Behavioral Risk Factor Surveillance System Research Articles

Association Between Lifestyle Behaviors and Obesity Among Stroke Survivors.

The aim was to investigate factors influencing obesity among stroke survivors based on demographics and lifestyle behaviors. Stroke survivors are more likely to experience stroke recurrence within a few years. As obesity is a traditional risk factor for stroke, obesity should be managed in stroke survivors to prevent stroke recurrence. A cross-sectional secondary data analysis analyzed data from the 2017 United States Behavioral Risk Factor Surveillance System (BRFSS) survey. Demographics, frequency of vegetable and fruit intake, smoking, alcohol use, physical activity, and sleep were examined. Among 1032 stroke survivors, 57.8% were obese. Advanced age, female sex, veteran status, at least once-daily fruit intake, current smoking, and lack of physical activity were associated with obesity. Stroke survivors should be encouraged to pursue healthy behaviors to manage obesity. Appropriate transitional care, including diet education and tailored exercise, can be an effective strategy.

Associations between Adverse Childhood Experiences and Gambling Severity in Youth Online Gamblers: The Mediating Roles of Internalizing, Attention and Externalizing Problems.

This study examined the association between Adverse Childhood Experiences (ACEs) and Gambling Severity (gambling severity), considering the mediating roles of internalizing, externalizing, and attention among youth online gamblers. 762 youth (agemean±SD= 15.03 ± 2.40; agerange = 10-18 years; 75.3% boys) completed the Persian Gambling Disorder Screening Questionnaire (GDSQ-P), Pediatric Symptom Checklist - Youth Report (Y-PSC), and Behavioral Risk Factor Surveillance System Questionnaire (ACE's section, modified by authors). The analysis was done using the SMART PLS software. The reliability and discriminant validity of the provided model were assessed using Partial Least Squares-Structural Equation Modeling (PLS-SEM). According to the results of the PLS-SEM analysis, the present model demonstrated suitable levels of reliability and validity. Adverse Childhood Experiences (ACEs) significantly affected attention, internalizing, externalizing problems, and gambling severity. Additionally, the level of gambling was directly correlated with ACEs. Moreover, the indirect influence of the independent variable on the dependent variable via the mediators was found to be statistically significant (P < .001).These findings suggest that externalizing behaviors, attention problems, and internalizing symptoms mediate the effect of ACEs on gambling severity. Lastly, fitness indices indicated that our proposed model fit the data well (SRMR = 0.06, d_ULS = 1.15, Chi-square = 1291.461, and NFI = 0.71). Our study found that ACEs significantly influence gambling severity among youth online gamblers, with internalizing, externalizing, and attention problems mediating this relationship. Practical implications include integrating ACE screening and targeted interventions for associated mental health issues into youth gambling prevention programs to mitigate the risk of problematic gambling behavior.

Prevalence of Stroke - Behavioral Risk Factor Surveillance System, United States, 2011-2022.

Stroke was the fifth leading cause of death in the United States in 2021, and cost U.S. residents approximately $56.2 billion during 2019-2020. During 2006-2010, self-reported stroke prevalence among noninstitutionalized adults had a relative decrease of 3.7%. Data from the Behavioral Risk Factor Surveillance System were used to analyze age-standardized stroke prevalence during 2011-2022 among adults aged ≥18 years. From 2011-2013 to 2020-2022, overall self-reported stroke prevalence increased by 7.8% nationwide. Increases occurred among adults aged 18-64 years; females and males; non-Hispanic Black or African American (Black), non-Hispanic White (White), and Hispanic or Latino (Hispanic) persons; and adults with less than a college degree. Stroke prevalence was higher among adults aged ≥65 years than among younger adults; among non-Hispanic American Indian or Alaska Native, non-Hispanic Native Hawaiian or Pacific Islander, and Black adults than among White adults; and among adults with less than a high school education than among those with higher levels of education. Stroke prevalence decreased in the District of Columbia and increased in 10 states. Initiatives to promote knowledge of the signs and symptoms of stroke, and the identification of disparities in stroke prevalence, might help to focus clinical and programmatic interventions, such as the Million Hearts 2027 initiative or the Paul Coverdell National Acute Stroke Program, to improve prevention and treatment of stroke.

Association of Hypertension with Well-Being: Results from the Behavioral Risk Factor Surveillance System (BRFSS) Study.

It remains unclear how hypertension affects subjective well-being, especially in light of its potential gender-specific impacts. In this study, we aimed to study the association between hypertension and subjective well-being and the potential gender differences in this relationship as well as mediating factors. We use individual-level data from >1million Americans who participated in six waves of the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey. We employ descriptive and regression analyses to determine the association between hypertension and subjective well-being while controlling for the usual well-being covariates identified from the related literature. Hypertension was negative associated with subjective well-being (p<0.001) and our results for covariates were in line with the findings in the related literature. The association between hypertension and subjective well-being was only found in males (p<0.001) but not in females. The relationship is mediated by age and exercising but only for females. Hypertension is negatively associated with well-being among males. The diagnosis of hypertension should not only lead to medical treatments but also involve a careful psychological management.

Social Determinants of Health Among American Indians and Alaska Natives and Tribal Communities: Comparison with Other Major Racial and Ethnic Groups in the United States, 1990–2022

Background and Objective Limited research exists on health inequities between American Indians and Alaska Natives (AIANs), tribal communities, and other population groups in the United States. To address this gap in research, we conducted time-trend analyses of social determinants of health and disease outcomes for AIANs as a whole and specific tribal communities and compared them with those from the other major racial/ethnic groups. Methods We used data from the 1990–2022 National Vital Statistics System, 2015–2022 American Community Survey, and the 2018–2020 Behavioral Risk Factor Surveillance System to examine socioeconomic, health, disability, disease, and mortality patterns for AIANs. Results In 2021, life expectancy at birth was 70.6 years for AIANs, lower than that for Asian/Pacific Islanders (APIs) (84.1), Hispanics (78.8), and non-Hispanic Whites (76.3). All racial/ethnic groups experienced a decline in life expectancy between the pre-pandemic year of 2019 and the peak pandemic year of 2021. However, the impact of COVID-19 was the greatest for AIANs and Blacks whose life expectancy decreased by 6.3 and 5.8 years, respectively. The infant mortality rate for AIANs was 8.5 per 1,000 live births, 78% higher than the rate for non-Hispanic Whites. One in five AIANs assessed their physical and mental health as poor, at twice the rate of non-Hispanic Whites or the general population. COVID-19 was the leading cause of death among AIANs in 2021. Risks of mortality from alcohol-related problems, drug overdose, unintentional injuries, and homicide were higher among AIANs than the general population. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates, with differences in these indicators varying markedly across the AIAN tribes. Conclusion and Global Health Implications AIANs remain a disadvantaged racial/ethnic group in the US in many health and socioeconomic indicators, with poverty rates in many Native American tribal groups and reservations exceeding 40%.

Prevalence of Obesity Among Electronic Cigarette and Tobacco Users in the United States: Results from the 2018 Wave of the Behavioral Risk Factor Surveillance System

Objective: Tobacco use and obesity are leading causes of preventable death in the U.S. E-cigarette use is on the rise; however, obesity prevalence among e-cigarette users is unknown. The present study characterized obesity prevalence among e-cigarette and tobacco users in a national sample of U.S. adults. Method: Data were obtained from the 2018 Behavioral Risk Factor Surveillance System. Approximately 249,726 participants provided data on e-cigarette and tobacco use, height, weight, and demographics, and were categorized as follows: Ever vaped, ever smoked; Ever vaped, never smoked; Never vaped, ever smoked; Never vaped, never smoked. Results: Obesity prevalence (BMI ≥30 kg/m2) differed significantly across groups: 33.0% (ever vaped, ever smoked); 27.7% (ever vaped, never smoked); 33.1% (never vaped, ever smoked); 32.1% (never vaped, never smoked), p < .001. Groups also differed demographically. Logistic regressions adjusted for demographics revealed subjects in the never vaped, ever smoked group were significantly more likely to have obesity relative to those in the never vaped, never smoked group (p < 0.001) with vaping status having no main effect. Secondary analyses using never smokers as the reference found current smokers were less likely to have obesity and former smokers were more likely to have obesity, p < .001. Discussion: The present study is the first to characterize U.S. obesity prevalence among e-cigarette and tobacco users. Obesity prevalence was lower in the ever vaped, never smoked group; however, this finding appears to be attributable to demographic variables. As e-cigarette use becomes more common, future research should examine the development and maintenance of obesity among users.

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 &lt; 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 &lt; 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.

Longitudinal comparisons in health, participation, life satisfaction, and depressive symptoms from pre-to post Covid 19 pandemic among people with spinal cord injuries.

To identify changes in health, healthcare utilization, participation, and life satisfaction and depressive symptoms from pre-pandemic to post-pandemic among ambulatory and nonambulatory participants with spinal cord injury (SCI). Longitudinal study with the first measurement taken within three months prior to pandemic restrictions and two follow-ups at approximately one year intervals. Medical University in the Southeastern USA. 219 adult participants with SCI, including ambulatory (n= 155) and nonambulatory (n= 64). Self-report assessment of health outcomes from the Behavioral Risk Factor Surveillance System; health service utilization including physician visits, emergency department visits and hospitalizations; items from the Craig Handicap Assessment Reporting Technique; three life satisfaction scales from the Life Situation Questionnaire, and the brief version of the Patient Health Questionnaire. Not applicable. After using a Z score correction for nonnormality, none of the time effects or interaction effects of time by ambulatory status were significant. Six comparisons between ambulatory and nonambulatory were statistically significant. Ambulatory participants reported significantly 3 more days in poor physical health (p = .02) and 2 more days feeling worried, tense, or anxious in the last 30 days (p = .03). They visited emergency department on 0.3 fewer occasions (p = .02), while reporting leaving the house 1 more day every week (p = .02), 2 hours more sitting tolerance (p<.01), and 1 higher score of vocational satisfaction (p = .03). The absence of statistically significant changes from pre- to post-pandemic and the absence of time by ambulatory status interactions suggest stability of outcomes, even in the presence of pandemic challenges.

Chronic Health Conditions and Longitudinal Employment in Survivors of Childhood Cancer

Employment is an important factor in quality of life and provides social and economic support. Longitudinal data on employment and associations with chronic health conditions for adult survivors of childhood cancer are lacking. To evaluate longitudinal trends in employment among survivors of childhood cancer. Retrospective cohort study of 5-year cancer survivors diagnosed at age 20 years or younger between 1970 and 1986 enrolled in the multi-institutional Childhood Cancer Survivor Study (CCSS). Sex-stratified employment status at baseline (2002 to 2004) and follow-up (2014 to 2016) was compared with general population rates from the Behavioral Risk Factor Surveillance System cohort. Data were analyzed from July 2021 to June 2022. Cancer therapy and preexisting and newly developed chronic health conditions. Standardized prevalence ratios of employment (full-time or part-time, health-related unemployment, unemployed, not in labor force) among adult (aged ≥25 years) survivors between baseline and follow-up compared with the general population. Longitudinal assessment of negative employment transitions (full-time to part-time or unemployed at follow-up). Female participants (3076 participants at baseline; 2852 at follow-up) were a median (range) age of 33 (25-53) years at baseline and 42 (27-65) years at follow-up; male participants (3196 participants at baseline; 2557 at follow-up) were 33 (25-54) and 43 (28-64) years, respectively. The prevalence of full-time or part-time employment at baseline and follow-up was 2215 of 3076 (71.3%) and 1933 of 2852 (64.8%) for female participants and 2753 of 3196 (85.3%) and 2079 of 2557 (77.3%) for male participants, respectively, with declining standardized prevalence ratios over time (female participant baseline, 1.01; 95% CI, 0.98-1.03; follow-up, 0.94; 95% CI, 0.90-0.98; P < .001; male participant baseline, 0.96; 95% CI, 0.94-0.97; follow-up, 0.92; 95% CI, 0.89-0.95; P = .02). While the prevalence of health-related unemployment increased (female participants, 11.6% to 17.2%; male participants, 8.1% to 17.1%), the standardized prevalence ratio remained higher than the general population and declined over time (female participant baseline, 3.78; 95% CI, 3.37-4.23; follow-up, 2.23; 95% CI, 1.97-2.51; P < .001; male participant baseline, 3.12; 95% CI, 2.71-3.60; follow-up, 2.61; 95% CI, 2.24-3.03; P = .002). Among survivors employed full-time at baseline (1488 female participants; 1933 male participants), 285 female participants (19.2%) and 248 male participants (12.8%) experienced a negative employment transition (median [range] follow-up, 11.5 [9.4-13.8] years). Higher numbers and grades of chronic health conditions were significantly associated with these transitions. In this retrospective analysis of adult survivors of childhood cancer, significant declines in employment and increases in health-related unemployment among cancer survivors compared with the general population were identified. A substantial portion of survivors in the midcareer age range fell out of the workforce. Awareness among clinicians, caregivers, and employers may facilitate clinical counseling and occupational provisions for supportive work accommodations.

Risk of Chronic Obstructive Pulmonary Disease and Receipt of a Breathing Test in 26 States and the District of Columbia, 2017–2018

Risk of Chronic Obstructive Pulmonary Disease and Receipt of a Breathing Test in 26 States and the District of Columbia, 2017–2018

Comparison of the characteristics of the population eligible for lung cancer screening under 2013 and population newly eligible under 2021 US Preventive Services Task Force recommendations.

In 2021, the United States Preventive Services Task Force (USPSTF) revised their 2013 recommendations for lung cancer screening eligibility by lowering the pack-year history from 30+ to 20+ pack-years and the recommended age from 55 to 50years. Simulation studies suggest that Black persons and females will benefit most from these changes, but it is unclear how the revised USPSTF recommendations will impact geographic, health-related, and other sociodemographic characteristics of those eligible. This cross-sectional study employed data from the 2017-2020 Behavioral Risk Factor Surveillance System surveys from 23 states to compare age, gender, race, marital, sexual orientation, education, employment, comorbidity, vaccination, region, and rurality characteristics of the eligible population according to the original 2013 USPSTF recommendations with the revised 2021 USPSTF recommendations using chi-squared tests. This study compared those originally eligible to those newly eligible using the BRFSS raking-dervived weighting variable. There were 30,190 study participants. The results of this study found that eligibility increased by 62.4% due to the revised recommendations. We found that the recommendation changes increased the proportion of eligible females (50.1% vs 44.1%), Black persons (9.2% vs 6.6%), Hispanic persons (4.4% vs 2.7%), persons aged 55-64 (55.8% vs 52.6%), urban-dwellers(88.3% vs 85.9%), unmarried (3.4% vs 2.5%) and never married (10.4% vs 6.6%) persons, as well as non-retirees (76.5% vs 56.1%) Respondents without comorbidities and COPD also increased. It is estimated that the revision of the lung cancer screening recommendations decreased eligibility disparities in sex, race, ethnicity, marital status, respiratory comorbidities, and vaccination status. Research will be necessary to estimate whether uptake patterns subsequently follow the expanded eligibility patterns.

Increasing Restorative Sleep Among Adults With Depressive Symptoms: A Quality Improvement Project.

The Centers for Disease Control and Prevention estimates that 34.8% of adults in the United States experience non-restorative sleep. The restorative theory of sleep is based on sleep as a means for the restoration of cellular function that is needed for activities when awake. Non-restorative sleep leads to awakening feeling unrefreshed and not ready for the activities of the day three or more times weekly. Aims: The aim of this quality improvement project was to increase restorative sleep by increasing the average amount of sleep over units of 24 h, decreasing perceived insufficient sleep, and decreasing episodes of unintended daytime sleep among patients with depressive symptoms ages 18 to 80 years in an outpatient mental health clinic. Methods: Ten patients with depressive symptoms and reporting non-restorative sleep volunteered to participate in the project. Participants kept a sleep diary and followed principles of healthy sleep such as limiting time in bed and going to bed at the same time nightly. The change in and the average amount of sleep over 24 h and daytime sleepiness were evaluated using the Behavioral Risk Factor Surveillance System. Results: All participants achieved at least one more day of restorative sleep, with nine increasing restorative sleep by at least 30 min per day, and nine having no episodes of unintentionally falling asleep.

Non-response to ACE items is associated with demographic variables and health indicators in the 2021 Behavioral Risk Factor Surveillance System

BackgroundAdverse childhood experiences (ACE) encompass traumatic events occurring before age 18, with lasting impacts on health. While ACE disclosure is important for understanding these effects, some individuals decline to respond to ACE-related survey items due to sensitivity, privacy concerns, or psychological distress. This study explores the relationship between non-response to ACE items and health outcomes, shedding light on the implications for those who choose not to disclose. MethodsWe performed a secondary analysis of the 2021 Behavioral Risk Factor Surveillance System (BRFSS)—a national telephone survey querying health behaviors and conditions. Sociodemographic factors, ACE exposure, and non-response to ACE items were analyzed. ResultsIndividuals who decline to respond to ACE items exhibit similar patterns of health behaviors and conditions as those reporting ACE exposure. Non-response is linked to both healthier behaviors (lifetime HIV testing) and riskier behaviors (higher odds of smoking and e-cigarette use). Moreover, non-responders have higher odds of being underweight or obese, experiencing concentration difficulties, reporting poor self-rated health, and reporting multiple health diagnoses including depression, diabetes, high blood pressure, heart attack, and stroke. ConclusionsThe study underscores the need to address health disparities associated with ACE, regardless of disclosure status. Healthcare interventions should target respondents and non-respondents of ACE screeners, tailoring strategies to promote healthier coping mechanisms and mitigate maladaptive behaviors. These results emphasize the importance of trauma-informed care, early intervention, and targeted public health initiatives for individuals affected by ACE, irrespective of their disclosure choices.

Association between adverse childhood experiences and health related quality of life in adult cancer survivors in the United States.

The impact of adverse childhood experiences (ACEs) on health-related quality of life (HRQOL) is increasingly recognized, however, this has not been studied in cancer survivors in the United States. This study investigates if ACEs are associated with HRQOL in cancer survivors. We conducted a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System from states that administered ACEs and Cancer Survivorship modules. Eligibility criteria included being a cancer survivor and not currently receiving cancer treatment. Primary exposure was number of ACEs (categorized as 0, 1-2, 3, or ≥ 4). Primary outcomes were self-reported measures of HRQOL including worse overall health and ≥ 14 unhealthy days (mentally or physically) per month. Mantel-Haenszel stratified analyses were performed and prevalence ratios were adjusted for age. Of 5,780 participants, 62.0% were female and 67.8% were ≥ 65 years. Prevalence of worse overall health was 22.5% for individuals with no ACEs compared to 30.2% for 2-3 ACEs (aPR = 1.4, 95% CI 1.2, 1.5) and 38.5% for ≥ 4 ACEs (aPR = 1.7, 95% CI 1.5, 2.0). Prevalence of ≥ 14 unhealthy days was 18.1% with no ACEs compared to 21.0% for 1 ACE (aPR = 1.3, 95% CI 1, 1.3), 29.0% for 2-3 ACEs (aPR = 1.6, 95% CI 1.4, 1.8), and 44.8% for ≥ 4 ACEs (aPR = 2.2, 95% CI 2.0, 2.5). Our study provides novel evidence of the association of multiple ACEs with higher prevalence of poor HRQOL in cancer survivors. Screening for ACEs is warranted in all patients to guide targeted interventions to improve HRQOL and mitigate the impact of ACEs on HRQoL in cancer survivors.

Prevalence of Positive Childhood Experiences Among Adults - Behavioral Risk Factor Surveillance System, Four States, 2015-2021.

Positive childhood experiences (PCEs) promote optimal health and mitigate the effects of adverse childhood experiences, but PCE prevalence in the United States is not well-known. Using Behavioral Risk Factor Surveillance System data, this study describes the prevalence of individual and cumulative PCEs among adults residing in four states: Kansas (2020), Montana (2019), South Carolina (2020), and Wisconsin (2015). Cumulative PCE scores were calculated by summing affirmative responses to seven questions. Subscores were created for family-related (three questions) and community-related (four questions) PCEs. The prevalence of individual PCEs varied from 59.5% (enjoyed participating in community traditions) to 90.5% (adult in respondents' household made them feel safe), and differed significantly by race and ethnicity, age, and sexual orientation. Fewer non-Hispanic Black or African American (49.2%), non-Hispanic Alaska Native or American Indian (37.7%), and Hispanic or Latino respondents (38.9%) reported 6-7 PCEs than did non-Hispanic White respondents (55.2%). Gay or lesbian, and bisexual respondents were less likely than were straight respondents to report 6-7 PCEs (38.1% and 27.4% versus 54.7%, respectively). A PCE score of 6-7 was more frequent among persons with higher income and education. Improved understanding of the relationship of PCEs to adult health and well-being and variation among population subgroups might help reduce health inequities.

Equity in oncology care: addressing disparities in cancer treatment in Georgia.

This research delves into the disparities in access to oncology care among cancer patients in Georgia, with a specific focus on the distinct challenges faced by African American (AA) individuals compared to non-African American (Non-AA) counterparts. Leveraging data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey and supplementary online resources, the study meticulously examines socioeconomic factors, including income, education, and insurance coverage, which significantly influence the quality of cancer care received. The analysis reveals substantial income gaps between AA and Non-AA patients, underscoring the critical implications for healthcare access. Moreover, AA patients exhibit lower rates of full insurance coverage for cancer-related treatments, posing additional barriers to comprehensive care. By investigating the intersections of race, income, and education, the research aims to pinpoint the root causes of these disparities and proposes evidence-based solutions to address the identified challenges. The ultimate objective is to contribute valuable insights that inform targeted policy recommendations and community-based interventions, fostering a more equitable landscape for oncology care in Georgia. This study seeks to amplify awareness and advocate for tangible measures, striving toward healthcare equity for all cancer patients, irrespective of their racial or socioeconomic backgrounds.

Relationship Between High ACE Score, HIV Risk Behavior, and Previous HIV Testing in the South Carolina BRFSS [ID 2683384

INTRODUCTION: The incidence of human immunodeficiency virus (HIV) in the United States is stable among women. Due to stigma, 13% of persons with HIV are unaware of their diagnosis. Adverse childhood experiences (ACEs) describe negative events during childhood using a standardized questionnaire. Limited data exist on how ACEs affect HIV screening. Utilizing state-collected data from the Behavioral Risk Factor Surveillance System (BRFSS), we assessed the relationships between high ACE, gender, HIV risk behaviors, and previous HIV testing. METHODS: This is a retrospective observational cohort study of the BRFSS from 2014–2016 and 2019–2021. High ACE score was ≥ 4. Using bivariate analyses, we compared percentages of individuals with high versus low ACE scores. We used logistic regression to determine factors associated with HIV risk behaviors and previous HIV testing. RESULTS: Over 54,000 individuals were surveyed; 15% had high ACE scores. 4% reported HIV risk behaviors and 35% reported previous HIV testing. The mean ACE was 1.6 (SD 2.1). High ACE demonstrated increased risk of HIV risk behaviors (adjusted odds ratio [aOR] 2.652; 95% CI, 1.987–3.538) and previous HIV testing (aOR 2.340; 95% CI, 2.031–2.696). Female respondents were less likely to report HIV risk behavior (aOR 0.442; 95% CI, 0.336–0.581) and previous HIV testing (aOR 0.822; 95% CI, 0.736–0.919). CONCLUSION: Persons with high ACE scores were more likely to engage in HIV risk behaviors and have a history of HIV testing. Our findings suggest ACE scores may be useful for identifying persons at risk for HIV. The stable incidence of HIV and reduced perception of risk among women demonstrate the need for tailored HIV screening for women.

Association of adverse childhood experiences with poor health condition among middle-aged and elderly adults in the United States: A nationally retrospective cohort study

BackgroundThe specific effects of adverse childhood experiences (ACEs) in adulthood and senectitude were less known. We aim to examine the relationship between early ACEs and overall health condition as well as specific dimensions in the middle-aged and elderly population. MethodsIn the 2019-2021 Behavioral Risk Factor Surveillance System Study, robust Poisson regression models were used to estimate the relationship between ACE exposure and current health status among adults aged 45 ≥ years. ResultsOf the 195,472 participants, 53.8% were female and the mean age was 65.0 years. Compared to populations without ACE, ACE exposures were more significantly associated with depression (PR: 2.03, 95%CI: 1.94-2.21), frequent mental health (PR: 1.85, 95%CI: 1.74-1.97) and subject cognitive decline (PR: 1.99, 95%CI:1.85-2.14) than with physical health (PR: 1.37, 95%CI: 1.32-1.44), with dose-response patterns. The association with mental disorder was especially significant among the elderly population. ConclusionEarly ACEs are associated with adverse health outcomes that persist into later life, particularly mental disorders and cognitive decline. Poor mental health may indirectly influence associations with ACEs and cognitive decline as well as physical health. Our findings emphasize the importance of lifelong psychological screening and support for the ACE-exposed middle-aged and elderly population.

Deep Learning-Based Assessment of Built Environment From Satellite Images and Cardiometabolic Disease Prevalence.

Built environment plays an important role in development of cardiovascular disease. Large scale, pragmatic evaluation of built environment has been limited owing to scarce data and inconsistent data quality. To investigate the association between image-based built environment and the prevalence of cardiometabolic disease in urban cities. This cross-sectional study used features extracted from Google satellite images (GSI) to measure the built environment and link them with prevalence of cardiometabolic disease. Convolutional neural networks, light gradient-boosting machines, and activation maps were used to assess the association with health outcomes and identify feature associations with coronary heart disease (CHD), stroke, and chronic kidney disease (CKD). The study obtained aerial images from GSI covering census tracts in 7 cities (Cleveland, Ohio; Fremont, California; Kansas City, Missouri; Detroit, Michigan; Bellevue, Washington; Brownsville, Texas; and Denver, Colorado). The study used census tract-level data from the US Centers for Disease Control and Prevention's 500 Cities project. The data were originally collected from the Behavioral Risk Factor Surveillance System that surveyed people 18 years and older across the country. Analyses were conducted from February to December 2022. GSI images of built environment and cardiometabolic disease prevalence. Census tract-level estimated prevalence of CHD, stroke, and CKD based on image-based built environment features. The study obtained 31 786 aerial images from GSI covering 789 census tracts. Built environment features extracted from GSI using machine learning were associated with prevalence of CHD (R2 = 0.60), stroke (R2 = 0.65), and CKD (R2 = 0.64). The model performed better at distinguishing differences between cardiometabolic prevalence between cities than within cities (eg, highest within-city R2 = 0.39 vs between-city R2 = 0.64 for CKD). Addition of GSI features both outperformed and improved the model that only included age, sex, race, income, education, and composite indices for social determinants of health (R2 = 0.83 vs R2 = 0.76 for CHD; P <.001). Activation maps from the features revealed certain health-related built environment such as roads, highways, and railroads and recreational facilities such as amusement parks, arenas, and baseball parks. In this cross-sectional study, a significant portion of cardiometabolic disease prevalence was associated with GSI-based built environment using convolutional neural networks.

Predictors of stool deoxyribonucleic acid test use in the United States: Implications for outreach to under-resourced populations

ObjectiveAlthough colorectal cancer screening (CRCS) is a public health priority, uptake is suboptimal in under-resourced groups. Noninvasive modalities, including stool deoxyribonucleic acid (sDNA) testing, may mitigate economic, geographic, cultural, or impairment-related barriers to CRCS. We assessed use of sDNA testing and other CRCS modalities in U.S. residents, comparing subgroups defined by several social determinants of health (SDOH). MethodsA nationally representative sample of community-dwelling respondents aged 50–75 years self-reported use of CRCS modalities in the 2020 Behavioral Risk Factor Surveillance System Survey. Statistical analyses assessed up-to-date screening status and choice of modality in the recommended screening interval. ResultsOf 179,833 sampled respondents, 60.8% reported colonoscopy, 5.7% sDNA testing, 5.5% another modality. The rate of up-to-date screening was 72.0% overall and negatively associated with Hispanic ethnicity (63.6%), lower educational and annual income levels (e.g., <high school, 63.7%, <$20,000, 67.2%), and cost-related difficulty accessing physician care (57.4%; all p < 0.001) but not with Black non-Hispanic race/ethnicity (74.6%) or sensory, cognitive, or physical impairments (73.1%–73.9%). Choice of sDNA instead of colonoscopy was made by 8.5% overall and was more common in the same SDOH groups (Hispanic ethnicity, 17.7%; <high school, 17.4%; <$20,000, 16.8%; cost-related difficulty accessing care, 12.0%); Black non-Hispanic race/ethnicity (11.6%); and impairments (sensory, 12.0%; other cognitive or physical, 12.9%). ConclusionsUnder-resourced persons were more likely than better-resourced persons to access sDNA testing, possibly offsetting screening barriers in some groups. Findings suggest opportunities to increase CRCS with heightened communication about sDNA testing to those who may experience difficulty accessing other modalities.