COVID-19 Vaccine Uptake Among People Living with HIV.

People living with HIV (PLWH) are at greater risk for severe COVID-19 and are a priority population for COVID-19 vaccination. As of June 15, 2021, 61.6% of PLWH in Oregon received ≥ 1 COVID-19 vaccine dose. Younger PLWH, Hispanic/Latinx PLWH and PLWH who inject drugs or reside in rural and frontier areas had low vaccine uptake while PLWH who were engaged in care, enrolled in the AIDS Drug Assistance Program, and vaccinated against influenza had high vaccine uptake. Greater advocacy, education, and care navigation are required to increase COVID-19 vaccine access and uptake among PLWH.

Impact of COVID-19 Among Immigrant and Communities of Color Living with HIV in Oregon, 2020: Two Pandemics Rooted in Racism.

Over 8100 people living with HIV (PLWH) in Oregon are at risk of acquiring COVID-19, and communities of color are disproportionately impacted by both COVID-19 and HIV. This study identifies factors associated with a positive COVID-19 test among PLWH in Oregon, with the goal of promoting health equity. We probabilistically linked COVID-19 laboratory results with laboratory-confirmed HIV cases. Crude and adjusted risk ratios of having a COVID-19 diagnosis were calculated for each covariate. Almost 6% of the 2390 PLWH tested for COVID-19 had a positive COVID-19 result. PLWH with positive results tended to identify as American Indian/Alaska Native or Hispanic/Latinx. Younger (age < 50) immigrant PLWH were more than twice as likely to have a positive COVID-19 result than did older (age ≥ 50) US-born PLWH. The pandemic has magnified disparities among American Indian/Alaska Native, Latinx, and younger immigrant PLWH. Dismantling institutional racism and redistributing power are strategies that could be considered to help reduce health disparities.

The Impact of the SARS-CoV-2 Pandemic on Human Immunodeficiency Virus and Bacterial Sexually Transmitted Infection Testing and Diagnosis in Oregon.

ABSTRACT: Human immunodeficiency virus, Neisseria gonorrhoeae/Chlamydia trachomatis, and syphilis testing decreased with the implementation of mitigation measures for SARS-CoV-2 and did not return to 2019 levels by September 2020. However, primary and secondary syphilis diagnoses increased during mitigation measures. Sexual health services are essential during the SARS-CoV-2 pandemic.

Patterns of cancer genetic testing: a randomized survey of Oregon clinicians.

Introduction. Appropriate use of genetic tests for population-based cancer screening, diagnosis of inherited cancers, and guidance of cancer treatment can improve health outcomes. We investigated clinicians' use and knowledge of eight breast, ovarian, and colorectal cancer genetic tests. Methods. We conducted a randomized survey of 2,191 Oregon providers, asking about their experience with fecal DNA, OncoVue, BRCA, MMR, CYP2D6, tumor gene expression profiling, UGT1A1, and KRAS. Results. Clinicians reported low confidence in their knowledge of medical genetics; most confident were OB-GYNs and specialists. Clinicians were more likely to have ordered/recommended BRCA and MMR than the other tests, and OB-GYNs were twice as likely to have ordered/recommended BRCA testing than primary care providers. Less than 10% of providers ordered/recommended OncoVue, fecal DNA, CYP2D6, or UGT1A1; less than 30% ordered/recommended tumor gene expression profiles or KRAS. The most common reason for not ordering/recommending these tests was lack of familiarity. Conclusions. Use of appropriate, evidence-based testing can help reduce incidence and mortality of certain cancers, but these tests need to be better integrated into clinical practice. Continued evaluation of emerging technologies, dissemination of findings, and an increase in provider confidence and knowledge are necessary to achieve this end.

Family history of colorectal cancer: clinicians' preventive recommendations and patient behavior.

Few population-based studies have addressed the role that family history of colorectal cancer (CRC) plays in clinician decision making or patient health choices. The objective of this study was to evaluate the effect of family history of CRC on clinician practice, patient CRC screening, and patient preventive behavior. We analyzed 2008 Oregon Behavioral Risk Factor Surveillance System data to examine associations between family history of CRC and 1) patient-reported clinician recommendations, 2) perceived risk of developing CRC, 3) adoption of preventive and screening behaviors, and 4) CRC risk factors among 1,795 respondents without CRC. A family history of CRC was positively associated with a higher likelihood of respondents reporting that their clinicians discussed colorectal cancer screening (OR, 4.2; 95% CI, 2.4-7.4) and of respondents having colorectal screening within the recommended time period (OR, 2.2; 95% CI, 1.3-3.9). A family history of CRC was also associated with respondents reporting lifestyle changes to prevent CRC (OR, 2.6; 95% CI, 1.7-4.0). A family history of CRC may prompt clinicians to recommend screening and preventive behavior changes and motivate patients to adopt such strategies.

Influence of family history of diabetes on health care provider practice and patient behavior among nondiabetic Oregonians.

INTRODUCTION: People with a family history of diabetes are at increased risk of developing diabetes; however, the effect of family history of diabetes on health care provider practice and patient behavior has not been well defined. METHODS: We analyzed data from the 2005 Oregon Behavioral Risk Factor Surveillance System, a state-based, random-digit-dialed telephone survey, to evaluate, among people with diabetes, associations between family history of diabetes and 1) patients' reports of health care provider practices, 2) patients' perceived risk of developing diabetes, and 3) patients' behaviors associated with an increased risk of developing diabetes. RESULTS: Compared with respondents at average risk, respondents with a positive family history (strong or moderate familial risk for diabetes) were more likely to report that their health care provider collects family history information about diabetes, discusses the risk of developing diabetes or other chronic conditions, and makes recommendations to change their diet or exercise behaviors to reduce the chance of developing diabetes. Respondents with a strong family history of diabetes were 5 times more likely to be very or somewhat worried about developing diabetes than were people at average risk (odds ratio [OR], 5.0; 95% confidence interval [CI], 4.0-6.2). Compared with respondents at average risk, respondents with a strong family history were more likely to report making changes in diet and exercise (OR, 1.7; 95% CI, 1.4-2.1). CONCLUSION: Integrating family history of diabetes into clinical practice offers opportunities to improve the effectiveness of diabetes detection and to promote interventions aimed at preventing or delaying the development of diabetes in people at high risk.

Health-related information on the Web: results from the HealthStyles Survey, 2002-2003.

INTRODUCTION: The World Wide Web is being used increasingly as a resource for accessing health-related information. In our study, we identified types of health-related Web sites visited most often, determined how often patients shared Web-accessed health information with their doctors, and examined factors that encouraged Internet use for locating health-related information. We also compared health-related Internet use among people who did not have any type of chronic disease with people who reported having one or more chronic diseases. METHODS: We merged data from the 2002 and 2003 HealthStyles surveys to generate frequency and descriptive statistics and used multivariate logistic regression to estimate odds ratios. RESULTS: Approximately 35% of survey participants reported using the Internet to search for health-related information. Among them, the Web sites visited most often included health information portals, government agencies, and nonprofit organizations. About 53% reported that they "sometimes" shared Internet information with their doctors. The most important features of the Internet that would encourage its use for health information were ease of finding and using the information and clarity of the information provided. Internet use differed by sex and age and was strongly associated with income and education. Respondents who reported having a chronic disease (odds ratio [OR] = 1.30; 95% confidence interval [CI], 1.16-1.45) were more likely to use the Internet to access health-related information, especially among those with depression (OR = 1.47; 95% CI, 1.27-1.71) and high cholesterol (OR = 1.18; 95% CI, 1.02-1.37). In addition, respondents who reported having two or more chronic diseases (OR = 1.35; 95% CI, 1.16-1.56) were more likely to search for online health information than respondents who reported having no chronic disease. CONCLUSION: Public health professionals have a unique opportunity to use the Internet as a tool to complement and supplement the health information that the public receives from health care professionals.

Perceived likelihood of developing diabetes among high-risk Oregonians.

INTRODUCTION: Prevention of diabetes in people at highest risk for developing the disease is an important public health opportunity, considering the disease's increasing prevalence, its devastating impact on health and its high economic cost, the availability of efficacious and cost-effective treatments to reduce complications, and recent evidence that it can be delayed or prevented with lifestyle interventions. METHODS: The Oregon Diabetes Prevention and Control Program collected and analyzed responses from a statewide telephone survey conducted in 2003 to determine whether Oregon adults at highest risk for diabetes 1) believed that they were at risk for developing diabetes in the future, 2) had talked with a health care professional about diabetes, and 3) had been tested for the disease. Pearson chi-square tests and logistic regression analyses were conducted to identify independent associations of select characteristics with the study factors of interest. RESULTS: Even among respondents at highest risk for developing diabetes, at most one third reported being concerned about developing diabetes, one fifth reported having discussed their risk with a health professional in the previous year, and less than half reported having been tested for diabetes by a health provider in the previous year. After adjusting for multiple factors, we found that having a family history of diabetes was consistently associated with perceived risk of developing diabetes, discussion about diabetes with a health professional, and diabetes testing. CONCLUSION: Many Oregon adults at high risk for developing diabetes are unconcerned about their risk for developing the disease, and few have discussed their risk of diabetes with a health professional. Findings from this study suggest the need for increased recognition of future diabetes risk by high-risk individuals and health professionals to help translate diabetes prevention into practice.

Association of acculturation with cesarean section among Latinas.

OBJECTIVES: Examine the association of acculturation and cesarean section after adjusting for clinical and non-clinical factors that could influence clinical discretion in performing the surgery. METHODS: A sample of 2102 low-risk, low-income primarily Mexican Latinas in San Diego County was divided into two groups: primiparas and multiparas. For each parity group, logistic regression was used to assess the association of acculturation and cesarean section. RESULTS: Among multiparous Latinas, the risk of cesarean section for highly acculturated women exceeded the risk for the less-acculturated women, but the result was reverse for primiparous women. The adjusted relative odds of cesarean section were twice as high [OR 2.1, 95%CI 1.1-4.1] for multiparous US-born Latinas relative to multiparous Spanish-speaking women born in Mexico. While for primiparous women this same comparison showed US-born Latinas to be approximately half as likely to have a cesarean delivery [OR 0.4, 95%CI 0.2-0.7]. CONCLUSIONS: In order to reduce the chances of unnecessary cesarean sections among Latinas, the role of acculturation in women who have and have not already given birth needs to be investigated further.

Relationships among community characteristics and walking and bicycling for transportation or recreation.

PURPOSE: Compare walking and bicycling for transportation and recreation with the percentage of the community devoted to parklands. METHODS: Behavioral Risk Factor Surveillance System (N = 206,992), Nationwide Personal Transportation Survey (N = 409,025), and Trust for Public Land (N = 55) data were used to estimate recreational walking and bicycling, utilitarian walking and bicycling, and parkland as a percentage of city acreage. Data were linked at the metropolitan statistical area or city level (N = 34). Pearson correlation coefficients were used to assess the associations among recreational and utilitarian walking and bicycling and parkland acreage. RESULTS: Utilitarian walking and bicycling and parkland acreage were significantly correlated (r = .62, p < .0001). No significant relationships were observed for leisure time walking or bicycling. DISCUSSION: Communities with more parks had significantly higher levels of walking and bicycling for transportation. Urban design features associated with leisure time physical activity might differ from those associated with transportation-related physical activity. Further studies are needed to articulate the relationships among community attributes and purposes of physical activity.

Ranking of cities according to public health criteria: pitfalls and opportunities.

Popular magazines often rank cities in terms of various aspects of quality of life. Such ranking studies can motivate people to visit or relocate to a particular city or increase the frequency with which they engage in healthy behaviors. With careful consideration of study design and data limitations, these efforts also can assist policymakers in identifying local public health issues. We discuss considerations in interpreting ranking studies that use environmental measures of a city population's public health related to physical activity, nutrition, and obesity. Ranking studies such as those commonly publicized are constrained by statistical methodology issues and a lack of a scientific basis in regard to design.