Experiences of sexual violence and their associations with suicidal ideation and behavior in the past year: an analysis of adults from the 2021 Ace Community Survey.

BACKGROUND: This research assessed forms of sexual violence and their associations with suicidal ideation among adults identifying on the asexual identity spectrum. METHODS: A secondary data analysis was conducted among adults, identifying on the asexual spectrum of asexual, gray-asexual, or demisexual, from the 2021 Ace Community Survey (n = 8,715). Multiple logistic regression analyses determined potential associations between sexual violence and suicidal ideation, adjusting for the covariates of age group, gender, education, racial/ethnic minority, employment, and asexual spectrum identity. RESULTS: Demisexual individuals were at statistically greater odds of suicidality compared to gray-asexual and asexual individuals. Sexual violence victims were more likely to be suicidal compared to non-victims. This was especially true for attempted rape and suicidal consideration (OR = 2.10, 95% CI (1.60, 2.75), planning (OR = 1.76, 95% CI (1.32, 2.34), and attempts (OR = 3.15, 95% CI (2.07, 4.81). CONCLUSIONS: Asexual victims of sexual violence were more likely to be suicidal compared to non-victims. Demisexual individuals were more likely to be suicidal compared to asexual individuals. These findings demonstrate the need for additional research on sexual violence and suicide.

START versus SALT Triage: Which is Preferred by the 21st Century Health Care Student?

IntroductionWhile the art and science of disaster triage continue to evolve, the education of the US health care student in matters pertaining to disaster preparedness and response remains stifled. Unfortunately, these students will be assuming major decision-making responsibilities regarding catastrophes that will be complicated by climate change, nuclear threats, global terrorism, and pandemics. Meanwhile, Sort, Assess, Life-Saving Interventions, Treatment, and/or Transport (SALT) triage is being advocated over the globally popular Simple Triage and Rapid Treatment (START) algorithm for multiple reasons: (1) it's an all-hazard approach; (2) it has four medical interventions; and (3) it has an additional triage color for victims with non-survivable injuries.Hypothesis/ProblemAs present-day threats become more ominous and health care education emphasizes the needs of vulnerable populations and palliative care, the authors hypothesize that, when given a choice, health care students will prefer SALT triage. METHODS: A convenience sample of 218 interprofessional, disaster-naïve health care students received just-in-time, unbiased education on both START and SALT triage systems. Students then completed a survey asking them to decide which triage system they believe would be most effective in their community. RESULTS: A total of 123 health care students (56.4%) preferred SALT while 95 (43.6%) preferred START; however, only the physician assistant students showed a statistically significantly preference (28 versus six, respectively; P=.042). Interestingly, there was also a statistically significant difference in preference by gender (Chi-square=5.02; P=.025) of the observed distribution versus expected distribution in SALT and START. The females preferred SALT (61.0%) while the males preferred START (55.9%).Among those who preferred START, START being easier to learn was the most important reason cited. Among those who preferred SALT, the most important reason cited was that the number of patient triage categories seemed more logical, comprehensible, and consistent with traditional medical care. CONCLUSION: While SALT's preference among females and physician assistant students was based on the addition of medical interventions and the provision of palliative care, START's preference was related to expediency. Based on this research, incorporating disaster concepts into US health care students' curricula encourages thoughtful consideration among the future health care leaders about the most effective approach to triage care. It is critical that further research be completed to determine, without reservation, which triage system will not only save the most lives but provide the most humane care to victims.Fink BN, Rega PP, Sexton ME, Wishner C. START versus SALT triage: which is preferred by the 21st century health care student? Prehosp Disaster Med. 2018;33(4):381-386.

Immersive simulation education: a novel approach to pandemic preparedness and response.

Pandemic management involves strategic and tactical concepts rarely experienced with other disasters. To comprehend the enormity of these tasks and experience the critical decision-making required, local public health and other stakeholders participate in tabletop and functional exercises. Students in Master of Public Health (MPH) programs not only rarely experience this educational format, but also are seldom afforded substantive time to appreciate the critical decision making that is unique to pandemics. An immersive semester-long simulation exercise was created to educate graduate public health students about pandemics. Students in a MPH course were divided into groups representing county health departments. During the semester, students collaborated and completed incident command training, received audio lectures, and materials concerning an imminent pandemic. The students then participated in the 2.5-hr facilitated tabletop exercises in the classroom. A survey was developed to assess their perceptions of the experience. Most students felt more knowledgeable afterward and thought that this training style was innovative, entertaining, educational, and recommended it to fellow students and colleagues. The students believed that delivering a tabletop exercise in this fashion was educational and entertaining. It gave the students a better appreciation of the role of public health in managing the complexities associated with pandemics.

Genetic variation in multiple biologic pathways, flavonoid intake, and breast cancer.

PURPOSE: We previously reported an inverse association between flavonoid intake and breast cancer incidence, which has been confirmed by others, but no studies have considered simultaneously potential interactions of flavonoids with multiple genetic polymorphisms involved in biologically relevant pathways (oxidative stress, carcinogen metabolism, DNA repair, and one-carbon metabolism). METHODS: To estimate interaction effects between flavonoids and 13 polymorphisms in these four pathways on breast cancer risk, we used population-based data (n = 875 cases and 903 controls) and several statistical approaches, including conventional logistic regression and semi-Bayesian hierarchical modeling (incorporating prior information on the possible biologic functions of genes), which also provides biologic pathway-specific effect estimates. RESULTS: Compared to the standard multivariate model, the results from the hierarchical model indicate that gene-by-flavonoid interaction estimates are attenuated, but more precise. In the hierarchical model, the average effect of the deleterious versus beneficial gene, controlling for average flavonoid intake in the DNA repair pathway, and adjusted for the three other biologically relevant pathways (oxidative stress, carcinogen metabolism, and one-carbon metabolism), resulted in a 27 % increase risk for breast cancer [odds ratio = 1.27; 95 % confidence interval (CI) = 0.70, 2.29]. However, the CI was wide. CONCLUSIONS: Based on results from the semi-Bayesian model, breast cancer risk may be influenced jointly by flavonoid intake and genes involved in DNA repair, but our findings require confirmation.

Nutrient pathways and breast cancer risk: the Long Island Breast Cancer Study Project.

The relative importance of biochemical pathways has not been previously examined when considering the influence of diet on breast cancer risk. To address this issue, we used interview data from a population-based sample of 1463 breast cancer cases and 1500 controls. Dietary intake was assessed shortly after diagnosis using a 101-item food frequency questionnaire. Age- and energy-adjusted odds ratios (ORs) for individual micro- and macronutrients were estimated with logistic regression. Hierarchical modeling was used to account for biologically plausible nutrient pathways (1-carbon metabolism, oxidative stress, glycemic control, and phytoestrogens). Effect estimates from hierarchical modeling were more precise and plausible compared to those from multivariable models. The strongest relationship observed was for the glycemic control pathway, but confidence intervals (CI) were wide [OR (95% CI): 0.86 (0.62, 1.21)]. Little or no effect was observed for the 1-carbon metabolism, oxidative stress, and phytoestrogen pathways. Associations were similar when stratified by supplement use. Our approach that emphasizes biochemical pathways, rather than individual nutrients, revealed that breast cancer risk may be more strongly associated with glycemic control factors than those from other pathways considered. Our study emphasizes the importance of accounting for multiple nutrient pathways when examining associations between dietary intake and breast cancer.

School superintendents' perceptions of schools assisting students in obtaining public health insurance.

BACKGROUND: Superintendents' perceptions regarding the effect of health insurance status on academics, the role schools should play in the process of obtaining health insurance, and the benefits/barriers to assisting students in enrolling in health insurance were surveyed. Superintendents' basic knowledge of health insurance, the link between health and learning, and specific school system practices for assisting students were also examined. METHODS: A 4-page questionnaire was sent to a national random sample of public school superintendents using a 4-wave postal mailing. RESULTS: Only 19% of school districts assessed the health insurance status of students. School districts' assistance in helping enroll students in health insurance was assessed using Stages of Change theory; 36% of superintendents' school districts were in the action or maintenance stages. The schools most often made health insurance materials available to parents (53%). The perceived benefits identified by more than 80% of superintendents were to keep students healthier, reduce the number of students with untreated health problems, reduce school absenteeism, and improvement of students' attention/concentration during school. The 2 most common perceived barriers identified by at least 50% of superintendents were not having enough staff or financial resources. CONCLUSIONS: Most superintendents believed schools should play a role in helping students obtain health insurance, but the specific role was unclear. Three fourths of superintendents indicated overwhelmingly positive beliefs regarding the effects of health insurance status on students' health and academic outcomes. School personnel and public policy makers can use the results to support collaboration in getting students enrolled in health insurance.

Early stage breast cancer and its association with diet and exercise-related perceptions and behaviors to prevent recurrence.

BACKGROUND: The favorable prognosis for early stage breast cancer survivors may be a reason for the minimal research regarding their quality of life. Prior research has observed more long-term weight gain among early stage survivors compared to cancer-free women of a similar age. It would be useful to study survivors' perceptions and reported behaviors regarding diet and exercise to see if there is a correlation with previous studies. METHODS: A sample of 700 breast cancer survivors from Ohio and Michigan was randomly selected from the Northwest Ohio affiliate of the Susan G. Komen For the Cure mailing list and sent a survey for completion. RESULTS: 389 survivors completed the survey and among Stage 1 (50/197 = 25.4%) and Stage 2 survivors (24/105 = 22.9%), a small proportion had a positive correlation between self-reported dietary behaviors and their perceived benefits of eating fruits and vegetables. Similar correlations were observed between their self-reported exercise behaviors and their perceived benefits of exercise (Stage 1: 36/197 = 18.3%, Stage 2: 18/105 = 17.1%). CONCLUSIONS: Regardless of stage, a small proportion of survivors' self-reported dietary and exercise behaviors match their perceived benefits of diet and exercise. Factors such as access, motivation, and lack of co-morbidities among early stage survivors may prevent them from living healthier post-diagnosis. More thorough dietary and clinical measurements will provide greater certainty. Thus, innovative, sustainable programs must be accessible and provide motivation and social support from family, friends, and other survivors to truly improve quality of life.

Analysis of the relationship between diet and exercise beliefs and actual behaviors among breast cancer survivors in northwest ohio.

INTRODUCTION: Studies have shown that a diet high in fruit and vegetable intake, as well as a routine including daily exercise or physical activity, can independently affect relapse rates and survivorship in breast cancer patients. Fruits and vegetables contain powerful anti-oxidant molecules, capable of preventing tumor formation and proliferation. Exercise can lower circulating levels of estrogen, the female hormone responsible for tumor proliferation in the estrogen-sensitive form of the disease. The most beneficial results have been shown in women who exercise and consume a diet rich in fruits and vegetables. We studied the attitudes towards and behaviors related to fruit and vegetable intake and exercise in a cohort of breast cancer survivors in northwest Ohio. MATERIALS AND METHODS: Data were gathered from a survey sent out by the Northwest Ohio Branch of the Susan G. Komen For the Cure Foundation. We assessed and evaluated survivors' self-reported beliefs, attitudes, and behaviors regarding exercise and fruit and vegetable intake. RESULTS: Nearly half of the survivors (46.5%) reported being unsure or in disagreement with the statement "Eating at least 5 servings of fruits and/or vegetables per day will reduce the risk of breast cancer recurrence." Only 46.8% of those in agreement with the previous statement actually report eating at least 5 fruits and/or vegetables per day. With respect to exercise, 32.9% reported being unsure or in disagreement with the statement "Engaging in regular physical activity will reduce the risk of breast cancer recurrence." Only 68.5% of those in agreement with the previous statement report any physical activity in the past 30 days. CONCLUSIONS: Many breast cancer survivors do not appear to be aware of the benefits of diet and exercise. Further, a large proportion of those who are aware of the benefits do not adapt a healthy diet and exercise as part of their lifestyle. A majority of these survivors see a primary care physician, which we believe is the best venue to bridge this education gap. It is apparent by the pattern our data shows that more needs to be done to educate breast cancer survivors about the benefits of exercise and fruit and vegetable intake. Steps need to be taken to ensure that those who are educated also remain motivated to engage in a healthy lifestyle with the hopes of avoiding breast cancer recurrence.

Dietary flavonoid intake and breast cancer survival among women on Long Island.

BACKGROUND: Laboratory research and a growing number of epidemiologic studies have provided evidence for a reduced risk of breast cancer associated with dietary intake of certain classes of flavonoids. However, the effects of flavonoids on survival are not known. In a population-based cohort of breast cancer patients, we investigated whether dietary flavonoid intake before diagnosis is associated with subsequent survival. METHODS: Women ages 25 to 98 years who were newly diagnosed with a first primary invasive breast cancer between August 1, 1996, and July 31, 1997, and participated in a population-based, case-control study (n=1,210) were followed for vital status through December 31, 2002. At the case-control interview conducted shortly after diagnosis, respondents completed a FFQ that assessed dietary intake in the previous 12 months. All-cause mortality (n=173 deaths) and breast cancer-specific mortality (n=113 deaths) were determined through the National Death Index. RESULTS: Reduced hazard ratios [age- and energy-adjusted hazard ratio (95% confidence interval)] for all-cause mortality were observed among premenopausal and postmenopausal women for the highest quintile of intake, compared with the lowest, for flavones [0.63 (0.41-0.96)], isoflavones [0.52 (0.33-0.82)], and anthocyanidins [0.64 (0.42-0.98)]. No significant trends in risk were observed. Results were similar for breast cancer-specific mortality only. CONCLUSION: Mortality may be reduced in association with high levels of dietary flavones and isoflavones among postmenopausal U.S. breast cancer patients. Larger studies are needed to confirm our findings.

Dietary flavonoid intake and breast cancer risk among women on Long Island.

Flavonoids are found in a variety of foods and have anticarcinogenic properties in experimental models. Few epidemiologic studies have examined whether flavonoid intake is associated with breast cancer in humans. In this study, the authors investigated whether dietary flavonoid intake was associated with reduced risk of breast cancer in a population-based sample of US women. They conducted a case-control study among women who resided in Nassau and Suffolk counties on Long Island, New York. Cases and controls were interviewed about known and suspected risk factors and asked to complete a food frequency questionnaire regarding their average intake in the prior 12 months. A total of 1,434 breast cancer cases and 1,440 controls provided adequate responses. A decrease in breast cancer risk was associated with flavonoid intake; the decrease was most pronounced among postmenopausal women for flavonols (odds ratio (OR) = 0.54, 95% confidence interval (CI): 0.40, 0.73), flavones (OR = 0.61, 95% CI: 0.45, 0.83), flavan-3-ols (OR = 0.74, 95% CI: 0.55, 0.99), and lignans (OR = 0.69, 95% CI: 0.51, 0.94). The authors conclude that intake of flavonols, flavones, flavan-3-ols, and lignans is associated with reduced risk of incident postmenopausal breast cancer among Long Island women. These results suggest that US women can consume sufficient levels of flavonoids to benefit from their potential chemopreventive effects.

Construction of a flavonoid database for assessing intake in a population-based sample of women on Long Island, New York.

Flavonoids have been hypothesized to reduce cancer risk. Previous epidemiological studies conducted to evaluate this hypothesis have not assessed all flavonoids, including classes that could contribute to intake among Americans, which would result in an underestimation of intake. This misclassification could mask variability among individuals, resulting in attenuated effect estimates for the association between flavonoids and cancer. To augment flavonoid and lignan intake estimates, we developed a database that can be used in conjunction with a food-frequency questionnaire (FFQ). Coupling information derived from the available literature with the U.S. Department of Agriculture databases, we estimated content of 6 flavonoid classes and lignans for 50 food group items. We combined these estimates with responses from a modified Block FFQ that was self-completed in 1996-1997 by a population-based sample of women without breast cancer on Long Island, New York (n = 1,500). Total flavonoid and lignan content of food items ranged from 0 to 129 mg/100 g, and the richest sources were tea, cherries, and grapefruit. Individual intake estimates, from highest to lowest, were flavan-3-ols, flavanones, flavonols, lignans, isoflavones, anthocyanidins, and flavones. Each class of flavonoids and lignans exhibited a wide range of intake levels. This database is useful to quantify flavonoid and lignan intake for other observational studies conducted in the United States that utilize the Block FFQ.

Fruits, vegetables, and micronutrient intake in relation to breast cancer survival.

OBJECTIVE: To determine whether fruit, vegetable, and micronutrient intake 1 year prior to breast cancer diagnosis is associated with a reduction in the subsequent risk of all-cause or breast cancer-specific mortality. METHODS: Follow-up data from 1,235 invasive breast cancer cases age 25-98 years from the Long Island Breast Cancer Study Project were analyzed. At the 1996-1997 case-control interview, respondents completed a food frequency questionnaire, which assessed dietary intake of fruits, vegetables, and vitamin supplement use in the previous 12 months. All-cause mortality (n=186 deaths) and breast cancer-specific mortality status (n=125 deaths, 67.2%) were determined through December 31, 2002. RESULTS: Hazard ratios (HRs) for all-cause mortality were insignificantly reduced for intake of any fruits, fruit juices, and vegetables (HR=0.68, 95% CI: 0.42-1.09) and leafy vegetables (HR=0.72, 95% CI: 0.41-1.24) among post-menopausal women only. Both of these associations were more pronounced among those with ER+PR+ tumors (HR=0.54, 95% CI: 0.27-1.10, and HR=0.66, 95% CI: 0.33-1.31, respectively). Similar associations were observed for breast cancer-specific mortality. CONCLUSIONS: In a cohort of women diagnosed with breast cancer, higher intake of fruits, vegetables, and micronutrients was associated with a non-significant survival advantage in post-menopausal women only.