Physical activity patterns among U.S. adults with and without serious psychological distress.

OBJECTIVE: A physically active lifestyle is recommended for overall health--both physical and mental. Serious psychological distress (SPD) is associated with adverse health behaviors. We compared patterns of physical activity (PA) among adults with and without SPD using current public health guidelines for PA and examined whether adults with SPD were physically active at recommended levels. METHODS: We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to assess SPD using the Kessler 6 (K6) scale of nonspecific psychological distress and PA categories based on the 2008 U.S. Department of Health and Human Services guidelines. Complete data were available for 78,886 adults in 16 states that used an optional BRFSS mental illness and stigma module containing the K6 scale. We performed multiple logistic regression analyses to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: The unadjusted prevalence of SPD was 3.9% (95% CI 3.6, 4.2), and the age-adjusted prevalence of SPD was 3.8% (95% CI 3.5, 4.1). After adjusting for age, sex, race/ethnicity, education, employment, body mass index, smoking status, and heavy drinking, adults with SPD were significantly less likely to be physically active at recommended levels than adults without SPD. PRs were attenuated but remained significant after further adjustment for limitations to PA. CONCLUSION: Adults with SPD are less likely to meet current PA recommendations than adults without SPD, highlighting the need for targeted interventions.

Comparing Stage at Diagnosis Among Patients With Breast Cancer Served by Military and Civilian Medical Care Systems.

BACKGROUND: Breast cancer (BC) remains one of the top causes of cancer-related deaths in women in the United States, and little is known about the differences in access to health care between military and civilians. This study compared the differences in access to health care between military and civilian female patients with BC. In particular, this study examined whether patients with BC, in an equal access health care system such as the military, are diagnosed at an earlier stage of disease process in comparison to the patients with BC in the civilian health care system. METHODS: Independent variables included military versus civilian care and demographic variables. Dependent variable was the stage of cancer at diagnosis. This cross-sectional study of 2 groups included data from 2198 women with BC (439 military and 1759 civilian) for years 2004 through 2008. Multiple logistic regression was used to analyze the data. RESULTS: There was no difference in the early BC stage (0, I, and II) diagnosis prevalence rate between the military and the civilian groups (95% confidence interval [CI], P = .15). The logistic regression analysis indicated that both the health systems had equal performance with respect to the stage at diagnosis indicator but found that black patients had higher odds of being in the late stage (III and IV) BC group at diagnosis (1.62 OR, 1.14-2.30 CI, P = .0068) than white patients. CONCLUSIONS: Although no difference was found between the performance of the 2 health systems in the early (0, I, and II) versus late stage (III and IV) at diagnosis indicator, this study further confirms the existence of racial disparities in late-stage BC regardless of whether the patient was diagnosed in the civilian or military health system. More research is needed to further investigate the potential explanations of racial disparities other than just differences in access to health care.

Differences in male breast cancer stage, tumor size at diagnosis, and survival rate between metropolitan and nonmetropolitan regions.

Although the incidence for breast cancer in men is lower than for women, male breast cancer (MBC) patients are diagnosed at a later stage and have a higher mortality rate than women. This study examined male cases reported from 1988 through 2006 in the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute for differences in cancer stage, tumor size at diagnosis, and survival rate between metropolitan and nonmetropolitan regions. Pearson's chi-square was used to evaluate differences in stage and tumor size at diagnosis. Cox proportional hazards regression was used to assess survival differences after adjusting for confounders (race, marital status, median family income, age, and education). Regional differences in tumor grade size and stage at diagnosis were not statistically significant; however, survival differences were observed between metropolitan and nonmetropolitan regions. An interaction between nonmetropolitan area and regional stage MBC was a significant predictor of poorer survival. Raising awareness of MBC in nonmetropolitan areas could save the lives of many men and action should be taken to improve health care access, treatment, and thus prognosis in this population.

Role of Pap Test terminology and age in the detection of carcinoma invasive and carcinoma in situ in medically underserved California women.

Our goals were to evaluate Pap Test findings classified by the Bethesda system, and follow up biopsies from participants in the California Breast and Cervical Cancer Control Program (Ca-BCCCP) for: 1) correlation in the detection of carcinoma in situ (CIS) and carcinoma invasive (CI), and 2) age-related trends, with discussion in the context of the 2001 ASCCP Management Guidelines. Women (n = 52,339) who had their initial screening Pap Tests with Ca-BCCCP between January 1995-December 1999 were followed for diagnostic services through December 2000. Descriptive and analytical methods were used in the analysis. Of the Pap results, 81.9% were negative, 10.6% showed infection, 4.7% showed an epithelial abnormality as defined by the Bethesda system (atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL)), 0.1% showed squamous-cell cancer (SCC), and 2.7% showed other or unsatisfactory. Subsequent to the initial Pap Test, follow-up results of carcinoma in situ (CIS) and carcinoma invasive (CI) accounted for 0.36% and 0.05% of the population, respectively. Among HSIL Pap Tests (n = 285), 40.7% had follow-up showing CIS. Among SCC Pap Tests, 17.9% had follow-up results of CIS and 28.6% CI. Of the 191 patients with CIS as a follow-up finding, the initial Pap smear showed: HSIL 60.7%, SCC 2.6%, LSIL 10.5%, ASCUS 13.6%, and negative or infection 9.9%. Of the 27 patients with CI, the initial Pap Test showed: HSIL 40.7%, SCC 29.6%, LSIL 7.4%, ASCUS 7.4%, and negative or infection 11.1%. Pap diagnoses of other or unsatisfactory accounted for 2.6% of the Pap results from patients with CIS and 3.7% of Pap results from patients with CI. Except for LSIL, there was an increasing age trend in the number of cases in each of Pap results, with the exception of age 65+ yr. However, the ratio of LSIL and ASCUS to negative cases decreased with age. (P < 0.0001 and 0.0293, respectively). HSIL Pap results indicate a reasonably high probability of CIS and CI. However, approximately 1/3 of patients with CIS and 1/4 of patients with CI presented with Pap diagnoses of less severity than HSIL. When a negative Pap Test result is chosen as reference group, there is a negative age trend for LSIL and ASCUS, and no age trend for other results. These findings all have important implications in the design of follow-up strategies, and support the 2001 ASCCP Consensus Guidelines for the Management of Women with Cervical Abnormalities.