Health Information National Trends Survey Research Articles

The impact of social media on guideline-concordant cervical cancer–screening: insights from a national survey

ObjectivesCervical cancer is one of the leading causes of cancer mortality in women, yet routine screenings lead to early detection and sometimes even prevention. Screening is an effective way to prevent cervical cancer, and it has been implemented in many countries and regions worldwide, especially in developed countries. However, the incidence of cervical cancer remains a public health problem due to screening disparities in the population. Social media engagement and overloading of online health information may be the cause of this disparity. Study designCross-sectional study. MethodsData from the Health Information National Trends Survey (a national survey conducted by the National Cancer Institute) was used to characterise cervical cancer screening into two dimensions; namely, high-frequency screening and guideline-concordant screening. The differences between these two screening frequency behaviours were compared by applying ordered logistic regression and binary logistic regression, and the mechanisms of guideline-concordant screening were explored. ResultsThe factors influencing high-frequency screening and guideline-concordant screening were different. Only self-efficacy (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 0.98, 1.37) had a significant positive association with the high-frequency screening behaviour. Social media engagement (OR = 0.57; 95% CI = 0.33, 0.96) was shown to have a significant negative impact on guideline-concordant screening. A theory-based mechanism of screening behaviour found that traditional health perception factors no longer influence guideline-concordant screening behaviour, whereas environmental factors (e.g., social media) significantly reduce guideline-concordant screening behaviour. ConclusionsThe results from this study indicate that while the internet has become the main channel through which women acquire health resources, and social media has become a main platform for people to obtain health information, online information cannot guide people to engage in appropriate healthy behaviours. Overloading of online health information and the digital divide may lead to excessive screening. Consequently, it is important to address the screening disparity caused by health behaviours as a result of environmental factors and the digital divide.

Patient-Provider Discussion About Lung Cancer Screening by Race and Ethnicity: Implications for Equitable Uptake of Lung Cancer Screening

BackgroundPhysician-patient discussions regarding lung cancer screening (LCS) are uncommon and its racial and ethnic disparities are under-investigated. We examined the racial and ethnic disparities in the trends and frequency of LCS discussion among the LCS-eligible United States (US) population. MethodsWe analyzed data from the Health Information National Trends Survey from 2014 to 2020. LCS-eligible individuals were defined as adults aged 55 to 80 years old who have a current or former smoking history. We estimated the trends and frequency of LCS discussions and adjusted the probability of having an LCS discussion by racial and ethnic groups. ResultsAmong 2136 LCS-eligible participants (representing 22.7 million US adults), 12.9% (95% CI, 10.9%-15%) reported discussing LCS with their providers in the past year. The frequency of LCS discussion was lowest among non-Hispanic White participants (12.3%, 95% CI, 9.9%-14.7%) compared to other racial and ethnic groups (14.1% in Hispanic to 15.3% in non-Hispanic Black). A significant increase over time was only observed among non-Hispanic Black participants (10.1% in 2014 to 22.1% in 2020; P = .05) and non-Hispanic Whites (8.5% in 2014 to 14% in 2020; P = .02). In adjusted analyses, non-Hispanic Black participants (14.6%, 95% CI, 12.3%-16.7%) had a significantly higher probability of LCS discussion than non-Hispanic Whites (12.1%, 95% CI, 11.4%-12.7%). ConclusionPatient-provider LCS discussion was uncommon in the LCS-eligible US population. Non-Hispanic Black individuals were more likely to have LCS discussions than other racial and ethnic groups. There is a need for more research to clarify the discordance between LCS discussions and the actual screening uptake in this population.

Disparities in HPV and the HPV Vaccine Knowledge Among Non-Hispanic Black Adults in the US - HINTS 2017-2020.

Disparities persists in HPV awareness and vaccination among different racial and ethnic groups. We assessed disparities in awareness of HPV and the HPV vaccine among non-Hispanic Black US adults. We analyzed the nationally representative data from the Health Information National Trends Survey of US adults 18 years or older (n = 16,092) administered by the National Cancer Institute (HINTS5-Cycle 1,2,3,4) for the years 2017-2020, of which 2,011 (n = 2,011) were non-Hispanic Black adults. Weighted Poisson regression models were used to estimate disparities in HPV and HPV vaccination awareness among non-Hispanic Black US adults. In the US, 63.2% of non-Hispanic Black adults had heard of HPV and 57.6% were aware of the HPV vaccine. Black females had 1.3 and 1.5 times the prevalence of HPV and the HPV vaccine awareness compared to males (PR = 1.3; 95% CI = 1.2-1.4; P ≤ 0.001) and (PR = 1.5; 95% CI = 1.4-1.6; P ≤ 0.001) respectively. Blacks with a college education had 1.8 and 2.2 times the prevalence of HPV and HPV vaccine awareness (PR = 1.8; 95% CI = 1.4-2.4; P ≤ 0.001) and (PR = 2.2; 95% CI = 1.8-2.7; P ≤ 0.001) respectively, compared to those with less than a high school education. Compared to 2017, Black adults with ≤ $35K income were less aware about HPV in 2020. There was evidence of disparities in HPV and HPV vaccine awareness among non-Hispanic Blacks. To foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers, future interventions must target men and disadvantaged populations, for whom awareness gaps exist.

Ambiguity in cancer-related recommendations among young adults: Relationships with health behaviors and psychological distress

BackgroundYoung adulthood represents a sensitive period in which cancer-related lifestyle behaviors (e.g., substance use, poor physical activity) are developed and sustained into adulthood, having consequences for cancer morbidity and mortality. However, cancer prevention and control (CPC) recommendations are often ambiguous and multifaceted which may increase health-compromising behaviors and psychological distress among this vulnerable young adult (YA) population. ObjectiveWe examined relationships between ambiguity in CPC recommendations and health behaviors and psychological distress. MethodsYAs (n = 811, aged 18–39) without cancer were drawn from the Health Information National Trends Survey 2019 data. ResultsRegression analyses indicated that higher perceived CPC ambiguity was associated with higher health behavior recommendations not being met and higher psychological distress. ConclusionFocusing on elucidating CPC recommendations may reduce engagement in negative health behaviors and promote well-being. Future research may benefit from developing effective communication strategies aimed at elucidating health behavior recommendations to help educate this YA population. Practical valueHealth care providers should be more aware of, and ready to address the potential ambiguity surrounding CPC recommendations and what that means for engagement in health-promoting and health-compromising behaviors and for psychological well-being.

Telemedicine in the Post-Pandemic Period: Understanding Patterns of Use and the Influence of Socioeconomic Demographics, Health Status, and Social Determinants.

Introduction: The rapid expansion of telemedicine during the COVID-19 pandemic has transformed health care delivery. However, it remains unclear whether telemedicine utilization is equitable across different demographic groups and whether the high levels of adoption during the pandemic have persisted in the post-pandemic period. This study investigates telemedicine use and patterns of use in the initial phases of the post-pandemic period and explores the impact of socioeconomic factors, social determinants of health, and patients' health-related factors on telemedicine utilization. Methods: This study analyzes data from the Health Information National Trends Survey (HINTS) 6, comprising responses from 6,046 U.S. adults collected between March and November 2022. Results: Of 6,046 HINTS respondents, 39.3% (2,517 individuals) reported using telemedicine in the past year. Among telemedicine users, 18.5% used video visits, 12.08% used telephone-based telecare, and 8.72% used both. The main reasons for telehealth visits were minor illnesses (29.67%), chronic condition management (21.4%), annual visits (18.82%), mental and behavioral health concerns (15.72%), and medical emergencies (1.58%). Among non-users, only 17% (578 individuals) were offered telehealth visits, with privacy concerns (16.43%), preference for in-person consultation (84.42%), and difficulty using telemedicine technology (18.96%) being the main reasons for non-use. Logistic regression analysis revealed significant associations of social determinants, socioeconomic demographics, and health factors with telemedicine utilization. Women had a higher likelihood of using telemedicine (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.09-1.78). Older adults showed lower inclination toward telemedicine. Married individuals were more likely to use telemedicine (OR = 1.35, 95% CI = 1.06-1.72), while Whites (OR = 1.52, 95% CI = 1.04-2.22) and Hispanics (OR = 1.80, 95% CI = 1.17-2.75) had higher odds of utilizing telemedicine compared with non-Hispanic African Americans. Lack of reliable transportation (OR = 1.29, 95% CI = 1.01-1.66), frequent provider visits (OR = 1.37, 95% CI = 1.28-1.46), a higher number of chronic conditions (OR = 1.39, 95% CI = 1.22-1.57), and residences in metropolitan locations were also associated with increased telemedicine usage. Greater satisfaction with internet connectivity positively influenced telemedicine utilization. Conclusions: This study highlights the continued preference for in-person visits among U.S. adults in the early post-pandemic period, despite the widespread use of telemedicine. Addressing barriers such as limited access, privacy concerns, technological difficulties, and demographic disparities is crucial for achieving equitable utilization of telemedicine.

Knowledge, goals, and misperceptions about palliative care in adults with chronic disease or cancer.

Limited evidence investigates how knowledge, misconceptions, and beliefs about palliative care vary across patients with cancerous versus non-cancerous chronic disease. We examined the knowledge of and misconceptions about palliative care among these groups. We used weighted data from the National Cancer Institute Health Information National Trends Survey 5 (Cycle 2) for nationally representative estimates and logistic regression to adjust for respondent characteristics. We identified respondents who reported having (1) cancer ([n=585]; breast, lung, and colorectal), (2) chronic conditions ([n=543]; heart failure, lung disease, or chronic obstructive pulmonary disorder), or (3) neither cancer nor other chronic conditions (n=2,376). Compared to cancer respondents, chronic condition respondents were more likely to report being Black or Hispanic, report a disability, and have lower socioeconomic status. In the sample, 65.6% of cancer respondents and 72.8% chronic conditions respondents reported they had never heard of palliative care. Chronic condition respondents were significantly (p<0.05) less likely to report high palliative care knowledge than cancer respondents (9.1% vs. 16.6%, respectively). In adjusted analyses, cancer respondents had greater odds of high palliative care knowledge (odd ratio [OR]=1.70; 95% confidence interval [CI]=1.01, 2.86) compared to respondents with neither cancer nor chronic disease; chronic condition respondents did not have increased odds (OR=0.96; CI=0.59, 1.54). Disparities in palliative care knowledge exist among people with non-cancerous chronic disease compared to cancer. Supportive educational efforts to boost knowledge about palliative care remains urgent and is critical for promoting equity, particularly for underserved people with chronic illnesses.

Use of Smart Devices to Track Cardiovascular Health Goals in the United States

BackgroundSmartphone-based health applications are increasingly popular, but their real-world use for cardiovascular risk management remains poorly understood. ObjectivesThe purpose of this study was to investigate the patterns of tracking health goals using smart devices, including smartphones and/or tablets, in the United States. MethodsUsing the nationally representative Health Information National Trends Survey for 2017 to 2020, we examined self-reported tracking of health-related goals (optimizing body weight, increasing physical activity, and/or quitting smoking) using smart devices among those with cardiovascular disease (CVD) or cardiovascular risk factors of hypertension, diabetes, obesity, and/or smoking. Survey analyses were used to obtain national estimates of use patterns and identify features associated with the use of these devices for tracking health goals. ResultsOf 16,092 Health Information National Trends Survey participants, 10,660 had CVD or cardiovascular risk factors, representing 154.2 million (95% CI: 149.2-159.3 million) U.S. adults. Among the general U.S. adult population, 46% (95% CI: 44%-47%) tracked their health goals using their smart devices, compared with 42% (95% CI: 40%-43%) of those with or at risk of CVD. Younger age, female, Black race, higher educational attainment, and greater income were independently associated with tracking of health goals using smart devices. ConclusionsTwo in 5 U.S. adults with or at risk of CVD use their smart devices to track health goals. While representing a potential avenue to improve care, the lower use of smart devices among older and low-income individuals, who are at higher risk of adverse cardiovascular outcomes, requires that digital health interventions are designed so as not to exacerbate existing disparities.

Associations of wearable tracker use with physical activity and health outcomes in patients with cancer: Findings from the HINTS-SEER (2021).

131 Background: Physical inactivity is a global issue for cancer survivors. Wearable trackers are promising to address physical inactivity by providing real-time feedback on physical activity (PA) and offer opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable trackers on improved physical inactivity and related health outcomes (e.g., BMI, anxiety and depression, and self-rated health). However, wearable trackers were often used an an adjunct to PA interventions, and the effectiveness of wearable trackers alone is unknown. The aim of this study was to determine the association of wearable trackers with PA and health outcomes (BMI, anxiety and depression, and self-rated health) in patients with cancer, using a national dataset. Methods: Data from 957 cancer survivors from Health Information National Trends Survey – Surveillance, Epidemiology, and End Results Program (HINTS-SEER-2021) were analyzed. The outcome variables examined were: time spent in moderate to vigorous physical activity (MVPA), weekly frequency of strength training, BMI, anxiety/depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable devices within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations, after controlling for sociodemographic, cancer-related clinical (i.e., type, stage, time since diagnosis), and general health-related factors (i.e., BMI and smoking). All data analyses accounted for the complex survey design and sample weights. Results: Only 28% of cancer survivors reported wearable devices use. Bivariate analyses showed younger age, higher income, and employed status were significantly associated with wearable tracker use ( P&lt;.001). Wearable devices use was significantly associated with higher time spent in MVPA (b=37.94, 95% OR:8.38, 67.5; P=.01), more frequent strength training per week (adjusted OR=1.50, 95% OR: 1.09, 2.06; P=.01), and better self-rated health status (adjusted OR=1.58, 95% OR:1.09, 2.29; P=.01), but not associated with BMI or anxiety/depression. Conclusions: This study suggests that the uptake of wearable devices is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable tracker use with PA and self-rated health, supporting using wearable trackers as a promising tool to facilitate PA promotion.

Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study.

Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and conflicting. This study aims to explore the relationship between mental health status (specifically, depression and/or anxiety) and the uptake of CRC screening. To achieve this, a larger and nationally representative sample from the adult population of the United States was utilized. We employed a cross-sectional approach using data from the 2019-2020 edition of the Health Information National Trends Survey (HINTS). The study examined disparities in CRC screening between individuals with self-reported history of depression diagnosis and the general population. Chi-square tests were used for analysis. Multivariable logistic regression models were applied to adjust for variables such as gender, age, education level, race, comorbidities, healthcare access, smoking status, household income, geographical residence, and insurance status. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. The findings of the study indicated that out of 5,398 eligible individuals, approximately 1,220 (weighted percentage: 22.8%) reported experiencing depression and/or anxiety, and approximately 4,154 (weighted percentage: 68.9%) reported adherence to colorectal cancer screening. In the bivariate analysis, there was no significant difference in participation in colorectal cancer screening between individuals with and without depression and/or anxiety (72.0% vs. 68.0%). Similarly, after adjusting for sociodemographic and health-related factors, the study found that the odds of participating in colorectal cancer screening did not vary based on an individual's depression status (OR 1.34, 95% CI 0.94-1.91, P = 0.05). Individuals with depression participate in colorectal cancer screening at comparable rates to the general population. The findings of this study suggest that factors beyond CRC screening may play significant roles in the higher CRC-associated mortality rate. Therefore, further research is needed to uncover the various mechanisms contributing to the increased cancer-related mortality rates among susceptible populations.

COVID-19 Pandemic as an Equalizer of the Health Returns of Educational Attainment for Black and White Americans

BackgroundCOVID-19 pandemic has immensely impacted the social and personal lives of individuals around the globe. Marginalized-related diminished returns (MDRs) theory suggests that educational attainment shows a weaker protective effect for health and behavioral outcomes for Black individuals compared to White individuals. Previous studies conducted before the COVID-19 pandemic demonstrated diminished returns of educational attainment for Black individuals compared to White individuals.ObjectivesThe study has three objectives: First, to test the association between educational attainment and cigarette smoking, e-cigarette vaping, presence of chronic medical conditions (CMC), self-rated health (SRH), depressive symptoms, and obesity; second, to explore racial differences in these associations in the USA during the COVID-19 pandemic; and third, to compare the interaction of race and return of educational attainment pre- and post-COVID-19 pandemic.MethodsThis study utilized data from the Health Information National Trends Survey (HINTS) 2020. Total sample included 1313 adult American; among them, 77.4% (n = 1017) were non-Hispanic White, and 22.6% (n = 296) were non-Hispanic Black. Educational attainment was the independent variable operationalized as years of education. The main outcomes were cigarette smoking, e-cigarette vaping, CMC, SRH, depressive symptoms, and obesity. Age, gender, and baseline physical health were covariates. Race/ethnicity was an effect modifier.ResultsEducational attainment was significantly associated with lower CMC, SRH, depressive symptoms, obesity, cigarette smoking, and e-cigarette vaping. Educational attainment did not show a significant interaction with race on any of our outcomes, suggesting that the health returns of education is similar between non-Hispanic White and non-Hispanic Black individuals.ConclusionCOVID-19 may have operated as an equalizer of the returns of educational attainment. This observation may be because White may have more to lose; Black communities may be more resilient or have economic and social policies that buffered unemployment and poverty regardless of historical anti-Black oppression.

Nativity Status Predicts Tobacco Use: A Comparative Analysis of US-Born and Foreign-Born Adults From the Health Information National Trends Survey (HINTS).

Introduction Tobacco smoking remains one of the leading causes of morbidity and mortality globally and in the United States (USA). We hypothesize that US-born naturals have higher odds of tobacco smoking compared to their foreign-born counterparts, and our study aims to assess the relationship between nativity status and odds of tobacco smoking using a nationally representative sample. Methods We utilized the Health Information National Trends Survey(HINTS) 5 Cycle 1 (2017) and Cycle 2 (2018) for this study. Our main outcome variable was smoking status divided asever smoker and never smoker. The main predictor was USbirth status. We controlled for sociodemographic characteristics such as age, race, gender, educational status, and marital status. We performed weighted descriptive statistics and bivariate analysis with chi-square for our variables. Unadjusted and adjusted logistic regression was used to ascertain the odds of our outcome given our predictor. Significance was set at 95% confidence, and the alpha level was set to 0.05. All analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). Results Our final sample consisted of 5,677 individuals (weighted: 429,613,693). Of our sample,36.89% were ever smokers, females were 50.73%, and the majority (57.90%) were high school graduates. In terms of nativity status, those born in the USA were 85.65%, while the non-US-born population was 14.35%. After adjusting for confounders, we found that non-US-born respondents had 42% lower odds of being ever smokers compared to their US-born counterparts(adjusted odds ratio (AOR) = 0.576; 95% confidence interval (CI) = 0.388-0.854; P = 0.0062). Females were 24% less likely to be ever smokers compared to males(AOR = 0.758; 95% CI = 0.644-0.893; P = 0.0010). Having a bachelor's degree or a graduate degree was associated with 42% and 53% lower odds of being ever smokers compared to high school graduates(AOR = 0.583; 95% CI = 0.474-0.717; P < 0.0001)(AOR = 0.471; 95% CI = 0.377-0.588; P < 0.0001). Whites had 97% higher odds of being ever smokers compared to Hispanics (AOR = 1.977; 95% CI = 1.459-2.679; P < 0.0001). Conclusion Our finding of lower odds of tobacco use among foreign-born nationals compared to US-born nationals is consistent with previous studies and suggests the need for equity in tobacco use prevention between the two populations assessed in our study. This is poised to improve overall tobacco use burden, morbidity, and mortality.

The Role of Health Information Technology on Colorectal Cancer Screening Participation Among Smokers In The United States.

Background: Despite advances in its prevention and early detection, colorectal cancer (CRC) remains a leading cause of morbidity and mortality in the United States and smokers are at an increased risk. Health information technology (HIT) has shown promise in the uptake of preventive health services, including CRC, and may prove useful among smokers. Methods: We obtained data from 7,419 adults who completed the 2018-2020 Health Information National Trends Survey. Using multivariable logistic regression models, we examined the relationship between HIT use and CRC screening participation. Results: Over 20% of current smokers had no access to HIT tools, and those with access were less likely than never smokers to use HIT in checking test results (odds ratio [OR] 0.58; 95% confidence interval [CI] [0.42-0.80]). Among former smokers, using HIT to check test results (OR 3.41; 95% CI [1.86-6.25]), look up health information online (OR 2.20; 95% CI [1.15-4.22]), and make health appointments (OR 2.86; 95% CI [1.39-5.89]) was associated with increased participation in CRC screening. Among current smokers, the use of HIT was not associated with a change in CRC screening participation. Conclusion: HIT use is associated with higher levels of CRC screening among former smokers, which is reassuring given their increased risk of CRC. The low ownership and use of HIT among current smokers of CRC screening age presents a challenge that may limit the integration of HIT into routine CRC screening services.

The Impact of physical exercise and alcohol conditions on self-reported health among cancer patients? An analysis of the Health Information National Trends Survey 2019

BACKGROUND AND OBJECTIVE: Sleep hours, physical exercise, and alcohol conditions were report to reduce or increase the detrimental side effects of cancer treatment. This study was aimed to evaluate the associations of outcomes of physical exercise and alcohol conditions with poor health among cancer patients when controlling socioeconomic factors. The secondary aim was to evaluate the joint effects of multiple cancers in the association of sleep hours, physical exercise, and alcohol conditions with poor health among cancer patients. METHODS: The data were from the Health Information National Trends Survey (HINTS) Wave 5 Cycle 3 administered by the National Cancer Institute since 2003 in the United States of America. Chi-square test and orthogonality tables were employed to assess the difference between pairs of variables. Logit regressions with marginal odds ratios (MOR) and 95% confidence intervals (95% CI) were conducted to examined the associations of socioeconomic variables with disadvantages of alcohol conditions and benefits of physical activity, respectively. King et al.'s (2000) simulation-based approach was employed to explore the moderating effects of multiple cancers on the associations of interest. Simulation extrapolation was conducted to examine the roles of socioeconomic factors, benefits of physical activity, and disadvantages of alcohol conditions in the fair/poor self-reported health (SRH) among cancer patients. RESULTS: The mean age of the sample was 69.79 ± 7.10, (range = 60 to 99) years old. Compared to cancer patients aged &lt;60 years, cancer patients aged ≥60 years had significant associations with alcohol-related cancer risk (MOR= 1.503, 95% CI: 1.029-2.196), alcohol-related heart disease (MOR = 3.015, 95% CI: 1.965-4.626), alcohol-related diabetes (MOR =2.300, 95% CI: 1.440-3.673), helping sleep (MOR =2.033, 95% CI: 1.267-3.263), and reducing anxiety (MOR =1.918, 95% CI: 1.218-3.021). Multiple cancers had limited moderating effects on the associations of sleep hours with outcomes of physical exercise and alcohol conditions. Socioeconomic factors (Coefficient=-0.311, 95% CI: -0.529, -0.094) and benefits of physical activity (Coefficient=-0.417, 95% CI: -0.737, -0.096) were mainly drivers of fair/poor SRH. CONCLUSION: A high proportion of cancer patients are abnormal sleepers, insufficiently active and alcoholic. Socioeconomic factors and physical exercise were mainly drivers of health changes among them. Multiple cancers and sleep hours had limited effects on outcomes of physical exercise and alcohol conditions.

Vaping E-Cigarette and Smoking Conventional Cigarettes are Associated with Depression Regardless of Gender, Race, and Ethnicity: Analysis of the Health Information National Trends Survey (HINTS) 2022

Background: While previous research has explored the bidirectional relationships between smoking, vaping, and depression, limited attention has been given to examining potential gender-, race-, and ethnic- specific patterns in these associations. Aims: This study aimed to investigate gender, race, and ethnic differences in the associations between smoking conventional and vaping e-cigarettes and depressive symptoms. Methods: Data from the Health Information National Trends Survey (HINTS–2022) survey were analyzed, including a representative sample (probability sample) of US adults. Variables of interest included smoking status, e–cig use, depression (PHQ-4), and demographic characteristics. Binary logistic regression models were employed to assess the association between smoking and e-cig use (current and ever), and depression overall, adjusting for covariates (age, education, marital status, and employment). Statistical Package for the Social Sciences (SPSS) software was used for data analysis, using univariate, bivariate, and multivariable models. We tested potential interactions between race, ethnicity, gender, and depression. Results: The study findings indicated significant associations between smoking, e-cig use, and depression. Individuals who were experiencing depression compared to those non-depressed were more likely to use conventional (p&lt;0.05) and e-cig (p&lt;0.05). However, no significant interactions were found for gender, race, or ethnicity. Conclusions: This study suggests that the association between smoking, e-cig use, and depressive symptoms is not different by race, sex, and gender. These findings contribute to the existing literature, emphasizing the need for universal approaches to promote mental health as a tool to help individuals quit smoking and vaping, regardless of their gender, ethnicity, and race.

E-Cigarette, Conventional Cigarette, and Depression: Role of Race/Ethnicity in the Health Information National Trends Survey (HINTS) 2022

Background: While previous research has established the role of depression as a correlate of tobacco use, limited research has been conducted on potential racial variations in these associations. Aims: This study had two objectives: (1) to investigate the associations between depression and smoking conventional and vaping e-cigarettes, and (2) to explore the role of race in modifying these associations. Methods: Data from the Health Information National Trends Survey (HINTS-2022) survey, which is a national probability sample of US adults, were analyzed. Variables of interest included lifetime and current smoking status, e-cigarette use, depression (PHQ-4), socioeconomic status (SES), and demographic characteristics. Binary logistic regression models were applied to assess the associations between depression as the independent variable and current and ever smoking conventional cigarettes and vaping e-cigarettes as dependent variables, adjusting for covariates (age, gender, education, marital status, and employment). We tested potential interactions between race/ethnicity (non-Hispanic Whites, non-Hispanic Blacks, Hispanic Whites and any other/mixed race/ethnicity) and depression on our outcomes. Results: The study findings indicated significant associations between depression and use of conventional cigarettes and e-cigarettes. Although individuals who were experiencing depression were more likely to use conventional cigarettes (p &lt; 0.05) and e-cigarettes (p &lt; 0.05) compared to those non-depressed, the positive associations between depression and lifetime and current smoking were stronger for Black than White individuals. Conclusions: This study suggests that depression may have a more salient role in smoking cigarettes and e-cigarette use for Black than White adults. It is unclear if Black adults are more likely to smoke if they are depressed, or if Black adults who smoke cigarettes are more likely to be depressed because of higher stigma and lower access to mental health care services.

Identifying contributors to disparities in patient access of online medical records: examining the role of clinician encouragement.

The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR). We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement. In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7-14.0), college education or higher (OR, 1.9; 95% CI, 1.4-2.7), history of cancer (OR, 1.5; 95% CI, 1.0-2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7-3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5-0.8, and OR, 0.5; 95% CI, 0.3-0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3-2.3), have college education (OR, 1.5; 95% CI, 1.1-2.0), history of cancer (OR, 1.8; 95% CI, 1.3-2.5), and greater income levels (OR, 1.8-3.6). Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity. Clinicians have an important role to ensure that all patients benefit from online EMR use.

The association between YouTube use and knowledge of human papillomavirus-related cancers

ObjectiveTo examine the association between YouTube usage and HPV-related cancer knowledge (cervical, anal, oral and penile). Study designCross-sectional study using data from the Health Information National Trends survey conducted between 2017 and 2020 (N = 16,092). Logistic regression was used to analyze the independent effect of YouTube use on cancer knowledge, controlling for sociodemographic characteristics. ResultsRespondents' knowledge of HPV-related cancers varied: 49.9% about cervical, 18% anal, 20.1% oral and 20.4% penile cancers. YouTube use was associated with increased knowledge for all cancers (cervical: OR 2.66, 95% CI 2.04, 3.46; anal: OR 1.83, 95% CI 1.32, 2.53; oral: OR 1.89, 95% CI 1.37, 2.61; penile OR 2.00, 95% CI 1.44, 2.77) in models adjusted for all covariates. Other independent predictors of HPV-related cancer knowledge included female gender, younger age, a higher income, and higher education. Conclusion(s)YouTube could play an important role in educating people about HPV-related cancers and should also target other populations, such as males and those with less formal education. InnovationThe study provides novel insights into the potential of YouTube as an educational tool for promoting cancer knowledge with the goal of cancer prevention.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study.

Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

Cancer survivors with sub-optimal patient-centered communication before and during the early COVID-19 pandemic

ObjectivesPatient-Centered Communication (PCC) is an essential element of patient-centered cancer care. Thus, this study aimed to examine the prevalence of and factors associated with optimal PCC among cancer survivors during COVID-19, which has been less studied. MethodsWe used national survey (Health Information National Trends Survey) among cancer survivors (n = 2579) to calculate the prevalence (%) of optimal PCC in all 6 PCC domains and overall (mean) by time (before COVID-19, 2017–19 vs. COVID-19, 2020). Multivariable logistic regressions were performed to explore the associations of sociodemographic (age, birth gender, race/ethnicity, income, education, usual source of care), and health status (general health, depression/anxiety symptoms, time since diagnosis, cancer type) factors with optimal PCC. ResultsThe prevalence of optimal PCC decreased during COVID-19 overall, with the greatest decrease in managing uncertainty (7.3%). Those with no usual source of care (odd ratios, ORs =1.53–2.29), poor general health (ORs=1.40–1.66), depression/anxiety symptoms (ORs=1.73–2.17) were less likely to have optimal PCC in most domains and overall PCC. ConclusionsWe observed that the decreased prevalence of optimal PCC, and identified those with suboptimal PCC during COVID-19. Practice implicationsMore efforts to raise awareness and improve PCC are suggested, including education and guidelines, given the decreased prevalence during this public health emergency.

The influence of political ideology on clinical trial knowledge, invitation, and participation among adults in the United States.

Clinical trials remain a critical component of medical innovation. Evidence suggests that individuals' political ideologies may impact their health behaviors. However, there is a paucity of literature examining the relationship between political ideologies and clinical trial knowledge and participation. Study data were derived from Health Information National Trends Survey 5 Cycle 4 (n = 3300), which was conducted from February to June 2020. We used participants' characteristics to estimate the prevalence of clinical trial knowledge and participation. We used multivariable logistic regressions to investigate whether political ideology had a significant impact on clinical trial knowledge and participation. Jack-knife replicate weights were applied for population-level estimates. Most participants were White (64.2%), earned above US$50,000 (62.4%), and lived in urban areas (88.0%). About 59.2% reported having some knowledge of clinical trials, and only 8.9% had ever been invited to participate in clinical trials. A total of 37.0%, 29.5%, and 33.5% of the population endorsed moderate, liberal, and conservative political viewpoints respectively. In the adjusted logistic regression analysis, compared to conservatives, liberals (adjusted odds ratio, 1.92; 95% confidence interval, 1.31-2.80) and moderates (adjusted odds ratio, 1.43; 95% confidence interval, 1.09-1.88) had significantly greater odds of having knowledge of clinical trials. Also, liberals had higher odds of receiving invitations to participate in clinical trials (odds ratio, 1.76; 95% confidence interval, 1.08-2.85; p = 0.023) and greater odds of trial participation (odds ratio, 3.90; 95% confidence interval, 1.47-10.33; p = 0.007) compared to moderates. The mechanism underlying the higher rates of clinical trial invitations to liberals is unclear and requires further comprehensive investigation. Similarly, further qualitative studies are needed to understand the attributes that promote knowledge and increased likelihood of clinical trial participation among liberals. This will provide crucial insight to help design interventions that further involve conservatives and moderates in clinical trials and scientific enterprise.