Assessment of potential adverse events following the 2022-2023 seasonal influenza vaccines among U.S. adults aged 65 years and older

BACKGROUND

While safety of influenza vaccines is well-established, some studies have suggested potential associations between influenza vaccines and certain adverse events (AEs). This study examined the safety of the 2022-2023 influenza vaccines among U.S. adults ≥ 65 years.

METHODS

A self-controlled case series compared incidence rates of anaphylaxis, encephalitis/encephalomyelitis, Guillain-Barré Syndrome (GBS), and transverse myelitis following 2022-2023 seasonal influenza vaccinations (i.e., any, high-dose or adjuvanted) in risk and control intervals among Medicare beneficiaries ≥ 65 years. We used conditional Poisson regression to estimate incidence rate ratios (IRRs) and 95 % confidence intervals (CIs) adjusted for event-dependent observation time and seasonality. Analyses also accounted for uncertainty from outcome misclassification where feasible. For AEs with any statistically significant associations, we stratified results by concomitant vaccination status.

RESULTS

Among 12.7 million vaccine recipients, we observed 76 anaphylaxis, 276 encephalitis/encephalomyelitis, 134 GBS and 75 transverse myelitis cases. Only rates of anaphylaxis were elevated in risk compared to control intervals. With all adjustments, an elevated, but non-statistically significant, anaphylaxis rate was observed following any (IRR: 2.40, 95% CI: 0.96-6.03), high-dose (IRR: 2.31, 95% CI: 0.67-7.91), and adjuvanted (IRR: 3.28, 95% CI: 0.71-15.08) influenza vaccination; anaphylaxis IRRs were 2.54 (95% CI: 0.49-13.05) and 1.64 (95% CI: 0.38-7.05) for persons with and without concomitant vaccination, respectively.

CONCLUSIONS

Rates of encephalitis/encephalomyelitis, GBS, or transverse myelitis were not elevated following 2022-2023 seasonal influenza vaccinations among U.S. adults ≥ 65 years. There was an increased rate of anaphylaxis following influenza vaccination that may have been influenced by concomitant vaccination.

Effectiveness of BNT162b2 COVID-19 primary series vaccination in children aged 5-17 years in the United States: a cohort study

BACKGROUND

COVID-19 vaccines are authorized for use in children in the United States; real-world assessment of vaccine effectiveness in children is needed. This study's objective was to estimate the effectiveness of receiving a complete primary series of monovalent BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine in US children.

METHODS

This cohort study identified children aged 5-17 years vaccinated with BNT162b2 matched with unvaccinated children. Participants and BNT162b2 vaccinations were identified in Optum and CVS Health insurance administrative claims databases linked with Immunization Information System (IIS) COVID-19 vaccination records from 16 US jurisdictions between December 11, 2020, and May 31, 2022 (end date varied by database and IIS). Vaccinated children were followed from their first BNT162b2 dose and matched to unvaccinated children on calendar date, US county of residence, and demographic and clinical factors. Censoring occurred if vaccinated children failed to receive a timely dose 2 or if unvaccinated children received any dose. Two COVID-19 outcome definitions were evaluated: COVID-19 diagnosis in any medical setting and COVID-19 diagnosis in hospitals/emergency departments (EDs). Propensity score-weighted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards models, and vaccine effectiveness (VE) was estimated as 1 minus HR. VE was estimated overall, within age subgroups, and within variant-specific eras. Sensitivity, negative control, and quantitative bias analyses evaluated various potential biases.

RESULTS

There were 453,655 eligible vaccinated children one-to-one matched to unvaccinated comparators (mean age 12 years; 50% female). COVID-19 hospitalizations/ED visits were rare in children, regardless of vaccination status (Optum, 41.2 per 10,000 person-years; CVS Health, 44.1 per 10,000 person-years). Overall, vaccination was associated with reduced incidence of any medically diagnosed COVID-19 (meta-analyzed VE = 38% [95% CI, 36-40%]) and hospital/ED-diagnosed COVID-19 (meta-analyzed VE = 61% [95% CI, 56-65%]). VE estimates were lowest among children 5-11 years and during the Omicron-variant era.

CONCLUSIONS

Receipt of a complete BNT162b2 vaccine primary series was associated with overall reduced medically diagnosed COVID-19 and hospital/ED-diagnosed COVID-19 in children; observed VE estimates differed by age group and variant era.

REGISTRATION

The study protocol was publicly posted on the BEST Initiative website ( https://bestinitiative.org/wp-content/uploads/2022/03/C19-VX-Effectiveness-Protocol_2022_508.pdf ).

Effectiveness of monovalent COVID-19 booster/additional vaccine doses in the United States

Background

Monovalent booster/additional doses of COVID-19 vaccines were first authorized in August 2021 in the United States. We evaluated the real-world effectiveness of receipt of a monovalent booster/additional dose of COVID-19 vaccine compared with receiving a primary vaccine series without a booster/additional dose.

Methods

Cohorts of individuals receiving a COVID-19 booster/additional dose after receipt of a complete primary vaccine series were identified in 2 administrative insurance claims databases (Optum, CVS Health) supplemented with state immunization information system data between August 2021 and March 2022. Individuals with a complete primary series but without a booster/additional dose were one-to-one matched to boosted individuals on calendar date, geography, and clinical factors. COVID-19 diagnoses were identified in any medical setting, or specifically in hospitals/emergency departments (EDs). Propensity score-weighted hazards ratios (HRs) and 95% confidence intervals (CI) were estimated with Cox proportional hazards models; vaccine effectiveness (VE) was estimated as 1 minus the HR by vaccine brand overall and within subgroups of variant-specific eras, immunocompromised status, and homologous/heterologous booster status.

Results

Across both data sources, we identified 752,165 matched pairs for BNT162b2, 410,501 for mRNA-1273, and 11,398 for JNJ-7836735. For any medically diagnosed COVID-19, meta-analyzed VE estimates for BNT162b2, mRNA-1273, and JNJ-7836735, respectively, were: BNT162b2, 54% (95% CI, 53%-56%); mRNA-1273, 58% (95% CI, 56%-59%); JNJ-7836735, 34% (95% CI, 23%-44%). For hospital/ED-diagnosed COVID-19, VE estimates ranged from 70% to 76%. VE was generally lower during the Omicron era than the Delta era and for immunocompromised individuals. There was little difference observed by homologous or heterologous booster status.

Conclusion

The original, monovalent booster/additional doses were reasonably effective in real-world use among the populations for which they were indicated during the study period. Additional studies may be informative in the future as new variants emerge and new vaccines become available.Registration: The study protocol was publicly posted on the BEST Initiative website (https://bestinitiative.org/wp-content/uploads/2022/03/C19-VX-Effectiveness-Protocol_2022_508.pdf).

Evaluation of potential adverse events following COVID-19 mRNA vaccination among adults aged 65 years and older: Two self-controlled studies in the U.S

BACKGROUND

Our near-real-time safety monitoring of 16 adverse events (AEs) following COVID-19 mRNA vaccination identified potential elevation in risk for six AEs following primary series and monovalent booster dose administration. The crude association with AEs does not imply causality. Accordingly, we conducted robust evaluation of potential associations.

METHODS

We conducted two self-controlled case series studies of COVID-19 mRNA vaccines (BNT162b2 and mRNA-1273) in U.S. Medicare beneficiaries aged ≥ 65 years. Adjusted incidence rate ratio (IRRs) and 95 % confidence intervals (CIs) were estimated following primary series doses for acute myocardial infarction (AMI), pulmonary embolism (PE), immune thrombocytopenia (ITP), disseminated intravascular coagulation (DIC); and following monovalent booster doses for AMI, PE, ITP, Bell's Palsy (BP) and Myocarditis/Pericarditis (Myo/Peri).

RESULTS

The primary series study included 3,360,981 individuals who received 6,388,542 primary series doses; the booster study included 6,156,100 individuals with one monovalent booster dose. The AMI IRR following BNT162b2 primary series and booster was 1.04 (95 % CI: 0.91 to 1.18) and 1.06 (95 % CI: 1.003 to 1.12), respectively; for mRNA-1273 primary series and booster, 1.01 (95 % CI: 0.82 to 1.26) and 1.05 (95 % CI: 0.998 to 1.11), respectively. The hospital inpatient PE IRR following BNT162b2 primary series and booster was 1.19 (95 % CI: 1.03 to 1.38) and 0.86 (95 % CI: 0.78 to 0.95), respectively; for mRNA-1273 primary series and booster, 1.15 (95 % CI: 0.94 to 1.41) and 0.87 (95 % CI: 0.79 to 0.96), respectively. The studies' results do not support that exposure to COVID-19 mRNA vaccines elevate the risk of ITP, DIC, Myo/Peri, and BP.

CONCLUSION

We did not find an increased risk for AMI, ITP, DIC, BP, and Myo/Peri and there was not consistent evidence for PE after exposure to COVID-19 mRNA primary series or monovalent booster vaccines. These results support the favorable safety profile of COVID-19 mRNA vaccines administered in the U.S. elderly population.

Use of Immunization Information Systems in Ascertainment of COVID-19 Vaccinations for Claims-Based Vaccine Safety and Effectiveness Studies

Importance

Safety and effectiveness studies of COVID-19 vaccines are being conducted using clinical data, including administrative claims. However, claims data only partially capture administered COVID-19 vaccine doses for numerous reasons, such as vaccination at sites that do not generate claims for reimbursement.

Objective

To evaluate the extent to which Immunization Information Systems (IIS) data linked to claims data enhances claims-based COVID-19 vaccine capture for a commercially insured population and to estimate the magnitude of misclassification of vaccinated individuals as having unvaccinated status in the linked IIS and claims data.

Design, Setting, and Participants

This cohort study used claims data from a commercial health insurance database and obtained vaccination data from IIS repositories in 11 US states. Participants were individuals younger than 65 years who resided in 1 of 11 states of interest and who were insured in health plans from December 1, 2020, through December 31, 2021.

Main Outcomes and Measures

Estimated proportion of individuals with at least 1 dose of any COVID-19 vaccine and proportion of individuals with a completed vaccine series based on general population guidelines. Vaccination status estimates were calculated and compared using claims data alone and linked IIS and claims data. Remaining misclassification of vaccination status was assessed by comparing linked IIS and claims data estimates with estimates from external surveillance data sources (Centers for Disease Control and Prevention [CDC] and state Department of Health [DOH]) and capture-recapture analysis.

Results

This cohort study included 5 112 722 individuals (mean [SD] age, 33.5 [17.6] years; 2 618 098 females [51.2%]) from 11 states. Characteristics of those who received at least 1 vaccine dose and those who completed a vaccine series were similar to the overall study population. The proportion with at least 1 vaccine dose increased from 32.8% using claims data alone to 48.1% when the data were supplemented with IIS vaccination records. Vaccination estimates using linked IIS and claims data varied widely by state. The percentage of individuals who completed a vaccine series increased from 24.4% to 41.9% after the addition of IIS vaccine records and varied across states. The percentages of underrecording using linked IIS and claims data were 12.1% to 47.1% lower than those using CDC data, 9.1% to 46.9% lower than the state DOH, and 9.2% to 50.9% lower than capture-recapture analysis.

Conclusion and Relevance

Results of this study suggested that supplementing COVID-19 claims records with IIS vaccination records substantially increased the number of individuals who were identified as vaccinated, yet potential underrecording remained. Improvements in reporting vaccination data to IIS infrastructures could allow frequent updates of vaccination status for all individuals and all vaccines.

Guidance for Selecting Model Options in the National Cancer Institute Joinpoint Regression Software

The purpose of this report is to provide guidance to users of NCHS data in the selection of modeling options when using the NCI Joinpoint regression software to analyze trends. This report complements another report, "National Center for Health Statistics Guidelines for Analysis of Trends." Considerations are presented for selecting the modeling options, with examples illustrating the choices. The tradeoffs and consequences of choosing the various modeling options using data from NCHS data systems are discussed.encounters.

Cancer Screening Test Use-U.S., 2019

INTRODUCTION

The U.S. Preventive Services Task Force recommends breast, cervical, and colorectal cancer screening to reduce mortality from these cancers, but screening use has been below national targets. The purpose of this study is to examine the proportion of screening-eligible adults who are up to date with these screenings and how screening use compares with Healthy People 2020 targets.

METHODS

Data from the 2019 National Health Interview Survey were used to examine the percentages of adults up to date with breast cancer screening among women aged 50‒74 years without previous breast cancer, cervical cancer screening among women aged 21‒65 years without previous cervical cancer or hysterectomy, and colorectal cancer screening among adults aged 50‒75 years without previous colorectal cancer. Estimates are presented by sociodemographic characteristics and healthcare access factors. Analyses were conducted in 2021.

RESULTS

Percentages of adults up to date were 76.2% (95% CI= 75.0, 77.5) for breast cancer screening, 76.4% (95% CI= 75.2, 77.6) for cervical cancer screening, and 68.3% (95% CI= 67.3, 69.3) for colorectal cancer screening. Although some population subgroups met breast and colorectal cancer screening targets (81.1% and 70.5%, respectively), many did not, and cervical cancer screening was below the target for all examined subgroups. Lower education and income, nonmetropolitan county of residence (which included rural counties), no usual source of care or health insurance coverage, and Medicaid coverage were associated with lower screening test use.

CONCLUSIONS

Estimated use of breast, cervical, and colorectal cancer screening tests based on the 2019 National Health Interview Survey were below national targets. Continued monitoring may allow for examination of screening trends, inform interventions, and track progress in eliminating disparities.

Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19

Background

Although frequently used in the early pandemic, data on the effectiveness of COVID-19 convalescent plasma (CCP) remain mixed. We investigated the effectiveness and safety of CCP in hospitalized COVID-19 patients in real-world practices during the first two waves of the pandemic in a multi-hospital healthcare system in Texas.

Methods and findings

Among 11,322 hospitalized patients with confirmed COVID-19 infection from July 1, 2020 to April 15, 2021, we included patients who received CCP and matched them with those who did not receive CCP within ±2 days of the transfusion date across sites within strata of sex, age groups, days and use of dexamethasone from hospital admission to the match date, and oxygen requirements 4–12 hours prior to the match date. Cox proportional hazards model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for effectiveness outcomes in a propensity score 1:1 matched cohort. Pre-defined safety outcomes were described. We included 1,245 patients each in the CCP treated and untreated groups. Oxygen support was required by 93% of patients at the baseline. The pre-defined primary effectiveness outcome of 28-day in-hospital all-cause mortality (HR = 0.85; 95%CI: 0.66,1.10) were similar between treatment groups. Sensitivity and stratified analyses found similar null results. CCP-treated patients were less likely to be discharged alive (HR = 0.82; 95%CI: 0.74, 0.91), and more likely to receive mechanical ventilation (HR = 1.48; 95%CI: 1.12, 1.96). Safety outcomes were rare and similar between treatment groups.

Conclusion

The findings in this large, matched cohort of patients hospitalized with COVID-19 and mostly requiring oxygen support at the time of treatment, do not support a clinical benefit in 28-day in-hospital all-cause mortality for CCP. Future studies should assess the potential benefits with specifically high-titer units in perhaps certain subgroups of patients (e.g. those with early disease or immunocompromised).

Characterization of test positivity among patients with coronavirus disease 2019 (COVID-19) in three electronic health records databases, February-November 2020

Background

Monitoring COVID-19 testing volumes and test positivity is an integral part of the response to the pandemic. We described the characteristics of individuals who were tested and tested positive for SARS-CoV-2 during the pre-vaccine phase of the pandemic in the United States (U.S.).

Methods

This descriptive study analyzed three U.S. electronic health record (EHR) databases (Explorys, Academic Health System, and OneFlorida) between February and November 2020, identifying patients who received an interpretable nucleic acid amplification test (NAAT) result. Test-level data were used to characterize the settings in which tests were administered. Patient-level data were used to calculate test positivity rates and characterize the demographics, comorbidities, and hospitalization rates of COVID-19-positive patients.

Results

Over 40% of tests were conducted in outpatient care settings, with a median time between test order and result of 0–1 day for most settings. Patients tested were mostly female (55.6–57.7%), 18–44 years of age (33.9–41.2%), and Caucasian (44.0–66.7%). The overall test positivity rate was 13.0% in Explorys, 8.0% in Academic Health System, and 8.9% in OneFlorida. The proportion of patients hospitalized within 14 days of a positive COVID-19 NAAT result was 24.2–33.1% across databases, with patients over 75 years demonstrating the highest hospitalization rates (46.7–69.7% of positive tests).

Conclusions

This analysis of COVID-19 testing volume and positivity patterns across three large EHR databases provides insight into the characteristics of COVID-19-tested, COVID-19-test-positive, and hospitalized COVID-19-test-positive patients during the early phase of the pandemic in the U.S.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13635-6.

Screening for Colorectal Cancer in the United States: Correlates and Time Trends by Type of Test

BACKGROUND

It is strongly recommended that adults aged 50-75 years be screened for colorectal cancer. Recommended screening options include colonoscopy, sigmoidoscopy, CT colonography, guaiac fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), or the more recently introduced FIT-DNA (FIT in combination with a stool DNA test). Colorectal cancer screening programs can benefit from knowledge of patterns of use by test type and within population subgroups.

METHODS

Using 2018 National Health Interview Survey (NHIS) data, we examined colorectal cancer screening test use for adults aged 50-75 years (N = 10,595). We also examined time trends in colorectal cancer screening test use from 2010-2018.

RESULTS

In 2018, an estimated 66.9% of U.S. adults aged 50-75 years had a colorectal cancer screening test within recommended time intervals. However, the prevalence was less than 50% among those aged 50-54 years, those without a usual source of health care, those with no doctor visits in the past year, and those who were uninsured. The test types most commonly used within recommended time intervals were colonoscopy within 10 years (61.1%), FOBT or FIT in the past year (8.8%), and FIT-DNA within 3 years (2.7%). After age-standardization to the 2010 census population, the percentage up-to-date with CRC screening increased from 61.2% in 2015 to 65.3% in 2018, driven by increased use of stool testing, including FIT-DNA.

CONCLUSIONS

These results show some progress, driven by a modest increase in stool testing. However, colorectal cancer testing remains low in many population subgroups.

IMPACT

These results can inform efforts to achieve population colorectal cancer screening goals.

Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014-2018

Historically, the American Indian and Alaska Native (AIAN) population in the United States has faced health disparities including greater prevalence of physical and mental health problems and high uninsured rates when compared with the non-AIAN population (1). Almost 80% of the AIAN population resides outside of reservations or land trusts and about 40% reside in rural areas (2). Rural Americans are more likely to die from preventable or selfmanageable conditions (3), and risk factors and health conditions may vary by urbanization level (4). This report examines differences in the percentage of selected health status and conditions by urbanization level between AIAN adults and all U.S. adults.

Breast Cancer Screening Among Women by Nativity, Birthplace, and Length of Time in the United States

Objective-The U.S. Preventive Services Task Force (USPSTF) recommends biennial mammography screening for women aged 50-74 to reduce mortality from breast cancer. In the United States, foreign-born women have historically had higher breast cancer mortality rates than their U.S.-born peers. This report presents national estimates of mammography screening among women by nativity, birthplace, and percentage of lifetime living in the United States. Methods-Combined data were analyzed from 29,951 women aged 50-74 years who participated in the 2005, 2008, 2010, 2013, and 2015 National Health Interview Survey. The percentage of these women who ever had a mammogram and met the USPSTF recommendations for screening by nativity, birthplace, and percentage of lifetime in the United States was generated. Estimates were adjusted for selected demographic, socioeconomic, and health care access and utilization factors and presented as predictive margins. Results-Overall, foreign-born women were less likely than U.S.-born women to have ever had a mammogram (88.3% compared with 94.1%). Foreign-born women living in the United States for less than 25% of their lifetime were less likely to have ever had a mammogram (76.4%) or meet the USPSTF recommendations (55.0%) compared with U.S.-born women. Foreign-born women living in the United States for 25% or more of their lifetime were also less likely to have ever had a mammogram (90.9%) compared with U.S.-born women. After adjustment for selected sociodemographic characteristics, the percentage of foreign-born women who ever received a mammogram increased but was still lower than that of U.S.-born women. Foreign-born women residing in the United States for less than 25% of their lifetime were as likely as U.S.-born women to have met the USPSTF recommendations (72.1% and 72.4%, respectively), while those residing in the United States for 25% or more of their lifetime (75.1%) were more likely to do so than U.S.-born women. Differences by birthplace were also observed.

Use of Yoga, Meditation, and Chiropractors Among U.S. Children Aged 4-17 Years

Yoga, meditation, and use of chiropractors are types of complementary health approaches developed outside of mainstream Western medicine (1-2). Although complementary health approaches as a whole are not widely used among children, previous work has established a rise in the use of selected approaches over time (3). This report presents the most recent national estimates of use of the three most prevalent approaches during the past 12 months, among children aged 4-17 years in the United States. Comparable estimates from 2012 are also included to examine changes over time.

Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Over

Complementary health is the use of holistic or unconventional medicine with mainstream Western medicine for health and wellness (1,2). Past research has identified yoga, meditation, and seeing a chiropractor as some of the most commonly used approaches (3). This report examines changes over time in the percentage of adults who used yoga, meditation, and chiropractors in the past 12 months, as well as variation by sex, age, and race and Hispanic origin.

State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015

This report presents national and state-level age-adjusted estimates of percentages of U.S. adults aged 18-64 who met the 2008 federal guidelines for both aerobic and muscle-strengthening activities during leisure-time physical activity (LTPA) in 2010-2015, by sex and work status (working compared with nonworking). State variation in work status, health status and difficulty in physical functioning, and occupational distributions for men and women were also considered.

Health Promotion at the Construction Work Site: The Lunch Truck Pilot Study

The transient nature of construction work makes it difficult to conduct longitudinal worksite-based health promotion activities. As part of a workplace health assessment pilot study, we worked with a commercial lunch truck company to disseminate four types of health education materials including cancer screening, workplace injury prevention, fruit and vegetable consumption, and smoking cessation to construction workers purchasing food items from the truck during their job breaks. Two weeks following the worksite assessment, we followed up with these workers to ascertain their use of the health promotion materials. Of the 54 workers surveyed, 83% reported reviewing and sharing the cancer screening materials with their families, whereas 44% discussed the cancer screening materials with coworkers. Similar proportions of workers reviewed, shared, and discussed the other health promotion materials with their family. Lunch trucks may be an effective strategy and delivery method for educating construction workers on healthy behaviors and injury prevention practices.

The Use of Complementary Health Approaches Among U.S. Adults with a Recent Cancer Diagnosis

OBJECTIVE

The object of this study was to explore the use of complementary health approaches among U.S. adults with a cancer diagnosis in the past 5 years and distinguish use for general wellness from use specifically for treatment.

METHODS

Using data from the 2002, 2007, and 2012 National Health Interview Survey, the study included 1359 persons with a cancer diagnosis of selected cancers in the past 5 years. Participants were asked about their use of complementary health approaches for general reasons and cancer treatment in the past 12 months. Responses were aggregated into the use of any complementary approach as well as examined by mode of practice.

RESULTS

Overall, 35.3% of persons with a cancer diagnosis used complementary health approaches in the past 12 months. These persons were more likely to have used a biologically based approach (22.8%) compared with other approaches. Persons with breast cancer were significantly more likely to use any complementary health approach (43.6%) compared with those with other recently diagnosed cancers. Few persons with a cancer history (2.3%) used complementary approaches specifically for cancer treatment. However, prevalence of use for treatment varied by cancer type (0.4%-6.8%).

CONCLUSIONS

This study highlights differences in the use of various types of complementary health approaches for different reasons among persons with recent diagnoses of some of the most commonly diagnosed cancers in the United States.

Use of Complementary Health Approaches for Musculoskeletal Pain Disorders Among Adults: United States, 2012

OBJECTIVE

This report examines the use of complementary health approaches among U.S. adults aged 18 and over who had a musculoskeletal pain disorder. Prevalence of use among this population subgroup is compared with use by persons without a musculoskeletal disorder. Use for any reason, as well as specifically to treat musculoskeletal pain disorders, is examined.

METHODS

Using the 2012 National Health Interview Survey, estimates of the use of complementary health approaches for any reason, as well as use to treat musculoskeletal pain disorders, are presented. Statistical tests were performed to assess the significance of differences between groups of complementary health approaches used among persons with specific musculoskeletal pain disorders. Musculoskeletal pain disorders included lower back pain, sciatica, neck pain, joint pain or related conditions, arthritic conditions, and other musculoskeletal pain disorders not included in any of the previous categories. Respondents could report having more than one disorder.

RESULTS

In 2012, 54.5% of U.S. adults had a musculoskeletal pain disorder. The use of any complementary health approach for any reason among persons with a musculoskeletal pain disorder (41.6%) was significantly higher than use among persons without a musculoskeletal pain disorder (24.1%). Among adults with any musculoskeletal pain disorder, the use of natural products for any reason (24.7%) was significantly higher than the use of mind and body approaches (15.3%), practitioner-based approaches (18.2%), or whole medical system approaches (5.3%). The pattern of use of the above-mentioned groups of complementary health approaches was similar for persons without a musculoskeletal disorder. However, prevalence of use among these persons was significantly lower compared with persons with a musculoskeletal disorder. For treatment, the use of practitioner-based approaches among persons with any musculoskeletal pain disorder (9.7%) was more than three times as high as the use of any other group of approaches (0.7%-3.1%). The patterns of use of specific groups of complementary health approaches also differed among specific musculoskeletal pain disorders.

Abstract 1772: Cancer prevalence and screening among US Asian adults by nativity

Background: While heart disease is the leading cause of death in the general United States (US) population, the number one cause of death among US Asian adults is cancer. The cancer burden in the US is higher than that in Asia. However as Asians migrate to the US, acculturation may increase their risk of acquiring cancers. We examine the prevalence of selected cancers and recommended screening behaviors among Asian Americans by US nativity.

Methods: We analyzed combined data from the 2010 and 2013 National Health Interview Survey (NHIS) to examine the prevalence of selected cancers and adherence to the US Preventive Services Task Force (USPSTF) recommended screening behaviors by US nativity among more than 4,000 non-Hispanic Asian adults aged 18 and over. Asian adults include persons who identified their race as “Asian,” “Asian Indian,” “Chinese,” “Filipino,” “Korean,” “Japanese,” “Vietnamese,” or other detailed Asian responses, identified no other non-Asian races, and now reside in the US. Nativity was determined by place of birth located within or outside the US or its territories. Survey data were weighted to produce national estimates that are representative of the civilian noninstitutionalized US adult population. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level.

Results: While the overall prevalence of cancer among Asian adults (3.1%) was not significantly different from that of their non-Hispanic white adult peers (3.4%), US born Asian adults were approximately 1.7 times more likely to have had a cancer diagnosis compared with Asian adults born outside the US. Nativity was not significantly related to cancer diagnosis for non-Hispanic white adults. There was no significant difference by US nativity in the prevalence of colorectal cancer among Asian adults aged 50-75 or breast cancer among Asian women aged 40-75. However, US born Asian women aged 21-65 without a hysterectomy were more than 5 times as likely to have a diagnosis of cervical cancer as their peers who were born outside the US. There was no significant difference in adherence to the USPSTF recommended mammography or colorectal screening among US born Asian adults within the recommended screening age groups compared with those born outside the US. However, US born Asian women were more likely to adhere to the USPSTF recommended screening for cervical cancer compared with those born outside the US (79.0% vs. 70.0%).

Conclusion: The higher prevalence of cancer among US Asian adults compared with those not born in the US appears to be driven by differences in cervical cancer prevalence. Although higher than their peers born outside the US, adherence to USPSTF recommended cervical screening among US born Asian women aged 21-65 remains lower than the Healthy People 2020 baseline of 84.5%.

Citation Format: Tainya C. Clarke. Cancer prevalence and screening among US Asian adults by nativity. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1772.

Abstract 1746: Tobacco use among US cancer survivors

Background: Combustible tobacco use is a known risk factor for several types of cancer including cancers of the head and neck, esophagus, lung, stomach, bladder, pancreas and cervix. Smokeless tobacco use is a known risk factor for cancers of the mouth, tongue, cheek, gum, and esophagus. Continued use of cigarettes, non-cigarette combustible tobacco products, or smokeless tobacco post diagnosis may interfere with treatment as well as increase the chance of developing a second malignancy. In the past, the US Food and Drug Administration (FDA) has designed targeted educational campaigns to prevent and reduce tobacco use among high-risk populations. Information on the prevalence of use among cancer survivors is vital to inform targeted smoking cessation programs.

Methods: We analyzed combined data from the 2012-2014 National Health Interview Survey (NHIS) for tobacco use by cancer status among over 6,000 cancer survivors aged 18 and older. Non-cigarette combustible tobacco products include cigars, pipes, hookahs, bidis or cigarillos. Smokeless tobacco refers to tobacco products which are placed in the mouth or nose and include chewing tobacco, snuff, dip, snus (snoose), or dissolvable tobacco. Current users had used at least 100 cigarettes in their lifetime— or used other non-cigarette combustible tobacco products at least once in their lifetime— and reported current use as “rarely,” “some days” or “every day.” Survey data were weighted to produce national estimates that are representative of the civilian noninstitutionalized US adult population. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level.

Results: More than 1 in 5 cancer survivors were current cigarette smokers. This was significantly higher than the population of persons without a cancer history. More than 1 in every 15 survivors were current users of some form of non-cigarette combustible tobacco product. However, this prevalence was not significantly different from persons without a history of cancer. The current use of smokeless tobacco products among cancer survivors (under 2%) was just over half the prevalence of that of their peers without a history of cancer.

Conclusion: Tobacco use is an important modifiable risk factor for cancer- and non-cancer related morbidity and mortality of cancer survivors, yet its use remains as prevalent among survivors as among persons with no cancer history. Current cigarette use is higher among US cancer survivors compared with persons without a cancer history, and there is no significant difference in the current use of non-cigarette combustible tobacco products between both groups. Findings from this study may be used to discern differences in use of various types of tobacco products among cancer survivors and their peers without a cancer history.

Citation Format: Tainya C. Clarke. Tobacco use among US cancer survivors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1746.

Occupational Differences Among Employed Adults Who Met 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities: United States, 2008-2014

OBJECTIVE

This report presents national estimates of occupational differences among employed adults meeting the 2008 federal guidelines for both aerobic and muscle-strengthening activities performed during leisure time from 2008 through 2014.

METHODS

Using pooled data from the 2008–2014 National Health Interview Survey, age-adjusted percentages of currently employed adults aged 18–64 who met the 2008 federal physical activity guidelines for leisure-time aerobic and muscle-strengthening activities are shown by occupation, sex, race and Hispanic ethnicity, education, and hours worked in the week before the survey interview.

RESULTS

Among all employed adults aged 18–64, those in production and related occupations were the least likely to meet the 2008 federal physical activity guidelines for both aerobic and muscle-strengthening activities performed during their leisure time. Across occupation categories, men were more likely than women to meet the guidelines. Non-Hispanic white adults in professional, teaching or social service, sales, and services occupations were more likely than non-Hispanic black or Hispanic adults in those occupations to meet the guidelines. In production and related occupations, Hispanic adults were less likely to meet the guidelines than non-Hispanic adults; in managerial occupations, by contrast, all adults were equally likely to meet the guidelines regardless of their race and ethnicity. The likelihood of meeting the guidelines uniformly increased as education increased across every occupation category. Lastly, employees in professional, services, and sales occupations who worked 50 hours or more in the last week were more likely to meet the guidelines than their counterparts who worked fewer hours. In production and related occupations, by contrast, the number of hours worked in the last week was unrelated to whether adults met the guidelines.

CONCLUSION

Occupational differences in meeting the 2008 federal guidelines for both aerobic and muscle-strengthening activities by sex, race and ethnicity, and education suggest that disparities in leisure-time physical activities across occupations and socioeconomic strata exist.

Wellness-related Use of Common Complementary Health Approaches Among Adults: United States, 2012

OBJECTIVE

This report presents national estimates of selected wellness-related reasons for the use of natural product supplements, yoga, and spinal manipulation among U.S. adults in 2012. Self-reported perceived health outcomes were also examined.

METHODS

Data from 34,252 adults aged 18 and over collected as part of the 2012 National Health Interview Survey were analyzed for this report. In particular, whether adults who used selected complementary health approaches did so to treat a specific health condition or for any of five wellness-related reasons was examined, as well as whether these adults perceived that this use led to any of nine health-related outcomes. Sampling weights were used to produce national estimates that are representative of the civilian noninstitutionalized U.S. adults population.

RESULTS

Users of natural product supplements and yoga were more likely to have reported using the approach for a wellness reason than for treatment of a specific health condition, whereas more spinal manipulation users reported using it for treatment rather than for wellness. The most common wellness-related reason reported by user of each of the three approaches was for "general wellness or disease prevention." The majority of users of all three health approaches reported that they perceived this use improved their overall health and made them feel better. Yoga users perceived higher rates of all of the self-reported wellness-related health outcomes than users of natural product supplements or spinal manipulation.

Abstract 3723: The use of complementary health approaches among US cancer survivors

Background: There are over 14 million cancer survivors in the United States (US). In addition to conventional care, many cancer survivors use complementary health approaches post-diagnosis for general health and wellness and for cancer treatment. This study sought to examine the use of complementary health approaches for any reason, and specific use for cancer treatment, by types of cancer among US adult cancer survivors with a diagnosis within the past 5 years.

Methods: Data from the 2002, 2007, and 2012 National Health Interview Survey (NHIS) were used. Adults aged 18 and older with a cancer diagnosis within five years of their interview were selected for analysis (n = 2,355). The sample size was sufficient to examine use of complementary approaches among prostate, lung, colorectal, bladder and breast cancer survivors. Participants were asked about the use of named approaches in the past 12 months, and whether their most frequently used alternative therapies were used specifically for cancer. Responses were analyzed by their mode of practice: biologically based, manipulative and body based, mind and body approaches, and whole medical systems. Information on concurrent use of conventional medical treatment for cancer was not available. Sample data were weighted to produce national estimates that are representative of the civilian noninstitutionalized US adult population.

Results: The study sample represented more than 5 million cancer survivors. In general, 35% of these survivors used complementary health approaches in the past 12 months; however, only 3.3% specifically used an approach for cancer treatment. More cancer survivors used a biologically based approach for any reason (22.8%) and specifically for cancer treatment (2.3%) in the past 12 months compared to mind and body approaches (14.9% and 1.9%), manipulative and body based approaches (14.2% and 1.1%) and whole medical systems (3.7% and 0.5%). Biologically based approaches were the most common approaches used for any reason among prostate (22.7%), lung (17.3%), colorectal (19.5%), and bladder (23.5%) cancer survivors. Breast cancer survivors were equally as likely to use biologically based (24.9%) and mind and body (26.2%) approaches. More than 5% of colorectal cancer survivors used a biologically based approach for treatment (5.5%); while 6.8% of lung cancer survivors used mind and body and 5.1% used manipulative and body based approaches.

Conclusion: The study findings offer information on the use of complementary health approaches and use specific to treatment among cancer survivors with a diagnosis within the past 5 years. The use of complementary health approaches among survivors differs by type of approach and by cancer type. When combined with evidence-based research, the knowledge gained may be used in physician-patient dialogue about the use of complementary health approaches during cancer treatment, or lend to developing personalized comprehensive and integrative cancer care plans.

Citation Format: Tainya C. Clarke. The use of complementary health approaches among US cancer survivors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3723. doi:10.1158/1538-7445.AM2015-3723

Racial and Ethnic Disparities in Men's Use of Mental Health Treatments

• Nearly 9% of men (8.5%) had daily feelings of anxiety or depression. Less than one-half of them (41.0%) took medication for these feelings or had recently talked to a mental health professional. • Racial and ethnic differences were observed only for men aged 18-44. • Among men aged 18-44, non-Hispanic black and Hispanic men (6.1%) were less likely than non-Hispanic white men (8.5%) to report daily feelings of anxiety or depression. • Among men aged 18-44 who had daily feelings of anxiety or depression, non-Hispanic black and Hispanic men (26.4%) were less likely than non-Hispanic white men (45.4%) to have used mental health treatments. • The significant racial and ethnic disparity in treatment utilization was associated with lack of health insurance coverage.

Use of complementary health approaches among children aged 4-17 years in the United States: National Health Interview Survey, 2007-2012

OBJECTIVE

This report presents national estimates of the use of complementary health approaches among children aged 4-17 years in the United States. Selected modalities are compared for 2007 and 2012 to examine changes over time.

METHODS

Data from the 2007 and 2012 National Health Interview Survey (NHIS) were analyzed for this report. The combined sample included 17,321 interviews with knowledgeable adults about children aged 4-17 years. Point estimates and estimates of their variances were calculated using SUDAAN software to account for the complex sampling design of NHIS. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level.

RESULTS

The use of complementary health approaches among children did not change significantly since 2007 (from 12.0% in 2007 to 11.6% in 2012). However, one approach, the use of traditional healers, showed a statistically significant decrease in use, from 1.1% in 2007 to 0.1% in 2012. No other significant decreases were identified. An increase in the use of yoga was observed during this period (from 2.3% in 2007 to 3.1% in 2012). Nonvitamin, nonmineral dietary supplements; chiropractic or osteopathic manipulation; and yoga, tai chi, or qi gong were the most commonly used complementary health approaches in both 2007 and 2012. Also consistent between 2007 and 2012 was that complementary health approaches were most frequently used for back or neck pain, head or chest cold, anxiety or stress, and other musculoskeletal conditions.

Trends in the use of complementary health approaches among adults: United States, 2002-2012

OBJECTIVE

This report presents national estimates of the use of complementary health approaches among adults in the United States across three time points. Trends in the use of selected complementary health approaches are compared for 2002, 2007, and 2012, and differences by selected demographic characteristics are also examined.

METHODS

Combined data from 88,962 adults aged 18 and over collected as part of the 2002, 2007, and 2012 National Health Interview Survey were analyzed for this report. Sample data were weighted to produce national estimates that are representative of the civilian noninstitutionalized U.S. adult population. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level.

RESULTS

Although the use of individual approaches varied across the three time points, nonvitamin, nonmineral dietary supplements remained the most popular complementary health approach used. The use of yoga, tai chi, and qi gong increased linearly across the three time points; among these three approaches, yoga accounted for approximately 80% of the prevalence. The use of any complementary health approach also differed by selected sociodemographic characteristics. The most notable observed differences in use were by age and Hispanic or Latino origin and race.

Correlates of leisure time physical activity compliance in colorectal cancer survivors

INTRODUCTION

Physical inactivity is a risk factor for cancer morbidity and mortality, but its influence in colorectal cancer (CRC) survivors is understudied. We investigated sociodemographic, physically limiting, and behavioral predictors influencing leisure time physical activity (LTPA) among CRC survivors.

METHODS

Pooled 1997-2010 National Health Interview Survey data (N=2378) were used to evaluate LTPA compliance in CRC survivors according to Healthy People 2010 recommendations. Univariate and multivariable logistic regression analyses were performed to identify predictors of LTPA compliance among CRC survivors. Independent variables included: age, gender, race/ethnicity, education, health insurance, body mass index (BMI), ≥2 chronic conditions limiting physical activity, time since cancer diagnosis, and poverty, marital, smoking and alcohol status.

RESULTS

Multivariable regression models reveal that Hispanics, non-Hispanic Blacks, those with ≥2 physically limiting chronic conditions, and current smokers were less likely to comply with LTPA recommendations. CRC survivors who were of "other" race, more than one race, those with some college degree or college degree, and current drinkers were more likely to comply.

DISCUSSION

Hispanics, non-Hispanic Blacks, those with >2 physically limiting chronic conditions and current smokers warrant additional efforts to encourage physical activity and to determine the impact of regular physical activity on CRC survivorship.

Regional variation in use of complementary health approaches by U.S. adults

Data from the National Health Interview Survey, 2012 Use of nonvitamin, nonmineral dietary supplements (17.9%) was greater than any other complementary health approach used by U.S. adults in 2012. The use of practitioner-based chiropractic or osteopathic manipulation was nearly twice as high in the West North Central region as in the United States overall. Use of nonvitamin, nonmineral dietary supplements was highest in the Mountain, Pacific, and West North Central regions. Use of yoga with deep breathing or meditation was approximately 40% higher in the Pacific and Mountain regions than in the United States overall. Complementary health approaches are defined as "a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine". They range from practitioner-based approaches, such as chiropractic manipulation and massage therapy, to predominantly self-care approaches, such as nonvitamin, nonmineral dietary supplements, meditation, and yoga. This report presents estimates of the four most commonly used complementary health approaches among adults aged 18 and over in nine geographic regions, using data from the 2012 National Health Interview Survey adult alternative medicine supplement.

Summary health statistics for U.S. adults: national health interview survey, 2012

OBJECTIVES

This report presents detailed tables from the 2012 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, education, current employment status, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates (frequencies and percentages) are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

DATA SOURCE

NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2012, data were collected on 34,525 adults in the Sample Adult questionnaire. The conditional response rate was 79.7%, and the final response rate was 61.2%. The health information for adults in this report was obtained from one randomly selected adult per family.

HIGHLIGHTS

In 2012, 61% of adults aged 18 and over had excellent or very good health. Eleven percent of adults had been told by a doctor or other health professional that they had heart disease, 24% had been told on two or more visits that they had hypertension, 9% had been told that they had diabetes, and 21% had been told that they had some for of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. Eighteen percent of adults were current smokers and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 28% were obese.

Risky drinking in the older population: a comparison of Florida to the rest of the US

INTRODUCTION

While alcohol use has traditionally been thought to decrease with age, several recent studies have shown an increase in heavy drinking among retirees. Florida's unique population distribution that includes a higher proportion of elderly residents warrants an in-depth look at the drinking patterns in the elderly and how they may differ from those in other areas of the country. However, state-level comparisons of excessive alcohol consumption are limited.

METHODS

We compared risky drinking (defined as ten or more drinks/week in men and seven or more drinks/week in women; or five or more drinks at one sitting, one or more times/year for both men and women) in Florida to the rest of the US. We used pooled data from the 1997-2010 National Health Interview Survey (NHIS).

RESULTS

The prevalence of risky drinking for those aged ≥65 in Florida and the rest of the US was 24.1%, and 21.8%, respectively, compared to 31.9% and 37.4% for all ages in Florida and the rest of the US, respectively. In multivariable analyses of those aged ≥65 years, risky drinking was significantly associated with male gender, younger age, non-Hispanic White race/ethnicity, more than a high school education, unemployment (including retirement), lower BMI, and current or former smoking. Floridians aged ≥65 were significantly more likely to report risky drinking than their counterparts in the rest of the US (Odds ratio=1.13; 95% CI: 1.04-1.21), in contrast to analyses of all ages where Floridians were less likely to report risky drinking compared to the rest of the US (0.77; 0.67-0.86).

DISCUSSION

Excessive alcohol consumption is an important modifiable risk factor for cancer, cardiovascular disease, and liver disease; a reduction among the elderly has great potential to reduce disease burden. Although Floridians overall were less likely to be risky drinkers than the rest of the US, almost a third of the Florida population reported this behavior. It is, therefore, an important public health concern, particularly in Florida's older population who are more likely to engage in this behavior than their counterparts in the rest of the US.

Nonantibiotic macrolides prevent human neutrophil elastase-induced mucus stasis and airway surface liquid volume depletion

Mucus clearance is an important component of the lung's innate defense system. A failure of this system brought on by mucus dehydration is common to both cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD). Mucus clearance rates are regulated by the volume of airway surface liquid (ASL) and by ciliary beat frequency (CBF). Chronic treatment with macrolide antibiotics is known to be beneficial to both CF and COPD patients. However, chronic macrolide usage may induce bacterial resistance. We have developed a novel macrolide, 2'-desoxy-9-(S)-erythromycylamine (GS-459755), that has significantly diminished antibiotic activity against Staphylococcus aureus, Streptococcus pneumonia, Moraxella catarrhalis, and Haemophilus influenzae. Since neutrophilia frequently occurs in chronic lung disease and human neutrophil elastase (HNE) induces mucus stasis by activating the epithelial sodium channel (ENaC), we tested the ability of GS-459755 to protect against HNE-induced mucus stasis. GS-459755 had no effect on HNE activity. However, GS-459755 pretreatment protected against HNE-induced ASL volume depletion in human bronchial epithelial cells (HBECs). The effect of GS-459755 on ASL volume was dose dependent (IC₅₀ ~3.9 μM) and comparable to the antibacterial macrolide azithromycin (IC₅₀ ~2.4 μM). Macrolides had no significant effect on CBF or on transepithelial water permeability. However, the amiloride-sensitive transepithelial voltage, a marker of ENaC activity, was diminished by macrolide pretreatment. We conclude that GS-459755 may limit HNE-induced activation of ENaC and may be useful for the treatment of mucus dehydration in CF and COPD without inducing bacterial resistance.

Trends in Adherence to Recommended Cancer Screening: The US Population and Working Cancer Survivors

INTRODUCTION

Over the past decade the United States (US) has seen a decrease in advanced cancer diagnoses. There has also been an increase in the number of cancer survivors returning to work. Cancer screening behaviors among survivors may play an important role in their return-to-work process. Adherence to a post-treatment cancer screening protocol increases early detection of secondary tumors and reduces potentially limiting side-effects. We compared screening trends among all cancer survivors, working survivors, and the general population over the last decade.

MATERIALS AND METHODS

Trends in adherence to recommended screening were analyzed by site-specific cancer. We used the Healthy People goals as a measure of desired adherence. We selected participants 18+ years from 1997 to 2010 National Health Interview Survey for years where detailed cancer screening information was available. Using the recommendations of the American Cancer Society as a guide, we assessed adherence to cancer screening across the decade. There were 174,393 participants. Analyses included 7,528 working cancer survivors representing 3.8 million US workers, and 119,374 adults representing more than 100 million working Americans with no cancer history.

RESULTS

The US population met the Healthy People 2010 goal for colorectal screening, but declined in all other recommended cancer screening. Cancer survivors met and maintained the HP2010 goal for all, except cervical cancer screening. Survivors had higher screening rates than the general population. Among survivors, white-collar and service occupations had higher screening rates than blue-collar survivors.

CONCLUSION

Cancer survivors report higher screening rates than the general population. Nevertheless, national screening rates are lower than desired, and disparities exist by cancer history and occupation. Understanding existing disparities, and the impact of cancer screening on survivors is crucial as the number of working survivors increases.

Abstract 3577: A decade of changed behavior: Trends in screening adherence and incidence 2000-2010

Background: Cancer is still one of the most prominent diseases of all times claiming more than 569,490 lives in 2010. Over the past decade the United States (U.S.), like many other industrialized and developed nations have seen a significant decrease in the incidence of cancers and have experienced an increase in the number of cancer survivors. The decrease in incidence can be attributed to an increase in the number of persons adhering to recommended cancer screenings. In 2012, there will be an estimated 1 million newly diagnosed Americans, 75% of who would have adhered to recommended cancer screening in the previous year. Methods: We used incidence data from the Surveillance Epidemiology and End Results database (2000 -2008) to assess the trend in incidence rates of some of the most common cancers in the United States. Using SAS version 9.2, we pooled data from the National Health Interview Survey (NHIS) - Cancer Supplements (2000, 2005 and 2010) and analyzed adherence to recommended screening (n= 90,959). The guidelines provided by the American Cancer Society were used to guide analyses. Screening compliance was measured among the appropriate age and sex cohort within the U.S. population. Results: There has been a 17.22% decrease in the incidence of colorectal cancers and a11.06% decrease in lung cancer incidence between 2000 and 2008. While Bladder and Cervical cancer showed no significant time trends, gender specific cancers, namely prostate and breast also showed significant decreases; 16.21% and 6.78% respectively. There was an 18.12% increase in the incidence of Melanoma cases. There was a significant increase in adherence to recommended screening between 2000 and 2010. Adherence to mammography screening guidelines increased two fold between 2000 and 2010 as represented by women interviewed in the NHIS. Similar trends were observed for pap smears and colorectal screenings; 2010 analyses showed 70.48% compliance for mammography, 72.80% for colorectal screening and 68.19% for pap smears. Conclusion: Though screening compliance is below the preferred level, there has been an increase in adherence to recommended screening in the U.S. population over the past decade. This has translated into decreased cancer incidence and an increased prevalence as more persons live beyond the five year survivor mark. Identification of cancers with high incidence rates is needed to direct targeted interventions and public health campaigns.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3577. doi:1538-7445.AM2012-3577

Worker populations at risk for work-related injuries across the life course

BACKGROUND

Workplace injuries can have a substantial economic impact. Rates of workplace injuries differ across age groups, yet occupations/industry sectors at highest risk within age groups have not been identified. We examined workplace injury risk across industry sectors for three age groups using nationally representative U.S. data.

METHODS

Data from 1997 to 2009 National Health Interview Survey (NHIS) were pooled for employed adults by age groups: (1) 18-25 (n = 22,261); (2) 26-54 (n = 121,559); and (3) 55+ (n = 24,851). Workplace injury risk comparisons were made using logistic regression, with the Services sector as the referent and adjustment for sample design, gender, education, race/ethnicity, age, and income-to-poverty ratio.

RESULTS

Overall 3-month injury prevalence was 0.88%. Highest risk sectors for workers aged 18-25 included: Agriculture/forestry/fisheries (odds ratio = 4.80; 95% confidence interval 2.23-10.32), Healthcare/social assistance (2.71; 1.50-4.91), Construction (2.66; 1.56-4.53), Manufacturing (2.66; 1.54-4.61); for workers 26-54: Construction (2.30; 1.76-3.0), Agriculture/forestry/fisheries (1.91; 1.16-3.15), and Manufacturing (1.58; 1.28-1.96); for workers 55+: Agriculture/forestry/fisheries (3.01; 1.16-7.81), Transportation/communication/other public utilities (2.55; 1.44-4.49), and Construction (2.25; 1.09-4.67).

CONCLUSIONS

Agriculture/forestry/fisheries and Construction were among the sectors with highest workplace injury risk for workers across all age groups. Differences in highest risk industries were identified between the youngest and oldest industry groups. Our results indicate a need for age-specific interventions in some industries, and a need for more comprehensive measures in others.

Working with cancer: health and disability disparities among employed cancer survivors in the U.S

INTRODUCTION

Approximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer.

METHODS

Cross-sectional data pooled from the 1997-2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n=22,952) and those without (n=358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors.

RESULTS

Relative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor-fair health (0.25; 0.24-0.26) and (2.06; 1.96-2.17) respectively, and ≥ 2 functional limitations (0.37; 0.35-0.38) and (1.72; 1.64-1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers.

CONCLUSION

Blue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers.

Abstract A7: Young adult cancer survivors and substance abuse: Results from the U.S. National Health Interview Survey, 1997–2009

Introduction: The five-year survival rates for young adult cancers continue to increase. Nonetheless, these young adult survivors may experience health complications or physical late effects that contribute to negative lifestyle behaviors potentiating the use of gateway drugs (e.g. alcohol and cigarettes). Examination of these negative behaviors during emerging adulthood (i.e., ages 18–24) may be particularly critical, as this developmental period is characterized by significant change, instability, identity exploration, and experimentation. In the present study, we examine the use of cigarettes and risky alcohol consumption among U.S. young adult cancer survivors.

Methods: We analyzed data on 39,433 U.S. young adults age 18–24 participating in the 1997–2009 National Health Interview Survey, who reported on their cigarette use and alcohol consumption, and socio-demographic characteristics.

Results: Among all youth, youth workers are almost twice as likely to smoke cigarettes when compared to their unemployed peers and Whites were more likely to engage in these negative behaviors when compared to their Black peers. There was no significant difference in alcohol or cigarette use by cancer history among young people. Approximately 35% of young cancer survivors were smokers and 70% current drinkers. Analyses did not reveal any significant reports of risky drinking.

Conclusions: Periodic clinical assessments for substance use among cancer survivors is important, particularly during the transition from late adolescence to emerging adulthood when baseline rates are relatively high compared to other ages. Research on processes involved in a young cancer survivors’ decisions to use substances will provide better insight regarding how best to intervene and who to include in educational interventions.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A7.

Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study

BACKGROUND

Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population.

METHODS

In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish) recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost) of the handheld administration method was recorded and compared to approaches available in the extant literature.

RESULTS

Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings.

CONCLUSIONS

Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data. These technological research modalities are useful in the collection and assessment of environmental and occupational research data.

Health care access and utilization among children of single working and nonworking mothers in the United States

To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.

Abstract A86: Sociodemographic correlates of cancer survivors in the United States

Introduction: Approximately 40% of the more than 1 million Americans diagnosed with cancer each year are working-age adults, likewise more than 11 million people in the U.S. are cancer survivors. Given almost 50% of cancer survivors are under 65 years of age, a large proportion of them return to work after treatment or even maintain regular work schedules during their cancer treatment. We described the socio-demographic characteristics and risky health behaviors of U.S. adults diagnosed with cancer by the five most commonly diagnosed cancer types.

Methods: Data pooled from the 1997-2009 National Health Interview Survey (NHIS) on adults 18 years of age and older with self-reported physician diagnosed cancer (n=27,906) were analyzed. Estimates on self-reported socio-demographic characteristics (age, gender, race, ethnicity, education, employment status, and job type) general health status, and negative health behaviors (risky alcohol drinking [men who consume ≥ 2 drinks and women who consume ≥1 drink per day] and cigarette use [current, former, never]) were stratified by specific-cancer type (non-melanoma skin cancer, lung cancer, colorectal, prostate, and breast) and employment status.

Results: Thirty-three percent of adults diagnosed with cancer work post-diagnosis. Among employed cancer survivors, 69.3% were employed in white collar jobs while 14.7% were in service jobs. This distribution differed among employed persons without a cancer diagnosis, with 58.5% employed in white collar jobs and 23.4% in service jobs. Among employed persons with cancer, 65.9% were 35-54 years old, while 15.6% were greater than 55 years. Breast and non-melanoma skin cancer rates were highest among those who returned to work. The percentage of cancer workers reporting fair-poor health was greater than workers without cancer. Lastly, workers with cancer reported lower risky drinking (7.8%) and cigarette use (4.7%) compared to workers without cancer (14.5% and 11.4%, respectively).

Conclusion: A large occupational health disparity exists among persons returning to work following a cancer diagnosis. Among all worker types, we found service workers were less likely (as compared to white collar workers) to be currently employed suggesting the need for integrating vocational rehabilitation programs and treatments services tailored to their workplace organization. In addition, the changing gender distribution in the U.S. workforce reflects our study findings that twice as many females as males continued to work following cancer diagnosis. The new U.S. healthcare reform bill that supports workplace health promotion programs may assist employers in developing the aforementioned reintegration programs and thwart the burgeoning occupational health disparities among working cancer survivors.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A86.