Risk Factors, Preventive Practices, and Health Care Among Breast Cancer Survivors, United States, 2010.

INTRODUCTION: We compared behavioral risk factors and preventive measures among female breast cancer survivors, female survivors of other types of cancers, and women without a history of cancer. Survivorship health care indicators for the 2 groups of cancer survivors were compared. METHODS: Using data from the 2010 Behavioral Risk Factor Surveillance System, we calculated the proportion of women with risk factors and their engagement in preventive practices, stratified by cancer status (cancer survivors or women with no history of cancer), and compared the proportions after adjusting for sociodemographic characteristics. RESULTS: A significantly higher proportion of breast cancer survivors had mammography in the previous year (79.5%; 95% confidence interval [CI], 76.0%-83.0%) than did other cancer survivors (68.1%; 95% CI, 65.6%-70.7%) or women with no history of cancer (66.4%; 95% CI, 65.5%-67.3%). Breast cancer survivors were also more likely to have had a Papanicolaou (Pap) test within the previous 3 years than women with no history of cancer (89.4%; 95% CI, 85.9%-93.0 vs 85.1%; 95% CI, 84.4%-85.8%) and a colonoscopy within the previous 10 years (75.4%; 95% CI, 71.7%-79.0%) than women with no history of cancer (60.0%; 95% CI, 59.0%-61.0%). Current smoking was significantly lower among survivors of breast cancer (10.3%; 95% CI, 7.4%-13.2%) than other cancer survivors (20.8%; 95% CI, 18.4%-23.3%) and women with no history of cancer (18.3%; 95% CI, 17.5%-19.1%). After adjusting for sociodemographic characteristics, we found that breast cancer survivors were significantly more likely to have had mammography, a Pap test, and colonoscopy, and less likely to be current smokers. CONCLUSION: Breast cancer survivors are more likely to engage in cancer screening and less likely to be current smokers than female survivors of other types of cancer or women with no history of cancer.

High Risk Behaviors but Low Injury-Related Mortality Among Hispanic Teens in Missouri.

OBJECTIVE: Our objective was to examine racial/ethnic disparities in injury-related risk behaviors and deaths among teens in Missouri, with a focus on Hispanic people-the fastest-growing racial/ethnic group in the state. METHODS: We used data from the 2013 Missouri Youth Risk Behavior Survey, which included 1616 students in grades 9 through 12 from 32 public and charter high schools. The overall response rate was 69%. We compared the prevalence of 10 injury-related risk behaviors among racial/ethnic groups and used multivariate logistic regression models to control for respondent age and sex. Using data from the 2000-2014 Missouri death records, we also compared injury-related death rates among racial/ethnic groups of teens aged 15 to 19 years. RESULTS: Hispanic students had a significantly higher prevalence than non-Hispanic white students for 9 of 10 risk behaviors and a significantly higher prevalence than non-Hispanic black students for 6 of the 10 risk behaviors included in the study. However, Hispanic teens aged 15 to 19 years had a significantly lower death rate from suicide, homicide, and unintentional injury combined (39.8 per 100000 population, 95% confidence interval [CI], 32.2-48.5) when compared with their non-Hispanic white (54.3 per 100000 population, 95% CI, 52.3-54.6) or non-Hispanic black (94.1 per 100000 population, 95% CI, 87.9-100.3) counterparts. CONCLUSION: Injury-related risk behaviors were more prevalent among Hispanic students than non-Hispanic white or non-Hispanic black students. Further efforts are needed to understand risk behaviors among Hispanic teens to guide intervention efforts.

The burden of chronic diseases in Missouri: progress and challenges.

Chronic diseases are the major causes of premature death, disability and loss of quality of life in Missouri. The prevalence of many chronic diseases, conditions and risk behaviors is greater in Missouri than the U.S. The medical costs for treating chronic diseases are a burden on the state's economy and will increase as the population ages. Prevention and control of chronic diseases is essential to the physical and economic health of Missourians.

Economic effect of smoke-free ordinances on 11 Missouri cities.

INTRODUCTION: The harmful effects of secondhand smoke are convincing more and more communities across the United States and the world to prohibit smoking in public places, especially in eating and drinking establishments. A 1993 Missouri state law allows smoking in designated areas in indoor public places such as restaurants and bars. Consequently, some Missouri communities have adopted local ordinances that prohibit smoking in all indoor workplaces, including restaurants and bars. We used an objective measure of economic activity, the taxable sales revenues of eating and drinking establishments, to empirically examine the economic effect of smoke-free ordinances. METHODS: We studied the economic effect of smoke-free ordinances in 11 Missouri cities using multivariate log-linear regression models with log-transformed taxable sales revenues of eating and drinking establishments as the dependent variable and the smoke-free ordinance as the independent variable, while controlling for seasonality, economic condition and unemployment. We used data from 20 quarters before the smoke-free ordinances and at least 10 quarters after the smoke-free ordinances for all cities. The null hypothesis of no effect of smoke-free ordinance on taxable sales of the eating and drinking establishments was tested. RESULTS: Eight of the 11 cities had increased taxable sales for eating and drinking establishments postordinance. The remaining 3 experienced no change. CONCLUSION: The findings of our study are consistent with findings from most published economic studies that a smoke-free ordinance does not harm a local economy.

Economic impact of a smoke-free ordinance on bars and restaurants in a small, rural, Missouri community.

The purpose of this study was to analyze the economic impact of a city-wide smoke-free ordinance in the small, relatively isolated, rural, Northeast Missouri community of Kirksville. A model similar to prior studies was applied to the taxable sales revenues of eating and drinking establishment data prior to and following enactment of a smoke-free ordinance. It was found that there was a significant positive change in eating and drinking establishment taxable sales revenues post-enactment.

Tobacco use among Missouri middle and high school students, 2003-2009.

Reducing tobacco use among young people is an important public health goal. This article summarizes the results of the analysis of Missouri Youth Tobacco Survey (YTS) data collected between 2003 and 2009. The YTS collects information regarding tobacco use and related issues among Missouri public middle and high school students. Downward trends in initiation of tobacco use and current cigarette smoking occurred during this period. However, increased implementation of evidence-based interventions is needed to continue the progress seen during this period.

Health and economic burden of traumatic brain injury: Missouri, 2001-2005.

OBJECTIVE: We examined the financial and social costs resulting from traumatic brain injury (TBI) in Missouri. METHODS: We computed mortality rates from death certificates, the direct cost of TBI from hospital and emergency department (ED) visit charges, the social cost in terms of years of potential life lost (YPLL) using an abridged Missouri life table, and the indirect financial cost in terms of lost productivity due to premature death for all TBI and four major causes of TBI in Missouri. RESULTS: During 2001-2005, a mean of 1358 lives were lost due to TBI in Missouri. Four major causes-unintentional falls, motor vehicle traffic crashes, motorcycle crashes, and firearms-accounted for 88% of all TBI deaths. We estimated the annual direct medical cost of TBI at $95 million, or about $1.67 million per 100,000 Missourians. This cost increased by about 60% between 2001 and 2005. The four major causes of TBI accounted for 68% of all direct medical costs of TBI. We estimated the cost per hospitalization and ED visit at $6948 and the indirect social cost at 48,501 YPLL. During this period, the mean age of TBI fatality was 44 years. We determined the lost productivity due to TBI mortality--$1.1 billion, or about $18.8 million per 100,000 Missourians--to be three times as high for males as for females. CONCLUSIONS: The types of costs covered in this study underestimated the total cost of TBI in Missouri, as we did not include outpatient care, rehabilitation, and drug costs. Nevertheless, we found the health and economic burden from medical care and mortality related to TBI to be substantial in Missouri.

The health and economic burden of smoking in Missouri, 2000-2004.

This study used the Smoking-Attributable Mortality, Morbidity and Economic Cost (SAMMEC) software developed by the Centers for Disease Control and Prevention to assess the health consequences and economic burden due to smoking in Missouri. During 2000-2004, cigarette smoking resulted in 9,600 deaths (17.5% of all deaths), 132,103 Years of Potential Life Lost, and $2.4 billion in productivity loss annually in Missouri. These data show that Missouri suffers enormous human and financial losses from smoking.