Anthony T. Pho

All Publications

• Asking sexual orientation and gender identity on health surveys: Findings from cognitive interviews in the United States across sexual orientations and genders SSM-QUALITATIVE RESEARCH IN HEALTH Pho, A. T., Bates, N., Snow, A., Zhang, A., Logan, R., Dastur, Z., Lubensky, M. E., Flentje, A., Lunn, M. R., Obedin-Maliver, J. 2023; 4

  View details for DOI 10.1016/j.ssmqr.2023.100344

  View details for Web of Science ID 001114510200001

• Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program. JAMA network open Tran, N. K., Lunn, M. R., Schulkey, C. E., Tesfaye, S., Nambiar, S., Chatterjee, S., Kozlowski, D., Lozano, P., Randal, F. T., Mo, Y., Qi, S., Hundertmark, E., Eastburn, C., Pho, A. T., Dastur, Z., Lubensky, M. E., Flentje, A., Obedin-Maliver, J. 2023; 6 (7): e2324969

  Abstract

  Limited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation.To evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people.This cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility.Self-identified gender identity and sexual orientation group.Twelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants' physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group.The analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups.In this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.

  View details for DOI 10.1001/jamanetworkopen.2023.24969

  View details for PubMedID 37523187

• Comparison of Newest Vital Sign and Brief Health Literacy Screen scores in a large, urban Hispanic cohort. Patient education and counseling Arcia, A., Pho, A. T., Lor, M., Bakken, S. 2023; 109: 107628

  Abstract

  Prior studies comparing subjective and objective health literacy measures have yielded inconsistent results. Our aim was to examine the concordance between Newest Vital Sign (NVS) and Brief Health Literacy Screen (BHLS) scores in a large cohort of English- and Spanish-speaking urban Hispanic adults.Item means, standard deviations, corrected-item total correlations, Cronbach's alpha, and Spearman correlations and area under receiver operating characteristic (AUROC) curve analysis were used to compare NVS and BHLS items and total scores.N = 2988 (n = 1259 English; n = 1729 Spanish). Scores on both measures demonstrated good internal consistency (NVS: α = .843 English, .846 Spanish; BHLS: α = .797 English, .846 Spanish) but NVS items had high difficulty; more than half of respondents scored 0. Measures were only weakly correlated (rs = .21, p < .001, English; rs = .19, p < .001, Spanish). The AUROC curves were .606 (English) and .605 (Spanish) for discriminating the lowest NVS scoring category.Subjective health literacy scores were poor predictors of objective scores. Objective scores demonstrated floor effects, precluding discrimination at low levels of the trait continuum.Subjective health literacy scores may fail to identify individuals with limited health literacy.

  View details for DOI 10.1016/j.pec.2023.107628

  View details for PubMedID 36646018

• Human Papillomavirus Vaccination Among Transgender and Gender Diverse People in the United States: An Integrative Review. Transgender health Pho, A. T., Mangal, S., Bakken, S. 2022; 7 (4): 303-313

  Abstract

  This integrative review explores the barriers to and facilitators for human papillomavirus (HPV) vaccination among adult transgender and gender diverse (TGD) people in the United States.A systematic search of electronic databases included PubMed/MEDLINE, CINAHL, and EMBASE from 1985 to 2020.Inclusion criteria included studies from the United States that described HPV vaccination barriers or facilitators and included adult TGD participants, both quantitative and qualitative studies. Exclusion criteria were studies that reported only HPV vaccine prevalence, non-English/non-U.S. studies, and studies limited to pediatric populations.Two investigators used Covidence software to screen studies and manage data extraction. Quality of the quantitative studies was appraised using a checklist proposed by the Joanna Briggs Institute (JBI); qualitative studies were appraised using quality criteria informed by the literature.The Social Ecological Model guided the review to organize barriers to and facilitators for HPV vaccination at the patient-, provider-, and system-levels.Database searches and hand-searching yielded 843 citations. After screening, eight articles were retained in the review. Seven were cross-sectional studies and one was a qualitative focus-group. All retained quantitative studies met six of the eight JBI quality checklist items.The low proportion of TGD participants in the retained studies highlights a gap in knowledge about HPV vaccination among this population. Future studies of HPV vaccination should recruit TGD people to better represent their perspectives.

  View details for DOI 10.1089/trgh.2020.0174

  View details for PubMedID 36033213

  View details for PubMedCentralID PMC9398477

• Three-Year Nursing PhD Model Recommendations from the RWJF Future of Nursing Scholars JOURNAL OF NURSING EDUCATION Rosa, W. E., Hartley, K., Hassmiller, S. B., Frisch, S. O., Bennett, S. G., Breen, K., Goldberg, J., Koschmann, K. S., Missel, A. L., de Campos, A., Pho, A. T., Rausch, J., Schlak, A. E., Shook, A., Tierney, M. K., Umberfield, E., Fairman, J. A. 2022; 61 (1): 19-28

  Abstract

  In response to the 2011 Future of Nursing report, the Robert Wood Johnson Foundation created the Future of Nursing Scholars (FNS) Program in partnership with select schools of nursing to increase the number of PhD-prepared nurses using a 3-year curriculum.A group of scholars and FNS administrative leaders reflect on lessons learned for stakeholders planning to pursue a 3-year PhD model using personal experiences and extant literature.Several factors should be considered prior to engaging in a 3-year PhD timeline, including mentorship, data collection approaches, methodological choices, and the need to balance multiple personal and professional loyalties. Considerations, strategies, and recommendations are provided for schools of nursing, faculty, mentors, and students.The recommendations provided add to a growing body of knowledge that will create a foundation for understanding what factors constitute "success" for both PhD programs and students. [J Nurs Educ. 2022;61(1):19-28.].

  View details for DOI 10.3928/01484834-20211202-01

  View details for Web of Science ID 000752964600005

  View details for PubMedID 35025685

• Patient and Family Engagement in Catheter-Associated Urinary Tract Infection (CAUTI) Prevention: A Systematic Review JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY Mangal, S., Pho, A., Arcia, A., Carter, E. 2021; 47 (9): 591-603

  Abstract

  Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention.Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist.After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results.The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.

  View details for DOI 10.1016/j.jcjq.2021.05.009

  View details for Web of Science ID 000689712200008

  View details for PubMedID 34215555

• Attitudes and Perceptions About Disclosing HIV and Syphilis Results Using Smarttest, a Smartphone App Dedicated to Self- and Partner Testing. AIDS education and prevention : official publication of the International Society for AIDS Education Kutner, B. A., Pho, A. T., Lopez-Rios, J., Lentz, C., Dolezal, C., Balan, I. C. 2021; 33 (3): 234-248

  Abstract

  We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.

  View details for DOI 10.1521/aeap.2021.33.3.234

  View details for PubMedID 34014111

• Examining Health Care Mobility of Transgender Veterans Across the Veterans Health Administration LGBT HEALTH Wang, K. H., McAvay, G., Warren, A., Miller, M. L., Pho, A., Blosnich, J. R., Brandt, C. A., Goulet, J. L. 2021; 8 (2): 143-151

  Abstract

  Purpose: Transgender veterans are overrepresented in the Veterans Health Administration (VHA) compared with in the general population. Utilization of multiple different health care systems, or health care mobility, can affect care coordination and potentially affect outcomes, either positively or negatively. This study examines whether transgender veterans are more or less health care mobile than nontransgender veterans and compares the patterns of geographic mobility in these groups. Methods: Using an established cohort (n = 5,414,109), we identified 2890 transgender veterans from VHA electronic health records from 2000 to 2012. We compared transgender and nontransgender veterans on sociodemographic, clinical, and health care system-level measures and conducted conditional logistic regression models of mobility. Results: Transgender veterans were more likely to be younger, White, homeless, have depressive disorders, post-traumatic stress disorder (PTSD), and hepatitis C. Transgender veterans were more likely to have been health care mobile (9.9%) than nontransgender veterans (5.2%) (unadjusted odds ratio = 2.02, 95% confidence interval = 1.73-2.36). In a multivariable model, transgender status, being separated/divorced, receiving care in less-complex facilities, and diagnoses of depression, PTSD, or hepatitis C were associated with more mobility, whereas older age was associated with less mobility. For the top three health care systems utilized, a larger proportion of transgender veterans visited a second health care system in a different state (56.2%) than nontransgender veterans (37.5%). Conclusions: Transgender veterans were more likely to be health care mobile and more likely to travel out of state for health care services. They were also more likely to have complex chronic health conditions that require multidisciplinary care.

  View details for DOI 10.1089/lgbt.2020.0152

  View details for Web of Science ID 000614582100001

  View details for PubMedID 33512276

  View details for PubMedCentralID PMC8098769

• Online health information seeking, health literacy, and human papillomavirus vaccination among transgender and gender-diverse people. Journal of the American Medical Informatics Association : JAMIA Pho, A. T., Bakken, S., Lunn, M. R., Lubensky, M. E., Flentje, A., Dastur, Z., Obedin-Maliver, J. 2021

  Abstract

  The purpose of this study is to describe online health information seeking among a sample of transgender and gender diverse (TGD) people compared with cisgender sexual minority people to explore associations with human papillomavirus (HPV) vaccination, and whether general health literacy and eHealth literacy moderate this relationship.We performed a cross-sectional online survey of TGD and cisgender sexual minority participants from The PRIDE Study, a longitudinal, U.S.-based, national health study of sexual and gender minority people. We employed multivariable logistic regression to model the association of online health information seeking and HPV vaccination.The online survey yielded 3258 responses. Compared with cisgender sexual minority participants, TGD had increased odds of reporting HPV vaccination (aOR, 1.5; 95% CI, 1.1-2.2) but decreased odds when they had looked for information about vaccines online (aOR, 0.7; 95% CI, 0.5-0.9). TGD participants had over twice the odds of reporting HPV vaccination if they visited a social networking site like Facebook (aOR, 2.4; 95% CI, 1.1-5.6). No moderating effects from general or eHealth literacy were observed.Decreased reporting of HPV vaccination among TGD people after searching for vaccine information online suggests vaccine hesitancy, which may potentially be related to the quality of online content. Increased reporting of vaccination after using social media may be related to peer validation.Future studies should investigate potential deterrents to HPV vaccination in online health information to enhance its effectiveness and further explore which aspects of social media might increase vaccine uptake among TGD people.

  View details for DOI 10.1093/jamia/ocab150

  View details for PubMedID 34383916

• Sexual Identity and Racial/Ethnic Differences in Awareness of Heart Attack and Stroke Symptoms: Findings From the National Health Interview Survey AMERICAN JOURNAL OF HEALTH PROMOTION Caceres, B. A., Turchioe, M., Pho, A., Koleck, T. A., Creber, R., Bakken, S. B. 2021; 35 (1): 57-67

  View details for DOI 10.1177/0890117120932471journals.sagepub.com/home/ahp

  View details for Web of Science ID 000599911300007

• Citizen science to further precision medicine: from vision to implementation JAMIA OPEN Petersen, C., Austin, R. R., Backonja, U., Campos, H., Chung, A. E., Hekler, E. B., Hsueh, P. S., Kim, K. K., Pho, A., Salmi, L., Solomonides, A., Valdez, R. S. 2020; 3 (1): 2-8

  Abstract

  The active involvement of citizen scientists in setting research agendas, partnering with academic investigators to conduct research, analyzing and disseminating results, and implementing learnings from research can improve both processes and outcomes. Adopting a citizen science approach to the practice of precision medicine in clinical care and research will require healthcare providers, researchers, and institutions to address a number of technical, organizational, and citizen scientist collaboration issues. Some changes can be made with relative ease, while others will necessitate cultural shifts, redistribution of power, recommitment to shared goals, and improved communication. This perspective, based on a workshop held at the 2018 AMIA Annual Symposium, identifies current barriers and needed changes to facilitate broad adoption of a citizen science-based approach in healthcare.

  View details for DOI 10.1093/jamiaopen/ooz060

  View details for Web of Science ID 000645420300002

  View details for PubMedID 32607481

  View details for PubMedCentralID PMC7309265

• The Role of Negative Mood in Driving Use of Mobile Hook-up Apps and Sexual Risk Behavior Among Men who have Sex with Men Pho, A., Schrimshaw, E., Siegel, K. LIPPINCOTT WILLIAMS & WILKINS. 2019: E134

  View details for Web of Science ID 000461444300288

• Nursing Strategies for Promoting and Maintaining Function among Community-Living Older Adults: The CAPABLE Intervention GERIATRIC NURSING Pho, A. T., Tanner, E. K., Roth, J., Greeley, M. E., Dorsey, C. D., Szanton, S. L. 2012; 33 (6): 439-445

  Abstract

  Although many programs aim to help older adults age in place, few target both the home environment and individual physical function. We present an interprofessional intervention called CAPABLE-Community Aging in Place: Advancing Better Living for Elders. CAPABLE's innovative approach incorporates a nurse, occupational therapist (OT), and handyman to address both individual and environmental factors that contribute to disability. The nurse component of CAPABLE addresses key barriers to functional independence such as pain, depression, strength and balance, medication management, and poor communication with the primary care provider. This article focuses primarily on the nursing aspect of the intervention and how it interrelates with the content and processes of the OT and handyman.

  View details for DOI 10.1016/j.gerinurse.2012.04.002

  View details for Web of Science ID 000313222500003

  View details for PubMedID 22651978

  View details for PubMedCentralID PMC3473152

• Nursing children after a disaster: A qualitative study of nurse volunteers and children after the Haiti earthquake JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING Sloand, E., Ho, G., Klimmek, R., Pho, A., Kub, J. 2012; 17 (3): 242-253

  Abstract

  The purpose of this study was to explore the experiences of nurse volunteers caring for children after the Haiti earthquake in January 2010.This descriptive qualitative study using in-depth interviews focuses on the experiences of 10 nurse volunteers.Four themes emerged: hope amid devastation, professional compromises, universality of children, and emotional impact on nurses.Nurses who volunteer after natural disasters have rich personal and professional experiences, including extremes of sadness and joy. Nurse volunteers will likely need to care for children. Nurses and humanitarian agencies should prepare for the unique challenges of pediatric care.

  View details for DOI 10.1111/j.1744-6155.2012.00338.x

  View details for Web of Science ID 000305687300006

  View details for PubMedID 22734877