Incorporating effective smoking cessation interventions into lung cancer screening (LCS) programs will be essential to realizing the full benefit of screening. We conducted a pilot randomized trial to determine the feasibility and efficacy of a telephone-counseling (TC) smoking cessation intervention vs. usual care (UC) in the LCS setting. In collaboration with 3 geographically diverse LCS programs, we enrolled current smokers (61.5% participation rate) who were: registered to undergo LCS, 50–77 years old, and had a 20+ pack-year smoking history. Eligibility was not based on readiness to quit. Participants completed pre-LCS (T0) and post-LCS (T1) telephone assessments, were randomized to TC (N=46) vs. UC (N=46), and completed a final 3-month telephone assessment (T2). Both study arms received a list of evidence-based cessation resources. TC participants also received up to 6 brief counseling calls with a trained cessation counselor. Counseling calls incorporated motivational interviewing and utilized the screening result as a motivator for quitting. The outcome was biochemically verified 7-day point prevalence cessation at 3-months post-randomization. Participants (56.5% female) were 60.2 (SD=5.4) years old and reported 47.1 (SD=22.2) pack years; 30% were ready to stop smoking in the next 30 days. TC participants completed an average of 4.4 (SD=2.3) sessions. Using intent-to-treat analyses, biochemically verified quit rates were 17.4% (TC) vs. 4.3% (UC), p<.05. This study provides preliminary evidence that telephone-based cessation counseling is feasible and efficacious in the LCS setting. As millions of current smokers are now eligible for lung cancer screening, this setting represents an important opportunity to exert a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related diseases. If this evidence-based, brief, and scalable intervention is replicated, TC could help to improve the overall cost-effectiveness of LCS.

Background Due to the concerns about the overtreatment of low-risk prostate cancer (PCa), active surveillance (AS) is now a recommended alternative to the active treatments (AT) of surgery and radiotherapy. However, AS is not widely utilized, partially due to psychological and decision-making factors associated with treatment preferences. Methods In a longitudinal cohort study, we conducted pretreatment telephone interviews (N=1,140, 69.3% participation) with newly diagnosed, low-risk PCa patients (PSA≤10, Gleason≤6) from Kaiser Permanente Northern California. We assessed psychological and decision-making variables, and treatment preference [AS, AT, No Preference (NP)]. Results Men were 61.5 (SD=7.3) years old, 24 days (median) post-diagnosis, and 81.1% white. Treatment preferences were: 39.3% AS, 30.9% AT, and 29.7% NP. Multinomial logistic regression revealed that men preferring AS (vs. AT) were older (OR=1.64, CI 1.07-2.51), more educated (OR=2.05, CI 1.12-3.74), had greater PCa knowledge (OR=1.77, CI 1.43-2.18) and greater awareness of having low-risk cancer (OR=3.97, CI 1.96-8.06), but also were less certain about their treatment preference (OR=0.57, CI 0.41 - 0.8), had greater PCa anxiety (OR=1.22, CI 1.003-1.48), and preferred a shared treatment decision (OR=2.34, CI 1.37-3.99). Similarly, men preferring NP (vs. AT) were less certain about treatment preference, preferred a shared decision, and had greater knowledge. Conclusions Although a substantial proportion of men preferred AS, this was associated with anxiety and uncertainty, suggesting that this may be a difficult choice. Impact Increasing the appropriate use of AS for low-risk PCa will require additional reassurance and information, and reaching men almost immediately post-diagnosis while the decision-making is ongoing.

Objectification has been conceptualized as a form of insidious trauma, but the specific relationships among objectification experiences, self-objectification, and trauma symptoms have not yet been investigated. Participants were women with (n = 136) and without (n = 201) a history of sexual trauma. They completed a survey measuring trauma history, objectification experiences (body evaluation and unwanted sexual advances), constructs associated with self-objectification (body surveillance and body shame), and trauma symptoms. The relationships among the variables were consistent for both women with and without a history of sexual trauma. Our hypothesized path model fit equally well for both groups. Examination of the indirect effects showed that experiencing unwanted sexual advances was indirectly related to trauma symptoms through body shame for those with and without a history of sexual trauma. Additionally, for women with a history of sexual trauma, the experience of body evaluation was indirectly related to trauma symptoms through the mediating variables of body surveillance and body shame. The data indicate that the experience of sexual objectification is a type of gender-based discrimination with sequelae that can be conceptualized as insidious trauma. Clinicians may consider the impact of these everyday traumatic experiences when working with women who have clinical symptoms but no overt trauma history.

Objective: Parents often report guilt about what they feed their child, but no studies have examined how this guilt might affect their child-feeding or own eating behavior. Some studies suggest that guilt motivates healthy behaviors, yet others show that guilt impairs the self-control needed to abstain from unhealthy behaviors. Method: One hundred ninety parents reported how guilty they felt about their current child-feeding habits. Parents then chose food for their child in a virtual reality buffet and reported their intentions to improve child-feeding and own eating behavior in the future. Finally, parents were offered candy while they completed an unrelated survey. Results: Parents with greater guilt reported stronger intentions to improve both feeding (b ϭ .27, p ϭ .010) and eating (b ϭ .21, p ϭ .019) in the future. However, among parents with higher (but not lower) BMI, those who reported greater guilt served more unhealthy foods for their child in the buffet (b ϭ .32, p ϭ .010) and were more likely to eat candy at the end of the study (b ϭ .92, p ϭ .004). Further analyses revealed that guilt only predicted greater feeding intentions when parents had served relatively more unhealthy foods in the buffet (b ϭ .43, p Ͻ .001). Conclusions: Findings echo the mixed conceptualization of guilt shown in previous literature on health behavior. More research is necessary to understand the long-term influence of guilt on eating and feeding behavior and the circumstances under which guilt is associated with detrimental versus healthy behavior.

No abstract