Behavioral Risk Factor Surveillance System Survey Research Articles

The association between food insecurity and colorectal cancer screening: 2018-2021 New York State Behavioral Risk Factor Surveillance System (BRFSS).

To assess the association between food insecurity and colorectal cancer screening uptake in screening eligible participants in New York State. We analyzed 28,154 adults who participated in New York State Behavioral Risk Factor Surveillance System (BRFSS) from 2018 to 2021, were age-eligible for colorectal cancer screening based on the USPSTF guidelines at the time of survey administration and answered a version of the administered survey that included the module on food insecurity. Participants were defined as food insecure if they self-reported being always, usually, or sometimesstressed about having enough money to buy nutritious meals in the past 12months. We compared demographic, healthcare access, overall health status, food insecurity by colorectal cancer screening status. Multivariable analyses were performed to assess the association of food insecurity and colorectal cancer screening status after adjusting for relevant covariates. Weighted analyses were performed using survey procedures to obtain population estimates. Food insecurity was statistically significantly associated a decreased likelihood of being up to date on colorectal cancer screening (ORadj 0.83, 95% CI [0.72, 0.94]) and being ever screened for colorectalcancer (ORadj 0.74, 95% CI [0.64, 0.87]) after adjusting for overall health status, healthcare coverage, interview year, age, race/ethnicity, sex, educational attainment, and income. Health status, health coverage, age, and Non-Hispanic Black race/ethnicity showed positive, statistically significant association with ever being screened and with being up to date for colorectal cancer screening. Lower income, lower educational attainment, and non-Hispanic Asian race/ethnicitywere statistically significant inverse predictors of ever being screened and being up to date on screening. This project assessed the association between food insecurity and colorectal cancer screening uptake using the BRFSS survey. Food insecurity may be an important predictor for colorectal cancer screening uptake in eligible adults in the United States. The results from the study can inform future interventions and policies designedto improve participation inroutinecolorectal cancer screening.

Regional Differences in American Indian/Alaska Native Chronic Respiratory Disease Disparity: Evidence from National Survey Results.

American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive pulmonary disease (COPD) in a BRFSS-defined subset of 11 states historically recognized as having a relatively high proportion of AI/AN residents. Here, we investigate the contributions of the AI/AN variable and other sociodemographic determinants to disease disparity in the remaining 39 US states and territories. Using BRFSS surveys from 2011 to 2019, we demonstrate that irrespective of race, the yearly adjusted prevalence for asthma and/or COPD was higher in the 39-state region than in the 11-state region. Logistic regression analysis revealed that the AI/AN race/ethnicity variable was positively associated with disease in the 39-state region after adjusting for sociodemographic covariates, unlike in the 11-state region. This shows that the distribution of disease prevalence and disparity for asthma and/or COPD is non-uniform in the US. Although AI/AN populations experience this disease disparity throughout the US, the AI/AN variable was only observed to contribute to this disparity in the 39-state region. It may be important to consider the geographical distribution of respiratory health determinants and factors uniquely impactful for AI/AN disease disparity when formulating disparity elimination policies.

Adult vaccination coverage in the United States: A database analysis and literature review of improvement strategies

ABSTRACT Despite vaccines being instrumental in reducing vaccine-preventable disease, adult vaccination rates in the United States (US) are below optimal levels. To better understand factors affecting vaccination rates, we analyzed trends in adult vaccination coverage using data from the Behavioral Risk Factor Surveillance System (BRFSS) and conducted a targeted literature review (TLR) on interventions to improve adult vaccination rates in the US. Both the BRFSS analysis and the TLR focused on influenza; pneumococcal disease; tetanus and diphtheria or tetanus, diphtheria, and acellular pertussis; herpes zoster; and human papillomavirus vaccination for US adults aged 18–64 years. The TLR additionally included hepatitis A and hepatitis B vaccination. Vaccination coverage rates (VCRs) and changes in VCRs were calculated using the 2011–2019 BRFSS survey data. For the TLR, the MEDLINE and MEDLINE In-Process databases were searched for articles on vaccination interventions published between January 2015 and June 2021. The BRFSS analysis showed that changes in VCRs were generally modest and positive for most states over the study period. The TLR included 32 articles that met the eligibility criteria; intervention strategies that improved adult vaccination outcomes incorporated an educational component, vaccination reminders or reinforcement at the point of care, or authorized non-clinician members of the healthcare team to vaccinate. Furthermore, interventions combining more than one approach appeared to enhance effectiveness. The strategies identified in this TLR will be valuable for policymakers and stakeholders to inform the development and implementation of evidence-based policies and practices to improve adult vaccination coverage.

Evaluating the Factors Associated With Increased Risk of Self-Reported Ischemic Heart Disease in Patients With Arthritis

Introduction. Arthritis has increased systematic repercussions either by extra-articular manifestations or due to limited activities. Methods. In this study, we used the 2020 and 2021 Behavioral Risk Factor Surveillance System (BRFSS), a large, nationally representative, cross-sectional telephone survey. The data was divided into the participants having arthritis and no arthritis. Results represented as an odds ratio (OR) with a 95% confidence interval (CI). We used a multivariate-adjusted logistic regression model to analyze the results. Fisher’s t-test was used to compare between 2 groups. P-value < 0.05 was considered significant. Results. BRFSS survey results led to 835,452 participants included in the final analysis. Of the included participant, 267020 has arthritis, and 568432 do not. In the arthritis group, 38.7% were males, and 61.3% were females. We found that patients with arthritis have a higher prevalence of diabetes and stroke. Adjusted logistic regression analysis showed that patients with arthritis have higher odds of reporting ischemic heart disease (IHD) (OR = 1.05, 95% CI 1.05-1.05, p-value < 0.001). Also, poor health status (mental, general, and physical) patients are more likely to report IHD. Conclusion. Patients with arthritis are more likely to report IHD, which further increases in patients with poor health status.

Trends in Arthritis Prevalence and Associated Chronic Health Indicators Among Adults: Insights From the Behavioral Risk Factor Surveillance System (BRFSS) Database.

Background Arthritis is a prevalent, chronic condition with significant implications for morbidity and healthcare utilization. Understanding trends in arthritis prevalence and associated chronic health indicators is vital for informing public health interventions and healthcare policies. Objective This retrospective study aimed to analyze trends in arthritis prevalence and associated chronic health indicators among adults using data from the Behavioral Risk Factor Surveillance System (BRFSS) database. Methods This retrospective study utilized data from the BRFSS database covering 2019 to 2022. Participants included United States adults aged 18 years and older who completed BRFSS surveys during the specified period. Primary variables included arthritis prevalence and its correlation with chronic health indicators and demographics. Data collection involved standardized telephone questionnaires administered annually, with rigorous attention to data quality and consistency. Prevalence estimates were calculated using weighted proportions, and statistical analysis utilized analysis of variance (ANOVA). Results The study revealed relatively stable arthritis prevalence over the study period, with notable demographic variations. Arthritis prevalence remained stable (2019: 43.3%, 2021: 42.5%). Females consistently had higher rates than males (2019: 45%, 2021: 44.9%). Activity limitation, joint pain, and work limitation were more prevalent in arthritis patients. White, non-Hispanic individuals had higher rates than other groups. Physical inactivity increased from 2019 (29.4%) to 2022 (72.4%), particularly in males. Counseling for physical activity was lower in males. Targeted interventions are needed to address these disparities and improve arthritis management. Conclusion This study provides insights into trends in arthritis prevalence and associated chronic health indicators among United States adults. The findings underscore the importance of considering demographic factors in arthritis prevention and management strategies. Targeted interventions promoting physical activity counseling, particularly among high-risk populations, are warranted to address the rising trend of physical inactivity among individuals with arthritis.

Changes in Self-Measured Blood Pressure Monitoring Use in 14 States From 2019 to 2021: Impact of the COVID-19 Pandemic.

Self-measured blood pressure monitoring (SMBP) is an important out-of-office resource that is effective in improving hypertension control. Changes in SMBP use during the Coronavirus Disease 2019 (COVID-19) pandemic have not been described previously. Behavioral Risk Factor Surveillance System (BRFSS) data were used to quantify changes in SMBP use between 2019 (prior COVID-19 pandemic) and 2021 (during the COVID-19 pandemic). Fourteen states administered the SMBP module in both years. All data were self-reported from adults who participated in the BRFSS survey. We assessed the receipt of SMBP recommendations from healthcare professionals and actual use of SMBP among those with hypertension (n = 68,820). Among those who used SMBP, we assessed SMBP use at home and sharing BP readings electronically with healthcare professionals. Among adults with hypertension, there was no significant changes between 2019 and 2021 in those reporting SMBP use (57.0% vs. 55.7%) or receiving recommendations from healthcare professionals to use SMBP (66.4% vs. 66.8%). However, among those who used SMBP, there were significant increases in use at home (87.7% vs. 93.5%) and sharing BP readings electronically (8.6% vs. 13.1%) from 2019 to 2021. Differences were noted by demographic characteristics and residence state. Receiving a recommendation from the healthcare provider to use SMBP and actual use did not differ before and during the COVID-19 pandemic. However, among those who used SMBP, home use and sharing BP readings electronically with healthcare professional increased significantly, although overall sharing remained low (13.1%). Maximizing advances in virtual connections between clinical and community settings should be leveraged for improved hypertension management.

Trends in American Indian/Alaskan native self-reported stroke prevalence and associated modifiable risk factors in the United States from 2011-2021

BackgroundStroke prevalence varies by race/ethnicity, as do the risk factors that elevate the risk of stroke. Prior analyses have suggested that American Indian/Alaskan Natives (AI/AN) have higher rates of stroke and vascular risk factors. MethodsWe included biyearly data from the 2011-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys of adults (age ≥18) in the United States. We describe survey-weighted prevalence of stroke per self-report by race and ethnicity. In patients with self-reported stroke (SRS), we also describe the prevalence of modifiable vascular risk factors. ResultsThe weighted number of U.S. participants represented in BRFSS surveys increased from 237,486,646 in 2011 to 245,350,089 in 2021. SRS prevalence increased from 2.9% in 2011 to 3.3% in 2021 (p<0.001). Amongst all race/ethnicity groups, the prevalence of stroke was highest in AI/AN at 5.4% and 5.6% in 2011 and 2021, compared to 3.0% and 3.4% for White adults (p<0.001). AI/AN with SRS were also the most likely to have four or more vascular risk factors in both 2011 and 2021 at 23.9% and 26.4% compared to 18.2% and 19.6% in White adults (p<0.001). ConclusionFrom 2011-2021 in the United States, AI/AN consistently had the highest prevalence of self-reported stroke and highest overall burden of modifiable vascular risk factors. This persistent health disparity leaves AI/AN more susceptible to both incident and recurrent stroke.

The Impact of Social Determinants of Health on the Diagnosis of Type 2 Diabetes Mellitus (T2DM) Among Asian Indians (AIs) in New Jersey: A Secondary Analysis of the BRFSS Survey From 2013 to 2017.

Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ). This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics. Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤ .05). These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs.

1548. Evaluation of rural HIV screening in adults with one or more risk factors

Abstract Background The National HIV/AIDS Strategy aims to end the HIV epidemic in the United States by 2030. However, despite significant medical advances in HIV prevention (specifically treatment as prevention), transmission without knowledge of HIV status remains a significant barrier to reducing new infections. Developing effective and equitable HIV screening methods is an essential step towards HIV elimination. Individuals residing in rural settings across the U.S. have limited access to HIV-literate providers due to complex and multifactorial barriers including long travel distances to appointments, fewer community support resources, and scarcity of specialized HIV care providers. The opt-out approach to HIV screening may be insufficient to adequately reach people living in rural communities, particularly those with elevated risk of HIV transmission. Methods Our study used Vermont-specific data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS) surveys from 2010 to 2012 and 2016 to 2019. We included participants who responded to three questions in the HIV/AIDS section of the BRFSS. BRFSS surveys from 2013 to 2015 omitted one of the three questions and therefore were excluded from the study. Participants were assigned either a low- or high-risk category based on a question which asked whether they engaged in certain behaviors associated with HIV transmission (e.g., intravenous drug use, condomless anal sex, etc.) over the past year. HIV screening was considered adequate for participants in the low-risk category if they had one or more lifetime HIV test. Participants in the high-risk category were deemed adequately screened if they had been tested for HIV in the past year. Results The results of the analysis are shown in Table 1. Pearson’s chi-squared value (χ2) was 5.1 with an associated p-value = 0.024 suggesting that the percentage of adequate screening varies significantly with HIV risk category. Conclusion Our results suggest that HIV screening remains suboptimal in Vermont, particularly for those at increased risk of transmission. These findings indicate that more inclusive and expansive strategies including targeted HIV screening may be warranted in rural regions. Disclosures All Authors: No reported disclosures

Contextual Influences on Nonresponse to Health Survey Questions About Sexual Orientation and Gender Identity.

Purpose: We examined the relationship between state context and survey nonresponse to sexual orientation (SO) and gender identity (GI) questions. Methods: We obtained data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Item nonresponse was defined as selecting "don't know/not sure" or "refused" for each of two questions about SO and GI. Nonresponse patterns included responding to both SO and GI questions; responding only to the SO question (nonresponse to GI); responding only to the GI question (nonresponse to SO); and responding to neither question. State-level contextual measures included legal protections for lesbian, gay, bisexual, transgender, or other sexual or gender minority (LGBT+) people, LGBT+ social movement strength, and public opinion regarding LGBT+ issues. Results: The analysis included 1,459,525 respondents from 44 states (190 state-years). On weighted analysis, 96.5% of adults answered both SO/GI questions, 2.4% responded only to GI, 0.4% responded only to SO, and 0.7% responded to neither. The demographic profile of individuals with GI-only nonresponse differed markedly from the profile of adults with SO-only nonresponse. An increasingly favorable legal climate for LGBT+ people was associated with greater rates of response to SO and GI questions. However, a more LGBT+ friendly state climate measured by social movement strength or public opinion was not consistently associated with reduced SO and GI question nonresponse. Conclusion: Contextual factors have mixed association with nonresponse to SO and GI question on BRFSS surveys. Our results warrant continued development of health survey questionnaires to elicit accurate information on respondents' SO and GI.

Abstract P2122: Coronary Heart Disease And Arthritis - An Analysis Of 2 Year Behavioral Risk Factor Surveillance System (BRFSS) Data

Introduction: Arthritis has increased systematic repercussions either by extra-articular manifestations or due to limited activities. Studies have fined an association between arthritis and heart disease. In this study, we try to find that arthritis is an independent association for myocardial infarction (MI) or coronary heart disease (CHD). Methods: In this study, we used the 2020 and 2021 Behavioral Risk Factor Surveillance System (BRFSS), a large, nationally representative, cross-sectional telephone survey. The data was divided into the participants having arthritis or no arthritis. Results were pooled and were represented with an odds ratio (OR) with a 95% CI interval. We used a logistic regression model to pool the results and adjusted for different variables. Two different models were constructed, and ANOVA was used to compare different models. The analysis was done by using R statistical software. Fisher t-test was used to compare between 2 groups. P-value &lt; 0.05 was considered significant. Results: Pooled results of the BRFSS survey led to 835,452 participants included in the final analysis. Of the included participant, 267020 has arthritis, and 568432 does not. 38.7% were males, and 61.3% were females. In the arthritis group, 38.7% were males, and 61.3% were females. Also, 55.1% of individuals in the arthritis group are older than 65. Our analysis found that arthritis people have a higher prevalence of diabetes and stroke. We analyzed logistic regression after adjusting for sex, race, age, diabetes, stroke, and BMI. It was found that participants with arthritis have higher odds of MI or CHD ( OR = 1.055, 95% CI 1.154-1.157, p-value &lt; 0.001) compared to non-arthritis people and when adjusted for sex, race, age it was 1.074, 95% CI 1.073-1.075, p-value&lt;0.001). Conclusion: We find that arthritis is associated with an increased risk of MI or CHD independent of other risk factors. Hence, patients with arthritis need close monitoring for heart-related disease.

Preventive behaviors and behavioral risk factors among gynecologic cancer survivors: Results from the 2020 Behavioral Risk Factor Surveillance System Survey.

Maintaining a healthy lifestyle is an important factor in promoting positive outcomes for gynecologic cancer survivors. We examined preventive behaviors among gynecologic cancer survivors (n = 1824) and persons without a history of cancer in a cross-sectional analysis, using data from the 2020 Behavioral Risk Factor Surveillance System survey (BRFSS). BRFSS is a cross-sectional telephone-based survey of U.S. residents 18 years of age and older, which collects information about health-related factors and use of preventive services. The prevalence rates of colorectal cancer screening were respectively 7.9 (95% CI: 4.0-11.9) and 15.0 (95% CI: 4.0-11.9) %-points higher among gynecologic and other cancer survivors compared to that of 65.2% among those without any history of cancer. However, no differences were observed in breast cancer screening between gynecologic cancer survivors (78.5%) and respondents without any history of cancer (78.7%). Coverage of influenza vaccination among gynecologic cancer survivors were 4.0 (95% CI: 0.3-7.6) %-points higher than that of the no cancer group, but 11.6 (95% CI: 7.6-15.6) %-points lower than that of the other cancer group. Pneumonia vaccination rate among gynecologic cancer survivors, however, was not statistically different than that of other cancer survivors and respondents with no history of cancer. When examining modifiable risk behaviors, the prevalence of smoking among gynecologic cancer survivors was 12.8 (95% CI: 9.5-16.0) and 14.2 (95% CI: 10.8-17.7) %-points higher than smoking prevalence among other cancer survivors and respondents without any history of cancer. The rate differentials were even higher in rural areas, 17.4 (95% CI: 7.2-27.6) and 18.4 (95% CI: 7.4-29.4) %-points respectively. There were no differences in the prevalence of heavy drinking across the groups. Lastly, gynecologic and other cancer survivors were less likely to be physically active (Δ = -12.3, 95% CI: -15.8 to -8.8 and Δ = -6.9, 95% CI: -8.5 to -5.3, respectively) than those without any history of cancer. Smoking prevalence among gynecologic cancer survivors is alarmingly high. Intervention studies are needed to identify effective ways to assist gynecologic cancer survivors to quit smoking and refrain from hazardous alcohol consumption. In addition, women with gynecologic malignancies should made aware of the importance of physical activity.

Low-Value Prostate-Specific Antigen Screening in Older Males

The US Preventive Services Task Force guidelines advise against prostate-specific antigen (PSA) screening for prostate cancer in males older than 69 years due to the risk of false-positive results and overdiagnosis of indolent disease. However, this low-value PSA screening in males aged 70 years or older remains common. To characterize the factors associated with low-value PSA screening in males 70 years or older. This survey study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide annual survey conducted by the Centers for Disease Control and Prevention that collects information via telephone from more than 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. The final cohort comprised male respondents to the 2020 BRFSS survey who were categorized into the following age groups: 70 to 74 years, 75 to 79 years, or 80 years or older. Males with a former or current prostate cancer diagnosis were excluded. The outcomes were recent PSA screening rates and factors associated with low-value PSA screening. Recent screening was defined as PSA testing within the past 2 years. Weighted multivariable logistic regressions and 2-sided significance tests were used to characterize factors associated with recent screening. The cohort included 32 306 males. Most of these males (87.6%) were White individuals, whereas 1.1% were American Indian, 1.2% were Asian, 4.3% were Black, and 3.4% were Hispanic individuals. Within this cohort, 42.8% of respondents were aged 70 to 74 years, 28.4% were aged 75 to 79 years, and 28.9% were 80 years or older. The recent PSA screening rates were 55.3% for males in the 70-to-74-year age group, 52.1% in the 75-to-79-year age group, and 39.4% in the 80-year-or-older group. Among all racial groups, non-Hispanic White males had the highest screening rate (50.7%), and non-Hispanic American Indian males had the lowest screening rate (32.0%). Screening increased with higher educational level and annual income. Married respondents were screened more than unmarried males. In a multivariable regression model, discussing PSA testing advantages with a clinician (odds ratio [OR], 9.09; 95% CI, 7.60-11.40; P < .001) was associated with increased recent screening, whereas discussing PSA testing disadvantages had no association with screening (OR, 0.95; 95% CI, 0.77-1.17; P = .60). Other factors associated with a higher screening rate included having a primary care physician, a post-high school educational level, and income of more than $25 000 per year. Results of this survey study suggest that older male respondents to the 2020 BRFSS survey were overscreened for prostate cancer despite the age cutoff for PSA screening recommended in national guidelines. Discussing the benefits of PSA testing with a clinician was associated with increased screening, underscoring the potential of clinician-level interventions to reduce overscreening in older males.

Model-based community health surveillance via multilevel small area estimation using state behavioral risk factor surveillance system (BRFSS): a case study in Connecticut

PurposeThe main objective of state behavioral risk factor surveillance system (BRFSS) is to produce reliable state-level estimates of various population health outcomes. A multilevel Regression and Post-stratification (MRP) methodology for small area estimation has been applied to the 500 Cities Project to provide population estimates at both city-level and census tract-level using national BRFSS data. To date, MRP has not been applied to any state BRFSS to produce health data at local geographic areas. In addition, the use of single year BRFSS might produce temporary inconsistency in small area estimates (SAEs). The predicted standard errors (SEs) and confidence intervals (CIs) of SAEs using Monte Carlo simulation could be substantially underestimated or overestimated. MethodsBy extending the current MRP approach and applying a parametric bootstrapping approach to Connecticut BRFSS (CT BRFSS), we were able to produce SAEs as well as SEs and CIs of SAEs for Connecticut counties and towns. We also applied this model to 5-year CT BRFSS (2011–2015) with an aim to improve the temporary consistency of SAEs. ResultsBoth single-year and 5-year estimates with SEs and CIs were generated for six selected population health indicators at town, county and state levels. Model-based SAEs were internally evaluated by comparing to single-year and 5-year direct BRFSS survey (2011–2015). SAEs were also externally validated when external data were available. ConclusionsModel-based SAEs are valid and could be used to characterize local geographic variations using single state BRFSS data.

HEALTHCARE-SEEKING BEHAVIORS AMONG OLDER AMERICANS WITH SUBJECTIVE COGNITIVE DECLINE

Abstract Subjective cognitive decline (SCD) in older adults is increasingly recognized as a harbinger of dementia. However, since SCD is, by definition, based on self-reports, it is unclear whether those who experience memory loss discuss these issues with physicians. Access to regular healthcare can be a catalyst for early detection of SCD because asymptomatic cognitive changes may not be apparent unless directly addressed with primary care physicians (PCP). Further, given the widely-known racial/ethnic disparities in healthcare access, minority adults might be further disadvantaged in healthcare seeking for SCD. Using a large national dataset, Behavioral Risk Factor Surveillance System (BRFSS) in 2019, the goals of the study are to a) examine the link between having a PCP and discussing memory issues with physicians and b) examine how race and ethnicity and the availability of PCPs are associated with discussion of SCD. The sample included 7,900 individuals 50 and older who reported SCD in the past year. We conducted a logistic regression adjusting for BRFSS survey weights, missing data, state-level clustering, and a set of covariates. Among those with SCD, those with a PCP were almost twice as likely to discuss their cognitive decline (OR=1.98, p&amp;lt;.001). There was also a significant interaction between Hispanic ethnicity and having a PCP (OR=0.25, p&amp;lt;.05, F=4.65, p=.03). Surprisingly, Hispanics with a PCP were less likely to discuss memory issues compared to Hispanics without one. The findings highlight the significance of routine healthcare service utilization for adults with SCD while providing a nuanced understanding of ethnic differences.

Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US

Approximately 13% of US adults are affected by visual disability, with disproportionately higher rates in groups impacted by certain social determinants of health (SDOH). To evaluate SDOH associated with severe visual impairment (SVI) to ultimately guide targeted interventions to improve ophthalmic health. This quality improvement study used cross-sectional data from a telephone survey from the Behavioral Risk Factor Surveillance System (BRFSS) that was conducted in the US from January 2019 to December 2020. Participants were noninstitutionalized adult civilians who were randomly selected and interviewed and self-identified as "blind or having serious difficulty seeing, even while wearing glasses." Demographic and health care access factors. The main outcome was risk of SVI associated with various factors as measured by odds ratios (ORs) and 95% CIs. Descriptive and logistic regression analyses were performed using the Web Enabled Analysis Tool in the BRFFS. During the study period, 820 226 people (53.07% female) participated in the BRFSS survey, of whom 42 412 (5.17%) self-identified as "blind or having serious difficulty seeing, even while wearing glasses." Compared with White, non-Hispanic individuals, risk of SVI was increased among American Indian/Alaska Native (OR, 1.63; 95% CI, 1.38-1.91), Black/African American (OR, 1.50; 95% CI, 1.39-1.62), Hispanic (OR, 1.65; 95% CI, 1.53-1.79), and multiracial (OR, 1.33; 95% CI, 1.15-1.53) individuals. Lower annual household income and educational level (eg, not completing high school) were associated with greater risk of SVI. Individuals who were out of work for 1 year or longer (OR, 1.78; 95% CI, 1.54-2.07) or who reported being unable to work (OR, 2.90; 95% CI, 2.66-3.16) had higher odds of SVI compared with the other variables studied. Mental health diagnoses and 14 or more days per month with poor mental health were associated with increased risk of SVI (OR, 1.87; 95% CI, 1.73-2.02). Health care access factors associated with increased visual impairment risk included lack of health care coverage and inability to afford to see a physician. In this study, various SDOH were associated with SVI, including self-identification as being from a racial or ethnic minority group; low socioeconomic status and educational level; long-term unemployment and inability to work; divorced, separated, or widowed marital status; poor mental health; and lack of health care coverage. These disparities in care and barriers to health care access should guide targeted interventions.

Association Between Alcohol Intake and Prostate Specific Antigen Screening: Results From a National Behavioral Survey

ObjectiveTo assess the association between self-reported alcohol use and prostate cancer (PCa) screening using the U.S.-based Behavioral Risk Factor Surveillance System (BRFSS) survey. Materials and MethodsA cross-sectional analysis of men aged between 55 and 69 who responded to the PSA screening and alcohol consumption portions of the 2018 BRFSS survey was performed. Alcohol consumption was assessed according with the Centers for Disease Control and Prevention definition of binge and heavy drinking. Rates of PSA screening between binge and non-binge drinkers and among heavy and non-heavy drinkers were compared. A complex weighted multivariable logistic regression model, adjusted for socio-economic covariates and weighted using BRFSS sample weights, was used to test the association between the self-reported alcohol use and the odds of PSA screening. ResultsAmong 57,774 men eligible for PCa screening, there were 8,276 binge drinkers with an unadjusted PSA screening prevalence of 37% versus 40% in the non-binge drinking group (P = .018). Among 3,836 heavy drinkers, the unadjusted PSA screening prevalence was 34% versus 40% in non-heavy drinkers (P < .001). In the multivariable analysis, only heavy drinking status was significantly associated with a lower odds of PSA screening (OR: 0.84, 95% CI: 0.72-0.98, P = .02). ConclusionGiven that alcohol overuse may increase the risk of developing cancer, our finding of lower utilization of PCa screening among heavy drinkers is noteworthy. Efforts to support guideline-concordant cancer screening among heavy drinkers may represent an important strategy to reduce the burden of cancer in these men.

Changes in Cancer Screening in the US During the COVID-19 Pandemic

Health care was disrupted in the US during the first quarter of 2020 with the emergence of the COVID-19 pandemic. Early reports in selected samples suggested that cancer screening services decreased greatly, but population-based estimates of cancer screening prevalence during 2020 have not yet been reported. To examine changes in breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) screening prevalence with contemporary national, population-based Behavioral Risk Factor Surveillance System (BRFSS) data. This survey study included respondents from the 2014, 2016, 2018, and 2020 BRFSS surveys who were eligible for BC (women aged 50-74 years), CC (women aged 25-64 years), and CRC (women and men aged 50-75 years) screening. Data analysis was performed from September 2021 to February 2022. Calendar year. Self-reported receipt of a recent (defined as in the past year) BC, CC, and CRC screening test. Adjusted prevalence ratios (aPRs) comparing 2020 vs 2018 prevalence and 95% CIs were computed. In total, 479 248 individuals were included in the analyses of BC screening, 301 453 individuals were included in CC screening, and 854 210 individuals were included in CRC screening, In 2020, among respondents aged 50 to 75 years, 14 815 (11.4%) were Black, 12 081 (12.6%) were Hispanic, 156 198 (67.3%) were White, and 79 234 (29.9%) graduated from college (all percentages are weighted). After 4 years (2014-2018) of nearly steady prevalence, past-year BC screening decreased by 6% between 2018 and 2020 (from 61.6% in 2018 to 57.8% in 2020; aPR, 0.94; 95% CI, 0.92-0.96), and CC screening decreased by 11% (from 58.3% in 2018 to 51.9% in 2020; aPR, 0.89; 95% CI, 0.87-0.91). The magnitude of these decreases was greater in people with lower educational attainment and Hispanic persons. CRC screening prevalence remained steady; past-year stool testing increased by 7% (aPR, 1.07; 95% CI, 1.02-1.12), offsetting a 16% decrease in colonoscopy (aPR, 0.84; 95% CI, 0.82-0.88) between 2018 and 2020. In this survey study, stool testing increased and counterbalanced a decrease in colonoscopy during 2020, and BC and CC screening modestly decreased. How these findings might be associated with outcomes is not yet known, but they will be important to monitor, especially in populations with lower socioeconomic status, who experienced greater screening decreases during the COVID-19 pandemic.

Self-reported well-being of cancer survivor (CS)-caregivers: An analysis of the Behavioral Risk Factor Surveillance System (BRFSS).

e22022 Background: With the advancement in cancer therapies and supportive care, the 5-year survival rate for all cancers combined has surpassed 67%, indicating an increased proportion of CS are going back to their life roles, including providing care to others. Being a caregiver is associated with an increased risk of physical and mental distress, depression, and sleep disturbance. Nevertheless, the well-being of “dual role” CS-caregivers remains unknown. Methods: Data were extracted from the BRFSS survey from 2016, 2018, and 2020. Outcome variables included self-reported poor general health, physical health, mental health, depression, physical inactivity, and inadequate sleep. Weighted multivariable logistic regression models were used to calculate the odds of self-reported well-being comparing CS-caregivers to non-CS caregivers. Results: 20% of CSs were caregivers. Among a total of 18,590 caregivers, 18,124 (weighted N=12,311,109) were non-CSs and 466 (weighted N= 287,807) were CSs. CS-caregivers were significantly more likely to have poorer general and physical health and be physically inactive than non-CS caregivers (Table). Differential impacts on the well-being of CS-caregiver were also observed by the female sex and less than 5 years since cancer diagnosis. Conclusions: One in five CS is a caregiver, translating into 3.4 million CS in the US population. CS-caregivers experience diminished well-being across a variety of measures than non-CS caregivers. These data suggest CS-caregivers may need additional psychosocial support. Future prospective longitudinal studies are needed to investigate the outcomes in this growing and vulnerable population.[Table: see text]

Examining Racial/Ethnic Differences in Positive Childhood Experiences Among Respondents in a Southern State.

Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) may impact brain development in children and adolescents into adulthood. While prior research demonstrated racial-ethnic disparities in ACEs, less is known about racial and ethnic differences in PCEs, particularly among adults. To better understand racial and ethnic differences in positive childhood experiences, this study (1) examined the prevalence of PCEs in an adult population in South Carolina (SC), a representative southern US state and (2) examined whether PCE exposure differed across racial and ethnic groups.Data were drawn from the 2019 SC Behavioral Risk Factor Surveillance System survey (BRFSS). Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions and unadjusted associations for each variable. Multivariable regression models were used to examine the association between race/ethnicity and PCEs.Our analyses revealed that people of color were less likely to be supported by friends, have an adult who took interest in them, and have a family who stood by them during difficult times. Education and poverty were significantly associated with feeling safe and protected, supported by friends, and having a family that stood by them during difficult times. Conclusions:Findings from this study may be used to promote health equity in early childhood through programs, policies, and practices that seek to address historic, systemic, and intergenerational trauma.