Longitudinal associations between susceptibility to tobacco use and the onset of other substances among U.S. youth.

We examined whether tobacco susceptibility at Wave (W) 1 (2013-2014) predicts the onset of tobacco and other substances at W2 (2014-2015) among 5325 U.S. youth (12-17 years) never substance users at W1 in the Population Assessment of Tobacco and Health (PATH) Study. Tobacco susceptibility was based on curiosity, use intentions, and response to a best friend's offer to use. Onset of use included past 12-month use of a specific substance or group of substances at W2 among those who had never used any substance at W1. Approximately, 31.3% of W1 youth were susceptible to tobacco use. W2 onset was 8.2% (SE = 0.4) for alcohol exclusively, 5.0% (SE = 0.4) for polysubstance including tobacco, 4.4% (SE = 0.3) for tobacco exclusively, 3.1% (SE = 0.3) for other drugs (misused prescription stimulants and painkillers, cocaine, other stimulants, heroin, inhalants, solvents and hallucinogens) exclusively, 1.4% (SE = 0.2) for polysubstance excluding tobacco, and 0.9% (SE = 0.1) for marijuana exclusively. Tobacco-susceptible compared with non-tobacco susceptible youth had higher odds of onset of exclusive tobacco use (AOR: 2.4; 95% CI: 1.7, 3.3), exclusive alcohol use (AOR: 1.5; 95% CI: 1.2, 1.8), and polysubstance use (AOR: 3.9; 95% CI: 2.8, 5.6 including tobacco and AOR: 1.8; 95% CI: 1.1, 3.0 excluding tobacco) compared with W2 never substance use. In this national study, tobacco susceptibility identified U.S. youth at risk for onset of tobacco and other substances, perhaps reflecting common etiology and clustering of substance use in youth. Identifying and preventing tobacco-susceptible youth from progressing to using addictive substances must remain a public health priority.

HRSA-funded Health Centers Are an Important Source of Care and Reduce Unmet Needs in Primary Care Services.

BACKGROUND: Evidence indicates the unmet need for primary care services including medical, mental health, and dental care is greater among uninsured and Medicaid beneficiaries than privately insured individuals, many of whom use Health Resources and Services Administration-funded health centers (HRSA HCs). OBJECTIVE: We examined differences in rates of unmet need between low-income uninsured and Medicaid patients of HRSA HCs and safety-net clinics in general or private physicians. RESEARCH DESIGN: We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians. SAMPLE: We used a nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care. We used the National Health Interview Survey to independently identify low-income individuals whose usual source of care was clinics (National Health Interview Survey clinics) or physicians (National Health Interview Survey physicians) in the general population. MEASURES: Dependent variables were unmet need and delay in medical care, and unmet need for prescription medications, mental health, and dental care. The primary independent variable of interest was the usual source of care. We controlled for potential confounders. RESULTS: We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs. CONCLUSIONS: HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.

The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening.

OBJECTIVE: Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population. DESIGN: This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture. RESULTS: Participants who had a regular physician and doctor's recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR) = 3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR = 6.61; 95% CI: 2.63, 16.65, respectively). A doctor's recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR = 4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR = 0.15; 95% CI: 0.03, 0.82 and aOR = 0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the'immigrant life,' who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer. CONCLUSIONS: Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.