES
DURING COVID TO OFFER OUR 2020
SAMPLE VIA TELEPHONE AND IN
2021, IT WAS PRIMARILY VIA
TELEPHONE. AND SINCE WE HAVE
RESUMED IN PERSON DATA
COLLECTION AND THE
RELATIONSHIPS OF PEOPLE WHO
WERE GOING TO THE SAME HOUSES
EVERY YEAR, THEY REALLY HAVE
BEEN ABLE TO BUILD A
RELATIONSHIP TO THE
PARTICIPANTS THEMSELVES. AND
ABLE TO STAY IN CONTACT WITH
THEM.
WE DO MAIL THROUGHOUT THE YEAR
BIRTHDAY CARDS AND OTHER WAYS
TO CONTACT THE PARTICIPANTS TO
REMIND THEM OF THE STUDY, AND
THE IMPORTANCE OF THE STUDY.
AND THAT SORT OF THING. WE ARE
CONSTANTLY UPDATING OUR
MATERIALS WITH INFOGRAPHICS,
AND DIFFERENT THINGS TO SHOW
HOW IMPORTANT THE DATA THAT
THEY ARE PROVIDING TO US ARE.
AND I WOULD SAY THAT YOU KNOW
WE DO VERY SIMILAR THINGS. WE
CONDUCT NONRESPONSE BIAS
ANALYSIS EVERY YEAR, ONE OF
THOSE VERY LONG DOCUMENT THAT I
AM NOT SURE ANYONE OUTSIDE OF
OUR RESEARCH GROUP READS. BUT
IT IS AVAILABLE AND IT IS
ONLINE.
THE LATEST ONE FOR WAVE 6 WAS
DONE AND IT INDICATED THERE
WERE NO MAJOR ISSUES. THE
WEIGHTING PROCEDURES WE HAVE
CORRECT FOR ANY POSSIBLE BIAS
THAT IS AN EXAMPLE. AND WE
ALSO APPLY RAKING PROCEDURES
AND ALSO TO THINK AND I AM NOT
METHODOLOGIST UNDERSTUDIES. AND
I WILL SPEAK VAGUELY ABOUT SOME
OTHER THINGS THAT I'M HAPPY TO
TAKE QUESTIONS AND BRING THEM
BACK, AND RESPOND VIA EMAIL IF
THAT IS MOST APPROPRIATE.
I WOULD SAY THEY JUST BEING
LONGITUDINAL, AND HAVING
REPEATED CONTACT, HAS REALLY
BEEN THE MOST BENEFICIAL IN
KEEPING OUR RESPONDENTS THERE.
AND THE SHIFT FROM ANNUAL DATA
COLLECTION TO BIANNUAL DATA
COLLECTION DID AFFECT SOMEWHAT
BECAUSE WE MAY BE LOST CONTACT
IN THAT IN BETWEEN YEAR. BUT
LIKE I SAID WE ATTEMPTED TO
MAINTAIN CONTACT BY OFFERING
INCENTIVES EVEN FOR UPDATING
YOUR CONTACT INFORMATION. IF
YOU MOVED OR SOMETHING ALONG
THOSE LINES.
SO THOSE ARE SOME OF THE WAYS
THAT WE HAVE WORKED ON OUR
RESPONSE RATES OVER TIME.
>>
>> WE WERE LOOKING AT THE
NONRESPONSE BIAS, WE STARTED
LOOKING AT DATA FROM 2010 AND
RAKING THE METHODOLOGY AND
INCORPORATING THAT IN THE
ACTUAL METHODOLOGY. WE HAVE
DONE SIMILAR TO WHAT AARON HAS
DONE, BUT WE STARTED ABOUT 10
YEARS AGO. WE CONTINUE TO LOOK
AT OTHER VARIABLES THAT WE CAN
INCORPORATE INTO THE BRFS. AND
INTO OUR WEIGHTING.
WE ALSO LOOKED AT OTHER WAYS
OF HOW CAN WE LOOK AT THE
DATABASE ON WHAT WE HAVE
ACTUALLY COLLECTED AND DOING
MULTIPLE PILOTS FROM YEAR TO
YEAR TO DETERMINE WHETHER OR
NOT THE DATA THAT WE ARE
COLLECTING IS IN LINE WITH WHAT
OTHER SURVEY METHODS CAN
COLLECT. SO WE ARE IN THE
PROCESS OF COMING UP WITH A
MULTIMODE SURVEY WHERE WE WON'T
JUST BE DOING MAIL AND CELL
PHONE ADMINISTRATION, LOOKING
AT ELECTRONIC HEALTH DATA, THE
ELECTRONIC HEALTH RECORDS AND
WE DID A REALLY GOOD PILOT TWO
YEARS AGO WHERE WE ACTUALLY
PULLED THE CHRONIC HEALTH DATA,
AND WE SURVEYED THOSE
PARTICULAR PERSONS IN THE
ELECTRONIC HEALTH RECORD TO SEE
IF THERE DATA, THEY
ADMINISTERED THE BRFS DATA WITH
THEIR DATA, THE SURVEY DATA
BEING IN LINE WITH THE ACTUAL
ELECTRONIC HEALTH DATA.
AND WHAT WE FOUND IS THAT MOST
OF THE DATA WAS IN LINE. WHEN
WE LOOK TO CHRONIC CONDITIONS.
BUT WHEN WE TALK ABOUT TIMING,
WHEN YOU HAVE HAD YOUR LAST
APPOINTMENT, OR WHEN YOU GOT
YOUR FLU SHOT, THAT PARTICULAR
DATA WAS LITTLE BIT OFF. BUT
WHEN YOU LOOK AT WHETHER OR NOT
THEY HAD A CHRONIC CONDITION,
OR DIFFERENT RISK BEHAVIORS
THAT DATA WAS IN LINE WITH WHAT
THE BRFS ACTUALLY COLLECTS.
SO WE CONTINUE TO LOOK AT THE
DATA TO SEE IF IT IS ACTUALLY,
IF IT IS BIASED, IF WE ARE NOT
COLLECTING ENOUGH DATA FOR
DIFFERENT PARTICIPANTS. OR WE
TRY TO MAKE SURE WE ARE
REACHING UNDERSERVED
POPULATIONS. AND WE CONTINUE
TO TRY TO COME UP WITH WAYS IN
WHICH WE CAN ACTUALLY SURVEY
DIFFERENT RACE AND ETHNICITIES,
WHEN WE ARE INCORPORATING
METHODOLOGIES. SO WE ARE TRYING
TO REDUCE BIAS BY LOOKING AT
DIFFERENT METHODS.>> THANKS
MICHELLE.
>> I WANTED TO CIRCLE BACK TO A
COUPLE OF THINGS. I REALIZE
THAT WE ARE TALKING ABOUT A
LARGER POINT OF VIEW OF PEOPLE
WHO HAVE DATA AND WANT TO
DISSEMINATE IT. AS DATA
COLLECTORS, THERE'S A COUPLE
OF THINGS WE SHOULD THINK ABOUT
TOO THAT ARE RELATED TO THE
PROBLEMS OF NONRESPONSE. ONE IS
TRUST. YOU PEOPLE KNOW WHY WE
WANT TO COLLECT WHAT WE ARE
DOING? AND WHAT WE ARE GOING TO
DO WITH IT? HOW ARE WE GOING TO
KEEP IT SAFE?
THAT MESSAGE IF IT IS NOT VERY
CLEAR EXACERBATES THIS PROBLEM.
THE OTHER IS BURDEN. I'M NOT
GOING TO PICK ON AARON LAST WHO
ASKS A 500 QUESTION SURVEY, BUT
BURDEN LEADS TO NOT ONLY
NONRESPONSE, BUT ALSO LEAD TO
LOWER QUALITY EVEN IF YOU GET
THEM TO RESPOND. SO IT'S A
QUESTION WE NEED TO TAKE VERY
SERIOUSLY.
AND IN TERMS OF CONSEQUENCE,
WE TALKED ABOUT BIAS AS THE BIG
THING. ANOTHER CONSEQUENCES IS
COST. IT MAKES SURVEY LESS
SUSTAINABLE WE HAVE TO TALK TO
TWICE AS MANY PEOPLE. AND THAT
IS ANOTHER VITAL THING THAT WE
HAVE TO HAVE RECKONING ABOUT.
CAN WE AFFORD TO DO THINGS THE
WAY WE ARE DOING THEM? THEY ARE
CAUSING PERHAPS TOO MUCH
BURDEN, AND PERHAPS THEY ARE
NOT ULTIMATELY GOING TO BE
SUSTAINABLE.
>> GREAT POINTS. THANK YOU.
MICHELLE?
>> DR. TOWN: WE DID HAVE A
REDESIGN A QUESTIONNAIRE IN
2020 AND WE STREAMLINE OUR
SURVEY. OUR CORE IS NOT GOING
TO BE 25 MINUTES. WE ARE
DETERMINED TO THE MODULE, WE
WANTED TO MAKE SURE WE WERE NOT
KEEPING PEOPLE IN TELEPHONE TOO
LONG. WERE TRYING TO GET AT
LEAST 400,000 COMPLETE EACH
YEAR AND WE GET 450,000
COMPLETE EACH YEAR.
AND TO GET PEOPLE TO ACTUALLY
ANSWER THE SURVEY, WE ACTUALLY
HAVE OUR TELEPHONE NUMBERS
COMING IN AT THE STATE HEALTH
DEPARTMENT. SO WHEN THEY SEE
THAT PARTICULAR NAME ON THE
TELEPHONE, THEY USUALLY ANSWER.
BUT LATELY WE HAVE HAD SOME
ISSUES THAT WE WILL TALK ABOUT
LATER.
>> THANK YOU ALL FOR ENGAGING
ON NONRESPONSE RATE. IT'S
SOMETHING THAT LIKELY ALL OF
THE STUDIES ARE BASED WHEN
SUBMITTING PAPERS AND GETTING
REVIEWER COMMENTS TO ASK ABOUT
RESPONSE AND POTENTIAL
NONRESPONSE BIAS USING YOUR
SERVICE AS WELL.
>> DR. BLAKE: SO LET'S MOVE
INTO CONVERSATION ABOUT DATA
LINKAGES ESPECIALLY FOR MACHELL
AND MELISA AND AARON. WHAT ARE
YOU CAN SYNERGY THE DATA
COLLECTION EFFORTS YOU LEAD.
ANY LINKAGES THAT ARE DATA
USERS MIGHT PURSUE. EVEN IF IT
IS NOT A LINKAGE BUT COMPARISON
OF ITEMS, PREVALENCE ESTIMATES,
THINGS LIKE THAT. I WANT TO
TALK ABOUT LINKAGES FOR A BIT.
DR. CREAMER I'M GOING TO HAVE
YOU START THIS TIME.
>> DR. CREAMER: HAPPY TO. SO
RIGHT NOW LIKE I SAID ALL OF
OUR SURVEY DATA ARE AVAILABLE
VIA -- THROUGH 2021, WAVE 6
SURVEY. THOSE DATA ARE
AVAILABLE TO DOWNLOAD MOST
MEASURES USED IN THE SURVEY ARE
PULLED FROM THE PHOENIX
TOOLKIT. WE TRY TO BE REALLY
CAREFUL WITH PULLING OUR
MEASURES AND MAKING SURE THEY
ARE COMPARABLE TO OTHER
SURVEYS. OR FROM VALIDATED
SUBSCALES. THINGS LIKE THE --
ASSESSMENTS LOOKING AT
DIFFERENT PSYCHOLOGICAL
VARIABLES AND RISK FACTORS
ASSOCIATED WITH TOBACCO USE.
ONE OF THE BEST WAY TO LINK
WITH OUR DATA TO GO THROUGH THE
CODEBOOKS AND UNDERSTAND THE
VARIABLES. I WON'T TELL YOU HOW
MANY QUESTIONS WE HAVE ON OURS,
BUT IT IS A 60 MINUTE IN PERSON
SERVE HER ADULT AND 45 MINUTES
FOR YOUTH. SO THERE'S A LOT OF
ITEMS AND A LOT OF QUESTIONS.
WE HAVE QUESTIONS ON
SCHIZOPHRENIA. WE WERE ABLE TO
DO NATIONAL ASSESSMENT ON
SCHIZOPHRENIA FOR INSTANCE
WHICH ISN'T NECESSARILY
AVAILABLE AND OTHER DATA SETS.
AND SO LINKING DATA TOBACCO USE
IS ONE THING. BUT I THINK
THERE'S A LOT OF OPPORTUNITIES
TO REALLY SYNERGIZE A LOOK AT
HOW CAN WE TRIANGULATE THE DATA
ACROSS THE SURVEYS.
>> DR. TOWN: WE HAVE THE DATA
ON THE WEBSITE AND A LOT OF
DOCUMENTATION AS AARON HAS
SAID. BRFS, WE TRY TO BE
TRANSPARENT WITH WHAT WE
ACTUALLY COLLECT SO EACH YEAR
WE DO HAVE MULTIPLE
DOCUMENTATION. OUR DATA
NORMALLY IS AT THE STATE LEVEL.
WE HAVE A COUNTY LEVEL THAT YOU
CAN USE BUT YOU HAVE TO GO TO
THE DATA RESEARCH CENTER TO PUT
IN A PROPOSAL. AND EVEN OTHER
AGENCIES THAT BLANK WITH OUR
DATA WE LINK THE BRFS DATA WITH
THE NATIONAL HEALTH INTERVIEW
SURVEY DATA. THERE IS A WAY
TO LINK THE BRFS DATA BY USING
THE COUNTY VARIABLE IF YOU GO
TO THE RESEARCH DATA CENTER.
>> DR. MAITLAND: NHIS DOES HAVE
LINKAGES TO A LOT OF DIFFERENT
SOURCES SO RESPONDENTS ARE
LINKED TO THINGS LIKE SOCIAL
SECURITY, MEDICARE FILES,
NATIONAL DEATH FILES. I KNOW
THAT HINTS AS AN AREA BASED
FILE AT THE COUNTY LEVEL. WE
ARE PROBABLY NOT A GREAT SOURCE
FOR THAT KIND OF LINKAGE
BECAUSE WE ARE THE NATIONAL
LEVEL. BUT, BRFS IS PROBABLY A
BETTER SOURCE FOR THAT TYPE OF
LINKAGE.
BUT IN TERMS OF OTHER TYPES OF
LINKAGES, IN TERMS OF YOU KNOW
COMPARING PREVALENCE ESTIMATES
AND THINGS LIKE THAT, NHIS HAS
HAD SOME HEALTH INFORMATION
QUESTIONS ON IT IN THE PAST.
THERE WERE A FEW YEARS WHERE
THEY WERE OFF. WE ACTUALLY PUT
THEM BACK ON. WE HAVE
QUESTIONS ABOUT LOOKING FOR
INFORMATION ABOUT HOW
COMMUNICATING WITH DOCTORS AND
USING THE INTERNET TO LOOK AT
MEDICAL TESTS RESULTS, AND
THINGS LIKE THAT.
AND THE REASON WE PUT IT BACK
ON ACTUALLY IS THAT WHILE WE
HAVE THIS RAPID SERVICE SYSTEM
RUNNING ALONGSIDE THE NHIS,
ONE OF THE THINGS, ONE OF THE
WAYS THAT WE WERE ABLE TO
CONVINCE OMB THAT IT WAS WORTH
GIVING THE COMMERCIAL WEB
PANELS THEY TRY, WE CAN
HOPEFULLY CALIBRATE THE
ESTIMATES FROM THE RAPID SURVEY
SYSTEM TO ESTIMATES FROM THE
NHIS.
AND SO WE WERE LOOKING FOR
THINGS THAT MAY BE PREDICTIVE
OF PEOPLE USING TECHNOLOGY AND
MAYBE, PAUL WAS TALKING ABOUT
THE PROPENSITY TO PARTICIPATE
IN WEB PANELS AND THINGS LIKE
THAT. SO THOSE REALLY SEEMED TO
BE GOOD CANDIDATES. BUT THOSE
VARIABLES WON'T BE ON THE NHIS
DATA FILE FOR PEOPLE TO USE FOR
OTHER TYPES OF PURPOSES. SO
YEAH THERE IS SOME SYNERGY
THERE.
>> DR. BLAKE:
SO WE HAVE A 11 MINUTES LEFT.
I WANT TO COMBINE THE LAST TWO
PIECES WE HAD DISCUSSED WHEN
WERE PREPPING FOR THIS PANEL TO
TALK ABOUT THE BIGGEST
CHALLENGE AND THAT DATA USERS
AND FEDERAL SURVEYS CURRENTLY
FACE OR WILL FACE IN THE NEXT
2-5 YEARS AND THE KEY
OPPORTUNITIES THAT PEOPLE
ANALYZING FEDERAL SURVEY DATA
SHOULD EMBRACE IN THE NEXT
COUPLE OF YEARS. MACHELL I WILL
START WITH YOU THAT IS OKAY.
>> DR. TOWN: AS BRFS MOVES TO
MULTIMODE SURVEY, WITHIN THEIR
DATA USERS WOULD DEFINITELY
HAVE TO UNDERSTAND HOW TO
ACTUALLY USE THE DATA. AND ALSO
I KNOW A LOT OF OUR DATA USERS,
THEY DO A LOT OF TREND ANALYSIS.
FOR LOOKING AT WHETHER OR NOT
THE DATA CAN STILL CONTINUE TO
BE USED LOOKING AT TRENDS. AND
SO I THINK THAT IS GOING TO BE
AN ISSUE THAT WE ARE GOING TO
HAVE TO FACE. AND ALSO ONE OF
THE THINGS THAT WE ARE HOPING
THAT WE ARE GOING TO DO WITH
THE MODE, THAT WE WILL BE ABLE
TO REACH MORE OF THE YOUNGER
POPULATION WHEN WE ADD SOME
OTHER WEB-BASED SURVEYS. SO
MAKING SURE THAT YOU LOOK AT
THE ESTIMATES AND UNDERSTAND
EXACTLY WHAT YOU'RE GOING TO GET
WITH THE NEW BRFS, WHEN WE ADD
A DIFFERENT MODE TO THE SURVEY.
>> DR. BLAKE: THANKS. MELISA?
>> DR. CREAMER: SURE WE HAVE
ALSO BEEN IN A MULTIMODE SINCE
2020 WHEN WE INTRODUCE THE
TELEPHONE PIECE TO IT. THAT
HAS BEEN CHALLENGING IN AND OF
ITSELF. BUT I THINK REALLY THE
PANDEMIC INFLUENCE-- WE DON'T
KNOW IF THE TRENDS AND THE
ESTIMATES HAVE HAPPENED DURING
THE PANDEMIC ARE REFLECTIVE OF
THE ACTUAL BEHAVIOR CHANGE. OR
IS IT A SHORT-TERM OR LONG-TERM
CHANGE?
SO BEING A MULTIMODE STUDY,
AND HAVING SIGNIFICANT CHANGES
FOR US PARTICULARLY HAS MADE US
THROUGH WHAT IS THIS GOING TO
LOOK LIKE? ARE THESE LONG-TERM
CHANGES?
BUT I THINK REALLY THE BIGGEST
CHALLENGE, SOMETHING THAT
PEOPLE WHO USE OUR DATA AND
WANTED USE OUR DATA, IS A
TIMELINESS. WE HAVE A 52-WEEK
COLLECTION PERIOD. WE ARE IN
THE FIELD ALL YEAR COLLECTING
OUR DATA, WHICH THEN MEANS THE
DATA OFTEN ARE NOT AVAILABLE
RIGHT AWAY. THEY ARE NOT
AVAILABLE FOR 6-9 MONTHS EVEN
INTERNALLY. AND THE RESEARCHER
FILE AND THE PUBLIC FILE AND SO
THE RESEARCH 2021 DATA JUST
BECAME AVAILABLE AS A PUBLIC
USE FILE THIS WEEKEND THAT IS
NEARLY A YEAR AND A HALF AFTER
THE DATA WERE FINISHED
COLLECTED. NOT BECAUSE WE ARE
HOLDING ONTO THE DATA. THERE'S
A LOT TO GOES INTO MAKING THE
DATA AVAILABLE. THAT IS
SOMETHING THAT WE WILL CONTINUE
TO FACE CHALLENGES WITH,
ESPECIALLY AS THERE IS PRESSURE
TO GET ESTIMATES TO OCCUR AND
UNDERSTAND WHAT IS HAPPENING IN
THE FIELD TO SEE WHAT IS GOING
ON.
AND IN TERMS OF AN OPPORTUNITY,
YOU KNOW THERE'S SO MUCH DATA
THAT ARE AVAILABLE. AND I THINK
THAT AS A RESEARCH COMMUNITY
LOOKING BEYOND PREVALENCE
ESTIMATES, BECAUSE I THINK THAT
IS OFTEN FROM THE NATIONAL SIDE
OF THINGS, FOCUSED ON WHAT IS
THIS, WHAT CAN WE PUT UP ON THE
WEBSITE AND WHAT IS HAPPENING.
THERE ARE REALLY INTERESTING
RESEARCH QUESTIONS THAT CAN BE
ANSWERED IN ALL OF THIS DATA.
SO UNDERSTANDING HOW CAN YOU
EITHER COMBINE DATA, DO
SUBPOPULATION ESTIMATES AND
REALLY UNDERSTAND WHAT IS
HAPPENING, AND YOU HAVE THE
LOGICAL LEVEL MULTIMODAL DATA
ALLOWING YOU TO LOOK OVER TIME
VIA REPEATED CROSS-SECTION OR
DO WITH IN PERSON CHANGES.
SO I THINK THERE ARE A LOT OF
WAYS TO EMBRACE THE DATA THAT
ARE AVAILABLE, AND LOOKED
TOWARDS THE REALLY INTERESTING
RESEARCH QUESTIONS TO PROPEL
THE FIELD FORWARD.
>> DR. BLAKE: THANK YOU. AARON
AND THEN PAUL.
>> DR. MAITLAND: YOU ALL DID A
GREAT JOB. I AM GOING TO ECHO A
LOT OF WHAT HAS ALREADY BEEN
SAID. LIKE PAUL SAID, WITH
RESPONSE RATES BEING WHAT THEY
ARE, OF COURSE THAT IS A
CHALLENGE, AND THAT IS TIED
DIRECTLY TO THE COST. WE DID
REDESIGN THE SURVEY IN 2019 TO
ADDRESS BURDEN AND MAKE IT
SHORTER. BUT THE INCREASE IN
COST IS HOW YOU GET BACK UP TO
500 QUESTIONS. RIGHT? BECAUSE
WE LOOK FOR OTHER PROGRAMS TO
HELP FUND THE SURVEY. AND THAT
COMES WITH ADDITIONAL CONTENT
ON THE SURVEY. SO YEAH,
DEFINITELY RESPONSE RATES AND
COSTS ARE A BIG CHALLENGE.
ALSO WANT TO ECHO THE THEME OF
TIMELINESS. A COUPLE OF YEARS
AGO FCSM, THERE WAS A REPORT
RELEASED THROUGH THEM, WE NEED
TO START THINKING ABOUT DATA
QUALITY IN BROADER TERMS AND
YES INCLUDE SUBSTANTIAL
ACCURACY AND RELIABILITY AND
INTEGRITY AND ALL THAT. BUT
TIMELINESS IS A PART OF THAT
TOO. YOU CAN HAVE THE BEST
DATA BUT IT'S NOT ON TIME TO
HELP POLICY DECISIONS, IT'S NOT
AS HELPFUL AS IT COULD BE.
AND THAT IS THE IMPETUS FOR
THINKING ABOUT THE RAPID SURVEY
SYSTEM TOO. AND, THE
OPPORTUNITIES -- I REALLY WANT
TO ECHO WHAT WAS SAID BEFORE ME
HERE. I THINK YOU KNOW, WE
ARE ALL APPEAR TALKING ABOUT
SURVEY DATA, BUT THERE IS SO
MUCH MORE THAT YOU CAN DO,
SURVEY DATA VIA ENGAGES, BY A
FILE, THE OBSERVER IS UNCLEAR
LIKE HANES HAS BEEN AROUND
FOREVER DOING EXAMS IN
CONNECTION WITH SURVEYS.
TECHNOLOGY IS GETTING BETTER
AND BETTER SO YOU CAN COLLECT
DIFFERENT TYPES OF DATA AND
SURVEY DATA, ALSO
ADMINISTRATIVE RECORD LINKAGES.
AND I THINK THE SURVEY DATA
STILL HAS A LOT TO OFFER WHEN
YOU'RE TRYING TO GO IN DEPTH
AND PARTICULARLY FOR THINGS
THAT YOU CAN'T GET OUT OF A
RECORD, AND CANNOT MEASURE ANY
OTHER WAY. KIND OF AN EXCITING
TIME FOR DATA USERS TO HAVE
THOSE LINKAGES.
>> DR. BLAKE: IT IS AND PAUL
WILL LET YOU CLOSE WITH THE
CHALLENGES AND OPPORTUNITIES.
AND THAT WILL OPEN IT UP FOR A
FEW QUESTIONS.
>> DR. BEATTY: SO A LOT OF I
WOULD SAY ECHO THE GREAT
COMMENTS EVERYONE ELSE HAS MADE.
BUT WHEN THINKING ABOUT
SURVEYS AND WE ARE LOOKING
ACROSS MANY SERVERS AND MANY
SYSTEMS, IT IS COST AND
SUSTAINABILITY THAT KEEPS US UP
AT NIGHT.
WHEN WE LOOK AT THE TRENDS AND
HOW MUCH IT COSTS TO PRODUCE
ESTIMATES THAT WILL BE
ACCEPTABLE, IT'S NOT GOING IN A
GOOD DIRECTION.
ONE THING WE HAVE A LOT OF
HOPE IN FIELD COSTS IS MOVING
INCREASINGLY TO MORE SELF
ADMINISTRATION. NOT EASY TO DO,
TO PLOP IT INTO A WEBSITE. BUT
WE FIND THAT INTERVIEWERS HAVE
A VERY COMPLICATED AND
INTERESTING RELATIONSHIP WITH
OUR DATA COLLECTION. THEY
MIGHT TAKE QUESTIONS THAT DON'T
REALLY WORK THAT WELL AS
STANDALONE MEASURES. AND HELP
TO FINESSE US TO GET PEOPLE TO
ANSWER THEM, WHETHER THROUGH A
COMBINATION OF MOTIVATING OR
REWORKING SLIGHTLY, THESE SORTS
OF THINGS.
IT IS A VERY BURDENSOME, AND
IT'S GOING TO BE A BIG PART OF
OUR EFFORTS OVER THE NEXT
SEVERAL YEARS TO BE THINKING
ABOUT HOW CAN WE REALLY GET A
FUNCTIONAL SURVEY THAT GETS THE
SAME DATA, BUT IS POSSIBLE FOR
SOMEONE TO DO WITHOUT AN
INTERVIEWER BEING PRESENT AND
ENGAGING WITH. AND STILL
WORKS.
WE ARE PLANNING TO SPEND QUITE
A BIT OF EFFORT ON THAT IN THE
NEXT YEARS. ANOTHER CHALLENGE
THAT I THINK WE ALL HAVE THIS
KIND OF MAKING SURE WE STAND UP
IN A CROWDED FIELD OF PEOPLE
ASKING FOR DATA. PEOPLE ARE
GETTING BOMBARDED WITH REQUESTS
FOR INFORMATION. THEY DON'T
REALLY WANT TO BE BOMBARDED
WITH REQUESTS FOR INFORMATION.
WE HAVE TO HAVE A REALLY GOOD
CASE FOR WHY OURS MATTER AND
WHY YOU SHOULD TALK TO US. AND
THERE ARE GREAT REASONS WHY YOU
SHOULD TALK TO US, AND ALL OF
THESE SERVICES WE HAVE BEEN
TALKING ABOUT TODAY. BECAUSE
THEY REALLY MAKE A DIFFERENCE
IN PEOPLE'S LIVES. BUT THAT
MESSAGE NEEDS TO BE FIRST OF
ALL IN PEOPLE'S FRAMES OF MIND.
THEY NEED TO UNDERSTAND WHAT
THE INFORMATION IS FOR AND THE
BENEFIT FOR SOCIETY, AND WHY IT
MATTERS. AND THE DIFFERENT
PRODUCTS THAT PEOPLE CAN SEE IS
REALLY CRITICAL.
IN TERMS OF-- THE LAST THING I
WILL SAY IS ABOUT A CHALLENGE
AND AN OPPORTUNITY. MAYBE WE
WILL BE ABLE AND NEED TO BE ABLE
TO FIND OTHER DATA SOURCES,
OTHER THAN SURVEYS THAT
SUPPLEMENT AND MEET OUR
RESEARCH NEEDS. AND IT'S A
DIFFERENT WORLD THAN THE ONE I
WAS TRAINED IN, WHERE WE REALLY
DESIGNED THE SURVEY AND WHAT WE
WANTED AND GOT THE DATA. NOW
YOU CAN ALWAYS COUNT ON THAT
WORKING. IT MAY NOT BECAUSE
FEASIBLE TO DO IT. IT MAY NOT
BE POSSIBLE TO GET PEOPLE TO
SIGN UP FOR THAT.
SO THE OPPORTUNITY THOUGH, IS
THAT IN LOOKING OTHER SOURCES
OF DATA, WE MIGHT FIND THAT
THEY GIVE US THE OPPORTUNITY TO
ANALYZE THINK THAT WE MIGHT NOT
HAVE THOUGHT ABOUT NECESSARILY.
WE DIDN'T USUALLY GO TO
ADMINISTRATIVE RECORDS AND
OTHER UNDESIGNED DATA SYSTEMS
BECAUSE WE WANTED TO. BUT
SOMETIMES FOUND THAT, NOT
ALWAYS BUT IN SOME CASES, THEY
ARE BETTER IN SOME WAYS, OR
DIFFERENT.
WHEN YOU THINK ABOUT HOW
EXCITING THE WORLD CAN BE,
INSTEAD OF THINKING ABOUT THE
STANDARD RECTANGULAR DATA FILE,
YOU'RE GOING TO HAVE TO PUT UP
SOMETHING THAT MIXES ALL KINDS
OF DATA WHETHER SELF RESPONSE
OR SOME ADMINISTRATIVE RECORDS,
OR OTHER FOUND DATA, WEARABLE
DATA. SOMETIMES THIS LEADS TO
REALLY NEW WAYS OF THINKING.
SO A QUICK EXAMPLE. I KNOW WE
ARE RUNNING OUT OF TIME. WE
HAVE BEEN LOOKING LATELY AT THE
CENSUS BUREAU, AT SOCIAL MEDIA
DATA. THINKING CAN SOCIAL MEDIA
TELL US THINGS THAT WE WERE
TRYING TO GET OUT OF
ATTITUDINAL SURVEYS? OR
WHATEVER. AN D IN OUR FIRST
ATTEMPT, TO SEE IF WE COULD GET
THE TRANCE TO FOLLOW CERTAIN
PATTERN, AT CERTAIN POINT WE
REALIZE THAT IS NOT THE ONLY
WAY TO ANALYZE THE DATA. THE
ACTUALLY MIGHT BE MEANINGFUL
THEMSELVES BECAUSE THEY ARE
ORGANICALLY PRODUCED, NOT IN
RESPONSE TO SURVEY QUESTION. SO
IT MAY NOT BE POPULATION-BASED
PERCENTAGE OF HOW MANY PEOPLE
TRUST THE GOVERNMENTAND A THE
PREDICTABLE GRAPH LIKE THAT.
BUT CHANGES IN SOCIAL MEDIA BY
BE MEANINGFUL, EVEN IF YOU DO
NOT KNOW IF IT'S THE SAME THING
THAT THE SURVEY DID. ANYWAY.
IT'S GOING TO BE A REALLY RICH
DATA WORLD. IT IS NOT GOING TO
CONTAIN THE DATA THAT WE ARE
ALL USED TO OR TRAINED ON
NECESSARILY. BUT THERE ARE
OPPORTUNITIES THERE AS WELL.
>> DR. BLAKE: WELL THANK YOU
ALL. PLEASE THANK ME THE PANEL
FOR JOINING US TODAY. IF
ANYBODY WOULD LIKE TO COME UP
TO THE MIC FOR A QUESTION OR
TWO BEFORE WE TRANSITION TO THE
NEXT PANEL?
>> SOPHIA CHAO FROM NCI. THE
QUESTION IS FOR EVERYBODY BUT
MOSTLY PERTAINING TO
SELF-ADMINISTERED ONLINE
SURVEYS. IN THE AGE OF CHAT GPT
AND AI, THERE HAVE BEEN
CONCERNS ABOUT CHATGPT
IMPERSONATING A PERSON. LIKE
IF YOU GET THE DATA SAYING YOU
ARE A 30-YEAR-OLD ASIAN WITH A
CANCER DIAGNOSIS, NOW GO ANSWER
ALL OF THE SURVEY QUESTIONS.
AND ANECDOTALLY, THEY ARE
FINDING A LOT OF SIMILARITIES
TO REAL-LIFE RESPONDENTS. AND
HAVE YOU THOUGHT OF THIS? IS
THIS SOMETHING THAT THERE ARE
WAYS TO MITIGATE SUCH HARMS OF
DATA INTEGRITY AND QUALITY?
BECAUSE OF GENERATIVE AI. THANK
YOU.
>> DR. BLAKE: ANYBODY THOUGHT
OF THAT YET?
>> I HAVEN'T THOUGHT ABOUT IT
BEFORE. BUT NOW I AM SCARED.
YEAH. I THINK THAT IS-- AI IS
CHANGING OUR WORLD SO QUICKLY.
I CANNOT EVEN IMAGINE SOMEONE
ASKING THAT QUESTION SIX MONTHS
AGO. AND NOW WE ARE TRYING TO
GRAPPLE WITH IT IN REAL TIME.
I THINK IT'S ABSOLUTELY
SOMETHING THAT WE NEED TO BE
CONCERNED ABOUT. I HAVE NOT
HAD A CHANCE TO THINK ABOUT IT
MUCH MORE BEYOND THAT. BUT I
WILL BY THIS TIME NEXT YEAR.
>> DR. TOWN: SAME HERE. I AM
CONCERNED NOW. HOPEFULLY WE
WILL EMBARK ON WEB-BASED
SURVEYS. WE PROBABLY HAVE TO
PUT SOMETHING IN PLACE WE HAVE
TO SHOW THAT YOU ARE A HUMAN.
PROBABLY HAVE TO DO THAT.
THANK YOU FOR BRINGING THAT TO
MY ATTENTION. WE ARE IN THE
PROCESS OF TESTING RIGHT NOW.
>> DR. CREAMER: WE HAVE NOT
THOUGHT ABOUT IT MUCH, BUT IN
TRANSITION FROM TELEPHONE TO IN
PERSON WE HAVE A LOT OF THINGS
ON HOW TO VERIFY. THIS IS A
LONGITUDINAL SURVEY. SHOULD BE
THE SAME PERSON. THERE WERE
VARIOUS VERIFICATION PROCESSES
THAT WENT INTO PLACE. I ASSUME
THAT IF WE WERE TO TRANSITION
TO WEB-BASED, WE WOULD HAVE
SOMETHING SIMILAR. I THINK THE
AI IS A LITTLE BIT SMARTER.
AND SO WE WILL HAVE TO CONSIDER
THOSE THINGS. IT IS AN
IMPORTANT TOPIC TO CONSIDER FOR
ALL RESEARCH REALLY.
>> JUST LIKE EVERYTHING WITH
AI. THE USES OF IT THAT HAVE
POTENTIAL HARM. ON THE OTHER
SIDE, THERE ARE THINGS THAT
COULD BE HELPFUL FOR US. WE
COULD HAVE WAYS TO ANALYZE THE
DATA THAT WE GET FROM OUR
SERVICE IN A WAY WE HAVE NEVER
BEEN ABLE TO ANALYZE BEFORE.
THAT IS NOT JUST THE SURVEY
DATA THEMSELVES, BUT THE
INTERACTIONS THAT HAPPEN WITHIN
THE SURVEYS. OUR ABILITY TO ASK
MORE OPEN ENDED QUESTIONS AND
HAVE AI HELP US OUT WITH THOSE.
SO YEAH, IT'S SOMETHING WE ARE
GOING TO HAVE TO GRAPPLE WITH
-- GRAPPLE WITH IT NOW, NOT IN
THE FUTURE.
>> DR. BLAKE: THANKS EVERYBODY
AND THANK YOU FOR JOINING.
SO OUR NEXT SET OF
PRESENTATIONS-- JUST A SECOND.
IS OR PRESENTATION SESSION #2,
MODERATED BY DR. MICHELLE
MOLLICA, NATIONAL CANCER
INSTITUTE. DIVISION OF CANCER
CONTROL POPULATION SCIENCES AT
NCI. MICHELLE HAS BEEN THE
CONTENT CHAMPION FOR THE
CAREGIVING ITEMS ON THE HINTS
SURVEY FOR MANY YEARS AND WE
ARE SO GLAD SHE'S HERE TO
MODERATE THIS PANEL, OR SESSION.
SO IF ALL THE SPEAKERS COULD
PLEASE COME UP TO THE STAGE. WE
WILL GET THE SESSION STARTED.
>> [SESSION 2]
>>> DR. MOLLICA: HELLO
EVERYONE, SO GREAT TO BE HERE
AND I'M THRILLED AND ADVISED,
AND THRILLED THAT WE ARE DOING
A SESSION CANCER SURVIVORSHIP.
WERE GOING TO SHIFT A LITTLE
BIT.
WHILE EVERYONE COMES UP, I AM
GOING TO INTRODUCE OUR SPEAKERS
FOR THE SESSION. BOTH OF YOU I
HAVE NOT MET I WILL DO MY BEST
TO PRONOUNCE YOUR NAME
CORRECTLY AND IF I PRONOUNCE IT
INCORRECTLY, PLEASE CORRECT ME
WHEN YOU GET UP HERE. I WILL
ANNOUNCE ALL THE PRESENTERS AND
THEN YOU WILL EACH HAVE ABOUT
12 MINUTES. THERE IS A TIMER
APPEAR JUST SO YOU ARE AWARE
OF. AND THEN WE WILL TAKE
QUESTIONS AT THE END. SO FIRST,
JEROME CORBIN WILL PRESENT
QUALITY OF CARE FOR CANCER
PATIENTS DURING THE COVID
PANDEMIC. DR. WHITNEY ZAHND
WILL TALK ABOUT CANCER SURVIVOR
CARE AND DR. KRISTIN MAKI WILL
BE PRESENTING FACTORS
ASSOCIATED WITH LUNG CANCER
SCREENING DISCUSSIONS AMONG
CANCER SURVIVORS. AND HEALTH
PROFESSIONALS A CROSS-SECTIONAL
ANALYSIS OF HINTS DATA.
AND DR. CHRISTOPHER WHELDON,
WILL PRESENT ON TEMPLE
UNIVERSITY - SOCIAL ISOLATION
AMONG CANCER SURVIVORS:
PREVALENCE, SYMPTOMS, AND THE
ROLE OF MARITAL STATUS.
>>
>> MR. CORBIN: I WILL LEAN OVER
A LITTLE BIT. THAT'S COOL.
HELLO EVERYONE MY NAME IS
JEROME CORBIN, MASTER STUDENTS
AT GEORGIA UNIVERSITY STUDYING
INTEGRATIVE MEDICINE AND TODAY
I'M GOING TO BE PRESENTING A
PROJECT, NATIONAL CANCER
INSTITUTE - CHANGES IN
CANCER CARE AND PERCEIVED
QUALITY OF CARE AMONG CANCER
PATIENTS DURING THE COVID-19
PANDEMIC. IT IS A MOUTHFUL, I
KNOW. I HAVE NO CONFLICT OF
INTEREST TO REPORT.
AS WE KNOW COVID MADE RAPID
CHANGES AND RESULT TRANSITIONS
TO TELEHEALTH AND CANCER
PATIENTS ALL SPECIFIC
CHALLENGES IN IN PERSON CARE,
AND CHEMOTHERAPY AND RADIATION
SESSIONS AND INTERRUPTED CANCER
SCREENING AND VACCINATION TOOK
HER IN HER STUDY WANT TO LOOK
AT HOW CANCER PATIENTS WERE
AFFECTED BY THE PANDEMIC.
WHILE OTHER STUDIES IN THE
FIELD HAVE LOOKED AT
CANCELLATION OF CANCER
APPOINTMENT DURING COVID, OUR
STUDY IS A LARGER STUDY IN THE
FIELD, AND THE ONLY STUDY WE
KNOW THAT MOST OF PERCEIVED
QUALITY OF CARE FOR CANCER
PATIENTS DURING COVID, AND THE
CHARACTERISTICS IT INFLUENCES.
IN THIS PROJECT WE AIM TO
DETERMINE CHANGES TO CANCER
SCREENING AND PREVENTATIVE CARE
APPOINTMENTS, CHANGES TO CANCER
TREATMENT AND FOLLOW-UP
APPOINTMENTS, PROCEED QUALITY
OF CARE AND CHARACTERS THAT
INFLUENCE IT, AS WELL AS GAIN
INSIGHT ON THE DOCTOR-PATIENT
RELATIONSHIP DURING CVOID-19.
WE USE THE HINTS 2021 DATABASE
FROM THREE REGISTRIES, IN IOWA,
THE BAY AREA NEW MEXICO AND THE
HINTS SERIES IS UNIQUE BECAUSE
INCLUDE COME QUESTION FOUND IN
THE ANNUAL HINTS SURVEY BUT
ALSO QUESTIONS IN COVID AND THE
DATA SUPPRESSION SET IS-- ANY
GROUP IN THE DS THAT IS LESS
THAN 25 RESPONDERS AND ADULTS
18 AND OVER WHO VISITED THE
HEALTHCARE PROVIDER AND LAST
MONTH. 55% WOMEN, 45% MEN. AGE,
MOST POPULAR WAS PATIENT GROUPS
OVER 75. RACE AND ETHNICITY
POPULATION WAS 76% WHITE, 12%
HISPANIC --
BY EDUCATION, 59% OF THE
POPULATION WERE COLLEGE
GRADUATES ARE HIGHER. 26% HAD
SOME COLLEGE EXPERIENCE AND 15%
HAD A HIGHSCHOOLER LAST LEVEL
OF EDUCATION. IN TERMS OF
HOUSEHOLD INCOME, 55% EARN
ABOUT 75,000 AND 17% EARNED
LESS THAN 75,000. THE SENTIMENT
IS FROM JANUARY 2020 OVER THE
FOLLOWING YEAR AND LOOKING MORE
SPECIFIC AT OUTCOMES AND
METHODOLOGIES ARE FIRST TWO
OUTCOMES LOOK AT CHANGES IN
APPOINTMENTS WITH THE RESPONSE
BEING APPOINTMENTS ON AFFECTED
ONLY, APPOINTMENTS CANCEL ONLY
OR APPOINTMENTS CHANGE TO
TELEHEALTH ONLY TO CLARIFY
DEFINITIONS HERE, A PATIENT
RESPONSE SELECTING APPOINTMENTS
CANCEL ONLY MEANS ALL
APARTMENTS DURING THE CVOID-19
PANDEMIC ROUTER CANCEL AND THE
THIRD OUTCOME LOOKS AT WHETHER
CVOID-19 CONVOCATIONS DURING
CANCER HISTORY WERE DISCUSSED
BY THE HEALTHCARE PROVIDER WITH
BINARY YES/NO. IN THE LAST
OUTCOME -- --.
OUR ANALYSIS WE GOT CODED
WAITED PREVALENCE FOR 95%
CONFIDENCE LEVELS AND RECEIVING
SUBOPTIMAL QUALITY OF CARE
USING INDIVIDUAL LOGISTIC
REGRESSION MODELS ADJUSTING FOR
SEX AND AGE.
IN OUR FIRST FIGURE HERE WE
CAN VISUALIZE
CHANGES IN APARTMENTS DURING
CVOID-19. SCREENING AND
PREVENTATIVE CARE PERMIT 22%
PATIENT REPORTED THAT ALL OF
THEIR APPOINTMENTS WERE
CANCELED. 9% PATIENT REPORTED
THAT ALL THEIR APPOINTMENTS
WERE CHANGED TO TELEHEALTH.
FOR TREATMENT AND FOLLOW-UP
APPOINTMENTS 23% PATIENT
REPORTED THAT ALL THEIR
APPOINTMENTS WERE CANCELED.
SORRY, 8% OF PATIENTS REPORTED
OTHER PONDS WERE CANCELED AND
21% REPORTED THEY WERE
RESCHEDULED TO TELEHEALTH.
LOOKING AT OTHER CANCER HEALTH
IMPACT DURING THE PANDEMIC,
AMONG PATIENTS UNDERGOING
TREATMENT 7% REPORTED THAT
CVOID-19 CHANGE THEIR TREATMENT
PLAN AND 82% PATIENTS REPORTED
THAT HEALTHCARE PROVIDERS DID
NOT DISCUSS CVOID-19
COMPLICATIONS.
4% OF PATIENTS REPORTED THAT
THE DOCTOR SOMETIME NEVER GET A
CHANCE TO ASK HEALTH-RELATED
QUESTIONS IN THE PAST 12
MONTHS. 8% REPORTED THAT THEY
WERE SOMETIMES NOT INVOLVED IN
DECISIONS ABOUT THEIR HEALTH.
6% REPORTED THAT DOCTOR
SOMETIMES OR NEVER MADE SURE
THEY UNDERSTOOD THEIR
HEALTHCARE. 4% REPORTED THAT
DOCTOR SOMETIMES NEVER EXPLAIN
THINGS CLEARLY. 10% REPORTED
THAT DOCTOR SOMETIMES NEVER
SPENT ENOUGH TIME WITH THEM.
AND FINALLY 20% REPORTED THAT
DOCTORS SOMETIMES NEVER HELP
THEM DEAL WITH HEALTH
UNCERTAINTY.
EVEN IF ADJUSTING OUTRAGEOUS
WICCANS EROSION SHOULD BE DOING
DEMOGRAPHIC CHARACTERISTICS AND
THE LIKELIHOOD OF HAVING AN
APPOINTMENT AFFECTED IN THE TOP
HALF IS PATIENT RESPONSE AND
CVOID-19 HAS AFFECTED MY CANCER
CARE FORMANTS AND THIS GROUP
HAD SIGNIFICANTLY LESS CANCER
SCREENING -- THIS IS CLOSE TO
THE LINE OF SIGNIFICANCE
INTERPRETING WITH CAUTION AND
THE BOTTOM HALF OF THE GRAPH
RESPONSE TO THE OUTCOME,
CVOID-19 IS AFFECTED MY CANCER
TREATMENT OR FOLLOW-UP
APPOINTMENT AND WE SEE NO
SIGNIFICANT VALUES AND IN
GENERAL MOST CHARACTERISTICS
WERE NOT SIGNIFICANTLY
ASSOCIATED WITH CHANGES IN
CANCER RELATED APPOINTMENTS,
INDICATING THAT APPOINTMENT
CHANGE DID NOT VARY BY
DEMOGRAPHICS.
IN THIS NEXT FIGURE, WE
ANALYZE OUTCOME OF PERCEIVING
SUBOPTIMAL QUALITY OF CARE AND
IN THE FIRST TWO ROWS WE SEE
EXPRESSING CHANGES TO AN
OPPONENT DOES NOT CORRELATE
WITH PERCEIVING QUALITY OF
CARE. GOING DOWN THE
DEMOGRAPHIC CHARACTERISTICS,
WE CAN SEE THE PATIENTS WITH NO
HIGH SCHOOL DIPLOMA PERCEIVED
SUBOPTIMAL QUALITY OF CARE 3.3
TIMES MORE FREQUENTLY COMPARED
TO COLOR PATIENTS AND PATIENTS
WITH HOUSEHOLD INCOME LESS THAN
35,000 PERCEIVED SUBOPTIMAL
QUALITY OF CARE 2.2 TIMES MORE
FREQUENTLY COMPARED TO PATIENTS
EARNING MORE THAN 75,000.
GOING INTO A SUMMARY OF OUR
FINDINGS, 23% OF PATIENTS
REPORTED THEIR CANCER SCREENING
OF PREVENTATIVE CARE FIRMS WERE
CANCELED AND 93% WERE
RESCHEDULE A TELEHEALTH AND 8%
REPORTED THEIR POINTS WERE
CANCELED AND 21% REPORTED THEIR
APPOINTMENTS WERE RESCHEDULED
TELEHEALTH AND BREAKING THESE
DOWN BY DIFFERENT TYPE OF
EMPLOYMENT SCREENING AND
PREVENTATIVE CARE APPOINTMENTS
WERE LIMITED BY INPATIENT
CANCER SCARE AND BECAUSE CANCER
CARE REQUIRE PHYSICAL
EXAMINATIONS THEY ARE NOT AS
ABLE TO ADAPT TO TELEHEALTH
FORMAT.
14.6% OF CANCER PATIENTS
REPORTED SUBOPTIMAL QUALITY OF
CARE DURING COVID NO
SIGNIFICANT VARIANCE BY
EFFECTIVE APARTMENTS BY
DEMOGRAPHIC AND THE
APPOINTMENTS DID NOT INFLUENCE
CARE PERCEPTION IN GENERAL WE
BELIEVE THIS REPORT OF
SUBOPTIMAL QUALITY OF CARE IS
(INDISCERNIBLE), ESPECIALLY
THE HEIGHT OF GLOBAL PANDEMIC
AND TRADITIONAL BEERS
EXPERIENCED BY CANCER PATIENTS
HOWEVER MOST STUDIES TO OUR
KNOWLEDGE LOOK AT CANCER
PATIENT PERCEPTION OF CARE
OUTSIDE OF PANDEMIC SO THERE IS
NO DATA TO COMPARE THIS TO.
WITH THE FACT THAT CHANGES
INFORMS DID NOT SIGNIFICANTLY
AFFECT QUALITY OF CARE THE
TRANSITION TO TELL HAVE
PROVIDED ACCESSIBLE AND
GENERALLY HIGH QUALITY OF CARE
DURING THE PANDEMIC.
FINALLY WE CONCLUDED THAT
PATIENTS WITHOUT A HIGH SCHOOL
DIPLOMA EXPERIENCE SUBOPTIMAL
QUALITY OF CARE 3.53 TIMES MORE
FREQUENTLY THAN WHEN COMPARED
TO COLLEGE GRADUATES IN
PATIENTS WITH INCOME BELOW
35,000 EXPERIENCED SUBOPTIMAL
QUALITY OF CARE 2.3 TIMES MORE
FREQUENTLY WHEN COMPARED WITH
PATIENTS WITH COLLEGE
EDUCATION.
AS I SAID BEFORE NOR THE STUDY
HAS LOOKED SPECIFICALLY AT
CANCER PATIENTS REPORTED
QUALITY OF CARE BUT STUDIES
HAVE LOOKED AT OTHER FACTORS OF
CANCER CARE FOR CANCER PATIENTS
INCLUDING IDENTIFYING PATIENTS
OF LOW SOCIAL ECONOMIC STATUS
OR EDUCATIONAL ATTAINMENT
GENERALLY HAVE LESS AGGRESSIVE
TREATMENT, WORSE HEALTH
OUTCOMES, AND A HIGHER
MORTALITY RATE.
WE CAN SEE THESE DISPARITIES
EXIST PERPETUALLY AND ARE NOT
JUST THE RESULT OF THE
PANDEMIC. BECAUSE OF THIS, IT
IS POSSIBLE TO INFER THE GROUPS
OF LOW HOUSEHOLD INCOME AND
EDUCATIONAL ATTAINMENT MAY BE
GENERALLY AT A HIGHER RISK OF
RECEIVING SUBOPTIMAL QUALITY OF
CARE.
WHILE THESE HEALTHCARE
DISPARITIES EXTEND PAST THE
PANDEMIC, THE MOVEMENT AWAY
FROM IN PERSON CARE TOWARDS
TELEHEALTH DURING THE PANDEMIC
EXACERBATED THESE IMPACTS FOR
GROUPS OF LAW SOCIOECONOMIC
STATUS AND LOW EDUCATIONAL
ATTAINMENT. PATIENTS WITH LOW
SOCIAL ECONOMIC STATUS A LOWER
USAGE RATE OF TELEHEALTH AND
COMPARED TO PATIENTS OF HIGH
SOCIOECONOMIC STATUS AND
PATIENTS WITH LOW EDUCATIONAL
ATTAINMENT ALSO EXHIBIT LOWER
USE OF TELEHEALTH WHEN COMPARED
TO COLLEGE GRADUATES.
LOWER RATES OF USAGE IN
PURSUING SUBOPTIMAL QUALITY OF
CARE CAN BE EXPLAINED BY ACCESS
TO QUALITY INTERNET AND VIDEO
DEVICES.
ONE STUDY SUGGESTS THAT AREAS
OF HIGH SOCIAL VULNERABILITY
WERE LESS LIKELY TO ADOPT VIDEO
TELEHEALTH AND INSTEAD PROPERLY
USE AUDIO TELEHEALTH. WITH
BARRIERS LIKE THIS TELEHEALTH
APPOINTMENT ARGUABLY GO FOR
LESS ACCESSIBLE AND
TECHNOLOGICAL LIMITATIONS AND
DIFFICULTIES IN EXPANDING THE
SUBPAR EXPERIENCE.
SOME STRENGTH OF OUR STUDY.
OUR STUDY USES THE HINTS
DATABASE -- AND THEY HELPED US
VERIFY THE CANCER CARE
DIAGNOSIS AND CONVERTED STUDIES
WE HAVE A HIGH UNWEIGHTED
SAMPLE, AND LOOKING AT MULTIPLE
OUTCOMES TO PROVIDE A MORE
HOLISTIC DETERMINATION OF
QUALITY OF CARE. THE SAMPLE
COLLECTED DATA FROM AUGUST 2021
SO WE WERE NOT ABLE TO GRAB THE
FULL SCOPE OF THE COVID
PANDEMIC AND LASTLY THE SAMPLE
BY RACE AND ETHNICITY LIMITED
THE ANALYSIS IN THE FUTURE. WE
WOULD LIKE TO COMPARE THE
FUTURE -- -- IN DOING THIS
PROJECT FURTHER EMPHASIZE THE
NEED TO IMPROVE HEALTHCARE
INFRASTRUCTURE AND BETTER
ADJUST THESE PERPETUAL HEALTH
DISPARITIES, ESPECIALLY WITH
THE EMERGENCE OF TELEHEALTH AS
AN OPTION INVESTMENT IN
TELEHEALTH INFRASTRUCTURE CAN
IMPROVE ACCESS AND QUALITY OF
APPOINTMENTS AND IMPROVING
QUALITY OF CARE.
THAT TAKE A MESSAGE IS THAT
COVID DISRUPTED HEALTHCARE
DELIVERY FOR ALL CANCER
PATIENTS AND EXACERBATED
EXISTING HEALTH DISPARITIES FOR
CERTAIN GROUPS OF LOW
SOCIOECONOMIC STATUS AND LOW
EDUCATIONAL ATTAINMENT. I WANT
TO THANK EVERYBODY TO THANK
EVERYONE WHO WORKED ON THIS
PROJECT WITH ME AND MY
COLLEAGUE ERIKA, WHO IS IN THE
FOURTH ROW, AND ALSO -- MY
MENTOR -- THANK YOU ALL FOR
HELPING ME MAKE THIS PROJECT
BECOME A REALITY. AND I WANT TO
THANK EVERYBODY WHO SHOWED UP
HERE TO HEAR ME PRESENT TODAY.
>> DR. MOLLICA: THANK YOU. NEXT
WILL HEAR FROM DR. ZHAND.
>> DR. ZAHND: GOOD AFTERNOON
EVERYONE. I THINK THE SEGWAY IS
REALLY WELL BECAUSE I AM
USUALLY PRESENTED ON THE SAME
DATA SET, JUST A SLIGHT
TWEAKING LOOKING AT
METROPOLITAN AND
NONMETROPOLITAN DIFFERENCES.
AND THE IMPACT OF THE PANDEMIC
ON CANCER SURVIVOR CARE, FITS
WITH WHAT WAS ALREADY SHARED
AND I DO WANT TO NOTE AN
APPRECIATION FOR HOW WELL THE
DATA IS INCLUDED RURAL URBAN
COMPARISONS OVER THE MANY YEARS
THAT IT HAS BEEN ADMINISTERED.
I AM A BIG FAN OF THIS ASPECT,
IT LEADS THE WAY IN PUBLICLY
AVAILABLE DATA SETS THAT HAVE A
RURAL VARIABLE. I WANT TO NOTE
THAT TO START OFF WITH.
A LITTLE BIT OF BACKGROUND.
AS WELL KNOW WHEN THE PANDEMIC
HIT HERE IN THE US, INITIALLY
IT WAS VERY MUCH HITTING URBAN
AREAS HARDEST BUT AS IT
PROGRESSED OVER TIME WE SAW
RURAL AREAS BECOMING
DISPROPORTIONALLY AFFECTED WITH
HIGHER HOSPITALIZATION AND
MORTALITY RATES, PUBLIC END OF
ANYBODY WHO WAS NEEDING
HEALTHCARE SERVICES OVER TIME
DURING THAT PERIOD REGARDLESS
OF IF THEY WERE CANCER
SURVIVORS OR NOT.
WE ALSO KNOW THAT BEING A
CANCER SURVIVOR PLACES PEOPLE
AT GREATER RISK FOR
COMPLICATIONS DUE TO THE
PANDEMIC. CVOID-19
SPECIFICALLY. AGAIN CREATING
ADDITIONAL COMPLICATIONS THAT
WE THINK ABOUT AND
CONSIDERATION WE THINK ABOUT
NECESSARY CARE.
WE KNOW THE PART OF THE
PANDEMIC AND DURING THE
PANDEMIC, DURING THE PANDEMIC
RULE POPULATIONS HAVE
CONSISTENTLY HAD LESS ACCESS TO
TELEHEALTH, WHETHER BROADBAND
ACCESS OR OTHER SOURCES OF
ACCESS MORE BROADLY AND LESS
ACCESS TO HOSPITALS THAT HAVE
TELEHEALTH AND CANCER CARE
AVAILABLE SIMULTANEOUSLY OR
HAVING ONE OF THE OTHER
AVAILABLE.
AT THE SAME TIME WE ALSO KNOW
THAT RURAL AND URBAN CANCER
CARE WAS NOTABLY IMPACTED BY
THE PANDEMIC. AND WE SAW THE
CONTINUUM FROM PREVENTION,
SCREENING, TO TREATMENT AND
SURVIVORSHIP CARE. SO THERE'S
A LOT OF CONSIDERATIONS THAT WE
NEED TO CONSIDER. AND OTHER
THINGS WE NEED TO CONSIDER IN
THE RELATIONSHIP BETWEEN
GEOGRAPHY, CANCER SURVIVORSHIP,
AND TREATMENT.
OR CARE IN GENERAL.
WE UTILIZED THE SIERRA HINTS
DATA ADMINISTERED TO CANCER
SURVIVORS ADMINISTERED THROUGH
THE IOWA -- IN NEW MEXICO
REGISTRY BETWEEN JANUARY AND
AUGUST 2021, LOOKING AT
SEVERAL QUESTIONS OR QUESTIONS
THAT A LOT OF PEOPLE ALLOWED TO
PROVIDE OPTIONS TO GET A SENSE
OF IF THE PANDEMIC HAD IMPACTED
THEIR TREATMENT OR FOLLOW-UP
CARE, AND WHETHER PEOPLE CANCEL
OR DELAY TREATMENT OR SHIFTED
TO PHONE OR TELEHEALTH AS WELL
AS ANY IMPACT ON PREVENTATIVE
OR ROUTINE CARE, AND HOW THAT
IMPACTED WHETHER CANCELLATIONS
OR DELAYS OR SHIFTS TO PHONE
TELEHEALTH. AND ALSO LOOKING
AND EXAMINING THE QUESTION
AROUND WHETHER PEOPLE HAVE
CONVERSATIONS WITH THE
PHYSICIANS REGARDING THE
INCREASED RISK DUE TO CVOID-19.
WE LOOKED AT THIS IS LARGELY A
DESCRIPTIVE ANALYSIS COMPARING
RURAL AND URBAN, OR
NONMETROPOLITAN/ METROPOLITAN
USES INTERCHANGEABLY HERE.
WHICH WE DETERMINED BY COUNTY/
RURAL URBAN CODE, REGARDLESS OF
WHICH CODE YOU USE IF YOU
DICHOTOMIZED NONMETROPOLITAN A
DEVELOPMENT YOU GOT THE SAME
SAMPLE WE ACCOUNTED FOR THE
COMPLEX SURVEY DESIGN AND
WEIGHTING AND PERCENTAGES.
SO THIS GIVES YOU A QUICK
OVERVIEW OF OUR STUDY
CHARACTERISTICS. THIS INCLUDED
JUST UNDER 1200 CANCER
SURVIVOR, NOT THE WEIGHTED
SAMPLE BUT THE RAW NUMBERS
THERE, WHICH IS A REAL STRENGTH
OF THIS HINTS DATA, AND HAVING
THE ROBUST TOTAL NUMBER OF
CANCER SURVIVORS. WE HAD ABOUT
17% THAT WERE FROM
NONMETROPOLITAN COUNTIES. WE
ALSO SEE A HIGH PERCENTAGE OF
RURAL CANCER SURVIVORSHIP, WHO
WERE NON-HISPANIC WHITE
COMPARED TO URBAN, AND WE SEE
ABOUT THE SAME PERCENT IN
NONMETROPOLITAN/ METROPOLITAN
SURVIVORS.
WE BROKE THIS DOWN BY CANCER
CARE AND THEN PREVENTATIVE
CARE, AND ROUTINE CARE
SEPARATELY. WHEN WE LOOK AT
CANCER CARE, WE SEE THAT A
HIGHER PERCENTAGE OF
NONMETROPOLITAN CANCER
SURVIVORS INDICATED THAT THEIR
CARE WAS UNAFFECTED BY THE
PANDEMIC. WE SEE THAT JUST
UNDER 40%. ABOUT 15% POINTS
LOWER WHO HAVE THEIR CARE
UNAFFECTED IN METROPOLITAN
AREAS.
WE SEE RELATIVELY LITTLE
DIFFERENCE OR SIGNIFICANT
DIFFERENCE WHEN WE LOOK AT THE
CANCELLATIONS DUE TO THE
PANDEMIC, OR SHOULD SAY
SPECIFICALLY-- BUT WE SEE A
HIGHER PERCENTAGE OF
METROPOLITAN CANCER SURVIVORS,
7% HIGHER, INDICATED THE REPORT
WAS SHIFTED TO PHONE OR
TELEHEALTH DUE TO COVID.
LOOKING MORE SPECIFICALLY AT
PREVENTATIVE CARE OR ROUTINE
CARE VERSUS TREATMENT AND
FOLLOW-UP, WE SEE THERE WERE NO
DIFFERENCES IN THE PERCENT
REPORTING THAT THERE CARE WAS
UNAFFECTED BY THE PANDEMIC. WE
SEE NO DIFFERENCE IN
CANCELLATIONS. BUT AGAIN WE
SEE THAT METROPOLITAN CANCER
SURVIVORS REPORTED A HIGHER
PERCENTAGE SHIFTING TO
TELEHEALTH OR PHONE.
LOOKING SPECIFICALLY ABOUT
RECEIVING COMMUNICATION FROM
PHYSICIANS ABOUT THE RISKS OF
CVOID-19 FOR CANCER SURVIVORS,
WE SEE A NONSPECIFIC
SIGNIFICANCE DIFFERENCE BETWEEN
NONMETROPOLITAN AND
METROPOLITAN SURVIVORS. IT IS
STILL BELOW 15% FOR BOTH
GROUPS.
SO THE DISCUSSION AND
IMPLICATIONS OF THIS
NONMETROPOLITAN BULLETIN CANCER
SURVIVORS REPORTED LESS IMPACT
ON CANCER CARE. IN A LOWER
PERCENTAGE OF THOSE REPORTING
-- CANCER SURVIVORS REPORTING
IS SHIFTED TELEHEALTH. AND THIS
INVITES THE QUESTION OF WHY DID
THIS HAPPEN? WAS THIS MORE OF A
LACK OF AVAILABILITY OF
TELEHEALTH SERVICES OR
FOLLOW-UP? OR TREATMENT? OR IS
THERE ANOTHER REASON
WAS THIS A CHOICE BY THE
PATIENTS TO CONTINUE TO SEEK
THE SERVICES IN PERSON? IS AN
IMPORTANT QUESTION TO CONTINUE
TO PURSUE
WE SAW LAST DIFFERENCES BY
GEOGRAPHY BUT HARDSHIP TO
TELEHEALTH. WE NEED TO MAKE
SURE PEOPLE GET THE CARE THEY
NEED REGARDLESS OF IN PERSON OR
TELEHEALTH AND TO MAKE SURE
THOSE SERVICES CAN BE AVAILABLE
IN WAY THAT MAKES PATIENTS MOST
COMFORTABLE. WE ALSO AGAIN
FOUND RURAL PERCENTAGE
REGARDLESS OF GEOGRAPHY WHO
REPORTED RECEIVING INFORMATION
ABOUT CVOID-19, COMPLICATIONS
FOR THEIR CARE, CONTINUED
OPPORTUNITY FOR BETTER
EDUCATION FOR PATIENTS GOING
FORWARD MAKING SURE PEOPLE ARE
AWARE OF THOSE THINGS, THOSE
ELEMENTS THAT MIGHT PUT THEM AT
GREATER RISK. I APOLOGIZE FOR
SOME OF THE OVERLAPPING DESK.
THERE WERE SOME CITATIONS
BELOW.
SO IN WRAPPING UP, I DO WANT
TO ACKNOWLEDGE THOSE WHO WERE
ALSO PART OF THE STUDY. SEVERAL
OF US AT INSTITUTIONS THAT HAVE
THESE CANCER REGISTRIES. THE
UNIVERSITY OF IOWA, IOWA CANCER
REGISTRY. UCFS, THE GREATER BAY
AREA, ALSO FOLKS AT NCI,
MEETING WITH THE MONTHLY IN
DOING ANALYSIS ABOUT THIS
SIERRA HINTS SURVEY LOOKING FOR
ADDITIONAL USES IN THE FUTURE
AND WITH THAT I WILL WRAP UP.
AND HAPPY TO ANSWER ANY
QUESTIONS AT THAT POINT OF OUR
PANEL. FEEL FREE TO REACH OUT
TO ME. THANK YOU VERY MUCH.
>> DR. MOLLICA: THANKS VERY
MUCH. WE ARE GOING TO MOVE NOW
TO DR. MAKI.
>> DR. MAKI: THANK YOU. MY NAME
IS KRISTIN MAKI, WAYNE STATE
UNIVERSITY SCHOOL OF MEDICINE -
FACTORS ASSOCIATED WITH LUNG
CANCER SCREENING DISCUSSIONS
AMONG CANCER SURVIVORS AND
HEALTH PROFESSIONALS: A
CROSS-SECTIONAL ANALYSIS OF
HINTS DATA. I WOULD LIKE TO
THANK MY AWESOME CO-AUTHOR WHO
IS AT RUTGERS CANCER INSTITUTE
OF NEW JERSEY. WE HAVE NO
DISCLOSURES TO REPORT.
WE WERE LOOKING AT CANCER
SURVIVORS WITH LOOKING AT
CANCER SCREENING, BECAUSE
CANCER SURVIVORS HAVE A HIGHER
RISK FOR DEVELOPING A SECOND
PRIMARY CANCER COMPARED TO THE
GENERAL POPULATION UP TO 1 IN
12 CANCER SURVIVORS DEVELOP THE
SECOND PRIMARY MALIGNANCY. THAT
IS DIFFERENT FROM THE
METASTATIC CANCER, WHICH IS
WHEN A CANCER METASTASIZES TO A
DIFFERENT PART OF THE BODY.
THIS IS THE SECONDARY PRIMARY
CANCER DIAGNOSIS.
LUNG CANCER IS THE MOST
DIAGNOSED PRIMARY CANCER. THIS
IS POTENTIALLY DUO TO
OVERLAPPING RISK FACTORS
PARTICULARLY RELATED TO TOBACCO
USE. YOU SEE A LOT OF SECOND
PRIMARY CANCERS WITH LUNG
CANCER AMONG CANCER PATIENTS.
ALTHOUGH THERE IS A HIGHER
ELEVATED, HIGHER RISK FOR LUNG
CANCER AMONG CANCER SURVIVORS,
CANCER SURVIVORS ACTUALLY
HAVEN'T REALLY BEEN INCLUDED IN
THE LUNG CANCER SCREENING
TRIALS VERY CONSISTENTLY. SO
WE DON'T KNOW HOW WELL LUNG
CANCER SCREENING WORKS, AND AT
WHAT INTERVALS FOR CANCER
SURVIVORS COMPARED TO THE
GENERAL POPULATION. BIGGEST
LUNG CANCER SCREENING TRIAL,
THE NATIONAL LUNG SCREENING
TRIAL, THE RESULTS WERE
PUBLISHED IN 2011 AND IT SHOWED
THAT ANNUAL SCREENING WITH CT
SCANS IS EFFECTIVE FOR REDUCING
LUNG CANCER DEATH BY ABOUT 20%
FOR PEOPLE WHO WERE IN THE
ELIGIBLE POPULATION. BUT LIKE
I SAID CANCER SURVIVORS WERE
NOT NECESSARILY INCLUDED IN
THAT TRIAL SO WE DON'T KNOW HOW
OFTEN IT MIGHT BE EFFECTIVE FOR
CANCER SURVIVORS.
AS A RESULT THE CURRENT
GUIDELINES FOR LUNG CANCER
SCREENING
DO NOT INCLUDE CANCER SURVIVORS
DIFFERENTLY FROM THE GENERAL
POPULATION. AND AS A RESULT OF
THIS, THIS AFFECTS THE
POTENTIAL HEALTH INSURANCE
COVERAGE AND SCREENING. AND SO
THE HEALTH INSURANCE COVERAGE
TENDS TO OVERLAP THE GENERAL
POPULATION FOR ADULTS WHO ARE
BETWEEN 50-80 YEARS OLD
COMPARED TO USING STANDARD
SERVICES (INDISCERNIBLE) --
YEARS OR CALCULATING BY
MULTIPLYING THE AVERAGE NUMBER
OF PACKS THE PERSON SMOKES PER
DAY BY THE NUMBER OF YEARS THEY
SMOKED. THAT COVERAGE TEND TO
OVERLAP WITH THOSE GUIDELINES.
FOR THIS PROJECT WE WANTED TO
ASSESS HOW MANY CANCER
SURVIVORS HAVE DISCUSSED LOW
DOSE CT SCANS WITH A HEALTH
PROFESSIONAL IN THE PAST 12
MONTHS. WE WANTED TO EXAMINE
WHAT FACTORS WERE ASSOCIATED
WITH HAVING THIS DISCUSSION.
AND CANNOT LIKE I MENTIONED
BEFORE, WE WERE EXPECTING TO
SEE SOME OVERLAP BASED ON
CANCER TYPES. FOR INSTANCE WE
EXPECTED THAT PEOPLE WHO WERE
SURVIVORS OF HEAD AND NECK
CANCER MIGHT HAVE HAD THIS
DISCUSSION MORE SO THAN PEOPLE
WHO HAD OTHER TYPES OF CANCER
DIDN'T HAVE SUCH A CLOSE
OVERLAP WITH RISK FACTORS. WE
USE THE HINTS 6 DATA COLLECTED
BETWEEN MARCH AND NOVEMBER 2022.
AND WE INCLUDED ADULTS WHO MET
TO SOME EXTENT OVERLAP OF THE
CURRENT MATERIAL FOR LONG
CANCER SCREENING GUIDELINES
BECAUSE WE THOUGHT
(INDISCERNIBLE).
WE INCLUDED ADULTS WHO WERE
50-80 YEARS OLD. PEOPLE WHO HAD
SMOKE 100 OR MORE CIGARETTES IN
THEIR LIFETIME WHICH GETS A
LEVEL OF SMOKE INTENSITY, AND
INCLUDED PEOPLE WHO WERE
DIAGNOSED WITH CANCER
PREVIOUSLY.
WE INCLUDED PEOPLE WHO HAD
PREVIOUSLY BEEN DIAGNOSED WITH
LUNG CANCER BECAUSE WE THOUGHT
THERE WAS A GREAT CHANCE OF
THEM HAVING DISCUSSED LUNG
CANCER SCREENING WITH A HEALTH
PROFESSIONAL.
WE USED "R" STUDIO USING THE
SURVEY PACKAGE TO ACCOUNT FOR
THIS DATA DESIGN AND THE
PRIMARY OUTCOME VARIABLE WAS
WHAT I HAVE ON THE SCREEN. SO
ANYTIME IN THE PAST YEAR, THE
DOCTOR OR HEALTH PROFESSIONAL
TALK WITH YOU ABOUT HAVING A
LOW-DOSE CT SCAN TO CHECK FOR
LUNG CANCER?
THE OTHER VARIABLES THAT WE
INCLUDED IN OUR ANALYSIS WHICH
WE USED LOGISTIC REGRESSION,
WERE AGE, SEX, RACE AND
ETHNICITY. EDUCATION AND
INCOME, REGION OF THE US PEOPLE
IN, HEALTH STATUS, SMOKING
STATUS, AND WE CHOSE THESE
VARIABLES DUE TO THE POTENTIAL
OVERLAP IN ASSOCIATIONS BETWEEN
THESE VARIABLES OF LUNG CANCER.
MY RESULTS. WE ENDED UP WITH
ABOUT 7.5 MILLION RESPONSES.
MOST WERE WHITE. THE AVERAGE
AGE WAS ABOUT 67 YEARS OLD,
WHICH WOULD BE IN WITH THE
AVERAGE AGE FOR PEOPLE WHO
MIGHT BE DIAGNOSED WITH LUNG
CANCER. WE WERE SURPRISED TO
FIND THAT MOST OF THEM DID NOT
DISCUSS LUNG CANCER SCREENING
WITH THEIR HEALTH PROFESSIONAL.
AND IN OUR LOGISTIC REGRESSION
RESULTS, WE SAW THAT AGE OR
PEOPLE WHO WERE BETWEEN 75-80
YEARS WAS ASSOCIATED WITH AN
INCREASED LIKELIHOOD OF HAVING
THIS DISCUSSION ABOUT LUNG
CANCER SCREENING.
THE INTERESTING THING WAS THAT
PEOPLE WHO WERE BETWEEN 75-80
YEARS OLD WERE AT THE UPPER END
OF THE SPECTRUM FOR PEOPLE WHO
MIGHT BENEFIT FROM LUNG CANCER
SCREENING. AND THIS GOES
OUTSIDE SOME OF THE INSURANCE
COVERAGE. FOR INSTANCE CMS --
-- THEIR CRITERIA FOR COVERAGE
ENDS AT 77 YEARS. PEOPLE WHO
ARE 50-77 YEARS CAN BE COVERED
FOR LUNG CANCER SCREENING.
WITHIN THIS AGE GROUP ONLY
ABOUT HALF WOULD POTENTIALLY
HAVE THAT SCREENING COVERED, IF
THEY WERE COVERED BY MEDICARE.
WITHOUT THAT WAS REALLY
INTERESTING, MAYBE BECAUSE OF
THIS POTENTIAL DOWNSIDE OF NOT
BEING COVERED FOR LUNG CANCER
SCREENING BY INSURANCE. MAYBE
THAT IS WHY THEY WERE TALKING
ABOUT IT. WE WERE NOT SURE BUT
WE DID THINK THAT WAS
INTERESTING.
WE ALSO SAW-- AND THIS IS LESS
SURPRISING-- THAT PEOPLE WHO
CURRENTLY SMOKE WERE ALSO MORE
LIKELY TO DISCUSS LUNG CANCER
SCREENING WITH A HEALTH
PROFESSIONAL. THIS IS
IMPORTANT BECAUSE SMOKING
CESSATION IS INCLUDED IN THE
SHARED DECISION-MAKING
REQUIREMENT BY CMS IS ONE OF
THE THINGS THAT NEEDS TO BE
DISCUSSED DURING A LUNG CANCER
SCREENING. SHARED
DECISION-MAKING CONSULTATION.
AND PRIOR RESEARCH HAS SHOWN
THAT SMOKING CESSATION
COUNSELING IS A REALLY GOOD
OPPORTUNITY FOR BRINGING UP
LUNG CANCER SCREENING WITH
PEOPLE. SO IT'S NOT SURPRISING
THAT WE HAVE THAT RESULT.
I WILL SAY WE WERE SURPRISED
TO SEE THAT WE DID NOT HAVE ANY
SIGNIFICANT ASSOCIATIONS BASED
IN CANCER TYPES. WE WERE
SURPRISED BUT WE DO NOT SEE
THAT.
SOME OF THE LIMITATIONS OF OUR
ANALYSIS WERE THAT THIS WAS A
CROSS-SECTIONAL ANALYSIS OF
SELF-REPORTED DATA. PEOPLE
COULD FORGET, OR SAY I'VE NEVER
HEARD OF THIS TEST OR I AM NOT
SURE. WE INCLUDED THOSE AS NO.
WE ALSO WERE NOT ABLE TO
CALCULATE (INDISCERNIBLE)
RESCREENING ELIGIBILITY TO
ASSESS WHETHER PARTICIPANTS
RECEIVED THE LAW THOSE CT LUNG
CANCER SCREENING IN THE FUTURE
WOULD LOVE IT IF HINTS CONCLUDE
THE SMOKING INTENSITY VARIABLES
THAT WOULD ALLOW YOU TO
CALCULATE THE PAC YEARS
(PHONETIC) TO SEE WHETHER
ELIGIBILITY OF PEOPLE WHO WERE
TALKING WITH THE HEALTH
PROFESSIONAL, IF THEY WOULD BE
ELIGIBLE FOR THIS AND I WOULD
LOVE TO SEE THAT IN THE FUTURE.
IT WOULD ALSO BE REALLY NICE
IF WE COULD ASSESS WHETHER
PEOPLE ACTUALLY RECEIVED THE
SCREENING OR NOT. THAT WAS ONE
OF THE LIMITATIONS IN OUR
ANALYSIS.
OVERALL, OUR RESULTS SHOWED
THE DISCUSSIONS ABOUT LUNG
CANCER SCREENING ARE NOT
ROUTINELY HAPPENING AMONG LUNG
CANCER SURVIVORS. THIS
ACTUALLY PROBABLY REPLICATES
WHAT HAPPENS WITH THE GENERAL
POPULATION FROM SOME RECENT
WORK THAT I HAVE DONE WITH
COMMITTEE MEMBERS. INCLUDING
SOME CANCER SURVIVORS. PEOPLE
ARE NOT VERY FAMILIAR WITH LUNG
CANCER SCREENING INCLUDING
PEOPLE THAT HAVE HAD OTHER
CANCER DIAGNOSIS. PEOPLE ARE
ROUTINELY NOT DISCUSSING THAT
WITH HEALTH PROFESSIONALS BUT
THIS MIGHT LEAD TO DISPARITIES
AMONG LUNG CANCER MORTALITY
AMONG THE CANCER SURVIVOR
GROUP, PEOPLE WHO MIGHT REALLY
BENEFIT FROM THIS HAVE NOT BEEN
INCLUDED IN THAT. HOPEFULLY IN
THE FUTURE WILL SEE
IMPROVEMENTS ON THAT AS WELL AS
BEING ABLE TO TRACK THIS MOST
RECENT SCREENING. WITH THAT
THANK YOU FOR YOUR TIME.
>>
>> DR. MOLLICA: THANK YOU SO
MUCH. AND WE WILL FINISH WITH
DR. CHRISTOPHER WHELDON.
>> DR. WHELDON: GOOD AFTERNOON.
TODAY I AM GOING TO TALK ABOUT
PERCEIVED SOCIAL ISOLATION
AMONG CANCER SURVIVORS. AND I
HAVE ONE DISCLOSURE. THIS IS A
NEW AREA OF RESEARCH FOR ME. I
AM REALLY OPEN TO YOUR FEEDBACK
ABOUT WHAT I SHOULD INCLUDE.
THE MODEL I JUST THOUGHT ABOUT.
THIS IS A WORK IN PROGRESS.
PERCEIVE SOCIAL ISOLATION OR
LONELINESS HAS REALLY GAINED A
LOT OF ATTENTION IN THE LAST
YEAR, ESPECIALLY FROM THE
OFFICE OF THE SURGEON GENERAL
WHO HAS RELEASED A REPORT
TITLED "THE EPIDEMIC OF
LONELINESS AND SOCIAL
ISOLATION," AND HAS PROMOTED
THIS NEW VARIETY OF DIFFERENT
CONTEXTS. IF YOU GO TO THE
SURGEON GENERAL WEBSITE THEY
HAVE AN ACTION PLAN FOR
BUILDING SOCIAL CONNECTIONS
AMONG PEOPLE IN THE UNITED
STATES. AND THIS IS ONE OF THE
PRIORITY AREAS.
I SHOWED THIS TO GET TO MY
UNDERGRAD STUDENTS GET REALLY
MAD ABOUT IT. BECAUSE IT
REALLY SHOWS HOW THE INDICATORS
OF LONELINESS VARY AT DIFFERENT
GENERATIONS. SO IT'S KIND OF
HARD TO TELL THE DIFFERENCE
BETWEEN THE TWO, THE GREATEST
GENERATION WHICH IS IN DARK
BLUE IN THE DARK BLUE GENZ, IS
A YOUNGER GENERATION THE
REPORTS HIGHER LEVELS OF THESE
INDICATORS OF LONELINESS. THIS
IS COUNTERINTUITIVE TO WHAT WE
MIGHT THINK, MAYBE SOMETHING
THE OLDER GENERATION IS
EXPENSING.
IT'S SORT OF A LINEAR
RELATIONSHIP HERE WHERE YOU SEE
THAT THE YOUNGER THE GENERATION
IS, THE MORE INDICATORS OF
LONELINESS THEY ARE
EXPERIENCING.
IN FACT IN PEOPLE BETWEEN THE
AGES OF 18 AND 24 OR ABOUT
TWICE AS LONELY AS SENIORS WHO
ARE 65 YEARS OF AGE OR OLDER.
THIS IS A REPORT PUT OUT BY
THE NATIONAL ACADEMY OF
SCIENCES, ENGINEERING AND
MEDICINE. AND IT'S IMPORTANT TO
DISTINGUISH BETWEEN SOCIAL
ISOLATION-- MY TALK WAS PROCEED
BECAUSE I FORGOT TO PUT
"PERCEIVED" IN THE TITLE--
SOCIAL ISOLATION IS DEFINED AS
THE OBJECTIVE LACK OF SOCIAL
CONTACTS. THAT IS FEWER NETWORK
TIES, OR IN FREQUENT CONTACT
WITH THOSE PEOPLE IN YOUR
NETWORK.
WHEREAS LONELINESS IS SORT OF
THAT SUBJECTIVE EXPERIENCE OF
FEELING LONELY. SO YOU CAN
IMAGINE THAT THESE ARE HIGHLY
RELATED TO EACH OTHER BUT THEY
ARE DISTINCT. AND SOMEONE
COULD HAVE HIGH OR LOW SOCIAL
ISOLATION BUT STILL HAVE HIGH
LEVELS OF LONELINESS.
THIS IS SORT OF THE CONCEPTUAL
FRAMEWORK. I THINK THE
WORKAROUND IS REALLY
INTERESTING. IS SORT OF
ONGOING NOW. HOW DO WE
CONCEPTUALIZE SORT OF THESE
CONCEPTS AND MEASURE THEM IN
OUR SURVEY RESEARCH? SO NASM IS
FRAMED AS SOCIAL CONNECTIONS
HAVE STRUCTURAL COMPONENTS. IF
YOU THINK OF YOUR SOCIAL
NETWORK, HOW MANY SOCIAL
CONTEXT YOU HAVE? HOW DENSE IS
THAT SOCIAL NETWORK? THE
STRUCTURE AROUND IT. AND IT
HAS FUNCTIONAL QUALITIES
PROVIDING SOCIAL SUPPORT AND
FEELINGS OF PERCEIVED
LONELINESS AS A PART OF THE
FUNCTION. AND OBVIOUSLY THOSE
RELATIONSHIPS CAN VARY BY
QUALITY.
BUT I WAS REALLY INTERESTED IN
LOOKING AT THESE THREE. HOW
SOCIAL ISOLATION IS RELATED TO
LONELINESS, AND WHAT ARE THE
STRUCTURAL VARIABLES OF MARITAL
STATUS. AND THAT IS WHAT I
WAS-- WELL THIS IS THE
INDIVIDUAL.
THEY ALSO PROPOSE THAT WE LOOK
AT THESE VARIABLES OF MULTIPLE
LEVELS OF INFLUENCE. AND FOR
THE STUDY ONLY LOOKED AT THE
INDIVIDUAL LEVEL. AND AS YOU
SEE IN THE SOCIAL CONNECTIONS
BOX, IT IS PROPOSED THAT THESE
THINGS ARE HIGHLY CORRELATED
WITH EACH OTHER: SOCIAL
ISOLATION, LONELINESS AND
SOCIAL SUPPORT.
HOWEVER THE RISK FACTORS FOR
EACH OF THOSE CONSTRUCTS ON
THEIR OWN COULD VERY. AND
THERE IS SOME REALLY
INTERESTING WORK DONE AROUND
THE PHYSIOLOGY OF SOCIAL
ISOLATION AND LONELINESS. AND
THE BODY REACTS TO THOSE IN
DIFFERENT WAYS, WHICH COULD
IMPACT HEALTH IN DIFFERENT WAYS
AND ULTIMATELY IN MORTALITY.
THE MODEL THAT I'M WORKING ON
IS THE IDEA THAT THESE RISK
FACTORS-- WE ALREADY KNOW FROM
THE GENERAL POPULATION CHRONIC
ILLNESS RELATED TO INCREASING
LONELINESS AND SOCIAL
ISOLATION. WHAT IS IT ABOUT
CANCER SPECIFICALLY THAT MY
CONSTRAINT PEOPLE'S SOCIAL
CONNECTIONS IN THEIR LIVES?
ONE OF THE VARIABLES IN THE
HINTS SERIOUS STUDY THAT LOOKED
AT HIS TREATMENT RELATED
STUDIES. THESE ARE THE SIDE
EFFECTS OF THE LATE OR
LONG-TERM EFFECTS OF CANCER
TREATMENT. I WANTED TO MODEL
TO SEE IF MARITAL STATUS
ACTUALLY ATTENUATED THE EFFECTS
OF THOSE SYMPTOMS ON SOMEONE'S
PERCEPTIONS OF LONELINESS.
I USED THE HINTS SER AND ALL
THE PARTICIPANTS WHO COMPLETED
THE PROMISE SOCIAL ISOLATION
FORM, FEELING LEFT OUT, FEELING
PEOPLE BARELY KNEW THEM,
FEELING ISOLATED FROM OTHERS,
FEELING THE PEOPLE AROUND ME--
I FEEL THAT PEOPLE ARE AROUND
ME, IT'S HARD TO CHANGE THAT--
PEOPLE AROUND ME BUT NOT WITH
ME. THESE ARE THE COMPONENTS
OF PERCEIVED SOCIAL ISOLATION
OR LONELINESS.
THE COGNITIVE IMPAIRMENT,
SEVERE FATIGUE, NAUSEA THAT
WERE PERCEIVED TO RESULT FROM
THE CANCER TREATMENT OR BINARY
ITEMS THAT I SUMMED. A PERSON
COULD HAVE A SCORE OF ZERO,
THEY DO NOT EXPERIENCE THOSE AS
A RESULT OF THEIR CANCER
TREATMENT OR EXPERIENCE TO ALL
THREE.
THE PROMISE MEASURE IS T
SQUARED TRANSFORMED, THAT MEANS
AN AVERAGE OF 50 IS IN THE
MIDDLE AND 10 POINT IS ONE
STANDARD DEVIATION, THAT IS HOW
WE CAN INTERPRET THAT. AND I
USED SAS AND APPLIED ALL THE
SURVEY PROCEDURES I LEARNED.
YOU CAN BE ASSURED IT WAS DONE
CORRECTLY.
ON AVERAGE, THESE PARTICIPANTS
WERE ABOUT 69 YEARS OLD. THEY
HAD EXPENSE CANCER USUALLY
AROUND 83 SO THERE WAS A TIME
GAP OF PARTICIPATION WHEN THEY
HAD CANCER AND A SMALL MINORITY
WAS FEMALE, NON-HISPANIC WHITE.
MOST WERE MARRIED,
COLLEGE-EDUCATED AND A SMALL
SUBSET WAS LGBTQ. WE KNOW THAT
LESBIAN, GAVE, BISEXUAL,
TRANSGENDER ADULTS ARE LESS
LIKELY TO GET MARRIED. I WILL
SPOIL THAT ALERT. THAT DESIGN
DID NOT COME UP AS A PREDICTOR.
PROMISE MEASURES DO HAVE
DESIGNATED CUT RATES. THEY WERE
DIVIDED BETWEEN MODERATE AND
SEVERE LONELINESS, AND AN
EXAMPLE IT WAS QUITE LOW. ABOUT
4% OF THE RESPONDENTS REPORTED
MODERATE TO SEVERE LONELINESS.
A LARGER CHUNK, ABOUT 11%, HAD
OF WHAT WE WOULD CONSIDER MILD
LONELINESS AND 85% WERE IN THE
NORMAL LIMITS OF THAT SCALE.
SO WHAT I DID IS I ACTUALLY
ANALYZED THIS AS A DICHOTOMOUS
VARIABLE TRYING TO PREDICT
MODERATE AND SEVERE LONELINESS
COMPARED TO THE MILD AND NORMAL
LIMITS.
IN TERMS OF CANCER TREATMENT
SYMPTOMS, ABOUT 40% OF THE
PARTICIPANTS HAD AT LEAST ONE
OF THESE SYMPTOMS AS A RESULT
OF THEIR CANCER TREATMENTS.
AND IT RANGED FROM ZERO TO
THREE AS YOU CAN SEE HERE.
THEY WERE HIGHLY CORRELATED
WITH EACH OTHER. AS YOU CAN
IMAGINE ALL THESE TREATMENTS
RESULT FROM CHEMO RADIATION
THERAPY. SO FATIGUE AND NAUSEA
AS WELL AS COGNITIVE IMPAIRMENT
EACH WERE INTERRELATED, WHICH
SUPPORTED MY IDEA TO CODE THEM
AS AN INDEX.
SO THIS IS THE BIVARIANT
RESULTS AND YOU CAN SEE THE
TREATMENT RELATED SYMPTOMS THAT
POSITIVELY ASSOCIATE WITH
MODERATE AND SEVERE LONELINESS,
AND MARITAL STATUS CORRELATED
INVERSELY. AS EXPECTED FROM
THE MODEL, MARITAL STATUS DOES
TEND TO HAVE A PROTECTIVE
EFFECT AGAINST LONELINESS,
ALTHOUGH IT WAS ONLY FOR THE
ONES WHO SAID THEY WERE MARRIED
AND NOT LIVING AS MARRIED. I
THOUGHT THAT WAS AN INTERESTING
FINDING. THAT IS A SMALLER
GROUP, AND A SUBSET. IT COULD
BE UNDERPOWERED. BUT IT WAS
LEGAL MARITAL STATUS THAT MADE
THE DIFFERENCE HERE.
THOSE MY ANIMATIONS I FORGOT
ABOUT. I DID NOT FIND ANY
SIGNIFICANT DIFFERENCES IN
DEMOGRAPHIC FACTORS, INCLUDING
SEXUAL ORIENTATION. I DID NOT
INCLUDE THOSE IN THE ADJUSTED
MODEL.
WHEN I MODELED THEM TOGETHER,
FOR EACH ADDITIONAL TREATMENT
RELATED SYMPTOM EXPERIENCE THAT
WAS ABOUT 66% HIGHER ARTS OF
MODERATE TO SEVERE LONELINESS.
SO THAT REALLY DID NOT CHANGE
AT ALL BY INCLUDING MARITAL
STATUS IN THE MODEL. AND
MARITAL STATUS STILL HAS AN
INVERSE RELATIONSHIP COMPARED
TO SINGLE, DIVORCED OR WIDOWED,
WERE MUCH LESS LIKELY TO
EXPERIENCE LONELINESS. AND THIS
IS A MEASURE OF LONELINESS THAT
IS CURRENT. IT IS NOT EXACTLY
TIED INTO WHEN THEY WERE
DIAGNOSED AND TREATED FOR
CANCER, BUT IT SHOULD BE
TEMPORARILY RELATED LATER IN
THE SYMPTOMS BY WHEN THEY WERE
DIAGNOSED.
DIRECTIONS FOR FUTURE
RESEARCH. I AM STILL THINKING
THROUGH THIS A LOT. I WANTED TO
GO BACK TO SORT OF THIS MODEL,
OR THIS CONCEPTUAL OF WHAT IS
SOCIAL CONNECTION. HOW DOES
CANCER, AND SPECIFICALLY THESE
CANCER- RELATED TREATMENT
OUTCOMES-- THE STRUCTURE OF
SOMEONE'S SOCIAL NETWORKS, HOW
THEY FUNCTION IN THEIR LIVES,
AND ULTIMATELY TO THEIR
WELL-BEING. AND ALSO THE
QUALITY OF THOSE SOCIAL
CONNECTIONS. IF YOU'RE FEELING
NAUSEOUS OR IF YOU HAVE SEVERE
FATIGUE YOU CAN IMAGINE THAT
YOU MIGHT BE ABLE TO MAINTAIN
THIS CONNECTIONS. BUT YOU
STILL GETTING THE SOCIAL
SUPPORT FROM THEM THAT YOU
WOULD NORMALLY?
AND FROM SOME OF THE FINDINGS
HERE IN THE LITERATURE WHICH I
CONSIDER THESE HIGH HYPOTHESIS,
I HYPOTHESIZED THAT THE LATE
LONG-TERM EFFECTS ARE SHRINKING
PEOPLE'S SOCIAL NETWORKS OF
SOCIAL TIES OR COLLAPSING.
THERE IS A DECREASE IN
CONNECTIVITY WITH THOSE PEOPLE.
AND THAT IT IS INCREASING THE
STRAIN ON RELATIONSHIPS. AND
THERE IS LITERATURE ABOUT HOW
MARRIAGE CAN BOTH HELP CANCER
SURVIVORS AND THEIR SUPPORT,
BUT IT CAN ALSO AFFECT THEM
INVERSELY IF THOSE
RELATIONSHIPS ARE ACTUALLY
DAMAGED BY THE CANCER DIAGNOSIS
OR THE LATE LONG-TERM EFFECTS
OF THEM. SO THIS IS WHERE I AM
AT. I'M ALSO LOOKING FOR
COLLABORATORS. PLEASE KEEP IN
MIND THAT TOO.
>>
>> DR. MOLLICA: THANK YOU SO
MUCH. SO AT THIS POINT WE ARE
GOING TO GO TO QUESTIONS. I'M
GOING TO MOVE THE SLIDE. SO,
IF YOU HAVE A QUESTION PLEASE
FEEL FREE TO COME UP TO THE
MICROPHONE. I SEE PEOPLE
MOVING ALREADY. I HAVE
QUESTIONS BUT I WILL HOLD THEM.
YOU GO RIGHT AHEAD.
>> THANK YOU FOR ALL THESE
PRESENTATIONS. MY NAME IS
NAOMI, A POSTDOC AT NCI. MY
QUESTION IS FOR DR. WHELDON. I
AM CURIOUS ABOUT PULLING OUT
MARITAL STATUS. I AM CURIOUS
ABOUT WHETHER OR NOT THERE IS
REVERSE CAUSATION THERE, AND
THINKING ABOUT DOWN THE LINE
WHEN WE THINK ABOUT WHAT THE
INTERVENTION MIGHT BE TO DEAL
WITH SOCIAL ISOLATION AND
LONELINESS. IS A SOLUTION
GOING TO BE THAT WE TELL
EVERYBODY TO GET MARRIED?
>> GREAT QUESTION.
>> DR. WHELDON: NO I DON'T
THINK THAT IS THE SOLUTION.
BUT IT IS THE ONE PREDICTOR.
WHEN YOU LOOK AT LONELINESS AS
PREDICTORS IN THE GENERAL
POPULATION, IT IS THE ONE
PREDICTOR THAT IS MOST
CONSISTENT. AND THERE IS A
REVIEW PUBLISHED-- PROBABLY A
LITTLE DATED, 5-10 YEARS OLD OF
CANCER SURVIVORS SPECIFICALLY.
IT WAS ONE THING THAT WAS
CONSISTENTLY ASSOCIATED.
AND I THINK IT'S NOT
NECESSARILY THE MARITAL
QUALITY, BUT THAT THEY HAVE
SOMEONE THAT THEY ARE LIVING
WITH. THAT IS THE OTHER THING
THAT IS COMPARED TO LIVING
ALONE.
SO I DON'T NECESSARILY WITH
PRESCRIBED MARRIAGE FOR THE
PREVENTION OF THIS. BUT I DO
THINK YOU CAN FACILITATE SOCIAL
CONNECTIONS IN OTHER WAYS. IF
YOU GO TO THE SURGEON GENERAL'S
WEBSITE THERE IS A LOT OF GOOD
INFORMATION THERE ABOUT THE
TYPES OF COMMUNITY LEVEL
INTERVENTIONS BUT ALSO
PSYCHOSOCIAL INTERVENTIONS,
PSYCHOLOGICAL INTERVENTIONS
THAT HAVE BEEN TALKED ABOUT,
HELPING PEOPLE TO DEAL WITH
SOCIAL ISOLATION IN DIFFERENT
WAYS. NOT JUST BRINGING PEOPLE
INTO YOUR LIFE AS MUCH AS HOW
YOU INTERPRET THOSE
RELATIONSHIPS.
>> THANK YOU.
>> DR. WHELDON:
GOOD TO SEE YOU AGAIN.
>> I'VE GOT TWO DIFFERENT SETS
OF QUESTIONS FOR THE PANELISTS.
MAYBE I WILL START WITH DR.
WHELDON FIRST. I WAS CURIOUS.
IT WAS INTERESTING TO SEE THAT
THERE WEREN'T ANY FINDINGS BY
GENDER IDENTITY. THERE IS A
BODY OF EVIDENCE THAT SUGGESTS
THAT MARITAL STATUS FRESHLY
BENEFITS FOR EXAMPLE OFTENTIMES
MEN AS COMPARED TO WOMEN IN A
HETEROSEXUAL PARTNERSHIP AND I
WAS WONDERING IF THERE WAS A
CONSIDERATION AROUND MODERATION
GENDER IDENTITY WITH RESPECT
LOOKING AT TREATMENT AND
LONELINESS. AND I WAS CURIOUS
AS TO WHETHER YOUR ABILITY TO
BE ABLE TO CONSIDER CHILDREN
WITHIN THE HOUSEHOLD. BECAUSE
IT MAY BE YOUR KIDS THAT MIGHT
BE KEEPING YOU FROM BEING
LONELY, AS OPPOSED TO A PARTNER
WITHIN A MARRIAGE RELATIONSHIP.
>> DR. WHELDON: THAT IS A
REALLY GOOD QUESTION AND THERE
IS A VARIABLE FOR THE NUMBER OF
PEOPLE IN THE HOUSEHOLD BUT I
DON'T BELIEVE WE CAN
DIFFERENTIATED THEIR CHILDREN.
WE MAY NOT BE ABLE TO DO THAT
IN THIS. BUT I CAN LOOK AT A
NUMBER OF PEOPLE IN THE
HOUSEHOLD. I DID NOT LOOK AT
THE INTERACTION WITH GENDER
WITH THE SETTLERS BUT I THINK
THAT IS A GOOD IDEA. IT MIGHT
BE CONSTRAINED A LITTLE BIT BY
THE SAMPLE SIZE. BUT I WILL
DEFINITELY CONSIDER THAT.
THE ISSUE ABOUT CHILDREN--
WHICH I DO KNOW FROM PREVIOUS
RESEARCH IS THAT THEY ARE NOT
ALWAYS HELPFUL-- I MEAN WE
DON'T KNOW THAT BUT THEY ARE
NOT ALWAYS PREDICTIVE OF LESS
FEELINGS OF LONELINESS. AND IN
FACT WITH SOMEONE GOING THROUGH
AN ACUTE CHRONIC ILLNESS,
CHILDREN CAN ACTUALLY INCREASE
THE STRESS AND STRAIN ON THEIR
ROLES IN THEIR LIVES AND CAUSE
MORE DISTRESS. SO YEAH. I
WOULDN'T NECESSARILY THINK
(INDISCERNIBLE).
>> DR. MOLLICA: I THINK WE CAN
SECOND THAT.
>> YEAH ABSOLUTELY IMPORTANT
FOR THEM. AND THEN I HAVE A
QUESTION FOR DR. ZHAND AND
JEREMY AS WELL LOOKING AT THE
SER HINTS SURVEY. LOOKING AT
-- DR. ZHAND DIMENSION THE
TEMPORAL GEOGRAPHIC CHANGES
WITH RESPECT TO THE CVOID-19
PANDEMIC IN THE EARLY
EPICENTERS OF THE CVOID-19
PANDEMIC FOR EXAMPLE THE BAY
AREA WAS AN EARLY CVOID-19
EPICENTER. TO WHAT EXTENT DID
YOU THINK-- THE QUESTION FOR
YOU WAS AROUND WHAT PROPORTION
OF THE METROPOLITAN
RESPONDENTS WERE COMING FROM
THAT AREA AND TO WHAT EXTENT
THE THEY COME INTO PLAY WITH
RESPECT TO SWITCH TO TELEHEALTH
WITH THE BAY AREA BEING AN
EARLY CVOID-19 EPICENTER.
AND WITH RESPECT TO BEING ABLE
TO GENERALIZE KIND OF CROSS THE
PANDEMIC AND LOOKING AT THE
DEMOGRAPHIC SHIFTS. AND THE
POTENTIAL DISRUPTION IN CARE
AND HOW THAT HAPPENED EARLY IN
THE DYNAMIC VERSUS LATER IN THE
DYNAMIC AND LEARNING LESSONS
BASED ON WHAT WAS HAPPENING IN
OTHER AREAS.
>> DR. ZAHND: IS AN IMPORTANT
AND EXCELLENT QUESTION. THE SER
HINTS QUESTION THERE WAS A
MINISTER BETWEEN JANUARY AND
DECEMBER 2021. THE SAN
FRANCISCO AREA BEING THE
EPICENTER AT THE BEGINNING, SO
HITTING EARLIER. AND THE
TEMPORAL NATURE OF THAT, IN THE
QUESTIONS REFLECTING CITY
BEGINNING OF THE PANDEMIC. SO I
THINK I HAVE NOTICED THAT IS A
CONSISTENT CHANCE WITH ANYTHING
WE ASSESSED IN THE PANDEMIC.
WHATEVER YOU ASKING THAT
QUESTION WILL REPRESENT
DIFFERENT PERIODS OF TIME
RELATIVE TO WHAT IS GOING ON AT
THE TIME AND THAT IS AN
IMPORTANT QUESTION.
I WILL EXPLORE
WE CAN ALSO SEE WHEN PEOPLE
RESPONDED, OR WHEN THEY GOT
THAT BACK BECAUSE IT IS AN
INTERESTING ELEMENT OF PEOPLE
ANALYZING OTHER SURVEYS. WHEN
DID THEY RESPOND TO IT? ANOTHER
ELEMENT IS WHETHER THIS WAS
ADMINISTERED-- WHETHER THE
BEGINNING OF THE ADMINISTRATION
OF THE SURVEY WAS RIGHT WHEN
THE VACCINES WERE MORE PUBLICLY
AVAILABLE. SO THAT THROWS
ANOTHER ELEMENT INTO IT
ESPECIALLY WHEN THINKING ABOUT
SHIFTING TO TELEHEALTH OR GOING
IN PERSON. SOMEBODY-- KNOWING
CANCER SURVIVORS WOULD BE HIGH
ON THE LIST WHEN WE WERE FIRST
RAMPING UP VACCINATION AND THE
TIERS, WHO WAS GOING TO BE ABLE
TO VACCINATE EARLY. AND SO
HAVING THE VACCINE RELATIVE TO
WHEN THEY WERE DISCUSSING AND
COMPLETING THE SURVEYS.
GOING TO THE GREATER BAY AREA,
I WOULD HAVE TO LOOK AT THE
DISTRIBUTION AS TO WHAT
PERCENT-- BECAUSE THESE ARE ALL
GOING TO BE URBAN, ON THE URBAN
SIDE. BUT WHAT PERCENT OF THE
OVERALL. BECAUSE IOWA AND NEW
MEXICO ARE A LOT MORE RURAL
STATES, CERTAINLY ALBUQUERQUE
IN NEW MEXICO, DES MOINES, IOWA
CITY, GOOD POINT TO FURTHER
EXPLORE, DIFFERENCES ACROSS THE
REGISTRY.
>> DO YOU WANT TO RESPOND
JEREMY?
>> MAYBE I WILL ADD FOR BOTH OF
YOU, WHEN LOOKING AT QUALITY OF
CARE WE ALSO ADD NCI WE DID
DATA LINKAGE WITH SERS, AND WE
HAVE SOME NEW ON-SITE
INFORMATION ON PATIENT EXPENSES
THAT YOU MAY BE ABLE TO GET OUT
WITH THE DATA. A LITTLE BIT OF
MORE COMPLICATED DATA BUT MIGHT
BE A USEFUL RESOURCE TO LOOK
INTO. ANOTHER QUESTION?
>> HI. I'M (INDISCERNIBLE) FROM
HAMPTON DEPARTMENT OF
ECONOMICS. I HAVE A QUESTION
FOR DR. WHELDON. SO ONE
PRIMARY FOCUSES MENTAL HEALTH
AND WHAT IS THE CORRELATION OR
CAUSALITY BETWEEN THE SOCIAL
ISOLATION AND MENTAL HEALTH?
WHETHER YOU FEEL WORSE MENTAL
HEALTH OR INDEXED
(INDISCERNIBLE), WHICH MEASURES
DURING THE PAST TWO WEEKS
(INDISCERNIBLE) SOMETHING LIKE
IT. DO YOU THINK YOU BE SOCIAL
ISOLATION OR LONELINESS IS
IMPORTANT FOR YOUR MENTAL
HEALTH INDEX?
AND ANOTHER THING IS, THE
ENVIRONMENTAL FACTORS LIKE
ECONOMIC CONSEQUENCES ON MENTAL
HEALTH. SO (INDISCERNIBLE)
LIKE MOST SURVEY, TOTAL INITIAL
EXPOSURE. YOU FEEL MORE LONELY.
(INDISCERNIBLE) AND THE
CONSEQUENCE OF -- LABOR MARKETS
-- I AM MORE THAN HAPPY TO
KNOW WHAT YOU THINK ABOUT THIS.
THANK YOU.
>> DR. WHELDON: THERE IS THE
ISSUE OF CAUSATION WHICH IS
MESSY HERE. YOU HAVE ISOLATION
WHICH IS CLOSELY LINKED TO
MENTAL HEALTH. BUT THERE HAVE
BEEN SOME REALLY INTERESTING
STUDIES THAT USE LONGITUDINAL
DATA. AND HOPEFULLY THESE
PROMISED MEASURES TAKEN TO THE
LONGITUDINAL DATA SET.
THEY HAVE ACTUALLY SOLD THAT
IT SEEMS LIKE THE LONELINESS
PRECEDES THE MENTAL HEALTH
OUTCOMES, ESPECIALLY DEPRESSION.
ANXIETY SEEMS TO BE MORE
CO-OCCURRING, BUT THEN
EXPRESSING LONELINESS CAN
INCREASE THE RECURRENCE AND
SEVERE ANXIETY LATER ON. AND I
THINK THERE IS A DYNAMIC
RELATIONSHIP THAT EXISTS
BETWEEN THEM. THERE IS THE
ISSUE OF WHEN YOU'RE GOING TO
CERTAIN CANCER TREATMENTS, YOU
HAVE TO BE SOCIALLY ISOLATED
FOR A POINT OF TIME. AND THAT
IS WHAT I THINK INTERVENTIONS
ARE NEEDED TO KIND OF THINK
ABOUT MORE BROADLY OF THE
PSYCHOSOCIAL HELP, INCLUDING
SOCIAL CONNECTIONS FOR CANCER
SURVIVORS WHO ARE UNDERGOING
ACTIVE TREATMENT.
BUT FROM THIS DATA AT LEAST
THERE IS CONSIDERABLE AMOUNT OF
TIME BETWEEN WHEN THEY WERE
DIAGNOSED AND TREATED AND THEY
WERE REPORTING THIS ISOLATION.
IT SEEMS TO ME THAT IT'S GOING
TO CHANGE IN THEIR SOCIAL
NETWORKS.
THE IDEAL STUDY LIKE TO DO IS
DO A LONGITUDINAL STUDY OF THE
ECO-NETWORK AND WE CAN FOLLOW
CANCER SURVIVORS DURING
TREATMENT AND AFTER AND SEE HOW
THE STRUCTURE OF THEIR NETWORKS
CHANGE. THAT WOULD GIVE US A
REALLY GOOD POINT OF
INTERVENTION.
>> DR. MOLLICA: WILL MAKE THIS
LAST QUESTION. GO AHEAD.
>> I'M -- FROM THE UNIVERSITY
OF NEVADA. THANKS FOR A VERY
INTERESTING TOPIC ON MENTAL
HEALTH.
YOU MENTIONED THAT FOR CANCER
SURVIVORS, A LINK BETWEEN
MENTAL HEALTH DIAGNOSIS, CAN IT
BE RELATED TO EMPLOYMENT
STATUS? YOU MENTION EMPLOYMENT
STATUS, BUT IT WASN'T IN THE
HINTS 2022. USING IT IS
IMPORTANT TO HAVE EMPLOYMENT
STATUS BECAUSE IT AFFECTS
MENTAL HEALTH? AND IT MIGHT BE
BECAUSE FOR EXAMPLE LOSING A
JOB.
>> DR. WHELDON: I DID NOT PUT
THAT IN THERE BUT THAT IS A
GOOD POINT. EMPLOYMENT STATUS.
THE OTHER ONE I THOUGHT WAS THE
FINANCIAL INSTABILITY QUESTION.
I THINK WE CAN ADD THAT TOO.
THAT IS A VERY GOOD POINT THANK
YOU
DR. MOLLICA: PLEASE JOIN ME
IN THANKING MY SPEAKERS. AT
THIS POINT IT IS MY PLEASURE TO
ALLOW YOU TO TAKE A BREAK UNTIL
3:30. AND I WAS ASKED SPEAKERS
FOR THE DATA BLITZ SECTION TO
MAKE SURE THAT BY 3:30 YOU
MEANDER UPFRONT TO BE READY TO
GO. THANK YOU VERY MUCH.
GOOD AFTERNOON EVERYONE. MY
NAME IS HEATHER D'ANGELO. THIS
IS THE DATA BLITZ: RAPID FIRE
HINTS RESEARCH RESULTS. WE
HAVE A LOT OF INTERESTING
TOPICS FOR YOU. EACH
PRESENTATION WILL BE A FIVE
MINUTE TALK. IT'S GOING TO BE
SHORT AND SWEET. WE ARE GOING
TO MOVE THROUGH EIGHT DIFFERENT
PRESENTATIONS AND AT THE END WE
WILL HAVE TIME FOR QUESTIONS
AND ANSWERS.
SO PLEASE JOIN ME IN WELCOMING
OUR FIRST PRESENTER. ALISHA
LANGFORD, WAYNE STATE
UNIVERSITY. THANK YOU.
>> DR. LANGFORD: THANK YOU I AM
GOING TO TALK ABOUT NYU
GROSSMAN SCHOOL OF MEDICINE -
BELIEFS ABOUT THE ROLE OF
LIFESTYLE FACTORS ON DEVELOPING
CANCER, HEALTH-RELATED, AND
SOCIODEMOGRAPHIC CORRELATES OF
NOTICING CALORIE INFORMATION ON
RESTAURANT MENUS
AND I WOULD LIKE TO
ACKNOWLEDGE MY CO-AUTHORS ON
THIS ABSTRACT WHO ARE FROM A
VARIETY OF DIFFERENT
UNIVERSITIES. AND ONE OF MY
COLLEAGUES, KATERINA, IS HERE
AND WILL BE PRESENTING IN A FEW
MINUTES ON A DIFFERENT TOPIC.
SOME OF YOU MAY BE AWARE OR
NOT THAT IN MAY 2018, THE FDA
ISSUED A FINAL RULE. IT
REQUIRES THAT RESTAURANT CHAINS
THAT HAD AT LEAST 20 OR MORE
LOCATIONS LIST CALORIE
INFORMATION ON THEIR MENUS.
ONE OF THE CAVEAT WITH THAT WAS
THAT THE RESTAURANT HAD TO BE
OPERATING UNDER THE SAME NAME,
AND GENERALLY OFFERING THE SAME
MENU OF FOOD AND BEVERAGES.
SO THE OBJECTIVE OF THIS
PARTICULAR STUDY, EXPLORATORY
STUDY, WHAT TO LOOK AT
ASSOCIATIONS BETWEEN NOTICING
COLOR INFORMATION ON MENUS, AND
A VARIETY OF BEHAVIORAL,
MEDICAL AND SOCIODEMOGRAPHIC
FACTORS.
SO, WE DID USE A
CROSS-SECTIONAL DATA FROM HINTS
5 CICLE 4. THE DATA WERE
COLLECTED BETWEEN FEBRUARY IN
JUNE 2020. AND WE SHORTEN THE
ANALYSIS RESPONDERS THAT HAD NO
MISSING DATA AND THAT WAS
SAMPLE SIZE OF ABOUT 307. AND
THEY HAD NO VARIABLES OF
INTEREST.
THINKING ABOUT THE LAST TIME
YOU ORDERED FOOD IN A FAST FOOD
OR SITDOWN RESTAURANT, DID YOU
NOTICE CALORIE INFORMATION
LISTED NEXT TO THE FOOD ON THE
MENU OR MENU BOARD? YES OR NO.
YOU ALL CAN THINK ABOUT THE
LAST TIME YOU ORDERED FOOD.
DID YOU NOTICE THE CALORIE
INFORMATION?
SO WE LOOKED AGAIN-- THIS WAS
AN EXPLORATORY ANALYSIS. WE
LOOKED AT THE VARIETY OF
VARIABLES. WAS INTERESTED IN
HOUSEHOLD INCOME, MEDICAL
CONDITIONS AND THAT INCLUDED
THINGS LIKE HISTORY OF CANCER,
DIABETES, HYPERTENSION, ETC.,
WHETHER KNOWING THAT YOU WERE
GENETICALLY PREDISPOSED FOR
DEVELOPING CANCER IF THAT WOULD
CHANGE BEHAVIORS. I WAS ALSO
PARTICULARLY INTERESTED IN
LIFESTYLE FACTORS. AND THAT
QUESTION WAS WORDED LOOKING AT
THREE DIFFERENT THINGS. ONE WAS
BEING OVERWEIGHT. ONE WAS
GAINING WEIGHT AS AN ADULT.
AND THE OTHER WAS EATING TOO
MUCH RED MEAT.
SO, PART OF OUR METHODS WERE
TO LOOK AT ALL OF THESE FACTORS
UNIVEARIANTLY. FACTORS THAT
WERE SIGNIFICANT P <1.5, WOULD
PUT THAT INTO A MULTIVARIABLE
REGRESSION ANALYSIS. THESE ARE
THE RESULT OF HER FINAL
MULTIVARIABLE MODEL. AND THE
FOUR FACTORS WERE SIGNIFICANT
FOR NOTICING CALORIE
INFORMATION, ONE FEMALES HAD
HIGHER ODDS OF NOTICING CALORIE
INFORMATION ON MENUS, THOSE
WITH A COLLEGE DEGREE ALSO HAD
HIGHER ODDS OF NOTICING CALORIE
INFORMATION ON MENUS. MAYBE NOT
SURPRISINGLY THOSE WHO WORE
DEVICES LIKE A FIT BIT OR APPLE
WATCH LIKE I HAVE HAD A HIGHER
ODDS OF NOTICING CALORIE
INFORMATION ON MENUS.
AND THOSE -- I WANT TO
ACKNOWLEDGE A FEW LIMITATIONS.
ONE IS WE COULD NOT DISTINGUISH
THOSE WHO ARE NOTICING CALORIE
INFORMATION ON FAST FOOD. SO
THINK OF BURGER KING,
MCDONALD'S, STARBUCKS VERSUS
PLACES WHERE YOU MAY SIT DOWN
LIKE APPLEBEE'S OR CHILI'S.
THERE COULD BE DIFFERENCES IN
HOW MUCH YOU PAID ATTENTION.
AND ALSO WE DON'T KNOW IF JUST
SIMPLY NOTICING INFORMATION
CALORIE INFORMATION ACTUALLY
CHANGES WHAT YOU ORDERED.
SOMETIMES IT DOES FOR ME.
SOMETIMES IT DOESN'T.
IN CONCLUSION, NOTICING
CALORIE INFORMATION ON MENUS
WAS ASSOCIATED WITH GENDER,
EDUCATION, WHAT PEOPLE BELIEVED
ABOUT THE LINK BETWEEN OBESITY
AND CANCER, AND ALSO USING
WEARABLE DEVICES TO TRACK
HEALTH.
AND I HAVE FIVE SECONDS. I
MADE IT IN FIVE MINUTES. THANK
YOU. THERE IS MY CONTACT
INFORMATION.
>> GOING TO HEAR FROM KRISTIN
SCHRADER, UNIVERSITY OF
TENNESSEE.
>> MS. SCHRADER: MY ADVISOR
ENCOURAGE ME TO USE THE HINTS
IN MY DISSERTATION RESEARCH
WHICH I AM PRESENTING TO YOU
TODAY. FIRST I'M GOING TO GIVE
YOU A COUNT OF THREE TO
IDENTIFY THE DIFFERENCES
BETWEEN THESE TWO IMAGES, 3, 2,
1.
YES! I HEARD SOME PEOPLE SOARS.
I'M HAPPY YOU NOTICED. YES,
THIS IS A GRAPHIC PUT TOGETHER
BY THE CDC AND I BORROWED IT
FROM THE SOCIAL MEDIA CAMPAIGN
WEBSITE FOR FLU VACCINATION AND
THEN ON THE RIGHT-HAND SIDE, I
CHANGE THE ATTRIBUTION TO A
LOCAL ORGANIZATION, THE GREATER
WASHINGTON COMMUNITY FUND.
THIS DIFFERENCE IS REALLY THE
CRUX OF MY RESEARCH, THERE'S A
LOT OF MESSAGE TESTING, AND A
LOT OF UNDERSTANDING OF WHAT
CHANGES MESSAGE BEHAVIOR BUT
LESS INFORMATION ABOUT HOW THE
CONTRACT CHANGES MESSAGE
BEHAVIORS OR MY INTEREST WAS IN
URBAN AND RURAL COMMUNITIES AND
HOW THOSE MESSAGES AFFECT
CHANGE.
I USED FOUR CYCLES OF THE
HINTS DATA AND USE THE SAMPLE
INTO AN URBAN GROUP IN A RURAL
GROUP AND USED FOR DIFFERENT
SOURCES. DOCTORS, FRIENDS
FAMILIES, RELIGIOUS
ORGANIZATIONS AND GOVERNMENT
HEALTH AGENCIES.
TRUST IN DOCTORS IS NOT
AFFECTED. YOUR RELIGIOUS
COMMUNITIES IN YOUR COMMUNITY,
AND SOMETHING YOU INTERACT WITH
AND GOVERNMENT HEALTH AGENCIES
ARE THE NATIONAL LEVEL SO I
WOULD EXPECT THAT PEOPLE IN
RURAL COMMUNITIES MAY BE LESS
TRUSTING OF THOSE AT THE
GOVERNMENT LEVEL AND MORE
TRUSTING TO THOSE CLOSE TO THEM
IN THEIR COMMUNITY.
THIS IS A QUICK CHART OF MY
SAMPLE. SO YOU WILL SEE THAT
THE RESPONSES WERE EVENLY SPLIT
BETWEEN RURAL AND URBAN. RURAL
IS A BLUE-COLLAR ON THE BOTTOM.
AND THE RURAL SAMPLES QUEUE TO
BE A LOT MORE NON-HISPANIC
WHITE WHEREAS THE URBAN SAMPLE
HAD A LOT MORE PERSONS WERE
IDENTIFIED AS SOMETHING OTHER
THAN NON-HISPANIC WHITE. THE
RURAL SAMPLES SKEWED SLIGHTLY
OLDER AND ALSO HAD SLIGHTLY
LOWER EDUCATIONAL ATTAINMENT.
AND ALL OF THAT IS IN LINE WITH
OTHER RESEARCH ON RURAL
DEMOGRAPHICS.
I ALSO LOOKED AT
HOMEOWNERSHIP, BECAUSE THAT CAN
BE AN INDICATOR OF
CONNECTEDNESS TO A PERSON'S
COMMUNITY. AND SO WE SEE THAT
RURAL PEOPLE ARE MORE LIKELY TO
OWN THEIR HOMES.
SO THEN I GOT INTO TRUSTING
THESE SOURCES AND THIS IS THE
MEAT WE ARE ALL INTERESTED IN.
AND OF COURSE THE HINTS DATA
PROVED ME WRONG AT MANY LEVELS
HERE.
FIRST WHEN I LOOKED AT DOCTORS
I DID A MEANS TEST TO COMPARE
THE MEAN SCORES AND I FOUND
THAT THERE WAS ACTUALLY A
SIGNIFICANT INTERACTION BETWEEN
VIRALITY AND TRUST IN DOCTORS,
THERE IS SOME DIFFERENCE OTHER
COMMUNITY YOU LIVE IN.
AND WHEN I LOOKED AT THESE
OTHER THREE THERE WAS NO
DIFFERENCE FROM FRIENDS AND
FAMILY. THERE WAS NO
SIGNIFICANCE, AND NO
SIGNIFICANT DIFFERENCE FOR A
RELIGIOUS ORGANIZATION.
THERE WAS A SIGNIFICANCE WITH
GOVERNMENT AGENCIES. THERE WAS
A LITTLE BIT OF A DIFFERENCE.
BUT I WAS VERY SURPRISED AND
VERY HAPPY TO SEE THAT RURAL
AND URBAN COMMUNITIES TRUSTED
GOVERNMENT AGENCIES UNDER
DOCTORS. PLACES LIKE NCI.
THE FUTURE OF MY RESEARCH IS
TO DO REGRESSION MODELING TO
PUT DEMOGRAPHICS AND HEALTHCARE
CHARACTERISTICS ON SEVERAL
OUTCOMES INCLUDING HEALTH
INFORMATION SEEKING, LIKELINESS
OF SEEKING INTERPERSONAL
SOURCE, A MEDIA SOURCE, OR A
PROVIDER SOURCE. AND THEN
TRUST, THE TRUST OUTCOMES. AND
ALSO I AM DESIGNING A
SURVEY--BASED EXPERIMENT TO
SHOW PEOPLE TWO GRAPHICS, LIKE
I SHOWED YOU AT THE START AND
SEE WHAT THE DIFFERENCES IT IS
GEOGRAPHIC ATTRIBUTED TO A
NATIONAL VERSUS A LOCAL
ORGANIZATION.
AND THE IMPLICATIONS HERE. WE
MAY BE ABLE TO ADVANCE POSITIVE
CHANGE IN HEALTH OUTCOMES
PARTICULARLY IN PREVENTATIVE
CARE. AND THIS IN MY RESEARCH
IS APPLYING IT TO RURAL AND
URBAN COMMUNITIES BUT THIS CAN
ALSO BE USED TO TARGET OTHER
UNDERSERVED POPULATIONS SUCH AS
DIFFERENT ETHNIC POPULATIONS.
AT THE START WITH HER A LOT
ABOUT THE LATINO POPULATION. I
THINK THIS IS REALLY VALUABLE
FOR SEVERAL DIFFERENT GROUPS.
THAT'S IT.
>>
>> DR. D'ANGELO: UP NEXT IS
ABIGAIL MURO, FROM THE NATIONAL
CANCER INSTITUTE.
>> DR. MURO: HI EVERYONE. I AM
ABIGAIL MURO, NATIONAL CANCER
INSTITUTE - TRUST IN HEALTH
INFORMATION SOURCES AND CLIMATE
CHANGE HARM PERCEPTIONS:
RESULTS FROM THE NATIONAL
CANCER INSTITUTE’S HEALTH
INFORMATION NATIONAL TRENDS
SURVEY (HINTS), 2022
SO, WE KNOW THAT THE NEGATIVE
HEALTH IMPACTS OF CLIMATE
CHANGE OF INCREASING.
SUPPORTIVE BELIEVE AND HARM DUE
TO CLIMATE CHANGE IS ESPECIALLY
IMPORTANT AND BECOMING MORE
IMPORTANT TO PREVENTION AND
PREPAREDNESS EFFORTS. AND
LEVELS OF TRUST IN VARIOUS
HEALTH INFORMATION VERSUS COULD
POTENTIALLY SHAPE PUBLIC BELIEF
THAT CLIMATE CHANGE IS HARMFUL
TO HEALTH, WHICH COULD IN TURN
PROMOTE BEHAVIOR CHANGE AND
SUPPORT CLIMATE RELATED
POLICIES.
SO OUR AIMS WERE TWOFOLD.
FIRST EXAMINE ASSOCIATIONS
BETWEEN DEMOGRAPHIC
CHARACTERISTICS AND CLIMATE
CHANGE HARM PERCEPTIONS AND
SECOND TO EXAMINE ASSOCIATIONS
BETWEEN TRUST AND SIX SEPARATE
INFORMATION SOURCES AND THOSE
SIX SOURCES WERE DOCTORS,
GOVERNMENT, SCIENTISTS, FAMILY
AND FRIENDS, CHARITABLE
ORGANIZATIONS, AND RELIGIOUS
ORGANIZATIONS.
WE MEASURED CLIMATE CHANGE
PERCEPTION USING HOW MUCH
CLIMATE CHANGE YOU THINK WILL
HARM YOUR HEALTH WE CODED THIS
INTO THREE CATEGORIES. CLIMATE
CHANGE HARMS HEALTH. CLIMATE
CHANGE DOES NOT HARM HEALTH. OR
DON'T KNOW.
WE MEASURE TRUST IN HEALTH
INFORMATION SOURCES USING THE
ITEM IN GENERAL, HOW MUCH WOULD
YOU TRUST INFORMATION ABOUT
CANCER FROM EACH OF THE
FOLLOWING. AND RECORDED THIS--
THIS IS A CONTINUOUS VARIABLE
ON A SCALE OF 1-4, WITH A
HIGHER VALUE MEANING A HIGHER
AMOUNT OF TRUST IN EACH
INFORMATION SOURCE.
WE RESTRICTED ANALYSIS ONLY TO
PARTICIPANTS WITH COMPLETE DATA
SO WE HAD AN N OF 5,585,
COMPUTED WEIGHTED MEANS FOR
EACH TRUSTED SOURCE ITEM
OVERALL AND BY CLIMATE CHANGE
FORM PERCEPTION CATEGORY. WE
ALSO DID WEIGHTED MULTIVARIABLE
LOGISTIC REGRESSION MODULES.
OVERALL 40% OF RESPONDENTS
SAID THAT THEY BELIEVE THAT
CLIMATE CHANGE HARMS HEALTH.
HOWEVER AROUND 20% BELIEVE
CLARK CLIMATE CHANGE DOES NOT
HARM HEALTH AND 60% DON'T KNOW.
WE CAN SEE THAT YOUNGER
PREPARATIONS HAD HIGHER LEVELS
OF BELIEF THE CLIMATE CHANGE
WHEN COMPARED TO OLDER
RESPONDENTS IN THE SAME IS TRUE
FOR FEMALES COMPARED TO MALES
AND NONWHITE RESPONDENTS
COMPARED TO WHITE RESPONDENTS.
IN PARTICULAR NON-HISPANIC
ASIAN RESPONDENT HAD HIGH
LEVELS OF BELIEF THAT CLIMATE
CHANGE HARMS HEALTH.
THOSE WITH A COLLEGE EDUCATION
OR MORE HAD HIGHER LEVELS OF
BELIEF THAT CLIMATE CHANGE
HARMS HEALTH COMPARED TO THOSE
WITH LESS EDUCATION.
SCIENTISTS, GOVERNMENTS
DOCTORS AND CHARITABLE
ORGANIZATIONS WERE THE FOUR
HEALTH INFORMATION SOURCES
WHERE TRUST IN THEM FOR HEALTH
INFORMATION WAS ASSOCIATED WITH
BELIEVE THAT CLIMATE CHANGE
WILL HARM HEALTH. THE ONLY
NEGATIVE ASSOCIATION WE FOUND
WAS WITH RELIGIOUS
ORGANIZATIONS, AND WE DID NOT
FIND ANY SIGNIFICANT
ASSOCIATION FOR FAMILY AND
FRIENDS.
SO, TO QUICKLY ACKNOWLEDGE
LIMITATIONS, THERE WAS NO
MEASURE OF POLITICAL IDEOLOGY
OR AFFILIATION ON HINTS 6.
THIS WAS ALSO CROSS-SECTIONAL
DATA; SO WHAT WE ARE MEASURING
ASSOCIATION WE CANNOT ESTABLISH
CAUSATION. AND WE ALSO HAD A
LACK OF INFORMATION ABOUT PRIOR
EXPOSURE TO CLIMATE -RELATED
EVENTS, THIS IS ABOUT
PERCEPTION.
KEY TAKEAWAYS. OUR FINDINGS
WERE CONSISTENT WITH PREVIOUS
RESEARCH ABOUT SOCIAL
DEMOGRAPHIC INFORMATION THAT
HAS FOUND THAT FEMALE HAD
GREATER PERCEIVED PERSONAL HARM
FROM CLIMATE CHANGE AND OLDER
ADULTS HAD LOWER PERCEIVED HARM
AND NONWHITE ADULTS PERCEIVED
MORE VULNERABILITY TO THE
IMPACT OF CLIMATE CHANGE AND WE
CONTRIBUTE THE BODY OF RESEARCH
ARE FINDING IS A GREATER TRUST
IN HEALTH INFORMATION FROM A
DOCTOR, SCIENTISTS, GOVERNMENT,
AND CHARITABLE ORGANIZATIONS
WERE ASSOCIATED WITH GREATER
ODDS OF BELIEF THAT CLIMATE
CHANGE HARMS HEALTH WHILE
GREATER TRUST FROM INFORMATION
FROM RELIGIOUS ORGANIZATIONS
WAS ASSOCIATED WITH REDUCED
COSTS.
FUTURE WORK IS TO LEVERAGE
TRUST IN HEALTH INFORMATION
CHANNELS IN ORDER TO HELP
PUBLIC TO SUPPORT CLIMATE
CHANGE MITIGATION POLICIES AND
ENGAGE IN CLIMATE FRIENDLY
BEHAVIOR.
THANK YOU.
>> DR. D'ANGELO: THANK YOU.
NEXT WE WILL HEAR FROM KATERINA
ANDREADIS, FROM THE NYU
GROSSMAN SCHOOL OF MEDICINE.
>> MS. ANDREADIS: HI EVERYONE
THANK YOU SO MUCH FOR ALLOWING
ME TO PRESENT HERE TODAY IN A
VERY SPECIAL THANK YOU TO
DOCTOR LANGFORD FOR MENTORING
ME.
TODAY I WILL BE TALKING HOW
PATIENTS UNDERSTAND HEALTH
INFORMATION AND ELECTRONIC
MEDICAL RECORDS AND PATIENT
PORTALS. WE KNOW THE PATIENT
PORTALS HAVE BEEN VERY
TRANSFORMATIVE AND HOW PATIENTS
INTERACT WITH HEALTH
INFORMATION. AND THE BENEFITS
THAT COME WITH ACCESSING AND
BEING ABLE TO EFFECTIVELY USE
YOUR HEALTH INFORMATION. AND
THAT IS PART OF THE REASON WHY
A LOT OF US HERE TODAY HAVE
BEEN TALKING ABOUT THE
DISPARITIES IN ACCESSING
PATIENT PORTALS AND TALKING
ABOUT STRATEGIES AND HOW TO
INCREASE ACCESS TO PATIENT
PORTALS AND ELECTRONIC MEDICAL
RECORDS. AND THERE'S A LOT OF
LEGISLATION SUCH AS THE 21ST
CURES ACT THAT SUPPORTS
INCREASED ACCESS TO HEALTH
INFORMATION HOWEVER WE KNOW
THAT JUST BECAUSE HEALTH
INFORMATION IS AVAILABLE IT IS
NOT NECESSARILY MEAN THAT IT IS
ACCEPTABLE FOR PATIENTS. AND
THAT REALLY BRINGS UP THE
CONCEPT OF HEALTH LITERACY.
SO FIRST WE HAVE PERSONAL
HEALTH LITERACY WHICH IS HOW
PATIENTS UNDERSTAND AND ARE
ABLE TO USE THE HEALTH
INFORMATION. BUT MORE RECENTLY
WE ARE ALSO TALKING ABOUT
ORGANIZATIONAL HEALTH LITERACY.
AND THAT IS REALLY THINKING
ABOUT THE GROWING
RESPONSIBILITY THAT WE HAVE AS
HEALTHCARE STRUCTURES AND
SYSTEMS TO EMPOWER PATIENTS AND
GIVE THEM RESOURCES TO
EFFECTIVELY BE ABLE TO NAVIGATE
THE SYSTEMS THAT WE DESIGNED
FOR THEM TO BE ABLE TO USE
THEIR HEALTH INFORMATION.
AND THINKING ABOUT THIS
RESPONSIBILITY, AS INFORMATION
AVAILABILITY ROSE WE HAVE TO
REALLY THINK ABOUT HOW DO WE
MAKE THIS INFORMATION TRIMS
TENABLE AND ACCESSIBLE FOR
PATIENTS. THAT IS THE PREMISE
FOR A STUDY WHICH EXAMINED THE
ASSOCIATION BETWEEN PATIENTS'
EASE OF UNDERSTANDING THEIR
MIND, HEALTH INFORMATION, AND
VARIOUS FACTORS INCLUDING
SOCIAL DEMOGRAPHIC,
HEALTH-RELATED VARIABLES,
NUMERACY AND TECHNOLOGY RELATED
FACTORS.
TO DO THIS WE USED HINTS 6
DATA WHICH INCLUDED OVER 6000
RESPONSES. WE LOOK AT THE ODDS
OF THE HEALTH INFORMATION BEING
VERY EASY TO EXTENDERS IS NOT
VERY EASY WHICH WAS A
COMBINATION OF SOMEWHAT EASY,
SOMEWHAT DIFFICULT, AND VERY
DIFFICULT.
WITH SECLUDED ANY PATIENT THAT
HAD MISSING DATA FOR THE
VARIABLES THAT WE WERE
INTERESTED IN, AS WELL AS
PATIENTS WHO DO NOT HAVE A
PATIENT PORTAL AND WHO REPORTED
THEY DID NOT LOG ON TO THE
PATIENT PORTAL AT ALL IN THE
LAST 12 MONTHS.
WE WERE THEN LEFT WITH A
SAMPLE OF A LITTLE BIT OVER
3000 PARTICIPANTS. THE
VARIABLES WANTED TO EXAMINE
WHETHER EASE OF UNDERSTANDING
YOUR HEALTH INFORMATION, YOUR
SOCIAL DEMOGRAPHIC VARIABLES
INCLUDING AGE, BIRTH, GENDER,
RACE, ETHNICITY AND EDUCATION.
AND WE HAD A GROUP OF HEALTH
RELATED VARIABLES INCLUDE
GENERAL HEALTH, CONFIDENCE IN
YOUR OWN ABILITY TO TAKE CARE
OF YOUR HEALTH, HAVING A
CHRONIC ADDITION OF BEING DEAF
AND HAD NUMERACY WHICH INCLUDED
A QUESTION ABOUT THE EASE OF
UNDERSTANDING. AND DIFFERENT
COMMUNICATION QUESTIONS
COMBINED INTO ONE SCORE WITH A
GROUP OF VARIABLES ON THE
TECHNOLOGY-RELATED VARIABLES
WHICH WERE PRIMARILY
(INDISCERNIBLE).
WE DID BOTH UNIVARIED AND
MULTI-VARIED. WITH THE RESULT
OF MULTIVARIATE ANALYSIS AND WE
HAD PARTICIPANTS -- COMPARED TO
75 AND OLDER.
ALSO LOOKING AT BIRTH GENDER
PARTICIPANTS REPORTED BEING
FEMALE THERE WERE 1.4 TIMES
MORE LIKELY TO FIND INFORMATION
EASY TO UNDERSTAND WHEN
COMPARED TO MALE PARTICIPANTS.
AND THOSE WHO HAD A HIGHER
PATIENT PROVIDER COMMUNICATION
SCORE WERE ASSOCIATED WITH
INCREASED ODDS OF UNDERSTANDING
THEIR HEALTH INFORMATION. AND
THEN THE MORE INTERESTING
FINDING WAS MEDICAL STATISTICS,
WHICH ARE VERY STRONG
ASSOCIATION. PARTICIPANTS WHO
HAD A VERY EASY TIME
UNDERSTANDING MEDICAL
STATISTICS, WERE 8.5 TIMES MORE
LIKELY TO FIND HEALTH
INFORMATION VERY EASY TO
UNDERSTAND.
AND FINALLY, MOTIVE
ACCESSIBILITY WORK SIGNIFICANCE
OF STATIONS WOULD PARTICIPATE
WHO ACCESSED PATIENT PORTAL AND
ELECTRONIC HEALTH RECORDS VIA
AN APPLICATION, IN BOTH AN
APPLICATION AND WEBSITE WERE
MORE LIKE YOU TO FIND
INFORMATION VERY EASY TO
UNDERSTAND THAN JUST THE
WEBSITE ALONE.
SO TO SUMMARIZE, OUR FINDINGS
SHOWED THAT THERE WERE SEVERAL
FACTORS ASSOCIATED WITH HAVING
EASY TIME UNDERSTANDING THE
HEALTH INFORMATION AND PATIENT
PORTALS INCLUDING NUMERACY,
PROVIDER COMMUNICATION, FEMALE
BIRTH GENDER, AND SPECIFIC ONLY
ACCESS MODE, SPECIFICALLY
MOBILE APP.
AND FORTUNATELY WE DID NOT
HAVE INFORMATION ABOUT WHAT
SECTIONS PATIENTS WERE THINKING
ABOUT WHEN ANSWERING HOW EASY
IT WAS TO UNDERSTAND HEALTH
INFORMATION. SO IT'S HARD TO
UNDERSTAND THIS WAS LAB
RESULTS, VERSUS A RADIOLOGY
REPORT, OR WAS IT PROGRESS
NOTES. IT WILL BE VERY
INTERESTING WHEN YOU THINK
ABOUT THIS IN FUTURE STUDIES.
HOWEVER OUR FINDINGS DO SHOW
THAT THERE ARE SOME DIFFERENCES
IN HOW PATIENTS UNDERSTAND
HEALTH INFORMATION AND WE
REALLY NEED TO BE THINKING
ABOUT OUR RESPONSIBILITY FOR
MAKING IT EASIER FOR PATIENTS
TO ACTUALLY HAVE ACCESSIBLE
HEALTH INFORMATION BESIDES JUST
AVAILABLE. THANK YOU SO MUCH.
>> [APPLAUSE]
>> DR. D'ANGELO: THANK YOU NEXT
WE HAVE LIJIAN XIAO FROM WRIGHT
STATE UNIVERSITY.
>> DR. XIAO: GOOD AFTERNOON
EVERYONE. MY NAME IS LIJIAN
XIAO, FROM WRIGHT STATE
UNIVERSITY. WRIGHT STATE
UNIVERSITY - A DECISION-TREE
ANALYSIS
OF ACCESS TO THE INTERNET AND
HEALTH INFORMATION TECHNOLOGY
TO PREDICT CONFIDENCE IN
FINDING ONLINE HEALTH RESOURCES
SO THE GOAL IS TO EXAMINE HOW
ACCESS TO THE INTERNET AND
INFORMATION TECHNOLOGY PREDICTS
CONFIDENCE IN FINDING ONLINE
RESOURCES BECAUSE RIGHT NOW NOT
EVERYBODY HAS ACCESS TO THE
ENERGY ESPECIALLY FOR OLDER
PEOPLE AND ALSO INTERNET
QUALITY ALSO AFFECTS THIS, AND
THE WAY YOU MESSAGE THE DOCTOR
OR THE WAY YOU HAVE ACCESS TO
THE PORTAL, AND ALSO IT AFFECTS
THE CONFIDENCE IN FINDING
ONLINE HEALTH RESOURCES.
THE METHOD I USED IS THE
GUASSIAN (PHONETIC) TREE,
PREDICTS THE CLASSIFICATION
ATTRIBUTES. THE DECISION TREE
ACTUALLY STARTS WITH THE ROOT,
AND THE ROOT IS THE MOST
IMPORTANT, SIGNIFICANT
ATTRIBUTES. AND THEY CALCULATE
EACH ATTRIBUTE, AND THAT MAKE A
WHOLE TREE FROM THE ROOT TO THE
BOTTOM. THEY USE HEURISTIC
METHODS CALLED INFORMATION
GAIN, IT CALCULATES INFORMATION
GAIN BASED ON THE ATTRIBUTES,
AND THEN IT SELECTS THE MOST
INFORMATION, AND IT PUTS THE
ATTRIBUTION A DIFFERENT TOOL.
THE VARIABLES WE CHOSE. THIS
IS FROM THE B SECTION OF THE
HINTS DATA. THE FIRST
INDEPENDENT VARIABLE WAS
INTERNET ACCESS. AND RELATED
YOU SATISFACTION WITH INTERNET
SPEED. USE OF HEALTH OR
WELLNESS APPS, HISTORY,
FREQUENCY, HOW FREQUENTLY
SOCIAL MEDIA IS USED IN
ATTITUDE TOWARDS HOW SOCIAL
MEDIA IS USED.
IN HERE YOU SEE THAT FOR --
THERE ARE MULTIPLE DIFFERENT
ATTRIBUTES FOR B3 AND B 12. BUT
FOR DATA WILL HAVE 6000 ROLES
FOR THE DATA BUT IF WE ONLY
HAVE SO MANY LEVELS OF EACH
ATTRIBUTE IT AFFECTS THE
ACCURACY OF THE MODEL. I MERGED
SOME OF THE ATTRIBUTES INTO ONE
LEVEL, TO MAKE SURE THAT THE
MODEL WORKS WELL. FOR EXAMPLE
FOR THE 3, HEALTH RELATED
INTERNET USE, I USE THE FIRST
ONE HOUSE INFO, AND I COMBINED
THE OTHERS INTO A DIFFERENT
LEVEL. SO IS A LIMITED LEVEL.
AFTER CLEANING THE DATA WE ONLY
HAD 4000 ROLES. WE MAKE SURE
THAT MODEL WORK BETTER.
AND FOR THE -- LEVEL, NOT VERY
CONFIDENT OR CONFIDENT OR I
DON'T KNOW, THREE TYPES OF
LEVELS.
SO B4 DATA, I USED 30% OF THE
TESTING DATA AND 30% OF THE --
DATA. THE APPROXIMATE ACCURACY
OF THE MODEL WAS 83% AND ALSO
-- CONFIDENT IN FINDING ONLINE
HEALTH RESOURCES AND ALMOST
EVERY RESPONDENT WAS SATISFIED
WITH THE INTERNET CONNECTION
AND USE THE INTERNET TO ENGAGE
IN HEALTHCARE SUCH AS SEEKING
ONLINE INFORMATION.
AND FOR THOSE WHO ARE NOT
SATISFIED WITH THEIR INTERNET
CONNECTION, 80% WERE CONFIDENT
IN FINDING ONLINE HEALTH
RESOURCES THEY USED THE
WELLNESS APP OR SOCIAL MEDIA
FOR HEALTH PURPOSES. AS YOU
CAN SEE OVERALL THE MOST
IMPORTANT AND SIGNIFICANT
ATTRIBUTES IS THE INTERNET
CONNECTION.
SO BASICALLY HERE IS WHAT THE
TREE LOOKS LIKE. THE FIRST ROOT
IS THE INTERNET CONNECTION, IF
PEOPLE WERE SATISFIED, IT GOES
TO THE RIGHT. ON THE LOWER
LEVEL AND THE LOWER PART IS THE
FINAL PREDICTION, WHETHER YOU
ARE CONFIDENT IN FINDING
INTERNET HEALTH ONLINE OR NOT.
SO OVERALL, THERE'S LIKE --
NUMBERS AND AS YOU CAN SEE THE
MOST NUMBER OF OBSERVATION IS
PEOPLE WHO WERE SATISFIED WITH
INTERNET CONNECTION. THEN THEY
ACTUALLY USED INTERNET HEALTH
INFO, WHICH GIVES THEM MORE
CONFIDENCE IN FINDING ONLINE
RESOURCES. THANK YOU THAT IS
ALL.
>> DR. D'ANGELO: NEXT WE HAVE
TRACY ONEGA, FROM THE HUNTSMAN
CANCER INSTITUTE, UNIVERSITY OF
UTAH.
>> DR. ONEGA: THANK YOU I AM
HERE TODAY TO PRESENT BRIEFLY
ON HUNTSMAN CANCER
INSTITUTE/UNIVERSITY OF UTAH
- INTER-GENERATIONAL
DIFFERENCES IN HEALTH
INFORMATION, DIGITAL TECHNOLOGY
USE AND CANCER BELIEFS AMONG
LATINA WOMEN IN THE U.S. BASED
ON THE HEALTH INFORMATION
NATIONAL TRENDS SURVEY (HINTS).
I HAVE THE FLIP SITUATION,
USUALLY PEOPLE WHO HAVE BEEN
LONGER IN THEIR CAREER LIKE ME,
MAKING OPPORTUNITIES FOR
TRAINEES TO COME UP AND
PRESENT. TODAY IT'S THE
OPPOSITE FOR ME, MY
UNDERGRADUATE TRAINING FOR THE
SUMMER DANIELLE ALVARADO IS
WITH HER FAMILY OF ORIGIN IN
ECUADOR SO I AM PRESENTING HER
WORK
THE RATIONALE FOR THE STUDY IS
TO TRY TO UNDERSTAND IN THE
CONTEXT OF THE INCREASING USE
OF DIGITAL TECHNOLOGIES TO
REACH HEALTH DISPARITY
POPULATIONS-- PARTICULARLY
WITHIN CANCER CONTROL-- HOW
THERE MAY BE INTERGENERATIONAL
DIFFERENCES AMONG LATINO WOMEN,
PARTICULARLY RELATED TO
SCREENING AND THIS IS BORN FROM
SEVERAL OBSERVATIONS AND
EVIDENCE.
FIRST THAT THERE IS NOTED TO
BE INCREASED USE OF BREAST
CANCER SCREENING UPTAKE AND
ADHERENCE WHEN THERE IS SOCIAL
MEDIA AND TEXTBASED
INTERVENTIONS, AND A MYRIAD
EXAMPLES OF THIS. THIS IS JUST
ONE DRIVER. AT THE SAME TIME
HISPANIC AND LATINA PUBLISHERS
HAVE BEEN SHOWN LESS LIKELY TO
USE DIGITAL HEALTH TOOLS AND
WEB-BASED HEALTH INFORMATION.
AND AS WE KNOW FROM SOME OF OUR
SPEAKERS THIS MORNING,
AGE-RELATED DIFFERENCES IN THE
USE OF DIGITAL HEALTH
TECHNOLOGIES IS WELL-RECOGNIZED
TO COMBINING THESE THINGS
REALLY MAY PUT SOME WOMEN
ACROSS THE LIFESPAN, THE LIFE
COURSE, WOMEN AT RISK.
PARTICULARLY AROUND SCREENING
FOR USE OF HEALTH INFORMATION
AND HEALTH DIGITAL
TECHNOLOGIES.
THE METHODS WE USE HERE, WE
SPECIFICALLY WERE IN HINTS 5
ACROSS FOUR CYCLES. WE SELECTED
FOR LATINA AND HISPANIC WOMEN
AGES 18 AND OVER. RESPONDENTS
COULD BE IN ENGLISH OR SPANISH.
AND THE ANALYSIS WERE PRETTY
SIMPLE, DESCRIPTIVE ANALYSIS OF
DIGITAL TECHNOLOGY USE AND
HEALTH INFORMATION SEEKING IN
RELATION TO AGE IS OUR MAIN
EFFECT.
AND WE ALSO APPLIED FOR
MULTIVARIABLE LOGISTIC
REGRESSION TO TEST THE EFFECT
OF AGE.
SO WHAT WE SEE HERE, WE HAVE
OUR QUARTILES OF AGE GROUPS ON
THE LEFT. AND THEN WE HAVE
SELF-REPORTED USE OF DIGITAL
TECHNOLOGY AND CANCER
INFORMATION SEEKING.
NOT SURPRISINGLY, FOR THE
OLDER AGE GROUP OF WOMEN SEEN
IN THE LIGHT BLUE BAR, BOTH FOR
USE OF MOBILE DEVICES AND
WEARABLES AND FOR USE OF THE
INTERNET, ALMOST HALF AS MANY
WOMEN OF THE OLDEST AGE GROUP
USE THOSE, COMPARED TO THE
YOUNGEST AGE GROUP.
SIMILARLY, FOR SEEKING CANCER
INFORMATION, THE OLDEST AGE
GROUP OF WOMEN HAD THE LOWEST
REPORTED CANCER INFORMATION
SEEKING. AND THIS IS THE GROUP
WITH THE HIGHEST CANCER RISK.
THINKING ABOUT SELF REPORTING
SOURCES, FOR THOSE WHO SOUGHT
CANCER INFORMATION SEEKING, THE
X AXIS IS NOT AT 100%.
FOR THE OLDEST WOMAN IN THE
OLDEST AGE GROUP THAT DOCTOR
WAS THE MOST TRUSTED SOURCE OR
MOST FREQUENTLY USED SOURCE.
WHEREAS THE INTERNET WAS BY FAR
LOWER FOR THE OLDEST AGE GROUP
OF WOMEN.
SIMILARLY FAMILY AND FRIENDS
AND CANCER ORGANIZATIONS AS
SOURCES FOR CANCER INFORMATION
WAS HIGHEST IN THE OLDER AGE
GROUP OF WOMEN.
WE TRIED TO ADJUST FOR SOME
FACTORS THAT ARE NOTED BELOW TO
TEST THE EFFECTIVE AGE AMONG
THESE LATINA WOMEN. WE FOUND
THAT FOR INTERNET USE AND
MOBILE TECHNOLOGIES IN
PARTICULAR, AGE WAS VERY
STRONGLY RELATED NOT
SURPRISINGLY, BUT THE MAGNITUDE
OF THE DETRIMENT WAS SURPRISING
AS YOU CAN SEE IN THE OLDEST
AGE GROUP REFERENCE TO THE
YOUNGEST AGE GROUP ALMOST 95%
PRODUCTION IN THE LIKELY USE OF
INTERNET AND MOBILE WEARABLE
DEVICES RESPECTIVELY. VERY
DRAMATIC DROP OFF AS WE GO UP
IN THE AGE GROUPS.
SO THINKING ABOUT WHAT THIS
CAN TELL US, WE USE THIS TO
INFORM OUR THINKING ABOUT
HEALTH-RELATED INTERVENTIONS IN
THE MOBILE AND DIGITAL HEALTH
TECHNOLOGY INTERVENTIONS
PARTICULARLY ACROSS THE COUNTER
CONTROL CONTINUUM. AND THE
OLDER LATINA WOMEN IN THE US
ARE LESS LIKELY TO BENEFIT FROM
DIGITAL TECHNOLOGY-BASED CANCER
CONTROL ACTIVITIES. AND REALLY
WANTED TO EFFECTIVELY ADDRESS
THESE-- PARTICULARLY BREAST
CANCER DISPARITIES IN LATINA
WOMEN WHICH IS THE RESEARCH
GROUP THAT I AM EMBEDDED IN--
MULTIPLE MODES OF INTERVENTION
BUT DIGITAL AND NONDIGITAL
SHOULD BE USED AND/OR THINKING
ABOUT STRATEGY AND TACTICS AND
SUPPORTS WE NEED TO RECRUIT
AND/OR USE INTERVENTIONS THAT
HAVE A DIGITAL HEALTH
COMPONENT. AND WE WANT TO
REPRESENT THOSE OLDER LATINO
WOMEN. BECAUSE REALLY THAT IS
THE POPULATION WITH THE HIGHEST
RISK OF CANCER. AND WITH THE
LOWEST DIGITAL USE. THAT
COMBINATION REALLY MAY
EXACERBATE SOME DISPARITIES.
AND WITH THAT I WANT TO THANK
YOU ON BEHALF OF DANNY ALVARADO
AND MYSELF.
>> [APPLAUSE]
>> DR. D'ANGELO: NEXT WE HAVE
KANG NAMKOONG, FROM THE
UNIVERSITY OF MARYLAND.
>> DR. NAMKOONG: THANK YOU FOR
THAT INTRODUCTION. MENTAL
HEALTH HAS BEEN A SERIOUS
SOCIAL AND PUBLIC HEALTH ISSUE.
THE DATA SHOWS-- I PERSONALLY
OBSERVED THE PREVALENCE OF
MENTAL HEALTH PROBLEMS THESE
DAYS.
TO TACKLE THIS ISSUE EXAMINED
THE ROLE OF PERCEIVED MEANING
AND PURPOSE OF LIFE AS PART OF
FORMATIVE RESEARCH TO DESIGN
OUR HEALTH COMMUNICATION
INTERVENTION.
DURING AND AFTER THE CVOID-19
PANDEMIC, SOCIAL ISOLATION AND
MENTAL HEALTH IS BEEN EVEN MORE
CRITICAL ISSUE. PURPOSE AND
MEANING OF LIFE, DEFINED AS THE
PURSUIT OF THE WORTHWHILE GOALS
IN LIFE CAN REDUCE THE NEGATIVE
INFLUENCE OF SOCIAL ISOLATION
AND IMPROVE MENTAL HEALTH
OUTCOMES. BECAUSE THE
PERCEIVED MEANING AND PURPOSE
OF LIFE HAS BEEN IDENTIFIED AS
AN ESSENTIAL RESOURCE TO
IMPROVE PSYCHOLOGICAL
WELL-BEING.
IN THE STUDY ARE EXAMINED IF
THE PERCEIVED MEANING AND
PURPOSE OF LIFE COULD MITIGATE
THE NEGATIVE INFLUENCE OF
SOCIAL ISOLATION AND MENTAL
HEALTH. AND ENHANCE THE
POSITIVE INFLUENCE OF SOCIAL
MEDIA USE ON MENTAL HEALTH.
TO BE SPECIFIC, I PROPOSED
FIVE HYPOTHESES. THE FIRST ONE
IS, I HYPOTHESIZED THAT SOCIAL
ISOLATION WILL BE NEGATIVELY
ASSOCIATED WITH PSYCHOLOGICAL
WELL-BEING. AND SOCIAL MEDIA
USE WILL BE POSITIVELY RELATED
TO PSYCHOLOGICAL WELL-BEING.
AND I ALSO PREDICTED PERCEIVED
MEANING AND PURPOSE OF LIFE
WOULD POSITIVELY IMPACT
PSYCHOLOGICAL WELL-BEING.
AND I ALSO EXAMINED THE
PERCEIVED MPL, WHICH MEANS THE
RELATIONSHIP BETWEEN SOCIAL
ISOLATION AND PSYCHOLOGICAL
WELL-BEING. IT ALSO MODERATED
THE RELATIONSHIP BETWEEN SOCIAL
MEDIA USE AND PSYCHOLOGICAL
WELL-BEING.
HINTS 6 DATA MEASURED ALL OF
THESE KEY VARIABLES WITH
MULTIPLE ITEMS. FOR EXAMPLE
PERCEIVED PLC WAS MEASURED WITH
FOUR ITEMS SUCH AS LIFE HAS
MEANING, I HAVE A CLEAR SENSE
OF DIRECTION IN LIFE, ARE
EXPERIENCE DEEP FULFILLMENT IN
MY LIFE, AND MY LIFE HAS
PURPOSE.
LIKEWISE, SOCIAL ISOLATION AND
PERCEIVED PSYCHOLOGICAL
WELL-BEING WERE ALSO MEASURED
WITH THE FOUR ITEM MEASURES.
RESEARCH. AS PREDICATED, NOT
SURPRISINGLY SOCIAL ISOLATION
WOULD NEGATIVELY ASSOCIATED
WITH PSYCHOLOGICAL WELL-BEING.
BUT THERE IS NO STATISTICALLY
SIGNIFICANT RELATIONSHIP
BETWEEN SOCIAL MEDIA USE AND
PSYCHOLOGICAL WELL-BEING. AND
AGAIN, AS PREDICTED, THE
PERCEIVED MEANING AND PURPOSE
OF LIFE HAD A POSITIVE IMPACT
ON PSYCHOLOGICAL WELL-BEING.
REGARDING MODERATING OR
PERCEIVED MPL, THE PERCEIVED
MPL WAS ELEVATED BETWEEN THE
RELATIONSHIP BETWEEN
(INDISCERNIBLE) THAT MEANS
PEOPLE READING AT A HIGHER
LEVEL OF MPL S NEGATIVE IMPACT
OF SOCIAL ISOLATION ON MENTAL
HEALTH OUTCOMES.
REGARDING SOCIAL MEDIA USE,
WITH THE LESS PERCEIVED MPL THE
SOCIAL MEDIA USE HAD A NEGATIVE
IMPACT ON THEIR MENTAL HEALTH
OUTCOMES COMPARED TO OTHERS.
THE MAIN OUTCOME OF THE STUDY
IS THE MEANING AND PURPOSE OF
LIFE HAS DIRECT AND MODERATING
EFFECT ON PSYCHOLOGICAL
WELL-BEING. AND THIS RESEARCH
IMPLIES THAT COMMUNICATION
CAMPAIGN, OR INTERVENTION THAT
AIMS TO ENHANCING INDIVIDUALS
IN A DRIVE TO FIND MEANING AND
PURPOSE IN LIFE COULD ALLEVIATE
THE MENTAL HEALTH PROBLEMS
CAUSED BY SOCIALIZATION. AND
HELP PEOPLE GET PSYCHOLOGICAL
BENEFITS FROM SOCIAL MEDIA USE.
THANK YOU.
>> [APPLAUSE]
>> DR. D'ANGELO: OUR LAST
PRESENTATION IS FROM JUAN
ALBERTORIO-DIAZ. FROM THE
FOUNDATION FOR SOCIAL
CONNECTION.
>> MR. ALBERTORIO-DIAZ: GOOD
AFTERNOON FOLKS. MY NAME IS
JUAN ALBERTORIO-DIAZ. I WANT
TO HAVE A BRIEF TALK ABOUT
SOCIAL ISOLATION AND LOOKING
HINTS. BEFORE MY TALK I WANT
TO CONGRATULATE DR. WHELDON FOR
THE WORK WITH SOCIAL ISOLATION
BECAUSE IT ALLOWS ME TO HAVE A
BRIEF TALK OF WHAT I WANTED TO
SAY ABOUT THAT. WE HAVE A
NOTION ABOUT HOW THIS AFFECTS
HEALTH, MORE BASICALLY
MORBIDITY AND MORTALITY. THIS
IS THE ARGUMENT THAT THE OFFICE
OF THE SURGEON GENERAL BRINGS
IN HIS REPORT AND IN COMMON
RESEARCH IN THE LAST 20 YEARS
HAVE PROVIDED NOTIONS OF HOW
SOCIETAL LONELINESS HAS BEEN
AFFECTING HEALTH AS A RISK
FACTOR IN HEALTH OUTCOMES AND
WE HAVE LITTLE NOTION ON HOW
LONELINESS MAY AFFECT
INFORMATION RESOURCES AND HELP
BELIEFS AND BEHAVIORS. AND THAT
IS THE ROLE WITH HINTS. HINTS
IS THE FIRST SURVEY OF FROM THE
PUBLIC HEALTH PERSPECTIVE TO
HAVE A MODEL TO MENTION
LONELINESS, ESTABLISHED IS AN
IDEA FOUR YEARS AGO. AND NOW WE
HAVE THE HINTS 6, THE FIRST
COMPLETE DATA FOR TWO YEARS
COMBINED ABOUT THIS MODEL.
TO THE BEST OF MY KNOWLEDGE,
AGAIN THIS IS ONE OF THE FIRST
PUBLIC HEALTH SURVEYS
CONDUCTING A MODEL ON
LONELINESS.
THE SECOND ONE THAT WE HAVE TO
MENTION IS BRFS WHICH HAS NEW
DATA FOR NEW CYCLES, WHICH YOU
CAN CONSIDER AND USE FOR YOUR
WORK AND FOLLOWING WE HAVE HIS
AND HANES. SO COMING SOON MORE
INFORMATION ABOUT IT.
SO WE TRY TO SEE HOW THE
CONSTRUCT OF SOCIAL ISOLATION
CAN BE GRASPED IN ONE WAY. WE
TRY TO USE SOCIAL METHODOLOGIES
FOR THIS QUESTION MODEL USING
THAT PART IN HAVING ALL THE
INFORMATION FOR THE
SOCIALIZATION MODEL.
WE USED MAXIMUM LIKELIHOOD
WITH MISSING VALUE WHICH ALLOWS
TO WORK WITH MISSING DATA FROM
THE HINTS DATA. ON A LATER
NOTE THERE IS A VERY NOMINAL
MISINFORMATION FOR LONELINESS
ABOUT THE HINTS. I SUGGESTED
TO USE THAT IN YOUR INTEREST
FOR RESEARCH.
WE TRY TO MEASURE HOW
LONELINESS AFFECTS HEALTH
INFORMATION, HEALTH BELIEFS,
AND HEALTH BEHAVIOR IN THE
SELECTED CONSTRUCT.
WITH THAT WE TRY TO MEASURE
LONELINESS, BASED ON THE FOUR
MEASURES USING THE RAW SCORE.
WOULD NOT USE THE T SCORE FOR
THE CMM MODEL.
WE TRY TO SEE HOW LONELINESS
AFFECTS. HERE WE CAN SEE THE
PEOPLE WHO ARE LONELY HAVE
HIGHER RATIO TO HAVE
INFORMATION FROM THE INTERNET
THAN FROM FAMILIES AND FRIENDS.
THEY ARE LESS LIKELY TO HAVE
THAT INFORMATION. WE CAN SEE
ALSO FROM SOME OF THE BEHAVIORS
OF PEOPLE WHO ARE LONELY ARE
MORE INTERESTED IN GETTING
INFORMATION FROM THE INTERNET,
CONSUME SODA, CONSUME PROCESSED
MEAT, RED MEAT, PROCESSED FOOD
AND NO FRUIT OR VEGETABLES IN
CAN ALSO DELINEATE THE PEOPLE
WHO ARE MORE LONELY ARE MORE
LIKELY TO HAVE NO SLEEP AND
LESS LIKELY TO NEVER SMOKE.
AND LESS LIKELY TO HAVE
UP-TO-DATE PAP SMEAR.
SO THAT GIVES YOU A SNAPSHOT
OF HOW THE MODEL OF LONELINESS
CAN BE USED. AND IN THAT SENSE
WE CAN INDICATE IN SUMMARY THAT
LONELY PEOPLE MAY TALK ABOUT
HEALTH, NOT ONLY WITH THEIR
PEERS OR PARTNERS. MOST LIKELY
THEY TEND TO LOOK FOR
INFORMATION USING
INTERNET-BASED. SO WE CAN USE
THAT AS AN ASSET TO PROVIDE
INFORMATION FOR UNDERSERVED
COMMUNITIES AND TAILOR THAT
INFORMATION FOR MINORITY GROUPS
IN THAT REGARDS.
AND AGAIN LONELY PEOPLE ARE
MORE LIKELY TO ATTRIBUTE HEALTH
BEHAVIORS TO CONDUCT BEHAVIOR
THAT MORE LIKELY PRODUCE CANCER.
AND I WANT TO GIVE YOU A
SNAPSHOT OF THE SOCIAL
SELECTION FOR LONELINESS IN
HINTS. AND I HOPE THIS SPARKS
YOUR INTEREST AND YOU TRY TO
USE IT. THANK YOU FOR YOUR
TIME.
>> DR. D'ANGELO: THANKS TO OUR
SPEAKERS. WE HAVE TIME FOR
QUESTIONS IF ANYONE HAS A
QUESTION. PLEASE MOVE TO THE
MIC. I SEE SOMEONE COMING
DOWN. YOU MAY HAVE TO SWITCH
IT ON.
>> WHAT WE COULD LEARN BY
ADDING A QUESTION TO THE
SURVEY, ABOUT WHETHER OR NOT
THAT DEVICE REQUIRES A
PRESCRIPTION. THE REASON I ASK
THAT IS BECAUSE OF THE DIABETES
PROBLEMS, VERY SPECIFICALLY. I
WILL SHARE A PERSONAL NOTE. I
HAVE TYPE I. I WOULD ANSWER YES
TO THIS QUESTION, BECAUSE I USE
THE CGM AND INSULIN PUMP. SO OF
COURSE I LOOK AT CALORIES AND
CARB CONTENT. I AM CURIOUS
ABOUT ANY COMMENTS YOU MAY HAVE
ABOUT ADDITIONAL INSIGHT WE
COULD GET FROM NOT JUST KNOWING
IF SOMEONE USES A DEVICE, BUT
WHAT TYPE OF DEVICE. AND WHAT
ITS PURPOSE IS.
>> YES SO I HAVE THE ACTUAL
WORDING OF THAT SPECIFIC
QUESTION FRENEMY. BUT I THINK
IT WAS BROUGHT. LIKE DO YOU
WEAR SOME KIND OF DEVICE, LIKE
FITBIT, HEART RATE MONITOR. I
CAN'T REMEMBER. BUT THERE'S A
FEW DIFFERENT EXAMPLES.
>> THE APPLE WATCH, THE GARMIN
AND THE FITBIT.
>> IF YOU ARE WEARING A FITBIT
OR MORE LIKE AN APPLE WATCH YOU
MAY BE DOING IT TO COUNT YOUR
STEPS WHICH IS IMPORTANT BUT IF
YOU HAVE A CLINICALLY
PRESCRIBED DEVICE-- LIKE A
GLUCOSE MONITOR OR MAY BE YOU
ARE USING A BLOOD PRESSURE
MONITOR AT HOME OR FOR SOME
OTHER MEDICAL REASON YOU MAY BE
PAYING ATTENTION TO CALORIE
INFORMATION OR OTHER TYPES OF
INFORMATION IN A DIFFERENT WAY.
BECAUSE IT MAY HAVE MORE
SIGNIFICANT IMPACTS ON YOUR
DATA, ESPECIALLY WITH TYPE I OR
TYPE II DIABETES VERSUS SOMEONE
WHO IS GOING TO GET MORE
EXERCISE. I THINK IT'S A
REALLY GOOD POINT. MAYBE THE
HINTS FOLKS, IF THERE IS A WAY
TO DISTINGUISH IT OUT BY TYPE,
AND MAY BE THE REASON. I THINK
THAT WOULD BE GREAT.
INTERESTINGLY ENOUGH, WE
LOOKED AT THAT PARTICULAR
ANALYSIS IN A COUPLE OF
DIFFERENT WAYS. SO HAVING A
WEARABLE DEVICE I THINK WAS--
IF YOU CHANGED THAT OUT -- IT'S
KIND OF A PROXY FOR INCOME. WE
WANT TO LOOK MORE CLOSELY AT
THAT AS WELL BECAUSE SOME
MONITORS ARE CHEAPER THAN
OTHERS-- I SHOULD PROBABLY NOT
HAVE PAID AS MUCH FOR THIS
APPLE WATCH, THERE ARE
CHEAPER-- WE ARE GOING TO LOOK
MORE DEEPLY AT THAT. BUT I
THINK IT IS A GREAT POINT.
>> IN OUR POSTER WE DID SEE
THAT THE HIGHEST INCOME WAS
ASSOCIATED WITH WEARABLE DEVICE
USE. WHICH SUPPORTS EXACTLY
WHAT YOU ARE SAYING.
>> THE CALORIE, IT MAY BE A
GOOD QUALITATIVE STUDY TO DO
AFTER THIS. BUT THE WAY THAT
QUESTION WAS WORDED,
ESSENTIALLY DO YOU NOTICE
CALORIE INFORMATION. LIKE IF
YOU HAVE TYPE I OR TYPE II
DIABETES, YOU MAY BE MORE
INTERESTED IN CARBOHYDRATES,
WHERE THE SUGAR CONTENT-- IF
YOU HAVE HYPERTENSION, YOU MAY
POTENTIALLY BE INTERESTED IN
SALT. SO THAT QUESTION WAS
REALLY BROAD. BUT HAVING MORE
SPECIFIC QUESTIONS BUT AGAIN
PARTICIPANT BURDEN BUT GIVING
YOU THE IDEA THAT MAYBE WE
SHOULD DO FOLLOW-UP WITH FOCUS
GROUPS OF PEOPLE TO TEASE OUT
WHAT THEY THINK MIGHT BE THE
TREND. GREAT QUESTION.
>> BRAINSTORM. SURVEY
DESIGNERS. IF PEOPLE DO SAY
YES TO THE WEARABLE DEVICE,
JUST ASKING THEM WHICH ONE
WOULD BE THE LEAST BURDENSOME
WAY.
THANK YOU VERY MUCH.
>> THANKS.
>> OKAY. THANK YOU. -- I HAVE A
QUESTION FOR AISHA. I AM
CURIOUS TO KNOW WHY FEMALES
HAVE HIGHER ODDS -- NOT THE
SAME CALORIE INFORMATION AS
COMPARED TO MALES.
>> WE OBSERVED THAT FEMALES HAD
HIGHER ODDS. SECONDARY DATA
SETS. I DON'T KNOW EXACTLY WHY.
I AM JUST GUESSING. ONE
POTENTIAL HYPOTHESES OR
EXPLANATION IS THAT MAYBE
BECAUSE OF SOCIAL PRESSURES OR
OTHER PRESSURES, MAYBE WOMEN
ARE MORE CONSCIOUS ABOUT WEIGHT
AND DIET AND WHAT THEY ARE
EATING. I AM GUESSING THAT
COULD BE ONE REASON.
IT COULD BE THAT WOMEN ARE
MORE CONSCIOUS ABOUT WHAT THEY
ARE EATING AND THE CONTENT.
THERE IS ONE POSSIBLE REASON.
I DON'T KNOW. THAT IS ONE OF
THE LIMITATIONS FOR DOING LIKE
A BIG CROSS-SECTIONAL STUDY.
YOU DON'T KNOW EXACTLY WHY.
THOSE ARE MAYBE TWO POTENTIAL
REASONS. IF ANYONE ELSE HAS A
THOUGHT.
>> THANK YOU. ABIGAIL, WHAT
ROLE DO YOU THINK POLITICAL
AFFILIATION-- YOU SPOKE ABOUT
THAT-- DO YOU THINK IT PLAYS IN
PROMOTING HEALTH?
>> DR. MURO: I THINK THAT IS
GOOD POINT. SOMETHING THAT I
WANT TO EXPLORE LATER. THAT
COULD DEFINITELY HAVE AN IMPACT
ON WHY CERTAIN SOURCES ARE
BEING TRUSTED. LIKE ONE OF OUR
HEALTH INFORMATION SOURCES WE
MEASURED WERE GOVERNMENT
AGENCIES. AND ALSO ESPECIALLY
THE PHRASE "CLIMATE CHANGE"IS
VERY POLITICAL NOW. AND THE
WAY IT'S TALKED ABOUT AND WHAT
SOURCE IT IS COMING FROM, HOW
THAT INFORMATION IS PERCEIVED
PROBABLY VARIES BY POLITICAL
AFFILIATION. YEAH, I WOULD LIKE
TO SEE THAT. THAT QUESTION
WILL BE ON HINTS 7, ABOUT
POLITICAL ORIENTATION. THAT
WILL BE GOOD. MAYBE WE CAN DO
THIS AGAIN BY TAKING THAT INTO
ACCOUNT.
>> CAN I FOLLOW-UP ON THAT
QUESTION? DO YOU REMEMBER HOW
THE CLIMATE CHANGE QUESTION WAS
WORDED? LIKE IS SMOKING BAD FOR
YOU? ARE YOU EATING TOO MUCH
FOOD? THESE BIG THINGS. I AM
CURIOUS HOW IT WAS ASKED. I
FEEL THAT IS SUCH A HARD THING
TO CONCEPTUALIZE VERSUS BEING
OVERWEIGHT, OR SOMETHING THAT
SEEMS TO BE MORE SPECIFIC.
>> YEAH IT WAS SOMETHING LIKE
HOW -- TO WHAT EXTENT DO YOU
BELIEVE THAT CLIMATE CHANGE
WILL HARM YOUR HEALTH? IT COULD
BE THAT PEOPLE ARE SEEING OR
FEELING THE EFFECTS BUT NOT
ATTRIBUTING IT TO CLIMATE
CHANGE OR TO THE ENVIRONMENT,
BUT NOT WANTING TO USE THE
PHRASE. THAT IS ALL
INTERESTING, AND THE TYPES OF
POLITICS IS A PART OF IT.
>> SO HI, I HAVE A QUESTION FOR
LIJIAN REGARDING THE TREE
ANALYSIS. PERHAPS THIS IS A
DUMB QUESTION BECAUSE I DON'T
KNOW ABOUT TREE ANALYSIS. SO,
IT'S VERY INTERESTING TO SEE
THAT YOU USED MULTIPLE FACTORS
TO PREDICT THE CONFIDENCE IN
FINDING HEALTH INFORMATION
ONLINE. DO YOU MIND EXPLAINING
TREE ANALYSIS A LITTLE BIT? HOW
IS THAT DIFFERENT FROM SAY
REGRESSION MODELS THAT WILL USE
THOSE PREDICTORS?
>> DR. XIAO: SO, FOR THE TREE
ANALYSIS, THERE WERE OTHER
CLASSIFICATION METHODS FOR
EXAMPLE -- BASICALLY IT'S LIKE
WHY. AND WE HAVE MULTIPLE
ACCESS LIKE (INDISCERNIBLE).
FOR THOSE IN IT MIGHTE BE ---
TO X7 THEN THE Y SHOULD BE
(INDISCERNIBLE) AND THE TREES
TO FIND THE MOST IMPORTANT
ATTRIBUTE. WE NEED TO FIND THE
NEXT LEVEL SIGNIFICANT
ATTRIBUTES. FOR EACH ATTRIBUTE
THERE ARE MAYBE DIFFERENT
LEVELS CATEGORICAL. YES OR NO.
OR 1, 2, 3. VERY SATISFIED.
LESS SATISFIED. I DON'T KNOW. I
DISAGREE. OR SOMETHING LIKE
THAT. MULTIPLE LEVELS. AT EACH
LEVEL THERE IS A BRANCH.
FOR EXAMPLE IF I HAVE A VERY
GOOD INTERNET CONNECTION, I CAN
GO THERE. IT'S YES. MY NEXT
LEVEL, MOST IMPORTANT ATTRIBUTE
WOULD BE WHETHER I WEAR AN
APPLE WATCH. IF I DO WHERE AN
APPLE WATCH. IF I DON'T WEAR IT
GOES LAST. YOU ARE THE PREDICT
YOU HAVE BETTER CONFIDENCE IN
FINDING RESOURCES IF YOU HAVE
GOOD INTERNET. WHY ON THE
BOTTOM. AND THE LABEL YOU WANT
TO PREDICT. YES, I DO HAVE
CONFIDENCE, OR I DON'T. THERE
ARE OTHER ATTRIBUTES THAT WON'T
SHOW IN THIS TREE WHICH MEANS
-- WE COULD HAVE AN IMPACT,
DEPENDS ON THE P VALUE. I HOPE
I MADE THAT CLEAR.
>> SO IS THAT -- KIND OF
SIMILAR TO HIERARCHICAL
REGRESSION?
>> DR. XIAO: A LITTLE BIT LIKE
THAT. THEY USE DIFFERENT
METHODS TO CALCULATE. THE USE
INFORMATION GAIN. MATHEMATICAL
EQUATIONS TO CALCULATING
INFORMATION GAINED. THE MOST
INFORMATION GAINED GOES TO THE
ROOTS, THE LESS GOES TO
DIFFERENT LEVELS AND HOW TO
CORRELATE THAT IS BASED ON THE
NUMBER OF INFORMATION SET
DIFFERENT LEVELS. SO THERE ARE
MATHEMATICAL -- BEHIND THAT. IT
TURNS OUT THAT IT LOOKS LIKE
(INDISCERNIBLE).
>> THANK YOU VERY MUCH.
>> THANK YOU.
>> QUICK QUESTION. I THINK THIS
PROBABLY RELEVANT TO BOTH
KRISTIN AND ABIGAIL. I WONDER
IF THERE ANY PLANS TO LOOK AT
INTERACTIONS OR DIFFERENCES IN
TRUST IN ASSOCIATION WITH
MORALITY BASED ON REGIONS. I
THINK THE SAME FOR ABIGAIL,
PERCEPTIONS OF CLIMATE CHANGE
MIGHT VERY BY REGION DEPENDING
ON EXPERIENCES WITH NATURAL
DISASTERS AND HOW THAT MIGHT
INFLUENCE TRUST AND PERCEPTIONS
OF CLIMATE CHANGE. ANY THOUGHTS
OR CONSIDERATIONS LOOKING AT
DIFFERENCES BY REGION AND
ASSOCIATIONS?
>> YEAH. I AGREE WITH THAT. I
THINK IT'S REALLY IMPORTANT TO
CONSIDER WHEN YOU'RE LOOKING AT
THE RURAL POPULATION. BECAUSE
BEING FROM RURAL MAINE, IS NOT
THE SAME AS RURAL UTAH, NOT THE
SAME AS RURAL TENNESSEE. SO
IT'S INTERESTING TO LOOK AT IT.
BUT IT'S THE FIRST LINE,
UNDERSTANDING WHAT DIFFERENCES
EVEN EXIST AT THE START. KIND
OF THE FIRST LEVEL. GETTING
INTO DIFFERENT REGIONS AND I
THINK THE CHALLENGE WILL BE TO
UNDERSTAND WHAT WE MEAN WHEN WE
SAY RURAL. I ALWAYS THINK THAT
WHEN WE DO RURAL RESEARCH, WE
ARE LOOKING AT PEOPLE WHO ARE
OLDER AND HAVE DIFFERENT
EDUCATION LEVELS. I DON'T KNOW
THAT IT'S GETTING AT WHAT IT
MEANS TO HAVE THAT RURAL
IDENTITY. AND ONCE WE START TO
GET INTO THE RURAL
CONSCIOUSNESS, AND THE IDEA OF
IDENTIFYING YOURSELF AS RURAL,
THAT IS WHERE THE REGIONS ARE
DIFFERENT. BUT THAT IS A MUCH
HARDER IDEA TO MEASURE THAN
JUST SOME OF THE CATEGORICAL
VARIABLES THAT WE CAN GET HERE.
>> YEAH. I AGREE WITH THAT.
THAT IS WELL SAID. AND WHEN
TALKING ABOUT CLIMATE CHANGE,
IT'S FIRST HOW DOES GEOGRAPHIC
AREA, RURAL VS. URBAN, IMPACT
IDEOLOGY? AND THEN THERE'S ALSO
THE IMPACT-- LIKE YOU WERE
SAYING EXPERIENCE WITH EXTREME
WEATHER OR WILDFIRES. AND HOW
THOSE INTERACT. LET'S SAY
SOMEBODY EXPERIENCES THAT, BUT
DO THEY ATTRIBUTE THAT TO
CLIMATE CHANGE? WE NEED TO LOOK
INTO THAT MORE.
>> DR. D'ANGELO: THANKS
EVERYONE AND THANKS TO ALL OF
THE SPEAKERS.
>> [APPLAUSE]
>> DR. D'ANGELO: BEFORE YOU
MOVE ON TO THE POSTER SESSION,
I JUST WANT TO DO A LITTLE
HOUSEKEEPING FOR TOMORROW
MORNING. FOR DAY 2 OF THE
CONFERENCE, WE HAVE AN OPTIONAL
WORKSHOP AT 8:30 IN THE
MORNING, A HINTS TUTORIAL. TWO
CONCURRENT SESSIONS. ONE
SESSION IS AN OPEN OFFICE
HOURS, SO BRING YOUR LAPTOP,
YOUR QUESTIONS, YOUR DATA, YOUR
SOFTWARE THAT YOU USE. AND WE
WILL DO OUR BEST TO HELP YOU
OUT AND GET YOU STARTED. OR
HELP YOU ALONG WITH YOUR
RESEARCH QUESTION.
IN THE SECOND SESSION IS A
HINTS OVERVIEW OF OUR METHODS,
OUR HISTORY, MEASUREMENT,
WEIGHTING AND USING THE HINTS
DATA IN R, THE STATISTICAL
PACKAGE.
IF YOU ARE NOT ATTENDING THESE
WORKSHOPS, THE REGULAR SESSIONS
BEGIN AT 10 AM. AND FOR BOTH
REMEMBER TO LEAVE ENOUGH TIME
TO GET THROUGH SECURITY,
ESPECIALLY IF YOU HAVE LUGGAGE
AND YOU HAVE TO GET TO THE
GATEWAY CENTER. I THINK THOSE
ARE ALL THE ITEMS WE NEED TO
COVER.
THE NEXT SESSION IS A POSTER
SESSION UPSTAIRS IN THE ATRIUM.
I WILL SEE YOU THERE