Household Education Level Research Articles

Climate Change Vulnerability of Marginal and Small Farmers in Nuapada District, Odisha

This study attempts to measure the level of livelihood vulnerability of farmers to climate change in Nuapada. Both descriptive and inferential statistics were used based on primary and secondary data. The study found that marginal and small farmers in the study area have different differential livelihood vulnerability to climate change. The study has used composite approach in which seven dimensions including 34 indicators were studied. Composite of factors such as low level of education, lack of access to credit, lack of access to critical irrigation were associated with the relatively higher Livelihood Vulnerability Index (LVI) values. The multiple linear regression analysis revealed that seven socio-economic variables account for 44% of variation in livelihood vulnerability index; three variables among them viz. number of household income sources, landholding size and highest level of education in household were found to have significant impact on LVI. The findings of the study conclude that there is differential vulnerability to climate change in the same context which was mostly determined by various socioeconomic factors. Thus climate change related studies and policies (which mostly limit district as the measuring unit) must expand their scope to understand and act on differential vulnerabilities in the same district.

Personal care products: Demographic characteristics and maternal hormones in pregnant women from Puerto Rico

Personal care products (PCPs) refer to a wide variety of items commonly characterized as health or beauty products. PCPs contain a number of ingredients, often including a wide range of endocrine disrupting chemicals such as phthalates and parabens. The present study examines the association between self-reported PCP use and prenatal sex-steroids and thyroid hormones levels in women from Puerto Rico. We recruited pregnant women (n = 1070) through the Puerto Rico PROTECT Cohort and collected blood, demographic and pregnancy-related data at recruitment and subsequent visits. PCP use in the 48-h preceding the blood sample was collected through self-reported questionnaires. Nine hormones (corticotropin-releasing hormone [CRH], sex-hormone binding globulin [SHBG], estriol [E3], progesterone, testosterone, thyroid-stimulating hormone [TSH], total triiodothyronine [T3], total thyroxine [T4], and free thyroxine [fT4]) were measured in maternal serum samples at two points during pregnancy. Linear mixed models with random intercepts were used to examine associations between PCP use and serum hormone levels. Use of cosmetics significantly increased with age, household income and education level (p < 0.01). Use of hair products, such as hair dyes and bleach, relaxers, and mousse, was associated with lower levels of all sex steroid hormones compared to non-use: SHBG (%Δ = −7.1, 95%CI: −12.4,-1.8), E3 (%Δ = −23.2, 95%CI: −32.2,-13.0), progesterone (%Δ = −21.5, 95%CI: −29.4,-12.9) and testosterone (%Δ = −21.5, 95%CI: −33.1,-7.8) adjusted for maternal age, education and pre-pregnancy body mass index. Our findings suggest that household income and education level influence PCP use among pregnant women in this study. Use of certain hair products was associated with lower concentrations of sex steroid hormones. Although there are limitations to questionnaire data, characterizing PCP use is inexpensive and may represent exposure from multiple classes of chemicals, including chemicals that may not specifically appear on product labels and/or have not been tested for endocrine disrupting potential, making it a useful complement to chemical biomarker data.

Trends in intake and sources of dietary protein in Korean adults, 1998-2018.

Although a decrease in carbohydrate intake and an increase in fat intake among Koreans have been reported, investigations of changes in protein intake have been limited. Thus, this study aimed to explore trends in the dietary intake of total, plant and animal proteins overall and by socio-demographic subgroups in Korea over the past two decades. A total of 78716 Korean adults aged ≥ 19 years who participated in the seven survey cycles of the Korea National Health and Nutrition Examination Survey 1998-2018 were included. Dietary protein intake, overall and by source, was calculated using a single 24-h dietary recall data. Changes in dietary protein over 20 years were estimated using multiple linear regression analysis after adjusting for potential covariates. For total protein intake, a significant decrease was reported from 1998 to 2016-2018 (P for trendlinearity < 0·001), whereas an increasing trend was observed from 2007-2009 to 2016-2018 (P for trendlinearity < 0·001). In terms of protein intake by source, plant protein intake decreased while animal protein intake increased over the past two decades, indicating steeper trends during the recent decade (P for trendlinearity < 0·001). These trends were more pronounced among younger adults and those with higher household income and education levels. These findings suggest that continuous monitoring of dietary protein intake overall and by source (plant v. animal) across socio-demographic group is needed.

Black Older Americans Have Lower Prevalence of Hearing Loss Than Their White Peers: Findings From Two Large Nationally Representative Surveys.

The purpose of this study was to investigate Black-White differences associated with hearing loss among older adults living in the United States. Secondary data analysis was conducted using the 2017 American Community Survey (ACS) with a replication analysis of the 2016 ACS. The ACS is an annual nationally representative survey of Americans living in community settings and institutions. The sample size of older Americans (age 65+ years) in 2017 was 467,789 non-Hispanic Whites (NHWs) and 45,105 non-Hispanic Blacks (NHBs). In the 2016 ACS, there were 459,692 NHW and 45,990 NHB respondents. Measures of hearing loss, age, race/ethnicity, education level, and household income were based on self-report. Data were weighted to adjust for nonresponse and differential selection probabilities. The prevalence of hearing loss was markedly higher among older NHWs (15.4% in both surveys) in comparison with NHBs (9.0% in 2017 and 9.4% in 2016, both ethnic differences p < .001). In the 2017 ACS, the age- and sex-adjusted odds of hearing loss were 69% higher for NHWs compared with NHBs, which increased to 91% higher odds when household income and education level were also taken into account (OR = 1.91; 95% confidence interval [CI; 1.85, 1.97]). Findings from the 2016 ACS were very similar (e.g., 65+ fully adjusted OR = 1.81; 95% CI [1.76, 1.87]). NHWs have a much higher prevalence and almost double the odds of hearing loss compared with NHBs. Unfortunately, the ACS survey does not allow us to explore potential causal mechanisms behind this association.

KETAHANAN PANGAN RUMAH TANGGA PETANI KOPI DI KECAMATAN ULU BELU KABUPATEN TANGGAMUS

The aims of this research are to analyze the level of food security, the factors that affect the level of food security, and efforts to increase the level of food security of coffee farmer households. The method used in this research is a survey method. Location is chosen purposively in Ngarip and Sukamaju Villages, Ulu Belu Subdistrict, Tanggamus regency with samples of 70 coffee farmer households selected using a simple random method. The data were primary and secondary data, collected in May - July 2018 and analyzed by cross-table between the share of food expenditure and energy adequacy level, ordinal logistic regression, and descriptive qualitative analysis. The results of the research according to BPS showed that the majority of respondents belonged to the category of food secure (31.43%), and the rest belonged to the category lack of food (30.00%), food vulnerable (22.86%), food insecure (15.71%). The results according to nutrition and 2012 food law showed that the majority of respondents belonged to the category of food security (50.00%), lack of food (41.43%), food vulnerable (5.71%), and food insecure (2.86%). The affecting factors on the level of food security were the household income and education level of housewives. The efforts to increase the level of food security by Government were conducted by monitoring of food availability and food reserves, developing food distribution and stabilization of food prices, developing diversification of consumption and food security as well as staple food assistance through the raskin program, whereas efforts are carried out by households coffee farmers, namely by doing productive activities outside the coffee farm.Key words: coffee farmer households, food expenditure, food security

Muscle Exercise Mitigates the Negative Influence of Low Socioeconomic Status on the Lack of Muscle Strength: A Cross-Sectional Study

Socioeconomic status (SES), which takes into account household income and education level, is an important factor in the role of muscle strength as a discriminator of sarcopenia. Although the benefits of exercise on muscle strength are well recognized, its influence on people of different SES has not been fully elucidated, informing the aim of this study. A total of 6081 subjects, for which we had complete data on measurements of handgrip strength (HGS) and other relevant variables, were included from the Korea National Health and Nutrition Examination Surveys (KNHANES) VII-3. A multivariable analysis showed that people with a low household income (odds ratio (OR) 1.637, p = 0.005) and low education status (OR 2.351, p < 0.001) had a poor HGS compared to those with a high SES, and that the difference in HGS made by muscle exercise was greater for people with a low household income (OR 7.082 vs. 3.619, p < 0.001) and low education status (OR 14.711 vs. 6.383, p < 0.001). Three-step logistic regression analysis showed that muscle exercise mediated the relationship between muscle strength and low household income (OR from 1.772 to 1.736, z = 2.373, p = 0.017) and low education level (OR from 2.368 to 2.309, z = 2.489, p = 0.012). This study confirmed that exercise improves the negative effect of SES on muscle strength, suggesting the greater importance of muscle exercise for people with a low SES.

Use of social networks in stock investment

PurposeDrawing on the literature regarding the social network and stock investment, this paper aims to focus on the use of the social network on stock ownership decisions at individual levels. This paper also attempts to shed light on potential mediators of the relationship between the social network and stock ownership.Design/methodology/approachTo determine the relationship between stock ownership and using the social network, logistic regression was used. In order to isolate the effect of using hs on stock ownership, a decomposing method was adopted.FindingsThe findings provide evidence of the positive contribution of the use of social networks in stock ownership. Personal characteristics, such as household net worth, homeownership, education level and risk tolerance, may play a vital role in influencing individuals' decisions regarding stock investment. In addition, this study contributes to our understanding of income's mediating role in stock investment decisions.Originality/valueFirst, the authors contribute theoretically by drawing from the assumptions of social networking contagion theory, social influence theory, and social capital theory. Second, we explored potential mediators of the relationship between the social network and stock ownership. Third, this study complements the literature in incorporating the social network in business, financial professionals to be exact.

It's more than just cancer biology: Health disparities in patients with pancreatic neuroendocrine tumors.

Pancreatic neuroendocrine tumors (PNETs) represent a rare form of pancreatic cancer. Racial/ethnic disparities have been documented in pancreatic ductal adenocarcinoma, but health disparities have not been well described in patients with PNETs. A retrospective review of patients with PNETs in the National Cancer Database was performed for 2004-2014. Approximately 16 605 patients with PNETs and available vital status were identified. Survival was compared by race/ethnicity and socioeconomic status using Kaplan-Meier methods and Cox regression. There were no significant differences in survival between Non-Hispanic, White; Hispanic, White; or Non-Hispanic, Black patients on univariate analysis. Kaplan-Meier analysis showed that patients from communities with lower median household income and education level had worse survival (p < 0.001). Patients age less than 65 without insurance, similarly, had worse survival (p < 0.001). Multivariable modeling found no association between race/ethnicity and risk of mortality (p = 0.37). Lower median household income and lower education level were associated with increased mortality (p < 0.001). Unlike most other malignancies, race/ethnicity is not associated with survival differences in patients with PNETs. Patients with lower socioeconomic status had worse survival. The presence of identifiable health disparities in patients with PNETs represents a target for intervention and opportunity to improve survival in patients with this malignancy.

Anxiety and coping strategies among women with hyperemesis gravidarum in Malaysia

Aim: Anxiety is prevalent among women with Hyperemesis Gravidarum (HG), which is associated with coping strategies and bio-psychosocial risk factors. This study aims to predict socioeconomic status (SES) and obstetric factors towards anxiety and stress-coping strategy, and to explore the significant differences in levels of anxiety on each coping strategy. Design: It was a cross-sectional survey in the Malaysian context. Methods: Forty women medically diagnosed with HG were recruited and completed Generalized Anxiety Disorder-7 (GAD-7) to assess generalized anxiety disorder and coping scale inventory using the Brief COPE questionnaire. Results: The employment status of pregnant women diagnosed with HG significantly predicted their anxiety. Household income and education level predicted emotion-focused coping strategies. None of the obstetric factors predicted the coping strategy. A significant difference was found across anxiety levels in problem-focused and dysfunctional coping strategies. The post-hoc test reveals that dysfunctional coping has the highest mean score in the severe anxiety category. Conclusion: It is essential to promote awareness about effective coping strategies for pregnant women who are diagnosed with HG. Greater efforts are needed to increase the duty of care among healthcare providers to propagate holistic and resourceful coping management with the HG that could help potential patients in the future.

ANALYSIS OF PERCEIVED CAUSES AND FACTORS INFLUENCING VEGETABLE FARMERS-PASTORALISTS CONFLICTS IN KADUNA STATE, NIGERIA

The study was carried out on analysis of perceived causes and factors influencing vegetable farmers-pastoralists conflicts in Kaduna State, Nigeria. Multi-stage sampling procedure was employed to select 360 respondents from the study areas of Northern, Southern and Central Senatorial districts of Kaduna State. Data were collected through structure questionnaire and analyzed using descriptive (mean, frequency distribution, percentages and standard deviation) and inferential statistics (logistics regression). The results showed that 80.6% and 91.6% of the vegetable farmers and pastoralists were found to be male, majority (80.2%) and (86.1%) were married farmers and pastoralists, respectively. Also, the vegetable famers and pastoralists had relatively higher education of 34.1% and 31.8%, respectively. A grand mean of 3.79 was revealed as the perceived causes of vegetable farmers-pastoralists conflicts meaning there was persistence conflicts in the study area. So, the results disclosed the major causes of farmer-pastoralists conflicts to include influx of migrant herders/transhumance and night grazing (= 4.32), inadequate grazing reserve (= 4.25) and destruction of crop by animals (= 4.24) as perceived by vegetable farmers. However, the pastoralists perceived major causes of conflicts to include inadequate grazing reserve (= 4.44), destruction crops by animals (= 4.21) and encroaching grazing reserves (= 4.11). The results of logit regression on factors influencing farmers-pastoralists showed that age, and widow, number of livestock were found to be positively significant (P≤0.01), respectively. Household size, educational level and farm size were significant (P≤0.05) in influencing conflicts. The coefficient (-0.16) of number of livestock was found to be negative but significant (P≤0.01) implying that as number of livestock increases, the tendency to participate in a conflict also increases.it was concluded that vegetable farmers-pastoralists conflicts in the study was mostly influenced by age, education level, household size, farm size and number of livestock. The study recommended that grazing areas should be provided for pastoralists as a means of preventing farmers and pastoralist conflicts like the ranching (ruga) policy by the federal government and private partners.

Socioeconomic status, food security, and chewing discomfort of Korean elders: results from the Korea National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVESThe purpose of this study was to investigate the association between socioeconomic status and chewing discomfort and identify the role of food insecurity in the association's causal pathway in a representative sample of Korean elders.MATERIALS/METHODSWe conducted cross-sectional analyses of the Korea National Health and Nutrition Examination Survey (2013–2015) data for elders aged ≥ 65 years. Socioeconomic status indicators used included household income and education level. Chewing discomfort was assessed according to the self-reported presence of chewing problems. Food security was surveyed using a questionnaire based on the US Household Food Security Survey Module.RESULTSThe odds ratios of chewing discomfort in the 1st and 2nd income quartiles were 1.55 (95% confidence interval [CI], 1.15–2.10) and 1.40 (95% CI, 1.03–1.90), respectively, compared to participants in the highest income quartile. Participants with the lowest education level were 1.89 (95% CI, 1.30–2.75) times more likely to have chewing discomfort than those without chewing discomfort. After including food security in the final model, the logistic coefficients were attenuated in the income and education quartiles.CONCLUSIONSLow socioeconomic status was associated with chewing discomfort. In addition, the results confirm that food insecurity can mediate the association between socioeconomic inequalities and chewing discomfort among the elderly.

High Parental Education Protects Against Changes in Adolescent Stress and Mood Early in the COVID-19 Pandemic

PurposeThe COVID-19 pandemic has brought dramatic changes to the daily lives of U.S. adolescents, including isolation from friends and extended family, transition to remote learning, potential illness and death of loved ones, and economic distress. This study’s purpose is to measure changes in adolescents’ perceived stress and mood early in the pandemic. MethodsThe present study drew from a racially and ethnically diverse sample of high school student participants in an ongoing intervention study in the Midwestern U.S., 128 of whom provided reports of their daily stress and mood both before (December 2017 to March 2020) and during (March–July 2020) the COVID-19 pandemic. We expected to see increases in perceived stress, declines in positive mood states, and increases in negative mood states, with larger impacts on individuals from households with lower parental education levels. ResultsMultilevel models revealed increases in perceived stress primarily for adolescents from low/moderate education families during the pandemic. Impacts on mood states also diverged by education: adolescents from low/moderate education households reported feeling more ashamed, caring, and excited than before the pandemic, changes that were not shared by their peers from high education households. Although changes in mood that arose with the onset of the pandemic became less pronounced over time, increased levels of home- and health-related stress stayed high for low/moderate education adolescents. ConclusionsDuring the COVID-19 period, we observed disparate impacts on adolescents according to household education level, with more dramatic and negative changes in the emotional well-being of adolescents from low/moderate education households.

Experience of Sleep for Families of Young Adults With Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) may experience sleep difficulties that worsen into adulthood and negatively influence both child and family, yet the experience is not well understood. Understanding the family's experience can inform occupational therapy providers, future research, and practice guidelines. To examine experiences surrounding sleep for families raising a young adult with ASD (YA-ASD). Qualitative study in the phenomenological tradition of Moustakas (1994). Experienced researchers analyzed transcripts from in-depth, in-person interviews to triangulate data, distill themes, and construct the essence of family experience. Trustworthiness was established through member checking, audit trails, and epoché diaries that were maintained throughout data analyses. Community setting (large city in the northeastern United States). People who self-identified as living in a family arrangement that included a YA-ASD age 15-21 yr, able to verbally participate in English. Families with children diagnosed with developmental disabilities other than ASD were excluded. Six eligible families identified through volunteer sampling participated. The participants' sociodemographic diversity was limited across household income, education level, and ethnicity. All YA-ASD in this study were limited verbally and unable to contribute. Analyses of interview transcripts revealed five themes that form the essence of the families' experience surrounding sleep. Sleep issues for YA-ASD continue into adulthood and affect the entire family because of continuous co-occupation; occupational therapy support is therefore important for families of YA-ASD. The lack of effective evidence-based interventions supporting the YA-ASD population also reveals an area for growth. What This Article Adds: The results indicate the importance of addressing sleep for YA-ASD and their families in occupational therapy practice because of its considerable impact on family life.

Emotions, Demographics and Sociability in Twitter Interactions

The social connections people form online affect the quality of information they receive and their online experience. Although a host of socioeconomic and cognitive factors were implicated in the formation of offline social ties, few of them have been empirically validated, particularly in an online setting. In this study, we analyze a large corpus of geo-referenced messages, or tweets, posted by social media users from a major US metropolitan area. We linked these tweets to US Census data through their locations. This allowed us to measure emotions expressed in the tweets posted from an area, the structure of social connections, and also use that area's socioeconomic characteristics in analysis. %We extracted the structure of online social interactions from the people mentioned in tweets from that area.We find that at an aggregate level, places where social media users engage more deeply with less diverse social contacts are those where they express more negative emotions, like sadness and anger. Demographics also has an impact: these places have residents with lower household income and education levels. Conversely, places where people engage less frequently but with diverse contacts have happier, more positive messages posted from them and also have better educated, younger, more affluent residents. Results suggest that cognitive factors and offline characteristics affect the quality of online interactions. Our work highlights the value of linking social media data to traditional data sources, such as US Census, to drive novel analysis of online behavior.

Association of Parental Socioeconomic Status and Physical Activity with Development of Arterial Stiffness in Prepubertal Children.

The present study examined the prospective association of parental household income, education level, migration background, and physical activity (PA) behavior with the development of pulse wave velocity (PWV) in prepubertal children. A total of 223 children (initial age 6–8 years) were included in this prospective school-based cohort study from 2014 to 2018. Parental socioeconomic status, migration background, and PA behavior were assessed by the use of questionnaires at both times points. PWV was measured by an oscillometric device at follow-up (2018). No significant association of household income, education level, and parental migration background with PWV in children after four years was found. However, a high level of maternal PA was related to a lower childhood PWV at follow-up (mean (95% CI) 4.6 (4.54–4.66) m/s) compared to children of mothers with a low PA behavior (mean (95% CI) 4.7 (4.64–4.77) m/s) (p = 0.049). Children of mothers with a high PA level revealed a beneficial arterial stiffness after four years. Little evidence for an association of socioeconomic status and migration background with childhood arterial stiffness was found. Increased parental PA seems to support the development of childhood vascular health and should be considered in the generation of future primary prevention strategies of childhood cardiovascular health.

Climate Variability and Household Welfare Outcomes in Uganda

This study examines the impact of climate variability on household welfare outcomes in Uganda by combining long-term climate data (1979-2013) interpolated at household level, and six waves of the Uganda National Panel Survey (2009-2019). Pooled average ordinary least squares and random effects models are used for empirical analysis. The results indicate that climate variability has a significant nonlinear impact on household welfare outcomes. Access to extension services, value of household assets, education level, gender and location of the household head were also found to influence Uganda’s household welfare outcomes. These findings, therefore, highlight the need for policymakers to move swiftly to counter climate variability and its effects by designing and adopting appropriate measures that mitigate climate variability, and enhance household welfare outcomes among the people of Uganda.&#x0D; JEL Codes: I31, Q12, Q54

Value chain analysis of wheat in Duna district, Hadiya zone, Southern Ethiopia

Wheat is a source of food and income for Ethiopian farmers in general, and the Duna district in particular. Despite the district's high wheat production potential, a number of constraints impede the wheat sector's and value chain's development. This study, thus, analyzed the wheat value chain in Duna district, Hadiya zone, Southern Ethiopia. Descriptive statistics, marketing margin, and a multiple linear regression model were used to analyze data from 149 respondents. The result showed that the actors in the wheat value chain have a shaky relationship. According to the findings, flour wholesalers had the highest market margin (18.36%), followed by flour processors (17.70%). The estimated multiple linear regression result revealed that wheat supply is influenced by the quantity of wheat produced, household education level, farming experience, frequency of extension contact, and lagged market price. Furthermore, wheat producers identified climate variability and low wheat prices as the top two problems in wheat production and wheat marketing, respectively. Hence, the government and other concerned bodies should focus on productivity increasing technologies in the study area in order to boost productivity and thus increase wheat market supply. In addition, to solve the marketing problem, the promotion of value-added practices and the formation of wheat cooperatives are suggested.

Vulnerability of community to climate stress: An indicator-based investigation of Upper Gana watershed in Omo Gibe basin in Ethiopia

The frequency and intensity of extreme climate events such as heavy rainfall and droughts are expected to increase with climate change and are predicted to severely affect the agriculture sector. However, drought vulnerability of rural communities in sub-Saharan Africa is not well documented, despite these communities being composed of mainly smallholder farmers whose livelihoods depend on rainfed agriculture. In this study, we evaluated the vulnerability of a rural community in Ethiopia to drought using both primary and secondary data. The primary data was generated from a household survey, whereas the secondary data was obtained from the National Meteorology Agency of Ethiopia and Climate Hazards Group Infrared Precipitation (CHIRP) product. We decomposed vulnerability in to three components which are exposure, sensitivity, and adaptive capacity to drought based on indices derived from the primary and secondary data. Results show that the average score for exposure, sensitivity, and adaptive capacity is nearly equal. High seasonal water variability coupled with severe, frequent, and long drought status increases exposure to drought in the study area. The main factor which affects sensitivity to drought in this community is the land cover. For adaptive capacity, the social capital of the community is low while their physical capital is high. The overall estimated drought vulnerability shows that the community is moderately vulnerable. The community's exposure and sensitivity analyses show the need to increase the amount of moisture stored within the soil with the adoption of appropriate soil and water conservation techniques. Results also show that the head of the household's educational level, the number of livestock owned, and annual income affect the community's adaptive capacity.

Trends and Outcomes in the Use of Radiation Therapy and Chemotherapy for the Treatment of Hodgkin's Lymphoma: An Analysis from SEER Database 1985-2014

Background:In the US, there are approximately 8,260 newly diagnosed HL cases and 21,210 death due to HL annually (Siegel et al, Cancer Statistics, 2017). Over the past few decades, a significant survival improvement has been observed due to the advancement in treatment for HL including radiation therapy (RT), multi-agent chemotherapy (CT) regimens and combination of both. However, concerns have been raised due to the risk of late complications from CT and RT, such as pulmonary disease, heart disease and secondary malignancies (Master et al. Anticancer Res. 2017). We aim to investigate whether the use of different treatment modalities are associated with outcome.Methods:Data were extracted from the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 18 program. Patients diagnosed with HL from 1985-2014 were included in this analysis. Demographic information including age, sex, race/ethnicity, annual household income, education and insurance status were also collected. HL is categorized by using International Classification of Disease for Oncology (ICD-O-3) into classical HL NOS (CHL NOS), nodular lymphocyte predominant HL (NLP), lymphocyte rich (LR), mixed cellularity (MC), lymphocyte depleted (LD), and nodular sclerosis (NS). Treatment was categorized into RT alone, CT alone, combination of RT and CT, and no RT or CT. Survival time is calculated by using the date of diagnosis and one of the following dates: date of death, date last known to be alive or date of the study cutoff (December 31, 2014). Chi-square test and Cox regression model was adopted by using SAS 9.4.Exclusion criteria:1) Exclude those with unknown or unspecified race.2) Exclude those patients whose survival was <6 months because time of radiotherapy/chemotherapy was not known to the time of diagnosis.3) Exclude patients with any other type of cancer prior to the diagnosis of HL.4) Exclude patients with second or later primaries, and who were not actively followed.Results:A total 39, 160 patients were included in this analysis. Table 1 shows the Cox regression analysis including adjusted and unadjusted hazard ratios (HRs). Receiving combination modality (both RT and CT) was associated with 45% decreased HR, 95% CI (0.42, 0.70) compared to those who had neither RT or CT. Black race and male patients had a worse survival outcome compared to white race and females, respectively (HR=1.40, HR=1.17). Age was a statistically significant factor associated with increased mortality. Compared to CLH NOS, histology of NS, LC, and NLP were associated with decreased overall mortality (HR=0.84, HR=0.62, HR=0.69, p=0.02) respectively. Stage IV and Stage III were 1.92 and 1.69 times likely to die compared to stage I patients, p<0.01. Those with B symptoms had 48% increased mortality compared to those without, p<0.01. Insured patient had 29% decreased risk of mortality compared to those without insurance, 95% CI (0.54, 0.91). However any Medicaid patients were associated with 36% increased risk of death, 95% CI (1.04, 1.79). Annual household income and education level did not appear to be related to death from HL.Figure 1 illustrates the change of treatment regimen from 1985-2014. An obvious rising was observed in CT from 34.76% to 58.30% from 1985-2014. The percentage among patients who received neither CT nor RT has been stable over the past 30 years. From 1985-2004, we observed that combination modality had been increasing from 16.20% to 37.48%; and after year of 2004, it started to slowly decrease.Table 2 presents the HR of death of patient with HL receiving different treatment modality by year of diagnosis. The HRs were not statistically significant associated with the use of combination modality nor single modality (CT or RT only) from 1985-1999. Among year of diagnosis group 2000-2004, 2005-2009, and 2010-2014, patients with combination modality were associated with 22%, 43% and 44% decreased mortality compared to those who did not have any therapy, respectively (p<0.01).Conclusion:Our results showed that among all HL patients diagnosed between 1985 and 2014, combination modality was associated with decreased mortality. Similar mortality benefit was not observed among patients receiving single modality. Though the use of combination modality has been decreasing over the past 2 decades, a significant lasting survival benefit compared to single modality was still observed. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Easy-to-Read Informed Consent (ETRIC) Form for Hematopoietic Cell Transplantation (HCT) Clinical Trials: Results from Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 1205 Study

The informed consent process, which allows potential participants to balance benefits and risks in making an informed decision about participation, is an essential aspect of conducting ethical clinical trials. Due to the complexity of HCT trial treatments, informed consent forms are often long and difficult to read, raising concern about compromise of the informed consent process. Whether enhancing the format of consent forms improves comprehension among HCT candidates participating in multicenter trials has not previously been investigated. The BMT CTN proposed a two-column ETRIC form incorporating evidence-based recommendations for health literacy, readability and plain language (Denzen et al, BBMT 2012). The BMT CTN 1205 study: (1) tested the efficacy of the ETRIC form in increasing comprehension of BMT CTN clinical trials, and (2) evaluated barriers and facilitators to its use at BMT CTN centers. The randomized study enrolled 198 patients at 25 centers participating in BMT CTN 0901, 1101, 1203, 1301 (parent) protocols (available at www.bmtctn.net). Adult patients (≥18 years) potentially eligible to participate in a parent trial, fluent in English, and providing consent were randomized to receive the ETRIC or standard consent form for that parent trial. Both forms were written at the 8th grade or lower reading level; the ETRIC form included additional formatting enhancements intended to improve readability. The primary endpoint was objective comprehension score on the Quality of Informed Consent Part-A (QuIC-A) instrument; the study was powered to detect a 4-point difference in mean scores between the study arms assuming a 25% dropout between enrollment and assessment completion. Secondary endpoints evaluated subjective comprehension, anxiety, satisfaction, information location and consent rates. One hundred sixty-three (82%) patients completed any assessments after consent discussion for the parent trial and 152 (77%) were evaluable for the primary endpoint. Patient demographics including annual household income, education level and health literacy scores were balanced between the two arms. Mean (±SD) QuIC-A scores were comparable between the two arms (80.5±8.7 ETRIC form, 81.8±9.5 standard form, P=0.37). In regression analysis that adjusted for the effects of potential confounders, there was no significant association between the consent type and the QuIC-A score (P=0.57). There were no significant differences in subjective comprehension scores, anxiety related to consent process, satisfaction with the consent process, information location times and consent rates on parent clinical trials. There were no significant interactions between the consent type and age, household income, education level, health literacy scores or parent trial protocol. In the parallel evaluation study, two trained moderators conducted semi-structured interviews of 49 site investigators, research staff, IRB members and legal/regulatory staff at 9 BMT CTN transplant centers to understand barriers and facilitators to implementation of the ETRIC form. Sequential, transcript-based qualitative analysis was performed by two experienced coders using NVivo 10 software. Inter-coder agreement was high (kappa=0.90). Several dominant themes were identified; there was general comfort and willingness to utilize the ETRIC template and interviewees suggested that formatting and layout enhancements of the ETRIC form would offer additional value to research participants, investigators and IRBs. Several perceived barriers to local implementation were identified including center IRB/legal language preferences and requirements, length, and prior experience with alternative consent formats. A need for educational resources for researchers, staff and IRB members for implementing the ETRIC form was also identified. In conclusion, the formatting enhancements of the ETRIC form did not alter comprehension, anxiety, satisfaction, information location or consent rates for BMT CTN clinical trials. Despite local challenges to implementation, BMT CTN center investigators, research staff and IRBs generally viewed the ETRIC form favorably, were comfortable using it, were pleased to have a resource that is ‘easy-to-read’, and expressed a willingness to utilize ETRIC over standard consent form. DisclosuresMajhail:Sanofi: Honoraria; Anthem, Inc.: Consultancy.