Predictors of genetic beliefs toward cancer risk perceptions among adults in the United States: Implications for prevention or early detection.

The objective of this study is to assess predictors of genetic beliefs toward cancer risk perceptions among adults, aged 18 years and over, in the United States (US). Data were obtained from the National Cancer Institute's (NCI) Health Information National Trends Survey 2014 (HINTS) 4 Cycle 4. Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with an individual's beliefs about genetic and cancer risk perceptions. The results showed that African Americans, Non-White Hispanics, Non-Hispanic Asians, individuals with a high school education or less, and annual household incomes less than $20,000 and do not believe that health behaviors play some role in determining whether a person will develop cancer was significantly less likely to report that genetics plays at least some role in whether a person will develop cancer. Findings of this study provide an opportunity for genetic counselors to address beliefs about genetics and cancer risk perceptions among minority populations and promote health equity.

Factors Associated with Human Papillomavirus Vaccination among Women in the United States.

BACKGROUND: Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States (US). HPV vaccines have the ability to prevent infection with HPV. The objective of this study was to assess the factors associated with HPV vaccination among women in the US. METHODS: Data from the 2014 Behavioral Risk Factor Surveillance System were used to assess predictors of HPV vaccination. A multivariable logistic regression analysis was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs). Analyses were conducted using SAS Version 9.4. RESULTS: Factors that decreased the likelihood of receiving HPV vaccination included: being between the ages of 27-50 (AOR: 0.08; 95% CI: 0.06-0.11), having some college education, and residing in the South Black Belt States (AOR: 0.49; 95% CI: 0.31-0.78), Midwest (AOR: 0.63; 95% CI: 0.44-0.90), and the West (AOR: 0.37; 95% CI: 0.15-0.95). Factors that decreased the likelihood of receiving HPV vaccination to completion included: being Non-Hispanic Black (AOR: 0.26; 95% CI: 0.11-0.64), Hispanic (AOR: 0.26; 95% CI: 0.10-0.68), between the ages of 27-50 years (AOR: 0.46; 95% CI: 0.26-0.84), and residing in the Midwest (AOR: 0.36; 95% CI: 0.18-0.73) and South Remainder (non- Black Belt) states (AOR: 0.30; 95% CI: 0.09-0.93). CONCLUSION: Our results suggest that sociodemographic disparities still exist in more recent data underscoring the urgent need for additional efforts to increase HPV vaccination in populations that are least likely to receive the vaccination.

Factors associated with self-reported history of depression diagnosis among cancer survivors aged 18 years and over in the United States.

OBJECTIVE: According to the American Cancer Society, 25% of cancer survivors in the United States develop depression. The objective of this study is to assess factors associated with self-reported history of depression diagnosis among cancer survivors aged ≥18 years in the United States. METHODS: Data were analyzed from the 2014 Behavioral Risk Factor Surveillance System (N = 6079). The Behavioral Risk Factor Surveillance System collects data about US residents regarding their health-related risk behaviors and events, chronic health conditions, and use of preventive services. Respondents were considered to have a history of depression diagnosis if they answered yes to the question "Has a doctor or other health care provider EVER told you that you have a depressive disorder, including depression, major depression, dysthymia, or minor depression?" Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with depression in cancer survivors. Analyses were conducted using SAS 9.4. RESULTS: After adjusting for demographic and socioeconomic factors, females (AOR: 1.70; 95% CI, 1.50-1.97); those with an annual household income of $24 999 or less (AOR: 2.48; 95% CI, 1.95-3.16); $25 000 to $49 999 (AOR: 1.62; 95% CI, 1.31-2.02), and $50 000 to $74 999 (AOR: 1.35; 95% CI, 1.10-1.71); those who were not married (AOR = 1.37; 95% CI, 1.17-1.60); and those who perceived their health as poor (AOR = 2.33; 95% CI, 2.01-2.70), were significantly more likely to report a diagnosis of depression. CONCLUSIONS: The results indicate that gender, income, marital status, and perceived health status were associated with self-reported depression among cancer survivors aged ≥18 years in the United States.

Factors Associated with Self-Reported Cervical Cancer Screening Among Women Aged 18 Years and Older in the United States.

In 2016, an estimated 4120 women will die as a result of cervical cancer. The objective of this study was to examine the factors associated with cervical cancer screening among women 18 years of age and older in the United States (U.S.). Using the 2012 Behavioral Risk Factor Surveillance System survey, women over the age of 18 in the U.S. were examined to assess factors associated with cervical cancer screening. Analyses were conducted using SAS 9.2. Of the 272,692 study participants, 258,496 (95 %) had obtained cervical cancer screening. After adjusting for demographic and socioeconomic factors, being non-Hispanic White, Hispanic or Latino, Asian, Native Hawaiian or Other Pacific Islander, in the age group 18-44 years and 75 years and above, having less than a high school education and an annual household income of less than a $25,000, having never married, and residing in the West region of the U.S. reduced the likelihood of participation in cervical cancer screening. Also, after adjusting for demographic and socioeconomic factors, being between the ages of 45-74 years of age, having more than a high school education, having a higher income, and residing in the South region of the U.S. increased the likelihood of participation in cervical cancer screening. The results of this study suggest that socio-demographic factors and region of residence are predictors of cervical cancer screening. These findings highlight the need to identify potential prevention strategies to promote cervical cancer screening among at-risk populations and groups.

Factors Associated with Self-Reported 14 or More Activity Limitation Days among Adults in the United States.

OBJECTIVE: It is estimated that 41 million American adults 18 and older experience poor physical or mental health which limits their ability to engage in their daily activities. The objective of this study was to assess the prevalence of and factors associated with ≥14activity limitation days (ALD) due to poor physical or mental health as self-reported by persons aged 18 years and over in the United States (U.S). METHODS: Using the 2012 Behavioral Risk Factors Surveillance System (BRFSS), persons over the age of 18 in the U.S. were examined to assess the prevalence of and factors associated with ≥ 14ALD due to poor physical or mental health. The BRFSS is administered on a continuous basis by telephone using random-digit dial sampling methods. A clustering sample design was used to account for differences in the probability of selection and non-response in order to accurately derive US and state-based population estimates. The design consists of a probability sample of all households with telephones in the state. Analyses were conducted using SAS 9.2. RESULTS: Of the 104,257 participants included in the analyses, 40% reported having ≥14 ALD due to poor physical or mental health. After adjusting for demographic and socioeconomic factors, males (AOR1.17, 95% CI: 1.14-1.21), those with high school or less education (AOR: 1.42, 95% CI: 1.37-1.21), those who were separated (AOR: 1.23; 95% CI=1.14-1.32), divorced (AOR: 1.10; 95% CI=1.06-1.15), those from the Southern Black Belt States (AOR1.14, 95% CI: 1.10-1.20), and those from the remainder of the Southern region of the U.S. (AOR1.14, 95% CI: 1.08-1.21) were significantly more likely to report ≥14ALD due to poor physical or mental health. CONCLUSION: The prevalence of ≥14ALD due to poor physical or mental health among the study population was associated with sociodemographic and region of residence factors. These findings highlight the need for prevention strategies specifically for populations who might be more at risk for ALD due to social determinants of health.

Factors Associated with Self-Reported HIV Testing Among Persons 18 Years and Over in the United States - Findings from the 2012 Behavioral Risk Factor Surveillance System (BRFSS).

BACKGROUND: The Centers for Disease Control and Prevention (CDC) estimates that 14 percent of persons infected with HIV in the United States (US) are unaware of their infection and many of the estimated 50,000 new HIV infections each year are transmitted by people who do not know that they are HIV-positive. HIV testing is an important component of HIV prevention. This study examined predictors of self-reported HIV testing among persons 18 years and over in the US. METHODS: Data from the 2012 BRFSS were utilized. We used univariate analysis to calculate relative frequencies for gender, race or ethnicity, age, education, income, marital status, region of residence, and having engaged in HIV/AIDS risky behaviors to characterize the overall sample. We conducted bivariate analysis for an initial assessment of factors independently associated with HIV testing. Multivariable logistic regression models were used to obtain the Adjusted Odds Ratios (AORs) and 95% Confidence Intervals (95% CIs) for factors associated with getting tested for HIV. Analyses were conducted using SAS version 9.2. RESULTS: Of the 439,327 respondents, 30% had been tested for HIV. Of those who had been tested for HIV, 59% were female; 41% were two or more races and 47% were between 18-44 years of age. The majority (39%) of the respondents were college graduates. Over one-third (31%) of the participants who had been tested had annual household incomes which were less than $25,000. Half (50%) were married and 24% of the respondents were from the Western region of the US. Five percent of the respondents reported that they had engaged in HIV/AIDS risky behaviors. Factors associated with lower odds of getting tested included being Asian (AOR=0.56; 95% CI=0.41, 0.78); Native Hawaiian or Other Pacific Islander (AOR=0.42; 95% CI=0.18, 0.90); and having an income between $25,000 to $49,000 (AOR=0.82; 95% CI=0.78-0.87); $50,000 to $74,999 (AOR=0.86; 95% CI=0.79-0.93); or $75,000 or more (AOR=0.87; 95% CI=0.81-0.94). Also, respondents from the Midwest (AOR=0.78; 95% CI=0.73, 0.83) and the West (AOR=0.88; 95% CI=0.83, 0.93) were less likely to get tested for HIV. Our adjusted analyses also showed that being non-Hispanic Black or African American, Hispanic or Latino, identifying as having two or more races, and being American Indian or Alaska Native increased the likelihood of getting tested for HIV. Having engaged in HIV/AIDS risky behaviors had significantly higher odds of being tested for HIV (AOR=2.45; 95% CI=2.19, 2.74). CONCLUSION: Our findings suggest that the HIV/AIDS prevention education and training programs in the US that have focused on traditionally classified high-risk populations have been effective. Findings from this study uncover an interesting paradox, which suggests that populations with higher incomes have been overlooked in efforts to combat HIV/AIDS. Our results suggest that these populations are at greatest risk of not knowing their HIV status and are therefore most likely to unknowingly contribute to the number of new HIV infections. Future research on multiple interacting factors that affect HIV testing behaviors should be considered top priorities. This is of upmost importance because knowing one's HIV status allows those who are infected to seek and receive treatment and prevention services, which are designed to improve health and reduce the likelihood of further transmission.

Hepatitis E as a cause of acute jaundice syndrome in northern Uganda, 2010-2012.

Hepatitis E virus (HEV) is a common cause of acute viral hepatitis in developing countries; however, its contribution to acute jaundice syndrome is not well-described. A large outbreak of hepatitis E occurred in northern Uganda from 2007 to 2009. In response to this outbreak, acute jaundice syndrome surveillance was established in 10 district healthcare facilities to determine the proportion of cases attributable to hepatitis E. Of 347 acute jaundice syndrome cases reported, the majority (42%) had hepatitis E followed by hepatitis B (14%), malaria (10%), hepatitis C (5%), and other/unknown (29%). Of hepatitis E cases, 72% occurred in Kaboong district, and 68% of these cases occurred between May and August of 2011. Residence in Kaabong district was independently associated with hepatitis E (adjusted odds ratio = 13; 95% confidence interval = 7-24). The findings from this surveillance show that an outbreak and sporadic transmission of hepatitis E occur in northern Uganda.

Psychosocial factors as predictors of HIV/AIDS risky behaviors among people living with HIV/AIDS.

Infection with the human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS) is still rising globally. In order to develop effective HIV/AIDS risky behavior reduction intervention strategies and to further decrease the spread of HIV/AIDS, it is important to assess the prevalence of psychosocial problems and HIV/AIDS risky behaviors in people living with HIV/AIDS (PLWHA). The objective of this study is to assess the relationship between psychosocial variables and HIV/AIDS risky behaviors among PLWHA. A total of 341 questionnaires were distributed and 326 were fully completed and returned, 96% response rate. The relationships between the identified psychosocial and HIV/AIDS risky behaviors among PLWHA were analyzed using The Moment Structures software version 17.0 (SPSS Inc.) The results indicate that psychosocial health problems were significant predictors of HIV/AIDS risky behaviors in PLWA. Further cross-disciplinary research that addresses the manner in which psychosocial problems and HIV/AIDS risky behaviors interact with each other among PLWHA is needed.

A quantitative risk assessment of multiple factors influencing HIV/AIDS transmission through unprotected sex among HIV-seropositive men.

The objective of this study is to conduct a quantitative risk assessment of multiple factors influencing HIV/AIDS transmission through unprotected sexual practices among HIV-seropositive men. A knowledgebase was developed by reviewing different published sources. The data were collected from different sources including Centers for Disease Control and Prevention, selected journals, and reports. The risk pathway scenario tree was developed based on a comprehensive review of published literature. The variables are organized into nine major parameter categories. Monte Carlo simulations for the quantitative risk assessment of HIV/AIDS transmission was executed with the software @Risk 4.0 (Palisade Corporation). Results show that the value for the likelihood of unprotected sex due to having less knowledge about HIV/AIDS and negative attitude toward condom use and safer sex ranged from 1.24 × 10(-5) to 8.47 × 10(-4) with the mean and standard deviation of 1.83 × 10(-4) and 8.63 × 10(-5), respectively. The likelihood of unprotected sex due to having greater anger-hostility, anxiety, less satisfied with aspects of life, and greater depressive symptoms ranged from 2.76 × 10(-9) to 5.34 × 10(-7) with the mean and standard deviation of 5.23 × 10(-8) and 3.58 × 10(-8), respectively. The findings suggest that HIV/AIDS research and intervention programs must be focused on behavior, and the broader setting within which individual risky behaviors occur.

The Association between Interrelationships and Linkages of Knowledge about HIV/AIDS and its Related Risky Behaviors in People Living with HIV/AIDS.

The relationship between knowledge about HIV/AIDS and its associated risky behaviors is complex and has not been sufficiently explored. It is especially important to look at some of the aspects of this relationship among people living with HIV/AIDS (PLWHA) in order to develop effective intervention strategies to reduce HIV/AIDS risky behaviors. The objective of this study was to investigate the association between knowledge about HIV/AIDS and its risky behaviors among PLWHA. METHODS: Risk taking behavior among the participants was measured as the number of all risky behaviors before and after the knowledge of their HIV/AIDS positive status. Knowledge was measured by the extent to which participants answered the HIV/AIDS related questions. The relationships between the identified HIV/AIDS risky behaviors and the knowledge among PLWHA were analyzed using Structural Equation Modelling. RESULTS: 341 questionnaires were administered and 326 (96%) were completed and returned from PLWHA clients of HIV/AIDS outreach facility in Alabama. Analysis revealed that, knowledge of HIV/AIDS, and knowledge of a properly used condom in preventing the infection through sexual activity were positively related with knowledge of where to get tested for HIV/AIDS. Using drugs before sex was significantly related with having sex with prostitutes (total effects' standardized regression coefficient (TESRC)=0.29, p<0.001). Sharing the same syringe or needle with another person or other people to inject oneself was strongly related with number of sexual partners within one year (TESRC=0.25, p<0.001), and sex with injecting drug users (TESRC=0.45, p<0.001). CONCLUSION: A deeper understanding of HIV/AIDS and some of its transmission pathways appears to be very effective in practicing the taking of preventive measures such as using condoms or getting tested for HIV. Increasing access to HIV/AIDS education could therefore be very useful in providing further gains in HIV/AIDS awareness among PLWHA.

The association between religious affiliation and frequency of attendance at religious services on HIV risky behaviors among people living with HIV/AIDS.

The purpose of this study was to examine if religious affiliation and frequency of attendance at religious services were associated with HIV risky behaviors among people living with HIV/AIDS (PLWHA). The participants are HIV positive clients of a community based HIV/AIDS outreach facility (CBHAOF) located in Montgomery, Alabama, USA. The participants completed the questionnaire during their medical visits to the clinic at their own convenience and that of the facility's staff. A total of 341 questionnaires were distributed to PLWHA and 326 (96%) were fully completed and returned. There were more male than female participants (56 versus 42%). The majority of the respondents (67%) were between 30 and 49 years of age. Nearly two thirds of the participants (64%) were African Americans whilst 36% were other races combined (White = 29%, Hispanic = 3% and other races = 4%). A chi-square test was used to examine the association between selected variables. Findings show substantial variations of selected HIV risky behaviors according to religious affiliation and frequency of attendance at religious services (p < 0.05). The study findings suggest the importance of religious affiliation and frequency of attendance at religious services in reducing HIV risky behaviors among PLWHA. The findings have implications for HIV/AIDS prevention and we recommend that it is important to incorporate Faith-based organizations in the global fight against HIV/AIDS.

Psychosocial responses associated with perceived risk of cancer in an African-American community.

This epidemiologic health survey study examined the association between health risk perceptions and psychosocial factors in 145 African Americans in East Montgomery, Alabama. The survey gathered information on demographics, population dynamics, health risk perceptions, and coping behaviors. Psychosocial variables measured were worries, concern, stress, and trauma associated with perceived risk of cancer. Results indicated that women were more concerned about the environmental health risks in their community than men. Compared to men, women were highly concerned about the economic effect of perceived environmental health risk. The findings indicate that an individual's health status and educational level were significant predictors of psychosocial responses.

Epidemiology of influenza A 2009 H1N1 virus pandemic in the U.S.

A novel influenza, Influenza A 2009 H1N1 virus outbreak, emerged in mid-April 2009, and by December 2009, spread across the world. This epidemiologic analysis uses the epidemiologic problem oriented approach to gather information for, and develop a quantitative risk assessment model that evaluates the likelihood of an influenza outbreak in the U.S., utilizing weekly incidence rates (WIR) and case fatality rates (CFR) stratified by age and the 10 U.S. regions. In addition ArcGIS was used to show variability regarding morbidity rate and WIR. Using data from the Centers for Disease Control and Prevention (CDC) Emerging Infections Program and applying Monte Carlo simulations with @Risk software, the analysis revealed morbidity to be highest in region 8 (1.27×10-2) and lowest in region 2 (0.13×10-2). Heat map results revealed WIR were higher in younger children, for all regions. Case fatality rates were 10 times greater in younger people than in older people and children. Using these different temporal-spatial epidemiologic methods can help decision-makers identify high-risk population clusters and help in prevention and control of pandemics.

A comparative study of substance use before and after establishing HIV infection status among people living with HIV/AIDS.

OBJECTIVE: To determine if significant differences exist in substance use among people living with HIV/AIDS (PLWHA) before and after establishing their HIV infection status. METHOD: The study participants are HIV positive clients of a community based HIV/AIDS outreach facility located in Montgomery, Alabama. The questionnaire includes demographics, substance use and risky sexual behaviors pertaining to HIV transmission. Each participant completed an anonymous questionnaire. A total of 341 questionnaires were distributed and 326 were fully completed and returned, representing a response rate of 96%. RESULTS: Findings revealed a statistically significant difference in alcohol consumption before sex among PLWHA before and after establishing their HIV infection status (p = .001). No significant differences were observed among participants who reported as having used drugs intravenously (p = .89), and among those sharing the same syringe/needle with another person (p = .87) before and after establishing their HIV infection status. CONCLUSION: There is continued substance use and alcohol consumption before sex among PLWHA after establishing their HIV status despite clear evidence of such risky behaviors that could lead to an increase in exposure to HIV.

Applying the epidemiologic problem oriented approach (EPOA) methodology in developing a knowledge base for the modeling of HIV/AIDS.

INTRODUCTION: In the epidemiologic modeling of diseases, the epidemiologic problem oriented approach (EPOA) methodology facilitates the development of systematic and structured knowledge bases, which are crucial for development of models. A detailed understanding of the epidemiology of a given disease provides the essential framework for model development and enables the laying out of the comprehensive and fundamental structures for the models. OBJECTIVE: To develop such a knowledge base for developing HIV/AIDS models. METHODS: The EPOA methodology was utilized to develop the knowledge base for HIV/AIDS; it is composed of six pillars within two triads: the Problem Identification/Characterization and the Problem Management/Solution/Mitigation Triads, interlinked by the diagnostic procedure. RESULTS: Using information from various sources, the triads are decomposed into their respective pillar variables and parameters. The agent pillar identifies the causative agent (HIV) and its characteristics. The host pillar identifies and characterizes the host (human). The environment pillar characterizes the physical, biological and socioeconomic environments for both the host and agent. The therapeutics/treatment pillar considers the treatment options for HIV/AIDS. The prevention/control pillar considers prevention and control measures. The health maintenance/health promotion pillar considers measures for the health maintenance of the population. CONCLUSION: Models for HIV/AIDS can be conceptual, in vivo or in vitro, systems analysis, mathematical, or computational just to name a few. The knowledge base developed using the EPOA methodology provides a well-organized structured source of information, which is used in the variable and parameter estimations as well as analysis (biological, mathematical, statistical and computer simulations), which are crucial in epidemiologic modeling of HIV/AIDS. EPOA methodology has become an important tool in the development of models that can enlighten decision making in public health.

Assessing HIV/AIDS intervention strategies using an integrative macro-micro level computational epidemiologic modeling approach.

INTRODUCTION: Epidemiologic research involves the study of a complex set of host, environmental and causative agent factors as they interact to impact health and diseases in any population. The most advanced of these efforts have focused on micro (cellular) or macro (human) population level studies but lacked the integrative framework as presented in this article. Modeling the cumulative impact of HIV/AIDS at the cellular, molecular, and individual behaviors at the population-level can be complex. The main objective of our research is to develop a macro-micro level computational epidemiologic model that integrates the dynamic interplay of HIV/AIDS at the cellular and molecular level (micro-epidemiologic modeling), and the dynamic interplay of multifactorial determinants: biomedical, behavioral, and socioeconomic factors at the human population level (macro-epidemiologic modeling). METHODS: The computational epidemiologic model was constructed using systems dynamics modeling methodology. The dynamics of the relationships was described by means of ordinary/partial differential equations. All state equations in the model were approximated using the Runge-Kutta 4th order numerical approximation method. RESULTS: Computational tools and mathematical approaches that integrate models from micro to macro levels in a seamless fashion have been developed to study the population-level effects of various intervention strategies on HIV/AIDS. The critical variables that facilitate transmission of HIV and intracellular interactions and molecular kinetics were examined to assess different interventions strategies. Such multilevel models are essential if we are to develop quantitative, predictive models of complex biological systems such as HIV/AIDS.

The correlation between alcohol consumption and risky sexual behaviors among people living with HIV/AIDS.

The objectives of this study were to determine if significant correlation exists between drinking any alcoholic beverage and risky sex among 326 AIDS patients. Participants completed anonymous surveys. The result of the regression and Pearson Correlation analyses revealed a significant positive correlation between drinking alcohol before sex and frequency of condom use (p < .0001). The number of sex partners respondents reported was also correlated with the frequency of alcohol use (p = .003). The result shows that the quantity of alcohol consumption was correlated with two indicators of risky sex: having multiple sexual partners (p < .0001) and having sexual intercourse without a condom (p < .001). Interventions are that integrate HIV risk reduction with alcohol risk reduction is very useful to minimize the risk of new HIV infections and/or manage existing infections.