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In This Issue of JAMA Internal Medicine
December 2018


JAMA Intern Med. 2018;178(12):1573-1736. doi:10.1001/jamainternmed.2017.5244


In this population-based cohort study of 68 946 French adults, Baudry and colleagues investigated the association between organic food consumption and the risk of cancer by using self-reported dietary and health information from participants. For 16 labeled organic food products, participants reported their consumption frequency of labeled organic foods, and an organic food score was then computed. There were 1340 first incident cancer cases identified and confirmed during follow-up, with the most prevalent being breast cancer, prostate cancer, skin cancer, colorectal cancer, non-Hodgkin lymphomas, and other lymphomas. Higher organic food scores were inversely associated with the overall risk of cancer. Hemler and colleagues provide the Invited Commentary.

Invited Commentary

Author Audio Interview and Continuing Medical Education

In this content analysis, Knutzen and colleagues assessed the prevalence of electronic tobacco and marijuana products and their brand placement in 796 hip-hop music videos from 2013 to 2017. Measurements included appearance or use of combustible tobacco and marijuana products, appearance of smoke or vapor, appearance or use of electronic tobacco and marijuana products, tobacco or marijuana brand placement, and appearance or use of tobacco and marijuana by a main or featured artist. Results demonstrated that tobacco and marijuana use frequently occurred in popular hip-hop music videos, which may contribute to a growing public health concern of tobacco and marijuana use.

In this randomized clinical trial, Sudore and colleagues compared the efficacy of a patient-directed, online advance care planning program plus an easy-to-read advance directive, called PREPARE For Your Care, with that of an advance directive alone to increase advance care planning and patient-reported engagement among older English- and Spanish-speaking populations. Compared with the advance directive alone, PREPARE For Your Care resulted in a higher rate of advance care planning documentation and higher self-reported increased advance care planning engagement scores. Results remained significant among English speakers and Spanish speakers.

Sheppard and colleagues performed this cohort study of electronic health record data to examine the association between antihypertensive treatment prescriptions and all-cause mortality, cardiovascular disease, and adverse events in low-risk patients with mild hypertension. Data were extracted from the Clinical Practice Research Datalink database for 38 286 patients aged 18 to 74 years who had mild hypertension and no previous treatment. During a median follow-up period of 5.8 years, no evidence of an association was found between antihypertensive treatment and mortality or between antihypertensive treatment and cardiovascular disease. However, treatment was associated with an increased risk of adverse events, including hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

In this randomized clinical trial, Kangovi and colleagues evaluated the effectiveness of a patient-centered program that used trained community health workers to assist patients with the socioeconomic and behavioral aspects of their health. Patients who resided in a high-poverty zip code, were uninsured or publicly insured, and who had a diagnosis for 2 or more chronic diseases were recruited from 3 primary care facilities. Participants set a chronic disease management goal with their primary care physician, and those randomized to the community health worker intervention received 6 months of tailored support. Results showed that a standardized intervention did not improve self-rated health but did improve the patient-perceived quality of care while reducing hospitalizations. Graddy and Fingerhood provide the Invited Commentary.

Invited Commentary

Dougherty and colleagues performed this systematic review and meta-analysis to evaluate interventions used to increase the rates of colorectal cancer screening tests and their effect sizes among average-risk adults in the United States. The main review included 73 randomized clinical trials identified through database searches, and the main outcome was completion of a colorectal cancer screening. Results showed that interventions that were associated with increased colorectal cancer screening completion rates compared with usual care included fecal blood test outreach, patient navigation, patient education, patient reminders, clinician interventions of academic detailing, and clinician reminders. Combinations of interventions were associated with greater increases than single components. Green provides the Invited Commentary.

Invited Commentary

Continuing Medical Education

In this population-based cohort study, Schummers and colleagues examined the risk of maternal mortality or severe morbidity, adverse fetal and infant outcomes, and spontaneous preterm delivery after short interpregnancy intervals in both younger and older Canadian women. Among 148 544 pregnancies, maternal mortality or severe morbidity risks were increased at 6-month compared with 18-month interpregnancy intervals for women 35 years or older but not for women aged 20 to 34 years. Adverse fetal and infant outcome risks, and risks of spontaneous preterm delivery at 6-month interpregnancy intervals were more pronounced for women aged 20 to 34 years than for women 35 years or older. Teal and Sheeder provide the Invited Commentary.

Invited Commentary

Reeve and colleagues performed this population-based survey study using data from the US National Health and Aging Trends Study to describe the attitudes of older Medicare beneficiaries toward deprescribing and whether individual characteristics are associated with these attitudes. Of the 1981 Medicare beneficiaries included in the study, 1752 reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 1241 wanted to reduce the number of medicines that they were taking. Older adults taking 6 or more medications had greater odds than those taking fewer than 6 medications of being willing to stop taking 1 or more of their medicines and wanting to reduce the number of medicines that they were taking.