Poor HIV-related Knowledge, Perceived Risks and Attitudes Among Urban-dwelling Malaysian Older Adults: Key Barriers to Zero HIV Transmission by 2030

Globally and in Malaysia, there are increasing rates of HIV infection among older adults but a corresponding decline in other younger age groups. We aimed to investigate the HIV-related knowledge, perceived risks, attitudes, and risk behaviours among multi-ethnic urban-dwelling older adults in Malaysia. A cross-sectional, questionnaire-based study was conducted among 320 adults aged 50 years and above residing in urban Klang Valley, Malaysia. Participants were recruited via convenience sampling in the community and in the outpatient clinics and pharmacy of University Malaya Medical Centre, Malaysia, from April 2021 to January 2022. The median (IQR) age of participants was 58 (55-64) and 42.5% were males. The median (IQR) knowledge score was 10 (8-12) out of 14. Significant knowledge gaps were noted and ethnic Chinese, higher education levels and better HIV-related attitudes were associated with better scores. The median (IQR) attitude score was 49 (41-55) out of 65. Ethnic Chinese and Indian, knowing people living with HIV (PLHIV), and better HIV-related knowledge were associated with better attitude scores. Many (43.8%) older adults were sexually active however rates of consistent condom use was low (19%) and the majority (89.9%) of participants had low self-perceived risk of HIV. These findings highlight underlying drivers for HIV transmission and delayed treatment among older adults in Malaysia and indicate a need for targeted HIV prevention programs for this population.

Psychosocial risk factors and cognitive decline in people living with HIV: results from the Malaysian HIV and aging (MHIVA) study

HIV-associated mortality has improved with the advent of antiretroviral therapy, yet neurocognitive decline persists. We assessed the association between psychosocial risk factors and cognitive function among Malaysian PLWH. Data of virally suppressed PLWH (n = 331) on stable ART, from the Malaysian HIV and Aging study was assessed. Psychosocial factors were assessed using the Lubben Social Network Scale-6 (social isolation) and Depression Anxiety Stress Scale-21 (DASS-21). The Montreal Cognitive Assessment (MoCA) with normative standards for the Malaysian population was used to determine cognitive function. Linear and logistic regression were used to assess the associations between cognition, and psychosocial risk factors. Median age of participants was 43.8 years (IQR 37.7-51.0). Participants were predominantly male (82.8%), with secondary education or higher (85.2%). Participants were on ART for 5.7 years (IQR 3.0-9.7), with a mean MoCA score of 24.6 (±3.7). Social isolation was found in 34.6% of participants, and severe depression, severe stress, and severe anxiety in 10.6%, 15.4%, and 6.0% respectively. After adjusting for demographic, clinical, and HIV parameters, MoCA scores were significantly associated with severe stress (β = -0.11, p = 0.02) and having marginal friendship ties (β = -0.13, p = 0.03). Social isolation and severe stress are associated with neurocognitive impairment in PLWH.

Direct-to-Consumer Sexually Transmitted Infection Screening Methods: Preferred Communication Sources and Channels Among Young Adult Women

BACKGROUND

Direct-to-consumer (DTC) sexually transmitted infection (STI) screening methods use self-collected samples in a nonclinical setting. Direct-to-consumer methods may reach a population of women who avoid screening because of stigma and privacy concerns, or who lack access to clinical care. Little is known about the salient dissemination approaches to promote these methods. The study's purpose was to identify preferred sources and communication channels for information about DTC methods among young adult women.

METHODS

Participants were sexually active 18- to 24-year-old college women at one university, recruited via purposive sampling using campus email, list-servs, and campus events to participate in an online survey (n = 92). Interested participants were invited to participate in in-depth interviews (n = 24). Both instruments were guided by the Diffusion of Innovation theory to identify relevant communication channels.

RESULTS

Survey participants ranked healthcare providers as their preferred source of information, followed by the Internet and college- and university-based resources. Race was significantly associated with the ranking of partners and family members as information sources. Interview themes focused on healthcare providers legitimizing DTC methods, using the Internet and social media to increase awareness, and linking DTC method education to other services provided by the college.

CONCLUSIONS

This study revealed common information sources that college-aged women may use when researching DTC method information and potential channels and strategies for DTC uptake and dissemination. Using trusted sources including healthcare providers, trusted Web sites, and established college resources as dissemination channels may be beneficial to increase the awareness and use of DTC methods for STI screening.

Health Care Provider Discussions Regarding HIV/Sexually Transmitted Infection Risk Factors and Associations with HIV/Sexually Transmitted Infection Screening Among Men

Little is known regarding the specific discussions health care providers (HCP) have with their patients and how these discussions may increase rates of HIV/STI screening. The main objective of this study was to examine the content of HCP-patient discussions and associations with HIV/STI screening while adjusting for patient characteristics. Using the 2017-2019 National Survey of Family Growth data, seven survey-weighted multivariable multinomial/binary logistic regression models were analyzed in men ages 15-49 years old (N = 4260). Patients had significantly higher odds of a lifetime HIV test when their HCP asked about number of sexual partners (adjusted odds ratio [aOR] = 2.325; 95% CI 1.379-3.919) and discussed HIV/AIDS (aOR = 4.149; 95% CI 2.877-5.983). Odds of a recent STI screening were higher among patients with HCP that asked about: sexual orientation (aOR = 1.534; 95% CI 1.027-2.291), number of sexual partners (aOR = 2.123; 95% CI 1.314-3.430), use of condoms (aOR = 2.295 95% CI 1.484-3.548), type of sexual intercourse (aOR = 1.900; 95% CI 1.234-2.925), and discussed HIV/AIDS (aOR = 1.549; 95% CI 1.167-2.056). Results may provide insight on how HCPs may potentially promote HIV/AIDS and STI screening among men and which patient groups are more likely to receive a discussion of risks factors from their HCPs.

NOT HAVING THE FAMILY, INSURANCE, AND MONEY AND EXPERIENCING LOTS OF PAIN: FEARS ABOUT CANCER AMONG OLDER LATINO MEN

Cancer is the second leading cause of death among Latino men. A total of 44.1% of Latino males 60-years or older have a lifetime probability of developing invasive cancer with lower survival rates, even when accounting for age and stage distribution. Given the population growth is essential to examine older Latinos’ understanding of a cancer diagnosis. The study consisted of 200 surveys that included a qualitative component consisting of open-ended questions in Spanish. We separately analyzed the responses of the 57 immigrant Latino men to understand their perspective regarding cancer, prevention, diagnosis, and treatment. The median age is 68 years and the length of stay in the US is 27 years. Utilizing a grounded theory approach and thematic analysis, codes were developed based on five priori interview themes: leaving people behind, worry and stress about payment, emotions of sadness and fear of uncertainty, struggle with acceptance, and faith as comfort.

Responding to "Don't Say Gay" Laws in the US: Research Priorities and Considerations for Health Equity

INTRODUCTION

Despite increased legal rights for lesbian, gay, bisexual, transgender, and queer-identifying (LGBTQ +) people in the USA over the past 30 years, there has been an increasing number of anti-LGBTQ + laws proposed and passed at the state level. One of the most notorious laws, Florida's HB 1557, also known as the "Don't Say Gay" law, garnered substantial national attention for prohibiting discussions of sexual orientation or gender identity in public school classrooms. Other states quickly proposed similar laws, but little scholarship exists on the potential impacts of these laws.

METHODS

We explore the potential health equity ramifications of laws like Florida's HB 1557, focusing on the individual, interpersonal, and broader policy and practice implications. Examining these policies through the lens of political determinants of health, we identify theoretical and methodological approaches needed to address recent "Don't Say Gay" policies.

RESULTS

Theoretical approaches emphasizing power, intersectionality, and the role of politics in health should guide research examining the impacts of recent anti-LGBTQ + policies. Laws like Florida's HB 1557 emphasize the need for methodological approaches that emphasize collaborative engagement between researchers and community members, and future research may be needed to understand how stressors created by law and policy can have individual and interpersonal consequences.

CONCLUSIONS

Public health researchers have a role to play in reversing policies that negatively affect LGBTQ + individuals and undermine health equity. Research combating harmful policies may require theoretical approaches attentive to power differences and methodological approaches that squarely focus on disrupting power imbalances.

Cancer Prevention and Diagnosis Knowledge among Spanish-speaking Older Latino/as Residing in Tampa, Florida

Objective

Cancer remains the leading cause of death among Latino/as in the United States, and advancing age is a major risk factor for developing most cancer types. Given the growing population of Latino/as immigrants aged ≥60 years and the current lack of relevant data, this study aims to understand the cancer prevention and perception of cancer diagnosis among older Latinos to ensure that they receive effective prevention, intervention, and psychosocial care.

Method

A survey exploring attitudes about cancer was developed and administered in Spanish. Using convenience sampling, 168 individuals identifying as Latino/as were surveyed in Tampa, Florida. Descriptive analysis was conducted to understand study population characteristics. Frequencies were assessed to understand the participants' responses to cancer-related attitude questions. The effects of age, country of origin, length of stay in the United States, and marital status on the participants' cancer-related attitudes were assessed using logistic regression.

Results

The mean age of the study participants was 67.9 years, 34.5% were male, and the mean length of stay in the United States was 25.8 years. In total, 29% and 24.4% of the participants knew that breast cancer and prostate cancer, respectively, can be diagnosed early. Individuals with an elementary education were less likely to have sufficient knowledge of cancer prevention and diagnosis. Additionally, 93.5% of the population was aware that tobacco use can lead to cancer, and 84.5% knew that exposure to tobacco smoke can affect both the smoker and their family.

Conclusion

Older Latino/as possess knowledge about cancer causes yet lack knowledge regarding cancer prevention and diagnosis, potentially creating barriers and causing them to avoid treatment. Focusing on cancer-related health education among older Latino/as is a step toward appropriate and equitable cancer care.

A Mixed-Methods Approach to the Examination of Cancer Treatment Preferences Among Older Latino Adults

Given the growing population of Latino immigrants 60 years and older and the current lack of relevant data, there is an urgent need to understand this population’s cancer treatment preferences to ensure effective interventions and psychosocial care. A study comprising 200 surveys with areas focused on cancer knowledge, attitudes, prevention, early diagnosis, and treatment was developed and administered in Spanish. The survey included a qualitative component consisting of open-ended questions. The mixed-method study gathered quantitative data regarding treatment preferences as well as the voices of older Latino men and women with a history of cancer, including their cancer treatment trajectory. Additionally, the survey data highlighted the lack of knowledge regarding available cancer treatments. The findings suggest that, while older Latino/as have knowledge about the causes of cancer, they lack knowledge regarding cancer diagnoses, which could potentially cause them to avoid treatment.

The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study

BACKGROUND

chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population.

OBJECTIVE

we examined the association between opioid use, and changes in cognitive function of older adults.

DESIGN

prospective study.

SETTING

community dwelling older adults.

SUBJECTS

study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia.

METHODS

medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models.

RESULTS

cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use.

CONCLUSION

prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.

Trends in anticholinergic and opioid dispensing in older adults from 2004 to 2015: Results from the Personality and Total Health (PATH) Through Life Study

OBJECTIVE

Due to potential adverse effects, guidelines recommend that anticholinergics and opioids be avoided in older adults unless necessary. This study examines the dispensing trends of these medications among older Australians.

METHODS

Data of 2222 PATH study (60+ cohort) participants were analysed. Medication dispensing data were obtained from the Pharmaceutical Benefits Scheme from April 2004 to March 2015. Temporal trends of prescriptions dispensed were assessed using joinpoint regression analysis.

RESULTS

Of all dispensed prescriptions, 5.5% were for anticholinergics and opioids, and 46.2% of anticholinergics dispensed were anti-depressants. Anticholinergic dispensing trend increased in 2004-2015 (annual per cent change, APC = 3.4%), particularly for moderately anticholinergic medications (APC = 6.8%). Dispensing trend for opioids increased in 2004-2011 (APC = 11.3%) and declined in 2011-2015 (APC = -4.4%).

CONCLUSION

While guidelines urge caution in prescribing these medications to older adults, dispensing increased over time in this study population.

The Effect of Cumulative Anticholinergic Use on the Cognitive Function of Older Adults: Results from the Personality and Total Health (PATH) Through Life Study

BACKGROUND

Multiple comorbidities are common in older adults, resulting in polypharmacy that often includes medications with anticholinergic properties. These medications have multiple side effects, which are more pronounced in the older population. This study examined the association between the use of anticholinergics and changes in the cognitive function of older adults.

METHODS

The study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health (PATH) Through Life Study in Australia. Medication data were obtained from the Pharmaceutical Benefits Scheme (PBS). Cognitive measures were obtained from neuropsychological battery assessment. Exposure to cumulative anticholinergic use was quantified to a total standardized daily dose (TSDD). The association between change in cognitive measures between baseline and 4-year follow-up, and cumulative use of anticholinergic was assessed through generalized linear models.

RESULTS

During the study period, 18.6% (n = 413) of participants filled at least one prescription for anticholinergics. Compared to those not on anticholinergics, participants on anticholinergics were more likely to be woman (62.7% compared to 45.1%) and spent lesser time engaging in vigorous physical activity (0.4 h/week compared to 0.9 h/week). Cumulative use of anticholinergic resulting in a TSDD exceeding 1,095 was significantly associated with poorer performance in Trail Making Test Part B (Model 1: β = 5.77, Model 2: β = 5.33, Model 3: β = 8.32, p < .01), indicating impairment in processing speed.

CONCLUSIONS

In our study, except for speed of processing, other cognitive domains measured were not affected by cumulative anticholinergic use over a 4-year period.

Honoring Older Latino Immigrants’ Perspectives on Cancer: Informing the Future

Cancer is the leading cause of death among Latinos in the U.S. Approximately 32.2% of Latinas and 44.1% of Latinos aged 60 years or older have a lifetime probability of developing invasive cancer (ACS, 2018), with lower survival rates for most cancers even when allowing for age and stage distribution. There is some evidence that older Latino/Latina immigrants lack knowledge about cancer treatment options and are often adversely impacted by healthcare inequities regarding cancer treatment and care options. This study compared the cancer beliefs and attitudes of 58 Latinos and 110 Latinas with a mean age of 67.9 years who reside in the Greater Tampa Bay area. Recruitment occurred in community-based settings, and interviews were conducted in Spanish and transcribed into English. The qualitative methods of constant comparison and thematic analysis will be presented along with the results related to diagnosis, medical decisions, finances, death, and family.

Informing the Future: Cancer Prevention and Diagnosis Beliefs Among Older Latino Immigrants

Despite emerging research on Latinos and cancer (Carrion et al., 2018), there are no data regarding beliefs about cancer prevention and diagnosis in older Latinos residing in Central Florida. Similarly, to the US in general, Central Florida’s older Latino population is growing. Compared with other national samples, Latino immigrants in the southern U.S. report poorer health than in other regions (Siegel et al., 2015). Using convenience sampling (N = 168), univariate analysis was done to recognize the study population’s characteristics. Frequencies were assessed to understand participants’ responses to questions on cancer-related attitudes. The effects of age, country of origin, length of stay in the U.S., and marital status were assessed using logistic regression. Of the 168 individuals in the study, 34.5% were male with a mean age of 67.9, and a majority had at least a high school education and 25.8 years residing in the U.S. The participants were aware that tobacco use can cause cancer (93.5%) and that smoking affects the smoker as well as their family members (84.5%). They were also aware that mammograms facilitate early diagnosis of breast cancer (81.5%) and of the association between prolonged sun exposure and skin cancer (86.9%). However, specific knowledge about early diagnosis was low. Only 29.2% of participants knew that breast cancer can be diagnosed early, which was similar to the response toward early diagnosis of prostate cancer (24.4%). Among the participants, 26.2% were categorized as having poor knowledge of cancer prevention.

STRENGTH IN SEEKING SUPPORT: OLDER LATINOS’ ATTITUDES ABOUT CANCER

Given the growing Latino population 60 years and older, the current lack of relevant data, there is an urgent need to understand their attitudes about cancer to ensure effective prevention, intervention, and psycho-social care. A survey exploring attitudes about cancer was developed and administered in Spanish. Using convenience sampling (N = 168), univariate analysis was done to understand the study population’s characteristics. Frequencies were assessed to understand participants’ responses to questions on cancer-related attitudes. The effects of age, country of origin, length of stay in the U.S., and marital status were assessed using logistic regression. The participants had a mean age of 67.9 years, 65.5% were female, 56.5% were married or living with a partner, and 35.5% had tertiary education. Most respondents were from South America (46.7%), with a mean length of stay in the U.S. of 25.8 years. A high number (91.0%) indicated a preference to know if they had cancer, and 87.5% said that they would share their diagnosis with family and friends. Of the respondents, 80.4% felt that cancer patients should receive care from a psychologist and that cancer improves if a patient is lively and positive (82.6%). Compared to college-educated individuals, those with a high school education were less likely to choose to know about a cancer diagnosis (β=-1.92, p&lt;0.01) or share it (β= 1.78, p&lt;0.001). Attitudes about cancer vary depending on the educational level of older Latinos and may impact treatment decisions. These findings can enhance cancer information and education for older Latinos.

THE POWER OF CANCER KNOWLEDGE EXCHANGE AMONG OLDER LATINOS

Prior studies have indicated that older Latinos/as diagnosed with cancer experience social inequalities and other barriers due to their limited English language proficiency and access to health care (Fernández & Morales, 2007). In addition, for Latinos, a cancer diagnosis magnifies health disparities substantially (Gehlert & Colditz, 2011). Despite the impact of the cancer experience, Latinos manifest meaning-based beliefs and coping strategies in dealing with cancer diagnoses (Carrion, Nedjat-Haiem, Macip-Billbe, Black, 2017). However, little is known about older Latinos’ (60 years and older) transmission of knowledge, beliefs, and attitudes to family members and friends. Understanding older Latinos’ advice regarding cancer is essential, given their role in the transmission of knowledge. This study disseminates the latest qualitative findings on older Latinos/as and explores the perspectives shared with family members and friends by non-cancer participants. It explores the types of knowledge, beliefs, attitudes, and advice older Latinos provide to family members and friends about cancer. The data represent individuals without cancer (n=168) residing in the Greater Tampa Bay area. Latinos manifest meaning-based beliefs and coping strategies that assist in dealing with their cancer diagnoses and access to care. Recruitment occurred in community-based settings, with interviews conducted in Spanish and transcribed into English. Qualitative data were analyzed using a constant comparison method and coded in ATLAS.ti to identify emerging themes, including knowledge that a cancer diagnosis is beyond individual control and is in God’s hands, careful choice of a doctor to ensure proper prevention and treatment, and a positive attitude despite the cancer diagnosis.

Obstetrics and Gynecology and Family Medicine Residents' Training and Knowledge on Emergency Contraception

Background: Emergency contraception (EC) has the potential to play a vital role in preventing unintended pregnancies after unprotected sexual intercourse or contraceptive failure. Residency training can influence practice behaviors, however, the extent to which EC-related information is taught in training programs remains unknown. This study examined where residents obtain information about EC and whether knowledge differs by resident program characteristics. Materials and Methods: Program coordinators of Obstetrics and Gynecology (OB/GYN) and Family Medicine residency programs (n = 689) were emailed and requested to forward the survey link to residents. The survey included measures of EC education (hours, sources, including lectures, grand rounds), and EC-related knowledge. EC knowledge items assessed the three methods of EC (copper intrauterine device, ulipristal acetate, and oral levonorgestrel), effectiveness, mechanism of action, contraindications, and side effects. t-Tests and analysis of variances were used to compare mean knowledge scores (maximum = 20; higher scores indicating higher knowledge). Results: Among participants (n = 676), 61% were Family Medicine residents, 66% were white, and 72% were female. Overall, 34% received <1 hour of EC education, with OB/GYN residents receiving significantly more hours than Family Medicine residents. OB/GYN residents (mean = 14.40, standard deviation [SD] = 2.69) had a significantly higher mean knowledge score than Family Medicine residents (12.12, SD = 2.63; p < 0.000). Mean knowledge score differences were found by region of residency program, with residents in the Northeast reporting higher knowledge. Conclusions: Overall, residents received very little EC education, with OB/GYN residents receiving more training and having higher knowledge than their Family Medicine counterparts. Additional training is needed to ensure that residents are knowledgeable about this effective method to decrease unintended pregnancies.

USA dental health providers' role in HPV vaccine communication and HPV-OPC protection: a systematic review

Background. Improving human papilloma virus (HPV) vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of dental provider communication about HPV vaccination. Methods. We searched MEDLINE, CINAHL, ScienceDirect, PsycINFO and JSTOR in August 2018 to identify studies of dental provider knowledge, perceived role and communication about HPV, HPV vaccination and HPV-associated oropharyngeal cancer (HPV-OPC). Results. We identified 10 qualitative and quantitative studies. Results of the primarily descriptive studies showed that although there were some deficiencies in knowledge about HPV-related outcomes and its effect on the male population, most providers understand HPV as a sexually transmitted infection and know the HPV vaccine is available, yet many are not discussing the HPV-OPC link or recommending vaccination. Providers were less often to recommend HPV vaccination if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Studies reported mixed results on providers' perceived role in expanded HPV vaccination and HPV-OPC education, but indicated support for the role of professional organizations in promoting awareness. Conclusion. Interventions are needed to help dental providers perceive their role to deliver effective recommendations within the complex communication environment surrounding HPV vaccination and HPV-OPC education.

Reorienting Health Services to People with Chronic Health Conditions: Diabetes and Stroke Services in Malaysia, Sri Lanka and Thailand

This paper explores whether middle-income Asian countries are reorienting their health services in response to non-communicable diseases (NCDs). Malaysia, Sri Lanka, and Thailand were selected as case studies of Asian societies experiencing rapid increases both in NCDs and an aging population. While NCD programs, especially those related to diabetes and stroke, are well-established in Thailand, health services struggle to respond to increasing numbers of people with chronic health problems. Health services at all levels must plan ahead for more patients with chronic and often multiple conditions who require better integrated health care.

Stroke incidence in the South West District of the Penang Island, Malaysia: PEARLs: Penang Acute Stroke Research Longitudinal Study

OBJECTIVES

This community based incidence study aims to report the stroke incidence in the south-west region of the Penang Island.

METHODS

All strokes occurring in the population of residents in the southwest region of the Penang Island, Malaysia during a period of 12 months, from April 2010 to March 2011 were screened and assessed. Standard definitions for stroke were used. All stroke cases were ascertained using multiple overlapping sources. Incidence rate was based on first ever in a lifetime stroke cases. All recurrent strokes were excluded from the incidence count.

RESULTS

The overall stroke incidence rate in the study region during the study period was 67 per 100,000 after age adjustment to 2010 Malaysian population.

CONCLUSION

This study provides the first stroke incidence data in Malaysia and is vital for effective health system planning.