News Brief: The 2017 APHA Meeting in Atlanta

PILOT STUDY: M-HEALTH TOOL COULD GUIDE PATIENT PRESCRIPTION OPIOID DECISIONS

An online tool that asks patients about their possible risks for prescription opioid misuse or abuse could help patients make more informed choices, including possibly opting for non-opioid over opioid medications, according to a new pilot study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The paper, “My Healthy Choices: Innovative M-health Intervention Addressing Opioid Misuse, Storage, and Disposal,” was presented at the American Public Health Association meeting on Tuesday Nov. 7.

The tool was developed by a software developer contracted by Bloomberg School researchers. To help build the tool, the researchers conducted informational interviews with 17 patients, 11 emergency room clinicians and six experts from national organizations about pain management and emergency medicine.

For the pilot study, the research team asked 124 emergency-room patients to complete an online questionnaire, part of an iPad-based-tool called MyHealthyChoices that assesses patients’ risks for opioid use and misuse. The pilot study showed that the tool was well received by patients and easy to integrate into busy emergency-room settings.

“Patient decision-making is an under-explored area in the search to combat the opioid epidemic,” says Eileen McDonald, MS, senior scientist at the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School and study team member. “A tool like this could empower patients with timely education about pain treatment options as well as personalized information about their own and their family’s risks for opioid misuse or abuse.”

The tool includes information that explains pain medication options (both opioid and non-opioid) to patients, and assesses and explains their personal and family risk factors related to taking opioids. The tool also helps the patient understand priorities related to treating his or her pain by asking the patient to rank a series of comparisons pain relief versus risk avoidance. Based on these answers, the tool then produces a tailored report that documents the patient’s priorities for pain treatment options and any personal or family risks relevant to opioids. Patients were encouraged to share the report’s findings with the treating clinician. 

Compared to a control group of patients, those who used the MyHealthChoices tool had increases in knowledge about opioids and significant reductions in decisional conflict, that is, anxiety about how their pain would be treated, based on the tool’s scoring system. The tool did not influence patients’ reports of patient/provider decision-making about pain medication nor did it significantly reduce prescribing. This is likely because this study focused on patients rather than doctors, and patients were not reqired to share their assessment results with their doctor.

Next, McDonald says, is enhancing the tool with a reporting feature for the prescribing physician. This could promote discussion about which pain medication might best suit a patient. “Improving patient knowledge and reducing their decisional conflict about pain treatment options is a step in the right direction for improving patient education about treating their acute pain,” says McDonald.

Other components of the tool, including educating patients about safe use, storage and disposal, were examined in this pilot study and will be reported in future work.

The presentation was prepared by Eileen McDonald, Elise Omaki, Renan Castillo, Karen Eden, Stephen Davis and Andrea Gielen.

STUDY: EMPLOYERS WANT DATA, GUIDANCE ON WORKPLACE ACTIVITY PROGRAMS

Employers participating in a state-run worksite wellness program in Maryland want policies, return-on-investment estimates, and guidance to support efforts to promote activity programs in the workplace, according to a new study from researchers at the Johns Hopkins Bloomberg School of Public Health.

The paper, “A qualitative study of workplace programs and policies that promote physical activity,” was presented at the APHA meeting on Nov. 6.

The workplace is an ideal location to promote physical activity given employed people in the U.S. spend approximately seven hours each day at work. Many jobs are sedentary, making the need for some physical activity all the more pressing. There is evidence that workplace wellness programs can help reduce worker absenteeism and work-related stress as well as promote job satisfaction and produce cost savings.

Worksites and coordinators desire more data – hard numbers – on the return-on-investment of physical activity programs, the study found. Policies and programs varied from business to business, depending on size. Few workplaces had a formal policy that allowed physical activity breaks outside of lunch, which was identified as a barrier.

“Businesses shared that they would emphasize physical activity if we connected the benefits of being physically active with metrics that they care about such as claims data and medical costs,” says Keshia Pollack Porter, PhD, MPH, professor in the Bloomberg School’s Department of Health Policy and Management. “Support from workplace leadership is critical for successful implementation of physical activity policies.”

These data are part of a larger study conducted in partnership with the University of Maryland School of Medicine that explores businesses participating in Healthiest Maryland Businesses (HMB), a worksite wellness program created by the Maryland Department of Health and supported by the Centers for Disease Control and Prevention. For this specific study, Pollack Porter and the researchers interviewed 21 employers. The sample included six HMB regional coordinators, their supervisors, and 15 firms participating in the HMB program. 

There were some surprises, the researchers say. Several businesses in the study were more concerned with healthy eating, smoking cessation and even diabetes prevention than promoting physical activity in the workplace. “This was unexpected because physical activity has so many benefits for both physical and mental health, and is important for the health conditions they do care about,” says Pollack. “Promoting physical activity could benefit employers by making employees more productive and more satisfied with their jobs.” 

This research is a product of a Prevention Research Center at the Centers for Disease Control and Prevention.

This presentation was prepared by Katherine Campbell, Erin Hager, Elizabeth Funsch, Meghan Ames, Erin Penniston, Erica Smith, Leah Perrotta and Keshia Pollack Porter.

DATA: BUILDING RESILIENCY TO OFFSET ADVERSITY AND TRAUMA

Only two out of five U.S. school-age children meet criteria for flourishing, a basic measurement that assesses children’s ability to respond to adversity with resilience and remain engaged in learning and life, according to new research issued by Johns Hopkins Bloomberg School of Public Health researchers.

Flourishing gauges the ability to stay calm and in control when faced with a challenge, to be curious and interested in learning new things and to be able to focus in order to complete tasks. The study found that flourishing rates varied from 48.7 percent to 50.0 percent across income groups for children who had not been exposed to the adverse childhood experiences (ACEs). For children who had experienced four or more ACEs, the flourishing rates assessed were between 14.7 to 20.0 percent across income groups. 

The paper, “Effects of positive experiences on child health and flourishing in the face of adversity: Results from the National Survey of Children's Health” was presented at the APHA meeting on Nov. 7.

“We are at something of a crossroads here, a confluence of findings in neuroscience, epigenetics, biology, psychology, sociology and humanities that point to a new science of thriving,” says Christina Bethell, director of the Child and Adolescent Health Measurement Initiative in the Bloomberg School’s Department of Population, Family and Reproductive Health. “The literature highlights possibilities to promote largely untapped capacities for positive health and resilience, even in the face of adversity and trauma.”

For their study, researchers used data from the recently released 2016 National Survey of Children’s Health, which represents 50,212 children and estimates child, youth and family health and well-being that are representative of the nation and all 50 states. 

Among the more promising findings: Children and youth with two or more ACEs were six times more likely to demonstrate the basic quality of resilience assessed when parents reported being involved with their children in seemingly simple experiences, like sharing ideas and talking about things that matter to their children. In turn, these more resilient children were over three times more likely to be engaged in school despite the adversities that they have experienced (71.4% vs. 19.2%). Similarly, rates of emotional, mental or behavioral problems among this same group of children dropped from 28.5% to 4.8% when they demonstrated this ability. It’s very encouraging, the researchers say, that this is a skill research shows can be taught to most children despite challenges they may face.  

Findings that flourishing is not over 50%, even for children without significant adversity, and that rates do not vary widely across household income groups suggest a broader public health approach to promote positive health skills for all children and youth, like those assessed in this study.

“While many neighborhood and systems factors are important, healthy relationships with children appear to be the most powerful to help children flourish,” says Bethell.

The study was conducted by Christina Bethell, Narangeral Gombojav, Caitlin Murphy, Kathleen Powers and Robert Whitaker.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Robin Scullin at 410-955-7619 or rsculli@jhu.edu.