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Huston-Paterson HH, Mao Y, Tseng CH, Kim J, Bobanga I, Wu JX, Yeh MW. Rural-Urban Disparities in the Continuum of Thyroid Cancer Care: Analysis of 92,794 Cases. Thyroid 2024; 34:635-645. [PMID: 38115602 DOI: 10.1089/thy.2023.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Objective: Rurality is associated with higher incidence and higher disease-specific mortality for most cancers. Outcomes for rural and ultrarural ("frontier") patients with thyroid cancer are poorly understood. This study aimed to identify actionable deficits in thyroid cancer outcomes for rural patients. Methods: We queried linked California Cancer Registry and California Office of Statewide Health Planning and Development databases for patients diagnosed with thyroid cancer (1999-2017). We analyzed time from disease stage at diagnosis, time from diagnosis to surgery, receipt of appropriate radioactive iodine ablation, surveillance status, and overall and disease-specific mortality for urban, rural, and frontier patients. Cox and logistic regression models controlled for clinical and demographic covariates a stepwise manner. All incidence figures are expressed as a proportion of newly diagnosed cases. Results: Our cohort comprised 92,794 subjects: (65,475 women [70.6%]; mean age 50.0 years). Compared to urban patients, rural and frontier patients were more likely to be American Indian, White, uninsured, and from lower quintiles of socioeconomic status (p < 0.01). Distant disease at diagnosis was more common in rural (56.0 vs. 50.4 cases per 1000 new cases, p < 0.01) and frontier patients (80.9 vs. 50.4 per 1000, p < 0.01) compared to urban patients. The incidence of medullary thyroid cancer was greater in rural patients (17.9 vs. 13.6 cases per 1000, p < 0.01) and frontier patients (31.0 vs. 13.6 per 1000, p < 0.01) compared to urban patients. The incidence of anaplastic thyroid cancer was higher in frontier versus urban patients (15.5 vs. 7.1 per 1000, p < 0.01). When compared to urban patients, rural and frontier patients were more often lost to follow-up (odds ratio [OR] 1.69 [confidence interval, CI 1.54-1.85], and OR 3.03 [CI 1.89-5.26], respectively) and had higher disease-specific mortality (OR 1.18 [CI 1.07-1.30], and OR 1.92 [CI 1.22-2.77], respectively). Rural and frontier residence was independently associated with being lost to follow-up, suggesting that it is a key driver of disparities. Conclusion: Compared to their urban counterparts, rural and frontier patients with thyroid cancer present with later-stage disease and experience higher disease-specific mortality. They also are more often lost to follow-up, which presents an opportunity for targeted outreach to reduce the observed disparities in outcomes.
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Affiliation(s)
- Hattie H Huston-Paterson
- Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, USA
- National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Yifan Mao
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Jiyoon Kim
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | | | - James X Wu
- Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Garlapaty AR, Rucinski KJ, Leary E, Cook JL. Do Patients Living in Rural Areas Report Inferior 1-Year Outcomes After Total Knee Arthroplasty? A Matched Cohort Analysis. J Arthroplasty 2023; 38:2537-2540. [PMID: 37659682 DOI: 10.1016/j.arth.2023.08.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Rural status has been associated with poor outcomes for several health problems, but its relationship and outcomes following total knee arthroplasty (TKA) has not been fully characterized. Patient-reported outcomes (PROs) are key measures of success following TKA. Therefore, this matched cohort study was designed to test the hypothesis that patients who live in rural settings will report significantly worse PRO scores 1 year after TKA when compared to those who live in urban or suburban settings. METHODS Patients undergoing TKA at our institution were categorized into urban, suburban, and rural cohorts based on Rural Urban Commuting Area scores using reported living setting zip codes. Cohorts were matched for body mass index classification. Demographic data were extracted from the medical records, and PRO data (Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR), Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health and Mental Health, University of California, Los Angeles (UCLA) Activity Score, and Visual Analog Scale Pain were collected preoperatively and 1-year postoperatively. Comparisons across living settings were made using analysis of variance (ANOVA) tests or Chi-square tests. A total of 882 TKA patients (n = 294 per cohort) were analyzed. RESULTS Patients living in urban areas had significantly lower preoperative pain scores compared to suburban and rural residents. All measured PROs significantly improved from preoperative levels at 1 year post-TKA with no significant differences among living setting cohorts. CONCLUSIONS In cohorts matched for body mass index, living in a rural setting was not associated with inferior PROs 1 year after TKA. LEVEL OF EVIDENCE Level 4, retrospective cohort study.
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Affiliation(s)
- Ashwin R Garlapaty
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Kylee J Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emily Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Bhattacharyya O, Rawl SM, Dickinson SL, Haggstrom DA. A comparison between perceived rurality and established geographic rural status among Indiana residents. Medicine (Baltimore) 2023; 102:e34692. [PMID: 37832101 PMCID: PMC10578664 DOI: 10.1097/md.0000000000034692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/20/2023] [Indexed: 10/15/2023] Open
Abstract
The study assessed the association and concordance of the traditional geography-based Rural-Urban Commuting Area (RUCA) codes to individuals' self-reported rural status per a survey scale. The study included residents from rural and urban Indiana, seen at least once in a statewide health system in the past 12 months. Surveyed self-reported rural status of individuals obtained was measured using 6 items with a 7-point Likert scale. Cronbach's alpha was used to measure the internal consistency between the 6 survey response items, along with exploratory factor analysis to evaluate their construct validity. Perceived rurality was compared with RUCA categorization, which was mapped to residential zip codes. Association and concordance between the 2 measures were calculated using Spearman's rank correlation coefficient and Gwet's Agreement Coefficient (Gwet's AC), respectively. Primary self-reported data were obtained through a cross-sectional, statewide, mail-based survey, administered from January 2018 through February 2018, among a random sample of 7979 individuals aged 18 to 75, stratified by rural status and race. All 970 patients who completed the survey answered questions regarding their perceived rurality. Cronbach's alpha value of 0.907 was obtained indicating high internal consistency among the 6 self-perceived rurality items. Association of RUCA categorization and self-reported geographic status was moderate, ranging from 0.28 to 0.41. Gwet's AC ranged from -0.11 to 0.26, indicating poor to fair agreement between the 2 measures based on the benchmark scale of reliability. Geography-based and self-report methods are complementary in assessing rurality. Individuals living in areas of relatively high population density may still self-identify as rural, or individuals with long commutes may self-identify as urban.
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Affiliation(s)
- Oindrila Bhattacharyya
- Indiana University Purdue University, Department of Economics, Indianapolis, IN, USA
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- The William Tierney Center for Health Services Research, Regenstrief Institute Inc, Indianapolis, IN, USA
| | - Susan M. Rawl
- Indiana University School of Nursing, Indiana University Melvin and Bren Simon Cancer Comprehensive Center, Indianapolis, IN, USA
| | - Stephanie L. Dickinson
- Department of Epidemiology & Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - David A. Haggstrom
- Indianapolis VA HSR&D Center for Health Information and Communication, Roudebush VA, Indianapolis, IN, USA
- Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
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Fowler ME, Kenzik KM, Al-Obaidi M, Harmon C, Giri S, Arora S, Stephenson C, Khushman M, Outlaw D, Bhatia S, Williams GR. Rural-urban disparities in mortality and geriatric assessment among older adults with cancer: The cancer & aging resilience evaluation (CARE) registry. J Geriatr Oncol 2023; 14:101505. [PMID: 37087962 PMCID: PMC10207384 DOI: 10.1016/j.jgo.2023.101505] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Rural-urban disparities persist in cancer mortality, despite improvement in cancer screening and treatment. Although older adults represent the majority of cancer cases and are over-represented in rural areas, few studies have explored rural-urban disparities in mortality and age-related impairments among older adults with cancer. MATERIALS AND METHODS We included 962 newly-diagnosed older adults (≥60 years) with cancer who underwent geriatric assessment (GA) at their first pre-chemotherapy visit to an academic medical center in the Southeastern United States. We used Rural-Urban Commuting Area (RUCA) codes to classify residence at time of diagnosis into urban and rural areas. We used one-year survival and pre-treatment frailty as outcomes. We used Cox proportional hazards regression to evaluate the association between residence and one-year mortality, and logistic regression to evaluate the association between residence and pre-treatment frailty. All tests were two-sided. RESULTS Median age at GA was 68.0 (interquartile rage [IQR]: 64.0, 74.0) years; most had colorectal cancer (24.3%) with advanced stage (III/IV 73.2%) disease. Overall, 11.4% resided in rural and 88.6% in urban areas. Rural areas had a higher proportion of White and less educated participants. After adjustment for age, sex, race, education, employment status, and cancer type/stage, rural residence was associated with higher hazard of one-year mortality (hazard ratio [HR] = 1.78, 95% confidence interval [CI] = 1.23, 2.57) compared to urban residence. Frailty was an effect modifier of this association (HROverall = 1.83, 95% CI = 1.27, 2.57; HRFrail = 2.05, 95% CI = 1.23, 3.41; HRNot Frail = 1.55, 95% CI = 0.90, 2.68). DISCUSSION Among older adults with newly diagnosed cancer, rural residence was associated with reduced one-year survival, particularly among frail older adults. The rural-urban disparities observed in the current study may be due to frailty in conjunction with disparities in social determinants of health across rural and urban areas. Future studies should focus on understanding and intervening on underlying causes of these disparities.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Kelly M Kenzik
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Smith Giri
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
| | - Sankalp Arora
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | | | - Moh''d Khushman
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Darryl Outlaw
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA; Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Building, Birmingham, AL 35233-1771, USA.
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, 1720 2(nd) Avenue South, BDB 860, Birmingham, AL 35294, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7(th) Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, USA.
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Liu A, Garcia-Torres LC, Johnson C, Haver MK, Gwede CK, Christy SM. Cancer screening educational interventions in rural and farmworker communities: a systematic literature review. ETHNICITY & HEALTH 2023; 28:335-357. [PMID: 35499269 PMCID: PMC9626390 DOI: 10.1080/13557858.2022.2056145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/16/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Men and women living in rural communities of the United States (US) are less likely than those in urban or suburban communities to be up to date with cancer screenings. Delayed screening contributes to later stage at diagnosis and higher cancer mortality for individuals living in rural areas. These effects may be compounded in some rural subpopulations (e.g. migrant and seasonal farmworkers). This systematic review examines educational interventions aimed at increasing colorectal, breast, prostate, oral, and/or cervical cancer screening in the rural US, with special consideration for the farmworker subpopulation. DESIGN Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, our systematic literature review employed the following databases: Ovid MEDLINE, CINAHL Complete, Embase, and Web of Science. Search terms included, but were not limited to 'rural,' 'cancer screening,' 'farmworker,' and 'cancer prevention.' Eligible studies featured an educational intervention implemented in agricultural or rural US settings with a cancer screening behavioral outcome, male and/or female participants, and were published in English between 2002 and 2020. Article screening and data extraction were conducted by two independent reviewers. RESULTS Twenty-six articles were eligible. Of the six studies focused on the farmworker population (n=2,732), 61.75% of participants reported Hispanic ethnicity. Of the sixteen studies on unspecified rural communities reporting participant race/ethnicity (n=10,442), 39.29% reported Black/African American race. Efficacious interventions included culturally-targeted educational materials, lay health advisors (LHAs), and components that addressed practical barriers (e.g. financial or logistical). CONCLUSION Results demonstrate the value of LHAs and targeted education to increase screening for multiple cancer types in rural communities. Prospective research should incorporate and facilitate access to screening and provider-level and/or organizational-level interventions to increase overall impact. ABBREVIATIONS HPV: human papillomavirus; LHA: lay health advisors; MeSH: Medical Subject Headings; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT: randomized controlled trial; US: United States.
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Affiliation(s)
- Anni Liu
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | - Caitlyn Johnson
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | - Clement K. Gwede
- Morsani College of Medicine, University of South Florida, Tampa, Florida
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Shannon M. Christy
- Morsani College of Medicine, University of South Florida, Tampa, Florida
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Gomes R, Nederveld A, Glasgow RE, Studts JL, Holtrop JS. Lung cancer screening in rural primary care practices in Colorado: time for a more team-based approach? BMC PRIMARY CARE 2023; 24:62. [PMID: 36869308 PMCID: PMC9982804 DOI: 10.1186/s12875-023-02003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Despite lung cancer being a leading cause of death in the United States and lung cancer screening (LCS) being a recommended service, many patients eligible for screening do not receive it. Research is needed to understand the challenges with implementing LCS in different settings. This study investigated multiple practice members and patient perspectives impacting rural primary care practices related to LCS uptake by eligible patients. METHODS This qualitative study involved primary care practice members in multiple roles (clinicians n = 9, clinical staff n = 12 and administrators n = 5) and their patients (n = 19) from 9 practices including federally qualified and rural health centers (n = 3), health system owned (n = 4) and private practices (n = 2). Interviews were conducted regarding the importance of and ability to complete the steps that may result in a patient receiving LCS. Data were analyzed using a thematic analysis with immersion crystallization then organized using the RE-AIM implementation science framework to illuminate and organize implementation issues. RESULTS Although all groups endorsed the importance of LCS, all also struggled with implementation challenges. Since assessing smoking history is part of the process to identify eligibility for LCS, we asked about these processes. We found that smoking assessment and assistance (including referral to services) were routine in the practices, but other steps in the LCS portion of determining eligibility and offering LCS were not. Lack of knowledge about screening and coverage, patient stigma, and resistance and practical considerations such as distance to LCS testing facilities complicated completion of LCS compared to screening for other types of cancer. CONCLUSIONS Limited uptake of LCS results from a range of multiple interacting factors that cumulatively affect consistency and quality of implementation at the practice level. Future research should consider team-based approaches to conduct of LCS eligibility and shared decision making.
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Affiliation(s)
- Rebekah Gomes
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Russell E Glasgow
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA.,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Jamie L Studts
- Department of Medicine, Division of Medical Oncology, and University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jodi Summers Holtrop
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA. .,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
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A double disparity: Rural sexual minorities and tobacco use among U.S. adults. Addict Behav 2023; 137:107527. [PMID: 36308838 DOI: 10.1016/j.addbeh.2022.107527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/15/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Marginalized groups continue to face an uneven distribution of the risks and consequences of smoking cigarettes, with rural/urban geography and sexual orientation status examined independently. However, little is known about the intersection of rural/urban geography and sexual orientation regarding tobacco use disparities. This study examined rural-urban sexual minority differences in tobacco use in the United States. METHODS Data came from the 2018-2020 Behavioral Risk Factor Survey System (N = 675,221). We estimated cigarette smoking prevalence for each year of survey data by rural/urban status and sexual orientation. Multivariable logistic regressions were used to assess associations of rural/urban location and sexual orientation status with cigarette use. Additional Multivariable logistic regressions were conducted, including stratified analyses by sex on multiple sexual orientation categories. FINDINGS Cigarette smoking was higher among participants who lived in rural areas and identified as lesbian or gay and bisexual. Furthermore, the disparities in smoking rates were significantly different, with 38 % higher odds of smoking among rural sexual minorities than urban sexual minorities (aOR = 1.38, 95 % CI = 1.19, 1.60). Stronger odds of cigarette smoking were found among rural gays or lesbians (aOR = 1.83, 95 % CI = 1.47, 2.28) and rural bisexuals (aOR = 2.40, 95 % CI = 2.03, 2.84) compared to urban straight counterparts. CONCLUSION Findings highlight rural populations, particularly sexual minorities, might have an elevated risk of cigarette use. Prevention and cessation efforts that help these especially disadvantaged groups will be beneficial in addressing tobacco use disparities.
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Hendi AS, Ho JY. Smoking and the widening inequality in life expectancy between metropolitan and nonmetropolitan areas of the United States. Front Public Health 2022; 10:942842. [PMID: 36159248 PMCID: PMC9490306 DOI: 10.3389/fpubh.2022.942842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/16/2022] [Indexed: 01/21/2023] Open
Abstract
Background Geographic inequality in US mortality has increased rapidly over the last 25 years, particularly between metropolitan and nonmetropolitan areas. These gaps are sizeable and rival life expectancy differences between the US and other high-income countries. This study determines the contribution of smoking, a key contributor to premature mortality in the US, to geographic inequality in mortality over the past quarter century. Methods We used death certificate and census data covering the entire US population aged 50+ between Jan 1, 1990 and Dec 31, 2019. We categorized counties into 40 geographic areas cross-classified by region and metropolitan category. We estimated life expectancy at age 50 and the index of dissimilarity for mortality, a measure of inequality in mortality, with and without smoking for these areas in 1990-1992 and 2017-2019. We estimated the changes in life expectancy levels and percent change in inequality in mortality due to smoking between these periods. Results We find that the gap in life expectany between metros and nonmetros increased by 2.17 years for men and 2.77 years for women. Changes in smoking-related deaths are responsible for 19% and 22% of those increases, respectively. Among the 40 geographic areas, increases in life expectancy driven by changes in smoking ranged from 0.91 to 2.34 years for men while, for women, smoking-related changes ranged from a 0.61-year decline to a 0.45-year improvement. The most favorable trends in years of life lost to smoking tended to be concentrated in large central metros in the South and Midwest, while the least favorable trends occurred in nonmetros in these same regions. Smoking contributed to increases in mortality inequality for men aged 70+, with the contribution ranging from 8 to 24%, and for women aged 50-84, ranging from 14 to 44%. Conclusions Mortality attributable to smoking is declining fastest in large cities and coastal areas and more slowly in nonmetropolitan areas of the US. Increasing geographic inequalities in mortality are partly due to these geographic divergences in smoking patterns over the past several decades. Policies addressing smoking in non-metropolitan areas may reduce geographic inequality in mortality and contribute to future gains in life expectancy.
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Affiliation(s)
- Arun S. Hendi
- Office of Population Research and Department of Sociology, Princeton University, Princeton, NJ, United States,*Correspondence: Arun S. Hendi
| | - Jessica Y. Ho
- Department of Sociology and Criminology and Population Research Institute, The Pennsylvania State University, University Park, PA, United States
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Changes in Attitudes toward Tobacco Smoking and Factors Associated with Quitting in 9-Year Observation of PURE Poland Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116564. [PMID: 35682151 PMCID: PMC9180719 DOI: 10.3390/ijerph19116564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 02/05/2023]
Abstract
(1) Background: This study aims to examine changes in tobacco smoking prevalence in the PURE Poland cohort study over the 9-year follow-up period. Moreover, it attempts to identify socio-demographic factors that affect changes in attitudes towards tobacco smoking. (2) Methods: The PURE Poland cohort study—baseline was performed in 2007–2010 and covered 2036 participants, including urban (59.4%) and rural (40.6%) residents of Lower Silesia, Poland. The following study reports the results of 1690 participants who took part in both the baseline (2007–2010) study and 9-year follow-up (2016–2019). (3) Results: There was a 3.5% decrease in current smokers during the analyzed period (from 20.2% at the baseline study to 16.7% in the 9-year follow-up). Living in rural area increased the likelihood of being a current smoker by more than 1.5-fold (OR = 1.65 CI = 1.26–2.14) and decreased the likelihood of being a former smoker (OR = 0.70 CI = 0.57–0.86). In the 9-year follow-up period, more women were current smokers than men (17.2% vs. 16.0%) and women had lower chances of being former smokers than men (OR = 0.77 CI = 0.62–0.95). People with a primary education had 1.5-fold higher likelihood of being a current smoker (OR = 1.45 CI = 1.03–2.05). Nearly 11% significant increase in the percentage of current smokers was observed in the oldest age group (1.9% in the baseline study vs. 12.6% in the follow-up period). (4) Conclusions: The results obtained during 9 years of observation indicate the necessity of intensifying anti-tobacco programs especially targeting women, elderly population, people with lower level of education, rural residents, and the unemployed.
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Beck AM, Piontek AJ, Wiedenman EM, Gilbert A. Perceptions of COVID-19 Mitigation Strategies between Rural and Non-Rural Adults in the US: How Public Health Nurses Can Fill the Gap. NURSING REPORTS 2022; 12:188-197. [PMID: 35324565 PMCID: PMC8954485 DOI: 10.3390/nursrep12010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to capture the perceptions of COVID-19 mitigations' efficacy of rural and non-rural participants, using the health belief model (HBM), as well as to describe where public health nursing may be able to fill behavior gaps in rural communities. Rural and non-rural participants completed electronic surveys. Surveys collected demographic information and perceptions of various mitigation strategies' effectiveness. Rurality was significantly associated with perceptions of the effectiveness of public health mitigation strategies including wearing facemasks, limiting time indoors, avoiding gatherings, non-essential business closure, and staying home. Our findings suggest people in rural areas perceive mitigations to be effective. Other researchers have consistently shown rural residents are least likely to partake in the same mitigations. Rural public health nurses on the front line serve as the key to closing the aforementioned gap. Understanding where their community's perceptions lie is pivotal in creating educational programs to continue mitigation efforts as we embark on the second year of this pandemic.
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Affiliation(s)
- Alan M. Beck
- Prevention Research Center, Washington University in St. Louis, St. Louis, MO 63130, USA; (E.M.W.); (A.G.)
| | - Amy J. Piontek
- Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO 63110, USA;
| | - Eric M. Wiedenman
- Prevention Research Center, Washington University in St. Louis, St. Louis, MO 63130, USA; (E.M.W.); (A.G.)
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Amanda Gilbert
- Prevention Research Center, Washington University in St. Louis, St. Louis, MO 63130, USA; (E.M.W.); (A.G.)
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Oser CB, Strickland J, Batty EJ, Pullen E, Staton M. The rural identity scale: Development and validation. J Rural Health 2022; 38:303-310. [PMID: 33666278 PMCID: PMC8418624 DOI: 10.1111/jrh.12563] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to conduct a psychometric evaluation of a new 35-item survey developed in the United States to measure rural identity. METHODS Factor structure, reliability, convergent validity, and incremental validity of the Rural Identity Scale (RIS) were examined using two datasets. Study 1 examined RIS psychometric properties using survey data collected from substance use treatment counselors in a southeastern state (n = 145), while Study 2 used data collected from women incarcerated in rural jails (n = 400). FINDINGS A one-factor structure containing 15 items was identified in the RIS, with acceptable internal reliability (α = .72-.83). In Study 1, participants from rural counties had significantly higher RIS scores than their urban counterparts. In both studies, convergent validity was evaluated and the RIS scores were significantly associated with other measures relevant to identity and rurality at the bivariate level. Incremental validity was supported in multivariable models as the RIS scores were significantly and uniquely associated with primary rural place variables in each sample. CONCLUSIONS This study is an initial step toward a reliable, valid scale measuring rural identity. RIS may be especially beneficial to health research as a methodological tool that can contextualize health behaviors among rural populations and highlight potential interventions to promote health equity.
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Affiliation(s)
- Carrie B. Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky
| | - Justin Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evan J. Batty
- Department of Sociology, University of Kentucky, Lexington, Kentucky
| | - Erin Pullen
- Indiana University Network Science Institute, Bloomington, Indiana
| | - Michele Staton
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, Kentucky
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Wang K, Malkin HE, Patchett ND, Pearlstein KA, Heiling HM, McCabe SD, Deal AM, Mavroidis P, Oakey M, Fenoli J, Lee CB, Klein JL, Jensen BC, Stinchcombe TE, Marks LB, Weiner AA. Coronary Artery Calcifications and Cardiac Risk After Radiation Therapy for Stage III Lung Cancer. Int J Radiat Oncol Biol Phys 2022; 112:188-196. [PMID: 34419565 PMCID: PMC8688314 DOI: 10.1016/j.ijrobp.2021.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Heart dose and heart disease increase the risk for cardiac toxicity associated with radiation therapy. We hypothesized that computed tomography (CT) coronary calcifications are associated with cardiac toxicity and may help ascertain baseline heart disease. METHODS AND MATERIALS We analyzed the cumulative incidence of cardiac events in patients with stage III non-small cell lung cancer receiving median 74 Gy on prospective dose-escalation trials. Events were defined as symptomatic effusion, pericarditis, unstable angina, infarction, significant arrhythmia, and/or heart failure. Coronary calcifications were delineated on simulation CTs using radiation software program (130 HU threshold). Calcifications were defined as "none," "low," and "high," with median volume dividing low and high. RESULTS Of 109 patients, 26 had cardiac events at median 26 months (range, 1-84 months) after radiation therapy. Median follow-up in surviving patients was 8.8 years (range, 2.3-17.3). On simulation CTs, 64 patients (59%) had coronary calcifications with median volume 0.2 cm3 (range, 0.01-8.3). Only 16 patients (15%) had baseline coronary artery disease. Cardiac events occurred in 7% (3 of 45), 29% (9 of 31), and 42% (14 of 33) of patients with no, low, and high calcifications, respectively. Calcification burden was associated with cardiac toxicity on univariate (low vs none: hazard ratio [HR] 5.0, P = .015; high vs none: HR 8.1, P < .001) and multivariate analyses (low vs none: HR 7.0, P = .005, high vs none: HR 10.6, P < .001, heart mean dose: HR 1.1/Gy, P < .001). Four-year competing risk-adjusted event rates for no, low, and high calcifications were 4%, 23%, and 34%, respectively. CONCLUSIONS The presence of coronary calcifications is a cardiac risk factor that can identify high-risk patients for medical referral and help guide clinicians before potentially cardiotoxic cancer treatments.
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Affiliation(s)
- Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - Hayley E. Malkin
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Nicholas D. Patchett
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kevin A. Pearlstein
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Hillary M. Heiling
- Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, NC
| | - Sean D. McCabe
- Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, NC
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, NC
| | | | - Mary Oakey
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Jeffrey Fenoli
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Carrie B. Lee
- Department of Internal Medicine, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC
| | - J Larry Klein
- Department of Internal Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC,Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Brian C. Jensen
- Department of Internal Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC
| | | | - Lawrence B. Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Ashley A. Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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Battalio SL, Pfammatter AF, Kershaw KN, Hernandez A, Conroy DE, Spring B. Mobile Health Tobacco Cessation Interventions to Promote Health Equity: Current Perspectives. Front Digit Health 2022; 4:821049. [PMID: 35847415 PMCID: PMC9284415 DOI: 10.3389/fdgth.2022.821049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Although US tobacco use trends show overall improvement, social disadvantage continues to drive significant disparities. Traditional tobacco cessation interventions and public policy initiatives have failed to equitably benefit socially-disadvantaged populations. Advancements in mobile digital technologies have created new opportunities to develop resource-efficient mobile health (mHealth) interventions that, relative to traditional approaches, have greater reach while still maintaining comparable or greater efficacy. Their potential for affordability, scalability, and efficiency gives mHealth tobacco cessation interventions potential as tools to help redress tobacco use disparities. We discuss our perspectives on the state of the science surrounding mHealth tobacco cessation interventions for use by socially-disadvantaged populations. In doing so, we outline existing models of health disparities and social determinants of health (SDOH) and discuss potential ways that mHealth interventions might be optimized to offset or address the impact of social determinants of tobacco use. Because smokers from socially-disadvantaged backgrounds face multi-level barriers that can dynamically heighten the risks of tobacco use, we discuss cutting-edge mHealth interventions that adapt dynamically based on context. We also consider complications and pitfalls that could emerge when designing, evaluating, and implementing mHealth tobacco cessation interventions for socially-disadvantaged populations. Altogether, this perspective article provides a conceptual foundation for optimizing mHealth tobacco cessation interventions for the socially-disadvantaged populations in greatest need.
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Affiliation(s)
- Samuel L. Battalio
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Samuel L. Battalio
| | - Angela F. Pfammatter
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alexis Hernandez
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David E. Conroy
- Department of Kinesiology, The Pennsylvania State University (PSU), University Park, PA, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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15
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Ling MYJ, Lim KH, Hasani WSR, Rifin HM, Majid NLA, Lourdes TGR, Saminathan TA, Chan YY, Ahmad A, Ismail H, Yusoff MFM. Exposure to secondhand smoke among school-going adolescents in Malaysia: Findings from the tobacco and e-cigarettes survey among Malaysian adolescents (TECMA). Tob Induc Dis 2020; 18:96. [PMID: 33262682 PMCID: PMC7694740 DOI: 10.18332/tid/128622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many studies have revealed that exposure to secondhand smoke (SHS) substantially increases the risk of smoking related diseases especially among the vulnerable groups, yet data on the location of SHS exposure among youth in Malaysia are still lacking. The study aims to describe the prevalence and factors associated with SHS exposure at home, outside the home, and inside the school among school-going adolescents in Malaysia. METHODS We derived the data from the TECMA study, which used a cross-sectional study design and multi-stage sampling method to obtain a representative sample of school-going adolescents aged 11-19 years in Malaysia in 2016. Data were collected through a self-administered approach using a pre-validated standard questionnaire. Descriptive and multivariate analyses were used to analyze the data, and results are presented as adjusted odds ratio (AOR) with 95% confidence interval (95% CI). RESULTS SHS exposure for the past seven days was higher outside the home (51.2%; 95% CI: 49.2-53.2) compared to at home (37.8%; 95% CI: 35.8-39.9) while 27.3% (95% CI: 25.1-29.5) of school-going adolescents reported exposure to SHS inside the school in the past one month. In the regression analyses, older adolescents, those of Malay and Bumiputra Sarawak ethnicities, adolescents from rural areas and current smokers had higher likelihood of exposure to SHS at home, outside home and inside the school. Our study also found that adolescents who were current smokers had higher odds of being exposed to SHS at home (AOR=2.87; 95% CI: 2.57-3.21), outside the home (AOR=3.46; 95% CI: 3.05-3.92) and in the school (AOR=2.25; 95% CI: 2.01-2.51). CONCLUSIONS Health promotion measures should target parents/guardians and household members to reduce SHS exposure among adolescents. In addition, smoke-free regulation should be fully enforced in school. Furthermore, more public places should be designated non-smoking areas to reduce SHS exposure and denormalize smoking behavior.
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Affiliation(s)
- Miaw Y. J. Ling
- Institute for Public Health, National Institutes of Health, Shah Alam, Malaysia
| | - Kuang H. Lim
- Institute for Medical Research, Kuala Lumpur, Malaysia
| | | | - Halizah M. Rifin
- Institute for Public Health, National Institutes of Health, Shah Alam, Malaysia
| | - Nur Liana A. Majid
- Institute for Public Health, National Institutes of Health, Shah Alam, Malaysia
| | - Tania G. R. Lourdes
- Institute for Public Health, National Institutes of Health, Shah Alam, Malaysia
| | | | - Ying Y. Chan
- Institute for Public Health, National Institutes of Health, Shah Alam, Malaysia
| | - Ahzairin Ahmad
- Institute for Public Health, National Institutes of Health, Shah Alam, Malaysia
| | - Hasimah Ismail
- Institute for Public Health, National Institutes of Health, Shah Alam, Malaysia
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Dahne J, Wahlquist AE, Smith TT, Carpenter MJ. The differential impact of nicotine replacement therapy sampling on cessation outcomes across established tobacco disparities groups. Prev Med 2020; 136:106096. [PMID: 32320705 PMCID: PMC7255419 DOI: 10.1016/j.ypmed.2020.106096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/15/2022]
Abstract
Cigarette smoking is increasingly concentrated among marginalized populations with limited access to evidence-based cessation treatment. This includes racial/ethnic minorities, lower income individuals, those with lower educational attainment, and residents of rural areas. To reach Healthy People 2020 objectives, successful cessation interventions must narrow these disparities. Nicotine replacement therapy (NRT) sampling is an easily translatable and scalable intervention that could enhance treatment access and thus narrow disparities. The present study examined individual-level demographic moderators of the impact of NRT sampling on cessation-related behaviors including: 1) use of a cessation medication, 2) making a 24-hour quit attempt, 3) floating abstinence, and 4) 7-day point prevalence abstinence at 6-months. Study participants included N = 1245 adult smokers enrolled in the Tobacco Intervention in Primary Care Treatment Opportunities for Providers (TIP TOP) study, a recently concluded large-scale clinical trial of NRT sampling relative to standard care within 22 primary care clinics across South Carolina. Generalized linear models examined individual-level demographic moderators of treatment effect. Results suggest that NRT sampling may be more effective among some of the most disadvantaged groups of smokers, including smokers with lower income and education, as well those who live in more rural areas. The effects of NRT sampling did not differ by race. In sum, NRT sampling is a low-cost, low-burden intervention that could be disseminated broadly to reach large numbers of smokers and potentially narrow cessation disparities.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Amy E Wahlquist
- Hollings Cancer Center, MUSC, Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA
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Afshar N, English DR, Chamberlain JA, Blakely T, Thursfield V, Farrugia H, Giles GG, Milne RL. Differences in cancer survival by remoteness of residence: an analysis of data from a population-based cancer registry. Cancer Causes Control 2020; 31:617-629. [PMID: 32356140 DOI: 10.1007/s10552-020-01303-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer survival is generally lower for rural compared with urban residents, but findings have been inconsistent. We aimed to assess inequalities in cancer survival by remoteness of residence in Victoria, Australia. METHODS Incident cancer cases diagnosed in 2001-2015 with 30 cancer types (n = 331,302) were identified through the Victorian Cancer Registry and followed to the end of 2015 through death registries. Five-year net survival was estimated using the Pohar-Perme method and differences assessed by excess mortality rate ratios (EMRRs) using Poisson regression, adjusting for sex, age and year of diagnosis. EMRRs adjusted for socio-economic disadvantage were also estimated. RESULTS People living outside major cities had lower survival for 11 cancers: esophagus, stomach, colorectum, liver, gallbladder/biliary tract, pancreas, lung, connective/soft tissue, ovary, prostate, kidney. No differences in survival were found for cancers of uterus, small intestine and mesothelioma. After adjusting for socio-economic disadvantage, the observed differences in survival decreased for most cancers and disappeared for colorectal cancer, but they remained largely unchanged for cancers of esophagus, stomach, liver, pancreas, lung, connective/soft tissue, ovary and kidney. CONCLUSION People with cancer residing outside major cities had lower survival from some cancers, which is partly due to the greater socio-economic disadvantage of rural residents.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - James A Chamberlain
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Helen Farrugia
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
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Association of Rurality With Survival and Guidelines-Concordant Management in Early-stage Non-Small Cell Lung Cancer. Am J Clin Oncol 2020; 42:607-614. [PMID: 31232724 DOI: 10.1097/coc.0000000000000549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rural populations of the United States have not experienced a similar degree of decline in lung cancer mortality recently seen nationwide. Several investigations examining survival differences in rural lung cancer patients have been incongruent. We investigated the association of rural residence with survival outcomes and receipt of guidelines-concordant treatment in early-stage non-small cell lung cancer (NSCLC). METHODS Retrospective study of National Cancer Data Base patients with NSCLC diagnosed from 2004 to 2015. Comparisons of survival outcomes and guidelines-concordant management with lobectomy or stereotactic body radiation therapy among rural and nonrural patients, classified according to the US Department of Agriculture's Rural-Urban Continuum Codes. RESULTS We identified 840,566 patients; 18.7% resided in rural areas. Rurality was associated with greater proportions of males, white patients, and higher comorbidities. Larger proportions of rural stage I patients (53.4%) did not undergo guidelines-concordant management with lobectomy or stereotactic body radiation therapy relative to nonrural patients (50.1%, P<0.001). Although rural patients within each stage at diagnosis have a significant disparity in overall survival (OS), stage I NSCLC had the largest absolute difference (nonrural=61.4 mo, rural=50.3 mo, difference of 11.1 mo, P<0.0001). In multivariable Cox regression, rurality was independently associated with impaired survival in both all-stages (hazard ratio=1.08, P<0.001) and stage I NSCLC (hazard ratio=1.09, P<0.001). CONCLUSIONS Small differences exist in OS among all rural NSCLC patients, but rural patients with stage I NSCLC have a marked disadvantage in OS. Rurality is an independent risk factor for decreased survival in all-stages and stage I NSCLC.
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Ramsey AT, Baker TB, Pham G, Stoneking F, Smock N, Colditz GA, James AS, Liu J, Bierut LJ, Chen LS. Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1728. [PMID: 32155775 PMCID: PMC7084618 DOI: 10.3390/ijerph17051728] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022]
Abstract
Rural populations face significant smoking-related health disparities, such as a higher prevalence of lung cancer and cancer mortality, higher prevalence of smoking, and lower likelihood of receiving cessation treatment than urban counterparts. A significant proportion of health disparities in rural populations could be eliminated with low-barrier, easy-access treatment delivery methods for smoking cessation. In this study, we assessed treatment engagement among patients in rural and urban settings. Then, we examined the effect of an electronic health record-based smoking cessation module on patient receipt of evidence-based cessation care. As part of a quality improvement project, we retrospectively observed 479,798 unique patients accounting for 1,426,089 outpatient clinical encounters from June 2018-March 2019 across 766 clinics in the greater St. Louis, southern Illinois, and mid-Missouri regions. Smoking prevalence was higher in rural versus urban clinics (20.7% vs. 13.9%, 6.7% [6.3, 7.1], odds ratio = 1.6 [1.6, 1.6], p < 0.0001), and yet rural smokers were nearly three times less likely than their urban counterparts to receive any smoking cessation treatment after adjusting for patients clustering within clinics (9.6% vs. 25.8%, -16.2% [-16.9, -15.5], odds ratio = 0.304 [0.28, 0.33], p < 0.0001). Although not yet scaled up in the rural setting, we examined the effects of a low-burden, point-of-care smoking module currently implemented in cancer clinics. After adjusting for patient clustering within clinics, patients were more likely to receive smoking treatment in clinics that implemented the module versus clinics that did not implement the module (31.2% vs. 17.5%, 13.7% [10.8, 16.6], odds ratio = 2.1 [1.8, 2.6], p < 0.0001). The point-of-care treatment approach offers a promising solution for rural settings, both in and outside the context of cancer care.
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Affiliation(s)
- Alex T. Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
| | - Timothy B. Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Faith Stoneking
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Graham A. Colditz
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aimee S. James
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jingxia Liu
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
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Keller-Hamilton B, Ferketich AK, Berman M, Conrad E, Roberts ME. Cigarette Prices in Rural and Urban Ohio: Effects of Census Tract Demographics. Health Promot Pract 2020; 21:37S-43S. [PMID: 31908190 DOI: 10.1177/1524839919881141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of smoking among rural Americans and Americans of lower socioeconomic status (SES) remains higher than among their urban and higher SES counterparts. Potential factors contributing to these disparities are area-based differences in the retail environment and tobacco control policies. We describe the association between neighborhood demographics and cigarette prices in rural and urban areas. Prices of one pack of Marlboro Reds, Newport menthols, and the cheapest cigarettes in the store were recorded from a stratified random sample of tobacco retailers in urban (N = 104) and rural (N = 109) Ohio in 2016. Associations between prices and census tract demographics (SES and race) were modeled separately in each region, controlling for store type. In the rural region, as the census tract income increased, the price of Marlboro and Newport cigarettes decreased, and the price of the cheapest pack of cigarettes increased. In the urban region, as the census tract income and percentage of White non-Hispanic people increased, the price of Marlboro decreased; there were no associations between census tract characteristics and the price of Newports or the cheapest cigarettes. Results describe a complex association between cigarette brand, prices, and area characteristics, where the cheapest brands of cigarettes can be obtained for the lowest prices in lower SES rural areas. Tobacco control policies that raise the price of cheap cigarettes, particularly minimum price laws, have the potential to reduce SES-related smoking disparities in both rural and urban populations.
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Azagba S, Shan L, Latham K, Qeadan F. Trends in cigarette smoking among American Indians and Alaska Natives in the USA: 1992-2015. Cancer Causes Control 2020; 31:73-82. [PMID: 31734765 DOI: 10.1007/s10552-019-01250-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE While smoking prevalence may be declining in the general population, health disparities in tobacco use remain a public health priority. This study examined national, sociodemographic, and geographic trends in American Indians and Alaska Natives (AIs/ANs) smoking prevalence from 1992/1993 to 2014/2015. Additionally, correlates of cigarette smoking were examined among this group. METHODS Data were drawn from the 1992-2015 Tobacco Use Supplement to the Current Population Survey. Cochran-Armitage tests were used to assess changes in the prevalence of smoking over time in the population, as well by sociodemographic characteristics. Multivariable logistic regression was conducted to examine the correlates of cigarette smoking for AIs/ANs in 2014/2015. RESULTS The trend analysis indicated that the prevalence of smoking, among AIs/ANs, decreased significantly from 39.1% in the 1992/1993 cycle to 20.9% in the 2014/2015. This decrease was seen in both males and females, with the prevalence of smoking decreasing from 43.6% and 35.4%, respectively, in 2006/2007 to 23.8% and 18.3% in 2014/2015. The decreasing trend was also found for all subgroups, except for the 55+ age group. Multivariable analysis showed higher odds of smoking among males, those with low income compared to those with median or higher income, and those living in non-metropolitan areas. Those aged 25-54 were more likely to be smokers compared with the 55+ age group. CONCLUSIONS Results indicate a recent decrease in AIs/ANs smoking prevalence, although these populations still experience a high prevalence of smoking compared to the general population. Our findings highlight the need for a comprehensive tobacco control strategy that includes working with stakeholders within the AI/AN community.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA.
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Keely Latham
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
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22
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Byaruhanga J, Tzelepis F, Paul C, Wiggers J, Byrnes E, Lecathelinais C. Cost Per Participant Recruited From Rural and Remote Areas Into a Smoking Cessation Trial Via Online or Traditional Strategies: Observational Study. J Med Internet Res 2019; 21:e14911. [PMID: 31714253 PMCID: PMC6880230 DOI: 10.2196/14911] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/09/2019] [Accepted: 08/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background Rural and remote residents are more likely to smoke than those who live in major cities; however, recruitment of research participants from rural and remote areas can be challenging. The cost per participant recruited from rural and remote areas via online (eg, social media) and traditional strategies (eg, print) has implications for researchers on how to allocate resources to maximize the number of participants recruited. Participant characteristics such as demographics, financial stress, mental health, and smoking-related factors may be associated with recruitment method (ie, online vs traditional), and so it is important to understand whether certain subgroups are more likely to be recruited via a particular strategy. Objective This study aimed to determine the cost per participant recruited and examine whether characteristics such as demographics, financial stress, mental health, and smoking-related factors may be associated with the recruitment method (ie, online vs traditional). Methods Participants were recruited into a randomized trial that provided smoking cessation support. Eligible participants were aged 18 years or older; used tobacco daily; had access to video communication software, internet, and telephone; had an email address; and lived in a rural or remote area of New South Wales, Australia. This study describes the natural (observed) experience of recruiting participants via online and traditional methods into a smoking cessation trial. Results Over 17 months, 655 participants were recruited into the smoking cessation trial. A total of 88.7% (581/655) of the participants were recruited via online methods. Moreover, 1.8% (12/655) of the participants were recruited from remote locations and none from very remote areas. The cost per participant recruited by the various online strategies ranged from Aus $7.29 (US $4.96, £4.09, and €4.43) for Gumtree, a local online classified website, to Aus $128.67 (US $87.63, £72.20, and €78.28) for email. The cost per participant recruited using traditional strategies ranged from Aus $0 (US $0, £0, and €0) for word of mouth to Aus $3990.84 (US $2757.67, £2227.85, and €2477.11) for telephone. Women had greater odds of being recruited via online methods than men (odds ratio 2.50, 95% CI 1.42-4.40). No other characteristics were associated with the recruitment method. Conclusions The cost per participant recruited via online and traditional strategies varied, with the range being smaller for online than traditional recruitment strategies. Women have greater odds of being recruited via online strategies into rural smoking cessation trials. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000514303; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372584&isReview=true
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Affiliation(s)
- Judith Byaruhanga
- University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia
| | - Flora Tzelepis
- University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christine Paul
- University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - John Wiggers
- University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Emma Byrnes
- University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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23
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Primm K, Ferdinand AO, Callaghan T, Akinlotan MA, Towne SD, Bolin J. Congestive heart failure-related hospital deaths across the urban-rural continuum in the United States. Prev Med Rep 2019; 16:101007. [PMID: 31799105 PMCID: PMC6883321 DOI: 10.1016/j.pmedr.2019.101007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 12/02/2022] Open
Abstract
Congestive heart failure (CHF) is a growing public health problem that affects nearly 6.5 million individuals nationwide. Access to quality outpatient care and disease management programs has been shown to improve disease treatment and prognosis. Rural populations face unique challenges in the availability and accessibility of quality cardiovascular care. In 2018, we conducted a pooled cross-sectional analysis of the Nationwide Inpatient Sample (NIS) for 2009–2014 to examine recent trends in CHF-related hospital deaths in the United States, highlighting urban-rural differences within each census region. We performed a multivariable logistic regression analysis to compare the odds of CHF-related hospital death, by levels of rurality and within each census region. Most CHF-related hospital deaths occurred in the South and Midwest census regions and in large central metropolitan areas. Findings from census region stratified models revealed that non-core residents living within the West (OR 1.47, CI 1.26, 1.71), Midwest (OR 1.30, CI 1.17, 1.44), and South (OR = 1.21, 95% C.I. = 1.12–1.32) had a higher relative risk (but not higher absolute numbers) of experiencing death during a CHF-related hospitalization, compared to patients in large central metropolitan areas. Within each census region, there were also differences in odds of a CHF-related hospital death depending on patient sex, comorbidities, insurance type, median annual income, and year. As efforts to reduce rural health disparities in CHF morbidity continue, more work is needed to understand and test interventions to reduce the risk of death from CHF in noncore areas of the West, Midwest, and South.
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Affiliation(s)
- Kristin Primm
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843-1266, USA.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Alva O Ferdinand
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Marvellous A Akinlotan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Samuel D Towne
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA.,Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL 32816, USA.,Department of Environmental & Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Jane Bolin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA.,College of Nursing, Texas A&M University, Bryan, TX 77804-1266, USA
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24
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Afshar N, English DR, Milne RL. Rural-urban residence and cancer survival in high-income countries: A systematic review. Cancer 2019; 125:2172-2184. [PMID: 30933318 DOI: 10.1002/cncr.32073] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/06/2019] [Accepted: 02/24/2019] [Indexed: 12/21/2022]
Abstract
There is some evidence that place of residence is associated with cancer survival, but the findings are inconsistent, and the underlying mechanisms by which residential location might affect survival are not well understood. We conducted a systematic review of observational studies investigating the association of rural versus urban residence with cancer survival in high-income countries. We searched the Ovid Medline, EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases up to May 31, 2016. Forty-five studies published between 1984 and 2016 were included. We extracted unadjusted and adjusted relative risk estimates with the corresponding 95% confidence intervals. Most studies reported worse survival for cancer patients living in rural areas than those in urban regions. The most consistent evidence, observed across several studies, was for colorectal, lung, and prostate cancer. Of the included studies, 18 did not account for socio-economic position. Lower survival for more disadvantaged patients is well documented; therefore, it could be beneficial for future research to take socio-economic factors into consideration when assessing rural/urban differences in cancer survival. Some studies cited differential stage at diagnosis and treatment modalities as major contributing factors to regional inequalities in cancer survival. Further research is needed to disentangle the mediating effects of these factors, which may help to establish effective interventions to improve survival for patients living outside major cities.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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25
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Coughlin LN, Wilson SM, Erwin MC, Beckham JC, Calhoun PS. Cigarette smoking rates among veterans: Association with rurality and psychiatric disorders. Addict Behav 2019; 90:119-123. [PMID: 30388505 DOI: 10.1016/j.addbeh.2018.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/28/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022]
Abstract
AIMS Compared to the general U.S. population, military veterans and those living in rural areas disproportionately smoke cigarettes at higher rates, leading to increased health consequences. In the current study, prevalence and severity of cigarette smoking in Iraq and Afghanistan era veterans was assessed across rural and urban areas and comorbid mental health disorders. METHOD Iraq/Afghanistan era veterans who participated in the Post-Deployment Mental Health study from 2005 to 2017 (N = 3229) were cross-sectionally assessed for the probability of being a current cigarette smoker based on locality status and psychiatric comorbidity. Multivariate logistic and linear regressions, adjusted for demographic characteristics, were used to model the odds of being a current smoker and the severity of nicotine dependence, respectively. RESULTS Veterans residing in rural regions, veterans with psychiatric comorbidities, and the interaction of locality and psychiatric disorders were significantly associated with smoking rates. Those veterans living in extremely rural areas and, independently, those living with psychiatric comorbidities were also more severely dependent on nicotine compared to urban veterans and veterans without psychiatric conditions. CONCLUSIONS Rural veterans and veterans with psychiatric comorbidities are at increased risk of smoking and are more severely dependent on nicotine than urban veterans. These findings underscore the need to reduce barriers for treatment both for smoking cessation and mental healthcare for veterans residing in the most rural areas.
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Affiliation(s)
- Lara N Coughlin
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA, United States; Durham VA Health Care System, Durham, NC, United States
| | - Sarah M Wilson
- Durham VA Health Care System, Durham, NC, United States; Center for Health Services Research in Primary Care, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | | | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, United States; Center for Health Services Research in Primary Care, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC, United States
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, United States; Center for Health Services Research in Primary Care, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC, United States.
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26
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Cepeda-Benito A, Doogan NJ, Redner R, Roberts ME, Kurti AN, Villanti AC, Lopez AA, Quisenberry AJ, Stanton CA, Gaalema DE, Keith DR, Parker MA, Higgins ST. Trend differences in men and women in rural and urban U.S. settings. Prev Med 2018; 117:69-75. [PMID: 29627511 PMCID: PMC6173654 DOI: 10.1016/j.ypmed.2018.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/21/2018] [Accepted: 04/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women. METHOD We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors. RESULTS Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups. CONCLUSION Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women.
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Affiliation(s)
- A Cepeda-Benito
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States.
| | - N J Doogan
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - R Redner
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Rehabilitation Institute, Southern Illinois University, United States
| | - M E Roberts
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - A N Kurti
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - A C Villanti
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - A A Lopez
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States
| | - A J Quisenberry
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - C A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, United States; Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, United States
| | - D E Gaalema
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - D R Keith
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - M A Parker
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - S T Higgins
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
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27
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Bernat DH, Choi K. Differences in Cigarette Use and the Tobacco Environment Among Youth Living in Metropolitan and Nonmetropolitan Areas. J Rural Health 2018; 34:80-87. [PMID: 27443961 PMCID: PMC5585066 DOI: 10.1111/jrh.12194] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine cigarette use and the tobacco-related environment among adolescents living in metropolitan and nonmetropolitan areas. METHODS Data from adolescents ages 14-17 that completed the 2012 Florida Youth Tobacco Survey were analyzed (n = 40,746). This includes a representative sample of middle and high school students throughout the state. RESULTS Nonmetropolitan adolescents were more likely than metropolitan adolescents to report lifetime smoking, past 30-day smoking, daily smoking, initiating smoking at younger ages, having smoked a greater number of cigarettes in their lifetime and in the past 30 days, friend acceptance of adult smoking, a parent offering them a cigarette, living with a smoker, and that smoking was allowed in their home. Nonmetropolitan adolescents were also more likely to have seen tobacco ads the last time they visited convenience marts, gas stations, grocery stores, and big box stores, and flavored tobacco products or ads for them. These differences persisted after controlling for demographics. CONCLUSIONS The present results suggest vast differences in smoking behavior among nonmetropolitan and metropolitan adolescents and that targeting social and environmental factors may be beneficial for reducing tobacco disparities among nonmetropolitan adolescents.
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Affiliation(s)
- Debra H Bernat
- Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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28
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Stillman FA, Tanenbaum E, Wewers ME, Chelluri D, Mumford EA, Groesbeck K, Doogan N, Roberts M. Variations in support for secondhand smoke restrictions across diverse rural regions of the United States. Prev Med 2018; 116:157-165. [PMID: 30261241 PMCID: PMC6689396 DOI: 10.1016/j.ypmed.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/30/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Significant disparities exist between rural-urban U.S. POPULATIONS Besides higher smoking rates, rural Americans are less likely to be protected from SHS. Few studies focus across all regions, obscuring regional-level differences. This study compares support for SHS restrictions across all HHS regions. DATA 2014/15 TUS-CPS; respondents (n = 228,967): 47,805 were rural residents and 181,162 urban. We examined bi-variates across regions and urban-rural adjusted odds ratios within each. Smoking inside the home was assessed along with attitudes toward smoking in bars, casinos, playgrounds, cars, and cars with kids. Urban respondents were significantly more supportive of all SHS policies: (e.g. smoking in bars [57.9% vs. 51.4%]; support for kids in cars [94.8% vs. 92.5%]. Greatest difference between urban-rural residents was in Mid-Atlantic (bar restrictions) and Southeast (home bans): almost 10% less supportive. Logistic regression confirmed rural residents least likely, overall, to support SHS in homes (OR = 0.78, 95% CI 0.74, 0.81); in cars (OR = 0.87, 95% CI 0.79, 0.95), on playgrounds (OR = 0.88, 95% CI.83, 0.94) and in bars OR = 0.88, 95% CI 0.85, 0.92), when controlling for demographics and smoking status. South Central rural residents were significantly less likely to support SHS policies-home bans, smoking in cars with kids, on playgrounds, in bars and casinos; while Heartland rural residents were significantly more supportive of policies restricting smoking in cars, cars with kids and on playgrounds. Southeast and South Central had lowest policy score with no comprehensive state-level SHS policies. Understanding differences is important to target interventions to reduce exposure to SHS and related health disparities.
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Affiliation(s)
| | - Erin Tanenbaum
- NORC at the University of Chicago, United States of America
| | | | - Devi Chelluri
- NORC at the University of Chicago, United States of America
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Amato MS, Graham AL. Geographic Representativeness of a Web-Based Smoking Cessation Intervention: Reach Equity Analysis. J Med Internet Res 2018; 20:e11668. [PMID: 30355557 PMCID: PMC6231756 DOI: 10.2196/11668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background Cigarette smoking is the leading cause of preventable death and disease in the United States. Smoking prevalence is higher in rural areas than in metropolitan areas, due partly to differences in access to cessation treatment. With internet use at 89% of all US adults, digital approaches could increase use of cessation treatment and reduce smoking. Objective We investigated the extent to which smokers from rural areas use a digital cessation resource. We compared the geographic distribution of registered users of a free Web-based smoking cessation program with the geographic distribution of US smokers. Methods We mapped user-provided ZIP codes to Rural-Urban Continuum Codes. A total of 59,050 of 118,574 users (49.80%) provided valid ZIP codes from 2013 to 2017. We used US National Survey of Drug Use and Health data from 2013 to 2017 to compare the geographic distribution of our sample of Web-based cessation users with the geographic distribution of US smokers. Reach ratios and 95% confidence intervals quantified the extent to which rural smokers’ representation in the sample was proportionate to their representation in the national smoking population. Reach ratios less than 1 indicate underrepresentation. Results Smokers from rural areas were significantly underrepresented in 2013 (reach ratio 0.89, 95% CI 0.87-0.91) and 2014 (reach ratio 0.89, 95% CI 0.86-0.92), proportionally represented in 2015 (reach ratio 1.08, 95% CI 1.02-1.14) and 2016 (reach ratio 1.03, 95% CI 0.94-1.14), and proportionally overrepresented in 2017 (reach ratio 1.16, 95% CI 1.12-1.21). Smokers from Large Metro areas were proportionally represented in 2013 and 2014 but underrepresented in 2015 (reach ratio 0.97, 95% CI 0.94-1.00), 2016 (reach ratio 0.89, 95% CI 0.85-0.94), and 2017 (reach ratio 0.89, 95% CI 0.86-0.91). Conclusions Results suggest that smokers from rural areas are more than proportionally reached by a long-standing digital cessation intervention. The underrepresentation of smokers from Large Metro areas warrants further study.
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Affiliation(s)
- Michael S Amato
- Schroeder Institute, Truth Initiative, Washington, DC, United States
| | - Amanda L Graham
- Schroeder Institute, Truth Initiative, Washington, DC, United States.,Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, United States
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30
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Berg CJ, Haardörfer R, Vu M, Getachew B, Lloyd SA, Lanier A, Childs D, Sandridge Y, Bierhoff J, Li J, Dossantos E, Windle M. Cigarette use trajectories in young adults: Analyses of predictors across system levels. Drug Alcohol Depend 2018; 188:281-287. [PMID: 29807215 PMCID: PMC6819815 DOI: 10.1016/j.drugalcdep.2018.03.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/23/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cigarette smoking escalates most in early to middle young adulthood. However, little research has examined a range of multilevel factors in relation to smoking trajectories during this time. METHODS We examined: 1) trajectories of cigarette smoking among 2967 US college students (aged 18-25) in a two-year, six-wave longitudinal study (using growth mixture modeling); and 2) intrapersonal- (i.e., other substance use, depressive symptoms, ADHD symptoms,); interpersonal- (i.e., adverse childhood events, social support, parental tobacco and marijuana use), and community-level (i.e., type of college, rural vs. urban setting) predictors of differing trajectories (using multinomial logistic regression). RESULTS We identified three trajectory classes: 1) Dabblers, who used cigarettes at one point in their life or not at all (85.6%); 2) College Onset Smokers, who began smoking regularly during the college years (6.2%); and 3) Later Onset Smokers, who began smoking during the mid- to late-20 s (8.2%). Multinomial regression (with Dabblers as the reference group) showed that predictors of being College Onset Smokers included being male (p = .031); Asian (p = .001) but not Black (p = .008; Ref: White); early onset smokers (i.e., initiation before age 15; p = .006); past 30-day users of little cigars/cigarillos (p = .024), alcohol (p < .001), and marijuana (p = .008); children of tobacco users (p = .050); and public (p = .031) or a technical college students (p < .001; Ref: private college); predictors of being Later Onset Smokers were being male (p = .019) and technical college students (p = .005). CONCLUSIONS Despite some young adults' smoking initiating/escalating in middle young adulthood, few risk factors were documented. This understudied period warrants greater examination to inform intervention.
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Affiliation(s)
- Carla J. Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA,Corresponding author at: Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Road, NE, Room 524, Atlanta, GA 30322, USA. (C.J. Berg)
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Steven A. Lloyd
- Department of Psychological Science, University of North Georgia, 82 College Circle, Dahlonega, GA 30597, USA
| | - Angela Lanier
- Department of Kinesiology, Berry College, 2277 Martha Berry Hwy NW, Mount Berry, GA 30149, USA
| | - Donyale Childs
- Department of Nursing, 504 College Drive Albany, GA 31705, USA
| | - Yasmeni Sandridge
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Jennifer Bierhoff
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Jingjing Li
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Elliyah Dossantos
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
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Muzi CD, Figueiredo VC, Luiz RR. [Urban-rural gradient in tobacco consumption and cessation patterns in Brazil]. CAD SAUDE PUBLICA 2018; 34:e00077617. [PMID: 29952399 DOI: 10.1590/0102-311x00077617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022] Open
Abstract
The degree of urbanization has been associated with both tobacco consumption and quit rates. The current study aims to examine the importance of the urban-rural context in the determination of tobacco consumption patterns and smoking cessation. Data were used from the supplement of the Special Survey on Smoking (PETab) from the 2008 Brazilian National Household Sample Survey (PNAD). The sample included 14,420 individuals over 15 years of age, of whom 7,003 were current smokers and 7,417 former smokers in the PETab. Smoking prevalence and cessation rates were calculated. Individuals were stratified according to urban and rural residence. Other sociodemographic variables were also analyzed: sex, age bracket, race, and schooling. To explore the difference in smoking prevalence and cessation rate for each stratum in the census situation, the data were adjusted using a Poisson model. Smoking prevalence was higher in places less influenced by the urban environment. Meanwhile, smoking cessation was higher in more urbanized places. Smoking prevalence showed a decrease in consumption as the population's urban characteristics increased (PR = 0.75 for eminently urban vs eminently rural, p = 0.001). Smoking cessation trends showed that the more urban population was more prone to quitting (PR = 1.22 for eminently urban vs eminently rural, p < 0.001). The results point to the need to improve the effectiveness of services for follow-up and encouragement of cessation in rural areas.
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Affiliation(s)
- Camila Drumond Muzi
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.,Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Ronir Raggio Luiz
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Houston KA, Mitchell KA, King J, White A, Ryan BM. Histologic Lung Cancer Incidence Rates and Trends Vary by Race/Ethnicity and Residential County. J Thorac Oncol 2018; 13:497-509. [PMID: 29360512 PMCID: PMC5884169 DOI: 10.1016/j.jtho.2017.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Lung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type. METHODS Using population-based cancer registry data-Surveillance, Epidemiology and End Results and National Program of Cancer Registries data-we present age-adjusted histologic rates and trends by race/ethnicity and residential county location at the time of first cancer diagnosis. Rate ratios were calculated to examine racial/ethnic differences in rates. Annual percent change was calculated to measure changes in rates over time. RESULTS We found that declines in squamous cell carcinoma are occurring fastest in metropolitan counties, whereas rates of adenocarcinoma increased fastest in counties nonadjacent to metropolitan areas. Further, although NH black men have increased lung cancer incidence compared with NH white and Hispanic men in all geographic locations, we found that the degree of the disparity increases with increasing rurality of residence. Finally, we discovered that among women whose lung cancer was diagnosed when they were younger than 55 years, the incidence of squamous cell carcinoma and adenocarcinoma was higher for NH blacks than for NH whites. CONCLUSIONS Our results highlight disparities among NH blacks in nonadjacent rural areas. These findings may have significant impact for the implementation of smoking cessation and lung cancer screening programs.
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Affiliation(s)
- Keisha A. Houston
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Khadijah A. Mitchell
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
| | - Jessica King
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Arica White
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
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Intrastate Variations in Rural Cancer Risk and Incidence: An Illinois Case Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 22:472-8. [PMID: 26193050 DOI: 10.1097/phh.0000000000000310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Although rural-urban cancer disparities have been explored with some depth, disparities within seemingly homogeneous rural areas have received limited attention. However, exploration of intrarural cancer incidence may have important public health implications for risk assessment, cancer control, and resource allocation. OBJECTIVE The objective of this study was to explore intrastate rural cancer risk and incidence differences within Illinois. DESIGN Illinois's 83 rural counties were categorized into northern, central, and southern regions (IL-N, IL-C, and IL-S, respectively). Chi-square test for independence and analysis of variance calculations were performed to assess regional differences in demographic characteristics, socioeconomic deprivation, smoking history, obesity, cancer-screening adherence, and density of general practitioners. Age-adjusted incidence rates were calculated for 5 cancer categories: all cancers combined, lung, colorectal, breast (female), and prostate cancers. Unadjusted and adjusted incidence rate ratios (IRRs) were calculated to evaluate regional differences in rates for each cancer category. RESULTS Socioeconomic deprivation varied by region: 4.5%, 6.9%, and 40.6% of IL-N, IL-C, and IL-S counties, respectively (P < .001). Smoking history also significantly differed by region. Mean former/current smoking prevalence in IL-N, IL-C, and IL-S counties was 46.4%, 48.2%, and 51.4%, respectively (P = .006). In unadjusted analysis, IL-C (IRR = 1.12; 95% confidence interval [CI], 1.02-1.23) and IL-S (IRR = 1.24; 95% CI, 1.13-1.35) had increased lung cancer incidence compared with IL-N. Elevated risk remained in IL-S after adjusting for relevant factors such as smoking and socioeconomic deprivation (IRR = 1.14; 95% CI, 1.04-1.26). CONCLUSIONS Socioeconomic deprivation, health behaviors, and lung cancer incidence varied across rural regions. Our findings underscore the importance of identifying cancer risk heterogeneity, even within a state, to effectively target risk factor reduction and cancer control interventions.
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Lim KH, Teh CH, Pan S, Ling MY, Yusoff MFM, Ghazali SM, Kee CC, Lim KK, Chong KH, Lim HL. Prevalence and factors associated with smoking among adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015. Tob Induc Dis 2018; 16:01. [PMID: 31516402 PMCID: PMC6659615 DOI: 10.18332/tid/82190] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The continuous monitoring of smoking prevalence and its associated factors is an integral part of anti-smoking programmes and valuable for the evaluation of the effectiveness of anti-smoking measures and policies. This study aimed at determining prevalence of smoking and identifying socio-demographic factors associated with smoking among adults in Malaysia aged 15 years and over. METHODS This is a cross-sectional study with a representative sample of 21 445 adults in Malaysia, aged 15 years and over, selected via a stratified, two-stage proportionate-to-size sampling method. Data were obtained from face-to-face interviews by trained research assistants, using a standard validated questionnaire. Multivariable logistic regression was performed to determine socio-demographic factors associated with smoking among Malaysians. RESULTS The overall prevalence of smoking was 22.8% (95% CI: 21.9-23.8%), with males having a significantly higher prevalence compared to females (43.0%, 95% CI: 41.1-44.6 vs 1.4%, 95% CI: 1.1-1.7). The highest smoking prevalence was observed among other ethnicities (35.7%), those aged 25-44 years (59.3%), and low educational attainment (25.2%). Males, those with lower educational attainment and Malays were significantly associated with smoking. CONCLUSIONS The prevalence of smoking among Malaysians, aged 15 years and over, remains high despite the implementation of several anti-smoking measures over the past decades. Specially tailored anti-smoking policies or measures, particularly targeting males, the Malays, younger adults and those with lower educational attainment, are greatly warranted to reduce the prevalence of smoking in Malaysia.
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Affiliation(s)
- Kuang H. Lim
- Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Chien H. Teh
- Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Sayan Pan
- Institute of Public Health, Kuala Lumpur, Malaysia
| | - Miaw Yn Ling
- Institute of Public Health, Kuala Lumpur, Malaysia
| | | | | | - Chee C. Kee
- Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Kuang K. Lim
- Institute of Public Health, Kuala Lumpur, Malaysia
| | - Kar H. Chong
- Hospital Sultan Haji Ahmad Shah, Pahang Darul Makmur, Malaysia
| | - Hui L. Lim
- Hospital Sultan Haji Ahmad Shah, Pahang Darul Makmur, Malaysia
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D'Angelo H, Ammerman A, Gordon-Larsen P, Linnan L, Lytle L, Ribisl KM. Small Food Store Retailers' Willingness to Implement Healthy Store Strategies in Rural North Carolina. J Community Health 2018; 42:109-115. [PMID: 27540735 DOI: 10.1007/s10900-016-0236-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Access to supermarkets is lacking in many rural areas. Small food stores are often available, but typically lack healthy food items such as fresh produce. We assessed small food store retailer willingness to implement 11 healthy store strategies to increase the availability, display, and promotion of healthy foods and decrease the availability, display, and promotion of tobacco products. Interviews were conducted with 55 small food store retailers in three rural North Carolina counties concurrently with store observations assessing current practices related to the strategies. All stores sold low-calorie beverages, sugar-sweetened beverages, candy and cigarettes. Nearly all sold smokeless tobacco and cigars/cigarillos, and 72 % sold e-cigarettes. Fresh fruits were sold at 30.2 % of stores; only 9.4 % sold fresh vegetables. Retailers reported being most willing to stock skim/low-fat milk, display healthy snacks near the register, and stock whole wheat bread. About 50 % were willing to stock at least three fresh fruits and three fresh vegetables, however only 2 % of stores currently stocked these foods. Nearly all retailers expressed unwillingness to reduce the availability of tobacco products or marketing. Our results show promise for working with retailers in rural settings to increase healthy food availability in small food stores. However, restrictions on retail tobacco sales and marketing may be more feasible through local tobacco control ordinances, or could be included with healthy foods ordinances that require stores to stock a minimum amount of healthy foods.
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Affiliation(s)
- Heather D'Angelo
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,, Westat, 1700 Research Boulevard, RB4224, Rockville, MD, 20850, USA.
| | - Alice Ammerman
- Gillings School of Global Public Health, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA
| | - Penny Gordon-Larsen
- Gillings School of Global Public Health, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura Linnan
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Lytle
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Public Health Agency Accreditation Among Rural Local Health Departments: Influencers and Barriers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:49-56. [DOI: 10.1097/phh.0000000000000509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Silva ACD, Vargas LS, Lucchese R, Calixto BDS, Guimarães RA, Vera I, Castro PAD, Pagotto V, Fernandes IL. Patterns of tobacco consumption among residents of a rural settlement: a cross-sectional study. Rev Saude Publica 2017; 51:100. [PMID: 29166444 PMCID: PMC5697925 DOI: 10.11606/s1518-8787.2017051006781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/02/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Investigate patterns and factors associated with tobacco consumption among residents of a rural settlement. METHODS A cross-sectional study conducted between September and November 2014, with 172 residents of a rural settlement in the Midwest region of Brazil. We analyzed as dependent variables tobacco consumption at some point in life; current tobacco consumption; tobacco abuse; and the high risk of nicotine dependence, with sociodemographic variables associated with tobacco use, and we applied the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and Self-Reporting Questionnaire (SRQ-20). RESULTS The prevalence of tobacco use in life, current use, tobacco abuse, and high risk of nicotine dependence were 62.2%, 20.9%, 59.8%, and 10.3%, respectively. Advanced age, low education level, evangelical religion, marijuana use, hypnotic or sedative consumption, and male gender were factors associated with smoking patterns in the settlers. CONCLUSIONS There was a high prevalence of smoking patterns, evidencing the need for public policies on tobacco prevention and control in this population.
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Affiliation(s)
| | - Lorena Silva Vargas
- Secretaria Municipal de Saúde de Catalão. Programa Municipal de Controle do Tabagismo. Catalão, GO, Brasil
| | - Roselma Lucchese
- Universidade Federal de Goiás. Departamento de Enfermagem. Catalão, GO, Brasil
| | | | | | - Ivania Vera
- Universidade Federal de Goiás. Departamento de Enfermagem. Catalão, GO, Brasil
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Zuniga SA, Lango MN. Effect of rural and urban geography on larynx cancer incidence and survival. Laryngoscope 2017; 128:1874-1880. [PMID: 29238975 DOI: 10.1002/lary.27042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS Investigate the impact of rural geography on larynx cancer incidence and survival. STUDY DESIGN Surveillance, Epidemiology, and End Results (SEER) database study. METHODS Incidence and survival rates by Rural-Urban Continuum codes for larynx squamous cell carcinoma patients diagnosed from 2004 to 2012 were evaluated using SEER statistical software and Cox proportional hazards survival analysis. RESULTS The lowest age-adjusted incidence rates for larynx cancer were seen in densely populated urban regions, with mean rates of 2.8 per 100,000 person years (95% confidence interval [CI]: 2.7-2.8); the highest were in the most rural areas, with mean rates of 5.3 per 100,000 person years (95% CI: 4.7-5.9). Nevertheless, of 23,659 larynx cancer patients diagnosed over this period, 19,556 (82.7%) arose in urban residents, compared with 1,428 or 6% from rural areas. Urban larynx cancer patients more likely lived in counties with an American College of Surgeons-approved cancer center and/or a fourfold greater otolaryngology physician supply. Nevertheless, frequency of advanced stage at initial presentation was similar. Cause-specific and overall survival were no different, both on univariable and multivariable analyses. CONCLUSIONS Compared with urban populations, Rural populations are at greater risk of developing larynx cancer, but initial stage and survival after diagnosis are comparable. Priority should be given to prevention strategies to decrease incidence rates. LEVEL OF EVIDENCE 4 Laryngoscope, 1874-1880, 2018.
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Affiliation(s)
- Steven A Zuniga
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University
| | - Miriam N Lango
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University
- Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, U.S.A
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James CV, Moonesinghe R, Wilson-Frederick SM, Hall JE, Penman-Aguilar A, Bouye K. Racial/Ethnic Health Disparities Among Rural Adults - United States, 2012-2015. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2017; 66:1-9. [PMID: 29145359 PMCID: PMC5829953 DOI: 10.15585/mmwr.ss6623a1] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PROBLEM/CONDITION Rural communities often have worse health outcomes, have less access to care, and are less diverse than urban communities. Much of the research on rural health disparities examines disparities between rural and urban communities, with fewer studies on disparities within rural communities. This report provides an overview of racial/ethnic health disparities for selected indicators in rural areas of the United States. REPORTING PERIOD 2012-2015. DESCRIPTION OF SYSTEM Self-reported data from the 2012-2015 Behavioral Risk Factor Surveillance System were pooled to evaluate racial/ethnic disparities in health, access to care, and health-related behaviors among rural residents in all 50 states and the District of Columbia. Using the National Center for Health Statistics 2013 Urban-Rural Classification Scheme for Counties to assess rurality, this analysis focused on adults living in noncore (rural) counties. RESULTS Racial/ethnic minorities who lived in rural areas were younger (more often in the youngest age group) than non-Hispanic whites. Except for Asians and Native Hawaiians and other Pacific Islanders (combined in the analysis), more racial/ethnic minorities (compared with non-Hispanic whites) reported their health as fair or poor, that they had obesity, and that they were unable to see a physician in the past 12 months because of cost. All racial/ethnic minority populations were less likely than non-Hispanic whites to report having a personal health care provider. Non-Hispanic whites had the highest estimated prevalence of binge drinking in the past 30 days. INTERPRETATION Although persons in rural communities often have worse health outcomes and less access to health care than those in urban communities, rural racial/ethnic minority populations have substantial health, access to care, and lifestyle challenges that can be overlooked when considering aggregated population data. This study revealed difficulties among non-Hispanic whites as well, primarily related to health-related risk behaviors. Across each population, the challenges vary. PUBLIC HEALTH ACTION Stratifying data by different demographics, using community health needs assessments, and adopting and implementing the National Culturally and Linguistically Appropriate Services Standards can help rural communities identify disparities and develop effective initiatives to eliminate them, which aligns with a Healthy People 2020 overarching goal: achieving health equity.
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Affiliation(s)
- Cara V. James
- Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | | | | | | | | | - Karen Bouye
- Office of the Director, CDC, Atlanta, Georgia
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Doney BC, Henneberger PK, Humann MJ, Liang X, Kelly KM, Cox-Ganser JM. Occupational Exposure to Vapor-Gas, Dust, and Fumes in a Cohort of Rural Adults in Iowa Compared with a Cohort of Urban Adults. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2017; 66:1-5. [PMID: 29095802 PMCID: PMC5829718 DOI: 10.15585/mmwr.ss6621a1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Problem/Condition Many rural residents work in the field of agriculture; however, employment in nonagricultural jobs also is common. Because previous studies in rural communities often have focused on agricultural workers, much less is known about the occupational exposures in other types of jobs in rural settings. Characterizing airborne occupational exposures that can contribute to respiratory diseases is important so that differences between rural and urban working populations can be assessed. Reporting Period 1994–2011. Description of System This investigation used data from the baseline questionnaire completed by adult rural residents participating in the Keokuk County Rural Health Study (KCRHS). The distribution of jobs and occupational exposures to vapor-gas, dust, and fumes (VGDF) among all participants was analyzed and stratified by farming status (current, former, and never) then compared with a cohort of urban workers from the Multi-Ethnic Study of Atherosclerosis (MESA). Occupational exposure in the last job was assessed with a job-exposure matrix (JEM) developed for chronic obstructive pulmonary disease (COPD). The COPD JEM assesses VGDF exposure at levels of none or low, medium, and high. Results The 1,699 KCRHS (rural) participants were more likely to have medium or high occupational VGDF exposure (43.2%) at their last job than their urban MESA counterparts (15.0% of 3,667 participants). One fifth (20.8%) of the rural participants currently farmed, 43.1% were former farmers, and approximately one third (36.1%) had never farmed. These three farming groups differed in VGDF exposure at the last job, with the prevalence of medium or high exposure at 80.2% for current farmers, 38.7% for former farmers, and 27.4% for never farmers, and all three percentages were higher than the 15.0% medium or high level of VGDF exposure for urban workers. Interpretation Rural workers, including those who had never farmed, were more likely to experience occupational VGDF exposure than urban workers. Public Health Action The occupational exposures of rural adults assessed using the COPD JEM will be used to investigate their potential association with obstructive respiratory health problems (e.g., airflow limitation and chronic bronchitis). This assessment might highlight occupations in need of preventive interventions.
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Affiliation(s)
- Brent C Doney
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Michael J Humann
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Kevin M Kelly
- The University of Iowa, Department of Occupational and Environmental Health, Iowa City, Iowa
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
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Doogan NJ, Roberts ME, Wewers ME, Stanton CA, Keith DR, Gaalema DE, Kurti AN, Redner R, Cepeda-Benito A, Bunn JY, Lopez AA, Higgins ST. A growing geographic disparity: Rural and urban cigarette smoking trends in the United States. Prev Med 2017; 104:79-85. [PMID: 28315761 PMCID: PMC5600673 DOI: 10.1016/j.ypmed.2017.03.011] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/01/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022]
Abstract
Rural areas of the United States have a higher smoking prevalence than urban areas. However, no recent studies have rigorously examined potential changes in this disparity over time or whether the disparity can be explained by demographic or psychosocial characteristics associated with smoking. The present study used yearly cross sectional data from the National Survey on Drug Use and Health from 2007 through 2014 to examine cigarette smoking trends in rural versus urban areas of the United States. The analytic sample included 303,311 respondents. Two regression models were built to examine (a) unadjusted rural and urban trends in prevalence of current smoking and (b) whether differences remained after adjusting for demographic and psychosocial characteristics. Results of the unadjusted model showed disparate and diverging cigarette use trends during the 8-year time period. The adjusted model also showed diverging trends, initially with no or small differences that became more pronounced across the 8-year period. We conclude that differences reported in earlier studies may be explained by differences in rural versus urban demographic and psychosocial risk factors, while more recent and growing disparities appear to be related to other factors. These emergent differences may be attributable to policy-level tobacco control and regulatory factors that disproportionately benefit urban areas such as enforcement of regulations around the sale and marketing of tobacco products and treatment availability. Strong federal policies and targeted or tailored interventions may be important to expanding tobacco control and regulatory benefits to vulnerable populations including rural Americans.
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Affiliation(s)
- N J Doogan
- Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA.
| | - M E Roberts
- Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA
| | - M E Wewers
- Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA
| | - C A Stanton
- Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Westat, 1600 Research Boulevard, Rockville, MD 20850, USA; Department of Oncology/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Research Building, Suite E501, 3970 Reservoir Road, N.W., Washington D.C. 20057, USA
| | - D R Keith
- Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA
| | - D E Gaalema
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
| | - A N Kurti
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
| | - R Redner
- Rehabilitation Institute, Southern Illinois University Carbondale, Rehn Hall, Mail Code 4609, Carbondale, IL 62901, USA
| | - A Cepeda-Benito
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA; Department of Psychological Science, University of Vermont, John Dewey Hall, Rm 248, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - J Y Bunn
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
| | - A A Lopez
- Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA
| | - S T Higgins
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
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Zahnd WE, James AS, Jenkins WD, Izadi SR, Fogleman AJ, Steward DE, Colditz GA, Brard L. Rural-Urban Differences in Cancer Incidence and Trends in the United States. Cancer Epidemiol Biomarkers Prev 2017; 27:1265-1274. [PMID: 28751476 DOI: 10.1158/1055-9965.epi-17-0430] [Citation(s) in RCA: 269] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends.Methods: We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013.Results: Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, P < 0.05), while temporal trends remained stable in urban areas.Conclusions: Cancer rates associated with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)-were higher in rural compared with urban populations.Impact: Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations. Cancer Epidemiol Biomarkers Prev; 27(11); 1265-74. ©2017 AACR.
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Affiliation(s)
- Whitney E Zahnd
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Wiley D Jenkins
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Sonya R Izadi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda J Fogleman
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois
| | - David E Steward
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Laurent Brard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois.,Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, Springfield, Illinois
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Dickson KS, Ahinkorah BO. Understanding tobacco use and socioeconomic inequalities among men in Ghana, and Lesotho. ACTA ACUST UNITED AC 2017; 75:30. [PMID: 28680593 PMCID: PMC5494801 DOI: 10.1186/s13690-017-0197-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/25/2017] [Indexed: 11/10/2022]
Abstract
Background Tobacco use is one of the leading causes of preventable deaths and has become a significant public health issue. Previous studies have paid less attention to tobacco use and socio-economic equalities among men in developing countries. This study examines the relationship between tobacco use and socio-economic inequalities among men in Ghana and Lesotho. Methods The study made use of data from the 2014 Demographic and Health Survey (DHS) from Ghana, and Lesotho. Binary logistic regression was employed to examine the associations between socio-economic inequality characteristics of respondents and tobacco use. Results The results showed that the prevalence of tobacco use was high in Lesotho (47.9%) as compared to that of Ghana (6.3%). Tobacco use was generally high across all age groups in Lesotho and in contrast, it was relatively low across all ages in Ghana. A statistically significant association was found between all the socio-economic variables and tobacco use in both countries. The prevalence of tobacco use was smaller in age group 15–24 years compared to the age groups 25–34 years and 35–59 years in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR’s in Ghana are respectively 5.3 (95% CI: 3.29–8.59) and 9.7 (95% CI: 6.20–15.06), compared to respectively 1.7 (95% CI: 1.32–2.11) and 1.7 (95% CI: 1.36–2.12). Smoking prevalence was smaller in men with higher level of education compared to men with no education in both Ghana and Lesotho, although the association was weaker in Ghana. The AOR in Ghana is 0.1 (95% CI: (0.02–0.11), compared to 0.2 (95% Cl: (0.17–0.30). The prevalence of tobacco use was smaller among men in urban areas compared to rural areas in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 2.1 (95% CI: 1.67–2.73), compared to 1.6 (95% CI: (1.31–1.95). In both countries, prevalence of tobacco use was higher in men who are traditionalist/spiritualists or who had no religion compared to Christians, although the association was stronger in Ghana. The AOR in Ghana is 6.2 (95% CI: (4.42–4.09) compared to 1.7 (95% CI: (1.21–2.47). The prevalence of tobacco use was low among men with richest wealth status compared to men with poorest wealth status in both Ghana and Lesotho, although the association is weaker in Ghana. The AOR in Ghana is 0.1 (95% Cl: (0.06–0.17) compared to 0.4 (95% CI: (0.51–1.12). In relation to occupation, prevalence of tobacco use was smaller among professional workers compared to men in the Agricultural sector in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 9.3 (95% Cl: (4.54–18.99), compared to 3.5 (95% CI: (2.27–5.52). Formerly married men in both countries were more likely to use tobacco compared to currently not married men, although the prevalence was higher in Ghana. The AOR in Ghana is 1.6 (95% CI: (0.99–2.28)], compared to 1.4 (95% CI: (0.89–2.28) in Lesotho. Conclusion Although similar socio-economic inequality factors provided an understanding of tobacco use among men in Ghana and Lesotho, there were variations in relation to how each factor influences tobacco use. Electronic supplementary material The online version of this article (doi:10.1186/s13690-017-0197-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Bright Opoku Ahinkorah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
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Blake KD, Moss JL, Gaysynsky A, Srinivasan S, Croyle RT. Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends. Cancer Epidemiol Biomarkers Prev 2017; 26:992-997. [PMID: 28600296 DOI: 10.1158/1055-9965.epi-17-0092] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/02/2017] [Accepted: 03/09/2017] [Indexed: 12/22/2022] Open
Abstract
Estimates of those living in rural counties vary from 46.2 to 59 million, or 14% to 19% of the U.S. POPULATION Rural communities face disadvantages compared with urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of 5-year cancer incidence and mortality from 2009 to 2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus nonmetropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011 to 2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in nonmetropolitan counties (P < 0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in nonmetropolitan counties (P < 0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011 to 2016 (3% of 1,655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer. Cancer Epidemiol Biomarkers Prev; 26(7); 992-7. ©2017 AACR.
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Affiliation(s)
- Kelly D Blake
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland.
| | - Jennifer L Moss
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
| | - Anna Gaysynsky
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
| | - Robert T Croyle
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, Maryland
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Abstract
: Background: The U.S. Department of Health and Human Services' initiative Healthy People 2020 targets tobacco use, including smoking during pregnancy, as a continuing major health concern in this country. Yet bringing the U.S. Public Health Service's 2008 clinical practice guideline, Treating Tobacco Use and Dependence, into routine prenatal care remains challenging. Our previous nurse-managed intervention study of rural pregnant women found no significant cessation effect and significant discordance between self-reported smoker status and urinary cotinine levels. PURPOSE The overall purpose of this follow-up study was to increase our understanding of the experiences of pregnant smokers and their providers. No qualitative studies could be found that simultaneously explored the experiences of both groups. DESIGN AND METHODS This qualitative descriptive study used focus group methodology. Nine focus groups were held in two counties in upper New York State; six groups consisted of providers and three consisted of pregnant women. Four semistructured questions guided the group discussions, which were audiotaped and transcribed verbatim. Transcripts were read and coded independently by six investigators. Themes were identified using constant comparative analysis and were validated using the consensus process. RESULTS The total sample consisted of 66 participants: 45 providers and 21 pregnant women. Most of the providers were white (93%) and female (93%). A majority worked as RNs (71%); the sample included perinatal and neonatal nursery nurses, midwives, and physicians. The pregnant women were exclusively white (reflecting the rural demographic); the average age was 24 years. All the pregnant women had smoked at the beginning of their pregnancies. Four common themes emerged in both the provider and the pregnant women groups: barriers to quitting, mixed messages, approaches and attitudes, and program modalities. These themes corroborate previous findings that cigarette smoking is used for stress relief, especially when pregnancy itself is a stressor, and that pregnant women may feel guilty but don't want to be nagged or preached to. CONCLUSIONS These results have implications for how smoking cessation programs for pregnant women should be designed. Health care providers need to be cognizant of their approaches and attitudes when addressing the subject of smoking cessation. Specific educational suggestions include "putting a face" to the issue of tobacco use during pregnancy. More research is needed on how best to implement the 2008 clinical practice guideline in specific populations.
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Dean C, Fogleman AJ, Zahnd WE, Lipka AE, Malhi RS, Delfino KR, Jenkins WD. Engaging rural communities in genetic research: challenges and opportunities. J Community Genet 2017; 8:209-219. [PMID: 28477297 DOI: 10.1007/s12687-017-0304-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/27/2017] [Indexed: 12/13/2022] Open
Abstract
Statistical analyses of health and disease in rural communities is frequently limited by low sample counts. Still, some studies indicate increased risk for some diseases even after adjustment for known risk factors. It has been hypothesized that the context of community formation in rural areas facilitates the propagation of genetic founder effects-potentially impacting disease susceptibility. However, outright examination of genetic diversity in such communities has not been performed. Our objective was to engage otherwise research-inexperienced rural communities of largely European descent in genomic research in the context of cancer susceptibility. From September 2015 to February 2016, we implemented a systematic process of progressive community engagement. This iterative method sought project buy-in from first the town mayor, then village council. If approved by both, a focus group of community members examined how residents might view the research, informed consent and specimen collection, and issues of privacy. We were successful in engaging three of the four communities approached for the research project. There was universal enthusiasm for the project by all mayors and village councils. The focus groups' main point of discussion involved wording in the informed consent, with little concern regarding the research question or privacy. Perhaps contrary to popular thought, we found each community we approached to be both welcoming and enthusiastic about collaborating in research on genomic diversity. The systematic method of engagement did much to preserve community respect and autonomy and facilitated buy-in.
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Affiliation(s)
- Caress Dean
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Amanda J Fogleman
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Whitney E Zahnd
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Alexander E Lipka
- Department of Crop Sciences, University of Illinois, W-201B Turner Hall, 1102 S Goodwin Ave, Urbana, IL, 61801, USA
| | - Ripan Singh Malhi
- Departments of Anthropology & Animal Biology, Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, 209F Davenport Hall, 607 Matthews Ave., Urbana, IL, 61801, USA
| | - Kristin R Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Wiley D Jenkins
- Population Health Science Program, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62794-9664, USA.
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Chertok IRA, Haile ZT. Trends in Modification of Smoking Behaviors Among Pregnant Women in West Virginia. Matern Child Health J 2017; 21:974-981. [DOI: 10.1007/s10995-017-2265-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stewart T, Formica MK, Adachi-Mejia AM, Wang D, Gerrard M. A Tobacco Cessation Intervention with Rural, Medically Underserved, Blue-collar Employees: A Quasiexperimental Study. Saf Health Work 2016; 7:293-298. [PMID: 27924231 PMCID: PMC5127975 DOI: 10.1016/j.shaw.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 02/16/2016] [Accepted: 03/17/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The aim of this study was to increase knowledge regarding the dangers associated with tobacco use, and decrease secondhand smoke exposure and tobacco use behaviors with an antitobacco messaging campaign among rural, medically underserved, blue-collar workers. METHODS A quasiexperimental study was conducted with employees at two worksites. One worksite received the intervention, which consisted of nine different antitobacco messages. Baseline and follow-up surveys were conducted at each worksite to assess change in knowledge and behavior; the data were compared across the two worksites. RESULTS Two hundred twenty-two and 243 participants completed baseline and follow-up surveys at the intervention and comparison sites, respectively. A statistically significant difference was seen over time between the worksites on knowledge of the dangers of tobacco (p < 0.0001); the mean knowledge score increased at the intervention site, but remained unchanged at the comparison site. In general, nonsmokers at both worksites appeared to try to decrease exposure to secondhand smoke over the follow-up period. Repeated measures analysis indicated that there were no differences in motivation to quit (p = 0.81), interest in quitting (p = 0.40), thinking about quitting (p = 0.53), or several tobacco-use behaviors over time among smokers at the intervention and comparison worksites. There were slight increases over time in the proportion of smokers who do not allow smoking in their homes/vehicles at the intervention worksite, although not statistically significant. CONCLUSION Participants at the intervention worksite increased their knowledge regarding the dangers of tobacco use and secondhand smoke exposure. Among current tobacco users, the intervention appeared to increase family rules regarding secondhand smoke exposure in their homes and vehicles.
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Affiliation(s)
- Telisa Stewart
- Department of Public Health and Preventive Medicine, Upstate Medical University, Syracuse, NY, USA
- Department of Urology, Upstate Medical University, Syracuse, NY, USA
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - Margaret K. Formica
- Department of Public Health and Preventive Medicine, Upstate Medical University, Syracuse, NY, USA
- Department of Urology, Upstate Medical University, Syracuse, NY, USA
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - Anna M. Adachi-Mejia
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
- Cancer Control Research Program, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, Upstate Medical University, Syracuse, NY, USA
| | - Meg Gerrard
- Cancer Control Research Program, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
- The Department of Psychology, University of Connecticut, Storrs, CT, USA
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Patterns and predictors of local health department accreditation in Missouri. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:116-25. [PMID: 24722052 DOI: 10.1097/phh.0000000000000089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Healthy People 2020 goal for the public health system is "to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services." To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri. METHODS Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R for each model are reported. RESULTS Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation. CONCLUSIONS Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.
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Noonan D, Dardas L, Bice-Wigington T, Sloane R, Benjamin R, Choi SH, Simmons LA. Understanding Multiple Behavioral Risk Factors for Cancer in Rural Women. Public Health Nurs 2016; 33:519-528. [PMID: 27377312 PMCID: PMC5962939 DOI: 10.1111/phn.12282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the demographic and health-related factors associated with risk behaviors that have been linked to cancer including smoking, high BMI, and low physical activity. DESIGN AND SAMPLE A secondary analysis was conducted using data from Rural Families Speak about Health, a multistate, epidemiologic study of rural American women and their families (N = 444). MEASURES Validated measures for various demographic and health-related items including tobacco use, BMI, physical activity, and depression were used. RESULTS Of the total sample with complete data (n = 399), the mean age was 32 years and the majority were White (64%), married (67%), had a high school education or higher (73%), and had an annual household income of less than $40,000 (90%). Regarding cancer risk behaviors, 36% of the sample were smokers, 39% reported low levels of physical activity, and 45% had a calculated BMI over 30. Thirty-five percent of participants reported engaging in two or more risk behaviors. There were significant differences in income, perceived health status, and depression depending on the number of risk behaviors reported. CONCLUSIONS Understanding combinations of risk behaviors can assist nurses and other health professionals in tailoring multiple health behavior change interventions to prevent cancer among rural women.
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Affiliation(s)
- Devon Noonan
- Duke University School of Nursing, Durham, North Carolina
| | - Latefa Dardas
- Duke University School of Nursing, Durham, North Carolina
| | | | - Richard Sloane
- Duke University School of Nursing, Durham, North Carolina
| | | | - Seung Hee Choi
- Michigan State University College of Nursing, East Lansing, Michigan
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