Alison Hwong

All Publications

• Cervical Cancer Screening Among Female Medicaid Beneficiaries With and Without Schizophrenia. Schizophrenia bulletin Hwong, A. R., Murphy, K. A., Vittinghoff, E., Alonso-Fraire, P., Crystal, S., Walkup, J., Hermida, R., Olfson, M., Cournos, F., Sawaya, G. F., Mangurian, C. 2024; 50 (6): 1499-1507

  Abstract

  In the United States, women with schizophrenia face challenges in receiving gynecologic care, but little is known about how cervical cancer screening rates vary across time or states in a publicly insured population. We hypothesized that women Medicaid beneficiaries with schizophrenia would be less likely to receive cervical cancer screening across the United States compared with a control population, and that women with schizophrenia and other markers of vulnerability would be least likely to receive screening.This retrospective cohort study used US Medicaid administrative data from across 44 states between 2002 and 2012 and examined differences in cervical cancer screening test rates among 283 950 female Medicaid beneficiaries with schizophrenia and a frequency-matched control group without serious mental illness, matched on age and race/ethnicity. Among women with schizophrenia, multivariable logistic regression estimated the odds of receiving cervical cancer screening using individual sociodemographics, comorbid conditions, and health care service utilization.Compared to the control group, women with schizophrenia were less likely to receive cervical cancer screening (OR = 0.76; 95% CI 0.75-0.77). Among women with schizophrenia, nonwhite populations, younger women, urban dwellers, those with substance use disorders, anxiety, and depression and those connected to primary care were more likely to complete screening.Cervical cancer screening rates among US women Medicaid beneficiaries with schizophrenia were suboptimal. To address cervical cancer care disparities for this population, interventions are needed to prioritize women with schizophrenia who are less engaged with the health care system or who reside in rural areas.

  View details for DOI 10.1093/schbul/sbae096

  View details for PubMedID 38842724

  View details for PubMedCentralID PMC11548919

• Comorbidity profiles in older patients last seen by mental health prior to suicide attempt. Aging & mental health Morin, R. T., Li, Y., Karel, M. J., Consolino, T., Hwong, A., Clark, R., Byers, A. L. 2024; 28 (3): 551-556

  Abstract

  Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide.Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012-2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository.2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion.Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression.

  View details for DOI 10.1080/13607863.2023.2228228

  View details for PubMedID 37545400

• Comorbidities, healthcare use, and contact with healthcare transition services in older veterans after incarceration. Journal of the American Geriatrics Society Hwong, A. R., Barry, L. C., Li, Y., Byers, A. L. 2024; 72 (6): 1847-1855

  Abstract

  The Health Care for Reentry Veterans (HCRV) program was established to support community reintegration for veterans after incarceration. Yet, it is unclear how those with and without HCRV contact differ. We sought to evaluate differences in medical and psychiatric conditions and healthcare utilization among mid-to late-life reentry veterans who did and did not receive HCRV outreach.Study participants were veterans aged ≥50 years who qualified for Medicare fee-for-service, had experienced incarceration for ≥1 year, and were released from incarceration between October 1, 2006, and September 30, 2018 (N = 9733). Using VA and Medicare claims data, we compared prevalence of medical and psychiatric diagnoses, and use of emergency, inpatient, and outpatient medical and mental health services up to 12 months after release between those with and without HCRV contact.Veterans with HCRV contact (35.5%) had significantly higher rates of psychiatric conditions and medical conditions related to substance use (e.g., liver disease) compared to veterans without HCRV contact. Average time between release and first healthcare service use was significantly lower for HCRV veterans (36.5 ± SD 59.5 days) versus non-HCRV veterans (58.9 ± SD 77.5 days) and HCRV veterans were more likely to utilize the emergency department, inpatient and outpatient mental health services, and inpatient medical services.HCRV reaches older reentry veterans with a large burden of mental health and substance use disorders. However, levels of multimorbidity were high among all older reentry veterans, pointing to a need to develop specialized geriatric models of care for this reentry population.

  View details for DOI 10.1111/jgs.18885

  View details for PubMedID 38525526

  View details for PubMedCentralID PMC11187764

• Racial Disparities in Emergency Department Physical Restraint Use: A Systematic Review and Meta-Analysis. JAMA internal medicine Eswaran, V., Molina, M. F., Hwong, A. R., Dillon, D. G., Alvarez, L., Allen, I. E., Wang, R. C. 2023; 183 (11): 1229-1237

  Abstract

  Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability.To synthesize existing literature on risk of physical restraint use in adult EDs, specifically in reference to patients of different racial and ethnic backgrounds.A systematic search of PubMed, Embase, Web of Science, and CINAHL was performed from database inception to February 8, 2022.Included peer-reviewed studies met 3 criteria: (1) published in English, (2) original human participants research performed in an adult ED, and (3) reported an outcome of physical restraint use by patient race or ethnicity. Studies were excluded if they were conducted outside of the US, or if full text was unavailable.Four independent reviewers (V.E., M.M., D.D., and A.H.) abstracted data from selected articles following Meta-Analysis of Observational Studies in Epidemiology guidelines. A modified Newcastle-Ottawa scale was used to assess quality. A meta-analysis of restraint outcomes among minoritized racial and ethnic groups was performed using a random-effects model in 2022.Risk of physical restraint use in adult ED patients by racial and ethnic background.The search yielded 1597 articles, of which 10 met inclusion criteria (0.63%). These studies represented 2 557 983 patient encounters and 24 030 events of physical restraint (0.94%). In the meta-analysis, Black patients were more likely to be restrained compared with White patients (RR, 1.31; 95% CI, 1.19-1.43) and to all non-Black patients (RR, 1.27; 95% CI, 1.23-1.31). With respect to ethnicity, Hispanic patients were less likely to be restrained compared with non-Hispanic patients (RR, 0.85; 95% CI, 0.81-0.89).Physical restraint was uncommon, occurring in less than 1% of encounters, but adult Black patients experienced a significantly higher risk of physical restraint in ED settings compared with other racial groups. Hispanic patients were less likely to be restrained compared with non-Hispanic patients, though this observation may have occurred if Black patients, with a higher risk of restraint, were included in the non-Hispanic group. Further work, including qualitative studies, to explore and address mechanisms of racism at the interpersonal, institutional, and structural levels are needed.

  View details for DOI 10.1001/jamainternmed.2023.4832

  View details for PubMedID 37747721

  View details for PubMedCentralID PMC10520842

• MULTIMORBIDITY PATTERNS AMONG OLDER ADULTS WITH SERIOUS MENTAL ILLNESS Hwong, A., Li, Y., Steinman, M., Mangurian, C., Zulman, D., Byers, A. ELSEVIER SCIENCE INC. 2023: E12-E13

  View details for Web of Science ID 001063122500014

• Breast Cancer Screening Rates Among Medicaid Beneficiaries With Schizophrenia. Psychiatric services (Washington, D.C.) Hwong, A. R., Vittinghoff, E., Thomas, M., Hermida, R., Walkup, J., Crystal, S., Olfson, M., Mangurian, C. 2023; 74 (5): 497-504

  Abstract

  Women with serious mental illness are more likely to be diagnosed as having late-stage breast cancer than women without serious mental illness, suggesting a disparity in screening mammography. This study aimed to compare screening mammography rates in a nationally representative sample of Medicaid beneficiaries with and without schizophrenia.Medicaid Analytic eXtract files, 2007-2012, were used to identify a cohort of women ages 40-64 with schizophrenia who were eligible for Medicaid but not Medicare (N=87,572 in 2007 and N=114,341 in 2012) and a cohort without schizophrenia, frequency-matched by age, race-ethnicity, and state (N=97,003 in 2007 and N=126,461 in 2012). Annual screening mammography rates were calculated and adjusted for demographic characteristics and comorbid conditions. Multivariable logistic regression was used to estimate the association between beneficiary characteristics and screening mammography rates.In 2012, 27.2% of women with schizophrenia completed screening mammography, compared with 26.8% of the control cohort. In the schizophrenia cohort, American Indian/Alaskan Native women had significantly lower odds of receiving mammography (OR=0.82, p=0.02) than White women, whereas Hispanic/Latina women had higher odds (OR=1.16, p<0.001). Women with schizophrenia and a nonalcohol-related substance use disorder had lower odds of receiving mammography (OR=0.74, p<0.001) than women without a substance use disorder. Having at least one medical visit in the past year (vs. no visits) increased the odds of receiving screening mammography (OR=5.08, p<0.001).Screening mammography rates were similar between Medicaid-insured women with and those without schizophrenia. Interventions to increase uptake may need to focus on improving socioeconomic conditions and primary care engagement for vulnerable populations, regardless of psychiatric condition.

  View details for DOI 10.1176/appi.ps.20220163

  View details for PubMedID 36226372

  View details for PubMedCentralID PMC10104476

• CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care. BMC psychiatry Hwong, A. R., Chagwedera, D. N., Thomas, M., Niu, G., Quan, J., Vittinghoff, E., Schillinger, D., Newcomer, J. W., Gonzalez, A., Essock, S., Mangurian, C. 2022; 22 (1): 687

  Abstract

  Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care.The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites.Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32-2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94-92.41, P < .001]. While we observed a significant increase in A1c screening rates at the intervention site, this increase did not persist after multivariable adjustment (aOR 1.37, 95% CI .95-1.99, P = .09).This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness.

  View details for DOI 10.1186/s12888-022-04293-4

  View details for PubMedID 36348280

  View details for PubMedCentralID PMC9644536

• Lessons Learned From a New Reverse-Integration Model to Improve Primary Care Screening in Community Mental Health Settings. Psychiatric services (Washington, D.C.) Mangurian, C., Thomas, M. D., Mitsuishi, F., Goldman, L. E., Niu, G., Handley, M. A., Riano, N. S., Hwong, A., Essock, S., Dilley, J., Newcomer, J. W., Schillinger, D. 2022; 73 (8): 942-945

  Abstract

  The authors sought to describe a reverse-integration intervention aimed at improving preventive health screening in a community mental health clinic. The intervention, CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness), integrated primary care services into a large urban community mental health setting. It was implemented in 2015 and included a patient-centered team, population-based care, emphasis on screening, and evidence-based treatment. CRANIUM's strengths included provider acceptability, a patient-centered approach, sustained patient engagement, and economic feasibility. Challenges included underutilized staff, registry maintenance, and unanticipated screening barriers. The CRANIUM reverse-integration model can be feasibly implemented and was acceptable to providers.

  View details for DOI 10.1176/appi.ps.202100177

  View details for PubMedID 35138129

  View details for PubMedCentralID PMC9357142

• Climate Change and Mental Health: Implications for the Psychiatric Workforce. Psychiatric services (Washington, D.C.) Hwong, A. R., Kuhl, E. A., Compton, W. M., Benton, T., Grzenda, A., Doty, B., Thompson, L., Gogtay, N., Clarke, D., Alpert, J. 2022; 73 (5): 592-595

  Abstract

  Climate change is a major global public mental health crisis that is expected to increase the need for mental health services. Psychiatrists and other mental health care providers must address workforce needs through recruitment, training and education, prevention and intervention, public policy and advocacy, and direct efforts to reduce climate change. This column discusses concrete steps for the psychiatric workforce to take to prepare for growing mental health needs associated with climate change.

  View details for DOI 10.1176/appi.ps.202100227

  View details for PubMedID 34369808

• Climate change and mental health research methods, gaps, and priorities: a scoping review. The Lancet. Planetary health Hwong, A. R., Wang, M., Khan, H., Chagwedera, D. N., Grzenda, A., Doty, B., Benton, T., Alpert, J., Clarke, D., Compton, W. M. 2022; 6 (3): e281-e291

  Abstract

  Research on climate change and mental health is a new but rapidly growing field. To summarise key advances and gaps in the current state of climate change and mental health studies, we conducted a scoping review that comprehensively examined research methodologies using large-scale datasets. We identified 56 eligible articles published in Embase, PubMed, PsycInfo, and Web of Science between Jan 1, 2000, and Aug 9, 2020. The primary data collection method used was surveys, which focused on self-reported mental health effects due to acute and subacute climate events. Other approaches used administrative health records to study the effect of environmental temperature on hospital admissions for mental health conditions, and national vital statistics to assess the relationship between environmental temperature and suicide rates with regression analyses. Our work highlights the need to link population-based mental health outcome databases to weather data for causal inference. Collaborations between mental health providers and data scientists can guide the formation of clinically relevant research questions on climate change.

  View details for DOI 10.1016/S2542-5196(22)00012-2

  View details for PubMedID 35278392

• Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy for Patients With Serious Mental Illness. Journal of the American College of Radiology : JACR Wang, G. X., Hwong, A. R., Mercaldo, S. F., Lehman, C. D., Dontchos, B. N. 2022; 19 (1 Pt B): 146-154

  Abstract

  The aim of this study was to investigate disparities in time between breast biopsy recommendation and completion and the impact of a same-day biopsy (SDB) program for patients with serious mental illness (SMI), with a focus on more vulnerable individuals with public payer insurance.In August 2017, the authors' academic breast imaging center started routinely offering needle biopsies on the day of recommendation. Primary outcomes were the proportion of biopsies performed as SDBs and days from biopsy recommendation to completion over a 2.5-year pre- versus postintervention period, comparing all patients with SMI versus those without, and public payer-insured patients <65 years of age with SMI (SMI-PP) versus without SMI (non-SMI-PP). Multivariable proportional odds and logistic regression models were fit to assess association of SMI status, age, race/ethnicity, language, and insurance with days to biopsy and SDB within each period.There were 2,026 biopsies preintervention and 2,361 biopsies postintervention. Preintervention, 8.43% of patients with SMI (7 of 83) underwent SDB compared with 15.59% of those without SMI (303 of 1,943) (P = .076), and 2.7% of the SMI-PP subgroup (1 of 37) underwent SDB compared with 15.88% of the non-SMI-PP subgroup (47 of 296) (P = .031). Adjusted for age, race/ethnicity, and language, disparities persisted in odds for undergoing SDB (adjusted odds ratio, 0.13; 95% confidence interval, 0.02-0.92; P = .04) and having longer days to biopsy (adjusted odds ratio, 2.35; 95% confidence interval, 1.26-4.37; P = .01) for the SMI-PP subgroup compared with the non-SMI-PP subgroup in the preintervention period. There was no evidence of these disparities postintervention for the SMI-PP subgroup. SDB proportion increased from 15.3% (310 of 2,026) to 36.09% (852 of 2,361) (P < .001) across all patients.A same-day breast biopsy program mitigates disparities in time to biopsy for patients with SMI and helps improve breast cancer care equity for this vulnerable population.

  View details for DOI 10.1016/j.jacr.2021.09.009

  View details for PubMedID 35033303

• The Effects of Climate Change on Child and Adolescent Mental Health: Clinical Considerations. Current psychiatry reports van Nieuwenhuizen, A., Hudson, K., Chen, X., Hwong, A. R. 2021; 23 (12): 88

  Abstract

  We review recent literature on the effects of climate change on child and adolescent mental health and discuss treatment and engagement by clinicians.Climate change affects child and adolescent mental health in many intersecting ways, including as a social and ecological determinant of health, a threat amplifier, and a source of trauma and distress. Single extreme weather events contribute to significant negative mental health consequences; however, subacute and chronic climate events also have mental health sequelae. Furthermore, awareness of the climate crisis is associated with emotional distress. Young people with pre-existing mental illness and lacking social support may be at elevated risk for climate change-related mental health effects. Climate activism is associated with resilience and positive development, but may also be a source of increased stress, particularly for marginalized youths. Climate change can affect the mental health of children and adolescents in complex and diverse ways. Sources of coping and resilience also vary greatly between individuals. Mental health clinicians must respond to this existential crisis by addressing research gaps in this area, obtaining relevant clinical training, educating their communities, and joining and supporting young people in their advocacy efforts.

  View details for DOI 10.1007/s11920-021-01296-y

  View details for PubMedID 34874507

  View details for PubMedCentralID 7306750

• Smoking cessation treatment for individuals with comorbid diabetes and serious mental illness in an integrated health care delivery system. Addictive behaviors Hwong, A. R., Schmittdiel, J., Schillinger, D., Newcomer, J. W., Essock, S., Zhu, Z., Dyer, W., Young-Wolff, K. C., Mangurian, C. 2021; 114: 106697

  Abstract

  Smoking is a significant modifiable risk factor for mortality for persons with serious mental illness (SMI), who have a life expectancy 15-20 years shorter than the general population. Individuals with SMI and comorbid diabetes who are smokers face an even higher risk of cardiovascular complications and early death. Yet despite high rates of smoking among people with SMI, tobacco cessation interventions have not been broadly offered to this population.We conducted a retrospective cohort study using electronic health records from 2014 in a large integrated care delivery system to examine whether use of smoking cessation pharmacotherapy among smokers with type 2 diabetes varies by serious mental illness (SMI) diagnosis. We analyzed smoking cessation medication prescription fills among adult smokers with diabetes, comparing those with SMI (N = 634) and without SMI (N = 18,021). Risk ratios were adjusted for age, gender, race, urban area type, and medical facility.Of the SMI group, 19.09% filled at least one smoking cessation prescription compared to 9.73% of the non-SMI group (adjusted risk ratio 1.80 [95% CI 1.52-2.13]; p < .001). For the SMI group, primary care providers wrote 80.24% of prescriptions, while psychiatrists wrote 8.81% of prescriptions.These findings offer an example of a delivery system with higher uptake of smoking cessation pharmacotherapy among people with SMI than without SMI, and highlight the opportunity to provide more smoking cessation interventions in mental health care settings.

  View details for DOI 10.1016/j.addbeh.2020.106697

  View details for PubMedID 33129613

  View details for PubMedCentralID PMC8186846

• Development and Implementation of a Chief Resident for Research Role in a Psychiatry Residency Training Program. Advances in medical education and practice Hwong, A. R., Morgan, S., Young, C. A., Besterman, A. D., Jacob, M., Williams, J., Reus, V. I., Mathews, C. A., Hung, E., Voglmaier, S. 2021; 12: 1231-1236

  Abstract

  Psychiatry residency programs with robust research training can prepare physician-scientists to make contributions that advance the mental health field. Our psychiatry residency developed a chief resident for research position to help provide mentorship, community building, and advising around scholarly activities for residents. We present the process of implementing this new position in our residency to offer a model for engaging psychiatry residents in research.

  View details for DOI 10.2147/AMEP.S330130

  View details for PubMedID 34720606

  View details for PubMedCentralID PMC8549966

• Breast Cancer Screening in Women With Schizophrenia: A Systematic Review and Meta-Analysis. Psychiatric services (Washington, D.C.) Hwong, A., Wang, K., Bent, S., Mangurian, C. 2020; 71 (3): 263-268

  Abstract

  Women with schizophrenia appear to receive breast cancer diagnoses at later stages of the disease compared with the general population. To study this disparity, this report reviewed and quantified the differences in rates of mammography screening for women with schizophrenia and other psychotic disorders compared with the general population.A systematic literature search was conducted in PubMed, Embase, Web of Science, and PsycINFO databases. Each database was searched from inception to September 14, 2018. The search strategy included search terms for breast cancer, mammography, schizophrenia, and psychosis. Two reviewers independently screened and evaluated eligible studies. The main outcome measure was the rate of mammography screening among women with schizophrenia and psychotic disorders versus a comparable population of women without these diagnoses. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for abstracting data, and the Newcastle-Ottawa Scale was used for assessing data quality. A meta-analysis with a random-effects model was performed.From a total of 304 abstracts reviewed, 11 studies met the inclusion criteria, representing 25,447 women with diagnoses of schizophrenia or psychosis across four countries. The meta-analysis showed that women with schizophrenia were less likely than women without schizophrenia to receive mammography screening (pooled OR=0.50, 95% confidence interval=0.38-0.64, p<0.001). In subgroup analysis, this association was not significantly affected by quality of the study.Women with schizophrenia and other psychotic disorders were about half as likely as the general population to receive mammography screening. Further research is needed to determine causes of this disparity.

  View details for DOI 10.1176/appi.ps.201900318

  View details for PubMedID 31722645

  View details for PubMedCentralID PMC7323869

• Reducing global disparities in cancer screening for people with mental illness. The lancet. Psychiatry Hwong, A. R., Irwin, K. E. 2020; 7 (1): 4-6

  View details for DOI 10.1016/S2215-0366(19)30470-5

  View details for PubMedID 31787584

  View details for PubMedCentralID PMC7319861

• Improving Breast Cancer Screening and Care for Women With Severe Mental Illness. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Hwong, A. R., Mangurian, C. 2017; 35 (36): 3996-3998

  View details for DOI 10.1200/JCO.2017.76.0462

  View details for PubMedID 29095679

• The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment. Journal of general internal medicine Hwong, A. R., Sah, S., Lehmann, L. S. 2017; 32 (11): 1186-1192

  Abstract

  Financial ties between physicians and the pharmaceutical and medical device industry are common, but little is known about how patient trust is affected by these ties.The purpose of this study was to evaluate how viewing online public disclosure of industry payments affects patients' trust ratings for physicians, the medical profession, and the pharmaceutical and medical device industry.This was a randomized experimental evaluation.There were 278 English-speaking participants over age 18 who had seen a healthcare provider in the previous 12 months who took part in the study.Participants searched for physicians on an online disclosure database, viewed payments from industry to the physicians, and assigned trust ratings. Participants were randomized to view physicians who received no payment ($0), low payment ($250-300), or high payment (>$13,000) from industry, or to a control arm in which they did not view the disclosure website. They also were asked to search for and then rate trust in their own physician.Primary outcomes were trust in individual physician, medical profession, and industry. These scales measure trust as a composite of honesty, fidelity, competence, and global trust.Compared to physicians who received no payments, physicians who received payments over $13,000 received lower ratings for honesty [mean (SD): 3.36 (0.86) vs. 2.75 (0.95), p < 0.001] and fidelity [3.19 (0.65) vs. 2.89 (0.68), p = 0.01]. Among the 7.9% of participants who found their own physician on the website, ratings for honesty and fidelity decreased as the industry payment to the physician increased (honesty: Spearman's ρ = -0.52, p = 0.02; fidelity: Spearman's ρ = -0.55, p = 0.01). Viewing the disclosure website did not affect trust ratings for the medical profession or industry.Disclosure of industry payments to physicians affected perceptions of individual physician honesty and fidelity, but not perceptions of competence. Disclosure did not affect trust ratings for the medical profession or the pharmaceutical and medical device industry. ClinicalTrials.gov identifier: NCT02179632 ( https://clinicaltrials.gov/ct2/show/NCT02179632 ).

  View details for DOI 10.1007/s11606-017-4122-y

  View details for PubMedID 28717899

  View details for PubMedCentralID PMC5653550

• Social network targeting to maximise population behaviour change: a cluster randomised controlled trial. Lancet (London, England) Kim, D. A., Hwong, A. R., Stafford, D., Hughes, D. A., O'Malley, A. J., Fowler, J. H., Christakis, N. A. 2015; 386 (9989): 145-53

  Abstract

  Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change.In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov, number NCT01672580.Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25-541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1-20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p<0·01) after correction for multiple comparisons. Targeting nominated friends increased adoption of the nutritional intervention by 12·2% compared with random targeting (95% CI 6·9-17·9). Targeting the most highly connected individuals, by contrast, produced no greater adoption of either intervention, compared with random targeting.Introduction of a health intervention to the nominated friends of random individuals can enhance that intervention's diffusion by exploiting intrinsic properties of human social networks. This method has the additional advantage of scalability because it can be implemented without mapping the network. Deployment of certain types of health interventions via network targeting, without increasing the number of individuals targeted or the resources used, could enhance the adoption and efficiency of those interventions, thereby improving population health.National Institutes of Health, The Bill & Melinda Gates Foundation, Star Family Foundation, and the Canadian Institutes of Health Research.

  View details for DOI 10.1016/S0140-6736(15)60095-2

  View details for PubMedID 25952354

  View details for PubMedCentralID PMC4638320

• A systematic review of state and manufacturer physician payment disclosure websites: implications for implementation of the Sunshine Act. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics Hwong, A. R., Qaragholi, N., Carpenter, D., Joffe, S., Campbell, E. G., Soleymani Lehmann, L. 2014; 42 (2): 208-19

  Abstract

  Under the Physician Payment Sunshine Act (PPSA), payments to physicians from pharmaceutical, biologics, and medical device manufacturers will be disclosed on a national, publicly available website. To inform the development of the federal website, we evaluated 21 existing state and industry disclosure websites. The presentation formats and language used suggest that industry websites are aimed at patient audiences whereas state websites are structured to transmit data to researchers and guide compliance officers. These findings raise questions about the intended audience and aims of the PPSA disclosure database and expected outcomes of the law. Based on our evaluation, we offer recommendations for the national website and discuss implications of this policy for the health care system.

  View details for DOI 10.1111/jlme.12136

  View details for PubMedID 25040384

• Anticipated discrimination among people with schizophrenia. Acta psychiatrica Scandinavica Uçok, A., Brohan, E., Rose, D., Sartorius, N., Leese, M., Yoon, C. K., Plooy, A., Ertekin, B. A., Milev, R., Thornicroft, G. 2012; 125 (1): 77-83

  Abstract

  The aim of this study was to evaluate the level of anticipated discrimination in people with schizophrenia (n = 732) from 27 countries in the International Study of Discrimination and Stigma Outcomes (INDIGO).Anticipated discrimination was assessed through four questions of Discrimination and Stigma Scale. Twenty-five individuals were identified at each site who were reasonably representative of all such treated cases within the local area.Sixty-four per cent of the participants reported that they had stopped themselves from applying for work, training or education because of anticipated discrimination. Seventy-two per cent of them reported that they felt the need to conceal their diagnosis. Expecting to be avoided by others who know about their diagnosis was highly associated with decisions to conceal their diagnosis. Those who concealed their diagnosis were younger and more educated. The participants who perceived discrimination by others were more likely to stop themselves from looking for a close relationship. Anticipated discrimination in finding and keeping work was more common in the absence than in the presence of experienced discrimination, and the similar findings applied to intimate relationships.This study shows that anticipated discrimination among people with schizophrenia is common, but is not necessarily associated with experienced discrimination.

  View details for DOI 10.1111/j.1600-0447.2011.01772.x

  View details for PubMedID 22017644

• High-frequency afferent stimulation induces long-term potentiation of field potentials in the ventral tegmental area NEUROPSYCHOPHARMACOLOGY Nugent, F. S., Hwong, A. R., Udaka, Y., Kauer, J. A. 2008; 33 (7): 1704–12

  Abstract

  Excitatory synapses on dopamine neurons in the VTA can undergo both long-term potentiation and depression. Additionally, drug-induced plasticity has been found at VTA synapses, and is proposed to play a role in reward-related learning and addiction by modifying dopamine cell firing. LTP at these synapses is difficult to generate experimentally in that it requires an undisturbed intracellular milieu and is often small in magnitude. Here, we demonstrate the induction of LTP as a property of evoked field potentials within the VTA. Excitatory field potentials were recorded extracellularly from VTA neurons in acute horizontal midbrain slices. Using extracellular and intracellular recording techniques, we found that evoked field potentials originate within the VTA itself and are largely composed of AMPA receptor-mediated EPSPs and action potentials triggered by activation of glutamatergic synapses on both dopamine and GABA neurons. High-frequency afferent stimulation (HFS) induced LTP of the field potential. The induction of this LTP was blocked by application of the NMDAR antagonist, d-APV, prior to HFS. As reported previously, glutamatergic synapses on GABA neurons did not express LTP while those on dopamine neurons did. We conclude that the potentiation of glutamatergic synapses on dopamine neurons is a major contributor to NMDA receptor-dependent LTP of the field potential. Field potential recordings may provide a convenient approach to explore the basic electrophysiological properties of VTA neurons and the development of addiction-related processes in this brain region.

  View details for PubMedID 17851541