stephen marcus
FAES Graduate School at NIH, Public Health, Faculty Member
- I am an experienced leader in public health research and education with wide-ranging expertise in the behavioral and ... moreI am an experienced leader in public health research and education with wide-ranging expertise in the behavioral and social sciences (psychosocial epidemiology) and health services/clinical epidemiology. I have been at the forefront of advances in research methodology throughout my professional career. I have helped foster transdisciplinary collaboration and team science and usher in an era of applying complex systems approaches, formal mixed-methods evaluation, and modern measurement science to health care and public health research and practice. I have also been at the cutting edge of public health education and have developed several new and unique courses at the Foundation for Advanced Education in the Sciences (FAES) Graduate School at NIH.edit
Abstract The authors studied the impact on clinical decision making of providing feedback of objective prognostic information describing the probability of survival for ICU patients with multiple organ system failure (OSF). The prognostic... more
Abstract The authors studied the impact on clinical decision making of providing feedback of objective prognostic information describing the probability of survival for ICU patients with multiple organ system failure (OSF). The prognostic estimates, derived from a control ...
Research Interests:
This study examined associations between cigarette smoking, cancer, and self-reported physical (SF-36 Physical Component Summary Score, [PCS]) and mental health (SF-36 Mental Component Summary Score, [MCS]) among 123,567 Medicare... more
This study examined associations between cigarette smoking, cancer, and self-reported physical (SF-36 Physical Component Summary Score, [PCS]) and mental health (SF-36 Mental Component Summary Score, [MCS]) among 123,567 Medicare beneficiaries enrolled in managed care plans. As expected for a sample of older individuals, the SF-36 PCS mean (42.6) was lower than the U.S. general population mean of 50. The SF-36 MCS mean (51.7) for the sample was higher than the general population mean. In addition, least squares means revealed significantly poorer health for current smokers and those who recently quit, regardless of their cancer status. Although statistically significant, the differences between current smokers and never smokers were small among those with or without cancer. Encouraging smokers to quit and providing abstinence support to persons who have recently quit may help reduce health-related impacts of cigarette use.
Research Interests: Demography, Quality of life, Database Management Systems, Humans, Smoking, and 13 moreSurvivors, Chronic Disease, United States, Female, Health Care Financing, Male, Medicare, Aged, Public health systems and services research, Neoplasms, Cohort Studies, Socioeconomic Factors, and Sickness Impact Profile
Research Interests:
Research Interests:
Smokeless tobacco has many adverse health effects. We analyzed long-term national trends in smokeless tobacco use. We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from... more
Smokeless tobacco has many adverse health effects. We analyzed long-term national trends in smokeless tobacco use. We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from Monitoring the Future surveys of adolescents, and 1991 to 2003 data from the Youth Risk Behavior Survey for 9th- to 12th-grade students to examine overall and demographic-specific trends. Smokeless tobacco use among adult and adolescent females was low and showed little change. Smokeless tobacco use among men declined slowly (relative decline=26%), with the largest declines among those aged 18 to 24 years or 65 years and older, Blacks, residents of the South, and persons in more rural areas. Overall and demographic-specific data for adolescent boys indicate that smokeless tobacco use increased for 12th-grade students from 1986 until the early 1990s, but has subsequently declined rapidly in all grades since then (range of relative overall declines=43% to 48%). Smokeless tobacco use has declined sharply, especially among adolescent boys. Ongoing prevention and cessation efforts are needed to continue this trend.
Research Interests: Adolescent, Humans, United States, Female, Smokeless tobacco, and 6 moreMale, American, Aged, Middle Aged, Adult, and Sex Factors
Research Interests: Personality, Puerto Rico, Public Health, Comorbidity, Humans, and 15 moreSmoking Cessation, African American, New York City, Female, Male, Young Adult, Risk factors, African Americans, Longitudinal Studies, Family Health, Adult, Ethnic Group, Risk Factors, Psychological Models, and Parent‐child Relations
Research Interests:
The 1990 Smoking Activity Volunteer Executed Survey collected information on a wide range of policy-relevant issues concerning public attitudes about cigarette smoking. These issues include cigarette taxes, advertising restrictions,... more
The 1990 Smoking Activity Volunteer Executed Survey collected information on a wide range of policy-relevant issues concerning public attitudes about cigarette smoking. These issues include cigarette taxes, advertising restrictions, minors' access to tobacco products, school-based prevention, and exposure to environmental tobacco smoke in workplaces and public areas. Survey data were collected during the spring and summer months of 1990 from random samples of adults from Arizona, Michigan, Pennsylvania, and Texas. Telephone interviews were conducted by trained American Cancer Society volunteers using standardized questionnaires. Cluster sampling techniques, interviewer training and supervision, and data collection procedures were designed in conformity with the methodology of the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention. Smoking prevalence ranged from a low of approximately 20 percent in Texas to a high of 31 percent in Michigan. Between 60 and 69 percent of the respondents in the four States, including between 44 and 71 percent of current smokers, believe tobacco should be classified as a drug. Around 65 percent of the respondents would support an extra tax on tobacco to finance public campaigns against smoking, and between 61 percent and 69 percent favor banning cigarette advertising in the print media and on billboards. More than 82 percent of the respondents believe that stronger laws should be enacted to prevent the sale of tobacco products to minors, and more than 86 percent believe that existing laws should be better enforced. Current smokers were only slightly less likely than were former and never smokers to indicate support of policy changes to prevent minors'access to tobacco products; the two groups had somewhat more disagreement in the amount of support for the other smoking control policies.Finally, although between 62 and 88 percent of working respondents reported the presence of smoking restrictions at their workplace, between 26 and 48 percent still reported being bothered by smoking at work.These study findings suggest that existing smoking control policies are not restrictive enough or are inadequately enforced. The study documents strong public concern in the four States about the in adequacy of current policies and support for the enactment of stronger legislation to control smoking behavior.
Research Interests:
We investigated the use of psychiatric consultations in short-term general hospitals using a national sample of 327 hospitals and examining the hospital experience of approximately 263,000 patients discharged from these hospitals. We... more
We investigated the use of psychiatric consultations in short-term general hospitals using a national sample of 327 hospitals and examining the hospital experience of approximately 263,000 patients discharged from these hospitals. We found that the demographic characteristics of patients receiving psychiatric consultations in the national sample were roughly similar to those reported for patients receiving consultations in earlier, single-hospital studies. Rates of consultation were considerably lower, however: 0.9%, compared with a median rate of 3.3% reported in the literature. We also found that patients receiving psychiatric consultations used more hospital resources than other patients.
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
Research Interests:
A significant number of patients in general hospitals suffer from psychiatric distress or illness, but not all receive psychiatric consultation. This study examined several potential predictors of such consultation. These included patient... more
A significant number of patients in general hospitals suffer from psychiatric distress or illness, but not all receive psychiatric consultation. This study examined several potential predictors of such consultation. These included patient characteristics (age, sex, race, insurance, disease stage, and number of medical diagnoses), characteristics of hospital stay (number of procedures, other consultations, length of stay, discharge destination), hospital characteristics (size, percent occupancy, teaching status, presence of a psychiatric unit, type of control), and community characteristics (region, urban/rural setting). Data were derived from a national sample of 327 hospitals. Parallel analyses using stepwise logistic regression were carried out across four samples: patients determined at discharge to have been hospitalized for diabetes, hip fracture, chronic obstructive pulmonary disease, and coronary artery bypass surgery. Results show a wide variation in the use of psychiatric consultations across different subgroups. Longer lengths of stay, urban setting. Northeast region, younger patient age, and other consultations were the most consistent predictors of the probability of psychiatric consultation. These variations may reflect differences in the need for consultation, differential recognition of these needs by providers, or differential availability of psychiatric consultation services. Moreover, they may have implications for equity and/or quality of hospital care.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This study collected data five times between 1983 and 2002 from 400 participants who originally came from upstate New York. These participants completed structured interviews as did their mothers three times. LISREL analysis generally... more
This study collected data five times between 1983 and 2002 from 400 participants who originally came from upstate New York. These participants completed structured interviews as did their mothers three times. LISREL analysis generally supported the hypothesized model. The results indicated that having parents who smoked and having low educational aspirations and expectations were associated with being unconventional, which, in turn, was related to having low emotional control and reporting more internalizing behaviors. Internalizing behaviors were directly associated with a lower likelihood of smoking cessation, as was parental smoking. Research and clinical implications are discussed and the limitations noted.
Research Interests:
The aging of the United States population and the contribution of tooth loss to oral health make it important to describe tooth loss among the elderly in this country. Data from the National Survey of Oral Health in US Employed Adults and... more
The aging of the United States population and the contribution of tooth loss to oral health make it important to describe tooth loss among the elderly in this country. Data from the National Survey of Oral Health in US Employed Adults and Seniors: 1985-1986, conducted by the National Institute of Dental Research, were analyzed to examine the prevalence and demographic correlates of tooth loss among the elderly. Results show that there were important differences in tooth loss among subgroups of the elderly sample (overall n = 5,649 persons aged 65+ years attending senior centers). The oldest seniors and those with the least education or income were the most likely to be edentulous. The oldest dentulous seniors, blacks, those with the least education or income, and those who lived in New England or the Northeast had the fewest number of teeth present. These findings suggest that efforts to reduce tooth loss among the elderly should target those with the least education and income.
Research Interests:
Research Interests: Education, Health Promotion, Evaluation, Tobacco, Ecology, and 15 morePreventive medicine, Communicable Diseases, Humans, Program Development, Smoking, Industry, Tobacco Use, United States, User, Products, Curriculum and Pedagogy, Preventive, National Cancer Institute, Cooperative Behavior, and Environment
Research Interests:
The existence of "hardcore" smokers, those most likely to have substantial difficulty quitting, may have far... more
The existence of "hardcore" smokers, those most likely to have substantial difficulty quitting, may have far reaching impact on how to best allocate cessation resources. It has been suggested that hardcore smokers make up only a small fraction of current smokers and therefore do not represent a significant public health problem. However, little is known about the prevalence and nature of this subgroup of smokers in the United States. Based on a national sample, the 1998-1999 Tobacco Use Supplement to the Current Population Survey, we categorized, based on smoking pattern, groups of current smokers who were over age 25 years (N=33,568). We compared hardcore smokers with other groups of current smokers on demographic, environmental, and smoking variables to assess whether hardcore smokers represent a unique group. Hardcore smokers were defined as established daily smokers, consuming 15 or more cigarettes per day with no reported history of quit attempts. Hardcore smokers represent 13.7% of all current smokers and 17.6% of all established smokers. They are more likely to be male, unmarried, not in the work force, and have lower education. They also are more likely to have started smoking at a younger age, smoke more, and are less likely to report contact with smoking restrictions. This analysis suggests that hardcore smokers are distinct from other groups of smokers. These results also indicate that hardcore smokers account for a substantial proportion of smokers and as such may represent a significant public health challenge that needs to be addressed.
Research Interests:
Research Interests:
Research Interests: Tobacco, Public Health, Humans, Smoking Cessation, Smoking, and 15 moreTobacco Use, Nicotine, United States, Female, Tobacco Control, Male, Gender Difference, Nicotine Dependence, Middle Aged, Adult, Health surveys, Current Population Survey, Logistic Models, Socioeconomic Factors, and Prevention and Control
Despite negative financial conditions in recent years, several states were able to successfully maintain funding for tobacco prevention and control, which provided an opportunity to understand the factors associated with success. One... more
Despite negative financial conditions in recent years, several states were able to successfully maintain funding for tobacco prevention and control, which provided an opportunity to understand the factors associated with success. One explanation may be the level of long-term program sustainability in some states. According to a model developed by Saint Louis University researchers, the five elements critical to tobacco control sustainability are state political and financial climate; community awareness and capacity; program structure and administration; funding stability and planning; and surveillance and evaluation. Five states (Nebraska, New York, Indiana, Virginia, and Colorado) maintained funding for their tobacco control programs. Four of these states gained additional legislative appropriations or prevented a massive reduction; Colorado used a statewide ballot initiative to increase funding. On the basis of the sustainability framework, case studies, and prior research, the major lessons learned for maintaining funding were the importance of (1) strong and experienced leadership, (2) broad and deep organizational and community ties, (3) coordinated efforts, (4) strategic use of surveillance and evaluation data, (5) active dissemination of information about program successes, and (6) policy maker champions. The sustainability framework and lessons learned may provide valuable insights for other public health programs facing funding threats.
Research Interests:
Data from four National Health Interview Surveys were combined, and a birth-cohort analysis was undertaken to determine the age when regular smoking is initiated. By the age of 25 years, most smokers have already become regular smokers.... more
Data from four National Health Interview Surveys were combined, and a birth-cohort analysis was undertaken to determine the age when regular smoking is initiated. By the age of 25 years, most smokers have already become regular smokers. Among men, the proportion of each birth cohort who become regular smokers has declined at a rate of about 1.0% for each year of birth since 1945. There has been no identifiable decline in successive birth cohorts of women. For those born in the most recent birth cohorts, there was no sex difference in the proportion who became regular smokers. The proportion of smokers beginning to smoke during the secondary-school years (less than or equal to 18 years of age) has increased steadily, especially among people with a high-school education or less. However, in the latest birth cohort (1960-1962), over 18% of ever smokers with at least a high-school education did not start to smoke regularly until their young-adult years (19-24 years of age). If the effect of tobacco-education programs in the schools is to postpone the uptake of regular smoking, it is important to have tobacco policies in place in other areas of society that will maintain non-smoking behavior through the young-adult years. Accordingly, the banning of smoking in colleges, universities, and worksites, as well as in secondary schools, may significantly decrease the proportion of young people who eventually become regular smokers.
Research Interests:
This study examined the associations of susceptibility, conceptualized as both a cognition (risk) and as affect (worry) and their possible interaction, with cancer screening behaviors. Data for this study were obtained from the 2003... more
This study examined the associations of susceptibility, conceptualized as both a cognition (risk) and as affect (worry) and their possible interaction, with cancer screening behaviors. Data for this study were obtained from the 2003 Health Information National Trends Survey (HINTS). Hierarchical regression models assessed the ability of risk, worry and their interaction (after controlling for other important variables) to predict cancer-screening behaviors. Results found that risk and worry (but not their interaction) were associated with regular mammography screening and having had a sigmoidoscopy or colonoscopy but with neither FOBT nor PSA screening. The findings suggest that risk and worry are both important in predicting some types of screening behavior and that these variables operate independently.
Research Interests: Psychology, Cognitive Science, Health Psychology, Health Promotion, Behavioral Sciences, and 15 moreCognition, Cancer, Health, Public Health, Behavioral Science, Humans, Perceived Risk, Female, Male, Cancer Screening, Health information, Regression Model, Neoplasms, Curriculum and Pedagogy, and Health Care Surveys
Research Interests: New Media, Health Communication, Health Promotion, Health, Access To Information, and 15 moreAdolescent, Information Services, Library and Information Studies, Humans, Health information, Behavior change, Questionnaires, Adult, Communication and media Studies, Public health systems and services research, Theoretical Framework, Neoplasms, National Cancer Institute, General Population, and Telephone Survey
Research Interests:
To identify recent studies in the scientific literature that evaluated structured postgraduate public health and biomedical training programs and reported career outcomes among individual trainees, a comprehensive search of several... more
To identify recent studies in the scientific literature that evaluated structured postgraduate public health and biomedical training programs and reported career outcomes among individual trainees, a comprehensive search of several databases was conducted to identify published studies in English between January 1995 and January 2012. Studies of interest included those that evaluated career outcomes for trainees completing full-time public health or biomedical training programs of at least 12 months duration, with structured training offered on-site. Of the over 600 articles identified, only 13 met the inclusion criteria. Six studies evaluated US federal agency programs and six were of university-based programs. Seven programs were solely or predominantly of physicians, with only one consisting mainly of PhDs. Most studies used a cohort or cross-sectional design. The studies were mainly descriptive, with only four containing statistical data. Type of employment was the most common outcome measure (n = 12) and number of scientific publications (n = 6) was second. The lack of outcomes evaluation data from postgraduate public health and biomedical training programs in the published literature is a lost opportunity for understanding the career paths of trainees and the potential impact of training programs. Suggestions for increasing interest in conducting and reporting evaluation studies of these structured postgraduate training programs are provided.
Research Interests:
Research Interests:
Dopaminergic genes are likely candidates for heritable influences on cigarette smoking. In an accompanying article, Lerman et al. (1999) report associations between allele 9 of a dopamine transporter gene polymorphism (SLC6A3-9) and lack... more
Dopaminergic genes are likely candidates for heritable influences on cigarette smoking. In an accompanying article, Lerman et al. (1999) report associations between allele 9 of a dopamine transporter gene polymorphism (SLC6A3-9) and lack of smoking, late initiation of smoking, and length of quitting attempts. The present investigation extended their study by examining both smoking behavior and personality traits in a diverse population of nonsmokers, current smokers, and former smokers (N = 1,107). A significant association between SLC6A3-9 and smoking status was confirmed and was due to an effect on cessation rather than initiation. The SLC6A3-9 polymorphism was also associated with low scores for novelty seeking, which was the most significant personality correlate of smoking cessation. It is hypothesized that individuals carrying the SLC6A3-9 polymorphism have altered dopamine transmission, which reduces their need for novelty and reward by external stimuli, including cigarettes.
Research Interests:
Research Interests:
Smokeless tobacco has many adverse health effects. We analyzed long-term national trends in smokeless tobacco use. We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from... more
Smokeless tobacco has many adverse health effects. We analyzed long-term national trends in smokeless tobacco use. We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from Monitoring the Future surveys of adolescents, and 1991 to 2003 data from the Youth Risk Behavior Survey for 9th- to 12th-grade students to examine overall and demographic-specific trends. Smokeless tobacco use among adult and adolescent females was low and showed little change. Smokeless tobacco use among men declined slowly (relative decline=26%), with the largest declines among those aged 18 to 24 years or 65 years and older, Blacks, residents of the South, and persons in more rural areas. Overall and demographic-specific data for adolescent boys indicate that smokeless tobacco use increased for 12th-grade students from 1986 until the early 1990s, but has subsequently declined rapidly in all grades since then (range of relative overall declines=43% to 48%). Smokeless tobacco use has declined sharply, especially among adolescent boys. Ongoing prevention and cessation efforts are needed to continue this trend.
Research Interests: Adolescent, Humans, United States, Female, Smokeless tobacco, and 6 moreMale, American, Aged, Middle Aged, Adult, and Sex Factors
Research Interests:
Research Interests:
Research Interests: Personality, Puerto Rico, Public Health, Comorbidity, Humans, and 15 moreSmoking Cessation, African American, New York City, Female, Male, Young Adult, Risk factors, African Americans, Longitudinal Studies, Family Health, Adult, Ethnic Group, Risk Factors, Psychological Models, and Parent‐child Relations
Research Interests: Education, Systems Thinking, Science, Systems Theory, Population Health, and 11 morePreventive medicine, Public Health, Group Processes, Translational Research, Protein Structure and Function, Humans, Public Health Administration, American, Interdisciplinary Communication, Public Health System, and Cooperative Behavior
Research Interests: Program Evaluation, Education, Psychometrics, Collaboration, Transdisciplinarity, and 13 morePreventive medicine, Group Processes, Humans, Team Science, Attitude, Questionnaires, Science of Team Science, Reproducibility of Results, Interdisciplinary Communication, Psychological Models, Factor structure, Cooperative Behavior, and Personal Satisfaction
Research Interests:
Research Interests:
To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) employees and the effect of the smoke-free policy on smoking behavior and air... more
To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) employees and the effect of the smoke-free policy on smoking behavior and air quality at work. A stratified telephone survey of 1181 CDC/ATSDR employees randomly selected from employee rosters. CDC/ATSDR work sites in Atlanta, Georgia, and other major CDC locations throughout the United States and Puerto Rico. Randomly selected employees of CDC/ATSDR1, or about 22% of the total CDC/ATSDR population; 98% of eligible persons selected agreed to participate. Demographic and smoking history variables, attitudes toward and impact of the smoke-free policy on smoking behavior, and self-report changes in air quality were the measures used. Overall cigarette smoking prevalence was only 11.1%. One percent reported using chewing tobacco, 1.1% reported smoking a pipe, and 1.4% reported smoking cigars. Average self-reported, daily cigarette consumption significantly decreased after the smoking ban took effect. Overall, 90% of the employees supported the smoke-free policy, and 80% of the employees believed that smokers were complying with the smoke-free policy. Most employees believed that the air quality of work areas and nonwork areas (65% and 69%, respectively) had improved since the smoke-free policy was implemented. These findings are consistent with previous evaluations of smoke-free policies and suggest that most employees are generally supportive of workplace smoking restrictions. Such policies can also have a positive impact on smoking behavior and perceived air quality.