Differences in Breast and Cervical Cancer Screening Among U.S. Women by Nativity and Family History.

INTRODUCTION: System-level factors such as poor access to health services can help explain differential uptake in breast and cervical cancer screening between U.S.- and foreign-born women. However, few studies have explored the roles of family history and perceived risk of these cancers on screening rates. To address these gaps, this study investigates whether a family history of cancer, perceived risk, and system-level factors independently and additively predict differential screening rates of breast and cervical cancer between U.S.-born and foreign-born women living in the U.S. METHODS: Data were analyzed in 2019 from the 2015 National Health Interview Survey. Descriptive and multivariable logistic regression modeling was performed to test whether there were differences in breast and cervical cancer screening within and between the 2 groups and whether family history of cancer and perceived risk of breast cancer were predictors of uptake. RESULTS: The sample comprised women aged 21-74 years (n=14,047). The mean age of the sample was 45.5 (SD=14.8 years). The majority of the women were U.S.-born (77.5%). U.S.- and foreign-born women had more mammograms and Pap tests with a usual source of care (p<0.001) and insurance (p<0.001). Healthcare access and utilization factors were also predictive for both groups of women. Data analyses were conducted in 2019. CONCLUSIONS: These findings are consistent with previous work. Access and healthcare utilization were associated with screening uptake. However, differences in risk perception, family history of breast and cervical cancers, and screening uptake were found between U.S.- and foreign-born women.

Risk factors associated with age at diagnosis of diabetes among noninstitutionalized US population: the 2015-2016 National Health and Nutrition Examination Survey.

BACKGROUND: Demographic and anthropometric factors associated with the age at diagnosis of diabetes have not been extensively studied. Much of the literature using anthropometric measures has been associated with other health factors such as obesity and coronary heart disease. The purpose of this study was to assess the relationship between different sets of anthropometric factors and age of diabetes diagnosis in the United States. METHODS: Using the NHANES 2015-2016 data set, weighted linear regression analysis was performed on observations from 600 qualified individuals with diabetes to study associations between anthropometric and demographic factors and the age of diabetes diagnosis. RESULTS: Results of our analysis support the evidence of significant relationships between the anthropometric characteristics and demographic factors and age at diabetes diagnosis. Specifically, age at diagnosis of diabetes is predicted to decrease by 1.03 (p < 0.01) and 0.91 (p < 0.01) years when BMI and upper leg length go up by one unit each, respectively. Similarly, age at diagnosis of diabetes decreases by 0.02 years and by 1.72 years when refrigerated glucose serum increases by 1 mg/dL (p < 0.05) and when household size increases by one person, respectively. Male respondents were diagnosed with diabetes 3.41 years later than their female counterparts. Conversely, age at diagnosis of diabetes increases by 1.24 years when the average sagittal abdominal diameter goes up by 1 cm (p < 0.05). In addition, Mexican American respondents were diagnosed 5.00 years younger than the non-Hispanic White counterparts. CONCLUSIONS: Our findings show that anthropometric factors, including BMI, refrigerated glucose serum and upper leg length increase have an inverse linear association with age of diabetes diagnosis. The results of this study can help improve the efficiency of the methods of health professionals attempting to lower the rate of diabetes diagnoses.

The Use of a Community-Based Preconception Peer Health Educator Training Intervention to Improve Preconception Health Knowledge.

This paper highlights the use of an adapted Office of Minority Health (OMH) Preconception Health Peer Educator program to address persistent infant mortality health disparities. The community-based Attack Infant Mortality (AIM Escambia) initiative was established to increase preconception health knowledge among African American women at risk for adverse birth outcomes. Participants (N = 122) attended a 6-h AIM peer educator training, completed pretest and posttest questionnaires about their health knowledge, health attitudes, and planned engagement in health behaviors. Study results support the use of preconception health education training to inform health knowledge, health attitudes, and planned health sharing behaviors. Multidisciplinary collaborations and targeted interventions should be considered when seeking to improve community health conditions and increase health knowledge and health literacy for minority populations.

Complementary and alternative medicine use among persons with multiple chronic conditions: results from the 2012 National Health Interview Survey.

BACKGROUND: Although a quarter of Americans are estimated to have multiple chronic conditions, information on the impact of chronic disease dyads and triads on use of complementary and alternative medicine (CAM) is scarce. The purpose of this study is to: 1) estimate the prevalence and odds of CAM use among participants with hypercholesterolemia, hypertension, diabetes, and obesity; and 2) examine the effects of chronic condition dyads and triads on the use of CAM modalities, specifically manipulative and body-based methods, biological treatments, mind-body interventions, energy therapies, and alternative medical systems. METHODS: Data were obtained from the 2012 National Health Interview Survey and the Adult Alternative Medicine supplement. Statistical analyses were restricted to persons with self-reported hypercholesterolemia, hypertension, diabetes, or obesity (n = 15,463). RESULTS: Approximately 37.2% of the participants had just one of the four chronic conditions, while 62.4% self-reported multiple comorbidities. CAM use among participants was as follows (p < 0.001): hypercholesterolemia (31.5%), hypertension (28.3%), diabetes (25.0%), and obesity (10.8%). All combinations of disease dyads and triads were consistently and significantly associated with the use of mind-body interventions (2-4%, p < 0.001). Two sets of three dyads were associated with use of manipulative methods (23-27%, p < 0.05) and energy therapies (0.2-0.3%, p < 0.05). Use of biological treatments (0.04%, p < 0.05) and alternative systems (3%, p < 0.05) were each significant for one dyad. One triad was significant for use of manipulative methods (27%, p < 0.001). CONCLUSIONS: These findings point to future directions for research and have practical implications for family practitioners treating multimorbid patients.

Socioeconomic Status, Family Functioning and Delayed Care Among Children With Special Needs.

Parents of children with special healthcare needs (CSHCN) face tremendous stress in caring for their children. Families of CSHCN face increased barriers to health services as evidence also reflects the influence of socioeconomic factors on access. This study investigates the impact of socioeconomic factors and family functioning on delayed care. Descriptive, bivariate, and adjusted multivariate logistic regression were performed using sampling weights. findings suggest that family dynamics are more impactful on delayed care than socioeconomic predictors. Promoting family-centered care that incorporates social support for families to reduce barriers is essential for improved quality of life and health outcomes.

Prostate and Colorectal Cancer Screening Uptake among US and Foreign-Born Males: Evidence from the 2015 NHIS Survey.

Research suggests that prostate and colorectal cancers disproportionately affect men in the US, but little is known about the determinants of prostate-specific antigen (PSA) and colorectal cancer (CRC) screening uptake among US and foreign-born males. The purpose of this study was to investigate what factors influence prostate and colorectal cancer screening uptake among US-native born and foreign-born men. Using the 2015 National Health Interview Survey, we conducted bivariate and multivariate analyses to highlight factors associated with the uptake of prostate and colorectal cancer screening among US-native born and foreign-born men. The sample size consisted of 5651 men respondents, with the mean age of 59.7 years (SD = 12.1). Of these, more than two-fifths (42%) were aged 50-64 years old. With respect to race/ethnicity, the sample was predominantly non-Hispanic Whites (65.5%), 863 (15.6%) Hispanics, and 710 (12.4%) Blacks. Our analysis found higher rates of both US-born and foreign-born men aged 65 years or older, who had either a PSA or CRC screening tests than those aged <65 years. Results of the general multivariate model suggest that men under 50 years old, US-born and foreign-born alike, are statistically significantly less likely to have prostate or colorectal cancer screenings than men aged 65 years or above. This study highlights the influencing factors that encourage or discourage PSA and CRC screening uptake between US-native born and foreign-born men. The results of this inquiry provide an evidence-based blueprint for policymakers and interventionists seeking to address prostate and colorectal cancer among men.

Complementary and Alternative Medicine Use by Normal Weight, Overweight, and Obese Patients with Arthritis or Other Musculoskeletal Diseases.

OBJECTIVES: The Centers for Disease Control and Prevention estimates that 50 million Americans have been diagnosed with arthritis and other musculoskeletal diseases. The purpose of the current study was to (1) estimate the prevalence of overall complementary and alternative medicine (CAM) use and (2) examine the role of body mass index (BMI) on CAM use among normal weight, overweight, and obese persons with chronic lower back pain, chronic neck pain, chronic/rheumatoid arthritis, or musculoskeletal diseases, while controlling for other covariates. DESIGN: Cross-sectional design using secondary data for 9724 adults from the 2007 National Health Interview Survey. Data were weighted and analyzed by using Stata 12 for Windows (Stata Corp., College Station, TX). Descriptive, bivariate, and multivariate logistic regression statistics were computed. PARTICIPANTS: The participants were randomly surveyed from U.S. households. OUTCOME MEASURES: CAM use was measured as reported use of any modality within the five National Center for Complementary and Integrative Health domains. RESULTS: CAM use was statistically significantly associated with female sex; race/ethnicity; having chronic neck pain, lower back pain, or chronic/rheumatoid arthritis; having limitations due to chronic disease; and geographic region (p < 0.05). Factors significantly associated with decreased odds of CAM use included age 50-64 years, income categorized as "other/missing," and having musculoskeletal diseases. Stratification by body mass index suggested increased odds of CAM use among normal/underweight persons with chronic neck pain but decreased odds for those with chronic musculoskeletal diseases. For overweight patients, increased odds of CAM use were significant for chronic lower back pain, musculoskeletal diseases, and chronic/rheumatoid arthritis. CONCLUSIONS: Musculoskeletal diseases and arthritis represent important public health problems with economic implications for the well-being of individuals and society. Identifying CAM use trends by patient weight can be used to improve strategies to increase awareness and access to CAM as part of comprehensive and cost-effective approaches for the management and treatment of these conditions.

Early Versus Delayed Mortality among HIV Infected Patients Initiating Highly Active Antiretroviral Therapy in Tanzania.

Development of HAART in the mid-1990's and its continued scale up has revolutionized the treatment of HIV-infected patients and led to remarkable reductions in HIV associated morbidity and mortality. However, recent studies have suggested a higher risk for early mortality in adults receiving ART in low-income countries as compared to those in high-income countries. There is dearth of data from developing countries where the burden of disease is high. The objective is to describe the burden and correlation between early vs. delayed mortality associated with HIV/AIDS in resource poor settings using data from Tanzania in East Africa. We performed a cross-sectional evaluation of routinely collected program data for 991 HIV-positive deceased adult patients who were placed on ART treatment, and died between January 1, 2007 and December 31, 2012. Data used were abstracted from records of patients who were treated at six health facilities in the Lake-zone Region of Tanzania in the timeframe. Bivariate and multivariate regression models were used to identify independent predictors of mortality and to calculate odds ratios. From the population, early deaths (within 3 months of ART initiation) occurred in 359 of the 991 cases, which represented 36.2%; while delayed deaths (after 3 months of ART initiation) occurred in 632 of 991 (63.8%). The average time to death for those who died within 3 months was 1 month compared to 22 months among those who died at > 3 months since initiation of ARV. In multivariate analysis, patients who were on WHO stage IV, had fever and cough symptoms at 6 months prior to death and patients with 0-1, 2-3, and 4-6 clinic visits had a higher risk of death in the first 3 months. Mortality among patients started on ART seems to be high. Where possible, healthcare providers should do more to vigorously monitor patients before starting them on ART for better outcomes. Additionally, public health efforts to encourage early testing and entry into treatment must be scaled up in resource poor countries to gain some lead-time and to keep the virus under control, sustain immune function, and delay the onset of opportunistic infections.

Health-Risk Behaviors and Dating Violence Victimization: An Examination of the Associated Risk Behaviors Among Detained Female Youth.

There are many health-risk behaviors that may elevate the risk of adolescents engaging in teenage dating violence. The purpose of this investigation was to examine the health-risk behaviors that are associated with a sample of female juvenile offenders to identify the extent to which those behaviors contribute to dating violence. The survey assessed respondents' health-risk behaviors prior to incarceration, their perceptions of quality of life, post-incarceration expectations, psychosocial factors, and other social determinants. Results indicated youth exposure to dating violence, alcohol, drug, and risky sexual behaviors in the year prior to incarceration. These findings demonstrate the need to address teen dating violence with at-risk adolescents in addition to risky behaviors.

Epidemiology of Cervical Squamous Intraepithelial Lesions in HIV Infected Women in Kenya: a cross-Sectional Study.

Cervical cancer is the second most common cancer among women worldwide. Infection with the human immunodeficiency virus (HIV) and its related immunosuppression are associated with an increased risk of prevalent, incident, and persistent squamous intraepithelial lesions (SILs) of the cervix. The objective of the study was to describe the prevalence and predictors of high-risk HPV and cervical cancer to support the need for strengthening cervical cancer screening programs for HIV infected women in Kenya. A cross sectional study was conducted in a hospital in Central Kenya, Kiambu district. The study population constituted of HIV positive women attending the ART treatment clinic. A total of 715 HIV positive women initiated on Antiretroviral Therapy (ART) were enrolled in this study. About 359 (52.1%) were less than 40 years of age and 644 (90.3%) of the patients were widowed. About 642 (92.6%) of the HIV infected women were in follow-up period of ≥ 1 year. The outcome/prognosis of the patients undergoing ICC was 3 cured, 5 good and 4 poor respectively. In a multivariable ordinal logistic regression analysis showed that for a one-unit decrease of CD4, we expect 1.23 log odds of increasing the severity of cervical cancer (B = 1.23, P < 0.0 15), given that all of the other variables in the model are held constant. In conclusion screening of all HIV infected women, who are under HIV care and treatment, enrolling patients on HAART with higher CD4 counts is recommended to see the net effect of HAART response.

Complementary and Alternative Medicine Use Among Overweight and Obese Cancer Survivors in the United States.

PURPOSE: The purpose of the study was to determine the prevalence of complementary and alternative medicine (CAM) use among US cancer survivors; examine whether use varies by underweight/normal weight, overweight, and obese body mass index status; determine reasons for use; and document disclosure rates of CAM use to medical professionals. METHODS: Data for 1785 cancer survivors were obtained from the 2007 National Health Interview Survey and CAM supplement. The prevalence and associations of CAM use in the previous 12 months were compared among underweight/normal weight, overweight, and obese adult cancer survivors. RESULTS: Nearly 90% of cancer survivors used at least one type of CAM therapy in the 12 months preceding the survey. Those who were overweight, but not obese, were more likely to use a CAM modality compared to normal/underweight respondents. Over two thirds (71%) reported using CAM therapy for general health and wellness and 39.3% used CAM because a health care provider recommended it. Disclosure rates of CAM use to conventional medical professionals varied widely by CAM modality. CONCLUSIONS: An overwhelming majority of US cancer survivors use CAM for a variety of reasons. Overweight cancer survivors may be more likely to use CAM than those who are underweight, normal weight, or obese. Cancer survivors should be screened by medical providers for the use of CAM therapies; furthermore, prospective clinical research evaluating the efficacy and safety of biologically based CAM therapies, often used by cancer survivors, is important and necessary for the well-being of this population.

Does race alter the relationship between Hba1c and glucose in type 2 diabetes?

OBJECTIVE: Hemoglobin Alc (HbAlc) is the standard measurement of glycemic control, and the HbAlc value can be used to estimate average glucose using a formula. Several studies suggest that the relationship between average glucose and HbAlc may be different for Blacks. This project enrolled non-Hispanic black and white individuals with type 2 diabetes and evaluated the relationship between HbAlc and blood glucose. METHOD: 22 black and 29 white adults with type 2 diabetes were included in the analysis. Approximately 42 measurements (fasting and postprandial glucose) were collected over three months and compared to HbAl1 of the third month. The effect of race was evaluated by ANCOVA and X2 analysis testing the slope and intercepts simultaneously for HbA1c and its relationship to fasting glucose and to postprandial glucose. RESULTS: The relationship between HbAlc and glucose was not statistically significantly different between Blacks and Whites (ANCOVA: P = 0.968 for fasting glucose, P = 0.428 for postprandial glucose), allowing us to calculate estimated fasting and postprandial glucose disregarding race. For fasting glucose, the linear regression is FGmgiadl = (18.939 X HbAlc%) - 1.864, R2 = 0.586, P < 0.0001. For postprandial glucose, the linear regression is In(PPG mg,dl) (1.261 X In(HbA1c%)) + 2.555, R2 = 0.614, P < 0.0001. Predicted values for postprandial glucose based on HbA1c were similar to estimated average glucose values reported by ADAG. CONCLUSION: This study reinforces the A1c-Derived Average Glucose (ADAG) group finding that the relationship between HbA1c and glucose is similar in non-Hispanic black and white adults with type 2 diabetes.