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Brady C.J.,Thomas Jefferson University | Brady C.J.,Wilmer Eye Institute | Villanti A.C.,Schroeder Institute for Tobacco Research and Policy Studies at Legacy | Gupta O.P.,Thomas Jefferson University | And 2 more authors.
Ophthalmic Surgery Lasers and Imaging Retina | Year: 2014

BACKGROUND AND OBJECTIVE: To determine whether tele-ophthalmology screening for proliferative diabetic retinopathy (PDR) can be cost-saving. PATIENTS AND METHODS: Adults with diabetes presenting for routine medical care underwent nonmydriatic fundus photography with remote grading. Direct medical costs were estimated using the Medicare fee schedule in the base case, with Medicaid and commercial insurance rates used for low and high values, respectively. One-way and probabilistic sensitivity analyses were performed. RESULTS: Of 99 participants, at least mild retinopathy was found in 24 (24.2%). Urgent consultation was recommended for eight participants (8.1%) for possible vision-threatening diabetic retinopathy, including two participants (three eyes) with PDR. In the base case, screening saved $36 per patient. A Monte Carlo simulation indicated that screening saved a median of $48 per patient. CONCLUSION: A substantial burden of diabetic retinopathy was identified, most of which was undiagnosed. In a closed system, tele-ophthalmology screening for PDR is likely to be cost-saving across the range of scenarios explored. Source


Cantrell J.,Legacy Foundation | Pearson J.L.,Behavior and Society | Pearson J.L.,Schroeder Institute for Tobacco Research and Policy Studies at Legacy | Anesetti-Rothermel A.,Schroeder Institute for Tobacco Research and Policy Studies at Legacy | And 5 more authors.
Nicotine and Tobacco Research | Year: 2016

Background: A growing body of evidence indicates that the density of tobacco retail outlets around the home residence may influence tobacco use among youth and adults. The purpose of this study was to examine the impact of neighborhood tobacco retail outlet density on young adult initiation of different tobacco product types. Methods: Cross-sectional data from a 2013 nationally representative sample of young adults aged 18-34 was examined in relation to a 2012 geocoded listing of all outlets likely to sell tobacco in the United States. Separate multivariable logistic regression analyses examined associations between neighborhood outlet density and past 6 months first use of cigarettes, non-cigarette combustible products, and noncombustible products among adults aged 18-24 and 25-34. Results: Outlet density was significantly associated with recent initiation of cigarettes and other combustibles, but this impact varied for younger and older groups. Increased density was significantly associated with a higher likelihood of initiating cigarette use among adults aged 25-34 (OR = 3.75, 95% CI = 1.18, 11.90), and of initiating non-cigarette combustible use among 18-24 year olds (OR = 3.16, 95% CI = 1.03, 9.74). There was no impact of outlet density on recent noncombustible product initiation among either group. Conclusion: This study is the first to examine the impact of tobacco outlet density on young adult initiation of cigarettes and other tobacco products. Findings demonstrate that residential neighborhood outlet density is associated with recent initiation of combustible products and this effect varies by product type and age. The tobacco outlet environment may be a critical factor in promoting young adult tobacco use initiation. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. Source


Villanti A.C.,Schroeder Institute for Tobacco Research and Policy Studies at Legacy | Giovino G.A.,State University of New York at Buffalo | Barker D.C.,Consultants LLC | Mowery P.D.,Biostatistics Inc | And 2 more authors.
American Journal of Public Health | Year: 2012

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes; by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes. Source


Levy D.T.,University of Baltimore | Levy D.T.,Pacific Institute for Research and Evaluation | Blackman K.,Pacific Institute for Research and Evaluation | Tauras J.,University of Illinois at Chicago | And 4 more authors.
American Journal of Public Health | Year: 2011

Objectives: We compared quit attempts and quit rates among menthol and nonmenthol cigarette smokers in the United States. Methods: We used data from the 2003 and 2006-2007 waves of the large, nationally representative Tobacco Use Supplement to the Current Population Survey with control for state-level tobacco control spending, prices, and smokefree air laws. We estimated mean prevalence, quit rates, and multivariate logistic regression equations by using self-respondent weights for menthol and nonmenthol smokers. Results: In 2003 and 2007, 70% of smokers smoked nonmenthol cigarettes, 26% smoked menthol cigarettes, and 4% had no preference. Quit attempts were 4.3% higher in 2003 and 8.8% higher in 2007 among menthol than nonmenthol smokers. The likelihood of quitting was 3.5% lower for quitting in the past year and 6% lower for quitting in the past 5 years in menthol compared with nonmenthol smokers. Quit success in the past 5 years was further eroded among menthol-smoking Blacks and young adults. Conclusions: Menthol smokers are more likely to make quit attempts, but are less successful at staying quit. The creation of menthol preference through marketing may reduce quit success. Source


Pearson J.L.,Schroeder Institute for Tobacco Research and Policy Studies at Legacy | Abrams D.B.,Schroeder Institute for Tobacco Research and Policy Studies at Legacy | Abrams D.B.,Georgetown University | Niaura R.S.,Schroeder Institute for Tobacco Research and Policy Studies at Legacy | And 2 more authors.
American Journal of Public Health | Year: 2013

Objectives. We assessed public support for a potential Food and Drug Administration (FDA)-mandated reduction in cigarette nicotine content. Methods. We used nationally representative data from a June 2010 crosssectional survey of US adults (n = 2649) to obtain weighted point estimates and correlates of support for mandated nicotine reduction. We also assessed the potential role of political ideology in support of FDA regulation of nicotine. Results. Nearly 50% of the public supported mandated cigarette nicotine reduction, with another 28% having no strong opinion concerning this potential FDA regulation. Support for nicotine reduction was highest among Hispanics, African Americans, and those with less than a high school education. Among smokers, the odds of supporting FDA nicotine regulation were 2.77 times higher among smokers who intended to quit in the next 6 months than among those with no plans to quit. Conclusions. Mandating nicotine reduction in cigarettes to nonaddictive levels may reduce youth initiation and facilitate adult cessation. The reasons behind nicotine regulation need to be communicated to the public to preempt tobacco industry efforts to impede such a regulation. Source

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