Behavioral Risk Factor Surveillance Survey Research Articles

Identifying emerging drivers and interventions to reduce vaccine hesitancy among long-term care facility nursing staff.

The study aimed to identify key drivers of vaccine hesitancy among healthcare workers (HCWs) employed at Long-term care facilities (LTCF) within selected states. It also sought to determine which interventions, policies, and programs effectively reduced HCW vaccine hesitancy for COVID-19 and influenza. The study employed a mixed methods approach, combining secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) data, survey research, and focus groups. BRFSS data on influenza and COVID-19 rates informed the selection of states for qualitative sampling frames. HCWs from LTCFs (i.e., skilled nursing facilities and nursing homes) were recruited to complete a survey based on the sampling frame. Additionally, administration and nursing management from participating facilities were invited to participate in focus groups. Survey results (N = 199 from 23 facilities) showed vaccine hesitancy among HCWs in LTCFs is a complex issue influenced by several factors, such as lack of knowledge, misinformation, and doubts about vaccine safety, efficacy, risks, and benefits. Focus groups (N = 25 from 15 facilities) revealed a spectrum of vaccine hesitancy, ranging from acceptance to outright refusal. The survey and focus groups identified effective interventions to reduce HCW vaccine hesitancy, including educational campaigns, onsite vaccination, and vaccine recommendations from trusted nursing staff. This study provides important insights into addressing vaccine hesitancy among HCWs in LTCF. It highlights the moral and ethical responsibility for targeted interventions to improve vaccine uptake in the healthcare sector.

Virginia Memory Project: Using the Healthy Brain Initiative Roadmap to design a statewide dementia registry.

The Virginia Memory Project (VMP) is a statewide epidemiological registry for Alzheimer's disease and related disorders (ADRD) and other neurodegenerative conditions. It aims to support dementia research, policy, and care by leveraging the Centers for Disease Control (CDC) Healthy Brain Initiative (HBI) Roadmap. To capture comprehensive data, the VMP integrates self-enrollment and automatic enrollment using Virginia's All-Payer Claims Database (APCD). It also adapts Behavioral Risk Factors Surveillance Survey (BRFSS) modules for self-reported cognitive and caregiving data, offering connections to research, clinical services, and education. Virginia successfully codified the VMP in the 2024 general assembly session. The VMP demonstrates a novel approach to Alzheimer's Disease and Related Disorders (ADRD) surveillance by combining traditional registry functions with community engagement and workforce development. Future efforts will focus on increasing enrollment, especially among underrepresented groups, to enhance data-driven dementia policy and care in Virginia. Integrated the Healthy Brain Initiative (HBI) domains into the newest statewide epidemiological dementia registry in the Commonwealth of Virginia. Collected data and identified gaps in the current research related to dementia and Alzheimer's related diseases. Aimed to mitigate barriers to dementia registry enrollment by identifying significant underdiagnosis and underrepresentation of racial and ethnic minority groups. Developed solutions to alleviate the current data and enrollment disparities and to connect individuals to research, physicians, and community groups.

State-level LGBTQ+ policies and health: the role of political determinants in shaping health equity.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals in the United States experience higher rates of discrimination and stressors that negatively impact health compared with their straight, cisgender counterparts. Using 2022 Behavioral Risk Factor Surveillance Survey (BRFSS) data, estimating multilevel mixed-effects logistic regressions, we examined the relationship between state LGBTQ+ policies and health among LGBT people. Findings reveal a statistically significant inverse link between protective (high) state policy scores and poor self-rated health, poor mental health days, and poor physical health days. Specifically, with each 1-point increase in policy score, the odds of poor self-rated health are reduced by 0.03%, high mental health burden by 0.02%, and high physical health burden by 0.02%. Inequalities in self-rated health, high mental health burden, and high physical health burden are greater in policy environments with fewer state-level protections, with LGBT individuals reporting better health where there are more protections. These results indicate that discriminatory state policies are linked to poorer health for LGBT individuals and suggest that protective policies could improve health. Further research with comprehensive data is needed to deepen understanding.

Social Risk Factors, Health Insurance Coverage, and Inequities in Access to Care.

Social risk factors are associated with worse access to care. This study measured the prevalence of social risk factors among low-income adults, assessed the relationship between number of social risk factors and access to care, and examined heterogeneity by health insurance type. Using 2022 Behavioral Risk Factor Surveillance Survey data from 39 states, the association between number of SRFs (0, 1, 2-3, 4, or more) and three access to care measures (having a personal doctor, having a routine checkup, and inability to see doctor because of cost) were measured using multivariable linear probability models. The analysis was stratified by health insurance coverage type (private, Medicare, Medicaid, or uninsured) to assess whether effects were differential. Analyses were conducted in 2024. Among 90,208 low-income adults, 46.6% reported at least one SRF. Compared to people who reported no SRFs, those who reported four or more were more likely to report being unable to afford care (28.21 percentage points [PP], p<0.001) and less likely to have a personal doctor (-4.98 PP, p<0.001) or routine checkup in the last two years (-4.29 PP, p<0.001). The magnitude of disparity by number of SRFs in inability to afford care was larger among privately insured and uninsured people compared to those with Medicare or Medicaid coverage. Higher levels of SRFs were associated with worse access to care among low-income adults. Policies that minimize cost-related barriers to care, coupled with care delivery reforms and social policies that address SRFs, may improve access to care.

Risk Factors for Adults with Chronic Obstructive Pulmonary Disease in the United States, Utilizing State-Based Surveillance

Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous condition. Exposure to tobacco smoke and air pollutants are key risk factors for COPD development; however, other risk factors include race/ethnicity, sex of adults, a history of asthma, occupational exposures, and chronic respiratory infections. Data for the current study were from the 2022 Behavioral Risk Factor Surveillance Survey. Chi-squares and multinomial logistic regression analyses, adjusted with the survey’s sampling weight, were used to examine how critical health indicators impacted a COPD diagnosis. Participants (N = 311,175) were adults aged 45 years and older. Adjusted multinomial regression analyses showed adults who reported asthma, current and former smoking, poor physical health, depression, less physical activity, and fatigue were more likely to report COPD. Those with COPD were more likely to be male than female. Moreover, those with COPD reported higher rates of health insurance coverage, and yet had lower income and more financial difficulty affording a doctor for health services. In a follow up regression analysis, examining racial differences in COPD for participants, American Indian adults had a higher odds of reporting COPD than the “other” race groups. Because COPD remains a leading cause of death and disability in the U.S., and racial disparities persist in respiratory outcomes, continuing to identify risk factors for vulnerable groups could assist health program planners with development of successful health messaging.

Health-Related Quality of Life and Bereavement in the 2019 Georgia Behavioral Risk Factor Surveillance System.

Poor Self-Rated Health (SRHp) is part of a four-item scale for self-assessment. SRH from the 2019 Behavioral Risk Factor Surveillance Survey (BRFSS) is used to test hypotheses linking population-level well-being influenced by bereavement due to the death of a close friend or relative. By linking the prevalence rates of population-level well-being with exposure to bereavement, we extend our knowledge of this exposure beyond single-person studies. SRHp and bereavement were asked about in the 2019 field survey of 7354 adults aged 18 years and older. Multiple imputation was applied to handle missing values. Data modeling included adjusted logistic regression and mediation analyses. In the total sample, the prevalence rate of SRHp was 23.1% and the rate of bereavement was 45.5%. The SRHp subgroup had a significantly greater prevalence of bereavement (24.9% versus 21.6% compared to all other SRH categories combined). Elevated bereavement rates were also observed for the group with poor physical health (18.3% versus 14.9%) and poor mental health (17.5% versus 12.8%). Multiple losses (three or more deaths) increased the risk for SRHp by 42% in adjusted logistic models. Although these are cross-sectional data, the analyses provide evidence that bereavement is more common among people engaged in negative health behaviors. In mediation analyses, bereavement increases the prevalence of SRHp by 56.8% through an indirect effect on smoking. Bereavement also increased the rate of SRHp by 40.7% through an indirect effect on obesity. More research is needed to evaluate the association between bereavement and health behavior.

High Rates of Obesity and Chronic Diseases Among North Carolina United Methodist Clergy: An Updated Analysis.

Varied demands and stressors experienced by clergy can contribute adversely to their overall well-being. Data from United Methodist Church (UMC) clergy in North Carolina in 2008 revealed that clergy had significantly higher non-communicable disease (NCD) rates than their fellow North Carolinians. Using data from the Clergy Health Initiative and Behavioral Risk Factor Surveillance Survey, the present study provided an updated analysis of obesity and 6 other NCDs among North Carolina UMC clergy compared to the general North Carolina population. First, we described the prevalence of each health condition among North Carolina UMC clergy and the general North Carolina population across multiple waves from 2008 to 2021. Then, we compared the predicted probabilities of each health condition in 2021 using logistic regressions to adjust for age, sex, and race. Comparing the unadjusted prevalence of health conditions between 2008 and 2021, we found that North Carolina UMC clergy have higher rates of obesity, hypertension, hypercholesterolemia, diabetes, angina, arthritis, and asthma than North Carolinians overall. Adjusting for age, sex, and race, we found that significantly higher rates of obesity, severe obesity, hypercholesterolemia, and asthma persisted among UMC clergy in 2021 compared to all North Carolinians, with the higher rates of severe obesity being particularly concerning. While the current study is limited to an update of health prevalence among UMC clergy, pastors across denominations are influential leaders in their communities, shaping the physical and social health environments of their congregations. Further research is needed to investigate risk factors, such as relocation and adverse childhood experiences, which may influence the higher prevalence of NCDs within and potentially beyond the UMC.

Cancer disparities by age: a focus on sexual and gender minorities.

The purpose of this study is to examine the age at which sexual and gender minorities are diagnosed with cancer relative to heterosexual cisgender individuals. We use population-based representative Behavioral Risk Factor Surveillance Survey data with self-reported sexual orientation, gender identity, cancer diagnoses, and the age at diagnosis. We determined the mean age at diagnosis and used logistic regression modeling to obtain odds ratios, reporting significant differences defined as p < 0.05. Separately, we adjusted for race/ethnicity and corrected for underlying differences in the age of survey respondents. Compared to heterosexual cisgender populations, sexual and gender minorities are diagnosed about 4-11years earlier, with bisexual women and transgender individuals reporting the youngest age, 43.9 and 52.1years, respectively. When focusing on select cancer types, lesbian and bisexual women are diagnosed earlier with breast, melanoma, other skin cancers, and leukemia & lymphoma. Gay and bisexual men are diagnosed earlier with colorectal cancers, and transgender individuals earlier with breast, prostate, melanoma, and other skin cancers compared to heterosexual men and women. These findings suggest that sexual and gender minorities experience earlier onset of cancer and many of these age differences remained even after adjustments were made. These findings need to be confirmed in oncology settings that have cancer incidence and sexual orientation and gender identity data and call for greater attention to sexual and gender minorities in cancer research.

Does cancer clinical trial enrollment for sexual and gender minority people differ from heterosexual, cisgender people?

BackgroundSexual and gender minority (SGM) people experience cancer disparities compared to heterosexual and cisgender (non-SGM) people and likely have barriers to cancer clinical trial enrollment. Data are sparse, however, regarding cancer clinical trial enrollment for SGM versus non-SGM people. MethodsUsing data from the 2020 Behavioral Risk Factor Surveillance Survey (BRFSS), we applied a logistic regression to assess associations between SGM status and clinical trial enrollment for 346 SGM and 9441 non-SGM people diagnosed with cancer. The model was adjusted for age at diagnosis, race/ethnicity, partnership status, education, employment, and sex assigned at birth. ResultsSGM individuals had 94 % greater odds than non-SGM individuals to report participation in a clinical trial (aOR 1.94; 95 % CI 1.02–3.68) after adjusting for other factors. ConclusionsData from the BRFSS suggest that SGM people with cancer have higher odds of clinical trial enrollment compared to non-SGM people with cancer. Future work is needed to prospectively track oncology treatment, including clinical trial participation, and outcomes of SGM people versus non-SGM people with cancer. Other studies will be needed to develop and implement systematic, consistent, and non-stigmatizing sexual orientation and gender identity data collection methods.

Abstract P365: Prevalence of Hypertension in Minnesota Adults in 2023 Using Data from a Statewide Electronic Health Record Consortium

Background: Data on prevalence of hypertension in the United States come primarily from in-person data collected by the National Health and Nutrition Examination Survey and self-reports in the Behavioral Risk Factor Surveillance Survey. Electronic phenotypic algorithms for hypertension that include diagnosis codes, blood pressure values, and antihypertensive treatment have been proposed and tested. Objective: To describe prevalence of hypertension in Minnesota adults using data from a statewide electronic health record (EHR) consortium, the Minnesota EHR Consortium (MNEHRC). Methods: Data from 11 health systems participating in the MNEHRC were standardized to a common data model allowing for distributed querying of EHR data. Data were de-duplicated using a one-way hash algorithm. Preliminary prevalence of hypertension in 2023 was estimated in Minnesota residents with ≥ 1 encounter in the past 3 years who had ≥1 diagnosis of hypertension in the past 5 years. Medicaid insurance status was determined via linkage with state enrollment files. Residential addresses of patients were geocoded to census tracts and social vulnerability index (SVI) of census tracts was determined. Results: Among 4,369,470 Minnesotan age 18 and older in 2023, 23.6% had hypertension based on ≥1 diagnosis code. Prevalence increased with age, was higher in men (26% vs. 22% in women), and adjusted for age and sex was highest in Black (30%) and Native American (27%) compared with White (23%) and Hispanic (21%) Minnesotans. Within each race/ethnic group, those insured by Medicaid had a higher adjusted hypertension prevalence than those with other insurance types. The prevalence of hypertension in census tracts with moderate to high SVI ranged from 3% to 43%, but on average was similar to the statewide prevalence of 24% (see image 1). Prevalence of hypertension in race/ethnicity, sex, and age subgroups in higher SVI census tracts was similar to the statewide prevalence in those subgroups. Conclusions: The prevalence of hypertension in Minnesota was described in detail by demographic characteristics, geography and social vulnerability. Future work will expand the electronic hypertension phenotype and examine quality of care.

Influenza Vaccination in Adults in the United States with COPD before and after the COVID-19 Pandemic (2017-2022): A Multi-Year Cross-Sectional Study.

There is limited literature regarding seasonal influenza vaccination (SIV) among those with a history of chronic obstructive pulmonary disease (HCOPD) prior to the COVID-19 pandemic, and no information on the topic assessing the years following the pandemic. This cross-sectional study used the Behavioral Risk Factor Surveillance Survey (BRFSS) data from the years 2017 to 2022 (n = 822,783 adults ages 50-79 years; 50.64% males). The exposure was a HCOPD, and the outcome was SIV within the past year. Weighted and adjusted logistic regression models were conducted overall and by the significant effect modifiers: smoking status, sex, and year. Having an HCOPD significantly increases the weighted adjusted odds (WAO) of SIV when compared to not having an HCOPD overall and by smoking status, sex, and year. For 2017 through 2022, among all current, former, and never smokers with an HCOPD, the WAO of SIV were: 1.36 (1.28, 1.45), 1.35 (1.27, 1.43), and 1.18 (1.09, 1.27), respectively. Among males with an HCOPD who were current, former, and never smokers, the WAO of SIV were: 1.35 (1.23, 1.48), 1.45 (1.33, 1.58), and 1.23 (1.05, 1.44), respectively. Among females with an HCOPD who were current, former, and never smokers, the WAO of SIV were: 1.31 (1.20, 1.43), 1.24 (1.15, 1.35), and 1.13 (1.04, 1.23), respectively. Study findings suggest males had significantly greater WAO ratios of receiving SIV than females in 2020 and 2022, during and after the COVID-19 pandemic. More specifically, males with an HCOPD who were former smokers had significantly greater WAOR of receiving SIV than females in 2020 and 2022. Understanding the potential barriers to SIV receipt by smoking status and sex, especially during a pandemic, and especially for individuals impacted by an HCOPD, is essential for better health interventions in times of a national crisis such as a pandemic. Additionally, SIV receipt is low among those with an HCOPD, and efforts should be made to improve this.

Prevalence and Predictors of Food Insecurity among Adults with Type 1 Diabetes: Observational Findings from the 2022 Behavioral Risk Factor Surveillance System.

The majority of data on food insecurity in diabetes comes from samples of type 2 diabetes or youth with type 1 diabetes. This study screened for food insecurity among adults with type 1 diabetes in the 2022 Behavioral Risk Factor Surveillance Survey, which was the first year that respondents who endorsed diabetes were asked to indicate whether they had type 1 or type 2. One validated screening item asked, "During the past 12 months, how often did the food that you bought not last and you didn't have money to buy more?". Respondents who answered "always", "usually", "sometimes", or "rarely" were categorized as having a positive screen for food insecurity. Seventy-six percent of the sample was white/non-Hispanic. Over one-quarter screened positive for food insecurity. This prevalence is higher than some reports of food insecurity in type 1 diabetes but consistent with reports that include 'marginal' food security in the count of food-insecure individuals. White/non-Hispanics had a lower risk of a positive screen than minoritized respondents. Respondents reporting older age, lower educational attainment, not working, lower income, and receiving SNAP benefits had higher rates of a positive screen. Significant healthcare factors associated with a positive screen were receiving government insurance instead of private, not being able to afford to see a doctor, and worse general, physical, and mental health. In conclusion, rates of a positive screen for food insecurity among people with type 1 diabetes in this study were alarmingly high and associated with other socioeconomic indicators. Screening for food insecurity with appropriate instruments for samples with type 1 diabetes, across the U.S. and internationally, should be a priority.

Differences in shared decision-making and prostate cancer screening by sexual orientation and race/ethnicity.

10525 Background: There are well-documented disparities among racial and sexual minorities in prostate cancer screening uptake and shared-decision making (SDM) conversations. However, it is unclear how racial/ethnic identity and sexual orientation interact to affect prostate-specific antigen (PSA) testing uptake. Methods: Data came from the 2018-2022 Behavioral Risk Factor Surveillance Survey (BRFSS). Outcomes were survey responses to questions about engagement in SDM and PSA testing uptake. The sample included 88,365 heterosexual (HS) men and 2,562 sexual minority (SM) men ages 55 to 69. Data were stratified by race/ethnicity and survey-weighted logistic regression models analyzed the association between sexual orientation and outcomes. Models controlled for age, relationship status, education, household income, insurance status, having a usual source of care, and region. Results: White SM men were more likely to have discussed disadvantages of PSA testing with their healthcare provider [odds ratio (OR)=1.407; p&lt;0.001] and to have undergone PSA testing [OR=1.320; p&lt;0.001] compared to White HS men. Asian SM men were more likely to have had discussions about PSA testing [OR=4.470; p&lt;0.05]; to have discussed advantages [OR=4.596; p&lt;0.05]; to have been recommended PSA testing [OR=4.836; p&lt;0.05] and to have undergone PSA testing [OR=4.401; p&lt;0.001] compared to Asian HS men. Black SM men were more likely to undergo screening because of an issue or a reason besides routine screening [OR=1.073, p&lt;0.05] compared with Black HS men. Hispanic SM men were more likely to have undergone screening as part of a routine checkup [OR=4.2, p&lt;0.001] compared with Hispanic HS men. There were no sexual orientation differences in PSA screening or SDM among American Indian or Native Alaskans. Conclusions: Differences in PSA testing uptake and SDM by sexual orientation vary by race/ethnicity. Further research is needed to study the factors affecting PSA testing uptake and SDM among sexual minority men of different racial/ethnic groups. [Table: see text]

Examining the Relationship Between E-Cigarette Status and Wearable Device Use on Physical Activity Levels in U.S. Adults.

The aim of this analysis is to investigate physical activity levels amongst e-cigarette users based on their wearable device use. Cross-sectional secondary data analysis using 2017 Behavioral Risk Factor Surveillance Survey (BRFSS). Data from the 2017 BRFSS were used. 5,562 U.S. adults (age 18+). Self-reported physical activity related variables from U.S. adults (age 18+). Separate unadjusted and adjusted linear regression models were performed for each of the dependent variables using survey analysis. Non-users of wearable devices and e-cigarettes account for 96.6% (95%CI [95.7, 97.6]) of the sample, whereas users of wearable devices and e-cigarettes account for 3.3% (95%CI [1.2, 5.4]) of the sample. Those who use e-cigarettes participate in almost 50% less vigorous physical activity minutes per week than nonusers, 46 (95%CI [0.43, 91.57]) and 93 (95%CI [80.59, 106.34]) minutes respectively. Individuals who use e-cigarettes and use wearable devices were found to spend significantly more time in total physical activity per week in both the unadjusted and adjusted linear regressions, P = =0.01 and P = =0.04 respectively. The use of e-cigarettes, wearable devices, or both technologies may influence the physical activity levels of its users. Additional research is needed to better understand the association between physical activity levels and the usage of these technologies.

Generational differences in latent classes of exposure to adverse childhood experiences

Adverse Childhood Experiences (ACEs) have increased across generations; however, it is unclear how ACE exposure clusters into classes and how exposure differs by generation. To examine this clustering, we used data from the 2019 Behavioral Risk Factor Surveillance Survey (n = 56,262). We identified ACEs exposure classes and examined the probability of belonging to each ACEs exposure class by birth generation, sex assigned at birth, race/ethnicity, and LGBTQ+ identity. We identified three ACEs exposure classes: Low ACEs, High ACEs without Sexual Abuse, and High ACEs with Sexual Abuse. Findings demonstrate that, relative to Baby Boomers, the probability of experiencing High ACEs without Sexual Abuse was 5 % higher for Gen X and 11 % for both Millennials and Gen Z. The probability of experiencing High ACEs with Sexual Abuse was highest for Gen X and lowest for Gen Z. Significant intersectional relationships were found between LGBTQ+ identity and both generation and sex assigned at birth. These findings have implications for health policy.

Abstract 1289: Disparities in healthcare utilization and access among female cancer survivors in Maryland

Abstract Background: Healthcare utilization can be defined as how often healthcare is used, through what venue, and if access is available. There are medically vulnerable groups of cancer survivors, such as racial/ethnic minorities and economically disadvantaged populations, that may underutilize healthcare throughout cancer survivorship compared to non-vulnerable groups. Factors associated with survivorship care access/utilization should be evaluated to identify at-risk groups and reduce risk of poor health outcomes. Among female cancer survivors in Maryland, we examined the associations between race/ethnicity, obesity, measures of economic stability, and healthcare utilization-related outcomes (including access to care providers, type of doctor provides majority of care, and unmet health care needs because of cost). Methods: Survey data were analyzed for 1,353 non-Hispanic white (NHW) and 280 non-Hispanic Black (NHB) women with a self-reported history of cancer living in Maryland who completed the Maryland Behavioral Risk Factor Surveillance Survey between 2011-2020. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the associations between independent factors and healthcare utilization outcomes. Results: On average, survivors were 66.8 (standard deviation (SD)=12.8) years of age at time of survey and 53.5 (SD=15.6) years of age at time of cancer diagnosis. Breast cancer was the most common cancer reported (58.9%). While most women reported being retired (50.6%), 30.6% reported being employed and 10% were unemployed. Most women were homeowners (81.5%) and 40.1% had household incomes &amp;gt;$50,000/year. Overall, race/ethnicity was not associated with any of the outcomes. Unemployed survivors (compared to employed) were 3.90 times more likely (95% CI 1.38-11.04, p=0.01) to report not being able to see a doctor because of cost. Survivors who were not homeowners (compared to homeowners) were 0.39 times less likely (95% CI 0.22-0.67, p &amp;lt;0.001) to report having a general/family practitioner for majority of cancer survivorship care. Survivors with household incomes ≤$50,000/year (compared to &amp;gt;$50,000/year) were 2.36 times more likely (95% CI 1.20-4.65, p=0.01) to not have seen a doctor in the past year. Lastly, obese survivors, compared to non-obese, were 0.25 times less likely (95% CI 0.07-0.84, p=0.02) to not have at least one healthcare provider. Conclusions: While race/ethnicity was not associated with healthcare access/utilization, our results do demonstrate various disparities in access to care and healthcare utilization during cancer survivorship by employment status, home ownership, and income. Our findings can inform interventions in collaboration with healthcare providers caring for female cancer survivors to address challenges associated with access to survivorship care among medically underserved survivors in Maryland. Citation Format: Avonne E. Connor, Mu Jin, Kala Visvanathan. Disparities in healthcare utilization and access among female cancer survivors in Maryland [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1289.

Measurement Invariance of Adverse Childhood Experiences Across Teacher Age and Race

ABSTRACT Adverse Childhood Experiences (ACEs) confer considerable risk for negative outcomes across the lifespan, but there is limited research examining whether the measurement of ACEs can be interpreted the same way across diverse groups of individuals. In particular, the measurement of ACEs among early child education teachers has received little attention. Given that millions of children receive care from early child education teachers, and evidence that ACEs can severely disrupt teacher’s abilities to support young children, it is critical to accurately assess for and respond to teacher ACEs. The present study examined the factor structure and measurement invariance of the 11-item Behavioral Risk Factor Surveillance Survey (BRFSS) version of the ACEs measure across a diverse group of teachers. Data were collected from 605 teachers in a southeastern state between 2018 and 2021. Teachers ranged in age from 18 to 81 years (35% young; 56% middle; and 9% older adults) and were diverse across race (46% White; 53% Black). Teachers completed the BRFSS version of the ACEs measure and a demographics questionnaire. Factor analyses replicated the theorized three-factor solution, with household dysfunction, emotional/psychological abuse, and sexual abuse emerging as distinct factors. Multigroup confirmatory factor analyses demonstrated measurement invariance across teacher age and race. Comparisons of scores indicated ACEs levels varied across teacher age and race. Overall, findings suggest the BRFSS version of the ACEs measure can be used to assess adverse childhood experiences across diverse groups of early child education teachers.

Association of Cannabis Use With Cardiovascular Outcomes Among US Adults.

We examined the association between cannabis use and cardiovascular outcomes among the general population, among never-tobacco smokers, and among younger individuals. This is a population-based, cross-sectional study of 2016 to 2020 data from the Behavioral Risk Factor Surveillance Survey from 27 American states and 2 territories. We assessed the association of cannabis use (number of days of cannabis use in the past 30 days) with self-reported cardiovascular outcomes (coronary heart disease, myocardial infarction, stroke, and a composite measure of all 3) in multivariable regression models, adjusting for tobacco use and other characteristics in adults 18 to 74 years old. We repeated this analysis among nontobacco smokers, and among men <55 years old and women <65 years old who are at risk of premature cardiovascular disease. Among the 434 104 respondents, the prevalence of daily and nondaily cannabis use was 4% and 7.1%, respectively. The adjusted odds ratio (aOR) for the association of daily cannabis use and coronary heart disease, myocardial infarction, stroke, and the composite outcome (coronary heart disease, myocardial infarction, and stroke) was 1.16 (95% CI, 0.98-1.38), 1.25 (95% CI, 1.07-1.46), 1.42 (95% CI, 1.20-1.68), and 1.28 (95% CI, 1.13-1.44), respectively, with proportionally lower log odds for days of use between 0 and 30 days per month. Among never-tobacco smokers, daily cannabis use was also associated with myocardial infarction (aOR, 1.49 [95% CI, 1.03-2.15]), stroke (aOR, 2.16 [95% CI, 1.43-3.25]), and the composite of coronary heart disease, myocardial infarction, and stroke (aOR, 1.77 [95% CI, 1.31-2.40]). Relationships between cannabis use and cardiovascular outcomes were similar for men <55 years old and women <65 years old. Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes.

(365) Understanding Suicide Trends Among Floridian Males; An Essential Component of a Men’s Health Initiative

Abstract Introduction Collecting regional health data is imperative to guide the planning and implementation of programs and policies that will ultimately improve men’s health. Suicide is a leading cause of mortality among males of all age groups within the United States. Understanding the demographics of male suicide, as well as age, racial, and ethnic disparities is critical in developing targeted solutions to this devastating problem. Objective The objectives were to identify the magnitude of male suicide within the State of Florida in terms of overall incidence. Additionally, we sought to identify age, racial, and ethnic disparities within the state, as well as any potential trends in these variables. A description of the various disparities of the modality used to commit suicide was of interest, as well. Methods Data was obtained from the United States Census Bureau, the State Department of Health, and the Center for Disease Control and Prevention. Included within a number of reports prepared by these organizations were demographic data on population size, age, race, and ethnicity within our state. The Florida Department of Health provided health indicator data from several different sources, which included death certificates and results from the 2015 and 2019 Behavioral Risk Factor Surveillance Survey (BRFSS). The BRFSS is an annual random sample, state-based, telephone survey used to collect data from Florida residents regarding individual health practices and risk behaviors. Finally, we used the Centers for Disease Control and Preventions’ National Center for Health Statistics Mortality in the United States Report to obtain life expectancy at birth data in Florida and in the US by both race and sex. Causes of death for suicide were coded based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Comparative data was developed in the context of age, race/ethnicity, and mechanism of suicide. Results Suicide is the 4th leading cause of death in Floridian men ages 18-54, accounting for 1,700 deaths annually. Floridian males have more than three times the rate of suicide deaths compared to females. In 2021, non-Hispanic and White men had the highest suicide death rate per 100,000 individuals at 24.3 and 24 respectively compared to Black men at 10.3. (see Figure 1). In 2021, firearms were used in the majority of suicide deaths across the state and all age groups, accounting for 63%. Suffocation accounted for 21%, followed by poisoning at 8%. Conclusions This study corroborates national data suggesting that suicide is a major health problem that preferentially impacts males. Racial, ethnic, and geographic health disparities among Floridian males exist as demonstrated by accumulated data on suicide death rates. This data is extremely important for Men’s Health experts to recognize and understand. A continued focus on strengthening data and research on suicide is needed to provide prevention initiatives and strategies targeted towards these vulnerable populations. Disclosure No.

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Racial disparities in sleep health may mediate the broader health outcomes of structural racism. To assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism. Two distinct difference-in-differences analyses examined the changes in sleep duration for the US non-Hispanic Black (hereafter, Black) population before vs after exposure to officer-involved killings of unarmed Black people, using data from adult respondents in the US Behavioral Risk Factor Surveillance Survey (BRFSS; 2013, 2014, 2016, and 2018) and the American Time Use Survey (ATUS; 2013-2019) with data on officer-involved killings from the Mapping Police Violence database. Data analyses were conducted between September 24, 2021, and September 12, 2023. Occurrence of any police killing of an unarmed Black person in the state, county, or commuting zone of the survey respondent's residence in each of the four 90-day periods prior to interview, or occurence of a highly public, nationally prominent police killing of an unarmed Black person anywhere in the US during the 90 days prior to interview. Self-reported total sleep duration (hours), short sleep (<7 hours), and very short sleep (<6 hours). Data from 181 865 Black and 1 799 757 White respondents in the BRFSS and 9858 Black and 46 532 White respondents in the ATUS were analyzed. In the larger BRFSS, the majority of Black respondents were between the ages of 35 and 64 (99 014 [weighted 51.4%]), women (115 731 [weighted 54.1%]), and college educated (100 434 [weighted 52.3%]). Black respondents in the BRFSS reported short sleep duration at a rate of 45.9%, while White respondents reported it at a rate of 32.6%; for very short sleep, the corresponding values were 18.4% vs 10.4%, respectively. Statistically significant increases in the probability of short sleep and very short sleep were found among Black respondents when officers killed an unarmed Black person in their state of residence during the first two 90-day periods prior to interview. Magnitudes were larger in models using exposure to a nationally prominent police killing occurring anywhere in the US. Estimates were equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity in very short sleep. Sleep health among Black adults worsened after exposure to officer-involved killings of unarmed Black individuals. These empirical findings underscore the role of structural racism in shaping racial disparities in sleep health outcomes.