A national survey of young women’s beliefs about quitting indoor tanning: implications for health communication messages

Mar 23, 2018

Indoor tanning is a risk factor for skin cancer, particularly among young, white women. Our researchers found that persuasive health messages that encourage young women to quit indoor tanning should focus on their beliefs that it helps their appearance and mood, rather than the health risks.

20% of our nation’s young, white women indoor tan, knowing the risk of skin cancer. In November and December of 2015, a national online  survey was conducted with 279 non-Hispanic white women, ages 18-25 in the United States, who indoor tan.

This survey investigated the young women’s beliefs and attitudes as well as social influences that kept them from quitting.

“Young women were most concerned about skin damage and that quitting tanning might affect their mood,” says Amy Bleakley PhD, MPH, lead author of the study. “It was interesting that quitting tanning to prevent skin cancer did not motivate their intention to quit. Health messages that focus on appearance and mood instead of skin cancer may be more effective in encouraging young women to quit indoor tanning.”

Researchers suggest that health messages from doctors, parents and other loved ones aimed at discouraging indoor tanning should highlight the belief that quitting indoor tanning will reduce skin damage. In addition, messages should counter the belief that quitting will make them less happy. Finally, messages should highlight key people who would approve of them quitting indoor tanning.

Read the article here.

 

Amy Bleakley, Amy Jordan, Morgan E Ellithorpe, DeAnn Lazovich, Sara Grossman, Karen Glanz

Translational Behavioral Medicine, ibx007, https://doi.org/10.1093/tbm/ibx007
Published: March 15, 2018

 

Viewpoint Op Ed: Don’t let a single diagnosis define the patient

Nov 7, 2017

In the November 6, 2017 edition of The Philadelphia Inquirer, Karen Glanz, PhD, MPH, shares her father’s experience with health care and offers ideas on how we handle patients and their diagnosis in the future.

 

While shared and electronic medical records have many benefits, they carry unacknowledged risks. One is that the primary diagnosis becomes a patient’s identity, even when that diagnosis is in error and anxiety-provoking for the patient and family.

 

When my father was first hospitalized, he was a relatively healthy 93-year-old who could get around on his own, was mentally lucid, and could even drive. But one day he went to the emergency room weak and with jaundice. He had an obstructed biliary tract and needed a cholecystectomy, or gall bladder removal. During his treatment, the doctors examined the insides of his biliary tract using a technique called “biliary brushing” — and then informed me and my father that he had a “possible diagnosis” of pancreatic cancer.

 

The surgeon met with us and explained that at his advanced age, treatment for pancreatic cancer would be worse than the disease, and we mutually agreed that keeping a lookout for symptoms was the best approach. Dad put the cancer diagnosis out of his mind, because he had other more pressing concerns — getting back his strength, being able to eat again, and recovering from the rapid de-conditioning that occurs when a very old person is in a hospital bed for eight days.

Dad left the hospital greatly weakened and spent the next three months in a skilled nursing facility just down the hall from his apartment. I accompanied him on follow-up visits, first with the gastroenterologist. The physician assistant saw him first. When she opened up the medical record on a computer screen, she said, “I see you have pancreatic cancer.” He was taken by surprise, since he thought he was simply having a follow-up visit for the stent placed in his biliary tract. But the cancer was the headline on the medical record — the most important problem that defined him.

 

Other appointments followed, with the surgeon and oncologist. I asked them for more information about the pancreatic cancer diagnosis. What were his “numbers” or “levels” from the biliary brush cytology? Was there any staging information? As a public health professional teaching in medical and nursing schools, and conducting cancer control research, I wanted more information. I was promised specifics, but never received them, despite my persistence.

 

Dad’s next visit to the ER occurred a few months later, when he was incoherent after a fall from his bed in the skilled nursing facility. The first reaction by the ER doctors and nurses — he has pancreatic cancer. As it turned out, he had a hip fracture and internal bleeding. He was found to have a healthy enough heart to go ahead with a hip replacement, in the hope that he could walk again.

 

He never developed any symptoms of pancreatic cancer. There was one more hospitalization, nine months after the first one. He was a very weak 94-year-old and the ER doctors said, “I see he has pancreatic cancer.” This time it was pneumonia and a few days later he entered a residential hospice, where he spent his last five days receiving palliative care from a wonderful hospice team. Cause of death? Sepsis. Other significant conditions contributing to death? Probable pancreatic cancer.

 

Just a few decades ago, doctors were reluctant to tell a patient about a cancer diagnosis. Now the doctors — really, the records — couldn’t repeat the diagnosis often enough. I was troubled by the possible or probable pancreatic cancer diagnosis and how it dominated his electronic health record. And I was concerned that I never received much information to understand it. So I ordered and paid for his medical records.

 

It turns out that only the hospital records were provided; I did not receive images of his electronic health record. And it turned out that the pancreatic cancer diagnosis was cut-and-pasted from one record to the next. It was “possible biliary tract cancer or pancreatic cancer” but no definitive diagnosis was made. Apparently, though not written in the record, the imaging tests for further diagnosis were determined to be of little value, and thus were not done.

 

So was my father his pancreatic cancer? Probably not, and not even the doctors know the whole story. But it seemed like the system failed him, and me and our family. Caregivers are responsible for the accuracy of the records. Cut-and-paste doesn’t cut it. They are also responsible for putting diagnoses in appropriate clinical priority and for being sure that something does not get passed on as a dehumanizing label.

 

Sooner or later, everyone will become a patient. We need new ways to modify the medical record to preserve its link to the uniqueness of the patient, so the diagnosis doesn’t supersede the person.

 

Karen Glanz, PhD, MPH is George A. Weiss university professor of medicine and nursing at the University of Pennsylvania and director of the UPenn PRC.

 

Op ed via The Philadelphia Inquirer, Viewpoint

 

PRC Director, Karen Glanz Appointed to The Editorial Board: American Journal of Preventive Medicine

Oct 19, 2017

Karen Glanz, PhD, MPH, was recently appointed to the Editorial Board for the American Journal of Preventive Medicine. “Members of the AJPM editorial board perform myriad services for the journal including peer reviewing, recommending reviewers in their areas of expertise, serving as guest editors for supplements and themes, and acting as ambassadors for the journal. Our editorial board members are key to helping AJPM stay at the forefront of preventive medicine and public health.”

 

Read more from the AJPM in their recent newletter here.

AUDIO: Knowledge@Wharton:Kevin Volpp on How Behavioral Economics Could Solve America’s Health Care Woes

Jun 7, 2017

LISTEN TO THE PODCAST

by Kevin Volpp on Knowledge@Wharton

UPenn PRC Director Kevin Volpp, MD, PhD, appeared on Knowledge@Wharton with Dan Loney to discuss health care reform and how behavioral economics help explain the challenges of insuring the largest number of people possible. Dr. Volpp and Dartmouth professor Jonathan Skinner addressed these issues in a JAMA Viewpoint “Replacing the Affordable Care Act: Lessons from Behavioral Economics“

“I think a big part of the Affordable Care Act, in terms of increasing coverage, was to think about the underlying incentives of why people are not buying coverage,” said Volpp. “For many people, it frankly just comes down to weighing the expected costs and benefits in the short term, and concluding that the short-term benefits to people who weren’t buying coverage were less than what their coverage would have cost.”

“The way the Affordable Care Act tried to deal with that was by subsidizing the cost of coverage by providing people who are low income with fairly generous subsidies. That’s a carrot-type incentive. In addition, they included a stick-type incentive in the form of an individual mandate, whereby people were required to buy insurance. If they didn’t buy insurance, they’d have to pay a financial penalty. One thing we could critique is that this mandate probably wasn’t strong enough. It started out at about $200. Eventually it became about $700. That’s much less than the cost of the cheapest plan. An individual could quite rationally conclude, “I’m willing to pay a $700 penalty. I’m not willing to pay $4,000 or more for my coverage.”

Volpp added,”There’s generally an acknowledgement that subsidies alone may not be enough to get people to sign up. There’s a well-documented literature in behavioral economics that carrots are weaker than sticks. People tend to be very loss-averse. Subsidies alone probably will not work in terms of getting sufficient people to enroll in these marketplaces.”

 

 

Congratulations: PRC Lead Doug Wiebe, Phd, Winner of the 2017 Kenneth Rothman EPIDEMIOLOGY Prize

Jun 5, 2017

Doug Wiebe, PhD is the 2017 winner of the Rothman Epidemiology Prize. Selected by the Editors and Editorial Board of Epidemiology, Wiebe received an award of $5000 which is funded from a private endowment and given annually for the best paper published in the journal in the preceding year. The selection criteria are importance, originality, clarity of thought, and excellence in writing. Dr. Wiebe’s winning paper, titled “Mapping Activity Patterns to Quantify Risk of Violent Assault in Urban Environments,” appeared in the journal’s January 2016 issue. The paper used a temporal and spatial scale relevant to the dynamics of violent assault, and showed that gunshot assault risks included being alone, acquiring a gun, and entering areas with more vacancy, violence, and vandalism.

Dr. Wiebe is an Associate Professor of Epidemiology at the University of Pennsylvania Perelman School of Medicine and a Senior Fellow at the Center for Injury Research and Prevention.

PRC Researcher Jason Karlawish in Forbes: Alzheimer’s Disease Patients Aren’t Zombies

May 16, 2017

In Forbes,  PRC Researcher Jason Karlawish, MD, challenges the social stigmatizing of Alzheimer’s in an article titled “Alzheimer’s Disease Patients Aren’t Zombies; They’re People And We Need To Treat Them Like People.”  Karlawish said, ” The inspiration came from a class I taught this semester on the public health challenges of Alzheimer’s disease.  The students and I discussed the stories of Alice Munro and how they pull the reader in and out of different realities.  The lives of the patient and the caregiver aren’t a juxtaposition of the unreal versus the real.  They both live in the surreal.  The challenge of living with Alzheimer’s disease, whether as patient or caregiver, is to negotiate this “surreality.”

PRC Director Kevin Volpp featured in NYTimes The Upshot: How Behavioral Economics Can Produce Better Health Care

May 9, 2017

In The New York Times The Upshot, Massachusetts General Hospital and Harvard Medical School resident physician, Dhruv Khullar, M.D., M.P.P., looks at how the field of behavioral economics contributes to improving provider performance and patient engagement in health care decisions and, in particular, the research of PRC Director Kevin Volpp, MD, PhD.

“A leader of this movement is Dr. Kevin Volpp, a physician at the University of Pennsylvania and founding director of the Center for Health Incentives and Behavioral Economics. He designs randomized trials around some of health care’s most important challenges: nudging doctors to provide evidence-based care; ensuring patients take their medications; and helping consumers choose better health plans.”

Replacing the Affordable Care Act – a JAMA Viewpoint by PRC Director Kevin Volpp

Apr 5, 2017

In the April 3 issue of JAMA, UPenn PRC Director Kevin Volpp, MD, PhD, and Jonathan S. Skinner, PhD, the Dartmouth Institute for Health Policy and Clinical Practice, discuss how research about behavioral economics in health care is useful when considering the challenges of replacing the Affordable Care Act.

Noting that “incentives to encourage healthy individuals to sign up for health insurance can be described as either carrots or sticks”, Volpp and Skinner observe that “the first principle from behavioral economics research is that carrots do not work nearly as well as sticks.”  Research suggests that individuals tend to favor immediate gratification over long-term consequences, which is why young adults historically are less inclined to enroll in insurance plans and why many people are frustrated paying premiums for coverage they may never use. Volpp and Skinner note “health insurance is an 80-20 proposition; 20% of enrollees account for 80% of costs. If the least healthy patients can be moved off of the exchanges, this will allow for a substantial decline in premiums on the exchange for the 80% healthier people who remain” and that lowering health insurance premiums would make a difference.

AUDIO: Karen Glanz: the Marketing of Junk Food on Knowledge@Wharton

Feb 16, 2017

LISTEN TO THE PODCAST

by Karen Glanz and Jason Riis on Knowledge@Wharton

UPenn PRC Director Karen Glanz, PhD, MPH, was interviewed with Penn Professor Jason Riis by Dan Loney on Knowledge@Wharton about how major brand marketing favors junk food over healthy food options in the consumer marketplace.  “Food production companies are in the business of making profit, not making healthier food,” Glanz noted, adding that short-term corporate expectations based on quarterly earnings hinder a long-term strategy to build consumer relationships with healthier food choices.

“Do they market healthy foods as heavily as unhealthy foods? Do healthy foods get the same bells and whistles and kid-friendly appeals as the bad stuff?” Glanz questioned, adding that the build-up of consumer dependence on salt, sugar, and fat has taken place over many years, a result of research and marketing that targets those taste cravings in consumers.

Glanz observed there has been more success in the promotion of low and zero calorie drinks and bottled water. “The beverage market is interesting and has a different trajectory than the food and snack market,” says Glanz. “Calorie-free drinks are well-established.  They sell less but sell well.”

Glanz also gave a nod to former First Lady Michelle Obama’s healthy eating and Let’s Move initiatives. “The First Lady’s signature programs have been a catalyst for promoting health. They’re two sides of the same issue.”

PRC Director Karen Glanz, PhD, MPH, Appointed to Advisory Council for the National Heart, Lung, and Blood Institute

Jan 18, 2017

PHILADELPHIA (January 13, 2017) – The United States Secretary of Health and Human Services (HHS), Sylvia Burwell, recently appointed the University of Pennsylvania’s Karen Glanz, PhD, MPH, George A. Weiss University Professor and Professor of Epidemiology and Nursing, to the Advisory Council for the National Heart, Lung and Blood Institute (NHLBI). The appointment is for a four-year term.

 

The Council advises the HHS Secretary, the Assistant Secretary for Health, the Director of the National Institutes of Health (NIH), and the Director of the National, Heart, Lung, and Blood Institute on matters relating to the cause, prevention, diagnosis and treatment of heart, blood vessel, lung and blood diseases; the use of blood and blood products and the management of blood resources; and on sleep disorders.  The Council also considers applications for research and research training grants and cooperative agreements and recommends funding for those applications that show promise of making valuable contributions to human knowledge and health improvement. The Council may also make recommendations to the Director, NHLBI, respecting research conducted at the Institute. The Council meets four times a year–winter, spring, and two meetings in the fall.

 

About Dr. Glanz

 

Dr. Glanz’s research in community and health care settings focuses on healthy eating, obesity prevention, cancer prevention and control, chronic disease management and control, reducing health disparities, and health communication technologies. Her research about understanding, measuring, and improving healthy food environments has been widely recognized and replicated.

 

Glanz has published more than 440 journal articles and book chapters. Over the past 15 years, she has received more than $40 million in research funding. Current studies range from a Centers for Disease Control (CDC)-funded examination of media communication strategies for reducing ultraviolet exposure to prevent skin cancer to an NIH-funded study of the impact of healthy food marketing in supermarkets and a Robert Wood Johnson Foundation-funded evaluation of the impacts of the New Jersey Food Financing Initiative.

 

The University of Pennsylvania recruited Glanz, who holds dual appointments in medicine and nursing, as a Penn Integrates Knowledge (PIK) Professor in 2009.  PIK professorships bring in eminent scholars whose work draws from multiple academic disciplines and whose achievements demonstrate a rare ability to thrive at the intersection of multiple fields.

 

Glanz and her colleagues founded the UPenn Prevention Research Center, which serves as a catalyst for interdisciplinary research in chronic disease prevention and for advancing prevention research. Launched in 2014 with a $4.35 million grant from the CDC, it’s one of 26 Prevention Research Centers nationwide, and has received more than $ 4 million in supplementary research funding. Glanz and Kevin Volpp, MD, PhD, direct the center, through which faculty from medicine, business, and other fields, and researchers from The Children’s Hospital of Philadelphia, collaborate on research in cancer prevention, weight loss, the economic impact of clinical trials, and other areas.  Glanz is also director of Penn’s Center for Health Behavior Research, which facilitates collaboration on health behavior research, and advancing measurement of health behaviors and the use of health behavior theory. It is part of the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine.

 

Glanz is an elected Member of the National Academy of Medicine (formerly named Institute of Medicine), and a Fellow in the Society for Behavioral Medicine. Her work and research has been honored with many awards including the Elizabeth Fries Health Education Award from the James and Sarah Fries Foundation, and a bronze award in the ‘Best Practices in Distance Learning Program’ from the US Distance Learning Association. Glanz received her PhD, Master of Public Health, and Bachelor of Arts degrees from the University of Michigan in Ann Arbor.

Healthy Foods Take a Back Seat to Junk Food When It Comes to Marketing: PRC Director Karen Glanz on Knowledge@Wharton

Dec 19, 2016

UPenn PRC Director Karen Glanz, PhD, MPH, was interviewed with Penn Professor Jason Riis by Dan Loney on Knowledge@Wharton about how major brand marketing favors junk food over healthy food options in the consumer marketplace.  “Food production companies are in the business of making profit, not making healthier food,” Glanz noted, adding that short-term corporate expectations based on quarterly earnings hinder a long-term strategy to build consumer relationships with healthier food choices.

“Do they market healthy foods as heavily as unhealthy foods? Do healthy foods get the same bells and whistles and kid-friendly appeals as the bad stuff?” Glanz questioned, adding that the build-up of consumer dependence on salt, sugar, and fat has taken place over many years, a result of research and marketing that targets those taste cravings in consumers.

Glanz observed there has been more success in the promotion of low and zero calorie drinks and bottled water. “The beverage market is interesting and has a different trajectory than the food and snack market,” says Glanz. “Calorie-free drinks are well-established.  They sell less but sell well.”

Glanz also gave a nod to former First Lady Michelle Obama’s healthy eating and Let’s Move initiatives. “The First Lady’s signature programs have been a catalyst for promoting health. They’re two sides of the same issue.”