Behavioral Risk Factor Surveillance System Research Articles

Lung Cancer Screening in the US, 2022

The US Preventive Services Task Force (USPSTF) recommends annual lung cancer screening (LCS) with low-dose computed tomography in high-risk individuals (age 50-80 years, ≥20 pack-years currently smoking or formerly smoked, and quit <15 years ago) for early detection of LC. However, representative state-level LCS data are unavailable nationwide. To estimate the contemporary prevalence of up-to-date (UTD) LCS in the US nationwide and across the 50 states and the District of Columbia. This cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) population-based, nationwide, state-representative survey for respondents aged 50 to 79 years who were eligible for LCS according to the 2021 USPSTF eligibility criteria. Data analysis was performed from October 1, 2023, to March 20, 2024. The main outcome was self-reported UTD-LCS (defined as past-year) prevalence according to the 2021 USPSTF eligibility criteria in respondents aged 50 to 79 years. Adjusted prevalence ratios (APRs) and 95% CIs compared differences. Among 25 958 sample respondents eligible for LCS (median [IQR] age, 62 [11] years), 61.5% reported currently smoking, 54.4% were male, 64.4% were aged 60 years or older, and 53.0% had a high school education or less. The UTD-LCS prevalence was 18.1% overall, but varied across states (range, 9.7%-31.0%), with relatively lower levels in southern states characterized by high LC mortality burden. The UTD-LCS prevalence increased with age (50-54 years: 6.7%; 70-79 years: 27.1%) and number of comorbidities (≥3: 24.6%; none: 8.7%). A total of 3.7% of those without insurance and 5.1% of those without a usual source of care were UTD with LCS, but state-level Medicaid expansions (APR, 2.68; 95% CI, 1.30-5.53) and higher screening capacity levels (high vs low: APR, 1.93; 95% CI, 1.36-2.75) were associated with higher UTD-LCS prevalence. This study of data from the 2022 BRFSS found that the overall prevalence of UTD-LCS was low. Disparities were largest according to health care access and geographically across US states, with low prevalence in southern states with high LC burden. The findings suggest that state-based initiatives to expand access to health care and screening facilities may be associated with improved LCS rates and reduced disparities.

Gardening and subjective cognitive decline: a cross-sectional study and mediation analyses of 136,748 adults aged 45+ years

BackgroundGiven the benefits of gardening for physical and psychological health, we explored whether gardening was associated with lower risks of subjective cognitive decline (SCD), a precursor of dementia, and SCD-related functional limitations.MethodsIncluded in this cross-sectional study were 136,748 participants aged 45 + years old from the Behavioral Risk Factor Surveillance System 2019 survey, who were then categorized into three groups according to self-reported exercise status: non-exercisers, gardeners, and other exercisers. SCD was assessed via a questionnaire, and SCD-related functional limitations were referred to as having difficulties in engaging in household or social activities due to SCD. The odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the associations of gardening with SCD and SCD-related functional limitations, adjusted for age, sex, socioeconomic status, lifestyle factors, and health status. Mediation analyses were conducted to examine whether the observed association between gardening and SCD was mediated by energy expenditure (MET-hours/week), depression status, and consumption of fruits and vegetables.ResultsOverall, 11.1% and 5.4% of participants self-reported experiencing SCD and SCD-related functional limitations, respectively. The adjusted OR for gardeners vs. non-exercisers, was 0.72 (95% CI 0.62–0.83) for SCD and 0.57 (95% CI 0.44–0.73) for SCD-related functional limitations. The observed association between gardening and SCD was explained by higher energy expenditure (39.0%), lower likelihood of having depression (21.5%), and higher consumption of fruits and vegetables (3.4%) (P<0.05 for all). Similar patterns were observed for SCD-related functional limitations.ConclusionIn this nationally representative sample, gardening was associated with better cognitive status, which may be mainly attributed to better depression status and energy expenditure.

Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer

Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December 31, 2018, whichever end point came first. Data were analyzed between September 2023 and January 2024. County-level PSA screening prevalence was estimated using the Behavior Risk Factor Surveillance System survey data from 2004, 2006, 2008, 2010, and 2012 and weighted by population characteristics. Multivariable logistic, Cox proportional hazards regression, and competing risks models were fit to estimate adjusted odds ratios (AOR) and adjusted hazard ratios (AHR) for associations of county-level PSA screening prevalence at diagnosis with advanced stage (regional or distant), as well as all-cause and prostate cancer-specific survival. Of 814 987 men with prostate cancer, the mean (SD) age was 67.3 (9.8) years, 7.8% were Hispanic, 12.2% were non-Hispanic Black, and 80.0% were non-Hispanic White; 17.0% had advanced disease. There were 247 570 deaths over 5 716 703 person-years of follow-up. Men in the highest compared with lowest quintile of county-level PSA screening prevalence at diagnosis had lower odds of advanced vs localized stage (AOR, 0.86; 95% CI, 0.85-0.88), lower all-cause mortality (AHR, 0.86; 95% CI, 0.85-0.87), and lower prostate cancer-specific mortality (AHR, 0.83; 95% CI, 0.81-0.85). Inverse associations between PSA screening prevalence and advanced cancer were strongest among men of Hispanic ethnicity vs other ethnicities (AOR, 0.82; 95% CI, 0.78-0.87), older vs younger men (aged ≥70 years: AOR, 0.77; 95% CI, 0.75-0.79), and those in the Northeast vs other US Census regions (AOR, 0.81; 95% CI, 0.79-0.84). Inverse associations with all-cause mortality were strongest among men of Hispanic ethnicity vs other ethnicities (AHR, 0.82; 95% CI, 0.78-0.85), younger vs older men (AHR, 0.81; 95% CI, 0.77-0.85), those with advanced vs localized disease (AHR, 0.80; 95% CI, 0.78-0.82), and those in the West vs other US Census regions (AHR, 0.89; 95% CI, 0.87-0.90). This population-based cohort study of men with prostate cancer suggests that higher county-level prevalence of PSA screening was associated with lower odds of advanced disease, all-cause mortality, and prostate cancer-specific mortality. Associations varied by age, race and ethnicity, and US Census region.

Evaluating the impact of depression on self-reported quality of life measurements for patients with a history of cancer: A 2022 behavioral risk factor surveillance system questionnaire study.

e23131 Background: Patients with cancer are known to have higher rates of depression than the general population. Depression is known to impact cancer-specific outcomes. We aimed to understand if a history of depression for patients with a history of cancer impacts self-reported quality of life measurements. Methods: We identified patients with a history of cancer and patients with a history of depression using the 2022 phone based Behavioral Risk Factor Surveillance System Questionnaire. The demographics and reported outcomes for several quality-of-life questions, including perceived emotional support, social isolation, cancer-related pain, memory, and ability to complete daily activities independently, were compared using a Chi-Square analysis. Results: Of the 441,339 patients over the age of 18 who completed the 2022 survey, 72,765 (16%) reported a history of cancer, and 90,489 (21%) reported a history of depression. Of those patients who reported a history of cancer 72,443 (99.6%) answered if they had ever been diagnosed with depression, and of these 14,987 (21%) reported a history of depression. Compared to patients with cancer alone, patients with a history of cancer and depression were younger (10% vs. 4% under the age of 45, p &lt; 0.001), less often married (45% vs.59%, p &lt; 0.001), more likely to be in the lowest income bracket (8% vs. 3%, p &lt; 0.001), more likely to be obese (36% vs. 26%, p &lt; 0.001), and more often active smokers (16% vs. 7%, p &lt; 0.001). Several quality-of-life questions were asked of the participants, although not everyone answered each question. Overall, among patients with cancer, patients with a history of depression were more likely to report &gt; 14 poor mental health or physical health days (35% vs. 6% and 34% vs. 14%, respectively, p &lt; 0.001) and more likely to report their general health as fair or poor (41% vs. 21%, p &lt; 0.001). Cancer patients with depression were less likely to report always having the social or emotional support that they need (33% vs. 55%, p &lt; 0.001) and more likely to report always or usually feeling socially isolated (17% vs. 5%, p &lt; 0.001). Cancer patients with depression were more likely to report pain associated with their cancer (16% vs. 7%, p &lt; 0.001) and five times as likely to report issues with making decisions and memory (31% vs. 6%, p &lt; 0.001). Finally, patients with depression were also more likely to report an inability to run errands alone (21% vs. 7%) and report difficulty getting dressed or bathing (12% vs. 4%, p &lt; 0.001). Conclusions: Among people with a history of cancer, those with a history of depression are more likely to report worse physical and mental health, report worse social and emotional support and report less independence in activities of daily living. Further work is needed to understand the complex interactions between depression and quality-of-life measures for cancer patients.

The Association of County-level Prostate-specific Antigen Screening with Metastatic Prostate Cancer and Prostate Cancer Mortality

Background and objectiveThere exists ongoing debate about the benefits and harms of prostate-specific antigen (PSA) screening for prostate cancer. This study sought to evaluate the association of county-level PSA screening rates with county-level incidence of metastatic prostate cancer and prostate cancer mortality in the USA. MethodsThis ecological study used data from the 2004–2012 Behavioral Risk Factor Surveillance System (BRFSS) to build a multilevel mixed-effect model with poststratification using US Census data to estimate county-level PSA screening rates for all 3143 US counties adjusted for age, race, ethnicity, and county-level poverty rates. The exposure of interest was average county-level PSA screening rate from 2004 to 2012, defined as the proportion of men aged 40–79 yr who underwent PSA screening within the prior 2 yr. The primary outcomes were county-level age-adjusted incidence of regional/distant prostate cancer during 2015–2019 and age-adjusted prostate cancer mortality during 2016–2020. Key findings and limitationsA total of 416221 male BRFSS respondents aged 40–79 yr met the inclusion criteria and were used in the multilevel mixed-effect model. The model was poststratified using 63.4 million men aged 40–79 yr from all 3143 counties in the 2010 Decennial Census. County-level estimated PSA screening rates exhibited geographic variability and were pooled at the state level for internal validation with direct BRFSS state-level estimates, showing a strong correlation with Pearson correlation coefficients 0.77–0.90. A 10% higher county-level probability of PSA screening in 2004–2012 was associated with a 14% lower county-level incidence of regional/distant prostate cancer in 2015–2019 (rate ratio 0.86, 95% confidence interval [CI] 0.85–0.87, p < 0.001) and 10% lower county-level prostate cancer mortality in 2016–2020 (rate ratio 0.90, 95% CI 0.89–0.91, p < 0.001). Conclusions and clinical implicationsIn this population-based ecological study of all US counties, higher PSA screening rates were associated with a lower incidence of regional/distant prostate cancer and lower prostate cancer mortality at extended follow-up. Patient summaryUS counties with higher rates of prostate-specific antigen (PSA) screening had significantly lower rates of metastatic prostate cancer and prostate cancer mortality in subsequent years. These data may inform shared decision-making regarding PSA screening for prostate cancer.

Exploring the Factors Influencing Coronary Heart Disease Prevalence in the US Population: A Retrospective Observational Study.

Coronary heart disease (CHD) remains a significant global health concernand is characterized by inadequate blood supply to the myocardium due to the accumulation of plaque in the coronary arteries. Despite therapeutic advancements, prevalence disparities persist across various segments of the U.S. population, posing a significant challenge to healthcare systems. This study aims to find the prevalence disparities of CHD using Behavioral Risk Factor Surveillance System (BRFSS) data. A retrospective observational study was done using the 2022 BRFSS dataset on January 17, 2024. The study examined the presence of CHD as the dependent variable and investigated various independent variables. Descriptive and logistic regression analyses were conducted using the BRFSS Web Enabled Analysis Tool (Centers for Disease Control and Prevention, Atlanta, GA). Data management and storage utilized Microsoft Excel, and graphical analysis employed GraphPad Prism, version 9.4.1 (GraphPad Software, Inc., San Diego, CA). In demographics, respondents aged 65+ had higher CHD odds, while females exhibited lower risk than males. Hispanics had the lowest odds of CHD among all races. Socioeconomically, inability to work and retirees had higher CHD odds, as did income below $20,000 but ≥$15,000. Poor physical health increased CHD odds, as did having multiple healthcare providers. Medicare users had the highest CHD odds among insurance options. Significant disparities in CHD prevalence were seen across demographic, socioeconomic, health status, and healthcare access dimensions in the United States, emphasizing the urgent need for targeted interventions to address these disparities and improve overall public health outcomes.

Supplemental Nutrition Assistance Program (SNAP) policy changes and mammography use in the United States.

11033 Background: The Supplemental Nutrition Assistance Program (SNAP) alleviates food insecurity among low-income households, which has been linked to healthcare access. Several states increased SNAP eligibility by implementing policies that eliminate asset tests and/or broaden income eligibility criteria. This study investigates the associations of SNAP policy changes on mammography use within the past year among low-income females eligible for breast cancer screening. Methods: Income-eligible females ages 40-79 years were identified from the 2006-2019 Behavioral Risk Factors Surveillance System. 28 and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Difference-in-differences analyses compared changes in the percentage of mammography within one year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that did and did not adopt policies expanding SNAP eligibility. The samples were limited to females with household income &lt; 130% and &lt;200% federal poverty level for analyses of asset test elimination and income eligibility increase policies, respectively, to correspond to typical eligibility criteria. Results: A total of 171,684 and 294,647 income-eligible females were included for the asset test elimination and income eligibility increase policy analyses, respectively. Overall, 58.4% reported mammography within 1 year. Adoption of asset test elimination policies was associated with a 2.11 percentage point (95% CI = 0.07 to 4.15, P=0.043) increase in mammography, particularly for non-metropolitan residents (4.14 percentage points, 95% CI = 1.07 to 7.21, P=0.008), those with household income &lt;$25,000 (2.82 percentage points, 95% CI = 0.68 to 4.97, P=0.01), and those residing in states in the South (3.08 percentage points, 95% CI = 0.17 to 5.99, P=0.038) or in states that did not expand Medicaid under the Affordable Care Act (3.35 percentage points, 95% CI = 0.36 to 6.34, P=0.028). There was no significant association between state-level policies broadening SNAP income eligibility and mammography use (-1.07 percentage points, 95% CI = -2.64 to 0.49, P=0.18). Conclusions: This nationwide study suggests that policies eliminating the asset test for SNAP eligibility were associated with increased mammography use within one year, with the most pronounced positive impact observed in Southern states, non-expansion states, non-metropolitan areas, and households with the lowest incomes. Findings highlight the role that states policies have to both meet essential needs and promote health among vulnerable populations.

E-cigarette use and United States Preventive Services Task Force (USPSTF) lung cancer screening (LCS) eligibility.

10531 Background: Electronic cigarettes (E-cigarettes) have become frequently used as a smoking cessation tool. Emerging research has shown that e-cigarettes have similar carcinogenic effects as combustible cigarettes. While current lung cancer screening (LCS) guidelines primarily rely on individuals’ smoking history, it's becoming increasingly important to understand the prevalence of e-cigarette use among individuals, especially in the context of their LCS eligibility. Methods: Individuals aged 40-80 years were extracted from the 2022 Behavioral Risk Factor Surveillance System. Eligibility was defined using the 2021 USPSTF LCS criteria, i.e., aged 50-80 years who ever smoked, with at least a 20-pack-year smoking history, currently smoke or quit within the past 15 years. We compared the prevalence of current and ever e-cigarette use among LCS-eligible and non-eligible populations, overall and by smoking (combustible cigarettes) status using chi-square tests. All analyses were weighted. The significance level was set at a 2-sided p-value of &lt;0.05. Results: Among the 208,317 individuals included, 9.9% were eligible for LCS. Overall, 3.8% and 22.1% reported current and ever cigarette use, respectively. Fewer LCS-ineligible individuals reported currently using e-cigarettes than their LCS-eligible counterparts (Table). Among former combustible cigarette users, LCS-ineligible individuals were less likely to be current e-cigarette user than LCS-eligible individuals. However, among current combustible cigarette users, LCS-ineligible individuals were more likely to be current e-cigarettes users than LCS-eligible individuals. When examining the prevalence of ever e-cigarette use, similar findings were observed. Conclusions: Our study reveals a significant prevalence of e-cigarette usage among older adults (aged 40-80), with 1 in 5 individuals reporting ever having used e-cigarettes. Moreover, current cigarette users who were ineligible for LCS were more likely to use e-cigarette than their LCS-eligible counterparts. Future epidemiological studies are warranted to assess the risk of e-cigarette use (including intensity, duration and interactions with combustible cigarettes) and lung cancer risks. E-cigarette use may need to be considered in formulating future LCS guidelines. [Table: see text]

The use of wearable devices on physical activity levels among individuals living with diabetes: 2017 BRFSS

AimThis study aims to examine the association between wearing wearable devices and physical activity levels among people living with diabetes. Methods1298 wearable device users and nonusers living with diabetes from eight states of the 2017 Behavioral Risk Factors Surveillance System were included in the analysis. Unadjusted and adjusted linear regression was performed to determine the association between self-reported physical activity per week (min) and wearable device usage (users and nonusers) among people living with diabetes using survey analysis. Results84.97 % (95 % CI [80.39, 88.89]) of participants were nonusers of wearable devices, while 15.03 % (95 % CI [11.11, 19.61]) were users. Across the sample, the average weekly physical activity was 427.39 mins (95 % Cl [356.43, 498.35]). Nonusers had a higher physical activity per week with 433.83 mins (95 % CI [353.59, 514.07]), while users only had 392.59 mins (95 % CI [253.48, 531.69]) of physical activity per week. However, the differences between the two groups were non-statistically significant (p=.61). In both adjusted and unadjusted linear regressions between physical activity per week and wearable device usage, statistically significant associations were not found (unadjusted: β=-41.24, p=.62; adjusted: β=-56.41, p=.59). ConclusionFurther research is needed to determine the effectiveness of wearable devices in promoting physical activity among people with diabetes. Additionally, there is a need to determine how people with diabetes use wearable devices that could promote physical activity levels.

Associations of State Supplemental Nutrition Assistance Program Eligibility Policies With Mammography

PurposeThe Supplemental Nutrition Assistance Program (SNAP) addresses food insecurity for low-income households, which is associated with access to care. Many US states expanded SNAP access through policies eliminating the asset test (ie, restrictions based on SNAP applicant assets) and/or broadening income eligibility. The objective of this study was to determine whether state SNAP policies were associated with the use of mammography among women eligible for breast cancer screening. MethodsData for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility. ResultsIn total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; P = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; P = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; P = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; P = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; P = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility. ConclusionsState policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states.

Uterine cancer incidence trends and 5-year relative survival by race/ethnicity and histology among women under 50 years

BackgroundUterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described. ObjectivesTo investigate age-adjusted, hysterectomy corrected incidence rates and trends, and five-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology. Study DesignWe included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20-49 years from the Surveillance, Epidemiology, and End Results Program (SEER 22). Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using SEER*Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program. ResultsWe included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/year for the entire period. Rising trends were more pronounced among women <40 years (3.0%/year and 3.3%/year in 20-29 and 30-39 years, respectively) than in those 40-49 years (1.3%/year), and among underrepresented racial/ethnic groups (Hispanic 2.8%/year, Non-Hispanic, [NH]-Black 2.7%, NH-Asian/Pacific Islander [PI] 2.1%) than in NH-White (0.9%/ year). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and non-endometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/year from 2000-2019. Recent endometrioid and non-endometrioid rates were highest in NH-Native American/Alaska Native [NA/AN] (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), NH-Asian/PI (10.2 and 0.9), NH-White (9.4 and 0.8), and lowest in NH-Black women (6.4 and 0.8). Sarcoma rates were highest in NH-Black women (1.8 per 100,000). The five-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, p≥0.05) and non-endometrioid subtypes (from 73.2% to 73.2%, p≥0.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, p<0.05). ConclusionsUterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among NH-Black, Hispanic, and NH-Asian/PI. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.

Racial/Ethnic Disparities in HRQoL and Associated Risk Factors in Colorectal Cancer Survivors: With a Focus on Social Determinants of Health (SDOH)

PurposeThis study aimed to understand how health-related quality of life (HRQoL) differs by race/ethnicity in colorectal (CRC) survivors. We aimed to 1) examine racial/ethnic disparities in HRQoL, and 2) explore the roles of social determinants of health (SDOH) risk factors for HRQoL differ by racial/ethnic groups.MethodsIn 2,492 adult CRC survivors using Behavioral Risk Factor Surveillance System (BRFSS) survey data (from 2014 to 2021, excluding 2015 due to the absence of CRC data), we used the Centers for Disease Control and Prevention (CDC) HRQoL measure, categorized into “better” and “poor.” Multivariate logistic regressions with prevalence risk (PR) were employed for our primary analyses.ResultsCompared with non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) (PR = 0.61, p = .045) and Hispanics (PR = 0.32, p < .001) reported worse HRQoL in adjusted models. In adjusted models, unemployed/retired and low-income levels were common risk factors for worse HRQoL across all comparison groups (NHW, NHB, non-Hispanic other races, and Hispanics). Other SDOH associated with worse HRQoL include divorced/widowed/never married marital status (non-Hispanic other races and Hispanics), living in rural areas (NHW and NHB), and low education levels (NHB and Hispanics). Marital status, education, and employment status significantly interacted with race/ethnicity, with the strongest interaction between Hispanics and education (PR = 2.45, p = .045) in adjusted models.ConclusionThese findings highlight the need for culturally tailored interventions targeting modifiable factors (e.g., social and financial supports, health literacy), specifically for socially vulnerable CRC survivors, to address the disparities in HRQoL among different racial/ethnic groups.

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.

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.

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.

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. 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. 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. 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.