eScholarship@UMassChan
eScholarship@UMassChan is a digital archive for UMass Chan Medical School's research and scholarship, including journal articles, theses, datasets and more. We welcome submissions from our faculty, staff, and students. eScholarship@UMassChan is a service of the Lamar Soutter Library, Worcester, MA, USA. See also our open access journal publishing services.
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Recent Publications
Publication Multi-level socioeconomic modifiers of the comorbidity of post-traumatic stress and tobacco, alcohol, and cannabis use: the importance of income(2025-02-07)Purpose: Post-traumatic stress (PTS) symptoms are highly comorbid with substance use (i.e., alcohol, tobacco, and cannabis). Few studies have investigated potential individual-, household-, and neighborhood-level socioeconomic effect modifiers of this comorbidity in longitudinal analyses. We aim to examine interactions between this multi-level environment and PTS symptoms on future substance use behaviors. Methods: Data were drawn from the Advancing Understanding of RecOvery afteR traumA (AURORA) study, including 2943 individuals who presented to the emergency department (ED) within 72 h of a traumatic event. Frequency of tobacco, alcohol, cannabis use, and PTS symptoms were reported at 6 timepoints. Mixed effect Poisson models, clustered by state, were used to generate incidence rate ratios (IRRs) substance use, both cross-sectionally and prospectively. Moderation analysis of PTS and substance use, stratified by household income and area deprivation index (ADI), was conducted using mixed effect models and parallel process growth curves. Results: Significant associations were observed between PTS with tobacco, alcohol, and cannabis use frequency cross-sectionally, and for tobacco and alcohol and PTS exposure prospectively. Lower income (P < 0.001) and higher deprivation (P < 0.001) were associated with tobacco use, while higher income (P < 0.001) and less deprivation (P = 0.01) were associated with increased alcohol use. We found modest modification by household income for alcohol and tobacco, and little evidence of modification by neighborhood ADI. Conclusions: Household income had greater evidence of effect modification for substance use, compared to neighborhood-level ADI. Our findings demonstrate that household indicators of socioeconomic status likely modify the relationship between PTS and substance use.Publication Statistics That Can Shape Disability Policy.(2025-02-07)Policy makers need disability statistics to determine whether, or what, new policy approaches are needed. Led by the University of New Hampshire, the NIDILRR-funded Rehabilitation Research and Training Center on Disability Statistics and Demographics (StatsRRTC) is a collaboration of the American Association of People with Disabilities (AUCD), Kessler Foundation, and Mathematica Policy Research. StatsRRTC's Disability Statistics Collection provides a singular location to obtain and compare the most recent federal, state, and county level disability statistics. This brief highlights just a few of the statistics can be that can be found through the work of StatsRRTC. © 2025 Boston University & UMass Chan Medical School. All Rights Reserved.Publication Diabetes Medical Group Visits and Type 2 Diabetes Outcomes: Mediation Analysis of Diabetes Distress(2025-02-06)Background: Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in low-income minority women, but the mechanism remains unclear. Objective: We tested whether diabetes group medical visits (GMVs) reduced hemoglobin A1c (HbA1c) by mitigating diabetes distress (DD), an emotional response affecting nearly half of adults with type 2 diabetes in community settings. Methods: We conducted a mediation and moderation analysis of data from the Women in Control 2.0 comparative effectiveness study, which showed that both technology-enabled and in-person diabetes GMVs improve HbA1c. We tested whether DD mediated the relationship between diabetes GMV engagement and reductions in HbA1c. We also tested whether this relationship was moderated by depressive symptoms and social support. Participants were 309 low-income and minority women. Diabetes GMV engagement was measured using the Group Climate Questionnaire. The mediator, DD, was measured using the Diabetes Distress Screening Scale. The outcome was the 6-month change in HbA1c. Social support was measured using the Medical Outcomes Study Social Support Survey. Results: DD mediated the relationship between engagement and 6-month HbA1c. Specifically, group engagement affected HbA1c by reducing distress associated with the regimen of diabetes self-management (P=.04), and possibly the emotional burden of diabetes (P=.09). The relationship between engagement and 6-month HbA1c was moderated by depressive symptoms (P=.02), and possibly social support (P=.08). Conclusions: Engagement in diabetes GMVs improved HbA1c because it helped reduce diabetes-related distress, especially related to the regimen of diabetes management and possibly related to its emotional burden, and especially for women without depressive symptoms and possibly for women who lacked social support.Publication Uncovering Structurally Differential Care: Pediatric Oncology Nurses' Perspectives Caring for African American Families(2025-02-05)Background: Psychosocial intervention studies aimed at reducing stress among parents of children with cancer have historically included insufficient samples of African American parents. Pediatric oncology nurses are uniquely positioned to identify and address parent psychosocial needs. However, research exploring their perspectives to serve as psychosocial interventionists specifically for African American families of children with cancer is limited. Objective: To explore the perspectives of pediatric oncology nurses on their role as psychosocial interventionists for African American families navigating childhood cancer. Methods: We conducted 32 remote individual interviews and 2 focus groups (n = 4 each) with 40 pediatric oncology nurses from three pediatric cancer centers and a large pediatric oncology nursing organization. Using Corbin and Strauss' Grounded Theory methodology, we used constant comparative analysis to generate a theory based on the nurses' perspectives. Results: Our emergent theory - Structurally Differential Care - had two major themes (psychosocial resource facilitators and psychosocial resource obstructors). Psychosocial resource facilitators: 1) appreciating families' experiences, 2) longitudinal presence, 3) open communication, 4) holistic care, and 5) safe spaces mitigated structurally differential care. Nurses also identified: 1) difficulty with serious illness conversation, 2) lack of nursing experience, and 3) competing work demands as psychosocial resource obstructors that intensify structurally differential care. Conclusions: This sample of pediatric oncology nurses described experiences that either bolstered or obstructed their psychosocial care provision, signaling potential opportunities for nurse-targeted interventions that may reduce factors contributing to disparities in the psychosocial care for African American families of children with cancer.Publication Using routinely available electronic health record data elements to develop and validate a digital divide risk score(2025-02-04)Background: Digital health (patient portals, remote monitoring devices, video visits) is a routine part of health care, though the digital divide may affect access. Objectives: To test and validate an electronic health record (EHR) screening tool to identify patients at risk of the digital divide. Materials and methods: We conducted a retrospective EHR data extraction and cross-sectional survey of participants within 1 health care system. We identified 4 potential digital divide markers from the EHR: (1) mobile phone number, (2) email address, (3) active patient portal, and (4) >2 patient portal logins in the last year. We mailed surveys to patients at higher risk (missing all 4 markers), intermediate risk (missing 1-3 markers), or lower risk (missing no markers). Combining EHR and survey data, we summarized the markers into risk scores and evaluated its association with patients' report of lack of Internet access. Then, we assessed the association of EHR markers and eHealth Literacy Scale survey outcomes. Results: A total of 249 patients (39.4%) completed the survey (53%>65 years, 51% female, 50% minority race, 55% rural/small town residents, 46% private insurance, 45% Medicare). Individually, the 4 EHR markers had high sensitivity (range 81%-95%) and specificity (range 65%-79%) compared with survey responses. The EHR marker-based score (high risk, intermediate risk, low risk) predicted absence of Internet access (receiver operator characteristics c-statistic=0.77). Mean digital health literacy scores significantly decreased as her marker digital divide risk increased (P <.001). Discussion: Each of the four EHR markers (Cell phone, email address, patient portal active, and patient portal actively used) compared with self-report yielded high levels of sensitivity, specificity, and overall accuracy. Conclusion: Using these markers, health care systems could target interventions and implementation strategies to support equitable patient access to digital health.