Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on selfreported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared selfreported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the ''gold standard,'' the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (k = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (k = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results. Validity of Self-reported Smoking Status among Participants in a Lung Cancer Screening TrialLung cancer is a devastating illness associated with substantial morbidity and mortality. In 2006, f174,470 Americans will be diagnosed with lung cancer, and another 162,460 will die from the disease (1). Improved survival with early diagnosis has prompted exploration of lung cancer screening technologies (2-5). In addition to the medical implications of early detection, participation in screening programs may be associated with decreased smoking rates (6-9), although some have suggested that negative screening results may actually lead to continuation of or return to smoking (6).Most studies exploring changes in smoking status associated with screening have relied solely on participant self-report of smoking status. The veracity of self-reports is often questionable in situations involving social pressure or medical disapproval (10-13). In these high-demand situations, studies have consistently suggested that smoking behavior is underreported (12-18). Although inaccurate self-reported smoking status in the general population occurs relatively infrequently (15,19), the lung cancer screening context may constitute a high-demand situation, a condition under which biochemical verification is recommended (1...

Objective The purpose of this study is to assess regional parental barriers in the diagnostic and therapeutic process following abnormal newborn hearing screening (NHS) testing. Study Design Cross-sectional questionnaire study Setting Tertiary medical center Patients Parents of infants who failed NHS in Kentucky from January 2009 – February 2012 Main Outcome Measure Demographic information, county of origin, and attitudes and perceptions regarding NHS and barriers in the NHS diagnostic process. Results There were 460 participants in the study, which included25.4% of parents were from the Appalachian region. 21% of Appalachian parents found the process on newborn hearing testing difficult. Appalachian parents were more likely to have no more than 12 years of education (OR 1.7, p=0.02) and Medicaid insurance (OR 2.3, p<0.001) compared with non-Appalachian parents. A higher percentage of Appalachian parents were unaware of the NHS results at the time of hospital discharge than non-Appalachians (14% v. 7%, p=0.03). Distance from the diagnostic/therapeutic center represented was a significant barrier for Appalachian parents (OR 2.8, p=0.001). Compared with urban parents, a greater percentage of rural parents had never heard of a cochlear implant (p=0.01). Appalachian parents expressed a strong interest in telemedicine and a desire for closer services. Conclusion Multiple barriers including education, distance, accessibility, socioeconomic factors can affect timely diagnosis and treatment of congenital hearing loss for children residing in rural areas. Educational and telemedicine programs may benefit parents in Appalachia, as well as parents in other rural areas.

Objective Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years). Method This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005 – June 2008). Women aged 40–64 and overdue for screening were recruited from churches and individually randomized to treatment (n=176) or wait-list control (n=169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome. Results Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR=2.56, 95%CI: 1.03–6.38, p=0.04. Independent of group, recently screened participants (last Pap >1 but <5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥5 years ago), OR=2.50, 95%CI: 1.48–4.25, p=0.001. Conclusions The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.

Research on the implementation of smoking cessation counseling within substance abuse treatment organizations is limited. This study examines associations among counselors’ implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization- and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors’ knowledge of the Public Health Service’ s clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors’ knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations.