Health Information National Trends Survey Research Articles

Climate change perception and its association with cancer screening intent.

As the climate crisis deepens, its adverse effects on human health are becoming evident, including impacts on cancer pathogenesis and treatment. This study explored the link between individuals' awareness of the health impacts of climate change and interest in cancer screening. Using the 2021 Health Information National Trends Survey, our study demonstrated astatistically significant association between recognition of climate change as a personal health threat and interest in cancer screening. Although the study's retrospective nature and self-reported data pose some limitations, these findings signal a promising avenue for future research on the intersection of climate and cancer risk. This research supports the development of public health interventions that incorporate components of environmental health literacy alongside cancer screening efforts.

The association between electronic health information usage and patient-centered communication: a cross sectional analysis from the Health Information National Trends Survey (HINTS)

BackgroundPatient-provider communication can be assessed by the patient-centered communication (PCC) score. With rapid development of electronic health (eHealth) information usage, we are uncertain of their role in PCC. Our study aims to determine the association between PCC and eHealth usage with the analysis of national representative survey data.MethodsThis is a cross sectional analysis using the Health Information National Trends Survey 5 (HINTS 5) cycle 1 to cycle 4 data (2017–2020). Seven specific questions were used for PCC assessment, and eHealth usage was divided into two types (private-eHealth and public-eHealth usage). A multivariate logistic regression was performed to determine the association between PCC and eHealth usage after the adjustment of other social, demographic, and clinical variables.ResultsOur study analyzed a total of 13,055 unweighted participants representing a weighted population of 791,877,728. Approximately 43% of individuals used private eHealth and 19% used public eHealth. The adjusted odds ratio (AOR) of private-eHealth usage associated with positive PCC was 1.17 (95% CI 1.02–1.35, p = 0.027). The AOR of public-eHealth usage associated with positive PCC was 0.84 (95% CI 0.71–0.99, p = 0.043).ConclusionOur study found that eHealth usage association with PCC varies. Private-eHealth usage was positively associated with PCC, whereas public-eHealth usage was negatively associated with PCC.

Impact of family history of cancer on colorectal cancer screening: a propensity score-matched analysis from the Health Information National Trends Survey (HINTS)

BackgroundEarly detection of colon cancer leads to better survival outcomes. This can be achieved through colorectal cancer (CRC) screening. People with a family history of cancer (FHC) have increased risk of developing CRC. Increasing screening in this group will reduce CRC mortality. This study evaluated CRC screening in people with FHC.MethodsThe study used data from the Health Information National Trends Survey (HINTS) 5, cycle 3. This is an annual cross-sectional survey with a nationally representative sample of American adults. The objective was to study the association between FHC and performing CRC screening. Propensity score matching was used to create a matched population with variables that constituted beliefs in cancer from the survey. Replication procedure, which is based on repeated sampling and allows for accurate computation of standard errors, was used for calculating statistical tests. Multivariable models were fitted in the matched population to assess the association between FHC and performing CRC screening.ResultsPeople with FHC were 14% (OR = 1.14; 95% CI: 0.81–1.60) more likely to perform CRC screening than those without FHC, even though not statistically significant. Age in years (OR = 1.14; 95% CI: 1.12–5.27) had increased likelihood of performing CRC screening, while other races such as American Indians/Alaskan Natives (except African Americans) compared to Caucasians (OR = 0.49; 95% CI: 0.29–0.84) had significantly decreased likelihood of performing CRC screening.ConclusionFHC was not significantly associated with having a colorectal cancer screening test. Public health advocacy should be directed towards increasing awareness of CRC screening among people with FHC.

Examining the existing usage gap of electronic health records in the United States: A study of National Health Survey

BackgroundLittle is known about the extent of geographic variation in online health record usage and related demographic characteristics in the United States. MethodsIn order to examine geographical variation in the usage of online e-health records (EHR) patient portals in the US, and the sociodemographic factors effects on the access and use of the EHR patient's portal. This study using data from the 2019 and 2020 Health Information National Trends Survey. Specifically, predictors associated with accessing patients' EHR portal were examined. Furthermore, geographic variation of EHR portal’ availability and usage gap were examined and mapped. ResultsRespondents had significantly higher likelihood to access EHR portals when they are higher educated, willing to seek health information online, insured and had regular providers (adjusted OR = 2.01, 95% CI: 1.44 – 2.80; adjusted OR = 3.51, 95% CI: 2.49 – 4.94; adjusted OR = 2.38, 95% CI: 1.05 – 5.43; adjusted OR = 2.1, 95% CI: 1.51 – 2.92, respectively). Individuals living in Central-West, South regions or other non-urban areas as well as deprived urban areas are less likely to access their EHR portals (adjusted OR = 0.6, 95% CI: 0.41 – 0.89). Furthermore, we found that people living in the Midwest, Southern regions, and Mountain rural areas are more likely to have greater difficulties to access EHR than other regions. Therefore, populations residing in these underserved (deprived urban, rural or remote) areas tend to face more considerable obstacles to e-healthcare. ConclusionsImprove the disparities, accessibility, and educational initiatives on the usage of eHealth resources and encouragement from both healthcare providers and policymakers should be implemented with a particular focus on targeting non-urban areas and underserved population.

Socioeconomic and clinical risk factors associated with moderate intensity physical activity before and during the COVID-19 pandemic

Although moderate intensity physical activity (MIPA) improves general mental health, morbidity, and mortality, the COVID-19 pandemic may have adversely impacted individuals’ ability to engage in MIPA. We examined the extent of socioeconomic factors, body mass index, anxiety/depression, and cancer diagnosis associated with MIPA before and during the COVID-19 pandemic. Multivariable logistic regression models were conducted on 4,551 U.S. adults aged 18–64 years using nationally representative samples from the 2019 and 2020 Health Information National Trends Survey datasets. The prevalence of MIPA before the pandemic was higher (77.07%) than during the pandemic (76.21%). Before the COVID-19 pandemic, lower odds of MIPA were observed for individuals with fair/poor health (OR = 0.24, 95% CI = 0.27, 0.63), obesity (OR = 0.51, 95% CI = 0.33, 0.79), anxiety/depression (OR = 0.60, 95% CI = 0.42, 0.85), or a cancer diagnosis (OR = 0.56, 95% CI = 0.32, 0.98). During the pandemic, lower odds were observed among those with obesity (OR = 0.44, 95% CI = 0.28, 0.70), anxiety/depression (OR = 0.61, 95% CI = 0.43, 0.86), less than high school education (OR = 0.33, 95% CI = 0.16, 0.70), or family income of $20,000 - $34,999 (OR = 0.42, 95% CI = 0.24, 0.74). There was a decline in MIPA during the pandemic, with certain subgroups, such as individuals of lower socioeconomic and physical and mental health status, less likely to engage in MIPA. This study highlights the need for concerted physical activity educational strategies aimed at improving access to and utilization of MIPA within subgroups to reduce MIPA disparities, particularly among disadvantaged groups during pandemics.

Abstract PR011: Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi

Abstract Background: This study aims to investigate cancer-related knowledge, attitudes, and beliefs among Pacific Islanders and Native Hawaiians in Hawaiʻi by examining social factors that influence healthcare utilization behaviors for cancer screenings. The National Cancer Institute developed the Health Information National Trends Survey (HINTS) to collect national data about the use of cancer-related information, access, as well as changing patterns and communications trends regarding health practices. However, HINTS data are not sufficient to address historically excluded demographic subpopulations as each year, an average of 7,393 Hawai‘i residents are diagnosed with invasive cancer and rates are disproportionate ethnically. Methods: We administered a cross-sectional survey during 2017-2018 to Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling (RDS) to recruit these geographically hard-to-reach groups. The modified HINTS survey included questions about cancer knowledge, attitudes, behaviors, social interactions, and cultural practices. A total of 515 Native Hawaiians, 305 Chuukese, and 180 Marshallese completed the survey. Differences were found across a variety of cancer and health-related attitudes, knowledge, and behaviors. The Gelberg and Anderson (2000) Behavioral Model for Vulnerable Populations and biculturalism guided the theoretical and conceptual models for analysis. Logistic regression analysis was used adjusting for age, income, health insurance, and occupational status, to measure social constructs of interest and their interaction with colorectal, pap test, and mammography cancer screenings. To triangulate these findings, key thematic analyses were included from thirteen interviews with adults living within the communities first surveyed. Results: Significant multivariable influences on not having a pap test included never being married (P=.004) and having no health insurance (P<.0001); while influences over having a pap test included a high ethnic identity (P=.001). Significant influences over not having a mammogram included never being married (P=.04), having no health insurance (P<.0001), and not currently employed (P=.009). Significant influences on never having a test for colon cancer included being semi-religious (P=.0001), having no health insurance (P=.005), and not being able to rely on physicians (P=.02). Key findings relating to cancer screenings from the interviews included fear of finding out, lack of language assistance, limited discussion within social circles relating to health and cancer practices, and a belief in a higher intervening power. Conclusion: Cancer prevention education and culturally tailored programs are greatly needed for Pacific Islander and Native Hawaiians in Hawaiʻi. This study provides insight into influences, both positive and negative, on cancer screenings for these communities and areas for future cancer prevention/intervention efforts. Citation Format: Mark L. Willingham Jr., Kevin D. Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Angelina G. Mummert, Wei Zhang. Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR011.

Abstract C140: A population-based analysis of awareness and knowledge of HPV and HPV vaccine among Asian American adults by origin group, 2014-2019

Abstract Background: Awareness and knowledge of human papillomavirus (HPV) and HPV vaccine are critical antecedents of HPV vaccine uptake. While emerging literature has examined racial and ethnic differences in these areas, most either exclude Asian Americans, subsume them under the category of “other,” or aggregate all origin groups under a single category of “Asians.” To fill this gap in the literature regarding data disaggregation, we conducted an analysis of awareness and knowledge of HPV, the HPV vaccine, and HPV-related cancers among six Asian origin groups (Chinese, Filipinos, Indians, Japanese, Koreans, and Vietnamese), using nationally representative samples. Methods: We performed a pooled cross-sectional study utilizing the Health Information National Trend Survey data (HINTS-4 cycle 4 [2014], HINTS-5 cycles 1-3 [2017-2019]), a nationally representative survey administered by the National Cancer Institute. We analyzed questions about knowledge of HPV, the HPV vaccine, and the facts that HPV causes cervical, oral, anal, and penile cancers by race and/or ethnicity. The sample included those who self-reported as Chinese, Filipino, Indian, Japanese, Korean, or Vietnamese origins; non-Hispanic White (NHW) respondents were the reference group. We used survey-design adjusted Wald chi-square tests. Results: A total of 8,865 non-Hispanic White respondents and 623 Asian respondents were included in this study. Significantly lower proportions of most Asian origin groups (Chinese 45.5%; Indian 45.6%; Korean 39.7%; and Vietnamese 43.5%) had heard of HPV compared with NHW counterparts (69.4%). Significantly lower proportions of Chinese (50.9%), Filipino (47.0%) Korean (46.1%), and Vietnamese (38.8%) respondents had heard of the HPV vaccine compared with NHW respondents (68.1%). Significantly lower proportions of Chinese (41.0%), Indian (36.2%), Korean (32.9%), and Vietnamese (30.6%) respondents knew that HPV causes cervical cancer compared with NHW (55.7%). Significantly lower proportions of Chinese and Vietnamese respondents knew that HPV causes anal and oral cancers, and significantly lower proportions of Indian respondents knew that HPV causes penile cancer, when compared to NHW counterparts. Discussion: Most Asian origin groups had lower knowledge of HPV-related facts, with varying magnitudes, compared with NHW counterparts. Vietnamese and Chinese respondents had significantly lower knowledge compared with NHW respondents for 5 out of 6 questions. For most questions, Vietnamese was the group with the lowest proportions of respondents reporting knowledge. Heterogeneity in HPV-related knowledge suggests the need to culturally tailor interventions about the HPV vaccine in appropriate languages to effectively reach different Asian origin groups, with particular attention to those with low awareness. Continued monitoring of HPV-related knowledge with disaggregated data collection for Asian origin groups is critical for efforts to increase educational outreach, combat vaccine misinformation, and improve HPV vaccine uptake. Citation Format: Milkie Vu, Yenan Zhu, Duy D. Trinh, Young-Rock Hong, Ryan Suk. A population-based analysis of awareness and knowledge of HPV and HPV vaccine among Asian American adults by origin group, 2014-2019 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C140.

The frequency of using wearable activity trackers is associated with minutes of moderate to vigorous physical activity among cancer survivors: Analysis of HINTS data

BackgroundDespite the health benefits, cancer survivors tend to exercise less after diagnosis and treatment. Wearable activity trackers (WATs) can provide avenues for self-monitoring and may enhance exercise motivation and enjoyment. However, less is known about the relationship between how often survivors use wearables and their amount of moderate to vigorous physical activity (MVPA). MethodsData was utilized from the National Cancer Institute’s Health Information National Trend Survey 5 Cycles 3–4 (January 2019 – June 2020). To account for overdispersion and excessive zeros in the outcome variable (weekly minutes of MVPA), a zero inflated negative binomial regression model was used. ResultsThe majority of the sample (n = 1369) were female (n = 735, 53.7 %), non-Hispanic White (n = 961, 70.2 %) and 34.3 % (n = 664) were between the ages of 65–74 years. Non-melanoma skin cancer was the most frequently reported cancer type (n = 334, 24.4 %) and 48.5 % (n = 664) reported that it had been 11 + years since their diagnosis. Survivors who reported daily WAT use were estimated to have 3.53 times higher number of MVPA minutes per week compared to survivors who reported non-daily WAT usage (RR: 3.53, 2.76–4.53, p = <0.001). Based on the model, daily WAT users had an expected mean MVPA of 202 min per week (95 % CI: 191.15–226.59) compared to non-daily users (132 min, 95 % CI: 119.81–140.22) and non-WAT users (88 min, 95 % CI: 84.46–92.50). ConclusionAccording to this model, survivors who reported daily WAT use were estimated on average to have weekly MVPA minutes that meet or exceed MVPA recommendations (>= 150 min of MVPA per week) compared to survivors who reported infrequent or no WAT use. Wearables may provide an opportunity for survivors to engage in self-monitoring and can potentially support exercise tracking and engagement.

Informing Patient-Provider Engagement for Shared Decision Making Through Mobile Health Applications.

The study utilized a cross-sectional dataset to identify demographic and health factors associated with patient utilization of mHealth applications for engaging with healthcare providers. The focus was on adults with chronic health conditions as the primary app user group. The goal was to reveal specific barriers and facilitators to app adoption among smartphone users, with the aim of highlighting opportunities for upgrades that promote patient empowerment as a prerequisite for shared decision-making (SDM). Data from the Health Information National Trends Survey (HINTS 5, Cycle 4, 2020) with 3865 respondents (≥18 years old) stratified analyses and weighted logistic regression were used. The study found that individuals having a wellness app on a smartphone increased the likelihood (OR 2.68, CI: 2.02-3.56, p-value < 0.0001) of discussing health conditions with providers. Furthermore, individuals with multiple chronic health conditions were more likely (OR 1.93, CI 1.26-2.95, p-value < 0.01) to use apps to use mobile health applications to engage with healthcare providers. Other significant variables affecting app usage such as race, marital status, and educational level. Due to difficulties obtaining in-person healthcare, the COVID-19 epidemic forced a swift deployment of mHealth technologies. Even in the absence of a crisis, mobile health applications continue to be crucial for improving patient-provider engagement and developing novel approaches to healthcare delivery. During the pandemic, people with numerous chronic diseases used apps to stay in touch with doctors and maintain their reliance on these platforms. Nonetheless, different smartphone users continue to use mHealth application in different ways. The findings revealing barriers in mHealth app adoption among certain patient subgroups suggest opportunities for developers, in collaboration with users and providers, to enhance inclusion and acceptability when upgrading mHealth application platforms.

Abstract A089: Examining the role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations: Evidence from a national representative sample

Abstract The role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations has not been systematically examined among adults in the United States adults despite the influential role of SDoH in shaping individuals' health behaviors and outcomes. Our purpose was to explore the effects of SDoH on adherence to cancer prevention recommendations among adults in the United States Methods: We used data from the Health Information National Trends Survey (HINTS), 6 cycle (2022). Adults aged 18 years and above were included. Adherence to cancer prevention recommendations was measured with the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations Score. SDoH was measured based on the American Cancer society's five core SDOH domains (economic stability, social and community context, neighborhood and built environment, education access, and healthcare access). Weighted hierarchical multiple regression models were conducted using each domain of SDOH as a block, controlling for age, gender, race, selfcare efficacy, cormorbidity, cancer risk perception and belief about cancer, Jackknife replicate weights were incorporated into the analyses. Results: The sample consisted of 6252 respondents with a mean age of 55.6 (SD, 17.4) years, The estimated mean adherence rate to cancer prevention recommendations among adults in the United States was 40.4% (SD 21.8) .Adherence to cancer prevention recommendations was positively associated with having a college education compare to less than high school education (Odd Ratio [OR], 6.29, P = .019), combined household income of $75,000 and above compare to combined household income of less than $20,000 ( OR, 5.11 , P= .014) , retired compared to full-time employement ( OR, 4.87, P &amp;lt; .001), access to health insurance compared to lack of health insurance (OR, 4.01, P= .020). These findings suggest that interventions targeting the effects of SDoH on cancer on adherence to cancer prevention recommendations may consider the socioeconomic context of targeted individuals. Such interventions should focus on addressing barriers related to education access, income stability, employment status and healthcare access. Citation Format: Adaeze Aroh, Ifeanyi N. Madujibeya. Examining the role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations: Evidence from a national representative sample [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A089.

Abstract A074: Cancer fatalism among Asian American adults by origin group, 2014-2022

Abstract Background: Cancer fatalism encompasses beliefs about external causes of cancer and the perceived inability of humans to prevent it. Existing research suggests that individuals with higher levels of cancer fatalism are less likely to engage in cancer prevention behaviors or adhere to cancer screening practices. However, limited information exists regarding the prevalence of cancer fatalism within various Asian origin groups. Understanding whether this prevalence varies by origin group can offer valuable insights for developing strategies to enhance beliefs and knowledge about cancer among these populations, ultimately leading to improved health outcomes. To fill this gap in the literature, we conduct a disaggregated analysis of cancer fatalism among Asian origin groups (Chinese, Filipino, Indian, Vietnamese, and other Asian respondents), using nationally representative samples. Methods: We performed a pooled cross-sectional study utilizing the Health Information National Trend Survey data (HINTS-4 cycle 4 [2014], HINTS-5 cycles 1-3 [2017-2019], and HINTS-6 [2022]), a nationally representative survey administered by the National Cancer Institute. We analyzed respondents’ agreement to two items: “It seems like everything causes cancer”; and “There’s not much you can do to lower your chances of getting cancer.” We used a survey-design adjusted Wald chi-square test for bivariate analyses. Results: The sample included 234 Chinese respondents, 173 Filipino respondents, 185 Indian respondents, 97 Vietnamese respondents, and 222 other Asian respondents (e.g., Korean, Japanese). Significantly lower proportions of Indian respondents (38.9%; 95% CI 26.1 – 51.8%) endorsed the statement “It seems like everything causes cancer,” when compared with Vietnamese respondents (70.4%; 95% CI 54.9% – 86.0%) and Filipino respondents (76.2%; 95% CI 65.1% – 87.4%). Additionally, lower proportions of Indian and Chinese respondents endorsed the statement “There’s not much you can do to lower your chances of getting cancer” when compared with Vietnamese and Filipino respondents, though these differences did not reach statistical significance. Conclusions: Our study represents one of the first efforts to use nationally representative data to explore disaggregated prevalence of cancer fatalism beliefs among Asian American origin groups. Filipino adults exhibit nearly double the prevalence of one of the cancer fatalism beliefs compared to Indian adults. Vietnamese adults also have a high level of cancer fatalism beliefs. These findings highlight the heterogeneity among Asian American origin groups and emphasize the importance of culturally tailored interventions, specifically targeting those groups with higher levels of fatalism beliefs. Data collection that is disaggregated by Asian origin group should be prioritized to gain a comprehensive understanding of these beliefs and design effective interventions. Citation Format: Milkie Vu, Yenan Zhu, Ryan Suk. Cancer fatalism among Asian American adults by origin group, 2014-2022 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A074.

Associations between Health-Related Use of Social Media and Positive Lifestyle Behaviors: Findings from a Representative Sample of US Adult Smokers

Background: Cigarette smokers have elevated cardiovascular risk factors, which contributes significantly to mortality. Although social media is a potential avenue to deliver smoking interventions, its role in health promotion among smokers remains relatively unexplored.Objective: To examine the uptake and impact of health-related social media use in cigarette smokers.Methods: Using data from the 2017–2020 Health Information National Trends Survey, we evaluated differences in health-related social media use between smokers and nonsmokers. Multivariable logistic regression was performed to examine the association between social media use and positive health behaviors.Results: We included 1863 current smokers and 13,560 nonsmokers; Most participants were women (51.0%), White (64.6%), and 49.2% were aged ≥50 years. Smokers who used ≥1 social media site for health-related purposes in the past year were significantly more likely to meet the guideline recommendations for: (i) weekly physical activity (AOR 2.00, 95% CI 1.23–3.24), (ii) daily vegetable intake (AOR 2.48, 95% CI 1.10–5.59), and (iii) weekly strength training (AOR 1.80, 95% CI 1.10–2.94). However, the odds of reporting intentions to quit smoking (AOR 1.81, 95% CI 0.98–3.34) and attempts at smoking cessation (AOR 1.68, 95% CI 0.90–3.12) did not differ by health-related social media use.Conclusion: Smokers use social media for health-related purposes at comparable rates to nonsmokers. While our findings indicate that these platforms present a novel opportunity for health promotion among smokers, future research exploring the utility of social media in smoking cessation is crucial.

Associations Between Cancer Risk Perceptions, Self-Efficacy, and Health Behaviors by BMI Category and Race and Ethnicity.

Cancer risk perceptions and high health-related self-efficacy may impact health behaviors and reduce risk of developing obesity-related cancers. The purpose of this study was to examine whether there are differences in associations among cancer risk perceptions, health-related self-efficacy, and health behaviors between people with healthy weight (PwHW) and people with overweight or obesity (PwO/O), and whether these associations vary by race and ethnicity. Data from the Health Information National Trends Survey (HINTS) 5 Cycles 2 and 3 were used. Data from 6944 adults were analyzed using multivariate logistic regression to assess associations among study variables. PwO/O who believed there are too many cancer prevention recommendations had lower log odds of meeting guidelines for strength training (β - 0.28; CI - 0.53 to - 0.04; p < 0.05) compared to PwHW. PwO/O who believed that obesity influences cancer risk were associated with low sedentary behavior (β 0.29; CI 0.05-0.54; p < 0.05) compared to PwHW. NHB PwO/O who held fatalistic beliefs and reported high self-efficacy ordered less food (e.g., fewer food items, foods with less calories, or smaller food sizes) compared to NHB Pw/HW (p < 0.05). Health behavior differences in PwHW and PwO/O may be associated with differences in cancer risk beliefs and health-related self-efficacy. Findings support the need for further research considering BMI and race and ethnicity in obesity-related cancer prevention and control.

Prevalence and associations of poor mental health in the third year of COVID-19: U.S. population-based analysis from 2020 to 2022

BackgroundPoorer mental health was found early in the COVID-19 pandemic, yet mental health in the third year of COVID-19 has not been assessed on a general adult population level in the United States. MethodsWe used a nationally representative cross-sectional survey (Health Information National Trends Survey, HINTS 5 2020 n = 3,865 and HINTS 6 2022 n = 6,252). The prevalence of poor mental health was examined using a Patient Health Questionnaire-4 scale in 2020 and 2022. We also investigated the factors associated with poor mental health in 2022 using a weighted multivariable logistic regression adjusting for sociodemographic and health status characteristics to obtain the odds ratio (OR). OutcomesThe prevalence of poor mental health in adults increased from 2020 to 2022 (31.5% vs 36.3 %, p = 0.0005). U.S. adults in 2022 were 1.28 times as likely to have poor mental health than early in the pandemic. Moreover, individuals with food insecurity, housing instability, and low income had greater odds of poor mental health (ORs=1.78–2.55). Adults who were females, non-Hispanic Whites, or age 18–64 years were more likely to have poor mental health (ORs=1.46–4.15). InterpretationMental health of U.S. adults worsened in the third year of COVID-19 compared to the beginning of the pandemic.

Chronic Health Conditions and Patient Portal Use in Caregivers of People With Alzheimer's Disease and Related Dementias.

This study aimed to investigate both chronic health conditions and the utilization of patient portals, focusing particularly on caregivers responsible for individuals with Alzheimer's disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2018-2020 were analyzed, involving a sample of 304 family and unpaid caregivers of individuals with ADRD. Among caregivers of individuals with ADRD, 77.6% had at least one chronic disease. A significant proportion (46.6%) of ADRD caregivers had never accessed their patient portals. The limited utilization of patient portals among caregivers responsible for individuals with ADRD, particularly those with lower education, advanced age, and few chronic conditions, becomes apparent due to challenges associated with digital literacy and discomfort with computers. Recognizing the crucial role caregivers play for individuals with ADRD and their health risks, there's a need for tailored training to enhance their health management skills and caregiving capabilities.

Human Papillomavirus Awareness by Educational Level and by Race and Ethnicity

ImportanceUnderstanding disparities in human papillomavirus (HPV) awareness is crucial, given its association with vaccine uptake.ObjectiveTo investigate differences in HPV awareness by educational attainment, race, ethnicity, and their intersectionality.Design, Setting, and ParticipantsThis cross-sectional study used the Health Information National Trends Survey (HINTS) 5 cycles 1 to 4 data (January 26, 2017, to June 15, 2020). The data were analyzed from December 12, 2022, to June 20, 2023. A sample of the noninstitutionalized civilian US population 18 years or older was included in the analysis.Main Outcomes and MeasuresWeighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cancer, stratified by educational attainment and by race and ethnicity. Interaction between educational attainment and race and ethnicity was assessed using a Wald test.ResultsA total of 15 637 participants had educational attainment data available; of these, 51.2% were women, and the median age was 58 (IQR, 44-69) years. A total of 14 444 participants had race and ethnicity information available; of these, 4.6% were Asian, 13.9% were Black, 15.3% were Hispanic, 62.6% were White, and 3.6% were of other race or ethnicity (including American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and more than 1 race or ethnicity). Awareness of HPV by educational attainment ranged from 40.4% for less than high school to 78.2% for college or higher; awareness by race and ethnicity ranged from 46.9% among Asian individuals to 70.2% among White individuals. Awareness of HPV vaccines across educational attainment ranged from 34.7% among those with less than high school to 74.7% among those with a college degree or higher and by race and ethnicity from 48.4% among Asian individuals to 68.2% among White individuals. Among adults who were aware of HPV, knowledge that HPV causes cervical cancer differed by educational attainment, ranging from 51.7% among those with less than high school to 84.7% among those with a college degree or higher, and by race and ethnicity, ranging from 66.0% among Black individuals to 77.9% among Asian individuals. The interaction between educational attainment and race and ethnicity on HPV awareness and HPV vaccine awareness was not significant; however, within each educational attainment level, awareness differed by race and ethnicity, with the lowest awareness consistently among Asian individuals regardless of educational attainment. Within each racial and ethnic group, HPV awareness and HPV vaccine awareness significantly decreased with decreasing educational attainment.Conclusions and RelevanceDisparities in HPV awareness were evident across social factors, with the lowest awareness among Asian individuals and individuals with lower educational attainment. These results emphasize the importance of considering social factors in HPV awareness campaigns to increase HPV vaccination.

Social media and partnership jointly alleviate caregivers’ psychological distress: exploring the effects of online and offline connectedness

BackgroundThe prevalence of caregiving in the United States has increased from 16.6% to 19.2% during the period between 2015 and 2020. Caregivers play a critical public health role post-pandemic and as the population ages. However, caregiving can be detrimental to the health of caregivers. Many studies have shown that communication and connectedness are effective forms of health intervention for caregivers, but how this can be achieved requires further investigation.ObjectiveThis study aimed to investigate the indirect effect of caregiving on problems of alcohol drinking through psychological distress. Moreover, this study aimed to provide initial evidence of the distinct effects of online and offline communication and connectedness on caregivers' well-being.MethodsThe predictions were evaluated by examining responses to the Health Information National Trends Survey 2020 (n = 3,865). A mediation analysis was conducted to test the mediating effect of psychological distress on the association between caregiving and alcohol drinking. A second-level moderation analysis was performed. The online communication and connectedness, social media use for health, and the offline type, marital or romantic partnership, were tested as moderators to lessen the psychological distress of caregiving.ResultsA competitive mediation was identified. We found a positive indirect effect from caregiving to alcohol drinking mediated by psychological distress (bp = .0017, p < .05) but a negative direct effect from caregiving to alcohol drinking (bp = -.0340, p < .05). Furthermore, the study reported a strongly positive effect of moderated moderation on the linkage from caregiving to psychological distress. The negative impact of caregiving on mental distress was greater among those who used social media less, particularly those without a romantic or marital partner.ConclusionsThe findings indicate that caregivers experience more mental distress, which leads to risky behavior. This study highlights the crucial role of both online and offline connectedness in mitigating the adverse consequences of caregiving.

Racial differences in knowledge, attitudes, and sources of information about germline cancer genetic testing in the U.S.A.: An analysis of the health information National Trends Survey System

PurposeTo understand racial disparities in germline cancer genetic testing and the role of prior knowledge, attitudes, and sources of information. MethodsA cross-sectional analysis of the Health Information National Trends Survey 5 (HINTS 5) was conducted between February 24th and June 15th, 2020. The study aimed to investigate knowledge and receipt of genetic testing, attitudes toward the importance of genetic testing in preventing, detecting, and treating cancer, and information sources of genetic testing in the United States of America. ResultsNon-Hispanic Black (NHB) and Hispanic race/ethnicity were associated with lower odds of being informed about genetic testing, whereas those of NHB race were more likely to endorse the importance of genetic testing in cancer prevention and treatment. Regarding sources of information about genetic testing: Non-Hispanic Asians were less likely to be informed about genetic testing from television (Mean Predicted Probability (MPP) 0.38 95%CI; 0.21–0.55, (Adjusted Risk Difference) ARD vs. Non-Hispanic White (NHW); −0.228, p = 0.01), NHB were less likely to report being informed about genetic testing from social media (MPP 0.27 95%CI; 0.20–0.34, ARD vs. NHW; −0.139, p < 0.01). ConclusionsNHB and Hispanic groups face unequal access to information about genetic testing. There are significant race-based differences in information sources. These differences could be used to promote equitable access to cancer genetic testing.

Progress and Persistent Disparities in Patient Access to Electronic Health Information

Patient access to electronic health information (EHI) available via online medical records and through patient portals has been shown to help individuals make informed health decisions, which are associated with better health outcomes. To assess progress in patient engagement with EHI and to identify racial or ethnic disparities in access to patient portals. This was a repeated cross-sectional study using data from the US Health Information National Trends Survey (HINTS), a nationally representative survey of US adults that tracks individuals' access and use of their health information. Six cycles of HINTS were included (2014, 2017-2020, 2022); data for the disparities analysis came from the 2022 HINTS. Data analyses were performed in April 2023. Patient reports of (1) being offered portal access by a health care provider (HCP); (2) being encouraged by the HCP to use the portal; (3) accessing their portal; and (4) using the portal for various purposes. Additional key measures included methods used to access portals and self-reported ease of understanding information contained in the online medical records or portals. The total study population included 22 266 individuals (mean [SE] age, 49.9 [0.15] years) of whom 13 348 (54%) were female; 909 (5%) self-identified as Asian, 3523 (12%) as Black, 3178 (14%) as Hispanic, 13 555 (66%) as White, and 785 (3%) as another or more than 1 race. Nationally, patient portal access increased each year from 2014 through 2022, with a 46% increase observed between 2020 (n = 3319) and 2022 (n = 5437). However, in 2022, Black and Hispanic individuals reported being offered access to a portal by their HCP at significantly lower rates compared with White individuals (73% vs 81%; χ21 = 22.24; P < .001; and 62% vs 81%; χ21 = 135.57; P < .001, respectively) as well as accessing a patient portal at lower rates (60% vs 70%; χ21 = 23.80; P < .001; and 57% vs 70%; χ21 = 49.02; P < .001, respectively). The findings of this repeated cross-sectional study of US adult respondents to the HINTS suggest that access to and engagement with patient portals increased significantly from 2014 through 2022, but racial and ethnic disparities in patient access persisted in 2022. However, there were no significant differences in use or understanding of information available in the online medical records among those who accessed them, which suggests that efforts to promote equitable opportunities to access EHI would likely be associated with increased patient access.

Knowledge of the health consequences of heavy alcohol consumption among individuals with different substance use statuses: A cross-sectional analysis of 2019 HINT Survey.

The aim of this study was to assess and compare knowledge of the health consequences of heavy alcohol consumption among individuals with different substance use statuses. We used a cross-sectional study design to analyze the Health Information National Trends Survey (HINTS) 5, Cycle 3 (2019). Participants were classified into four categories based on their substance use status: (a) nonsmoker and nondrinkers; (b) nonsmokers but drinkers; (c) smokers but nondrinkers; and (d) smokers and drinkers. Weighted logistic regression models were utilized to evaluate the association between knowledge of heavy alcohol consumption and health conditions by participants' substance use status. More than 79% of participants were aware that drinking too much alcohol causes liver disease. However, less than 40% of them realized that heavy alcohol consumption also contributes to cancer. The odds of correctly identifying heavy alcohol consumption as a risk factor for diabetes were 3.00 times (95% confidence interval (CI): 1.29,7.00) higher among smokers but nondrinkers than smokers and alcohol drinkers. Education level was significantly associated with participants' awareness of risk factor (p < 0.01). There is an urgent need for targeted educational campaigns and interventions to increase understanding of the impact of heavy alcohol consumption on cancer risk.