Extending harm reduction through public health vending machines: Insights from implementation efforts in the United States.

Naloxone vending machines in county jail

Introduction: In 2020, an estimated 4,290 deaths in the United States (U.S.) will be attributed to cervical cancer, the most frequently detected in women of ages between 35 to 44 years of age. For the years 2011 to 2015, South Carolina (SC) ranked 19th in the U.S. for cervical cancer incidence and 14th for mortality. South Carolina has a higher proportion of both rural and Black residents compared to the U.S. population. Drastic differences in cervical cancer incidence by race exist with Black women having an approximately 18% higher incidence rate (8.9 per 100,000 women) compared to white women (7.5 per 100,000 women).The purpose of this study is to identify and compare cervical cancer survival by race and rural-urban status in South Carolina. Methods: We analyzed data from South Carolina Central Cancer Registry (SCCCR), available at the SC Department of Health & Environmental Control (DHEC). Our cohort included 3,016 women diagnosed with cervical cancer between 2001 to 2016. Rural Urban Commuting Area codes were used to classify rural residence based on place of residence at the time of diagnosis. Descriptive statistics were calculated and compared by rurality using a chi-square test. We constructed Kaplan-Meier curves and calculated 3, 5, and 10-year survival rates. Adjusting for rurality, race, age, SEER staging, type of insurance & census tract poverty estimates, multivariable Cox regression models were used to estimate the hazard ratio (HR). All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Results: The 10-year overall survival proportion was 51% for rural residents [vs 58% urban, P<.05]. Significant rural & racial differences were observed in overall 10-year survival proportion [urban white 63% vs 46% in urban Black & 55% in rural white vs 44% for rural Black, P<.001]. Similarly, rural residents who live in 0% - 5% census tract poverty levels had much lower overall 10-year survival of <40% [vs urban 72%, P<.001]. In Cox multivariable model stratified by SEER staging of the disease, even after accounting for rurality and other factors, the risk of death was higher among Black women with regional stage as compared to white women for disease-free survival (HR,1.42; 95% CI, 1.16 – 1.74) and overall survival (HR, 1.40; 95% CI, 1.16 – 1.68). Women aged 66 or higher, with a localized cancer had significantly greater risk of death as compared to 30-49 year olds for both disease free survival (HR, 8.22; 95% CI, 5.22 – 12.94) and overall survival (HR, 8.92; 95% CI, 6.29 – 12.66). Conclusions: Significant racial & geographic disparities exist in cervical cancer survival for South Carolina residents with the poorest survival rate experienced by rural Black women. Assessing the geographic variations in survival among patients diagnosed with cervical cancer can inform opportunities to improve screening rates and treatment to improve mortality especially in high risk populations. Citation Format: Radhika Ranganathan, Whitney Zahnd, Swann Arp Adams. Disproportionate burden of cervical cancer survival by race and rurality in South Carolina, 2001 - 2016 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-086.

Reflections on AIDS, 1981–2031

Promotion of Research on the HIV Continuum of Care in the United States: The CFAR HIV Continuum of Care/ECHPP Working Group.

Objective: In Marseille, southeastern France, HIV prevention programs for injection drug users (IDUs) simultaneously include access to sterile syringes through needle exchange programs (NEPs), legal pharmacy sales and, since 1996, vending machines that mechanically exchange new syringes for used ones. The purpose of this study was to compare the characteristics of IDUs according to the site where they last obtained new syringes. Methods: During 3 days in September 1997, all IDUs who obtained syringes from 32 pharmacies, four NEPs and three vending machines were offered the opportunity to complete a self-administered questionnaire on demographics, drug use characteristics and program utilization. Results: Of 485 individuals approached, the number who completed the questionnaire was 141 in pharmacies, 114 in NEPs and 88 at vending machines (response rate = 70.7%). Compared to NEP users, vending machine users were younger and less likely to be enrolled in a methadone program or to report being HIV infected, but more likely to misuse buprenorphine. They also had lower financial resources and were less likely to be heroin injectors than both pharmacy and NEP users. Conclusions: Our results suggest that vending machines attract a very different group of IDUs than NEPs, and that both programs are useful adjuncts to legal pharmacy sales for covering the needs of IDUs for sterile syringes in a single city. Assessment of the effectiveness and cost-effectiveness of combining such programs for the prevention of HIV and other infectious diseases among IDUs requires further comparative research.

Introduction: Skin cancer is the most common cancer in the United States (US) and is associated with notable morbidity and mortality. There has been mixed evidence regarding whether rural vs. urban residence is an independent risk factor for skin cancer, and it is not clear to what degree these differences are driven by demographic or behavioral factors. We investigated if there are differences in skin cancer sun protection behaviors between urban and rural residents. Methods: We used data from three (2013-2018) National Health and Nutrition Examination Survey (NHANES) cycles. Sunburns and sun exposure and behavior measures were dichotomized: 2+ hours outside during work days or non-work days, at least one sunburn in the past year (yes/no); sunscreen use, wearing long sleeves, staying in the shade (never, rarely, sometimes/most of the time, always). Urban/rural residence was measured as a 2-level indicator. We compared sunburn and sun behavior measures by rural-urban status using adjusted survey-weighted logistic regression models. Because of distribution difference by rural-urban status, we stratified by non-Hispanic (NH) white identity vs. identifying as a person of color. Odds ratios and 95% confidence intervals presented were adjusted for age, sex, income, education, body mass index, and smoking. Results: When comparing urban vs. rural residents, both NH white individuals (42.9 vs. 29.1%, OR: 1.60 [1.27, 2.01]) and people of color (48.9 vs. 36.5%, OR: 1.54 [1.08, 2.19]) in rural communities had greater odds of spending 2+ hours outside on work days. Rural NH white residents had greater odds of spending 2+ hours outside on non-work days (64.8 vs. 72.2%, OR: 1.45 [1.12, 1.88]). Both rural NH white individuals (26.7 vs. 21.6%, OR: 0.72 [0.57, 0.89]) and rural people of color (41.1 vs. 35.5%, OR: 0.81 [0.68, 0.97]) had lower odds of staying in the shade. Rural NH white residents reported lower sunscreen use (35.1 vs. 26.0%, OR: 0.74 [0.59, 0.93]). Among people of color, rural residency was associated with greater odds of at least one sunburn in the past year (34.5 vs. 24.7%, OR: 1.60 [1.23, 2.09]). Sunburns were more frequent overall (59-61%) in NH white individuals; however, no significant differences by rural-urban residence were observed. Conclusions: Rural residents report engaging in skin cancer preventative sun behaviors less often than urban residents. Greater sunburn frequency among rural and urban NH white individuals compared with individuals of color is consistent with higher skin cancer rates in NH white individuals. However, over 25% of people of color reported a sunburn in the past year, highlighting the importance of intervention on skin cancer risk beyond NH white individuals. Consistently less sun protection behavior across rural populations even after adjustment for demographics emphasizes that rurality should be recognized as an independent risk factor for sun risk behaviors. Citation Format: Allison C. Dona, Patricia Jewett, Rehana L. Ahmed, DeAnn Lazovich, Rachel I. Vogel. Not just demographics: Urban and rural differences in skin cancer sun protection behaviors in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1929.

<div>AbstractBackground:<p>Evidence regarding whether rural residence is a risk factor for skin cancer is mixed. We compared sun exposure and protection behaviors between rural and urban residents by ethno-racial group in the United States.</p>Methods:<p>We analyzed data from three (2013–2018) National Health and Nutrition Examination Survey cycles. We compared self-reported sun exposure and protection measures (sunburn, time spent outside, sunscreen use, wearing long sleeves, staying in shade) by rural–urban residential status using survey-weighted logistic regression models stratified by ethno-racial group, adjusting for age, sex, income, education, body mass index, and smoking.</p>Results:<p>Hispanic rural versus urban residents more often reported sunburns in the past year [41.6% vs. 31.2%, adjusted OR (aOR): 1.46 (1.15–1.86)]. White rural versus urban residents more often spent 2+ hours outside on workdays [42.9% vs. 29.1%, aOR: 1.60 (1.27–2.01)] and non-workdays [72.2% vs. 64.8%, aOR: 1.45 (1.12–1.88)] and less often used sunscreen [26.0% vs. 35.1%, aOR: 0.74 (0.59–0.93)] and stayed in the shade [21.7% vs. 26.7%, aOR: 0.72 (0.57–0.89)]. Black rural versus urban residents stayed in the shade less often [31.6% vs. 43.9%, aOR: 0.60 (0.39–0.91)] but less often spent 2+ hours outside on non-workdays [47.6% vs. 56.8%, aOR: 0.67 (0.51–0.90)].</p>Conclusions:<p>Across all ethno-racial groups included, rural residents reported greater sun risk behaviors than urban residents, with some nuances by ethno-racial identity, suggesting rural residence is a potential risk factor for skin cancer.</p>Impact:<p>Sun protection promotion programs should consider rural–urban settings while also accounting for ethno-racial identities.</p></div>

Background: Although research shows that digital health tools (DHT) are increasingly integrated with healthcare in the United States, very few studies have investigated the rural-urban differences in DHT adoption at the national level. Individuals in rural communities experience disproportionately greater rates of chronic diseases and face unique challenges in accessing health care. Studies have shown that digital technology can improve access and support rural health by overcoming geographic barriers to care.Objective: To evaluate the rates of ownership and preferences for utilization of DHT as a measure of interest among rural adults compared to their urban counterparts in the United States using a National Inpatient Survey.Methods: Data was drawn from the 2019 (n= 5438) iteration of the Health Information National Trends Survey (HINTS 5 cycle 3). Chi-square tests and weighted multivariable logistic regressions were conducted to examine rural-urban differences regarding ownership, usage, and use of digital health tools to interact with health care systems while adjusting for health-related characteristics and sociodemographic factors.Results: The ownership rates of digital health technology (DHT) devices, including tablets, smart phones, health apps, and wearable devices, were comparable between rural and urban residents. For tablets, the ownership rates were 54.52% among rural residents and 60.24% among urban residents, with an adjusted odds ratio (OR) of 0.87 (95% confidence interval {CI}: 0.61, 1.24). The ownership rates of health apps were 51.41% and 53.35% among rural and urban residents, respectively, with an adjusted OR of 0.93 (95% CI: 0.62, 1.42). For smartphones, the ownership rates were 81.64% among rural residents and 84.10% among urban residents, with an adjusted OR of 0.81 (95% CI: 0.59, 1.11). Additionally, rural residents were equally likely to use DHT in managing their healthcare needs. Both groups were equally likely to have reported their smart device as helpful in discussions with their healthcare providers (OR 0.90; 95% CI 63 - 1.30; p = 0.572). Similarly, there were similar odds of reporting that DHT had helped them to track progress on a health-related goal (e.g., quitting smoking, losing weight, or increasing physical activity) (OR 1.17; 95% CI 0.75 - 1.83; p = 0.491), and to make medical decisions (OR 1.05; 95% CI 0.70 - 1.59; p = 0.797). However, they had lower rates of internet access and were less likely to use DHT for communicating with their healthcare providers.Conclusion: We found that rural residents are equally likely as urban residents to own and use DHT to manage their health. However, they were less likely to communicate with their health providers using DHT. With increasing use of DHT in healthcare, future research that targets reasons for geographical digital access disparities is warranted.

<div>AbstractBackground:<p>Evidence regarding whether rural residence is a risk factor for skin cancer is mixed. We compared sun exposure and protection behaviors between rural and urban residents by ethno-racial group in the United States.</p>Methods:<p>We analyzed data from three (2013–2018) National Health and Nutrition Examination Survey cycles. We compared self-reported sun exposure and protection measures (sunburn, time spent outside, sunscreen use, wearing long sleeves, staying in shade) by rural–urban residential status using survey-weighted logistic regression models stratified by ethno-racial group, adjusting for age, sex, income, education, body mass index, and smoking.</p>Results:<p>Hispanic rural versus urban residents more often reported sunburns in the past year [41.6% vs. 31.2%, adjusted OR (aOR): 1.46 (1.15–1.86)]. White rural versus urban residents more often spent 2+ hours outside on workdays [42.9% vs. 29.1%, aOR: 1.60 (1.27–2.01)] and non-workdays [72.2% vs. 64.8%, aOR: 1.45 (1.12–1.88)] and less often used sunscreen [26.0% vs. 35.1%, aOR: 0.74 (0.59–0.93)] and stayed in the shade [21.7% vs. 26.7%, aOR: 0.72 (0.57–0.89)]. Black rural versus urban residents stayed in the shade less often [31.6% vs. 43.9%, aOR: 0.60 (0.39–0.91)] but less often spent 2+ hours outside on non-workdays [47.6% vs. 56.8%, aOR: 0.67 (0.51–0.90)].</p>Conclusions:<p>Across all ethno-racial groups included, rural residents reported greater sun risk behaviors than urban residents, with some nuances by ethno-racial identity, suggesting rural residence is a potential risk factor for skin cancer.</p>Impact:<p>Sun protection promotion programs should consider rural–urban settings while also accounting for ethno-racial identities.</p></div>

Evidence regarding whether rural residence is a risk factor for skin cancer is mixed. We compared sun exposure and protection behaviors between rural and urban residents by ethno-racial group in the United States. We analyzed data from three (2013-2018) National Health and Nutrition Examination Survey cycles. We compared self-reported sun exposure and protection measures (sunburn, time spent outside, sunscreen use, wearing long sleeves, staying in shade) by rural-urban residential status using survey-weighted logistic regression models stratified by ethno-racial group, adjusting for age, sex, income, education, body mass index, and smoking. Hispanic rural versus urban residents more often reported sunburns in the past year [41.6% vs. 31.2%, adjusted OR (aOR): 1.46 (1.15-1.86)]. White rural versus urban residents more often spent 2+ hours outside on workdays [42.9% vs. 29.1%, aOR: 1.60 (1.27-2.01)] and non-workdays [72.2% vs. 64.8%, aOR: 1.45 (1.12-1.88)] and less often used sunscreen [26.0% vs. 35.1%, aOR: 0.74 (0.59-0.93)] and stayed in the shade [21.7% vs. 26.7%, aOR: 0.72 (0.57-0.89)]. Black rural versus urban residents stayed in the shade less often [31.6% vs. 43.9%, aOR: 0.60 (0.39-0.91)] but less often spent 2+ hours outside on non-workdays [47.6% vs. 56.8%, aOR: 0.67 (0.51-0.90)]. Across all ethno-racial groups included, rural residents reported greater sun risk behaviors than urban residents, with some nuances by ethno-racial identity, suggesting rural residence is a potential risk factor for skin cancer. Sun protection promotion programs should consider rural-urban settings while also accounting for ethno-racial identities.

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Secondary exchange of sterile injecting equipment in a high distribution environment: A mixed method analysis in south east Sydney, Australia

Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019

Japan Grapples With Alcoholism Crisis

Characterization of indigenous community engagement in arthritis studies conducted in Canada, United States of America, Australia and New Zealand