Incidence of Etiology-specific Hepatocellular Carcinoma: Diverging Trends and Significant Heterogeneity by Race and Ethnicity

BACKGROUND & AIMS

The main causes of hepatocellular carcinoma (HCC) include chronic hepatitis C and B viral infections (HCV, HBV), nonalcoholic fatty liver disease (NAFLD), and alcohol-related disease (ALD). Etiology-specific HCC incidence rates and temporal trends on a population-basis are needed to improve HCC control and prevention.

METHODS

All 14,420 HCC cases from the Florida statewide cancer registry were individually linked to data from the hospital discharge agency and the viral hepatitis department to determine the predominant etiology of each case diagnosed during 2010 to 2018. Age-adjusted incidence rates (AAIRs) were used to assess the intersection between etiology and detailed race-ethnicity. Etiology-specific temporal trends based on diagnosis year were assessed using Joinpoint regression.

RESULTS

HCV remains the leading cause of HCC among men, but since 2017 NAFLD-HCC is the leading cause among women. HCV-HCC AAIRs are particularly high among U.S.-born minority men, including Puerto Rican (10.9 per 100,000), African American (8.0 per 100,000), and U.S.-born Mexican American men (7.6 per 100,000). NAFLD is more common among all Hispanics and Filipinos and HBV-HCC among Asian and Haitian black men. HCV-HCC surpasses HBV-HCC in Asian women. ALD-HCC is high among specific Hispanic male groups. Population-based HCV-HCC rates experienced a rapid decline since 2015 (-9.6% annually), whereas ALD-HCC (+6.0%) and NAFLD-HCC (+4.3%) are rising (P < .05).

CONCLUSIONS

New direct acting anti-viral drugs have impacted rates of HCV-HCC, offsetting important increases in both ALD- and NAFLD-HCC. Hispanics may be a group of concern because of higher rates for ALD- and NAFLD-HCC. HCC etiology varies remarkably and may warrant specific interventions by detailed race-ethnicity.

Effects of Peer Sexual Health Education on College Campuses: A Systematic Review

Objective. College peer health education groups have grown in popularity to provide information about health and wellness topics. The purpose of this systematic review was to evaluate the effectiveness of peer education groups on reducing sexual health risks and increasing sexual health knowledge on a college campus. Method. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed in searching, extracting, appraising, and synthesizing the evidence. A quality assessment was also conducted. The review was conducted in April 2017. Results. The initial search yielded 2,503 records. After critical appraisal, eight articles remained. Peer education was beneficial for increasing knowledge of sexual health topics and creating some behavior change such as increased condom use and HIV testing. Additionally, interventions developed specifically for women were effective. Conclusions. Peer education is an effective way to disseminate sexual health information and can be a reliable resource for college students.

The effect of a trail use intervention on urban trail use in Southern Nevada

OBJECTIVE

Communities are building or improving trail networks for biking and walking to encourage physical activity, but the relationship between trail environments and physical activity is not well understood. We examined the effect of a trail use intervention in Southern Nevada.

METHODS

We monitored the usage of urban trails (n=10) in Southern Nevada before, during, and after an intervention which included a marketing campaign promoting trail use and the addition of way-finding and incremental distance signage to selected trails (October 2011-October 2012). Data were collected with infrared monitors placed on the trails for three periods of 7days. We compared pre-, mid-, and post-intervention usage rates on the 6 trails where signage was added to usage rates on the 4 control trails.

RESULTS

The groups of trails experienced different patterns of increases and decreases over the 1-year study period. Mean users per hour increased 31% for the study trails and 35% for the control trails (p<0.001), but the total increase did not vary between the groups.

CONCLUSION

Trail use increased about 33% during the 1-year study period for the intervention. Adding wayfinding and incremental distance signage appeared to support the increase in usage which followed the marketing campaign.

Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study

The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all chronic diseases, for physical inactivity, obesity and smoking. They were significantly more likely to participate in some preventive services (flu/pneumonia vaccination, HIV test) and significantly less likely to participate in other preventive services (mammogram, Pap test). Our findings suggest that people with disabilities are less able to fully participate in all preventive services offered.

The Effects of Signage and the Physical Environment on Stair Usage

Background:

Physical activity (PA) is a health behavior that most Americans do not participate in at recommended levels.

Methods:

We sought to increase PA by use of motivational signs in selected buildings. Because physical environments are known to influence PA, the relationship of building characteristics and stair usage was also assessed. One pre- and two post-intervention observations were conducted.

Results:

The proportion of those using the stairs increased from baseline to the second data collection, (χ2 = 39.31, p < 0.01) and baseline to a final data collection (χ2 = 10.1, p < 0.01). Built environment factors, including steps to the next higher floor and the number of floors in the building were consistent predictors of stair use. With signs positioned, the visibility of the stairs while standing in front of elevators became a significant predictor of stair usage.

Conclusions:

Motivational signs and characteristics of built environments are associated with increased stair usage.

Physical Activity Opportunity in K-12 Public School Settings: Nevada

Objectives:

We examined the status of physical activity opportunity in Nevada K-12 public schools. The focus was on determining both prevalence and nature of existing programs as well as school administrators’ perceived barriers to offering physical activity programs.

Methods:

A 15 item questionnaire was used to assess prevalence and nature of programs as well as perceived barriers.

Results:

Nevada school-age children do not have regular access to physical education. Excluding physical education, more than 30% of schools do not provide physical activity programming. Most existing programs are competitive sport related. In addition, as students matriculate through school, fewer program options and opportunities to participate throughout the school day are available. Lack of funds was the most frequently reported perceived barrier to offering physical activity programs.

Conclusions:

Opportunities to be physically active over the course of the school day are limited and as a result, hinder important national objectives for health-related outcomes.